With deference to J.R.R. Tolkien
In a house on a street there lives a family. Not a cluttered, crowded condo filled with noisy neighbors and parking lots, nor a cold and rigid hospital with nothing in it to eat or to bathe in. It is a family home and that means comfort. In a neighborhood of grass and trees at the end of a street, a cul-de-sac they call it. It’s a place called Irvine and in the house lives a mother and a father and a daughter.
Mother is a psychology professor, Father a gastroenterologist. They were expecting their second baby in a little more than two weeks. It was an uncomplicated pregnancy, healthy and receiving good prenatal care with her obstetrician. Then one good morning their peace was disturbed by an unexpected journey. Was it a good morning or a morning to be good on or, perhaps, just good that it was morning? No matter in any event because their path was changed forever for they were informed that their baby had decided to turn footling breech. Now all would prefer a calm and predictable course through pregnancy and this couple was no different. Nothing exciting or unusual is expected in Irvine, California. Like Hobbits, pregnant couples and their practitioners do not like excitement or surprises.
This was not anticipated. Change is very difficult especially for the well organized and planning professional. So they did what we all might do at this time….panic! Then they settled in to do some browsing and seek information. “Breech deliveries are dangerous. No one does them anymore”, they were told. If the baby doesn’t turn then we will schedule a cesarean for Thanksgiving weekend. They tried the usual positioning maneuvers and several chiropractic adjustments. Conversations with baby were, sadly, unproductive. Their physician offered and performed an external cephalic version. She tried a backward roll. She tried a forward roll. Momma even begged her to try a third time all without success. A noble effort but Baby decided that he liked his foot just where it was.
However, once the information door is opened and you set your foot out on the road you never know where it will take you. Referred by Cathy the doula, Mom came a calling on me for a consult on November 12th at 38 weeks. We spent an hour or more reviewing her history, discussing all her options, answering questions, looking at baby on ultrasound and getting acquainted. Baby’s foot was still presenting but I felt confident it would not stay that way. Now it is also not in the nature of Hobbits or Humans to adapt easily. If baby’s foot were to move then would Mom and Dad accept a breech vaginal birth? Her first delivery was uneventful so the chance of success was enhanced. But we were not talking only about a breech delivery but a breech delivery at home! Talk about disruption and stress at a time usually reserved for nesting and resting.
Over the weekend we waited to see what baby would do and on Monday it seemed baby was determined to keep his foot down. Dad was uncertain about a home birth anyway. Most institutional physicians would certainly be uncomfortable with this option. But Mom absolutely did not want a cesarean and the idea of a home delivery was beginning to grow on her even though that foot was still lurking out there. What we needed was a wizard. Fortunately, here in Southern California we have our chiropractic Gandalf, Elliot Berlin, D.C. One visit with Dr. B and confirmed on ultrasound one week before her due date, on November 20th, her baby was now in the frank breech position with flexed head and meeting all the criteria for selected vaginal breech delivery.
Mom was very excited. Dad, well, not so much and still in need of some convincing. Time for a home visit on Sunday, November 23rd. Braving the beast that is the unexpected LA traffic my midwife colleague, our student and I made the trek to Irvine. Surprisingly, no traffic orcs were encountered and the journey took less than an hour. Portable ultrasound showed the active baby’s feet up by the head. We spent over an hour with this family reviewing the literature once again and all of Dad’s questions concerning my experience and reasoning were answered. We could feel his confidence building and, therefore, Mom’s comfort growing. Now at 39 ½ weeks all we could do now was wait. Still, the cesarean loomed on the horizon and was scheduled for 3 days hence. But there is always hope! With that in mind the team made the trip back to Los Angeles in the late afternoon.
Comfort and confidence play a very important role for a successful pregnancy and labor and cannot be understated. Too often they are ignored or at best downplayed. Fear and anxiety predominate in the culture and have taken root in the medical community. When adversity such as breech presentation presents itself too many succumb to those fears, see it as hopeless and wish it had never happened. Here, the wisdom of Gandalf speaking of misfortune is vital, “So do all who come to see such times but that is not for them to decide. All we can decide is what to do with the time that is given to us”. This couple made an informed decision to do just that. And so….
Just before midnight that very same evening I received a call reporting the leaking of clear fluid. Within the hour her contractions started and there was a sense of urgency in her tone. Even though the contractions were not that strong and only 6 minutes apart her intuition told us to come. There and back again we went, arriving around 2:00 AM on November 24th. Maybe it is a coincidence that she went into labor just hours after her home visit but I do not think so. I think she and her husband finally felt safe. This is not the first time I have seen labor in a breech mom start within hours of the home visit. Feeling safe permits the intellect to rest and allows the instinctual to come forth.
At 3:20AM, less than 3 hours after her labor began we welcomed a baby boy from an all fours, hands off, frank breech delivery. Doula Cathy, Grandma and Grandpa along with Dad were awed and Mom was incredibly happy that she got the birth she wanted. Her husband, the conformist, and her father, who she labels the non-conformist, both very smart, were raving about the birth and calling me a genius. In gratitude I replied, “Thank you but what I do is basic logic and ethics and not rocket science”. Mom replied, “That’s the genius of it – the simplicity that all the other OBs have missed!” I have to say that the team was honored to be a witness to their trust and accomplishment. Holding her baby on her chest in her bed she was radiant. The visual was a triumphant culmination of a tumultuous two weeks. She kept saying she couldn’t wait to call her OB in the morning to cancel her cesarean section scheduled in two days!
From The Shire, to Rivendell to Irvine wisdom comes from experience of the open mind and is allowed to blossom in free society. Ignorance thrives in the fear and darkness of Mordor and some halls of academia. This couple, encountering an obstacle they didn’t intend, believed in themselves and in what their birth team represents and achieved a dream. Dreams, like prophesies, can come true. When returning home after his great adventure to the Lonely Mountain, Bilbo Baggins still seemed surprised that such a prophesy could have happened. Gandalf once again reassured him saying, “And why should not they prove true? Surely you don’t disbelieve the prophesies because you had a hand in bringing them about yourself.”
In a house on street there lives a family. In a neighborhood of grass and trees at the end of a road, a cul-de-sac they call it. It’s a place called Irvine and in the house lives a mother and a father and a daughter and a new baby brother, now four where there once were three. They are home! It is a family home and that means comfort.
Happy Thanksgiving to all,