|Elke's Letter - the Midwife's Version|
First of all a big thank you for all of you who organise the inspiring and informative 'Day at the Breech' but a special thank you to Jane Evans who came out to a planned breech birth last night to support Jacqui and I.
Jacqui and I attended one of your study days maybe 3 years ago and had booked ourselves on another one to refresh our memory, unfortunately Jacqui couldn't come due to a birth, but I went to Croydon and was really spell- bound. I remember Brenda saying that she wants us to leave the day really excited and boy, you three succeeded!
Already half way through the morning I thought who might/could have the next breech baby and thought of Hilary whose baby had been breech at 34 weeks and I knew she had been trying acupuncture, moxabustion and inverse positions. Thirty minutes after that thought Hilary phoned reporting that she just had her 2nd acupuncture session during which the baby turned to transverse and then back to breech again. We had just covered the steps that could be taken prior to deciding where and how to have the baby. I asked Hilary if she thought the baby wants to turn and she said yes s/he wanted to but couldn't. H felt strongly that she wanted to give an ECV a go and Jacqui arranged this with a consultant at H's local hospital. The ECV was booked for today.
I saw Hilary last Thursday discussed what happens during an ECV and stressed that she did not have to have it and could change her mind at any time if it didn't feel right - memories of Brenda's story about her 2nd baby resurfaced. I was struck by the fact that Hilary kept saying that she doesn't think EVC will work, that she hates the thought of going to hospital but she still wanted to go ahead... She felt strongly that if the baby stayed breech she would stay at home and was supported by this by her husband Richard. I explained that the lovely, skilled and -yes- famous Jane Evans had volunteered to support us. I left her a copy of the Benna Waites book.
Yesterday evening Hilary phoned me reporting mild contractions and more pressure in her bottom - prior to that the breech had been free! I suggested to observe and to phone again if any changes. I wondered if we were dealing with 'engaging pains' or a trial run often experienced by multips. What contradicted that was the fact that she was alone with her toddler - her husband a 3 hour train journey away and her mother needing to come from Norwich (she lives in East London). I therefore thought it prudent to alert Jacqui with whom I work in close partnership and Jane who said she would be available whenever..
An hour later Hilary rang again contractions now painful and desperately trying to get Oscar the toddler to bed. I offered to come and asked Jacqui and Jane to make their way there too, there is always a possibility a breech might be quick and Hilary had a 10 hour labour last time...
When I got there Hilary informed me that she could still breath! Her main focus was to get Oscar to sleep it was by now 20.10h. I brought my equipment in, noted the electric heater I had requested as Hilary's house is often a bit cold. I spread a soft matt out for her and when Jacqui arrived 10 minutes later we made tea waiting for Hilary to return. Which she did: she was contracting 3:10 moderate. On abdominal palpation the baby seemed RSA 2/5 palpable and on reflection with an extended head.
Jane came 1/2 hour later and helped us set the room up after some life affirming hugs!!! Still no sign of grandma or dad!
Hilary's contractions now came 4:10. Jacqui decided to read to Oscar so that Hilary could concentrate on her labour she was kneeling on the mat with a small beanbag and a cushion in front of her.
Around 21.30h H's mum arrived and H seemed greatly relieved and contractions seemed to get a bit stronger still. The baby's heartbeat had been good throughout with a lot of reactivity.
Around 22.00h Hilary's waters broke lots of clear liquor and a reassuring FH. Pale red line was rising, Hilary got slightly more vocal but nothing expulsive yet.
Around 23.00h Hilary's husband arrived and sat by her head end he seemed calm but somewhat surprised to see Hilary in such strong labour - as far as he was concerned that was the practice run as Hilary had never updated him!
It was probably 20 min after he arrived when contractions got more expulsive (times were kept by the lovely Jacqui while I was able to massage Hilary's back; I so love the way we work together). Of course Hilary had manoeuvred herself to an area with little space but both Jacqui and Jane managed to perch and squeeze in - Jacqui was taking lots of pictures and Jane was right behind me so she could prompt or direct when necessary. I realised quite early that something pointy was distending Hilary's perineum and in the recesses of my mind Mary's slides of the knee presentation resurfaced and sure enough a very chubby thigh came down followed by a knee, calf and foot, next contraction the other leg - I think then the pelvis and it was great to see the juicy cord as the chest came into view the baby had been wriggling a few times too the arms came with great ease and then it was hanging there. What an extraordinary sight - even after all the pictures it seemed so strange.
Jane then suggest that H should push a bit more for the head; I tried to perform a 'Smellie Veit Manouver' and discovered more cord round the neck and for a split second thought about looping it over the baby's head - a no go with a breech I discovered. I flexed the baby's head from behind and had just found the cheek bones when hey presto the baby emerged a little shocked admittedly but seemed to recover quickly and just showing her the bag and mask seemed to do the trick - she was no shrimp.
Weight 4300g or 9lbs 10oz H/C 37cm. The cord had been tightly round the neck twice.
Afterwards we speculated about the possible outcome of the ECV and Hilary's wisdom to labour beforehand!
I also thought had Hilary had a caesarean everyone would have said it could never have happened vaginally: extended head with cord round it twice (the cord was incredibly long more than 50cm!), the birth weight and the h/c and of course the knee presentation according to Jane 1:6000!!!
It was truly amazing to witness, I am sure there is so much more to say especially when we look back at the pictures and debrief with Jane, but I just felt compelled to write it all down while it was fresh and say thank you to you all!!
Lets keep up the fight to keep these options open for women.
Needless to say Hilary is over the moon too.... Lots of Love Elke and Jacqui