Remy Ocean born 20 May 2012

“Closer to my heart,” by Leah Sandretzky of Heartbeat Studio

The baby was called Ocean from as early as I can remember. The first trimester was coloured by nausea and extreme tiredness. I knew I wanted a homebirth (Hypnobirthing) and contacted a highly experienced and esteemed midwife who agreed to attend me. I booked in at my local tertiary hospital as back-up in the event of transfer in labour, and also to have easy access to blood tests and ultrasound should I require it. The second trimester was filled with energy and joy as I found myself moving into my body with yoga and swimming – even meditation became easier as I enjoyed the effects of the endorphins.  The third trimester was focussed squarely on the position of the baby who was happily transverse (sideways) and then breech (bottom first).

I tried visualisation, artwork, talking to the baby, upside down tilting, crawling off couches, acupuncture and moxibustion, Webster chiropractic technique, cranio-sacral therapy, and emotional freedom technique. When we got desperate we used a combination of these all at once – hanging upside down, while getting moxibustion from my partner, while both visualising the baby turning, while tapping on my tummy (wish we got that on video!).  When all these complementary methods had failed, I had an experience of deeply surrendering to giving birth to a breech baby and feeling absolutely confident in my ability to do so. The next morning I saw the midwife at 36 weeks and the baby had turned over night to head down and fixed in the pelvis (engaged). The power of surrender!

Suddenly I felt I could focus on preparation for homebirth, so I gathered together a list of everything I might need or desire and began to decorate the lounge room with rainbow jute covered fairy lights, birthing images, birthing artwork, and set up the birth pool surrounded by colourful cushions and infused with the scent of geranium oil. I had a Blessingway (baby shower) with female friends and family where we threaded a birthing necklace and painted prayer flags for labour with one word blessings like ‘open’, ‘breathe’, ‘strength’, ‘let go’.

At the 39 week visit the baby was again found to be breech. Both Hypnobirthing midwives said they lacked confidence in supporting a breech birth at home, particularly in the current political climate where homebirth midwives were being targeted (and potentially de-registered) for attending ‘high risk’ homebirth. I felt abandoned, scared and angry.

The next day I made an appointment at the antenatal clinic. The baby was confirmed frank breech (with extended legs), spine to the left and the front (LSA), and breech not fixed in the pelvis. I agreed to have an external cephalic version (ECV) that day which is about 70% effective at turning babies to head down. Despite several attempts by an experienced practitioner the baby’s bottom just would not shift. I came home a sobbed at the prospect of having a caesarean section. I couldn’t face the prospect of more frantic alternative therapies and felt that breech birth was the right way for me and my baby as s/he was so clearly showing me.

I made a plan to set up support for a “calm, upright, vaginal breech birth” at my local hospital with the assistance of an experienced public consultant and two experienced birth suite midwives. I met with the consultant who was happy to take me on (and be on call for my birth) as long as I agreed to have pelvimetry (to assess the internal size of my pelvis) and as long as I “didn’t want anything weird”. I had pelvimetry the following day, not realising until I was in the room that I was subjecting my baby to x-ray, but I felt powerless to say no and went ahead, talking to the baby as we went and feeling very guilty. I wrote a birth plan which included that the birth would be upright (squat, stand, birth stool) and that there would be no manoeuvres to deliver the baby without a clinical indication. I sent this plan to the consultant and the midwives who had agreed to be on-call in birth suite. The consultant phoned me almost immediately to say that he had an issue with both those preferences. He explained that he gets “girls to get into a comfortable position in stirrups” and does a “gentle forceps to the after-coming head”. When I clarified that he used forceps, even when the birth was progressing spontaneously, he said “that’s how I’ve been doing breech deliveries since 1974 – I know what you want but I’m not the doctor to provide it for you.” I got off the phone and again sobbed, yet another plan torn to shreds.

I knew a doctor in Sydney, Dr Andrew Bisits, who I had worked with briefly as a midwifery student, and who specialised in supporting upright breech birth. He agreed to take me on and within a few hours we were packed and on the road from Brisbane to Sydney, two days before my due date. The next afternoon we had an appointment with Dr Bisits and two midwifery group practice midwives (one who was a colleague I knew well). He outlined his parameters for safe breech birth: frank or complete breech, less than 4kg, no other risk factors, spontaneous onset of labour, adequate progress of labour in 1st stage (1cm an hour), and 2nd stage (pushing the baby out) within 1 hour! We discussed these and my birth plan. I felt respected, heard, safe and supported – deep exhale!

We initially stayed in Coogee, then Bondi, and then as the baby really went overdue we ended up in an apartment in Clovelly overlooking the ocean (full-circle). Each day we walked along the cliff top path, swam in the ocean, and spent time together connecting in preparation for the journey of birth and parenthood. The baby really gave us this gift of time together by going overdue.

At 40 weeks plus 10 days my clear waters broke on the apartment floor. I went to the hospital the next morning for a routine ultrasound for postdates (all normal except for no fluid!), a swab from GBS (negative) and a routine CTG (normal). I agreed to come in daily for assessment but wanted to wait at least 96 hours before induction of labour, unless there was a reason individual to me and my baby. Each afternoon I had acupuncture, did nipple stimulation, had plenty of orgasms, walked sideways and ran up and down stairs, and massaged clary sage on my belly.

At 40 weeks plus 13 days I woke around dawn surprised and frustrated that I had not gone into labour.  I sat quietly on the balcony taking in the dawn and talking to Ocean about his upcoming birth – I had a feeling today was the day. When my partner woke we went for a walk along the coast line to Bronte beach. I had not felt any baby movements all morning and started to feel panic rising. Once at the café I felt a few very mild movements and was only partially reassured. I was keen to get checked out by the midwife. We arrived at the hospital mid-morning. The doctor expressed concerns about the baby’s well-being, including the increasing risk of stillbirth, which resonated with my own concerns that morning. He gave 3 options: elective caesarean, induction that day, induction the following day at 42 weeks. If we agreed to induction, he gave me a parameter of just 4 hours to go into labour with the use of Syntocinon (an artificial drug form of the labour hormone). I really did not want Syntocinon because of the increased risks of an intervention-filled birth and the interference with the hormones of love, bonding and attachment for bot
h me and the baby. My partner and I took some time together to discuss the options and we phoned our Hypnobirthing midwife to seek her advice. She didn’t push me in any direction but said induction was a reasonable option at this stage. More importantly she said if we decided to have an induction, then I needed to commit to it 100% in my mind, to forget about the clock, and go inwards into the space of labour.

At 12.00 we returned home to pack the apartment (as we were due to check out the following morning), had a rushed lunch and quickly made a chocolate ganache and mixed berry birthday cake for Ocean which we had intended to make whilst I was in labour.

At 14.00 on the way back to the hospital I told my partner it was now quite possible that I would have a caesarean, and that if that happened and I was unable to have skin-to-skin with the baby then I wanted her to do so, and to protect the baby against any routine interventions (like weights, measures, Vitamin K) until I had breastfed him/her. I had a little cry as I was talking this through but it too felt like surrender to the prospect of caesarean which enabled me to let any fear of caesarean go and focus on having the normal birth I wanted. My partner and I had both learnt and practised Hypnobirthing (breathing, relaxation, positive visualisation techniques) to use in labour. Our plan was to begin these techniques as soon as the induction commenced, to move into the right space physiologically and mentally, rather than staying in the everyday mind of conversation waiting for labour to start.

At 14.30 when we arrived the midwives had decorated the birth suite beautifully and my partner finished the space with my birthing prayer flags, my personal drawings of positive breech birth, some chill-out music and aromatherapy. I was examined and my cervix was found to be 1cm dilated and stretchy, but the baby’s bottom was still fairly high in the pelvis (which may be part of why I didn’t go into labour spontaneously).

At 15.30 the Syntocinon drip started. I put on my headphones and listened to positive affirmations while my partner gave me an endorphin massage, and I felt myself drift into deep relaxation. I had agreed to CTG (fetal heart monitoring) for 15 minutes every hour rather than continuously which enabled me freedom of movement. I could feel contractions starting to come regularly, the sensation in my lower belly was quite pleasurable as I visualised the cervix opening with each contraction.

By 18.00 I was having contractions every 3 minutes but was totally relaxed and using long slow breathes with each. This confused the midwife who could palpate (feel) and see (on the CTG) that the contractions were regular but my behaviour did not match up.

At 20.30 the midwife told us to go for a walk to ‘get things going’ as she still didn’t believe I was in good labour. We walked to the other end of the birthing floor, stopping every few minutes to hang off my partner during a contraction. Suddenly I felt a gush of pink fluid and a sensation of heaviness as the baby dropped deeply into my pelvis. We made our way quickly back to birth suite. I remember saying to my partner that now this was starting to feel intense. We put on world music to dance to as I felt the need to rock, swing and sway my body with each contraction. Soon the power of the contractions brought me to my knees (literally) and I burst into tears ‘it’s too much, I can’t do it’. I wondered if this was transition – I hope it was.

It was 22.00 and the midwife examined me again, this time I was 8cm dilated with the baby’s bottom at the top of my vagina, I had made awesome progress. This was a turning point in the labour (transition). I stripped off all my clothes including my birthing necklace and started making intense sounds as I moved my body exactly as I felt I needed to move. The contractions were now one on top of the other (too close together because of the Syntocinon), and very intense. As soon as I leaned forward to rest on a bean bag, another would come and I would throw the bean bag out of the way. I felt at this point in the labour that I understood why women ask for epidural. I was blessed to have a support team who absolutely supported me to be, sound, feel and move exactly as I needed to – without holding back, without self-consciousness. I remember my mother quietly in the corner until this point, suddenly standing up and saying ‘YES, this is it, this is labour, you’re doing it!’ This gave me confidence that how I was ‘doing labour’ was okay, even though I had changed from almost meditating to making a lot of sound. I also asked myself what I would do if I felt this during my homebirth – would I transfer to hospital for an epidural? No, I would just get through it, and this knowledge helped me through without drugs. It was not painful but it was overwhelming.

About 23.00 I vomited copiously all the snacks and raspberry leaf tea I’d been drinking, it felt like such a strong release and relief. At this point the midwife whispered to me ‘that’s the last of your cervix gone’ and she was right. Soon after that I felt the anal sensations of second stage (pushing) as the baby began to really descend and stretch me. I also had pain above my pubic bone which was a full bladder so I went to sit on the toilet for a few contractions, which only intensified the pressure. I remember thinking I could ask the doctor for local anaesthetic and an episiotomy to take this sensation away! And as soon as I’d thought it, I could let it go again and carry on, just knowing I had an ‘out’ if I needed one (no matter how ridiculous it was). I felt claustrophobic in the bathroom, so returned to the main room and sat on the birth stool.

The lights were very dim and the midwife and the doctor both knelt on either side of me. Everyone was respectfully quiet. I worked with my breath and my body with each contraction and felt the baby descend gradually and start to stretch the perineum. I had no idea where I was up to, when the midwife invited me to look in the mirror, and I could see the baby’s whole torso had been born. This gave me the impetus to keep going. Next I felt the baby’s legs (which had been extended along the body) flick out and the shoulders corkscrew out and the arms release. When the baby’s head did not move with the next push, the doctor did a simple manoeuvre to flex the head and the baby was born immediately onto the mat in front of me at 00.07 (after 6 hours of labour).

The doctor milked the cord to deliver as much fetal blood as possible to the baby, before cutting it and giving me Syntocinon by injection to manage the moderate haemorrhage that had begun (which is not uncommon following in induced labour). The baby came up to me skin-to-skin and as I talked to him and blew on his little face he transformed from blue to pink within seconds. It was magic. He was so alert that he breastfed instinctively, attaching himself, and having a leisurely breastfeed for about 2 hours on and off. I had only sustained labial grazes which were repaired by the midwife.

After the midwives left, we ate birthday cake and adored him for hours as he slept in bed with me ” I was too high to sleep. The confidence and ecstasy I felt during and after his birth has supported me in my new life as a confident and loving mother. I feel so grateful that we were able to have the best start by achieving a natural breech birth without drugs.

Jyai and Kelly, Brisbane

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