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I have to admit that I did a birth this past week and the mother was two weeks over her due date. We did everything we could to get labor going - she was determined that if she didn't have her baby in two days, she was going to the hospital.

One of the things we discussed was breaking her water. She was a good 3-4cm, her cervix was very soft and baby was low in the pelvis. After a day of trying various things, she wanted to break water.

We broke water and it was clear. She started having contractions about eight hours later, with the help of some homeopathics.

Labor progressed quickly (three hours), then she was pushing and I had only checked her an hour earlier at her request (8cm with a very molded head - or so I thought!). Meconium - fresh, from-the-butt meconium appeared. I felt again and baby was breech.

Now, when I went in to break water, I felt a head. I know now that it was a tight bum. Baby was frank breech, with feet up by his head, so that's why we were getting feet over to the side. The head did not feel like a head. Baby was so low in her pelvis we were getting heart tones where we should have been getting it had the baby been head down. I never suspected baby was breech.

In hindsight, I am sorry we broke water, however, I know it would have been the first thing to happen in the hospital when she went in the next day. When I break water, I keep my fingers in there to control the head coming down and also to feel for position and to check for cord. I didn't feel anything that would have clued me in that this baby was breech.

(The outcome would have been the same because the mother did NOT want to do a breech birth at home, but if we had waited for labor to start or for the next day, we wouldn't have gotten the friendly docs at all!)

So, while I think it's really sad that the baby in the post didn't get more time to get in a better position, I feel like AROM is a big risk. I don't do it without a firm discussion of all the risks involved. It usually takes hours to decide because I really want mom to feel that it's best, not just something we half-ass do.

She asked for a cesarean section, and luckily, we had two of the friendliest docs in town come in to the hospital off call. They both are supportive of homebirth (and homebirths themselves) and they did the surgery (even after telling her she could have the baby vaginally!!). Still, I can't help but to wonder why I didn't see the breech coming (since breech babies and births has been a pet topic of mine since school). I feel like I wasn't supposed to see it - that for some reason, it happened. I also feel good that the mother initiated the process of intervention, instead of it being initiated from me. I was fine to wait - baby sounded great. I just knew she was serious about going to the hospital.

All in all, she ended up with a hospital birth. Isn't that what we were trying to "prevent"?

So, while some things can be felt before labor, sometimes there are good reasons why labor isn't kicking in and the number one reason is usually positioning. Baby needs time to get in a better position - usually the stronger BH contractions or the stop-start patterns at night that are so irritating are helping put baby in a better position.

It's so much better to trust the wisdom of the body and the baby.

I wonder, too, why this woman's butt wasn't in the air. That's the first thing - it would help get the baby off the cord better with the help of the nurse's hand. Did she have an epidural?

Sorry about the long story/saga. Guess it really cemented for me what I do - and how to balance a mother's desires and how she wants her birth to be with mine.
 
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