Moms&Dads: March 2012

It’s 9 o’clock in the evening on Monday, March 12, 2012, and a 39-year-old mom carrying a breech baby (butt down) who had given birth before by cesarean section because of her baby being breech the first time, is twelve days past her due date, and has begun to have regular contractions. She informs the birth team and continues to rest at her home in Ventura in gearing up for what’s to come.

At that moment, her doctor, Stuart Fischbein, gets a call from his other client, a second time mom living in Hollywood with also a breech baby who is one week early from her due date calls to say that her water has broken. She tells him that she hasn’t been experiencing contractions though, so she too is going to try and rest and will keep him updated with any new change. (However, being a second time mom, it means that when she does start having contractions, she will most likely fly through labor and be ready to push.)

So, crossing his fingers that both moms sleep a little longer, Stuart, not having left his home yet in Westlake (geographically right in between locations of both clients in labor), is trying to rest as well until someone needs him. Who would have predicted that one woman who is one week early, and the other who is twelve days late, 70 miles apart from each other, are in labor at the same time!

Karni, the midwife who will be attending the birth in Ventura as the mom will be birthing at her birth center, calls me to ask me to come up to the birth center just to have another set of hands in case mom comes in, she is ready to give birth, and Stuart is in LA.

As a side note, delivering breech babies is an automatic “no-no” in hospitals these days as the medical community are afraid that once the baby’s body is out, the head will get stuck, the baby will lose oxygen, and need resuscitation and/or possibly die. But with the proper training of delivering the head, one can manage just fine at home.

So, Stuart is the doctor who women go to after their other doctor in the hospital has told them that the only way to deliver their breech baby, twin babies, and/ or someone who wants to deliver a baby vaginally after having had a C-section (VBAC) is by having a (another) C-section. The research shows that each of those conditions, “breech”, “VBAC”, etc. are not in themselves a necessity to intervene, so why do we do it? Ego, fear of litigation, inconvenience, and lack of training…

When these same women don’t agree with that option and are determined to birth naturally, they seek out alternatives. While some midwives are comfortable delivering these “high-risk” babies, it is a pretty politically fucked system and a midwife could simply lose her license for doing it because it’s outside of her scope of normal birth.

So that leaves Stuart. Having been trained over thirty years ago to deliver twins, breeches, and babies born to a mother who is a VBAC is what he knows, trusts, and supports. After being threatened by the medical community while working at Cedars Hospital because he supported home birth by backing up midwives who needed to transport their patients, he took his practice out of the hospital and into the home where his views of birth were clearly supported, encouraged, and practiced gently, safely, and with a lot of love and gratitude.

Anyways, as I am on my way up to Ventura that evening, I get a call back from Karni, telling me, “Well, Sarah’s water just broke”. What this means is that most likely contractions will get stronger and more intense as there now isn’t anything buoying the baby up between its head and the cervix, putting more pressure on the cervix to thin out and dilate for baby to pass through it.

I get to the birth center close to 11 pm and fall asleep in a spare bedroom until 3:30 am when Karni wakes me up to tell me that Ventura mama is going to be coming in in a half hour and that Stuart will also be here around then (as he hadn’t heard back from the LA mom). Stuart shows up around 4 am and sets his birth bags down. The couple comes in shortly after that, she moaning through contractions and her guy bringing their birth kit in from the car along with their other stuff. She gets on the bed and after awhile Stuart checks to see how far along her cervix is dilated. She is at a good 6-7 cm, which is awesome, as she has to get to 10 in order to start pushing the baby out. So, our plan is for her to just lie down so that she can rest in between contractions and switch sides every half hour so that the baby’s head hits all parts of her cervix.

At that moment, his client in Hollywood texts to say she has just woken up with contractions that are about 5 minutes apart. This is where all hell breaks loose!

Stuart, immediately calls another midwife in LA to go to the house in Hollywood to just check on mom and baby to give him an update as he will very soon have to decide what to do.

Here is the predicament he is in: If he stays in Ventura, he will (1) be asking a not so experienced midwife in LA to deliver a breech baby, which could be potentially dangerous. He will (2) be missing his client’s birth, which no one likes especially the mom in labor, plus (3) they are celebrities so he feels like he really has to be there as they will most likely help support him and the word of home birth, etc.

But if he leaves Ventura, a mom who suffered from severe post-partum depression from the C-section she had with her first child could (1) potentially flip her shit on him and make it a very hostile environment and maybe even sue, and (2) leave Karni to deliver a breech baby which she is experienced in, but still it’s a sticky situation for her to be put in.

After Stuart tells the dad the truth of the matter in that he might have to go to LA, the dad has a moment of being pretty pissed, but lets it go, and promises not to say anything to the mom until it was time. Right then, the mom in LA texts to say that her contractions are now one minute apart. Stuart jumps up and says he has got to go! The laboring mom at the birth center says, “Go”, and we had just hoped that he makes it time being that it’s now 6:30 am with impending Los Angeles traffic on the 101 freeway.

The mama at the birth center kept on laboring and was doing great. Stuart calls a little over an hour later to say that he had gotten to the house in time and baby was born about 15 minutes later. He was waiting for the placenta to come out, and to make sure everyone was stable and that he was going to leave the postpartum care of breastfeeding, etc. to the midwife so that he can whizz back up to Ventura.

He got back to the birth center by 10 am with the mom having the same labor contraction patterns - kind of spaced apart and not very strong. But we let her go on walking, getting in the tub, lying down, and nipple stimulation to get the contractions stronger and closer together. In the mean time, we ate, chatted, watched a birth video online, and discussed what we thought was going to happen with this one.

Stuart checks her again around 1 pm – 9 hours from when she first walked in and he checked her the first time – she as around 8 cm. So, in that span of time she had only progressed a centimeter and a half and her cervix was now a little swollen. We know mama is tired and the problem with letting a woman go on when she is exhausted in labor is that she not only has to have the power to push the baby out but also care for it for the next 48 hours straight. One of the main leading causes of post-partum depression is exhaustion – which we were all especially conscious of due to her history. The other problem with a tired body in labor is that the uterus is especially tired, which means less oxygen rich blood getting to the baby and less of an ability for the uterus to contract down after the baby is out to stop the bleeding once the placenta has separated from the uterine wall and there are exposed, open blood vessels. So then you are dealing with a potentially bad situation of mom who is hemorrhaging (bleeding out) and a baby who is possibly unresponsive due to not enough oxygen and needing to resuscitate. It’s an interesting line to ride – one that is careful and done with impeccable judgment.

When Stuart and Karni decide that they have tried everything they can think of, he presents the last trick up his sleeve, which is to attempt to push the last two centimeters of cervix over the baby’s butt in order for her to start pushing. We thought we would give it a go. But as we all sat in that room, mom, dad, and Stuart on the bed, Karni off on one side of the bed, and me on the other, Stuart tells them the situation that is at hand. If pushing the cervix doesn’t work, we have to call it and take her into the hospital to have a C-section (because no hospital would try to deliver a breech, VBAC vaginally despite the fact that she is nearly completely dilated and would just need an epidural to fall asleep for awhile to regain the strength to push baby out). Her guy put his head in his hands and I could see tears running down his face as I am sure he was not only upset to lose this opportunity to birth out of the hospital, but scared for her and of the idea that she could potentially go through the terrible depression she went through before and how hard that was to deal with especially now with two young children to care for.

So, Stuart tries it as she sits on the birth stool but he couldn’t do it as there was way too much cervix to push over baby. That was it. Show was over.

Mama sits there and cries and as Karni helps her up off the stool, she cries harder into Karni’s arms as her guy wraps his arms around her. It was a moment of pure disappointment and sadness.

She did say that all she had wanted was a chance to do it, birth vaginally, which she got and did beautifully, but the idea of going through massive surgery once again and being incapacitated afterward was heart wrenching for her. But, they got their courage together, wiped their tears, and packed up their stuff in the car to follow Stuart to the hospital to finally meet their baby.

While I didn’t get to see a vaginal VBAC breech at home, that whole experience was perhaps much more enriching than to see a normal birth. It was the times of Stuart and Karni trouble shooting every possible scenario and tool to use that were incredibly invaluable for me as a learning student. I was in the presence of such greatness that I felt truly lucky to know this side of life.

As I drove back to LA a couple hours later, I thought about those precious, hair-raising, intense, fragile, empowering and moving aspects of what I had just experienced that were all simply rolled up into just another day at the office.

...Go to this link http://www.birthinginstincts.com/aurora-breech-birth.htm. It's of a birth that Stuart attended which shows the seemingly effortless way of delivering a breech birth. It's pretty crazy. Unfortunately you can't skip right to the birth, so you have to watch a bit of the laboring part - swaying of the hips, big titties - you'll hate it. :)