Months later, here's our story...
Home birth options in our area are limited. When we were exploring options for our birth, we met Karen, a certified professional midwife in Tennessee, who seemed like a great fit for us. She does not attend home births in Alabama, but her Alabama clients can birth at a small house in Ardmore, TN, right across the state line. It was about two and half hours from our home, but we believed the drive would be worth it in order to have an out of hospital birth with attendants we trusted.
At 37 weeks, we had not been able to determine with certainty the position of the baby. I felt confident the baby was head down, but we decided to have an ultrasound just to be certain. I was shocked when the doctor said the baby was breech. The baby was in an unusual half frank position, with one foot down in my pelvis and one foot up in the pike position. We went straight to Karen’s from the doctor’s office to talk about our options. She has successfully turned a number of babies in the past, but our little one wouldn’t budge. Karen offered to contact Ina May Gaskin at the Farm for us and we also decided to see an O.B. in ********** so we could understand all of our options. At the same time, I began trying every suggested method for turning babies: taking pulsatilla, a homeopathic remedy, doing hip tilt exercises, seeing a chiropractor for the Webster technique, and talking to the baby, gently encouraging him to move.
Two days later we were driving up to Summertown to meet with Ina May. She felt that baby’s position and did an internal examination and confirmed the baby was still breech and she could still feel something in my pelvis that we assumed was the little foot. She said I had an ample pelvis for birthing, which was reassuring. Ina May also attempted to turn the baby, but again, no luck. She agreed that she would attend our birth if we wished to birth at the Farm, answered many “what if” questions for us, and gave us a video of breech births to watch at home. She also said she doubted the baby would keep its foot down in my pelvis and would probably shift position in some way before or during labor. I told her I was concerned that my fears would inhibit my labor. “You can do it,” she told me, and somehow I believed her.
We left the Farm feeling excited about the possibility of birthing there. That night I woke in the middle of the night to a fierce thunderstorm and the babe moving vigorously within me. Early the next morning we headed to the hospital to meet an OB who I’d been told attended vaginal breech births and who agreed to see us at the last minute. She did an internal exam and found that my cervix was soft, 75% effaced, 1 cm dilated. She sent us for another ultrasound that revealed the baby still head up, but with both feet up as well. I realized that in all the movement during the night, the baby had moved its foot up. It was now in a full frank position with its head tucked down, the best possible position for a vaginal breech delivery. Following the ultrasound, we met again with the OB and a few minutes conversation revealed that while she had attended a breech birth during her residency in another state, she had not since arriving in Alabama. Since ACOG recommends planned cesarean sections for breech presentation, particularly in first time mothers, vaginal breech births were simply not done and the OBs did not have the chance to practice this skill. She strongly recommended doing an external version, using the drug terbutaline to relax the uterine muscles. She had a 75% success rate in doing versions, which were done in the hospital with ultrasound and monitoring four hours following the procedure. In some 5% of cases, the fetus displays such distress that a cesarean is immediately ordered. She was willing to do the version for us that afternoon.
After some long conversation and a phone consultation with our midwife, Mark and I decided to decline the external version. We felt uncomfortable about the medication required and with the level of force the OBs might use, compared to the midwives who had been firm but gentle. We wanted to encourage but not force the baby to move.
We left feeling like the Farm was still our best option and I felt encouraged and confident about it. Then I watched the videos of the breech births. I cried through most of it. Designed as an educational tool for midwives, the video outlines all of the risks involved in a vaginal breech delivery and then shows a number of births. I was shocked by the maneuvering required to extract some of the babies and sobered by the pain and the effort of the laboring moms. A couple of them pushed for five hours! I felt almost panicked as it became clear that there was no easy way for this baby to come – either hard labor or major surgery. The next night I went to the bathroom and realized I was beginning to lose my mucous plug. I immediately burst into tears – “I’m not ready yet!” We still didn’t know where we were having the baby.
On Saturday, we returned for a visit to Karen and her assistant to let them attempt a version one more time, hoping that the baby’s change in leg position would make it easier to move. We brought a bottle of wine and I drank a glass and a half as we waited, then spent about ten minutes laying down in the darkened room quietly with Mark, relaxing as much as possible. Still the baby would not budge.
Mark was extremely supportive. He believed the Farm was the best option for us, but was willing to support whatever option I chose. We spent hours talking through all of our options. We began to make plans for me to go to the Farm to the farm as soon as possible, believing getting up there would help me relax. Perhaps that would help the baby turn and if not, I would be better rested for labor. But even as we made plans, I was still fighting the fear that welled up inside me and looking for any other options. I called Ina May back and asked many more questions. I explored the possibility of having a vaginal breech delivery in a hospital in Tennessee, where there were OBs with more experience and where our midwife could be present. “I just don’t want you to make your decision out of fear,” Karen had told me.
What did I fear? I feared that something would go terribly wrong in the birth and we would lose the baby, something that could have been prevented if I’d just gone to the hospital or had a cesarean. Could we live with ourselves if something happened? I felt enormous pressure, the unspoken message that if I loved my baby, I would of course have the c-section. “The most important thing is that the baby’s okay,” I heard over and over again. And of course that baby’s wellbeing was my first concern. But I also wondered about why my wellbeing was not of concern. Mark never bought this line of thinking. “I want both of you to be okay,” he told me. And I came to understand that my baby’s wellbeing and my wellbeing were tied up together – and we needed the solution that was best for both of us together, not one that pitted the wellbeing of one against the other.
We read books and studies and ACOG recommendations and all the rest. And eventually we realized that no study, no statistic could tell us what our outcome would be. There were no guarantees and no right answers. I simply had to make the decision and let go. I could not control the outcome but had to be prepared to accept whatever happened. I prayed hard for clarity, and on Wednesday morning, some ten days after we found that the baby was breech, I finally awoke with a sense of peace. We would birth at the Farm.
I went to see the chiropractor again because it was relaxing but did not expect the baby to turn. Throughout the day my sense of calm and peace grew, and I felt confident this was the right decision. Mark and I talked about it over dinner, decided that we would try to go up to Tennessee on Friday. He would spend the weekend with me then return home to work until I called him. After dinner we took our dog for a long walk and stood on hill watching rain clouds roll in. I paused in the driveway for a contraction to pass. Around 9:30 that night, I emailed Ina May to let her know we’d finally made our decision and wanted to birth at the Farm and hoped to come on Friday. I bustled around the house and went to bed around 11:00.
I woke up at 3:30 in the morning feeling the baby move a lot, then noticed I was having contractions. I watched the clock and realized they were coming every ten minutes. I tried to doze but couldn’t and finally woke up Mark to tell him what I was feeling. I drank some water, hoping the contractions would subside. “I need more sleep,” I thought, “I’m not rested enough to do this!” The contractions were down low, across the underside of my belly. At five, I called our midwife Karen who suggested eating something, moving around, a warm bath, to see if anything changed. I ate a banana and packed up some things around the house. I went to the bathroom and realized I was spotting. I took a warm bath. The contractions continued nine to eleven minutes apart throughout. I was beginning to realize this was really it. While Mark made arrangements to get off work, I got dressed, finished packing, tried to straighten up the house. My mood shifted from “Oh no, I’m too tired!” to excitement. I talked to Karen again and to Ina May. We decided that we would stop at Karen’s house in Ardmore on the way, and she would accompany us from there to the Farm.
Before we left, I had Mark lay his head on my belly to hear the baby’s heart rate, which sounded strong and steady. By the time we finally got going, it was close to nine and my contractions were coming five to seven minutes apart. Sitting in the front seat was really uncomfortable, as the seat belt made it hard to move or find better positions. A couple of times I turned around to kneel in the seat to stretch my back. About halfway to Ardmore, we stopped and I went to the bathroom at a gas station, wondering what people would think if they knew I was in labor. I moved to the backseat, where I laid pillows on the car seat base and kneeled, resting my arms and head on the pillow. I rode like this the rest of the way to Ardmore, drinking Recharge and munching on pretzels, listening to Norah Jones. Mark talked me through each contraction. My back was hurting with each contraction and fantasized about a warm bath and back rubs. I told Mark, “I need you to help me remember that when Karen checks me, whatever my dilation is, it is and it’s okay, if it’s one or if it’s six.” When we finally arrived at the house, Karen and her assistant and apprentice all came out, and I had to squat to get through a contraction before getting into the house. Karen’s eyes widened and said, “How long have they been like this?” She was clearly surprised at how hard I was working through them. It was about ll:30, we think. I went to the bathroom and had a lot of bloody show. My cervix was clearly opening up. First they checked the baby’s heartones – sounded good. Karen then checked me and almost immediately said, “Ok, we need to head out right now, you’re 6-7 cm.” She later told us that my bag of waters was bulging.
Karen had another mom in labor, so she decided to follow us to the Farm so she could return as needed. This final leg of the trip was the worst. The contractions were really hard to get through by now. It felt like a band tightening all the way around my hips and back. I began to feel pain in my hips as if they were being pushed apart. I needed Mark to talk me through each contraction. He was speeding, navigating, trying not to lose Karen, and trying to avoid the Amish horse and buggies – all while talking me through my contractions. He was amazing. At some point, Karen and Mark turned on their flashers. I lost all sense of time. Throughout the hours laboring in the car, I never doubted our decision to go to the Farm or worried that the baby would arrive before we got there. I felt so present in each moment with no fear or doubt.
When we finally arrive at the Farm around 12:30, they waved us through the gate house, we passed by the clinic and turned up Tower Road, stopping at the little red house I recognized from the Farm website. Ina May and another midwife Carol came on the porch to greet us, helped me get my shoes on to come inside. I immediately went to the bed and they brought me water to drink and checked the baby’s heart tones. Still good. Mark helped me through each contraction, while the midwives sat back, drinking tea at the little table, waiting until they were needed. I must have been in transition at that point; I was so nauseous I thought I would throw up but never did. I spent most of my contractions on my hand and knees, resting on my side in between them. Some contractions double peaked, and it felt as though my pelvis was being wrenched open. The pain rocked me to my core. I felt so tired and longed for a break, just to rest. At some point I asked how far apart the contractions were, as I had no sense of time. Two minutes, they told me. At some point I shed my clothes (“Now we’re getting serious!” Ina May said). She noted that I looked pink, not green anymore, and I realized the nausea had subsided. Ina May suggested it might be a good time to check my progress. It was uncomfortable, but she checked and could find no cervix – I was fully dilated.
Transition was past. The contractions became easier to bear. Now it was a matter of waiting for the pushing urge. I tried different positions – on the toilet, back to the bed, hanging my arms around Mark’s shoulders. At first this stage felt confusing; I was unsure what to do and experimented with little pushes. Then the urge to push became stronger. I was on my hands and knees on the bed and gave my first really good push – and splash! My water broke all over the bed, and I heard a cheer from the midwives. The fluid was mostly clear, with some flecks of meconium, not a surprise for a breech baby. I went to the bathroom while they cleaned up the bed. Then I really began to feel the urge to push – felt pressure and stretching on my perineum for the first time. They suggested I move to the birth stool so I did, with Mark sitting on the bed behind me, supporting me, with the midwives in front. The pushing contractions were astonishing, so beyond my control. It felt as if I were possessed, as if I were being lifted up by the power of the rushes and I was adding my pushes to that force. They cheered me on through every push, telling me how much progress I was making each time. They reminded me to keep my mouth open and relaxed while I pushed. I was vocalizing through every push – somehow it helped to make noise. The stinging was intense, and they held warm compresses to my perineum. I felt like I would tear open. The rapid progress was so encouraging and they told me when his bottom was showing and then, with an enormous sense of release, his bottom and legs were out. I remember looking down and seeing him half in and half out, his lower torso and legs and Ina May’s hands, his skin shiny and blue. And seeing, to my surprise, a little penis – It’s a boy! Ina May freed his arms and then I remember her saying, “We have an airway” but I still had to push the rest of his head out. But the pushing contractions were over, my body seemed to think we were done, and my own pushes felt so feeble. I knew this was urgent, to get him all the way out, and everyone encouraged me on, and finally the rest of his head came out. Then I was reaching for him and they held the oxygen up to his face and within moments he began to cry and immediately began to pink up. They helped me up on to the bed, with Mark and behind me, and put Thomas up to my chest. He cried for a few minutes, as if to say “What just happened here?” and then began to look around. He was born at 3:30 PM, after just half an hour of pushing. He was awake and alert for the next couple of hours. We stared in disbelief and wonder, held him close. I was hardly aware when they cut the cord and when the placenta came without problem. Ina May checked and found I had a small tear, and she gave me three small stitches. Eventually Carol weighed and measured him and Ina May put on his first diaper and gown. The midwives left us alone and we called family and friends to share the news. Mark made us dinner, Carol came to check on us one more time, and we settled in for the night. We slept, but not deeply, so high from the experience, waking often to look at Thomas in amazement. He’s really here.