When a baby turns breech in The Netherlands you are faced with a choice. A planned cesarean or a vaginal birth. There are many different opinions and disputed evidence on what the safest option actually is. Is breech just another form of normal or is it in fact a reason to do major abdominal surgery?
Theodor and Janet were hoping for a natural birth before their baby turned breech. After weighing up the pro’s and con’s and trying everything they could to turn the little one they decided there was no reason why they should not try to birth their breech baby vaginally. The Gynecologists in the hospital were agreed that if anyone could birth a breech baby vaginally, it was this Mama. She knew how to relax and had trust in her baby and her body. The birth would have to be in the hospital under the care of a Gynecologist, as is the protocol in The Netherlands, and not in the birthing center with their midwife as they were originally planning. In the weeks leading up to the birth there were three unsuccessful try’s to turn the baby head down.
Theodor and Janet came to terms with their little one being “stuit” which in dutch means both breech and naughty! The waiting began. The second day after her estimated due date the contractions started at 2.30 in the morning. They were not painful but gave enough discomfort to keep Janet up and moving. Her labour progressed very well and at 8am she already had 4cm dilation.I arrived at the hospital at 10am. Janet was in bed, smiling and breathing through the contractions and after catching up a bit she got out of bed to allow gravity do its work. Around 11.30am the labour seemed to increase in intensity. A little while later an internal examination showed that the baby was staying high in the pelvis and not descending at all even though the dilation was progressing well. It was too risky to break the membranes, to help things along, as the baby could then drop into the pelvis and the risk of the umbilical chord getting in the way and the baby’s life supply being compromised was too high. The Gynecologist was patient and felt good about giving more time for progress and we didn’t see her again till 3pm.
During that time we tried some rebozo sifting to help the baby come down a bit and to increase the contractions. The contractions got heavier and Janet swayed, circling her hips and breathing through them while standing at the bed side. She was amazing, following her body’s cues and giving her baby all the room to find her way out as she needed! There was a lot of laughter in between contractions and the atmosphere was relaxed, the love and respect these two shared was evident and a joy to witness.
Everything was looking good. The contractions were nice and strong, the baby was doing well, the cervix was soft but the baby was staying high. From 12-3pm the dilation stayed at 5cm and there was little change in the baby’s position.
It seemed that maybe the baby knew something we didn’t. We all couldn’t help but wonder if the natural process was trying to tell us something. The Gynecologist said so and went to discuss with her colleagues. At 3.30pm a unanimous decision was made to have a cesarean section. Even though Jan believed deep down this was the right decision it wasn’t without some tears of disappointment. This was not the beginning she had hoped to give her baby.
She asked if I could attend to make photo’s, which is very unusual, and the Gynecologist said she would ask the“nice” anesthesiologist. I was excited. Could this be my second time in the operating room to witness a baby coming into the world by cesarean? As soon as I knew it was a possibility I started trying to take my wedding ring off which has become too small over the years. I grabbed some soap and eventually pried it off… this was not going to be the reason I would not be allowed in the operating room. It almost was, the first time I got invited into the operating room. The Gynecologist came back and said I could go with. I was happy! Although sad this Mama wasn’t going to give birth naturally as she had hoped to, I somehow felt it was the right decision and I was going to do all I could to document this well for her.
Janet’s tears kept coming as we walked down through the corridors on what was a quiet Ascension Sunday weekend. I knew how quick this process was and knew that very shortly she would be holding her little one and her tears of anxiety and disappointment would be turned into tears of joy. It was intense for Theodor too. He stayed right by her side and they continued supporting each other til the operating room doors.
Theodor and I followed the nurse and robed up in the blue outfits and waited at the operating room door. Theodor went in first to sit at Janet’s head and when the operating team were ready the nurse told me I could go and stand at the foot end to take photo’s.
The incision was made the Gynecologist reached in and the baby was born into the world bottom first as she would have been had she been born vaginally. It was 4:23 pm on June 1st 2014. She was quite a size and looked perfectly healthy. The Gynecologist gently wiped her face and held her up for a peak over the curtain. I was taken with the way the Gynecologist handled the baby, with a gentle respect and care.
She was handed straight to the nurse and was taken to her excited parents. For a long 3 minutes or so the baby was squished up against her Mama’s face receiving her first kisses. Tears of joy were flowing and this Mama and Papa were totally overwhelmed and happy.
The baby was taken to the little room next door to be checked over by the pediatrician. Her little body was typically staying in the breech baby stance with her legs reaching upwards to her face. I quickly took some pictures, and knowing that Janet was lying not far behind me missing these moments, I went back to her to show some photo’s on my camera screen.
It seemed like a long wait for her but as soon as the baby was declared to be fit and healthy she was quickly weighed and loosely wrapped up and taken to her Mama. I think it was about 10 minutes later. The baby was quickly tucked in skin to skin with her Mama. She was wrapped around her Mama’s neck like a scarf all 3.935kilo’s of her. Janet savoured every moment, her baby girls skin so warm and soft. Theodor wrapped his arms around them both. his girls!
“What’s her name?” the nurse asked. “Anna” they said in unison. They had been waiting so long to tell the name and this was the moment. There are many special moments at a birth but this is one that many don’t realize is so special. I love it! It is as if parents are telling a secret. Saying the name out loud for the first time, outside of the relationship, is a proud and triumphant moment. The name finally has a face and the face of their little one has a name. Anna! She was quiet and content, she hardly made a sound. As the operation was continuing this little family was bonding and getting to know each other during the first hour of little Anna’s life. All in the operating room!!
The atmosphere was relaxed and ‘gezellig!’ I was free to discretely move around and take photo’s of this new sweet family, of which I am very grateful. When the operation was finished we all took a moment to have a look at the placenta. It seemed that the umbilical chord was attached to the placenta via a long piece (about 25cm)of very fragile membrane with no jelly as protection. We could not see where it was attached as the membranes were already quite torn. It seemed this may have been the reason the baby somehow needed to stay in a breech position and why she was not descending during the birth. The Gynecologist had not seen anything like it before. It was clear to everyone that had the membranes been manually broken it could have been dangerous. This very fragile part of the umbilical chord, that was needed for nourishing the baby, could have been torn too. There was relief that we had not manipulated nature and a sense of awe that this baby and Janet’s body somehow had this wisdom.
After the operation was finished the baby went to the room next door to have skin on skin with Papa while Mama was moved to a different bed for transport to the recovery room.
The nurses came to peak at the baby. Theodor snuggled and shed a tear or two. When everyone was ready, she was put in the incubator for transport to the recovery room. Together we all walked down the corridor, baby constantly in Mama’s view.
Theodor and I went to the changing rooms to get back into our normal clothes. We were supposed to meet the rest by the lift but in our anticipation to get dressed quickly and not miss a thing neither of us had heard where we were supposed to go afterwards. After getting a little bit lost we eventually arrived at the recovery room where Mama was already breastfeeding little Anna who was latching on very well.
We got to stay in the recovery room all together and I took many more photo’s as the reality of the last hour continued to set in for this brand new family.
It was not how they had hoped to bring their baby into the world but wise little Anna somehow knew this was what she needed. The hospital staff were so sweet and respectful. This gentle cesarean or mother/baby friendly cesarean or family centered cesarean (whatever you wish to call it) was a huge contrast to a traditional cesarean. Mother and baby’s emotional and physical needs were more central and not just the obvious physical ones. The scientifically proven benefit of instant skin on skin bonding immediately after birth was respected and there was a better outcome for everyone involved. The father was present the whole time and didn’t have to leave and sit on another floor far away in the hospital for an hour worrying about his partner while feeling he should be happy with his new baby in his arms. A world of difference. Together they got to share this life experience without it being too fragmented.
Thank you to the Gynecologist and operating team at Amphia Ziekenhuis, Breda for respecting this Mama’s wishes and for allowing me to document this experience. May this form of cesarean section become more normal for Mama’s needing to birth in this way. There are additional aspects of a mother/baby friendly cesarean that were not utilized during this birth. For more information click here for Nederlands and here for English.
Lea ~ 20-06-2016 ~
I love my repeat clients. Especially sweet when the first hire was only for birth photography and the value of your presence during the birth meant so much that with the second baby they hire you for your doula support too.
This is one strong Mama! So much respect for her journey to parenthood.
Two photos of the two sisters, one born by c-section and one VBAC
Read big sister Anna’s, birth story here. https://www.doulasophie.nl/?s=anna
This week I was thrilled to spend a day listening to Ina May Gaskin tell stories. What a gentle and fierce woman. What a storyteller and what humour!!
There were many, many gems and nuggets of wisdom in her stories and I have been pondering a few things particularly.
First the idea of helping a woman feel grateful during labour. I quote Ina May: “A whining woman does not give birth easily, we need to help women feel gratefulness in labour. Gratefulness produces oxytocin”
Going into labour with an attitude of gratitude will help a woman to labour well. Wow I love that concept!! I have been thinking about gratitude a lot this summer. I get that and it makes so much sense to me. A woman’s mindset is different when she is in thankful mode, she stays positive and emotionally open and her body opens. “A woman who lives in a state of ‘poor old me’ struggles and does not labour well” said Ina May. This is usually something that someone is pre-disposed to right? This kind of woman typically goes through life whining and feeling sorry for herself, it is not usually something that just started during pregnancy. Can we help change that negativity by simple gratefulness? Even positive women struggle when they go into labour and find it hard to stay positive and grateful.
So I have been thinking about how we as birth workers can help women move into a space that is more positive for labour and birth? Gratitude is a great life skill after all.
I discovered Brené Brown this summer and she talks about how practicing gratitude in moments of vulnerability can help to shift your perspective. If ever there was a moment in your life that is vulnerable and when you feel emotionally wide open it is when you are in labour. Brown talks about the practice of naming what you are thankful for when you feel depression or anxiety creep in and when you feel you are going to your dark space. The darkness seems to dissipate in the light of the gratitude. It works! Before we go to sleep my husband and I have started naming 5 things we are thankful for that happened that day. What starts to happen, when you know that exercise is coming, is that during the day you start to see things you are grateful for. It starts to change how you look at life.
Maybe we can encourage our pregnant mama’s to keep a gratitude journal through pregnancy. Name 5 things every day you are thankful for. I am pretty sure it will revolutionize how they experience their pregnancy and how they go into labour and birth. If we can help women focus on being grateful during labour it will increase the production of oxytocin and dissipate adrenaline helping the labour process. I don’t know about you but I am going to start a little experiment with my present clients to see how this works in practice.
Another theme that came out in Ina May’s story telling was how we need to help woman laugh during labour. “Laughing produces oxytocin and also helps the process” she said. Ina May told many stories of how she as a midwife observed that when the birthing process would stall or women were stressed she would somehow make them laugh and the process would continue. I so recognize this.
I have been noticing in my doula work just how powerful laughter is. It relaxes and opens you up. Knowing my client a little bit more personally (than the other care providers) somehow gives me a unique way to speak into the situation with humour. Laughter is the best medicine and lifts the anxiety, lifts the stress and makes way for oxytocin to do its work for a better birthing experience. As a doula I have a unique role because I stand outside the medical responsibility for the birth. I stand outside of the relationship the couple have and am not part of the dance they may have in how they communicate around stress. Those two things are invaluable. That sometimes allows me to reach the birthing woman when the partner can’t or to bring the couple together in laughter so they instantly relax and feel a connection with each other again.
This all sounds a bit pre-determined and makes me sound as if I am a very funny person. I can assure you it isn’t and I am not! It is a natural and gentle process that happens because you have gotten to know your clients a little. It is something I have been observing recently. The more births I support the more themes I see during birth that are similar. Ina May talked about laughter as if it was some kind of wonder drug. I like that. It really often is like the oil that keeps the whole process working well.
This reminds me of a quote by Anna Verwaal “A woman, as long as she lives, will remember how she was made to feel at her birth.” What a difference it would make if gratitude and laughter were an integral part of labour.
If we get to know our clients better, their fears, their hopes and dreams we can be more relevant to them during labour. We can’t speak to a fear we don’t know about and we can’t counter act negativity if we don’t know where it comes from. We are less likely to be able to make a meaningful joke with someone if we don’t know a little bit about what makes them tick.
So yes, lets get to know our clients, lets make them laugh, lets help women birth with gratitude and see what a difference it makes. Thank you Ina May, I love it!
At the end of the day we all brought a bead to share to make Ina May a necklace to remember us by (seen in the photo.) One woman had a blue and white bead and Ina May said quietly and kind of under her breath “Oh I love blue and white, food always looks so good on blue and white” And my heart did a little skip and I smiled with delight. My Grandma and my Mum always said that. I felt a little bit of nostalgia and was deeply grateful for a wonderful day with this wonderful wise and honest woman.