Sarah's VBB.png — Now this is not one we get to hear about very often... Vaginal Breech birth (VBB) is quite rare — many women are unable to find an experienced care provider to support them if their baby is breech, to birth vaginally.
This is mostly linked to vaginal breech birth being viewed unfavourably after a large study conducted in 2000, known as the ‘Term Breech Trial’, which concluded that caesareans were a safer mode of birth for breech babies — however numerous inconsistencies with the methods, design and conclusions taken from the trial have since been identified.
But despite that, it has resulted in a decline of VBB and a lack of experience and training for doctors & midwives.

Sarah’s story is a really inspiring one, I love how open and honest she is about how tough she found it to advocate for herself, but how ultimately she did just that! The strength and belief she had in her body, plus a wonderful supportive care provider who shared that trust and who viewed it through the lens of excitement rather than fear.

I’d love to leave you with Sarah’s words as I simply love her message and I think we need a HELL yesss to it!! (also Sarah - you actually ARE a superwoman🦸).

“I don’t feel like I’ve done anything super amazing. At the end of the day I am a woman who birthed a baby. But what I am proud of is listening to myself & my baby. Asking for help & questioning the medical professionals who were caring for us. If anything, I want all women who have read this to know you have a choice. You can challenge the system & seek out other options so your making an informed decision about you and your baby.”
“Because birth is important and the way we birth our babies, matters.”

AMEN 🙏🏼.... And a very big thank you to you Sarah, for sharing your story so generously.

Check it out below.

Sarah’s story

My pregnancy and birth of Isabelle has taught me a lot about myself as I never knew I had the strength and courage to trust myself and to trust my body. I have always been a huge supporter of women and their choices during pregnancy and birth. I have strived to support women and advocate for them to ensure they are making an informed decision regarding the care of themselves and the care of their baby. I never thought I’d be on the other side of it. I never thought I would have to challenge the system so I could fight for what I knew was right for me and my baby…

3-4% of babies are diagnosed as breech at term. A high percentage of these babies are born by caesarean as it is deemed the safest birth method for both mother and baby. Breech babies being birthed vaginally is rare as obstetricians are becoming unskilled in this type of variation of normal birth. I wanted more from the medical system that I am a part of as a midwife and to be given a chance to birth my baby in a way that is deemed unsafe and has a high chance of morbidity and mortality for the baby. It is so rare that in a hospital which has thousands of babies born each year, approximately four of these babies are birthed vaginally.

This is my story of my breech vaginal birth of Isabelle.

My pregnancy with Isabelle was textbook. I did suffer from some morning sickness and fatigue in the first trimester and had days of pure exhaustion as being pregnant and chasing after our two young daughters took its toll on me. Some days were hard and some days were a breeze. It wasn’t until late in the third trimester that my little babe decided to challenge me.

At 35 weeks I knew Isabelle wasn’t cephalic (head down). I was exceptionally uncomfortable and voiced this to my GP/OB who, on palpating my tummy, agreed with me. An ultrasound confirmed her lie as transverse, which meant her body was lying across my abdomen, head under my right rib, her back along the top of my uterus and her bottom under my left rib.

I knew she had time to turn as being my third pregnancy allowed her some extra space to move around. Following the ultrasound I began to utilise my knowledge on optimal fetal positional to try to encourage her to turn. The Spinning Babies website is a very informative website which aims to educate women, couples and birth workers with many techniques and exercises to help babes be in the best position for birth. I also reached out and spoke to other midwives for advice to help turn her.

I focused on my position and posture, drank raspberry leaf tea to help tone my uterus and borrowed an exercise ball to literally roll around on to allow my baby space to move. At my 37 week appointment I knew Isabelle had changed position however I also knew she wasn’t cephalic. My GP/OB again agreed with me and this time an ultrasound confirmed breech with her legs tucked up under her bottom. She still had time to turn, I was remaining positive.

Feeling Isabelle may have been breech prior to the ultrasound, I had discussed with my GP/OB the potential of having an External Cephalic Version (ECV). An ECV is a manual procedure where an obstetrician will use his hands to help turn a baby to cephalic. This is done wit the use of an ultrasound to confirm position of the baby before and after the procedure. The optimal time for this procedure is between 36-37 weeks. As I was already 37 weeks my chances of having one were minimal however my GP/OB called me two days later as he had organised for an obstetrician who was visiting my local hospital that day to review me.

I felt very hesitant as part of me wanted to leave things be and hope my baby knew her way. The other part of me was thinking this is an opportunity that I couldn’t refuse as it might just work. I quickly phoned my husband Nathan, my sister and my good friend who is also a midwife to get their advice and to also reassure me. They all encouraged me to attend the hospital and to have a chat to the obstetrician. If I then felt it would be worthwhile then why not try? I agreed and headed up to the hospital. The obstetrician reviewed me and felt I was a good candidate to try. He confirmed she was still breech by ultrasound, covered my tummy with gel and began to move Isabelle. I tried to relax as best I could but it was very painful. I actually underestimated how painful it would be. She was very stubborn and it took a little time but he was able to turn her cephalic and the ultrasound confirmed she was head down. When I saw her head sitting in my pelvis I felt so relieved that I cried tears of happiness. It had worked! I stood up from the bed and helt a huge Braxton HIck which wasn’t unusual for me and I didn’t think anything of it.

I wandered around to maternity as I was to have a CTG for an hour following the ECV to check Isabelle’s wellbeing. When I laid down on the bed so the midwife could put the CTG on me I felt a familiar feeling. My heart sank, I knew she wasn’t cephalic anymore and I asked the midwife to palpate my tummy. I was right. She had moved, and she was breech again. The obstetrician came back to review me and was disappointed the EVC hadn’t been successful.

He said my only option now was for me to plan a caesarean section from 39 weeks. After he left the room I was so overwhelmed that I broke down. I was heartbroken. I couldn’t believe that Isabelle turned back and that now my only option of birthing her was by a caesarean. After two normal vaginal births I was now going to have to have a caesar.

As my midwives consoled me and spoke of the positives of having a caesarean I thought to myself how can this be? How can I not have any other options? Why is my baby being so difficult? What is wrong with my body? Why is this happening to me? After an hour I felt defeated. The CTG was normal trace and Isabelle was perfectly well. I was able to leave and I couldn’t wait to get out of there. The experience had rattled me. The fact it didn’t work, that I had even allowed it to happen and now I was suffering with intense abdominal pain from the procedure as a constant reminder of it being unsuccessful.

It took five days to fully recover from the ECV and every single one of those days I was worried. I was continually questioning myself and talking to the other supportive people in my life to figure out what I was going to do. Do I keep trying to turn her? She has a 1% change of turning at term, maybe she will? Should I follow the obstetrician’s recommendation and have an elective caesarean? Should I stop being so stubborn? Or should I refuse a caesarean and seek out someone who is willing to allow me to try for a vaginal breech birth?

I continued to focus on turning Isabelle so I started visiting the chiropractor who worked on my body and attempted to give her space to move. The chiropractor was proficient in the Webster technique which has been proven to help assist babies to turn by massaging ligaments around the uterus in an attempt to release tension and relax them, which then aids the baby to move. I had many sessions and even though things looked promising she didn’t turn.

My GP/OB called me a few days shy of me being 39 weeks pregnant. He wanted to meet with me to start making a plan to birth my baby. I didn’t want to see him. I didn’t want to make any plan. I wanted to avoid it all and hope she would turn and I could have my normal birth. I had been an emotional wreck and his phone call left me feeling more stressed out than ever before. I was constantly thinking about my options. I was educating Nathan on the pros and cons of both a caesarean and a breech birth. He was hesistant for a breech birth but I couldn’t shake this feeling that it was the right thing to do. That this baby should be birthed this way. That maybe she was trying to teach me something. After many discussions, Nath was on board with any decision I made and he said that I knew what was best for me and our baby and I had to trust myself. It was a Friday and my GP/OB visited my whilst I was at a midwives appointment. I was 39 weeks pregnant and feeling very vulnerable.

When I arrived I spoke to my midwife about getting a referral for a second opinion and to see if I could have a vaginal breech birth at Ballarat Base Hospital. When my GP/OB arrived and after a lengthy discussion he said I could book in for my caesarean the following Wednesday. Just like that! It was all too easy and I lost it! I couldn’t believe that was it. There was a space for me on the teahtre list and all I had to say was yes… but I couldn’t. I couldn’t even visualise myself signing the consent form for an elective caesarean. I was emotional and overwhelmed yet again. My midwife spoke to me and said to the GP/OB about a referral. My GP/OB did seem keen on the idea but he said he would refer me that afternoon and I could discuss with them my options. He insisted I make an appointment on Monday so I could make my decision by that afternoon so things could be organised for my potential elective caesarean on the Wednesday.

I took the weekend to rest and think. Think about my options. Think about what I wanted and to accept that my baby wasn’t going to turn. I had been so focused on trying to turn her that it was time for me to accept that she wasn’t going to. I needed to change my focus and I did that by planning to birth her the way she was telling me to.

On the following Monday I was 39 + 3 and heading to Ballarat to be reviewed by an obstetrician about the possibility of a vaginal breech borth. I was refreshed and ready to discuss my options so I could make an informed decision about the way my baby was born. At my consultation I was assessed and my tummy scanned to determine what time of breech position Isabelle was in. The obstetrician sat me down and said, “So, there is an obstetrician who is working on Wednesday and he things you’re the perfect candidate for a vaginal breech birth. He is positive it will be a success.” She explained to me that the obstetrician is very skilled in vaginal breech births and the only thing is I would need to be induced as he is only working for a 24 hour period. I was shocked. I was sure she was going to say no but she was positive all would go well and that I should pat myself on the back for even having the consultation.

A fire lit up in my belly. I finally had hope! I was excited! I explained everything the obstetrician spoke to me about to Nathan (he was unable to attend the appointment due to COVID restrictions) and he could see my excitement. He felt that was a great plan and that we had to do it. We had to try. I phone my GP/OB and told him the consultation had gone well and I was going to try for a vaginal breech birth. When Nathan and I arrived at the hospital we asked how many vaginal breech births the hospital has and the midwife said about four a year. We looked at each other in disbelief. This is very rare. We were going to attempt something very special.

I settled in for the night. I tried to get my head in the best frame of mind and stay positive. I had to try surrender myself to the process. Believe in myself, my baby and my body and stay calm. I met the obstetrician on the Wednesday morning and he oozed positivity. I was placed in birth suite for assessment and for an artificial rupture of my membranes to commence labour. It was unsuccessful. My cervix wasn’t ready for labour. He suggested some Prostin gel to start the process and he would review me in six hours. If my cervix wasn’t showing some signs of change then he would have another attempt of artificially rupturing my membranes. If there was no change then we were starting to run out of time and a caesarean was a real possibility. Those six hours were tough. My cervix was irritated from the medication and my emotions were all over the place. I worried about the next assessment and if there was no change then we were off to theatre to have our baby. Nath kept telling me to stay positive.

At 1pm the obstetrician walking in to say he had good news for me. There was another obstetrician who was starting when his shift ended and he was also proficient in birthing breech babies and was happy to care for me. I couldn’t believe my luck. Maybe this was meant to be. It gave me more time which made me more emotional as I had already accepted we might be going for a caesarean that afternoon but in fact I could have more medication and continue on with the induction. He reviewed me and there was some change but not enough for an artificial rupture of membranes so I agreed to a second dose of Prostin gel.

He then discussed with me the potential of a balloon catheter being inserted into my cervix and the registrar would assess me later than evening and make that decision. When the obstetrician left I said to Nath I will be seeing that man later on and he will be there to help me have this baby. I think Nath thought I was losing my mind.

I possibly was. Nathan went back to Ararat to be with our girls and I spent the evening uncomfortable and exhausted. I tried to rest. I showered and I covered myself in essential oils to help calm me. I had my crystals close by which I had used throughout my entire pregnancy. The registrar came to review me at 10:30pm and I agreed to be assessed. She explained it would be best for the balloon catheter to be administered so my membranes could definitely be broken in the morning. A balloon catheter is a soft silicon tube with two small balloons on the end which is placed on either side of the cervix and inflated with sterile water. The pressure of the balloons then help to gradually thin and open the cervix.

I consented and she went ahead with the procedure. The pressure on my cervix was instant and I began to have tightenings. At this stage, I wasn’t in a great headspace and I had no idea how I could continue. The beautiful midwife caring for me that night could see I was struggling. She displayed true kindness to me. She showed me such compassion that it filled me up again with hope.

She encouraged me to stay focused and made me feel supported and that I was worthy of this birth and that I could do it. She helped me relax and then tucked me into bed.

I felt so empowered afterwards and I tried to get some sleep in between my tightenings that were increasing in frequency. After 90 minutes of the balloon catheter being in place my waters broke. 12:30am and it was go time! My contractions were immediate and I was having 3 of them in 10 minutes.

A wave of adrenaline took over my body! This was it! It was really happening. My girl was on her way. I phone Nath to come back to Ballarat. He was ecstatic! My beautiful midwife was beaming with excitement and I told her it was her fault my waters broke because she made me relax and refocus. It’s all I needed to do. She placed me into a birthing suite and under the light of a salt lamp I focused my mind. I needed to calm myself and surrender to the contractions and let my body labour. I had to surrender myself to my baby and trust she knew her way. I repeated to myself “stay calm, you can do this, trust my baby, just surrender…”

The obstetrician who I farewelled earlier that evening returned to review me. He was smiling from ear to ear and couldn’t wait for me to birth my baby. He knew I could do it! Nathan arrived and the obstetrician assessed me. I was 5cm dilated and it was only 2am. My contractions continued and I began breathing on the nitrous oxide to help relieve the back pain I felt during each contraction. I remained active by walking around the birth suite and standing at the side of the bed. I felt comfortable. Nathan was by my side supporting me.

A few hours later I was starting to tire and I laid on the bed to allow my body to rest. With this my contractions slowed and I drifted off to sleep in between them. I remember my body feeling so heavy, so tired and that it was important I rested. I also remember waking to see the sun was rising and the obstetrician was in the room to review me.

I heard him say to the midwife “She is exhausted,” and I was. My labour had become quiet as my body rested but I felt the urge to push. I knew I wasn’t fully dilated as I had felt this feeling twice before with both my girls’ labour. I knew I was 8cm dilated and I was. My obstetrician asked me “Where have your contractions gone, Sarah?” I said I don’t know. He said “What should we do?” I replied “Put synt up” and they did. Syntocinon is a synthetic form of oxytocian which is administered intravenously. It helps to stimulate contractions. It was 6am and he said he would be back to review me at 7am and we would see how things were going.

With my contractions intensifying again I had to calm myself. Having had syntocinon before with my first daughter’s birth for the exact same reason, I knew it would overwhelm me. I breathed through each contraction until the urge to push took over my body and I began involuntary pushing just before 7am. The obstetrician assessed me once more and said “It’s time! Let’s have this baby!” I was in disbelief! Everything that had happened over the last few weeks. The highs and the many lows we had gone through and the time had come. It was time to birth my baby.

Nathan was right beside me and away we went. The contractions took over my body and I began to push. I could feel a change in my body with each push but I couldn’t feel her descending. I continued to listen to my body and go with what it was telling me to do. I tuned into the guidance of my midwives and the obstetrician and after a few minutes of pushing, there was a foot. A perfect foot with five tiny toes emerged. The obstetrician was surprised as the presenting part at full dilation was her bottom, not a foot. Her foot had slipped through my cervix as I pushed.

I continued to work with my body and then her right leg appeared and then her left foot. In no time at all her lower body was birthed. I continually kep asking where we were up to. I’m trained to deliver breech babies and I understand the mechanisms of a breech baby’s descent through the birth canal. I’d also watched so many videos leading up to Isabelle’s birth that I needed to visualise her body so I knew were we were up to as I couldn’t feel her like I had her sisters who were born cephalic.

After a few minutes her body descended more and her shoulders and arms were next. This was a little challenging as my sweet girl had her arms above her head (not down by her side or across her chest as most breech babies do). The obstetrician was able to guide her with some slight maneuver and her arms were birthed.

I could then feel pressure down below and I knew her head was next and with the whispers of my husband in my ear and with one huge surge I pushed as hard as I could, the hardest I have ever pushed before and she was born. She was placed on my tummy for a few seconds as I sobbed uncontrollably in disbelief that she was here. She was here. She was safe and I was ok. We did it!

Isabelle was taken to the resuscitate and be reviewed by the paediatric team who reassured Nath and I that she was doing well. She was a little stunned at birth and required some oxygen within the first few minutes of her life when helped her to breathe up and cry. The paediatricians decided to take her to the Special Care Nursery for observation and to monitor some swelling she had to her bottom and to both of her legs and feet. Nathan went with her and stayed by her side until I got there.

When I got to the nursery I was able to pick her up and immediately do skin to skin. It was so important for me to get to her as we had been separated for over an hour. She latched immediately to my breast and fed. She remained in the nursery for another hour and then we were able to take her back to my room. We spent the rest of the morning and the afternoon snuggling our girl, sleeping, feeding and sharing our news. I also kept her undressed so we could do as much skin to skin as possible. I was recovering perfectly and Isabelle was cleared from the paaediatricians the following morning. We were able to be discharged home and we were so excited to bring our daughter home to meet her sisters.

My pregnancy and birth of Isabelle has taught me a lot about myself as I never knew I had the strength and courage to trust myself and to trust my body. I have always been a huge support of women and their choices during pregnancy and birth. I have strived to support women and advocate for them to ensure they are making an informed decision regarding the care of themselves and the care of their baby. I never thought I’d be on the other side of it. I never thought I would have to challenged the system so I could fight for what I knew was right for me and my baby…

Thank you so much again to Sarah for sharing her incredible story!

Much love -

*Information shared is of a general nature only and is not medical advice — please see your own care provider for specific and individualised information and advice. All personal stories & photos shared with permission.

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