There are two parts to Francis' story: in ON BREECH, you can read about the issues which Francis considered when deciding to opt for a homebirth or you can go directly to the story of MAIRI'S BIRTH
ON BREECH
I am thankful in retrospect that our baby Mairi was breech. Having to deal with this
situation took me from ignorance to knowledge and dare I say it - wisdom. I changed
from a terrible state of fear and anxiety to one of confidence and strength (the most Iíve ever felt in my life) and the outcome was a beautiful breech birth at home with
the assistance of my partner, midwife, sister and mother (and our dog).
When it first started to look like a breech presentation was a real possibility, a
relative commented along the lines "They'll do a caesarian for sure"! I was shocked
and upset having planned from the start to birth at home. I'd read enough to know
that the high caesarian rate in Queensland is unjustified and didn't want our perhaps one
and only birth to be one of those figures. However at that time I believed that
breech presentation was too risky to deal with at home and that I'd better just accept
that a caesarian was on the cards.
Then I started reading more. My midwife Sue provided information collected from a
variety of sources including papers by independant midwives and obstetric and gynacological
journals. She also pointed out that in her extensive midwifery experience, it wasn't that long ago that breech was considered nothing more than a variation on "normal".
We discussed the information at hand in the context of our particular situation
and all the while, willed our baby to do a duck dive.
She persisted in sitting head up and as she grew her bottom started pressing down
on my sciatic nerve causing pain, irritation and lack of sleep (more than usual).
I became extremely anxious about everything and would sit on the front stairs hugging
my belly, sobbing and pleading with her to please turn. Somewhere in the literature I'd
read the words "cerebral palsy" and in my over-tired and irrational state, felt frightened
and overwhelmed at this possibiltiy, however remote. I just wanted out of the whole thing - and that was certainly impossible.
Sue listened, understood and offered suggestions. The first thing to do was to get
some sleep and although I had to fight feelings of guilt, I took some sleeping tablets.
(I was practicing yoga relaxation and meditation but the sciatica was persistent).
Another solution was to accept that just resting was okay when sleep wasn't possible.
Slowly I became mentally calmer and able to think more rationally. A visit from an
old and true friend also helped a great deal.
Sue suggested investigating the hospital option. By this stage, I was convinced that
in my case a caesarian was not necessary so I didn't hold out much hope that the
hospital could offer me much. However I phoned the ante-natal clinic at the Royal
Women's Hospital and asked to see an obstetrician who was comfortable with vaginal breech
delivery. An appointment with Dr Stephen Cook was arranged. My partner Gerard and
our midwife Sue attended. Knowing the Queensland caesarian rate for breech delivery
was near 80% and this was my first pregnancy, I feared the worst but apart from the unacceptably
long wait of one and a half hours I was pleasantly surprised at the outcome. Yes
I probably could have a vaginal delivery so long as we agreed to a scan to get an accurate picture of the position and a good idea of head size. We were willing to
do this because the knowledge to be gained was also useful in the event of deciding
to stay at home.
Dr Cook had worked in England where vaginal breech delivery is more common and he
was very reassuring regarding the risks and outcomes. He was also supportive of
our bid to use an inflatable tub of warm water for pain relief during the first stage
of labour so as to avoid epidurals and the like. (The hospital granted verbal approval but
were unwilling to do so in written form). On the negative side, he was not in favour
of standing or using a birth stool and was insistent about me being up on the bed,
admitting that this was for his comfort. The method he used to assist delivery of the
head was the same used by Sue.
So the hospital was an option after all (whereas before I had completely written it
off) but it still fell short of what I really wanted. I found myself not knowing
what was the best choice. Despite the hospital's shortcomings I felt that medical
backup was important. On the other hand, giving birth in an environment I have always felt
extremely uncomfortable in and one in which most of the staff were nervous about
breech birth, would make the process more difficult than it needed to be and perhaps
lead to unwanted intervention. Besides, hospitals are for treating sick people and I certainly
wasn't sick. Another important issue was the fact that given such a high caesarian
rate, it was impossible to have confidence in the obsteticians' skills with breech delivery (except perhaps for Dr Cook, but there was no guarantee that he would be
available for me when the time came).
I had to know more so I started hanging out at the Herston Medical Library, becoming
familiar with the CD-Rom database Medline which lists most international publications
pertaining to childbirth. ( A few times as I walked through the hospital precinct,
I imagined my waters breaking and me yelling "Out of my way - I have to get out of
here"). I read as many relevant and recent articles from different obstetric journals
as I had time to and as I synthesised the information, became more and more aware
that many of the problems associated with breech outcomes are either beyond anyone's control
(i.e. pre-existing conditions) or directly related to the skill and experience of
the birth assistant.
In Sue, we had a trusted friend, advisor, and dedicated midwife with skills and experience
in breech delivery who would come to our home whenever we needed her and wanted us
to have the sort of birth we desired. In the hospital, we had maybe a chance of
some of the sort of birth we wanted IF my baby's timing happened to coincide with Dr
Cook's timetable. (As it happenned, it didn't). I reached an emphatic decision based
on balanced indepth reading and discussion with experienced practioners. All the
reasons that we initially chose homebirth applied even more in our particular breech situation.
The hospital option posed too many risks - an unfamiliar, uncomfortable place with
unfamiliar people feeling nervous about breech birth. To have the birth we wanted there would have been impossible because we would have had to literally fight for
it ... and at such a time!!! I knew I could only give birth in the best and safest
way at home with our midwife and in the end, there was no longer any choice to make.
MAIRI'S BIRTH
Saturday 29th March - Easter Saturday
Early on Friday evening the 28th of March (41 weeks and 2 days) I had a feeling that
tonight would be it, but Iíd had such "feelings" a few times in the previous few
weeks, so I kept it to myself. We (Gerard and I) had been for our usual walk and
cliff climb in the late afternoon (rather brisker than usual) and had champagne with dinner
and a video.
In the shower I thought I detected a smell which suggested amniotic fluid but I had
no idea what it was supposed to smell like. Still I took a towel to bed with me
at 9:30 and slept peacefully until 10:30 when I woke to the warm gush. No mistaking
it - we were off! I felt relieved, euphoric and excited.
Mum and Bronwyn (my sister) were staying with us and Bronny combed and braided by
hair. Mum was still asleep. I put a loaf of bread on. Three or four mild 5 minutely
contractions were followed by mild short-lived 10 minutely ones. By 1:30am they
were 5 minutely but still quite mild.
I had phoned Sue (Smith) at 10:30 with news of the "broken waters" and I phoned her
again at about 1:30 feeling bad about waking her - I wasn't sure how long it would
take and thought that if things really took off suddenly, she wouldn't make it on
time. I asked her to come over which she did, arriving at about 2.30 or so. Meanwhile Gerard
and Bronny filled the tub.
The contractions gradually increased in intensity - things were progressing nicely.
Hot water bottles gave comfort. Even though I hadn't wanted to immerse myself in
the tub until the contractions were pretty hard to take, once I dipped my toe in,
it was irresistable, so in I sank at about 4am.
I made a lot more noise than I thought I would and clung to Gerard as the contractions
worked to dilate my cervix. At one point during the most intense contraction phase,
I had a clear visual image of my cervix dilated to about 7 or 8 cm, which encouraged me on to the most intense time of all - transition. Gerard said later I'd screamed
in his ear. I also threw up and started to get faint pushing urges. This time of
transition was classic in nature. I felt terribly unable to proceed any further
thinking that I was at a stage where I couldnít take any more and yet our baby was yet to
start her journey. I was beginning to feel tired. When offered the hospital option,
there was no question of accepting it. That would only make it all the harder - transporting to and then entering a pathological, controlling, intervening environment made
all the riskier because of all the unfounded fears about breech birth. No way!
I knew I could do it best at home.
Once the uncontrollable urge to push started, I started to feel better but still a
little discouraged. Gerard supported me strongly from behind on dry land, and anchored
me for each contraction. With Sueís encouragement I reached into my vagina and felt
the incredibly soft bottom of my girl. She was on her way. My confidence picked
up more and more as with each push she edged out a bit further before sliding back
a little. It was really helpful to hear Geard say she was about 5 inches out and
with the next push, her bottom was out and staying out. Soon I could reach down and gently
release her feet - that was an amazing feeling.
After about 2 minutes and 45 seconds (roughly), there was no sign of a contraction
and I didn't feel I could push her head out. We had agreed to assist the birth
of her head in these circumstances. Sue said she thought she could feel the baby
possibly gasping and seeing we were still in the water, Gerard hoisted me up. With Sue working
her manoeuvre, I found pushing power from somewhere (maybe my abdominal muscles),
and with the most determined effort of my life, we helped her through. I felt the
big roundness of her head pass through with a kind of gentle pop.
It was nearly 10am Saturday morning and we'd done it...but how was she!
She was in my arms in no time half floating in the warm water. She looked pale against
the red water and she had blood in her hair. Very soon with gentle coaxing she gasped
and gasped again. I wasn't sure if this was right or not but Sue reassured us that this was exactly what we were looking for and she kept listening to her strengthening
heartbeat.
And then...sweetly and simply...she opened her eyes and looked into mine.
Love and thanks to Gerard, Sue, Bronwyn and Mum.
Frances Blines (October 1997)
BIRTH NOTICE
On 29th March 1997 (Easter Saturday) Mairi Burford was born at home to Frances Blines
and Gerard Burford. Thanks to our midwife Sue Smith, Bronwyn, Mum/Audrey and Sinbad.
© 1997 hma_@hotmail.com
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