I Was Able to Have a Breech Baby Vaginally!

by Jessica Reese, Guest Blogger

Baby Elias was a vaginal breech birth!

Summer 2018 after a short amount of trying we were pregnant with my second child.  Unfortunately, we found out at the 12 week ultrasound appointment that the pregnancy was due to a blighted ovum and I needed to have a D&C to clear the remaining tissue that did not pass on its own.  We were able to become pregnant on the first ovulation post D&C with our third child.  For the beginning of all of our pregnancies, I go to see Dr. Michael Podraza at St. Francis Women's Health and Fertility in Memphis, TN. Dr. Podraza will see patients as soon as they get a positive pregnancy test.  He is also a doctor trained in Naprotechnology, which means that he incorporates natural family planning (cycle charting) into his approach.  I see him because I have hypothyroidism and luteal phase deficiency, and he provides a different approach than most OB/GYNs or Endocrinologists.  Since, I have luteal phase deficiency, he prescribes progesterone injections up to 14 weeks to help maintain the pregnancy.

At 16 weeks, I was able to get a transfer appointment with Dr. Aguayo in Huntsville, AL.  Dr. Podraza had placed me on daily progesterone suppositories starting at 14 weeks because of a previous preterm birth at 35+3 weeks.  Upon transferring to Dr. Aguayo, she suggested switching from the suppositories to Makena (progestin in oil) for weeks 16-36.  During weeks 14-24, I had ultrasounds to check my cervical length to see if a cerclage was needed to prevent preterm labor.  Fortunately, my cervix remained long and closed.

Since, I had had a previous preterm baby without warning signs, this pregnancy I was cautious to get several checks for preterm labor whenever I had too many consistent contractions in an hour.  Upon one of these preterm checks, I received a positive fetal fibronectin test.  Since, there is a high false positive rate with the test Dr. Aguayo had me come into her office for an ultrasound to check my cervix.  This ultrasound show a low level of amniotic fluid (4 low pockets and a single acceptable pocket).  Due to the result of this ultrasound and preterm delivery history, Dr. Aguayo referred me to a Maternal Fetal Medicine specialist from Brookwood, Dr. Antonio Gonzalez-Ruiz  for a more extensive ultrasound.  I received weekly ultrasounds from Dr. Gonzalez-Ruiz's office, each showing my baby boy was happy and healthy, but my fluid level was staying within the low-normal range and my baby, since the beginning, was staying in a breech position.

I had an ultrasound at Dr. Gonzalez-Ruiz's office at 35 weeks, and we discussed with him regarding attempting an ECV.  He suggested that the ECV may not work due to the lower fluid levels, but it was a very low risk procedure.  He also encouraged us that when he was practicing in Ohio with 12 midwives, that he would let people like me who fit certain criteria attempt a vaginal breech birth if they desired.  He told us a good candidate for a breech birth in the hands of an experienced provider was not unnecessary risk.  After, speaking with Dr. Aguayo's office I learned that she only performs ECVs at 38 weeks or later and in conjunction with either induction or, if the ECV fails, performs a c-section.  Since, I was worried that I had had a previous fast, progressing labor and a preterm birth, I really wanted to attempt the ECV sooner to avoid being very far along with a breech baby and rushed into an emergency c-section.  I was definitely influenced by the research in this article:y/.

Upon asking for recommendations, I got a consultation with Dr. Joshua Johansson to attempt an ECV. He agreed to attempt the ECV and suggested using the epidural, since there was a lower chance of success with lower fluid levels.  At 36+5 weeks, Dr. Johansson attempted an ECV, unfortunately after 4 attempts the baby did not turn.  However, the baby tolerated the ECV well and his heart rate did not drop.  Dr. Johansson stated that sometimes he would offer people a second attempt, but in this case he felt it would not be worth the time.

Dr. Bootstaylor's criteria for a vaginal breech birth.

During this process, I had also tried spinning babies to help turn the baby.  I was seeing a Webster trained chiropractor, Dr. Misty Browning, to help create space for the baby to move.  Because I realized there was a decreasing chance the baby would turn before labor, I assumed I might have to have a c-section due limited options.

Since I was still very worried about having a fast labor with a breech baby, and not having any skilled OBs in the area, I was considering what I could do.  Upon the recommendation of Dr. Gonzalez, at 37 weeks I got a consultation with an experience breech provider and Maternal Fetal Medicine Specialist Dr. Brad Bootstaylor  at See Baby in Atlanta who told me I was a good candidate for a breech birth. He said he would be willing to accept me as a late transfer at 39 weeks if I was motivated for a breech birth. Interestingly enough, See Baby's motto is "Bring Birth Back."

At this point, I was still torn on the decision.  I had my 38 week appointment with Dr. Aguayo, and she discussed the c-section with us.  She also told us that I could be a good candidate for a vaginal breech birth, but she was unable to do it and there was no doctor in Huntsville that would do it.  She also said I would be a candidate for a VBAC for the next pregnancy, but that in all future pregnancies I would always be considered a VBAC.

Still weighing my decision I had an appointment with Dr. Gonzalez that Tuesday to discuss his view on the breech birth.  Monday night at 5:30 PM after I was home from work baby Elias kicked the amniotic sac and my water broke.  Since, with my daughter my water broke and labor did not begin until around 20 hours later I knew I would have time to drive to Atlanta for the birth.  My parents came and got our 2 year old and my husband and drove to Atlanta.

We called Dr. Bootstaylor's office and he called us back and stated I may not want to go into the hospital until I was further along in labor.  When we got to Atlanta we got a hotel in downtown Atlanta to rest and wait for labor to begin.  Much later in the evening I was having some regular contractions that I was working through in the shower.  Since the contractions were regular we decided to check into the hospital.  At that point I was 4 cm dilated and 80% effaced and station -2, since I had a fast labor previously I decided to stay in the hospital.  While I was at the hospital, my blood pressure was very erratic during monitoring.

Later that morning, Dr. Bootstaylor came in with a nurse midwife trainee to discuss my progress and care.  He was concerned that my blood pressure numbers were high and erratic and I was still 4 cm and 90% effaced and station -2. He explained that there were some decisions we needed to make.  Dr. Bootstaylor said if I stayed in the hospital with higher blood pressures and labor stalled, and already being a higher risk with a breech baby then it seems more likely to start discussing a c-section per hospital protocol.  Also, he said with breech it is not ideal to augment the labor with Pitocin, especially at this first labor stage.  He told that we do have the option of taking an AMA and leaving the hospital.  He said if I stayed in the hospital with erratic blood pressures, then they would want to monitor my blood pressures, and I wouldn't be able to have the freedom I would at home to rest, eat, and move around which are all things that help labor progress naturally.

Jessica and Elias with their birth team

We discussed our options with Hannah Ellis, our doula, and we decided that I would take the AMA and we would stay close to the hospital.  After we left the hospital we went and ate lunch; I got a large ribeye steak, and then I went and rested.  A little bit later I asked my husband Jarrod if he wanted to walk from our hotel for 20 minutes to the Ponce Street Market and get some gelato.  So we walked, and I got some gelato.  As I was eating my gelato, I began to feel some more contractions picking up, especially walking back to the Airbnb.  When I got back I laid down for 20 minutes, and then I felt the need to go to the bathroom.

I had two bouts of diarrhea, and I decided to get in the shower and start working through contractions and timing them.  While I was laboring in the shower I did a lot of hands and knees to manage the back labor.  My contractions remained 5 minutes apart and we notified Dr. Bootstaylor that the contractions had picked up and labor was moving smoothly.  Hannah  also noticed blood signs of change in cervical dilation.  My contractions continued to be 5 minutes apart and I was thinking my labor might last another 6-7 hours.  I could also talk quite a bit between contractions.  After quite a long contraction, I felt baby Elias make a big rotation to get in position.  Then instinctively with the next contraction I started squatting.  Hannah asked me if I was feeling the urge to bear down, and I said yes.  She said we need to go to the hospital now.

She called Dr. Bootstaylor, and I got in the back of our van and tried not to push on the way to the hospital.  As I got to the hospital, we pulled up to the valet parking and I walked as quickly as I could to the elevator to get up the stairs.  Elias' booty was hanging out before I was getting on the elevator.  I got to L&D and they got me into a room quickly and I got up on the bed in hands and knees.  Kim Holderfield, Dr. Bootstaylor's trainee was already there.  Since I came in so far along, there were several people in the room.  One nurse was able to get right by my ear and get me to focus and tune everyone out.  Dr. Bootstaylor arrived a little bit later.  The nurse helped me focus on pushing and making every push count by pushing past the contractions to get the head out quickly.

Elias Jude Reese was born on 5/14/19 at 8:06 EST with 4.5 of active labor 6 lbs 2 oz and 20" long.  Thanks to Dr. Brad Bootstaylor and midwifery student Kim Holderfield who did most of the delivery as he guided her.  Elias was healthy when he was born, and only needed some bulb syringe suction which is typical of breech babies.  Dr. Bootstaylor encouraged us to have delayed cord clamping.  I am very thankful to have the option and shared decision making and shared responsibility provided by the See Baby team.