Charli's Journey to First Time Mum Breech Vaginal Birth

I’m Charli, I’m a midwife and this is the story of the birth of my first baby after a long journey trying for a baby and then having IVF.

I would like to share my experience because even though I’ve been a midwife for many years now and know lots about pregnancy and birth I learnt so much from my experiences in my own pregnancy in decision making and how difficult it can be when your plans change. I feel I overcame many obstacles and would love to help others in a similar situation

I had a good idea what I would like for my own labour and birth, long before I was pregnant, my preferences were

1. To have a spontaneous labour, I wouldn’t of ruled out induction completely but there were few indications in my mind that would of led to me choosing an induction

2. I was planning to have my baby at home with the team I work in looking after me

3. I wanted to try all the coping mechanisms that being at home had to offer including use of my own space, bath, my own bed, TENS, Yuula Acupressure comb, Hypnobirthing breathing techniques, my birthing playlist, the Birthing pool and the Gas and air because I LOVE that stuff

4. A physiological third stage- I wanted my baby to have all of her blood from the cord and to only have the cord clamped and cut after the placenta had been born

I had an uncomplicated pregnancy and really enjoyed being pregnant, I was one of the lucky ones who just loved it and felt really well and loved every milestone of pregnancy.

My challenges came later in pregnancy

Curve ball 1. My midwife measured me and the plot looked as though there was ?reduced growth at 34 weeks. My initial preference was to only be measured by the midwife and not have growth scans due to them only estimating a baby’s weight within 10-15% of what the baby would actually end up being (and 5% of the time the weight wouldn’t even be within this 30% range!) However, baby plotting under the 10th centile after previously plotting on the 90th centile changed my mind on this. I wanted to have a scan with the midwife sonographer (I always send the women I look after to her and think she’s great) which I did and my baby had predicted normal growth and normal dopplers

Curve ball 2. My baby was in breech position at 34 weeks, I did everything I could to move her as I knew being breech would mean I would choose to change my birthing plans massively. Nothing worked and I had to come to terms with this, which took some time!

Over the coming weeks we did spinning babies, moxibustion, chiropractor, Accupuncture, hypnotherapy, swimming, yoga, float. You name it I tried it, we then had 2 failed ECVs before accepting that Miss Kerr wasn’t going to move. This took some time to come to terms with!

I then had big decisions to make about how I wanted to give birth, the recommendation was to have a CS. However I knew that with an attendant skilled in breech birth present, vaginal breech was a valid option and something I wanted to explore.

I found it really tricky to decide whether I wanted a planned CS or a vaginal breech. I knew the research, the options, yet was really struggling with knowing what I felt was best for me and my baby.

I’d attended Shawn walkers physiological breech birth study day a year ago and felt really excited by it at the time. Shawn told us about how they were developing teams at different hospitals across the UK that were skilled in providing labour care and better choice to women with babies in breech position. Now it was time to decide if this was something I wanted to try for myself.

It was a really tough few weeks of going back and fourth, struggling with what I felt was right for me and my baby. At 38 weeks I managed to have contact with Shawn Walker (the lead in optibreech). I didn’t realise until this point that I could travel to an optibreech site to give birth. I was thinking my options were CS or vaginal breech at my local trust which does not have optibreech in place. Shawn showed me all the statistics for the trial and if I’d like to attempt a vaginal breech I could be cared for at Queen Charlottes Hospital in Chelsea where they have 4 experienced optibreech practitioners who would be on call for my birth.

The following day Gemma (one of the optibreech midwives) called Matt and I and went through everything, I was sent the proformas they use for labour and birth with breech presentation. Gemma was open about the higher chance of an emergency CS and why this may happen. With optibreech care, if things aren’t going perfectly to plan an emergency CS would be recommended in labour. So I knew my chance of emergency CS was a lot higher and was preparing myself for this. Optibreech care felt really well thought out and that the safety of my baby would be paramount.

Both Matt and I felt happy and excited about this and started making plans for labour and travelling to London when things kicked off. The car was packed with my notes in and everything we could possibly need. We decided we would only drive to London if it felt safe, not at rush hour etc!

Prior to this I had booked a CS for 40 weeks, thinking that if I laboured before I would have a vaginal breech at my local trust. However now I was under optibreech I felt more confident to cancel this CS and move it to 41 weeks (where my baby was estimated at a size where I felt it was safer to then go for CS rather than vaginal breech).

I found changing my date really difficult, I knew this meant changing it to a week where there were doctors strikes and that this wouldn’t be ideal for the hospital and the maternity system. I encourage women all the time that it’s about their birth and how they feel, not about fitting into the system and making things easier for the hospital but taking this advice myself was really difficult. These were my colleagues and I didn’t want to make their lives any harder, but I had to tell myself that in a few months time the system wouldn’t care how or when I gave birth. But that these were decisions I would have to live with forever.

So despite finding it challenging, I changed my CS date and I’m SO pleased I did. I finally had a plan!  I had all 4 of the optibreech professionals on WhatsApp and knew who was on call when. The team included 3 midwives and one consultant obstetrician.

At T+4 Matt had finished work and we spent the day together and went out for lunch, I felt pressure in my lower back and had many trips to the toilet and wondered if it could be signs of change coming. That night I went to bed at 10 and woke up to feeling my waters had gone at midnight.

I rang the optibreech midwife Claire, she was coordinating the delivery suite that night and said to head in and she would organise the pool room for me to settle in and get some sleep before labour starts.

The car was packed so we headed straight to London, early tightenings started at 1am and we got there around 3. The drive there was smooth and plain sailing. When we arrived they checked me and baby over then settled me down into the pool room to establish.

Claire was finishing her shift at 7 but reassured me that she would be sleeping in a room in the hospital and would be back with me as soon as needed. In the meantime I had another midwife looking after me (Natalie).

I spent the morning having irregular contractions using the Freya app. At 9 I felt them ramp up and I was then needing to stand rather than breathing through laying on my side. I started using the TENS machine and the acupressure comb and Matt massaged my lower back throughout each contraction whilst encouraging me to sip lucosade and eat jelly babies

At 11 o’clock I noticed my waters had changed from clear to light meconium, which became significant ‘toothpaste meconium’ by 12 o clock. At this point i was put on the CTG and accepted a VE, I was 1cm. This was a little demoralising but as my contractions were still irregular I knew this was really normal and tried to put it at the back of my mind.

I carried on and felt a big shift in how the contractions were feeling at 2pm, I felt I had to stand up and lean over the bed going on my tip toes during each contraction. I made Matt write down the time to remember that’s when I was established. Midwife brain was still partly on clearly 🤣

At 2.30pm I had a wobble and felt really tempted to bail and ask for a CS, but had a stern word with myself and thought let’s just try the gas and air first. I thought worst case I’m not actually established like I think I am and I can ask for a CS if I’m still 1cm at 4pm.

I really wanted to get in the pool too, the midwife said that the doctors weren’t keen for me to get in due to being breech with meconium but I was determined and asked her to challenge it/ ask Claire as we had made a plan in my pregnancy that I could use the pool and get out for pushing. As she walked out of the room I said ‘and if they say no ask them why they’re so scared of a big bloody bath’

Claire apparently came and asked which doctors had a problem with her plan, to which she got radio silence. I feel very lucky I was advocated for so strongly by Claire even though she was between two night shifts she still made sure I was ok and had everything I needed at each point.

So we were back on to get in the pool if I was ‘established’ at the 4 o clock VE. I asked the pool to be filled ready for 4 as I couldn’t bare the thought of waiting till 4 before even starting to fill it! It got to half 3 and the pool was only half full so Matt started filling it for me, I think he was nervous what I’d be like if I couldn’t get straight in after the examination at 4🤣

Claire came at 4pm to do the examination and I was 6cm, I was SO relieved that I could get in the pool and jumped straight in. Matt put my birthing playlist on and the whole atmosphere in the room changed. Gemma, another one of the optibreech midwives arrived after finishing a study day and took over from Natalie, with Claire popping in and out throughout.

The relief from the water was AMAZING, it really reset me and made me feel like I could do it and that I was in control. The next few hours I enjoyed the water and the music whilst using the gas through the contractions. My whole body relaxed into it and I told myself that I could do this.

Then transition came, after supporting so many women through transition I was interested to see if I would experience it myself. I did and recognised those feelings of ‘I can’t do it’ and couldn’t help but think ‘oh god I’m transitional, they’re going to tell me I can do it and I can’t!!’ The midwives reassured me and talked me through and I just kept thinking ‘ohhhh bullshit I can’t I can’t 🤣’

At this point the noises I was making changed, I stopped wanting the gas and air and started to bear down.

After a while, Claire and Gemma got me out of the pool and said about pushing on all fours on the bed, which I did, but it just felt really strange and all in my lower back and I couldn’t really feel where to push, they reassured me that it was really normal for a breech as you don’t have that same pressure you get with a head. But I had started to lose it a bit, they kept me going and got me standing at the side of the bed and squatting and pushing, that felt better and like I was moving baby more. Some time went past and they asked to examine me to double check I was fully dilated which I agreed to, I was 9cm but baby was coming easily beyond that little bit of cervix and Claire felt it was safe to continue pushing.

After pushing for 1 hour I was exhausted, felt I wasn’t really getting anywhere and was getting scared, my contractions were going off I think due to being scared and the adrenaline. Claire was guiding me pushing with her fingers which was really painful, I felt like I was in a war zone and started saying she wasn’t coming and that it wasn’t going to happen. Claire at this point said she’s really close, let’s give it 10 more minutes and if she’s not here by then we may need to decide she’s not coming this way.

I thought ok 10 minutes more, I can do that and then either way she will be here.

I gave it EVERYTHING I had and I could hear the midwives getting excited. I knew what that meant, she was coming. I was pushing on my back, the only place I could feel what I was doing. With the plan to turn to all fours when her bottom was visible. Which is what we did, but as soon as I turned onto all fours I couldn’t push again! So I turned back to being on my back and they lowered the bottom part of the bed to help her have gravity that way. They asked if they could give me an episiotomy to help aid her being born which I consented to.

I continued pushing, my contractions had nearly all stopped at this point so was just pushing when I felt able to. I was waiting for them to say she was Rumping (birth of the pelvis) as I knew at this point with optibreech they aim to get baby fully out within 7 minutes and I knew at this point I would be pushing regardless of whether there was a contraction until she was born which is also part of the new optibreech guidance/ protocols.

I heard them say Rumping and again just WENT FOR IT, pushed so hard. Next thing I knew I felt a hand strongly do suprapubic  pressure in one big strong movement and I felt her head go from inside my pelvis to being born within seconds. She was here, 3 minutes from rumping and I could see she was absolutely perfect and pink and ready to give out a big cry

The midwives rubbed her back and handed her straight to me, the most surreal incredible moment. We had done it, me and my baby girl a powerful team together. It was an incredible experience, the optibreech team made me feel so safe as everything was monitored closely to ensure my little girl remained safe in the process whilst giving us both the chance to benefit from a normal birth.

Our fourth trimester has been a dream so far and I put this down to having a spontaneous unmedicated labour and birth, the benefits we’ve both experienced from having this care is incredible and I really hope more women get told about their options around breech presentation in late pregnancy. A vaginal breech won’t be right for everyone but if you feel it might be right for you then you have an incredible opti breech team at Queen Charlottes that you can access for more information

Also a massive thank you to the incredible Jenny B for taking care of me in pregnancy and in the postnatal period and the rest of Juniper team who have supported me and are just the best team to be a part of. I’ll miss you during my Mat leave ♥️