A note from my future self: In the years after my birth I’ve done a lot of a learning about breech presentation and how safe breech vaginal birth can be when supported properly. I highly recommend diving into this episode of Evidence Based Birth as a starting point if you’re interested in learning more about the facts surrounding breech birth and what your options might be.
When I thought about writing this post, I always imagined the pride I’d feel sharing my beautiful home birth. No fear or panic, just essential oils, fairy lights and all of the women I respect and admire most crowded around a birthing tub in my living room. Together, with all the girl power we could muster between my midwives, my doula, friends and family, we’d welcome this new life into the world with no monitors, chords, masks or scalpels, just love (and maybe a couple well-placed crystals for good measure).
Reality check – as my doula Birth Boss likes to say, it’s great to have a birth vision, but there is no such thing as a birth plan.
I’ve always known when I finally became pregnant I wanted to have as little medical involvement in my birth as possible. I have trust issues from past trauma when it comes to medical professionals, I hate needles, and tend to go on the defensive whenever I’m asked to lay down on a paper-covered table. I don’t even take painkillers for goodness sakes! On top of that, I also had total faith that if I could stay calm and keep fear and panic at bay, my body knew how to do the rest – birth is hard, but it’s a natural process, so why would I need any medical intervention? Forget confidence, I’ll be the first to admit I was downright cocky.
I chose midwifery care over working with an OB (both options are covered by insurance in Ontario, which is amazing!) as it was really important to me to have a strong relationship with my birthing team versus potentially ending up with a doctor I hadn’t met before that happened to be on call when I went into labour. I found out I was pregnant early enough that I was able to shop around the city a bit, and in the end I went with Kensington Midwives based on recommendations from a handful of trusted friends. We started our monthly appointments and all signs pointed to a successful, healthy, happy home birth. I set up my birthing tub rental , researched all the supplies to stock up on (think Dexter level plastic sheets) and talked through every detail with my Doula, right down to what sort of scents I react well to. To prep myself mentally I enrolled in the Hypnobirthing course at West End Mamas, which I highly recommend to anyone with fear or anxiety about their birthing day, and I walked out of those six classes with even more confidence than I’d started with. Side note – I’ll be sharing all of the things I did to prep for baby during my pregnancy in a separate post, from Bump Method pilates classes to the books I read, but for now we’re sticking to the birth story!
Everything was going according to my plans all the way up until Christmas eve, six weeks out from my due date. I was calm, collected, and so excited to brave my birthing day; if I could sum up my attitude in three words, they’d be “Bring it on!” But all of that changed in an instant when one of my midwives felt around in my belly and couldn’t quite place what exactly she was feeling. Her look of concern grew when I explained I myself was born in frank breech position, and that it had been one of my biggest fears throughout my pregnancy after hearing about my mom’s birth experience. By that time, baby ideally should have been head down, and for weeks my chiropractor and midwifery team had been sure baby was, but this particular midwife had enough doubt to send me for an ultrasound to confirm position. I tried my best to fight the sinking feeling of fear that started to creep in. I kept repeating to myself “My mother’s birth story is not my birth story”.
There’s a lot to be said about breech birth, and I’ll likely save the bulk of it for a another separate post about everything I learned because I got SUPER into it, so for now I’ll stick to the basics. Gravity naturally pulls most babies head down so they’re ready to engage in the pelvis by 32 weeks, but some babies end up breech, aka head up. There are different types of breech, but in my case I was born frank breech, or bum first (bent in half, feet to head with my bum down, if you need a visual). Only 3% of babies remain breech until term (37 weeks), and guess what? I was one of those stubborn babies. Still, my mom had me vaginally after 24 hours of induced labour with no pain relief whatsoever (!!!), plus the help of forceps and a very extreme episiotomy that later had to be redone. Her birth story has always been a source of inspiration for me, but it’s absolutely not the ideal, and though everything worked out in the end, I was born not breathing and blue, requiring resuscitation before I let out my first cry. My dad still gets teary talking about it.
By the time I walked into my ultrasound and undressed a few days after Christmas, I already knew deep down what the results would be. As soon as the wand touched my belly just under my right rib cage, there it was – my baby’s head. Turns out all those times the pros had felt the head ready to engage near my pelvis, it was actually baby’s bum, as far back as 20 weeks based on the ultrasound records! My baby was in the exact same position on the exact same side that I had been inside my mom’s belly 28 years ago, only she had only been told on her due date – with 5 weeks left until mine, I became determined to turn my baby and get my birth plan back on track.
There are a LOT of ways to turn a baby inside the womb, and according to testimonials all over the internet it’s possible all the way up until labour (or in some rare cases, DURING labour too!) I can safely say I tried every single trick in the book over the next three weeks, a somewhat hilarious series of uncomfortable upside down positions, doing flips in the pool amongst elderly folks trying to swim laps, acupuncture, pointing a flashlight at my vagina… I’ll save all of the details for the above mentioned breech-specific post in case you’re in the same boat. Sadly for me, all of my efforts didn’t seem to make a dent – morning after morning I woke up to find baby’s head in that same painful, bruised spot under my ribs, and week after week ultrasounds confirmed my fear that baby hadn’t budged even an inch. I barely made it out to of the clinic each time without breaking down and bursting into heavy sobs in the street. For someone who loves to be in control and make things happen, I can’t begin to explain the anger and frustration I felt with every minute that ticked by – it was a powerlessness like I’ve never known. I went from counting down the seconds until my due date to wishing I could freeze time altogether.
At 37 weeks I booked my first ECV with the midwives. Successful roughly 50% of the time, ECV involves attempting to turn the baby by literally pushing it into place from the outside of the belly. Fetal heart rate is monitored for any signs of distress, and though the odds are low, the attempts can lead to breaking the waters, placental abruption, broken bones for baby, or worse. I showed up to Kensington Midwives with my emergency hospital bag packed and waiting in the car, and we got to work. I’d be lying if I said these sessions weren’t some of the most painful moments I have ever experienced – at one point three midwives were pressing their hands so deep into my belly that their arms were all shaking from the force. Some practitioners will only do this procedure under epidural because it’s so intense for mom, but my midwives assured me they literally couldn’t have pressed harder even if I had been totally numb (my Hypnobirth breathing came in really handy here!) My team tried as hard as they possibly could on two separate days a week apart, and though they were able to get baby about halfway around each time, for some reason no amount of pressure could accomplish a full turn. After the second unsuccessful try we started talking alternate options; unless baby chose to make a last minute flip, my home birth plan was officially out the window.
Though my mom had a breech vaginal delivery it’s now generally considered unsafe, especially in North America, and in a lot of cases obstetricians and midwives aren’t even trained in the art of breech deliveries anymore. Most breech births, especially in Canada, are automatically scheduled c-sections, which couldn’t have been further from the birth I had planned. These practices are slowly changing, and in some countries like Germany there are specific wards that do screening and provide specialized care aimed to support breech vaginal births, but even there, with perfect conditions and careful screening, the emergency c-section rate is still about 40%.
At this point my determination turned into a full-blown obsession, and it felt like all I read about, talked about, and thought about was breech babies. With only three weeks till my due date, I knew I was running out of time, especially since each passing week meant baby had less room to move at all, never mind turn head down. I poured myself into as much research as possible and prepared to fight the uphill battle for the same birth my mom had been given the chance to try.
Breech vaginal births are extremely rare in Toronto, especially at the hospital my midwives had privileges at, but my midwives told me someone had pulled it off successfully last Spring with the help of a specific OB on staff, so I was hopeful. I made an appointment to consult with that same OB, but the way the system works was never in my favour: even with his full support, I’d have to hope that I went into labour naturally, with no complications and steady progression, on the day this specific OB happened to be on call (a 1 in 11 chance). Generally breech births are not induced, and they also can’t go post-date because baby gets too big to have any chance of getting through the pelvis, so there was a very small window of time for all of the stars to align. In the case I went into labour and the OB wasn’t on call, my choices would likely be to accept an emergency c-section from another OB on call before baby dropped too far into my birth canal to turn back, or to brave the birth with no OB’s support and put all my trust in my midwives, who admitted they had somewhat limited training. The worst case – baby’s body is born but the head becomes trapped, leading to brain damage from oxygen deprivation or even death. Preventable death. At the end of the day it was entirely my decision, my child’s life in my hands. I was so hesitant to surrender control, to give up my plans, to let go of all of the excitement I had built up to labour and breath and push. I didn’t know how to stop fighting, even when everything appeared to be stacked up against me.
And then I lost my dog Honey. In the same few days I was trying to decide how to bring my baby into the world, I had to make the decision to say goodbye to my best friend. In a moment, it all came crashing down on me – watching the life fade from Honey’s eyes at the vet that Friday night humbled me, and all at once the fragility of it all swept over me. You know that feeling when you run into the ocean to play in the waves, confident and excited, but slowly they get stronger and you start to lose your footing? The waves may even sweep you off your feet, and though you’re swimming you’re no longer in control of your direction at all. Something much larger and more powerful has you in it’s grasp, and suddenly you realize you’re in too deep, surrender, and swim with the waves until you’re safely back to shore? This felt like that. Growing up on the West Coast I learned early that one should never underestimate the power of the ocean, but I’d somehow lost track of the power of life and death itself.
When Honey went, all of my fight went with her. The feeling of loss was suddenly so tangible, and I just kept repeating, “I can’t lose even more”. For the first time in my entire pregnancy and birth planning experience, I was scared, really truly scared.
I went to meet the OB with my Doula by my side, and though my original plan was to argue my right to a breech vaginal birth no matter how hard he resisted the idea, I walked in ready to listen to him instead. The OB was young, warm, and respectful even when I asked about 100 questions that made it clear I didn’t trust him at all. When I asked about vaginal breech birth, he said it was out of the question – hospital policy had become more strict after the case last Spring that I had heard about, and it was no longer an option any OB at my midwives’ hospital would be comfortable supporting. If I wanted to go that route, he said I’d basically be going rogue, taking on a risky birth with only my midwives’ limited experience, against his medical advice. Of course I could try to find another OB at another hospital in the city (a few exist!) that would support my plan within the next week, but that would mean losing my midwives because they only have privileges at the one hospital. And then he said the words that really hit me: “As an OB I have a lot of tricks, and I’m trained to do a lot of different things when a baby is in trouble, but nothing gets my heart racing like a breech baby whose body is born but the head is stuck.”
I finally surrendered. I asked him what my best options were and he suggested coming in for one final ECV attempt under epidural with ultrasound monitoring in the OR at the hospital. If he was able to turn baby, I could go home and wait for labour to start naturally, and have the birth I had always hoped for, or we could induce on the spot to ensure baby didn’t turn back. If he couldn’t make the baby turn, he’d offer me a c-section that same day, as that would be the end result anyway, and I’d already be prepped with an epidural and ready to go. “I can book you in for Friday” he said. I took a second before agreeing, “Ok, let’s do it. Next Friday right?”
“No,” he replied, “I can only fit you in this Friday.”
It was Tuesday.
The next few days were a blur. I held off my tears until I was safely in the car, called my mom and told her she probably needed to get on a plane. Then I went home and let myself feel it all: mourning Honey and wishing she could be around to comfort me, accepting the loss of the birth I had dreamed of, trying to wrap my head around having a major surgery in just two days, around caring for an infant on my own while healing from surgery for 6 weeks. Yes, the top priority had always been getting my baby here safely, but I don’t believe delivering a baby safely cancels out being protective of your own body and experience too. I felt like I had failed myself, my midwives, and my baby – had I given up too easily? Those hours before my family arrived from across the country were some of the hardest and loneliest I have ever been through.
But then my parent’s flight landed, and we went to Baskin Robbins to pickup tubs of ice cream, and made a reservation at my favourite restaurant for a “last supper”. We cleaned the house from top to bottom, and I poured myself into my birth playlist, a comfort from my original home birth plan that the OB was allowing me to bring into the OR. By the time my sister arrived Thursday night I was starting to feel something new bubbling up: excitement. We sat down to our late night dinner (you can’t eat after midnight the night before, so we really ATE!) and talked about how it might be our last dinner as just four Garrisons (plus Johanna, who was there as an honorary family member of course). I can’t begin to tell you how hard it was to get to sleep that night.
We headed to the hospital at 6:30am with way too many bags of supplies for pretty much any outcome. Everything had happened so fast that most of my friends had no idea any of this was even happening, which made the whole thing feel like some sort of crazy secret mission. After we’d checked in I was asked to strip down immediately, and they hooked me up to a monitor to watch baby’s heart rate and movements, tracking that everything was ok before trying any procedures. My midwife, doula, mom, dad, sister, and Johanna (aka the dream team) all huddled around me as the monitors took their measurements, nervously laughing amongst ourselves and listening to the woman in labour on the other side of the curtain to our right. On the outside I tried to keep it together, but on the inside? Panic is an understatement – you better believe that under those hospital blankets I was shaking like a leaf.
The OB came in with an ultrasound machine to confirm baby hadn’t done a miraculous flip (it happens!), which of course my headstrong baby had not, and within minutes I was saying goodbye to my big birth entourage and heading to the OR with my midwife and my mom by my side. We met the anesthesiologist, a truly lovely man who reminded me “an epidural is very different when you’re not in labour and needing it” when I admitted how terrified I was. With the help of all of my breathing practice I stayed super still, holding hands with my amazing midwife, and the epidural went in no problem (though it was NOT a fun feeling). Before I knew it I was laid out on the table half-naked with a catheter in (I didn’t feel that part thanks to the epidural, PHEW), monitors all over my belly and my arms stretched out beside me like I was being prepped for crucifixion. The OB came in and we were about to get started with the ECV when the baby’s heart rate dropped. Apparently this is a very common reaction to the epidural, but I had been listening to baby’s heart rate my entire pregnancy with an at-home fetal doppler and I had never heard it anywhere close to that slow. Panic rose in me on top of all the nerves already coursing through my body, and though I could barely feel my legs I knew they were shaking more than ever. Everyone froze for what seemed like forever, until baby’s heart rate slowly climbed back up to a normal reading and we all let out a big sigh of relief. I was half expecting someone to have to grab a scalpel and cut me open right then and there!
The OB put in a good effort to turn my baby, but unlike the earlier attempts with my midwives there was almost no sign of movement at all – I was 39 weeks, and baby was simply too big to be shifted. Even my wonderfully optimistic midwife, who stayed hopeful about turning baby and having my home birth right up until the very end, admitted there was just no chance.
And so with the epidural already in, my dream team by my side, and only a week left until my due date, I said yes to a planned c-section, the one birth story I had never ever thought would be my birth story.
There was no rush because I wasn’t in labour, so everyone moved slowly and carefully around the room. My epidural was turned up and when asked to move my legs I found them buried under a pile of invisible cement. The room swelled with more medical staff, but each person that came in took the time to come over and introduce themselves. I had given my OB a long list of requests I hoped he’d honour if it came to a cesarian, and to my surprise he and his team did their best to accommodate every single one. The paediatrician agreed to hand me my baby immediately, without the traditional checks and wipe off at the warmer, as long as baby came out pink and crying, and my gown was moved out of the way for immediate skin to skin cuddles. Everyone in the room was aware I wanted no shop talk during the surgery, delayed chord clamping, and to keep my placenta so that it could be encapsulated for consumption (more on that later!) I had also told the OB I really wanted to watch my baby being taken out, and he agreed to setup the light above me so that I could see the surgery in the reflection if I chose, something he admitted he’d never offered to anyone before. But my favourite detail? My mom was struggling to setup the bluetooth speaker with my birth playlist because her Spotify kept playing ADVERTISEMENTS (I was in a panic, repeating over and over “My baby can’t be born to an AD mom!”) and she didn’t know how to use my android phone to access my premium account, so after making sure I was ready to go and totally numb the anesthesiologist went over and helped her setup the speaker. One of the nurses even mumbled, “Well, you don’t see that every day!”
After they had checked I definitely couldn’t feel anything from the chest down, a blue sheet was raised between me and the surgery zone. My mom was holding one hand, my midwife the other, and I looked up into the light’s reflection just in time to see the OB take out a scalpel and make a cut. My baby’s birth had officially begun.
I don’t know how many minutes getting to baby took, but it felt like forever. My mom and I both had tears in our eyes as we remarked in disbelief that I was having a baby that very moment. I kept asking the midwife, “Are they close?”, and she’d give me little reports on what stage of the surgery the OB was at. Watching all of the cutting bits in the light’s reflection got the best of me at one point and after a particularly gruesome squirt of blood I became convinced I was going to throw up, but the anesthesiologist jumped into action and added gravol to my IV, which instantly took the nausea away. It was around then that my midwife reported “they’ve broken your waters!” The surgery team lowered the sheet by my head and someone told my mom to stand up and get ready to take photos. I don’t know exactly which song from my playlist was playing – in that moment everything went silent around me.
At 10:02am on January 25th, during a snowstorm that would last a whole week, Summer Honey Rose Garrison changed my life forever and made me a Mom. 6 pounds 5 ounces, long and skinny, with a full head of dark wispy hair and the sweetest little rosebud mouth you ever did see (rumour has it she got it from her mama). The OB pulled her out bum-first, the same unique way I had come into the world, and because she was pink as can be they put her right onto my chest, blood, vernix and all, just like I had dreamed all along. I had left the sex of my baby a surprise, so my mom got to announce “it’s a girl!” to the room, though it took her a couple moments because fresh babies are born so swollen and she was terrified to make a mistake. She was tiny and precious and perfect from her spindly fingers down to her oddly long toes. Holding her in those first few moments was a high like I have never known. She was more beautiful than I ever could have imagined, and yet I felt like I had been waiting for her all of my life.
I clung to her the whole time the surgeons were stitching me up, and then my mom took her with the midwife to meet me in the recovery room. Once settled there, Summer and I cuddled up naked and tried our first attempt at breastfeeding, all the while shooing away the nurse who kept trying to clean her and get her into a diaper (“She’s going to pee on you!”) and laughing hysterically about my mom’s account of the whole experience. Apparently she had put the placenta down for a minute after it was handed to her and before she could get back to it the anesthesiologist was heard exclaiming “ummm, there’s a placenta on my chair…”
After about an hour it was time to move from the recovery room to my hospital room, which meant reuniting with the rest of my birth crew. We rounded the corner and rolled down the hallway to find all of my nearest and dearest waiting with phones poised for photos and tears running down their faces. For the next couple of hours as Summer met her people, our people, I don’t think I stopped smiling for a second. I’m still smiling over two weeks later as I write this. Hospital or no hospital, crystals and essential oils aside, every second was soaked in magic.
The rest, as they say, is history. Summer and I passed all of the discharge tests early with flying colours, and because I had made it clear from the very beginning that I was not happy in the hospital, we were able to go home after just 24 hours instead of three days later. Breastfeeding was as painful and awkward at first as I had expected, but we got the hang of it pretty quickly and my milk came in on day three despite the c-section, which can delay things in that department. I had prepped myself mentally to be bedridden on one floor of my home with no hope of escape for 6 weeks, but it turns out my body had other plans – I’ve been able to get up and down the stairs no problem as long as I take it slow, and since I never needed narcotics, just over the counter pain medication, driving isn’t completely forbidden either. Summer, being the unicorn baby she is, has slept constantly and cried very little, giving me ample time to heal. I still can’t lift anything heavier than the baby, which is a lot of things considering she’s SO small, but my mom has been staying with me to help out, and watching the way my family has come together to support me as I regain my strength has been the most beautiful, heartwarming gift. Every morning I wake up to Summer’s hungry cry, leaky nipples that soak through my shirt, and the sound of my mom boiling the kettle for tea downstairs, and I don’t feel sad for the birth experience I lost – I marvel at all of the love I’ve gained.
In the end, nothing went the way I wanted it to, and yet looking back I wouldn’t change a thing. I believe the most important thing about a birth story is that the birthing person felt empowered, heard, and in control, able to advocate for what matters to them and ensuring everything that was done was done with consent. My experience went above and beyond that criteria, and if anything it helped me regain a bit of faith in the medical system’s ability to work with an individual on a more personal level. Of course part of me wishes I had been given more support from the hospital and their medical team to try for a breech vaginal birth, especially after watching my mom’s kickass birth video recently (she is a warrior), but with the headspace I was in and the options available to me, I think I made the right choice. Hopefully in the future more research and training will lead to more options for birthing people with breech-presenting babies in Toronto and beyond. It is possible for many, and from what I gather change is on the horizon, it just wasn’t meant to be the birth story for me – and that’s okay. Having a c-section wasn’t any worse or better, it was just different.
On January 25th 2019 Summer came early, with the help of monitors, chords, masks and scalpels, but most of all, with so much love.
Special thanks to Scarlet O’Neill for the incredible birthing day photos, to my doula BIRTH BOSS who made sure I never felt alone, and to my team at Kensington Midwives for always making me feel strong and supported
*The above story is based on my personal story and experience. I am not an expert or medical professional.