Consumers Supporting Midwifery Care

We knew Miriam was breech for months. Kept waiting for her to turn, but she didn’t. We tried everything – lying with my hips in the air, acupuncture, moxibustion, hypnosis, playing music to her, and an unheard-of 4 attempts at external cephalic version (ECV). Nothing had any effect and it became very clear that she was either going to turn of her own volition, or not at all.

So we started exploring options for delivering her breech – by necessity a hospital birth because breech delivery is considered “high risk” and outside our midwife’s area. She was in the “perfect” position and conditions for vaginal breech delivery – her feet up by her head, chin tucked, was a smaller baby than Samuel had been (although obviously we didn’t know by how much), I had delivered Samuel very quickly and easily. Unfortunately, with the help of our midwife, we were only able to find two practitioners in the region who would be willing to catch the baby, IF we were to go into labour when they were on call, AND we walked into the hospital ready to push. We figured our chances were about 50-50 that we’d get what we wanted. As it turned out, we went into labour on the wrong day.

It was funny – on Friday morning when we woke up, I looked at Stephen and said, “I don’t think I’m going into labour any time soon – I feel completely normal.” Famous last words. My waters broke gently around 8am – I wasn’t sure at first that it had happened, but then when the trickle didn’t stop, and started “gushing” when I changed position, it became pretty clear. But no contractions yet. I called our midwife and she started making phone calls. We knew we were on an “off” day but there was a possibility, if there was a different senior OB on call at one of our identified hospitals, that if we walked in about to push that, like it or not, they’d catch the baby. Our midwife found out that there was “no chance” at our local hospital, she knew the OB who was on. She knew that once contractions started, I was likely to go very fast, so she advised us to meet her as soon as possible at a different hospital because at least there, there was still a chance because we didn’t KNOW the OB wouldn’t do it. Stephen left to drop Samuel off at the sitter, and I continued to assemble things to leave the house. Our midwife called back shortly after that, and let us know that she had talked to our “consult” OB from the hospital and his feeling was the OB on call wouldn’t be able to do it for us either. I started crying. Her advice was still to go to the rural hospital, that we might have more flexibility there than we would with the “big admin” local hospital, and suggested we get there asap, hopefully still before I started contractions, so that we could have a rational conversation with the OB who was “in.” I had a couple of very low-grade contractions in the car – nothing that felt any different from a Braxton-Hicks contraction.

We got to the hospital and the OB was in clinic. Since we still hadn’t “started” we went down to the cafeteria to have some lunch and wait either for her to arrive or for us to “need” her to arrive. I was feeling hopeful again at this point – once she looked me in the face, how could she not agree?

When she arrived, though, she told us point blank that she couldn’t offer anything other than “elective c-section.” She had trained after the Term Breech Trial and had only delivered about 12 in the course of her career. Here we were again, though, with that “elective” word that was just not an option. So I said, “What if I refuse a c-section?” I felt I was being so rude, but I had to push, and make sure she wasn’t bluffing. She said if that were the case she’d have to call the medical emergency service, which would proceed to search the entire province for an OB on call who would be willing to help us. Except that there was no way I could leave town to deliver this baby, not with Samuel at home, not with how fast labour was going to go once it started (risking Stephen having to deliver a breech baby in the car somewhere between cities), and we already knew that the service would find nobody in town, because we had already done that homework. “I’m not in labour yet” I said “there’s still a chance she’ll turn, babies DO turn in labour sometimes, I don’t want to cut short the time she’s got to do it in”. I was feeling more and more desperate. I said, “This isn’t an emergency, I’m not IN labour right now, I don’t believe we need to do this right now. How long do I have before this becomes a problem for you?” and she told me that 24 hours from ruptured membranes was as far as we “could go” (which we pretty much knew). Thing is, if the baby waited 24 hours, then it would be Saturday at 8am, and one of our identified OB’s would be on at the other hospital. We explained this to her and she was willing to give us this chance. If we went into labour before then, and the baby still didn’t turn, we would come back to this hospital for the surgery.

So they let us “out on a pass” and we went walking downtown. We went in and out of a couple of stores, and I quickly found I couldn’t bear to be looking at people who were having ordinary lives, and REALLY couldn’t bear their very friendly questions about my pregnancy, when I was due, and “Oh my goodness you’re having it TODAY? That’s so EXCITING!” We went and sat and watched the waterfall while I cried my heart out – my poor mother. We walked down to the other park by the river and I asked Stephen and my mum to leave me alone to meditate for a while. I sat in the sun for more than an hour and watched the water and cried and breathed and waited. I had one big contraction sitting there, and it happened after I was finally able to think PAST the inevitable and think about holding Miriam and nursing her.

Shortly after that, my mum and Stephen came back to me and suggested we go find a Bed & Breakfast so that if evening came and we still hadn’t gotten started we’d have a place to lie down. So we went back to the main street and into the antique shop we’d been in before to ask for recommendations. Had another contraction. Went next door to the little department store to buy high-waist undies (I don’t normally own these) – had 2 more contractions. We got in the car and headed for the B&B and signed in. It was about 5:30. I had 2 major contractions while we were there (within about 20 minutes), and we decided we’d better head back up to the hospital.

We got to the hospital at 6pm and it was as if a switch turned on and suddenly I was in transition. The OB came into the room and actually sat down cross-legged on the floor so that she could talk to me at eye level, and went over the “risks of c-section” (as if I had a choice) and things I “should know.” I had about 8 contractions over the next hour, and at about 7pm alerted our midwife that I was starting to feel pressure in back and that they had better check me. The OB came back in to check me and just kinda stopped dead. “Where are we at?” I asked. “9 cm” she said. All I had left was a lip. I swear she almost let me go. Almost. Then she got scared again I guess because all h*ll broke loose as they suddenly rushed to get me into the OR. They were paging people, had trouble finding the pediatrician, etc… I was pushing before they got me in there. The only reason Miriam didn’t just come out was because my midwife got right in front of my face and I could look into her eyes and breathe with her – not pushing was the hardest thing I could’ve imagined. And my body was still doing it. Once they had the spinal in it slowed my body down but only just enough for them. I don’t think anybody in that room thought the right thing was happening. “Somebody is PUSHING” said the anaesthetist… I think she was trying to give the OB an excuse to stop.

Spinal anaesthetic is a WEIRD feeling. I thought I’d be completely numb but wasn’t – just no temperature and no pain; my legs felt fuzzy, like pins and needles, and I could still feel them touching me and all kinds of pulling, just no pain. Not what I expected.

They tried really hard to give us as close to a gentle birth as they could. They let Stephen and my mum and our midwife all come in with me. They brought in the cd I’d been listening to. Our midwife told me what was going on as they went through the layers, and my mum described as Miriam came out. She says the OB used really really gentle hands on my daughter. Miriam came out proclaiming that she was breathing and didn’t need to be suctioned. My mum told me she was bright red, I don’t know her apgars but they must’ve been good with the amount of noise she was making. They laid her on my belly (couldn’t feel it, but my midwife told me when she was there), and let the cord stop pulsing before clamping and Stephen cut it. They let the placenta detach more-or-less on its own (the OB did some pretty heavy massage to help it but didn’t cut it away) before sewing me up.

Stephen and our midwife went with Miriam to the warmer while they did their initial checks, and then our midwife popped Miriam inside Stephen’s shirt as soon as she could get her hands on her. As soon as they could they brought her over and laid her beside my head – I couldn’t really see her but she was alert and touching my face and I sang to her while they closed the incisions. As soon as I was closed they put her on my chest and moved us into our room to “recover” – crazy word, that, as if it’s something that could happen overnight.

The staff was wonderful. They had EACH read our birthplan and were doing their damnedest to give us everything that they could, and it was as if each nurse was silently apologizing to me for what had happened. Nobody believed that it had been right – only that it had been the only choice, because the OB had never had the opportunity to get good enough at breech delivery to do it “safely.” Realistically, I would’ve had that little baby out in about 3 pushes and nothing would’ve gone wrong. And everybody knew it.

The OB came to talk to me before she went home, and said as much herself. “This doesn’t feel right,” she said. I know that if the opportunity arises for her to gain experience in delivering breeches she’ll jump at it – she clearly believes that especially with “low risk breeches” like ours the choice of how to deliver should belong to the family.

They let us go home the next night – unheard of for a c-section – because we had the midwifery care that includes home visits. We’re recovering “normally” for what we’ve been through.

Miriam is a wonderful baby. Very patient and gentle, cries very little. At birth she was 6lbs 10oz, and 20” long. At 5 days old she was already 7lbs 3oz – growing like her brother did! She was born with a head of dark hair that we think will probably fall out and come back blonde, but then probably darken again over time as mine did. We are lucky to have her, and my love for her is undiminished by the circumstances of her birthing.