The birth of Iko: breech birth in an Estonian hospital
Our baby boy Iko was born as a Christmas miracle on December 24th at 2:31 PM, two weeks ahead of the due date.
We had planned a home birth, just like with our first child. But Iko had other plans. By the beginning of the third semester he was breech and he stayed bottom down until his birth. In Estonia, planned home birth is not possible with a breech baby. My husband and I read everything we could get our hands on about breech, and I used every possible method trying to persuade the baby to turn around: daily special exercises, homeopathy, reflexology, hypnobirthing methods, etc.
On week 36 I also underwent an external cephalic version, but the baby stayed breech. The doctors were able to turn him 90 degrees, but he refused to move further. So breech he was.
As a mother, I was faced with a difficult dilemma: shall I try to give birth vaginally or go for a cesarean section? 3-4% of babies are breech by the time of birth and only about 10% of them are born vaginally in Estonia. Obstetricians' experience in delivering breech babies is rather scarce, while cesarean section is usually considered the safer option. Vaginal birth is allowed under certain conditions: the baby must weigh less than 3.5 kg and must be frank breech, and the birth must begin spontaneously and proceed actively. I was supposed to have an appointment with an obstetrician on December 28 to establish a birth plan after an ultrasound examination. But the baby chose otherwise :)
When I woke up around 8 a.m. on Christmas morning. I experienced mild contractions. I had had Braxton Hicks contractions often since mid-pregnancy, which meant that my belly tightened for a certain period of time and made it very uncomfortable to walk or even stand up. Twice I even ended up in the emergency room to have me checked because I was worried about giving birth prematurely.
This time something different was going on--the contractions lasted for only a short while but they had a different intensity. Initially, the contractions appeared irregularly, the intervals ranging from half an hour to five minutes. Interestingly, I experienced a deep inner calm and I laid down in bed until breakfast.
After breakfast I made preparations for Christmas lunch. I discussed with my husband whether and when I should call our private midwife Siiri, and I packed a few last things in the hospital suitcase, just in case. I called Siiri at quarter to twelve. The contractions were still irregular, but the intervals were more even, about 10-20 minutes apart. Siiri said that it would be too early to go to the hospital immediately, but I should let her know when contractions have become regular. It happened an hour later, when the intervals were about eight minutes. We're going!
Siiri said that it takes her about half an hour to get to the hospital, so we took it easy and arrived there at about half past one. Upon arrival we told the staff that we were there to give birth and that our baby was breech. The hospital staff was already informed about us and we were taken to the birthing room and were told to wait for Siiri.
I was a little surprised that no one was there to immediately set up a CTG and an ultrasound. Depending on the position and condition of the baby, the decision between natural or cesarean birth would be made. We made the birthing room comfortable for ourselves by setting up LED candles and turning on some quiet music. I was hugging a huge yoga ball on the mat and listening to the sounds of the mantras of Medicine Buddha.
When Siiri finally arrived, the contractions were about every three minutes, and I was already using my voice for breathing out. She said that soon the CTG will be attached, and then she disappeared again for a little while. In the meanwhile, the contractions quickly intensified and the intervals between them grew shorter.
At one point I went to the toilet only to be struck by the intense urge to push. Some blood dripped to the toilet. I shouted to my husband that the child was on his way and he ran out to look for Siiri and the doctors. I was helped on the bed where I ended up on all fours, roaring like a wild tiger. Doctor V. stepped in and said that she had not yet had a chance to read my birth plan, but that it seemed that there was no longer time to read it anyway--immediate action was needed. She determined that I had full openness and asked me to turn down my tiger roars so she could talk to me and listen to the child's heartbeat.
Suddenly there was like a bang and my waters broke, they were greenish. "Vivian, listen carefully to what I am telling you. Your child is in a complete breech position--I can feel his buttocks and feet. You arrived at the hospital too late-- now you will have to give birth vaginally. You need to turn on your back." Suddenly the birth room was full of staff.
"Oh no, not on my back! I had it even written in the birth plan that I did not want to give birth on my back, damn it!" I thought to myself in horror. (More on this below.)
"Please turn on your back!" I was told.
"I can't! I'm going to sit on the baby!" I exclaimed, feeling that the baby was already partly out. However, the doctor made it clear to me that in my current position she could not help me, so I agreed to be flipped over and my back was raised by the bed, so I could see for myself what was going on below. My husband was at my head telling me I was brave and the baby was coming.
In this position I also saw the baby's buttocks myself. And then the urge to push suddenly disappeared, the pause seemed endless. "Dear, please come out! Please come out!" I was repeating. The doctor asked me to tell her when the urge to push returned. Finally it did. I exhaled and repeated with every outbreath "Yeah! Yeah!", using the J-breathing I had learned at the hypnobirthing course.
The baby's feet were born with the sound of a clap. I could no longer see what was going on, being focused on breathing the baby out and calling him: "My dear, please come out!" The baby gradually moved down until someone said the baby's hands were out. Pause again. The doctor asked me to let her know when I felt the urge to push again.
And then finally the baby's head was born. Iko--our real Christmas miracle--was placed on my belly! Oh, honey, you're here! So beautiful and so delicate! My husband was in tears whereas I felt immeasurable peace, happiness, and gratitude. This wonderful little person on my belly--I fell in love with him at first sight!
When the umbilical cord had stopped pulsing, my husband cut it. The pediatrician quickly examined Iko, and he was placed on my belly again. The doctor joked: "This is no way to treat a doctor! Especially at Christmas time!"
Iko's Apgars were 7-9-9. He weighed 3134 grams and measured 49 cm long. The medical report said that he had had the umbilical cord around his neck; a classical maneuver was used to free his arms and the MSV (Mauriceau-Smellie-Veit) maneuver was used to free his head.
We learned that we were extremely lucky with the doctor who happened to be on call that day--our midwife said that this doctor teaches breech birth to medical students and is probably the most experienced obstetrician in the clinic for delivering breech babies.
Well done, Iko! You chose the best time for being born! You got the best doctor and mommy didn't have to go through a cesarean section. In fact, my perineum was completely intact--not even a slightest tear. Iko insisted on being born naturally, legs and bottom first.
He eagerly started to nurse and pediatricians were generous with compliments. We were released from the hospital within 48 hours.
Let me now return to why I was reluctant to swap my position at a critical moment. When I was faced with the difficult dilemma of whether to give birth vaginally (in case the doctors allowed it) or go for a cesarean, I tried to inform myself of the pros and cons of both options, speaking to my midwife and doctors and searching for information on the internet.
Breech Without Borders ended up as the best internet source on this topic. I also contacted Rixa Freeze, the founder of Breech Without Borders. She was very kind to reply immediately and responded to my still unanswered questions. Among other things, she referred to the study by Louwen et al, which concludes that breech delivery in an upright position instead of on the back improves outcomes: "Upright vaginal breech delivery was associated with reductions in duration of the second stage of labor, maneuvers required, maternal/neonatal injuries, and cesarean rate when compared with vaginal delivery in the dorsal position."
It made perfect sense to me. My first child was born when I was on all fours--it simply felt the most comfortable position to me. So if I had had time, I would have discussed birthing positions with the doctor. I would have preferred to stay in an upright position instead of being flipped over to my back. In Estonia, like in many other countries, the maneuvers that obstetricians have been taught for delivering breech babies require that women lay on their backs. It's a pity, because research and logic say that upright positions are safer because the pelvis is more open. It's more comfortable for the woman and gravity can also contribute.
After Iko's birth I wrote a big thank you letter to the clinic, but I also gave the clinic feedback about the birthing position and forwarded them the link to Louwen's study. I really hope that in the near future the training of obstetricians in my home country will include maneuvers for supporting physiological breech birth.