Wednesday, June 1, 2011

Breech: Fearing the Curse.

Two week ago, Wecnyin and her family arrived in early labor with a breech child. Even though her dates said she was only 8 months pregnant, she measured more, so I prepared for a breech delivery.

However, after awhile I wasn’t convinced she was really in labor. Her contractions were very short, and she hadn’t had anything to drink for days. Since dehydration can cause Braxton-Hicks contractions, I hydrated her and watched. My chief concern, however, was her reported ruptured membranes. I saw no evidence of it, but I couldn’t rule it out either. So I admitted her for observation.

At the time, she was only 2 cm dilated. After several hours of no significant progress, I tried to send her home, but she refused. She kept insisting that her home was too far away, and that it was getting dark. I tried to convince her all would be okay for the night, but she looked panicked at the thought.         -- Strange.

After digging deeper, her family finally explained that her first child was born breech and died shortly after the birth. The head was trapped for well over an hour.        -- Oh.

Even though her labor had stopped, I let her family convince me she needed to be augmented. They weren’t going to go home, so I obliged. Fortunately, the augmentation/induction failed, but by then it was too late for them to go home. So, they stayed the night.

The next morning, her labor had completely stopped. It was clear she hadn’t had any water come out, so I told them to go home, drink water, and come back when labor started. The great news was that in the night, her baby seemed to have turned cephalic (head down).    

I expected to see her a few days later for a check-up, but she never came. I reasoned that she must have delivered at home. But I was wrong.

A full two weeks later, she arrived yesterday morning for a prenatal; she was in labor. The contractions were strong and close together, making feeling the position of the baby difficult. Was she still breech? I couldn’t tell.

When I did a vaginal exam, I was happy to see her fully dilated, but the baby was not engaged. All I could feel were taut membranes bulging powerfully each contraction. After some preparation, I opted to do an artificial rupture of membranes (AROM) to see what would come down.

Sarah monitored the fetal heart tones continually to search for any signs of cord compression, and within minutes, the butt was engaged and making its way through her pelvis. Knowing how frightened she’d be to hear her child was breech, I explicitly kept it from her.

She pushed well, and the blue-tinged buttock moved lower with each contraction. Since she was on her hands and knees, it made assisting her very easy.
A few minutes later, the legs dropped, the arms emerged, and then the head followed in sweet succession. She was perfect --small but lovely in every way!

When Wecnyin realized she was born breech she looked grief stricken. While the rest of the room broke out in smiles and cheers, she remained silent. Why? Her little girl cried sporadically a tiny whelp of confusion and surprise, making the rest of us rejoice. But still, Wecnyin sulked.

So, I asked her why.
-- You seem sad to me Wecnyin. Don’t you know that your baby is doing well.
-- But she came out breech. Now she will die.
-- What do you mean? She is healthy. There is no reason to think she will die.
-- Well my first baby died after being born breech.... so this one will too. Something is wrong with me that my babies come out this way. I’m cursed.
-- Oh...

It took me a few minutes to explain to her the whys and hows that caused her first baby to die, but eventually she understood. Once reassured, she started to bond with her girl and a few minutes later found her smile.

It was such a simple and calm birth. What an honor!

Please pray for Wecnyin and her family to trust God for this child’s life and learn to rest in Him. Thanks. And praise God with me that this birth went so well.

(Loud shout out to MTw and her midwife friend in Switzerland, who taught me this new breech delivering technique. It worked like a charm! Thanks girls!)