#198 | Midwife Jessy's Undisclosed Breech Home Birth

February 1, 2023

Jessy is a  Certified Professional Midwife (CPM) in the state of Utah where breech home birth is against state law.  In her second pregnancy, she made three attempts using gentle version techniques to turn her baby, yet her baby turned back to breech every time. Weighing out the risks of breech vaginal home birth versus cesarean, she opted for home birth but kept her baby's  breech position to herself and off-the-record. She only hinted to her midwife that her baby was being "stubborn." Jessy's intuition told her that forcing her baby to turn around was not the safest choice, which became evident as truth when her baby arrived with a short cord and a velamentous insertion. This inspiring story overcomes many obstacles including threatened early miscarriage, retained placenta, breech birth, a short cord and vaginal prolapse and demonstrates the ultimate power of a mother's intuition.

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We woke up from the nap. I was starting to have more intense contractions and I went to the bathroom and there was thick meconium coming out. But with it being a breech birth, the butt is first, the codium coming out is literally just coming straight out. It's not going up into the amniotic sac, and her cord was under 12 inches long. Like it was a super short cord with a small twist insertion. And all of it just kind of clicked in place. I was like, Oh my gosh, I realized in that moment after we were looking at this placenta, that that was the reason why she had to be born breech.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

So I'm Jessica Collins. I am a midwife in the state of Utah. And this is my birth story about my breech baby. We had our first little girl at a birthing center. Her birth was pretty great, unremarkable. Everything went smoothly. I did have three hours of pushing with an anterior lip. But she came out perfectly fine. And then about two well, she was about a year and a half when we started trying again. And just a brief background. My mom and dad couldn't get pregnant. So I wasn't an in vitro baby. So I always had that fear in the back of my mind that Oh, what if I'm not able to get pregnant? And so we tried for a little over a year, and I just applied for an infertility clinic when we got pregnant. So I took the test and two days later, I started bleeding. And I was like, oh, no, I lost the baby all of this. And I was in contact with my midwife. She was the one who trained me. So I really trusted her I really loved her way of doing midwifery. And I texted her like, Hey, I thought it was pregnant, but I start bleeding. And she's like, oh, yeah, you might be low on progesterone. I was like, Well, I wasn't low on both my first and she's like, Oh, it can happen. Any pregnancy is like, okay, so I told my sister I was pregnant, and she's a nurse. So she drew my blood and I was able to test my blood that way. And I for sure I was low on progesterone. So I got on that and the bleeding stopped. So that little pregnancy scare was over pretty quickly. And then with my first pregnancy, I'd found out we had had a ovarian cyst on my one of my fallopian tubes, and it was pretty big. But I had thought that it had burst when I was giving birth with her. But when we went to check to see if there was still a fetus after the progesterone scare, they saw that there was still that cyst there. And then of course, the little yolk sac with the heartbeat. So right around 10 weeks, I started getting this pain, like the ovarian cyst was bursting. And if you've ever had an ovarian cyst burst, it is not fun, whatsoever. So I was going through that pain, and I was like, okay, I can handle this totally fine, and it was just getting worse and worse and worse. I was like, I'm just gonna call my husband home. Um, I felt like the cyst burst. And then I woke up from a nap with more pain. And I was like, Okay, this is not following the normal cycle of how a variance is feels. So we ended up going to the hospital and being a midwife working specifically in out of hospital, I kind of put a guard up immediately whenever I go to hospital. So like they wanted me to undress into a hospital gown. I was like, No, I'm not changing. They wanted me to do a vaginal exam, which didn't make any sense for variances. And I'm like, No, you're not doing that. So I was on arms about this hospital. And so finally they did an ultrasound and they could see the cyst. And I was like, yeah, so I think it is. And then they saw ovarian torsion, which is where kind of your ovary gets twisted and cut off the circulation. Right. So basically, my ovary was dying on my left side caused by this cyst. And so the doctor comes in, and I personally wasn't terribly concerned about the sister the ovary, I was concerned about the baby. Because I'm like, Well, if we do surgery, what are the complications on that with it being right there next to the uterus. He was an expert surgeon, I would say, but he of course tried to do all the tactics of like If you don't get this surgery, then you're going to definitely lose that ovary. And if you were my wife, I would have you do the surgery, like all of those things instead of like, hey, here are the pros and cons of doing it and not doing it. And we were able to have a good conversation with him and we did decide to end up doing the surgery. But after the surgery was done, my big concern was was the baby. Okay, so he comes in and he does an ultrasound. And with ultrasound, he's clear up in my abdomen, like, up next to my ribs with ultrasound. And yeah, you guys are.

We're making faces.

Yes, you're making faces. Within only 10 weeks, you know that your uterus is only like right above your pubic bone. So he's saying that, Oh, I see the baby clear up in my abdomen. And I'm like, Ah, and he's like, look, there's there's the baby and like, I didn't want to argue because I was so tired.

I'm sorry, was this a surgeon or this was just the ER doc, this was the so he was an OB, he was an OB. And he's telling me that my uterus is clear up in my abdomen anyway. So I just said, okay, and I we just went straight to my work after so I could do an ultrasound on myself, because he clearly didn't know how to work in ultrasound. So the pregnancy was completely normal. We got her 20 week ultrasound and she was breech. Which I thought okay, no worries, we keep going. And then 30 weeks comes around where we can actually really feel the baby and Oh, baby's breech some more. Okay, well, babies turn super late, it's totally fine. Again, this is what I tell clients all the time. So I'm not worried. My midwife kind of sat down with me like, okay, baby's still breech. Let's start having to do like the spinning babies things. And I was all on board for that. So I go on, I do the spring babies things. And one of them is where you're like, kind of inverted where your butts up in the air, your heads down on the floor, all of that every single time I tried to do a position similar to that I got a wave of sickness, and I got lightheaded, and my body seemed to be fighting it. And then at 36 weeks, my midwife start does a gentle version. So a gentle version isn't quite the same as an ECB, where it's gently turning the baby, it's seeing if they're going to turn and not forcing them to turn.

So let's just talk about ECB for a second that is external cephalic version. And that's the traditional way to turn a baby. By traditional I mean, the most common way. So even homebirth midwives typically recommend this in the case of breech babies, and you go to the hospital and they typically they hook you up to an ultrasound, they typically give you a drug to relax the uterus. And, and then by looking at the ultrasound de Trisha, you can confirm this, but they quite aggressively attempt to manipulate the baby's position and get the baby vertex or head down. Whereas with a gentle version, it's a much more gentle approach. There's no drugs involved. And they're just kind of maybe applying a little bit of pressure to try to coax the baby into a head down position is Yeah, I think that I'm not sure drugs are involved 100% of the time and an ECV. And it doesn't always have to be aggressive. But if the baby's not turning easily, then they will go to more extreme measures to try to get the baby to move without putting the baby at risk. Although there is a risk and you signed paperwork that they could give you an emergency C section if they disrupted the placenta, yes, it's a very different experience from a gentle version. I just wanted everyone to understand what that means. And there's no official definition of a gentle version. It's just in contrast to the traditional approach, which is an ECV.

Yeah, usually with an ECV is done in under like 10 minutes. With a gentle version, it can last a half an hour an hour because you're really working with the baby versus in the hospital. They're not going to really spend that time they're just going to be like Oh, baby's not turning let's try harder to turn baby.

Right Are they are they then say it's not working and it's an unsuccessful ECV which is quite common.

Yeah. So the baby did turn head down we confirmed it I could clearly feel about up in my abdomen which being a midwife I was able to really feel where she was at more it's still a lot harder to feel on yourself than on other people but I could like firmly see okay, this is a but this is a head just because they feel differently like for listeners sake, the head if you feel a head it kind of moves on its own versus if you feel a but it moves the whole body. Interesting. That's part of the law. Your maneuvers right. So we were able to turn her successfully and we were getting heart tones in my lower abdomen. So that's another sign of a baby's breech. If you get heart tones in your upper abdomen, that's where the heart would be right? So usually that's where you hear the heart rate, if it's breech, and then if they're not breached, you hear like right above the pubic bone area, especially in labor. We finished that appointment and she did talk to me again about like, Okay, well, if baby's breech, legally, we're not able to do that in Utah, but I am trained in breach and if we can find a way to not she didn't want to fudge the chart, she was very clear on that. But she still wanted to follow the law. I kind of put that in the back of my head, like, okay, she's trained in breach, but she still doesn't want to have to flush her charts at all. She leaves and the baby turns back two hours later, I could feel the baby transverse and I was like, Oh, you better not be turning breech again. And then she she turned back. The next week was 37 weeks, and we did another gentle version successfully. This time I tied a bandana or it was a scarf above my abdomen. It's a trick to kind of keep baby downloads. If you tie a scarf above, it kind of prevents them from being able to turn because they have less room. But I couldn't sleep with the scarf on. So I took off the scarf to go to bed. And immediately after I took off the scarf, she started moving. And I was like I think she's gonna turn breech again. At this point. With that second version, I was feeling more uncomfortable with the idea of turning her again because in my mind, there might be a reason for her being breech. And that was just a thing in the back of my mind of like, okay, well, what if she's breached for a reason? I didn't know before then what that reason might be, I've just heard that some babies need to be breech. So she for sure by morning had turned back. I actually worked the next day. So I went in and confirmed with ultrasound that she was breech again and texted my midwife, hey, she turned back, we can try. And she wanted to try another gentle version this next week with the next appointment and I was like, okay, but after that, I don't know how comfortable I am with turning her again. So the next appointment my 38 week, prenatal we did do another gentle version. And my body kind of fought it. And I even mentally was uncomfortable, more uncomfortable with this version. I had a contraction right in the middle of it. It just felt like my body was fighting against having her turn. But my midwife said that it was successful. But once she left, I was really feeling my belly. I was like, I don't think it was successful. I still think he's breech. And so because I have access to an ultrasound, I was able to go just do an ultrasound on myself and confirm that she was breech. And that for all of these breech presentations. She's She was Frank breech. So Frank breech is where they're folded in half where their feet are next to their head, and it's one of the safest position to deliver a breech baby and because then you don't have to worry about any feet dropping down any core prolapse is a lot.

So let's just take a second and explain that to everyone. Frank breech means the baby's bottom is presenting, thereby filling the cavity of the cervix, which is what the head usually does. But if we're talking about a footling breech baby, now we're talking about the skinny part of the baby coming through the cervix first, and there is an opportunity for the cord to come down and the baby while the wider part of the baby starts to emerge, the baby could cut off its own oxygen supply because the head is up still inside of the uterus. And the cord is the only means of getting oxygen so the baby could pinch that cord on the way out which is where the risk is. Though we have seen many women have successful footling breech births as well.

So I had told her that she had turned back to breach and she at this point we had developed a code word. If she had been breached, I was supposed to use this code word of like, Oh, she's being stubborn. And that would tell her oh she's breached without actually saying it so she could be in the know without being in the know for because of the legal laws in Utah, but she wasn't allowed to do a breech birth.

What reminds you that no matter what the law is, if a woman strongly feels in a way she's gonna do it. Like there's a whole reason why there's a huge free birth movement right now is because women don't feel comfortable in the hospital. Oh, midwifery isn't supported in their area. Or free birth, which isn't ideal because no matter where a woman wants to go, of births, she should be able to plan her own birth. It shouldn't be so extreme as you must give birth in a hospital or the state doesn't support you and you're doing something unlawful. One of the key problems we have with the maternity system in the United States is that midwifery care isn't supported. So there is no integration between home birthing and hospitals. It's this binary choice. And as you're pointing out, in some states, it's even so extreme as being unlawful, which really brings into question a woman's own freedom.

I only know one OB who would ever do a vaginal breech birth, all the rest require C section. So I felt like I didn't have a choice if I didn't want a C section. So in Utah, an OB can do a breech birth in the hospital, it's just illegal for midwives or illegal at home.

Illegal for midwives, illegal. Midwives are not allowed to deliver breech.

And they probably have more experience with it than the obese.

Probably. Well, their whole argument is that happens so rarely that they will need to learn the breech skills and that's accepted happens in 6% of pregnancies.

And throughout this time, I had also been going to a breach training course just to make myself feel better whatsoever in breach. And then I also had my husband listening in on a couple of sessions where they were reviewing the research, reviewing the pros and cons of C section versus vaginal breech because there is risks for both. And personally, I was more okay with the risk for vaginal breech than it was for the risk for C section. And that's primarily because I planning on having more kids after this. And I didn't want that VBAC label and the risks that are associated with that after. So at 39 weeks, I went to work and I came home. And we were at my in laws house, picking up my kids because they were watching the kids and I started having contractions that I thought were really early labor contractions. And I was like, ah, it might be early labor. It might not. Let's just go home. And so we went home and we were having a home birth. So I made my husband clean the house with me, just to prep every everything. And then we went to bed. And the next morning, I woke up with a good strong contraction and I went to the bathroom and on the way to the bathroom, my water broke. And so I text my midwife, I get heart tones right after the water because that's what you're trained to do as a midwife or water breaks get heart tones. So I go grab my Doppler get heart tones, waters clear. And so I text her like, hey, just so you know, probably it's gonna be today or tomorrow, My water just broke, I've been having pretty good contractions. So I went back to bed, and was working through more of those contractions. And they were getting more intense. And so it's my first I was able to handle them more when I went to the bath. So I went and took a bath. And it's so funny to me, because I tell my clients all the time, wait till active labor to take bath. And for me, I was definitely more in early labor. But I was so tired. I was just like, the bath was gonna relax me. And so I went to the bath and the contraction stopped. And I was like, Oh, I exactly did what I usually tell my clients not to do is take a bath in early labor. So my midwife came over later that day, just to check on baby. And when I had texted her, I said, I felt baby move. And I think she's head down. Now I'm getting heart tones right by my pubic bone, which I was. And she was like, oh, okay, sounds good. I told my husband that she had moved. And I told I had my sister, my mom at the birth too. And I was told both of them. Oh, she moved, she's now head down and they were all relieved. And Secretly, I knew that she was still breech. But I think in the back of my mind, the reason why I told everyone is because I didn't want them to treat me differently. I didn't want them to have any fear at the birth. Because I still strongly believe that even with a breech birth, birth happens naturally, normally, unless there's extra complications. My mom wanted to come over so I texted her in the morning and my mom and sister wanted to come over right away. And I specifically said, No, I just want it to be my husband and I right now. I don't want to be distracted. I want labour to be able to come back. I want to be able to work through it without extra people distracting. So when my midwife came over to check the baby, I asked her to do a stretch and sweep. And she said no, I don't think we should. I think your body is just taking the break it needs and then you're gonna go into labor. And I was like, okay, yes, I totally agree with you. And so she left so I was able to go on a walk I Did some lunges, and all bunch of other exercises to bring baby down and lower. And then we went and took a nap. And we woke up from the nap, I was starting to have more intense contractions and I went to the bathroom, and there was thick meconium coming out. But with that being a breech birth, the butt is first. So the myocardium coming out is literally just coming straight out. It's not going up into the amniotic sac. So I just kept that in the back of my mind. And we call my midwife shortly after to come and check on us see how it was, I believe I checked my cervix at that time, and I was four centimeters. But I felt like things were getting more intense and that I would need aid soon. So we called the whole birth team, my mom and sister came over and started setting up the birth tub and everything while I'm working through these contractions. My midwife was planning on having an assistant there with her, but she was out of town. So she actually let my sister be her assistant, which my sister is an RN. And she was so thrilled about it. So it was such an intimate close birth because I really only had the photographer there, my midwife, my mom and my sister, now and my husband, of course. So it was such a special space, which I just was amazing to me. And so I was able to labor really well. In and out of the tub. I just I personally love the tub for labor as it just fully relaxes me I'm able to fully open up and let baby come down. When my midwife saw the formed meconium she did ask me if I wanted to transfer cuz she was like, oh, there's a lot of accordion coming out. Are you sure you don't want to transfer? And I was like, Yeah, I'm okay. Because she's still under the belief. Well, I thought she was under the belief that baby was head down. And so that much meconium would be more concerning.

She was clued in at that point the baby was actually breech.

Oh, yeah. She admitted after the birth that she knew the whole time that baby was breech. Yeah, okay. Figured out. We basically end up in the bed because babies not liking the water. Before that, I had whispered to my sister in the bathroom, my little secret of like, you want to hear my secret, baby's breech. And she was like, oh, that's why you're not concerned with the conium. That's why Laura is not offering to check you anything like that. So I went into the bedroom, and I was laboring on the bed and took a wonderful nap. And it's like one of my favorite things to have moms do is take a nap right before pushing, because it's the rest and descend phase. And I was able to get a wonderful 20 minute nap. And once I woke up, I started feeling really pushy. And so I started pushing a little bit. But with my first I had had an anterior lip that stalled my pushing. I was so concerned about having that anterior lip again, because that had caused my pushing stage for my first to be three hours long. And I was like, I don't know if I can do that. And so I asked my midwife to check me and she, of course was like, No, you're pushing spontaneously. This is what your body's doing. Trust your body. Which tells you even midwives have to remind themselves that oh, yeah, you have to trust your body, stuff like that. So I instead reached down and I felt what I thought was my cervix, and I started holding it up over the baby's head. And I realized as I was pushing that, oh, this is way too low to be your cervix, it's got to be your hymen. So your hymen is kind of a thick bit of tissue, just under your pubic bone, that sometimes needs to be pushed out of the way in order for baby to come through. And so I started pulling that and holding it up and baby, the baby was really, really coming down. And lo and I had her crowning or bumping into my hand. And I just remember her body just kept coming and kept coming and kept coming. And I was like, Oh, wow, how long is this baby in my mind. And that's when my midwife noticed that there was a cord kind of wrapped around her and she was kind of stuck. So she was able to maneuver her to kind of free that cord a little bit and birth her and it was a really simple birth. Honestly, when it comes to a breech birth, we actually didn't really need to do anything. We just rubbed her back a little bit and she started crying. It was so wonderful. But the cord was so short, it only went to my lower abdomen like I could only have her on my lower abdomen. And I was like, wow, that is a short cord. And so we're holding her and what's the cord stop supposing we cut the cord and I get a separation gush, which is the sign of the placenta starting to come. And so honestly, I pushed harder for my placenta than I did for my baby, because I kept pushing and pushing, and we could see it like right in there. And we're like, why is it not coming? Finally, we get part of the placenta out. And it's still like connected a little bit to part of the placenta inside of me. And what happened is my placenta was formed in two separate lobes. She's holding part of my placenta in her hand, while the other placenta is connected still inside of me. And we're trying everything to get this placenta out. And it's like, the worst part of a retained placenta is you have this amazing magical homebirth. And then you have to transfer port retained placenta, it's like, just the way to ruin a perfectly good birth. And so I didn't want to transfer it because I knew that the hospital with real fit, if they found out she was breech, they would want to take her and do a bunch of tests, all of that. And I just didn't want to do that. So I was so determined. I pushed, pushed, pushed. And finally, we also had a prayer and I got up and pushed again and the placenta came out. And then I reached down and I thought that there was still a bit of placenta inside of me. But I realized that was part of my vagina kind of, they pushed so hard, I pushed part of my vagina out. And so the placenta came out and it was just in tatters, like, we could kind of piece it together. But there definitely could have been a couple pieces missing. So, my midwife talked with me like, okay, retained placenta bits can cause problems postpartum, I think it's a good idea to do a manual sweep. So manual sweep is where they stick their hand up inside of the uterus and kind of sweep the uterus to get all of the chunks out. It's not super routine at home birth, but it's, I would say, some doctors, I've seen a couple doctors do it in the hospital. And it's, it's not fun for them all, especially if she doesn't have pain meds because they're literally shoving something up there in that really, really sensitive area. So I agreed we could just because I had no I knew what the complications of like retained placenta could cause stuff like that. And so and I wanted her to kind of re push up my vagina and my uterus, in case I had pushed and caused a uterine prolapse on top of a vaginal prolapse. She did the manual sweep. And it was very intense. But I was able to hold my husband's hands the whole time. And honestly, I think she was as gentle as she could be. Like, she didn't do anything unnecessary that any extra sweeps or anything like that, or wasn't in there for a terribly long time. That honestly wasn't super traumatizing for me because she was as gentle as she could be. And I knew that this was what had to happen. After that, the birth was the recovery was totally fine. I haven't had any problems with the vaginal prolapse, which I feel beyond blessed for. And with examining the placenta, we found out that the placenta had a voltage Miss insertion. So this is where the cord isn't fully inserted directly into the placenta. It's kind of goes through the amniotic sac, and it spreads out into weaker veins. And when you have a vote, Miss insertion, the risk of the cord breaking off the placenta is very high. And I realized in that moment, after we were looking at this placenta, that that was the reason why she had to be born breech. And her cord was under 12 inches long. Like it was a super short cord with a small twist insertion. And all of it just kind of clicked in place. I was like, Oh my gosh, that is why did you ever on ultrasound determine where your placenta had implanted in the uterus?

It was in the lower front part.

So that's why she was not able to be vertex.

Yeah. Yeah.

And the why she kept turning around because the placenta was low and the cord was short, so it kept pulling her back.

Mm hmm. Exactly. I've kind of speculated like, if I had gone in for an ECV, they probably would have done such a rough version on her that the court could have snapped and I would have gone in for emergency C section. If I had done a C section. They would have seen the court insertion and taking her for even more testing and stuff and I would have wouldn't have had that time with her. And she came out she was a perfectly wonderful, healthy baby. And she's actually I have a couple pictures where her legs are up by her head where she's sleeping because she's was stuck in that position. For so long, she just slept with her legs like straight up. The lesson that I really learned from this birth was even as a midwife, knowing all of the extra complications and stuff that could happen with breech birth, I still felt like that was the way my baby needed to be born. And I should have trusted my instincts sooner than I did with having not having her do that third version. But I was able to test my instinct after that and not do another one and not go to the hospital. And because I was able to know that somehow she needed to be breached and that was her choice, and I needed to respect that decision.

Thank you for joining us at the Down To Birth Show. You can reach us @downtobirthshow on Instagram or email us at Contact@DownToBirthShow.com. All of Cynthia’s classes and Trisha’s breastfeeding services are offered live online, serving women and couples everywhere. Please remember this information is made available to you for educational and informational purposes only. It is in no way a substitute for medical advice. For our full disclaimer visit downtobirthshow.com/disclaimer. Thanks for tuning in, and as always, hear everyone and listen to yourself.

I started listening to you guys right after I became a midwife because I was still wanting to learn more information and I really loved how you guys talk to your to the people that called in. I loved your philosophy of like, no moms know what's best for them. We need to trust them. We need to get them all the information and not influence them in any way. And I just I love that I really connected with it. So keep doing what you're doing. You're doing amazing work.

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About Cynthia Overgard

Cynthia is a published writer, advocate, childbirth educator and postpartum support specialist in prenatal/postpartum healthcare and has served thousands of clients since 2007. 

About Trisha Ludwig

Trisha is a Yale-educated Certified Nurse Midwife and International Board Certified Lactation Counselor. She has worked in women's health for more than 15 years.

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