Tuesday
23Sep2008
Only Photo of Presentation of Breech Baby
Tuesday, September 23, 2008 at 07:42AM 
The first moment we were able to see through the water clearly... and the last moment before we had mom get out of the tub and transfered her to the hospital for a cesarean for a vaginal breech baby. From this picture to being in the ambulance was about 10 minutes, 7 of them waiting for EMS and getting her into the ambulance.
There was nothing but one butt cheek showing; no anus, no testicles, no meconium. The shadow was from positioning, not a cleft in the butt cheek. Note how white the presentation is - this was our first clue the baby might not be vertex.
Reader Comments (6)
Isn't it more dangerous to yank a 'butting' baby out of a pelvis in a surgery than just to let her push it out?
I don't think they "yanked" the baby out. They lifted the baby out.
And (hypothetically), what if the head had gotten stuck? Would it have been better to just let the baby's butt crown and not go get the kid?
The reality is what happened happened. I'm sharing my process so others can play things out for themselves. If you, when you are a midwife with a crowning butt in front of you, want to keep going with the delivery, go for it! But know what you are doing. It isn't always as simple as letting her "push it out."
Hi Barb,
I want to say first that I admire your ability to write with such clarity and conviction. I read your blog often but rarely post because my ability to put words and thoughts to print is a pain forsaking task.
On the breech transport, good for you for saying "not on my clock, no"! Good for you for knowing where you draw the line and why!
I'll share a story. I recently took a client who was found to be carrying twins. After about 12 pages of informed consent, months of worrying, constant weighing of the pros and cons(dammed If I do, dammed if I don't dilemma) and being very torn between keeping her in my care, and getting rid of her. At 34 week her water broke, while she was devastated, I felt like the world was lifted from my shoulders.
Today I'm still a little disappointed with the entire scenario. Not because the outcome was bad, nor do I feel that it would have been deferent had another midwife cared for this client, but because I was not true to myself, I sold out. I drew a line in the sand and I crossed it. Had she made it to term and something happened in birth I could not have stood before the midwifery board, medical community, homebirth community, and stated with certainty, that I kept this client safe and that I had done the right thing by keeping her in my care, regardless of how OK things appeared to present themselves.
I was caught up in wanting to believing in ‘birth is safe’ hype and knowingly stepping outside my comfort zone. I feel that not drawing clear lines or stepping outside of those line once drawn is unsafe midwifery practice.
I need to stay true to this belief, and to myself. Thanks for the reminder.
MW in Texas
Thank you for sharing this story; I can totally relate.
I am working on a post called "Decisions in Midwifery: Legal, Ethical, Practical"
It's hard to write! But I think it will be important for my own introspection. I hope others get something from it, too.
Hi there,
I too am in agreement in congratulating you on keeping your comfort zone in perspective and getting her to a hospital!
Can I ask a question, in good faith, not to be inflammatory? Had you done a cervical exam at all during labor? The reason I am asking bc my guess is this would have been diagnosed much earlier and not been such a rush to the hospital sort of thing. With my patients, I check everyone on admission or just ultrasound them quickly for position. In my residency so far I've inherited a good handful of midwife patients (who practice in the hospital), who don't check or scan and we end up sectioning them - sometimes rather quickly as the foot dangles, other times much earlier. So, just wondering if this experience might change your practice, or no? (By the way, I think Leopolds are OK but imperfect. Lots of the ones we inherited are Leopold'ed vertex.)
So, not trying to be inflammatory, but just thinking out loud!
And I just read your previous post (der). You did check her! Happens to all of us. Hence my love of my ultrasound, esp while I still learn...and learn. I can't imagine the terror of losing a breech baby, let alone 2, like in your other post.