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Unexpected Cesarean due to Surprise Breech Baby

Posted Sep 25 2009 10:36pm

I am sharing this story of a birth I attended as a doula, with permission from the mom.

Charlotte’s Birth

Jennifer had a few weeks of pre-birth pressure waves, it was a bit surprising to us all when she kept getting closer and closer to her guess date, as her first daughter was born at 37 weeks.  But this baby was waiting until she was ready!

Jennifer called me around 6 pm on Monday saying that this was probably the day.  They had spent the day enjoying Irvine Regional Park and now were home.  Her pressure waves were every 4 minutes or so, one would be strong, the next would be smaller then the next one strong again.  I suggested a shower and then call back to update me.

An hour later I called Jennifer and asked if it was ok if I came over.  She said yes, so I headed out.  Ryan called soon and said Jennifer was craving Cinnamon Rolls.  I tried our neighborhood Cinnamon Productions but it was closed!  So Ralphs Bakery Cinnamon Rolls would have to do.  I got to Jennifer’s around 7:40 and she was resting in the chair.  She was still having pressure waves pretty regularly.  She ate her cinnamon roll while we chatted.  We decided we should probably get ready to head out and call Grandma to come over.

Jennifer was busy getting things ready, having pressure waves and then her water broke about 8pm.  Jennifer got a little emotional, but we reassured her, she was doing great!  I let her know once she got settled in the car and listening to her CD it would help.  She WAS doing great!

I called the OB to let them know we were coming.  I met Jennifer and Ryan in the main lobby.  Jennifer was in the bathroom and I went into check on her.  She was excited that today was the day!  We made our way up to triage, arriving about 9 PM.   She explained her water had broken and we asked if she could skip triage.  They wanted to be sure her water had broken, so sent her into triage.  They only allow one person back there at a time, so Ryan hung out with her and then after awhile, I went in for a little bit and then Ryan went back in.

Jennifer was doing well, but the nurse would talk to her and distract her and sometimes it would make things slow down, not to mention make it harder to stay focused!  I was getting pretty frustrated that they weren’t getting her settled into a room.  It was evident she was in her birthing time, but they were not able to determine if her water had broken.

Then they did a swab to see if that would help them determine.  I saw the nurse at the microscope examining, for what seemed like forever.  Then the OB was there, looking in the microscope.   Then he came in and said he couldn’t see any amniotic fluid on the swab they took.  He watched her relax through a pressure wave.  He explained that he could tell she was in her birthing time, but he would like to do a vaginal exam to see what was going on.  Jennifer said ok.  This was about 10:30, an hour and a half after getting there!

Ryan and I went out of the curtain area.  Then I see the nurse getting the ultrasound and I was wondering what was up.  I heard the word breech and my heart sunk.  Ryan and I went in and Dr. Winter explained that Jennifer was 6cm and doing great, but the baby was breech.  He showed us the baby’s position with the ultrasound.  I asked if they could do a version.  But because her water HAD broken and she was having pressure waves, it wouldn’t be safe.

He said, had it been 20 years earlier she would be an ideal candidate for a vaginal breech birth, because she had already had a baby and her birthing time was progressing well.  He was impressed at how well she was doing.  But now the hospital doesn’t allow vaginal breech births, because of an increased liability to the hospital.  He said we had time to get used to the idea, it wasn’t an emergency situation.

I read the change of plans script.  I was near tears at the beginning.  It is such a hard situation, to be faced with a cesarean when it is such a surprise.  But by the end of the script I felt calmer, I hope Jennifer and Ryan did too.  Then it was a flurry of activity.   The nurse tried to put in an IV.  The Anesthesiologist was explaining things and answering questions.  Jennifer would have to pause for pressure waves.  Then about 11 Jennifer and Ryan walked to the OR and I went to the room to wait.  I prayed that all would go well and wondered, WHY?

Then about midnight, they came back to the room.  Charlotte was SO cute.  She was 7 pounds 2 oz, which is smaller than her sister had been.  Jennifer was a bit shaky, but once she had Charlotte in her arms she was good!  Charlotte latched right on and nursed like a champ.

That night when I went home, I couldn’t sleep and was up writing and pondering about Jennifer’s experience.  What I came up with was that even though it wasn’t ideal, I could see God’s hand in the process.  I was so surprised and irritated that they couldn’t tell her water had broken.  But if they had, then they wouldn’t have checked her until she felt like pushing.  Imagine the chaos if they determined the baby was breech while Jennifer was starting to push.  They would still want her to have a cesarean and then there wouldn’t have been time for a change of plan script and a much more emergency situation.  So it made me grateful that God knew what was happening and made it so that the OB felt the need to check her.

Though as an educated Childbirth Educator and Doula I know that she was a great candidate for a vaginal breech birth, I also know that sadly that option wasn’t really available to her.  It is FRUSTRATING!

I am in the process of making medals for moms.  You know the saying, “You don’t get a medal for natural birth.”  But I think moms DO deserve medals.  Every mom does, especially Jennifer, who worked hard to prepare for a natural birth, was DOING it and would have made it all the way, but for the safety of her baby agreed to a major abdominal surgery!  She totally deserves a medal!  (When I get them, I will bring one over for you.  You will get on of the first ones!)

Edited to add over at the At Your Cervix blog, she posted about a similar tale.  I wonder how often this happens?

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