I receive the call from my lovely client at about 5pm. She has been contracting a bit over the last days and has had a show and possibly waters broken. When she rings me she is unsure if her of the frequency and duration of her contractions, she says “it feels like one long contraction” and I start to feel a bit concerned. A month earlier her baby went into the breech position for some unknown reason. This is not super normal at 36 weeks, but baby was turned using the Mexican rocking technique(Robozo) by our doctor Ortruid Linderman and my colleague Maria. Because of this and because she is unsure how often her contractions are coming as well as the distance I have to travel to get to her but more than this I feel she needs some support, I set off to her house. For this birth I am accompanied by one of our training Doulas who will prove to be a true blessing before it is all over.
I let my colleagues know I am on my way to my clients home and set off on the 45 min train Journey to her village. On arrival to her home my client looks very bright and fresh, I am nearly sure she is not in labour, but as I know her pretty well I know she is very emotionally contained and she could be cracking on with out us seeing it. We have a cup of tea and I lay my things out on the table. We chat for about 40 min as I observe her. Her contractions seem to occur every 5-7 min but she is easily distracted by caring for her husband, dogs and other animals in the house.
An hour and a half later I decide to to a vaginal exam. I know she had said she thought her waters had gone, but over the time we were with her her pad had remained very dry. She had been quit active as she has always has restless legs and can not sit still for more than 10 min. Taking her consistent movement into account and a still bone dry pad I feel it is safe to progress with a sterile VE just to obtain some vital info. As I mentioned, she is a very emotionally guarded woman and observation was telling me very little at this point.
My exam at around 8pm showed she was 3cm dilated and head was well applied. Still early days but I knew I needed to encourage her to really allow her contractions, which were now every 5 min, to do their work. After much talking and explaining to her and her husband I finally got her to find a space in the house which was safe and relaxing her for her. She found her bathroom to be the perfect place, so I suggested she take a lovely long bath, which she did. After two hours and many strong contractions now 3 min apart she decided to stay in the bathroom, although out of the bath. She was happy to sit in candle light with her tortoise who was hibernating at the time, but woke up to sit with her.
It was about 12:30 am by this point and I spoke with my colleague Maria, to let her know how we were doing. Once I mentioned the tortoise Maria sighed and said that this would be a long birth. She said she had found that if a woman chooses an animal to be beside her in birth, she will birth as this animal. Maria has loads of home birth experience and I consider her to be a very wise woman indeed, so when she says things like this I listen, even if they sound a bit weird. Maria is rarely wrong about these
things. After my chat with Maria I suggest to my clients husband and the Doula that we all get some sleep, mummy and baby were well and I felt she needed time to really labour. I slept in the room next to the bathroom so I could hear if she called out.
Around 5am I received a text from my client who did not want to disturb me by knocking on the bedroom door. She said she was lonely and wanted to see how she was progressing. We all met in the front room and had some tea. Her contractions were still 3min apart but much stronger as they took her attention and made her stand during each one. She even told her husband to be quite at one point, which was very unlike her. During this time her husband let us know that he had to go to work at 8am as there was no one to cover him. We all talked this through and mu client seemed fine with him leaving. I thought that perhaps with him gone things could really kick off as she was so very concerned about how he was dealing with her labour.
He left at 8am and I informed Maria, who told me that she still did not expect the labour to move much faster even with him gone. Yet again Maria was correct. As the morning wore on and the Doula made breakfast, walked the 3 dogs, fed the hamsters and guinea pigs my clients contractions intensified but stayed at 3-4 min apart. We spoke of her fears, of which she had none, tried feeding her and resting her to help build her energy for more powerful and effective contractions but nothing changed the pattern. At around 1pm I decided to do another VE. I had established that her waters had not gone on the first exam so felt that it was safe to do. I do not usually VE very much in my home births. I prefer to observe the mother and at times when it is present, the purple line. But this was not easily seen on my client and my observations told me very little. My exam revealed that she was now 4cm, but with a very rigid os and strangely enough I did not feel babies head at all when I entered. What I felt was a head at the front of her pelvis and nothing on the side but waters. She was very tight so I could not get behind to read suture lines. I was a bit freaked to say the least. I had never done an exam that felt like that. I wrote my findings down and rang Maria after explaining my findings to my client and the Doula. I was honest about what I did not understand and what I did. She was a bit disappointed to have only progressed 1cm but happy to continue at home.
I spoke with Maria who had no advice about this exam, just to see if contractions would get babies head back into position. So this is what we did, but in the back of my mind I knew this was something I was really missing. But as mummy and baby were fine we went on. Maria came to support me later that afternoon. My clients husband returned with news he would be gone the whole next day and she contracted through the night. I kept a very close eye on mum and fetal heart, she seemed almost as fresh as when we arrived and so it went until the early afternoon the flowing day when things began to change.
Sometime around 9 am the following day my clients contractions began to space out to about 7-10 min, but they were much long lasting. At about 11am I decided to do an exam but Maria said to wait until the afternoon. My client had managed to rest with these spaced contractions and hopefully they would now pick up with her new energy. This time Maria was not right. The contractions never picked up and after another exam at 1pm exactly 24 hours after the last and there was no change at all with that head still in a crazy position, my client slowly started to experience awful pain after each contraction. I knew something was very wrong and then it came to me. I had heard this word and studied this but had never felt it before it was an, asynclitic head. Once I had the word in my noggin I went on line on my phone and found all I needed to know on a site called Spinning Babies. I actually read my vaginal exam there on the site. Everything I felt was there and I knew I needed help. Maria had gone to see another client so I rang our doctor ant told her everything. She knew how things were going and had prescribed homeopathy the day before but now she was as clear as I was. She told me to try to tip the babies head out of the malpositon if I could because we were not going to progress any further with out this change.
After my conversation with her Maria came back and I explained everything to her and our client. I showed then a picture of babies malposition and explained why she was experiencing this horrid after contraction pain. I discussed with Maria, Ortruids suggestion and with Maria’s support I decided to try a couple of less intrusive methods first, like the ‘pancake method’ explained on Spinning babies and Ronnie Falco. This was to try to relax and loosen the muscles holding the pelvis to allow baby space to move his head. We tried this and my client was given some relief from the pains but baby did not change head position. I decided against the internal manouver as it was something unfamiliar to me and to risky to preform at home and with out experience. It was no longer normal and for me home birth, at least in the western world, is about birthing within in the confounds of normality. I discussed this with my client and the decision was made together to go to hospital.
In Spain this decision is never taken lightly. Going to hospital carries very strong concerns here as the system is highly medicalized and very old fashioned. Dignity and respect of the birthing mother are not apart of the job and many women are bullied and forced into unnecessary procedures by doctors and subservient under educated midwives. The term undereducated is in reference to not understanding the basic physiology of normal birth. It is hard to believe but it is very true. In this case however we were amazed by the team who met us and continued to care for my client through out the following 18 hours she was in labour. Far from having a section forced on her, the midwives, nurses and doctors worked to keep her out of theaters and support her vaginal birth. This is even more remarkable when considering that baby was found to be not only asynclitic but in brow presentation and twisted in such a way that babies spine was not in line with his head.
I very skilled doctor delivered baby by maneuvers and forceps 10 hours after our arrival to hospital. My client had 3 epidurals as the strength of the pain, which was nerve based required several different sitings. She only gave in once and asked for a section and the doctors supported and encouraged her as they knew this was truly not her wish. She had told me she would feel a failure if she had a section which was not needed. At all times babies heart rate was strong and he delivered in good condition. Mummy and baby are home and well now after only two days or rather 1 day and a half in hospital. Baby will need many sessions with our craniosacral osteopath as will mummy but all is well. Amazingly he feeds well and except for a bit of extra jaundice, which was to be expected with his bruising, he is very well.
As for me, I was yet again amazed of the strength of women and baby. Although it took me some time to identify this malposition I have learned it and my fingers will not falter in this respect again. I have learned amazing lessons and feel total gratitude for the fortune we had that mummy and baby were well through out. I now also believe even more that breech is breech for a reason. I want to hone my home birth breech skills as do my colleagues, to offer this service to our mothers. I do believe this we babe was telling us from 36 weeks that he needed to come in a different way, but we did not listen. The story continues