Human Rights in Childbirth: Breaching the Breech
By Marieke van Bommel
We continue our series of articles from the Human Rights in Childbirth Conference. Here one woman tells of her struggle to give birth outside the usual protocols.
The international conference Human Rights in Childbirth, took place in The Hague on 31st May and 1st June, 2012. During the conference many speakers, pannelists and participants spoke passionately about their belief, hopes and experiences. With permission, we are re-publishing some of the stories of the conference that have appeared elsewhere on the web, in order to continue to promote the dialogue the conference opened.
The author of the following story expressed some concern that her story might scare some women. We are publishing it anyway because we believe that whilst the author’s experience may not be unique it is hopefully not common. We also believe, and have always believed, that it is more important to tell these stories so that others may learn from them than it is to hide them away. We trust our readers to experience it in the way the author intended.
Birth used to be a community experience involving mothers, aunts, relatives, village elders. Stories were passed down through the generations to inform and educate. Somewhere along the way we have lost that experience, we need to get it back. We would like to thank the author for permission to reproduce her story, first published on her blog. Over to Marieke:
My husband and I made a choice, the best choice we could have made as parents-to-be. It was the best choice for our unborn baby, I’m absolutely convinced.
We chose to have our birth of our breech baby at home. It was a deliberate choice, and we would make it again.
From 29 weeks, our child was in breech. I got the feeling that this wouldn’t change. We tried moxa therapy, which didn’t work. At 36 weeks, we had a terrible attempt of turning our baby. We thought that a gynecologist would look with ultrasound to see if the conditions were favorable to make an attempt to turn our baby at 37 weeks. Instead, without asking or even warning me, she stabbed two fingers into my abdomen and roughly attempted to turn my baby. I was in shock. It felt like an assault, an attack at the deepest core of my being and an attack on my baby. We decided against seeing her again.
At 37 weeks, we had a check-up with a gynecologist who we had never met before. He made a very friendly and soft attempt of turning my baby, which didn’t work. He asked whether I wanted a vaginal birth or a c-section. I said that I wanted to try on my own. He gave me a list of conditions for a vaginal breech birth, and ended his speech with “but I have the last say in this delivery.”
We felt like we were put aside in our child’s birth. I thought, “Hey, who’s giving birth here? I’m connected to my baby. I feel what it wants, not you!”
At this point, we had already contacted a doula, because we could use all the help we could get. We made a birth wish with her, and during that conversation it became clear that I really, REALLY didn’t want a c-section. I would give birth to this baby myself!
I am a resident anesthesiologist, and I’ve seen and performed spinal anesthesia for c-sections many times. I did not want to go through that surgery unless it was truly necessary. And I didn’t want the cord to be clamped immediately after birth, or my baby to be taken away from me in the OR. I didn’t want my baby’s natural instinct to find it’s mommy’s nipple for drinking to be disrupted. I didn’t want all the medication that will be administered for a c-section. I knew that after a c-section, you can’t lift things for several weeks, which would be very uncomfortable with two dogs in the house, besides a newborn baby. And above all, for future pregnancies I would be stuck with the hospital!
Besides all the reasons above, the most important one, I didn’t feel SAFE in the hospital. I didn’t feel safe to tell them my birth wishes. Even if they “let” me birth my baby vaginally, I would have had to give birth on my back, in the stirrups, tied to the bed with monitors, in an environment where I did NOT feel safe and relaxed. In such an environment, I felt that a c-section would be inevitable, because of the lack of relaxation.
Our doula advised us to make an appointment with a midwife who had assisted breech births before, and who probably could reassure us about whether a physiological birth was possible. We made an appointment with her, and she laid all our options on the table. On the ride over, we were hoping she would support us in a choice for a home birth. And indeed, at the end of our long conversation, she agreed that she would. We were thrilled. But because it was an important decision, we all agreed to think it over for a couple of days. Our birth wish of having a breech birth in a birthing pool became possible. Our baby was 38 weeks at that moment.
I already started my preparation with an internet search for protocols of breech births all over the world, but I searched even more from that point on. I’ve watched dozens of movies of breech births, on all fours, in the water, standing, footling breeches. With our doula, we talked about every aspect of the birth, what we wanted, what we didn’t want. What ifs.
I also asked myself the question, “What if things went wrong?” Then I would be sad for losing my baby, but it still would have been our choice. We took responsibility for our decision.
At our last meeting (which we didn’t know at the time) with the gynecologist at 39 weeks, we were in his office for five minutes. “How are you feeling?” “Fine.” “Let’s take your blood pressure.” “OK, let’s look at your baby with the ultrasound. Everything looks OK. If there are any problems, call us, and not anyone else.” We said good bye and walked towards the door. In parting, the gynecologist said, “At 40-41 weeks, you have to think about a c-section.” I responded, “Let’s postpone that as long as possible, shall we?”
We never mentioned that we were not going to the hospital for the birth of our baby. We wanted to prepare ourselves for this birth, and not start an argument which probably would have cost a lot of energy. Besides that, if things wouldn’t turn out the right way, we needed the gynecologist and the hospital for backup, so we didn’t want to disrupt the relationship.
On a Sunday morning, after a very good night’s sleep, my water broke around 9.30am. I was 39.5 weeks pregnant. After 45 minutes, I got light contractions; they would come and go until 16.30. Our midwife checked upon us two times, and things were going fine. I got in the birthing pool at 16.30, and regular contractions started. We called our doula and midwife to come over. I dilated in the next four hours. Again our midwife checked several times whether everything was going fine, with a handheld fetal heart monitor. At around 20.45, I got the urge to push. The transition came gradually and I was excited to go into the next phase. A second midwife, experienced in water births, came to assist as well.
Time didn’t exist for me, only what I felt, and the incredible power released within me. I was squatting, and held my balance with two handles on the top of the pool. I felt something pop out. It was his foot. During the next contractions, his first leg was out, and all the while he was moving his leg. That was the strangest feeling I ever experienced. After half an hour pushing, there was no more than one leg out. My midwife had checked if I was fully dilated, and gave me another four contractions this way, or else we would have tried another position. At that point I thought, well then, I have to push along.
The next contractions were enough to birth the rest of our baby’s legs, abdomen and thorax. He was now sitting on the bottom of the pool, with his hands folded, like he was praying. Our midwife felt his cord pulsating strongly. He was ‘jumping’ up and down the bottom of the pool. His jumping hurt me badly, and my contractions stopped. According to the instructions of my midwives, I turned to sit, and they helped our baby’s head being born.
He (it was a boy) was born after more than hour of pushing. He was laid in my arms and I held him close to me. He started to breathe after a few seconds, while I was stimulating him with a towel. Our midwives observed us from the couch during the next hour,while we remained in the pool. Enjoying everything about our son. After an hour, I birthed the placenta, and my husband tied the cord with a lace and cut our son loose from his placenta.
It was an incredible journey, which took a lot of preparation and went like we wished. I was only examined for dilation once, I birthed my son in the water, and the cord stopped pulsating naturally before it was cut. I was supported in my belief in myself and the connection I had with my son. I was able to feel every turn he made inside me throughout his birth.
To forward on the timeline, we made an appointment 6 weeks later with the gynecologist we saw the last two times when I was pregnant. It felt very disappointing for us. Our midwife had sent the report of our delivery to that gynecologist, with a note that she very much would like to discuss our case with him. Our goal for making an appointment was to explain why we made the choices we did. He let us tell our story, and then said that he was shocked, that he didn’t have words for what had happened. He found the midwife to have been irresponsible for guiding a breech home birth. We tried to explain that we lost confidence when he said that HE would have the last say in our delivery. He denied saying it.
Between the lines, he actually called us liars, for he denied our most important reason why we lost confidence in him. This did not make it better. I felt shocked about it. And it got worse. He NOW told us things he did not tell us before. He said that he would go very far along in the birth wishes of women. That giving birth vertically was an option. My mouth fell open. I felt like I was being lied to. This was a total different story. He ended his speech by saying that he was going to take steps against my midwife. At that point I broke. I started crying and responded that I was very sorry to hear that. He responded with “Well, little girl, you didn’t think you were going to get away with this without any consequences, did you?”
I was stunned. How could I explain my feelings of unsafety and being ill-informed to him, someone who thinks that breech babies can’t come into this world without a gynecologist’s hand? How could I reason with a doctor who believes that a midwife could not possibly be experienced enough to guide these situations? How could I ask a gynecologist to step outside of his comfort zone, to feel unsafe with what he would be doing, because he is not used to observing and handling only when it is necessary? How could I make him see that I had less chance of complications with midwives who observe WITHOUT fear, who know when to handle when necessary, but also know when to let nature do its work without disrupting it?
In conversation with our midwife, the gynecologist also said that, if he had known in advance that we were having a home breech birth, he would have called the police and ambulance to take us to hospital to birth. I found this outrageous! Where would he get the right to do that? It is nowhere in the law that I, with my breech baby, am obliged to give birth in the hospital!
Later on I heard through various channels that throughout the region, our case was being discussed without people knowing full details. That they spoke inaccurately about our case. It almost felt like slander. Like our story was being distorted to create an example of how NOT to handle a breech birth.
I believed, and I still believe, that I took less risks by having a natural breech birth at home in a birthing pool, with midwives who are trained in assisting natural births, and a doula to support me if I needed it, than with a gynecologist who doesn’t know how to keep his hands on his back when doing so is in the best interest of me and my baby. My choice avoided the risk of somebody pulling on my child to get it out, and creating complications along the way for me or my baby.
We made our choices with our son’s interest in our minds. Does that make us bad parents? I do not think so. I gave my son the best start to his life he could have ever wished for. And when I look at my son sleeping next to me on the couch while I’m writing this, I feel blessed that we had the opportunity to make this choice!
About Marieke de Haas – van Bommel
Name: Marieke van Bommel
Country: the Netherlands
Profession: resident anesthesiology
Marital state: married
Children: 1 son
Last modified: June 10, 2012
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