The Ordinary Doula Podcast
Welcome to The Ordinary Doula Podcast with Angie Rosier, hosted by Birth Learning. We help folks prepare for labor and birth with expertise coming from 20 years of experience in a busy doula practice, helping thousands of people prepare for labor, providing essential knowledge and tools for positive and empowering birth experiences.
The Ordinary Doula Podcast
E68: 3 Breech Deliveries
Breech births present unique challenges and require both education and empowerment for expectant parents. We dive into real-life stories, shedding light on the skills needed for breech deliveries and the importance of having informed practitioners.
• Exploring the definition and implications of breech births
• Case study of a hospital breech delivery experience
• The significance of experienced practitioners in breech scenarios
• The art of breech delivery by skilled midwives
• The role of home birth in expanding breech delivery options
• Addressing common concerns and questions about breech births
• Importance of informed choices and preparation for unexpected scenarios
Visit our website, here: https://birthlearning.com/
Follow us on Facebook at Birth Learning
Follow us on Instagram at @birthlearning
Show Credits
Host: Angie Rosier
Music: Michael Hicks
Photographer: Toni Walker
Episode Artwork: Nick Greenwood
Producer: Gillian Rosier Frampton
Voiceover: Ryan Parker
Welcome to the Ordinary Doula Podcast with Angie Rozier, hosted by Birth Learning, where we help prepare folks for labor and birth with expertise coming from 20 years of experience in a busy doula practice Helping thousands of people prepare for labor, providing essential knowledge and tools for positive and empowering birth experiences.
Speaker 2:Hello, my name is Angie Rozier and I want to welcome you to the Ordinary Doula podcast. We do this podcast to help folks prepare for all things labor, birth, delivery, breastfeeding, that newborn phase, that end of pregnancy phase. I think, yeah, information is powerful and knowledge is king. So, hopefully, the better prepared you are, I want you to have access, access to knowledge, information and be able to ask the questions to get a good experience for yourself, whatever your situation is Because, yeah, you should be empowered to do that. Your situation is Because, yeah, you should be empowered to do that. So this is a follow up to last episode about breach kind of some breach facts, a little bit of history, where we are with breach deliveries in the United States. I've had a couple interesting breach deliveries in the last couple months, so I just wanted to. This has been on my mind and just wanted to share a little bit about those. I'm going to go back to cause. This illustrates a lot of what I talked about in our previous episode about breach history.
Speaker 2:I want to go back about four years. I had a um, a client whose baby was breached. We didn't know it till the like towards the end of pregnancy, Um, kind of a you know, interesting situation. And she I found myself with this client. We were in a hospital and for other risk factors, she ended up having the MFMs, which is maternal fetal medicine doctors, so your high risk doctors were became her providers. This baby was breech and this client I mean she was planning on a home birth. Things were, you know, changed very quickly for her, which is hard, it's really difficult. So she was really insistent upon's really difficult, Um, so she was really insistent upon delivering her baby. After we discovered it was breech, she wanted to deliver breech. It was not her first baby, Um, so she delivered babies before, had what we call a proven pelvis. Um, this baby wasn't termed to be very big, Um, she was healthy, she was of low risk factors for that.
Speaker 2:So the team little team of MFMs met and they talked to her and they were awesome as we discussed it and talked about it and they said, well, and this is not a great facility, right, Like, it was an awesome facility that I worked at in North Carolina and this team of amazing doctors so I really enjoyed working with. They said, you know what? We don't, we don't know how to do that. Like, we're happy to you know, given the situation, we're happy to support you in that, but none of us have those skills. Like, we just don't know how to do that. Um, and they said what we do have, we have a chance of finding someone who does. So. There's a certain doctor in the area this was a weekend and if he is available, if he's home this weekend this was a weekend and if he is available, if he's home this weekend, then we're happy to try it. So her chances were on the fact that this doctor would be available.
Speaker 2:And this doctor is older. He came from a time where he was taught to do breach deliveries and he had done hundreds of them in his career. He was in his 70s. He got a call from the hospital, they he got a call from from the hospital and, yes, he was available that weekend. He was willing to come in, willing to do it. Um, he came in, he sat with us through the night. So great it was. Just it was amazing to have him there.
Speaker 2:He made another interesting comment this is going down a tiny rabbit hole here, Um, because his career had spanned several decades, you know. And he said you know, as we kind of sat there and this, this baby was born in the morning time, kind of as the sun was coming up, and he sat there with us throughout labor and he said you know what? This is how it used to always be Like babies so often were born as the sun was coming up, like in the morning. That's when we did so many deliveries. It was a very busy time before we started taking control of labor and inducing. This is kind of a natural time that babies would be born. So I thought that was kind of interesting too. So he'd seen shifts in his career and how, how practices change right, how we manage labor and do inductions and things. So I thought it was interesting. They called this doctor in who had the skills and he's 74 years old and he was good at it and he did have the skills and he he had a maternal fetal medicine doctor assist him and they did some maneuvers, things that these younger, newer, very talented, smart doctors had never been taught. So that was kind of interesting.
Speaker 2:Um, all right, so my more recent breach stories. What was that? A couple months ago, and this person had chosen an out of hospital birth. They were birthing at home with a midwife. It was her second baby, Um, and she had given birth unmedicated before, right she, like in a hospital setting, and um. So she, she knew what she was getting into and she made the decision to have a home birth. Great, I love it, Um. And towards the end of pregnancy, found that well, I think we were like a 33, 34 weeks the midwife found that this baby was breech right, Head is up. So she gave the mom some things to do and I'm like all right, let's try these few things. And the mom, the pregnant mom, did them and the baby turned, the baby went head down, cooperated pretty nicely, I you know I was like, oh good, that simplifies things. And then in time the baby went head up again. So I'm like, oh, here we are again, where you know babies breach.
Speaker 2:This home birth midwife, um, had been trained in delivering breach babies, that you know. That may seem preposterous to some, but this is a skill that has been used for think back on it right Centuries, millennia midwives way before obstetrics was even invented midwives were delivering breech babies at whatever rate breech babies were coming right. They delivered 100% of breech babies vaginally over the millenn, the millennium Um. So this is an art that's, that's out there, right, it's, it's. We have lost it in our medical community, but it's out there. So this home birth midwife said, all right, we'll just, we'll deliver, we'll, do you know, deliver a breech baby. And, um, I was like, okay, should we try the things again to turn the baby? And we did, they didn't work. So we got, you know, to the due date and kind of creeping past the due date and in my mind I'm like, all right, I wonder if we need a transfer plan. Like, where are we going to go, if you know? And this mom's previous baby, by the way, was born very early for some medical reasons, I think at 34, 35 weeks. So very little baby, right? So, yes, she'd had a baby before, unmedicated, but a small baby. And now we are past due date. Right, we're past 40 weeks with a bigger, theoretically a bigger baby, like almost surely going to be a bigger baby. So I, like in my mind, was getting a little bit nervous. I'm like, all right, what can this pelvis accommodate? We know this pelvis can accommodate a five pound baby. Can this pelvis accommodate a larger baby and a baby who is in a breach position? And the midwife was just calm and confident about it. We were getting to 41 weeks.
Speaker 2:I think we went a couple days past 41 weeks and in my mind I'm like, all right, what's our plan? Like you know, we can't like just induce labor because they're at home, not in the same ways anyway, right, the midwife, home birth midwives have some gentler ways of inducing. They're not nearly as strong or powerful as the hospital ways and that's why they're home birth midwife ways. But in my mind I wanted a plan like all right, where are we going to transfer? Is this baby going to be born by C section? And I wanted my client, on an emotional side, to be prepared for that. So I gently explored with her what those plans were and, um, she was fine not to have any. The midwife hadn't presented any.
Speaker 2:So this was a learning thing for me, right, like years and years into my um practice, like I again, once again, like all right, cool, like I learned to trust because I mostly work. I'm about 90% 93% in hospital and about 7% out of hospital, and so that's my main experiences hospital deliveries, which in this case would be a C-section, right, A C-section, probably two weeks ago at this point, um, so I was a little had a little bit of trepidation, but I got to this, the the, the mom finally went into labor. Midwife did a little bit of prompting with some um, the ways home birth, the way home birth midwives do, and labor began. Um, I arrived there and the home birth midwife was talking um to the mom, actually had an apprentice doula with me and she was talking both of us through. All right, you're going to see some stuff we don't see very often. Here's what we're going to do and you'll see me maybe do some maneuvers that we might need to do. We will just kind of see what's needed. And she said this was fascinating to me because in hospitals we don't see this. But she said and we will never, with a breach delivery, want her to be on her back. We want to be up on our hands and knees and have her body in that position is much better for a breech delivery.
Speaker 2:So it was interesting to hear from her like, yeah, she had a plan, she was prepared for this, she had she brought in her very best assistants, like, who had deep experience. We had three midwives there, myself and an apprentice doula. And labor labor's different, right Like it feels different with a breech delivery. The presentation of the body parts are different and so for someone who's had a baby before, she knew this felt a little bit different, not bad, not wrong, just different. She was aware of that.
Speaker 2:Labor went beautifully, she labored, you know just this nice steady pattern. Things picked up. She had that urge to push. She pushed for a while. I want to say it was about an hour, um, a little more, you know it was longer than she had with her first baby, who was small. And, yep, that baby's cute little butt came first and babies like a lot of meconium gets pushed out. So you got meconium coming, coming out before the baby does. And, um, mom was on her hands and knees. The team was ready with with what was needed. They're ready to resuscitate, they were ready to do some maneuvers, you know, based on where the baby's head, if the baby's head is extended, and that was a perfect, slick delivery. That baby slid out like butter, and that's what the midwife called it. She goes I have butter breaches, I call them, where they just slide right out.
Speaker 2:Others make me work a little harder, but it was fascinating to me to see this ancient skill at work in our modern world. On a little side street in a city, a cute little brick house, when a baby was born on the living room floor on a Saturday night. Um, it worked, it worked beautifully. So taught me again, um, back to roots, old ancient roots, that birth works right. Um, because a lot of times we don't trust that in some hospital settings. So that was. That was interesting. It was very interesting for me. So I'm going to flip now and do another breach story that was a little bit more recent. That other one was a couple months ago. This one was a couple of weeks ago.
Speaker 2:Had a client who was having a baby in a hospital. She had a great midwife. She'd chosen this amazing midwife, amazing hospital. This client is incredibly conscientious of health, of fitness, of what she puts into her body what she does. She's very disciplined when it comes to eating healthy and exercising. It's a very healthy lifestyle and so it matched for her lifestyle to want a simple, uncom, uncomplicated, unmedicated, low intervention birth. That's what. That was her goal. She set everything up for that. She hired a doula. We were prepared for that and then we find out this baby is breech. I think we're at 36 weeks.
Speaker 2:She tried all the things. Look at my last episode trying all the things to turn a baby. She tried them all right. She did the water, she did the inversion, she did moxibustion, she did chiropractic. She did all the stuff to try to turn a baby. I think she did light sound temperature. The last thing to try was an ECV external cephalic aversion. Remember, it's not an aversion, it's just aversion. I love it when my clients call it I'm having an aversion. It's just aversion. We're trying to turn that baby's head.
Speaker 2:So she goes to the hospital on the appointed day. She and I talk through it, walk through it. What would it be like? What could she expect? We talked about the sensory things about it. It could be pretty intense Things. It can be pretty intense things. They could give her to help with that. She was nervous but felt comfortable, like prepared, going in, right.
Speaker 2:So she goes in in the mid morning time to get this done. They did it in a labor and delivery room. They had her kind of reclined. The midwife and a doctor came in to do it. They're monitoring the baby and she's like it was intense, like when they were doing that version, like oh my gosh, that was tough, very, very difficult, painful to try to turn that baby.
Speaker 2:And during the version this baby's heart rate tanked pretty good, like the heart rate went down. I remember we talked about in our last episode whenever a version is done in a hospital they are, they want to do it in a. In a way they have a, an OR ready, available, open and a team ready in case things don't go great. This baby's heart rate went really low for a while. Uh, trying to do this version.
Speaker 2:Baby did not turn. They tried for like three minutes. I think. Um, interesting to know. You can try for up to 16 if the baby's doing well, 16 minutes, that is. They tried for about three minutes. They tried three times. Um, baby didn't budge, baby wasn't going to dive forward, baby wasn't going to dive backwards.
Speaker 2:So she knew this was to be a possibility. Right and aversion has about a 50% chance of working. It's not amazing, um, but it's one of the the you know an effective, more effective things to try. So she was like, all right, well, we have our answer. I was prepared for this possibility, of course. I think I'll be having a C-section.
Speaker 2:Her midwife said, all right, well, we tried, that was great, let's plan a C-section for a couple of weeks from now. So she was at 37 weeks. This was going to be, you know, a C-section about 39 weeks. She's like, all right, let's do it. And her husband went out to get the car she was checking out at the nurse's desk. She took three steps away from the nurse's desk when her water broke. It was all on its own, right on the floor. The nurses heard it. She's like, whoa, what just happened? She's like, wow, my water just broke. I said, all right, you know, come on back. So she had her husband go park the car again.
Speaker 2:They came back and with her midwife decided, all right, we'll do a C-section later today, unless, you know, baby warrants or labor starts up or whatever, that we need to do it earlier. So her her plan that she got used to got expedited by a couple of weeks. It was happening today Um, that was about 11 or 12, I think and they've said let's do a C-section about five o'clock tonight. So we kept in touch. She had the afternoon to kind of get used to that wrap her head around that. She cried some. You know it was going to be a big day anyway to find out will this work? Am I going to have the birth that I've been planning for, or am I going to have a C-section in a couple of weeks? Well, so we're having it today. So she had the afternoon to process that.
Speaker 2:They did the C-section, took her back at the appointed time she was. She didn't go into labor, which was great during that day and this was what was fascinating to me Like they got in there and found that this baby's cord was about six inches long. So he was Frank Breach. He was kind of sitting up. He. This placenta was anterior, which sometimes has something to do with it. He just had to be right next to his placenta because that cord was so short. He could not deviate, he couldn't, he couldn't dive down, he couldn't move. There was no tangling in his cord because it was so very short. So interesting to know like. This was a very good call, right, like and it's a very common call, right.
Speaker 2:But this baby, even if this baby had been head down the entire pregnancy, would not have tolerated labor very well, would not have tolerated the traveling the path he needed to go down to go descend into the pelvis. With a cord that short it was literally like six inches short there's no way he could have descended. So this would have been a cesarean either way. It happened to be a cesarean at 37 weeks and where the cord was held him in a position he could not dive down with that version. There's no way he could have turned with a cord like that. That's why his heart rate was tanking and going low during the version.
Speaker 2:It all made sense after we had the full picture of things. So my client, after she knew that she's like oh, okay, okay, and she was pretty amazing. She had to do some shifting and some processing, but she was really good at honoring what that baby needed Um, she, it could be easy to be devastated by that right Like. She's like this is not what I wanted, this is not what I planned or prepared for, but you know what. It's what that baby needed and she was in a good space pretty quickly. But you know what. It's what that baby needed and she was in a good space pretty quickly, you know still processing things, but in a good space to say this is what my baby needed and she was able to honor what the baby needed rather than to mourn what she wanted. So we had a cute little baby.
Speaker 2:As you know, with breech babies their little hips are just wild right. They have their toes, are kind of by their ears and they're they have hip. You know we watch for hip dysplasia, but this baby was very folded up. Um help them in their home a couple of times with lactation. He's doing amazing. He's adorable, um, and she's doing well too. That as a couple they're they're doing quite fine. They do want to plan for a VBAC, um when they have a second child and she's a great candidate for it.
Speaker 2:So so that those are my couple little recent breach stories, very different from each other you know one at 41 weeks, one at 37 weeks. One went smooth as butter, one was smooth for a c-section right and a very warranted and super grateful that that's how it worked out. So interesting to know all the different ways things can happen out there. So if you or someone you know you know has a baby that's breached, do a little research, do a little digging, see what you can find out, um, see how you feel about aversion, See how you feel about trying to turn a baby, see how you feel about having a plan cesarean, or what resources do you have If that's not the route you want to go, what doctors in your area whether that's older docs, because some of the articles that I looked at and preparing for this said the the doctors who are trained to deliver breech babies are going gray like they're.
Speaker 2:They're, you know, they're a dying breed. Really it's not trained anymore. But there are places you know, in a lot of home birth communities. Some areas have very robust home birth communities. In our area we have a home birth midwife who's incredibly skilled at at breech deliveries. She has even been asked to come into the hospital and work with an OB to talk him through a breech delivery, which is pretty fascinating because that's her specialty is breech deliveries. So we get a lot of breech deliveries to get headed her way and even we have a little crossover from home birth to hospital birth community in collaborating on that, which I think is fascinating.
Speaker 2:Hopefully, I don't know, like pie in the sky, this comes back as a medical art, a medical skill that is resurrected somehow. But just one generation ago it was very common and now it is pretty obsolete in our medical world. Hard for the you know the medical world to wrap their head around this, the fact that this was so common because it's lost. It's lost for a variety of reasons. Anyway, little, those are my three breach stories. Hopefully helps you in some way, if it's, if nothing else, hopefully just interesting. Thanks so much for being with me here today on the Ordinary Dula podcast. My name is Angie Rosier. I'm your host, so happy to be with you and, as always, I want you to reach out and connect to someone important in your life today. Reach out and make a difference in their life and see what it does for you. Have a great one and we'll see you next time.
Speaker 1:Thank you for listening to the Ordinary Doula podcast with Angie Rozier, hosted by Birth Learning. Episode credits will be in the show notes Tune in next time as we continue to explore the many aspects of giving birth you.