Unexpected Cesarean due to Surprise Breech Baby

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!)

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14 thoughts on “Unexpected Cesarean due to Surprise Breech Baby”

  1. Man, that IS so frustrating! It sounds like even the doctor saw what a bummer of a situation that was, even if he’s basically used to it by now. I appreciate the way it sounds like he handled the whole thing.

    All the more reason for America to follow Canada’s example & bring back the breech!

  2. We need to start with the medical students and residents – teaching them how to catch a vaginal breech baby. It is just not done anymore in the hospital. In my 8+ years in L&D, I have NEVER seen a vaginal breech birth. None. How incredibly sad and frustrating!!! These docs just don’t know how to do one, because they are not taught how. It is a lost art.

  3. I think this is so true. We NEED to teach OBs how to do this safely. If they are not trained, then what about the mom who shows up pushing and there is NO time for a cesarean?

    The fact that they are not training OBs to do this is a great disservice to the doctors and certainly the moms.

    During this birth, I asked the OB, “Are you trained to catch a breech baby?” He was an older OB so I am pretty sure he was. His response, “That is not the point, the hospital will not allow a vaginal breech birth.”

    I felt so conflicted. If I had been the mom I would have refused the cesarean. I KNOW the risks, I would KNOW I was a good candidate. I would force the OB to say if HE was trained. Then I would have refused a cesarean.

    BUT as a doula I can not put my client in that position. She doesn’t KNOW. She didn’t have time to truly make an educated decision and I gave the OB a chance to give her an out. If he had said, “Yes I am trained.” I would have gone the next step.

    It was a tough position for me to be in.

  4. canadian obs are now being required to learn to deliver breech babies hope america follows suit. i winder if her bag was only one layer broken and why moms do not demand vaginal deliveries if they are not a primip

  5. oh and the comment the ob made about the hospital policy is why going thru the e/r has some legitimacy so that a woman retains more rights

  6. Pingback: Unexpected C-Section for Breech, and Expected C-Section for Breech with Unexpected Vertex Baby. « Reality Rounds

  7. It is sad to me to prepare for a natural childbirth and then end up with a breech baby and being forced into a cesarean. I don’t know what I would have done in this situation, but I’d love to have a provider that was trained in catching breech babies to have that option available to me. I hope more OBs become trained…I know in my area of one midwife who will deliver breech babies with home births.

  8. It was sad. I guess it is a question moms could ask early in their pregnancy. Are you trained in catching breech babies. But even if they were, would they be willing to do it?

  9. hi, i had a breech baby and made a film about it. In a nutshell:

    A BREECH IN THE SYSTEM. A woman wants to give birth to her breech baby in a hospital. They say she has to have a caesarean section. This is an inspiring documentary about her to attempt to birth naturally against all odds.

    She intends to use this film as a tool to support the voice of ‘woman’.

    Prepare to be moved by this intelligent and poignant film about one woman’s birth journey with a breech pregnancy and breech birth. Experience the fear, anticipation, support and birth outcomes when you are clear about your boundaries and in touch with your inner voice in pregnancy. The role that care givers have in a woman’s birth is highlighted beautifully, ensuring this is must see film for all midwives, doulas and especially obstetricians.
    This production is excellent making the film a joy to watch. I can best describe this film as a vital and stunning contribution for all humankind allowing us all to witness with absolute clarity the entry to our world of one human soul in a unique way.

    Jannine Barron, Nature’s Child


  10. A mom “could” refuse a cesarean. But when you are being told your baby may die if you deliver vaginally, that is pretty scary and hard to choose not to.

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