It’s a Thursday evening at my hospital clinical site. I knew I would probably see 6 deliveries before 8:30 in the AM. My preceptor on this day is Mary. Mary is an incredible teacher and CNM despite only having passed her boards two years before. The two of us have earned the nickname “double trouble” from one of the physicians because well… interesting occurrences out of our control seem to be our norm. I could make a long list of “firsts” that we have experienced together. I have yet to have a dull rotation with Mary. I had just returned to the call room from examining a pt when the phone rings…
“ Hey Jessie,” says Mary, “Come on down to RM 15, we have just gotten a pt in that’s 7 cm, bulging bag and traveling fast. She’s a G3P2 VBAC, 36 and 5, Come break her water and we will have a baby” Off I go, I sure do love this calling of mine!!!!
I enter the room and spy Ana and her husband, I’ve seen them several times for prenatal visits in the office this was Baby Girl # 3 and I had even helped name her “Jennifer,” a fantastic perk of my job. Ana was from Mexico, she spoke enough English and I spoke enough Spanish that we had managed to build a very nice rapport. I was very pleased to be present for Jennifer’s birth
There are several nurses in the room readying for delivery. I lower the bottom of the bed, glove up and Mary hands me the amniohook. Nice hard vertex presentation, large bulging bag, just a bit of an anterior lip, then AROM, and clear fluid. It was going to be easy. Ana bears down, my fingers still in. But… something is just not quite right, palpate around, what is that at 3 o’clock? Lips? Nope. Ear? No. Scrotom? Yep!
I glance over to Mary and in a remarkably calm voice, say:
“Glove up”
“Huh?” says she.
By this time Mary is taking in the rather “unable to ignore” saucer- sized eyes that I’m exhibiting.
“We’re breech”
Mary gloves and examines, “No I don’t think so”
“Three o’clock,” I reply.
“Oh Shit!” she says under her breath.
We were frank breech indeed, RST to be exact.
The nurses begin to scramble, NICU team is called. The physician is notified but in the middle of a section and can’t come, no other physicians are in house. It’s up to us, a fairly new CNM and, me her student.
I’m a girl of faith. I wear around my neck a silver Hebrew childbirth amulet that says “El Shaddai” or God Almighty. I repeat Psalms 121: 1-8 on my way into clinical. I know my help truly does come from the Lord. God is with me in RM 15, I am so very calm. During this birth, I am replaying our section on breech delivery in my head, the one that was on the IP test review recording. I could hear our instructor’s voice on what to do (thank you nice instructor and Ana and her husband thank you too). Above all, remain calm, don’t rush a breech and don’t let the baby rotate into OP.
Buttocks are crowning, I allow birth to the umbilicus and gently place my hands around baby’s hips. Mary pulls down legs one by one, baby emerges to neck, then I deliver arms one by one, shoulders following the Curve of Carus. The room is most definitely at a level of high tension, but I’m not paying any mind, all of my attention being focused on….
Now at the foot of the bed standing directly behind me is Abebi. Abebi is from Nigeria, where she was a midwife, but, here in the US, she practices as an RN. Once we were to the baby’s head she whispered to me “Put your finger in the baby mouth, put your finger in the baby mouth.”( I’ll never forgot those words, or that lovely accent, being whispered in my ear) .Oh yeah, Mariceau-Smellie-Veit, for some odd reason I even remembered the name of that maneuver, I performed it, keeping baby’s head flexed. With the help of suprapubic pressure per Mary, and a little bit of coaxing baby’s trunk up and then down (Curve of Carus) birth was accomplished. Cord was clamped, and baby was taken to the warmer where the NICU team was waiting, Apgars were 3, 7 and 9, EBL 300, weight 6# 8 ( impressive being that Mom was a petite 5.0). By the way, those weren’t testicles, just very swollen labia. It was a “Jennifer” after all.
In review, I realized I was reflexively chewing my gum that I hadn’t had time to discard (perhaps an oral version of a worry stone?), at the time, I wasn’t afraid, I didn’t panic, and I agreed with Abebi who later told me “ A frank breech will often be the easiest delivery you will ever do, no shoulders.” Thank you God for never, ever leaving me and keeping me calm. That first clue something was wrong? The smoothness of the presenting part, I didn’t feel any hair on this baby’s head. With my couple being from Mexico, I was expecting a full head of hair, and when Jennifer’s head finally emerged (last but not least), indeed there was!
By the way, Ana’s perineum remained intact and she was so very happy with her vaginal breech delivery, that when I saw her recently at her PP visit she was still beaming but did request a very reliable method of birth control.
Know those textbook instructions for a vaginal breech delivery, practice them in your head, it’s will happen sooner or later. Also if you are lucky enough to have a Nigerian midwife present, LISTEN TO HER!!!
