The Birth of Leliana

Jessica with Leliana

Image: Jacqueline Sequoia, used with permission

From Atlanta, back to Asheville

Jessica’s baby remained persistently breech at term, and she was unable to find a provider in South Carolina to facilitate a vaginal breech birth. When she attempted to decline a CS and negotiate a vaginal birth, she was informed that if she came into the hospital in labour, she would be given general anaesthesia and her CS would be ‘a lot rougher.’ (Folks, the ACOG published something just for you: Committee Opinion No. 664: Refusal of Medically Recommended Treatment During Pregnancy.)

This was Jessica’s first baby, in a frank breech position (extended legs), with no additional complexities. Her sister, Family Practice Doctor Jacqueline Sequoia MD, heard about Dr David Hayes and Harvest Moon Women’s Health because they were hosting my physiological breech birth training. Jacqueline includes obstetrics as part of her practice and booked to attend the workshop with some colleagues. Jessica and her husband Brian met with Dr Hayes to consider their options, and once Jessica made her decision, found a rental apartment in Asheville on Craigslist.

Let’s contemplate that for a moment. In order to have support for a physiological birth, rather than the threat of a coerced CS, women are having to relocate to another state and rent temporary accommodation, because the baby is presenting breech.

When Dr Hayes and I arrived at Jessica and Brian’s apartment, Jessica’s labour appeared to be progressing well. As people entered her space, Jessica gradually moved into the tiny bathroom at the back of the apartment, reminding me of Tricia Anderson’s metaphor of cats in labour. I turned off the light. This labour had a journey, as all labours have. Throughout her journey, Jessica was surrounded by people who love her. At the end of it, Jessica beautifully and instinctively birthed her little girl, Leliana, who weighed 7lbs 8oz.

This video contains graphic images of a vaginal breech birth.

Being attuned to the general lack of training in physiological breech birth among health professionals, and the consequences for women and babies, Jessica and Brian were keen to share this video of Leliana’s birth to help others learn. If you would like to read more about the minimally invasive manoeuvres used at the end of this birth, you can read our blog on Shoulder Press and Gluteal Lift.

brian

Thank you, Jessica, Brian, Leliana, Dr Sequoia and Dr Hayes for sharing this video. The link to this blog post can be shared, but the video cannot be downloaded or reproduced without permission.

Shawn

https://twitter.com/jsequoia/status/736602696115879936

28 thoughts on “The Birth of Leliana

  1. Corryn

    ❤ Just so lovely. Thank you so much for sharing!

    Normalising Vaginal Breech Birth, one birth, one video, one amazing woman-baby dyad at a time 😀

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      1. Carole Dodd

        Cool. It was very difficult to tell how baby ‘was’ at birth. Was that a true knot I saw in the still photo at the end of the video?? Lovely cord – lots of wharton’s gel in the cord. We have 1 or 2 vaginal breech births most months where I work. I work just outside of Brisbane, Qld, Australia. Thanks for the speedy reply. Cheers, Carole

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      2. midwifeshawn Post author

        Yes, you saw a true knot. I should also say, of course the cord remained intact throughout the inflation breaths, which undoubtedly assisted her transition as well. Great to connect with other breech providers! 🙂

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      3. Carole Dodd

        Glad to hear delayed cord clamping – I didn’t even think that the cord would be clamped and cut to deliver the assistance. Not like a typical ‘hospital’ birth anyway. Plenty of room for you to do your job. Not a Lotus birth? Love breech births – they are just, well a pleasure to see mother nature do what she does best. CD

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  2. Amy

    That was incredible! Jessie you are one brave lady! I was so relieved when your baby emerged I burst into tears! Thank you for being brave enough to share with the world what real, raw and authentic childbirth looks like … I could feel your pain and was with you, supporting you every step of the way. What an amazing achievement! Best of all you now have a precious person to nurture and enjoy.

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  3. Maryn Green

    Amazing birth, congrats to the mama and to the practitioners who guided her so well, without unnecessarily intervening! What fabulous teaching and learning we have in sweet Leliana’s birth. 🙂 Another tool for keeping the art of physiologic breech birth alive. Thank you!

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  4. Leah

    That was the most beautiful thing I have ever seen in my life. I agree, I was with you every step of the way, even chanting, affirming and telling one of your birth supports to “shut the f – up and stop laughing” lol!!!! I just kept saying “you’ve got this, your beautiful, your amazing” lol – like I was in the room with you. Thank you for not giving into the mainstream narrative on breech birth and birth in general. You are a hero to me and all mama’s out there I am sure xoxoxo big love from Australia

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  5. Maarten

    Brave.. no fetal heart monitoring; Taking all the time in the world after the scapula is likely to be born and the head therefor entering the pelvis and umbilical flow interrupted; Brave not to check for that neither; Brave not to help at all even though the baby doesn’t seem to have any tonus. Brave to trust in nature even though nature does not always seem to care so much for the individual.

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    1. midwifeshawn Post author

      “Brave.. no fetal heart monitoring; Taking all the time in the world after the scapula is likely to be born and the head therefor entering the pelvis and umbilical flow interrupted; Brave not to check for that neither; Brave not to help at all even though the baby doesn’t seem to have any tonus. Brave to trust in nature even though nature does not always seem to care so much for the individual.”

      Hello Maarten —

      It’s difficult to read the tone of your comment. If I could translate it into a constructive statement, I guess it would be something like, “I am concerned about the length of time without a confirmed fetal heart rate. And I am concerned about the lack of intervention in view of the baby’s lack of tone. I would have intervened sooner.”

      And if I were to attend the same birth again, perhaps I would as well. If I have done anything brave, along with other health care professionals, it is exposing myself and my practice to criticism so that we can have open, honest and constructive conversations about breech birth. I am so grateful to the professionals who have trusted me to view their work with compassionate understanding, for what they were trying to do, and what we can always learn to do better.

      Thank you for contributing to the conversation.
      Shawn

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      1. Judith

        Guys; physiological pregnancy, breech, vaginal birth, all fine. On all fours, great! But you need to know your physiology and! your pathology. This birth takes too long – exactly form the moment the scapulae are out. Hold your breath and see how long you would make it from that moment on. Again, nothing wrong with vaginal breeches on all fours – but even then, one can assist. Know your manoevers upside-down and it’s fine. Don’t let the kid hanging – that has nothing to do with physiology. This is a case where physiology turns pathology and it’s not acknowledged nor professionally assisted.

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      2. midwifeshawn Post author

        Guys; physiological pregnancy, breech, vaginal birth, all fine. On all fours, great! But you need to know your physiology and! your pathology. This birth takes too long – exactly form the moment the scapulae are out. Hold your breath and see how long you would make it from that moment on. Again, nothing wrong with vaginal breeches on all fours – but even then, one can assist. Know your manoevers upside-down and it’s fine. Don’t let the kid hanging – that has nothing to do with physiology. This is a case where physiology turns pathology and it’s not acknowledged nor professionally assisted.”

        Hello Judith. To balance your subjective judgements with fact — This is a birth in which the baby was crying vigorously by one minute of age.

        The physiological breech movement has come about in part because women want the opportunity to give birth vaginally, with agency in a mobile position, and they want to know that interventions are truly necessary. For example, physiological breech principles have challenged the notion that episiotomies are necessary for breech birth, that lithotomy positions are necessary, that manoeuvres are necessary in every birth — all of which have been vigorously advocated for many years. The boundaries have changed, and that requires the community of health care professionals who attend breech births to re-learn the boundaries of safety. Births like this, which lie close to those boundaries, but do not cross them, are very valuable to assist learning about how to recognise a birth that may need assistance.

        Some of the important things I’ve learned from this birth are:

        1) How the mothers’ responses in these comments differ from health professionals. I remain committed to balancing these two perspectives with mutual understanding.

        2) How to teach breech novices about tone. In our training days, we do this by playing the last 1:59 of this video alongside one of a baby with excellent tone, to assist pattern recognition. We find visually teaching, establishing patterns of recognition, is essential to enable people to ‘know their physiology and pathology.’

        3) How easy it is to interfere with normal physiology. Towards the end, as the head is clearly descending, someone lifts the mother’s buttocks away from her heels. The video clearly captures the effect this has — to arrest descent of the head and cause it to rise back up slightly. This is because coming out of the kneeling squat position brings the ischial spines of the pelvis closer together before the biparietal of the head has passed them. This lifting of the maternal pelvis away from her heels is a common intervention we need to reconsider in otherwise normal breech births.

        4) How beautifully effective shoulder press is. We find that thorough theoretical, visual (through videos) and practical (hands-on) teaching of manoeuvres for when the baby is facing you (right-side up?) is the most effective way to help people ‘know their manoeuvres.’

        Please can I ask everyone visiting these pages, or any others, to view all videos with compassionate understanding. By all means, offer constructive explanations how you would have done differently and why, so that others can learn. But respect that others practice differently, try to understand why and acknowledge that a safe outcome is a safe outcome.

        We teach approximately 2000 health care professionals how to recognise normal/abnormal physiology and how and when to perform manoeuvres each year, and we would welcome the constructive contribution of any breech-experienced health care professionals to continue developing this course in our contemporary context.

        Shawn

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  6. Maarten

    Dear Shawn,
    Sorry for a long pause in this reply.
    Fair enough: you deserve compliments for showing us your technique and opening yourself to criticism and you deserve positive feedback on it.
    True.. there was a tone of skepticism in my ‘how brave’ comment.
    What i felt watching your video was increasing belly ache and concern about how this baby was going to start life, not about whether it would eventually come out. I am relieved to hear it did well but my concern is.. you had no information (as far as I can see) and the long period of just hanging there was really long and made asphyxia not so unlikely. And yes asphyxia is more common in breech delivery as are it’s complications.
    You then received nothing but compliments on this blog and most of them rather ecstatic..

    Now.. no one can claim to have the ‘right’ technique but there are some physiological points to observe, like the head entering te pelvis and the likeliness of having cord obstruction at that moment. Like Judith put it: ‘try hold your breath from that moment onwards’.

    Obstetrics and its history are full of techniques that were strongly recommended and later abandoned or falsified. And that might lead to the conclusion of ‘anything goes’ and ‘might as well leave nature to do as it does’ but that would be denying the enormous progress that has been made over the last century in neonatal and maternal survival and health. Nature is beautiful but doesn’t care for you; not more than for a butterfly in autumn. (-:

    We had a group discussion recently over fetal monitoring in low risk births and some argued that ‘none at all’ was fine too. Or that it was only acceptable if the mother asked for it. And what to do if the mother refused but the midwife thought it was necessary? I asked: ‘who’s birth is it: the midwife’s or the mother’s? And the midwife said: the baby’s! It is her birthday. But she has no voice.. just a heartbeat. We should listen to that one thing.

    Watching your video and then reading the ecstatic compliments (‘I burst into tears” /. ‘most beautiful thing I’ve ever seen’) made me fear that this was not about technique or discussion, but about ideology. Maybe about redemption. And that I find a bit scary.
    I didn’t have the heart to criticize bluntly and wrote ‘with a tone’. I could have done better.

    To be short: really nice to do this on all fours. Please continue to do so. But please check the baby’s pulse and help it once it’s scapula is visible.. Or when the scapula never become visible because the arms are next to the head, blocking further progress.

    Best regards, Maarten (sorry for language imperfections that might be: not my mother tongue)

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    1. midwifeshawn Post author

      Hello Maarten,

      I appreciate your willingness to engage and be open to how others ‘hear’ you. Most of the comments on this blog are directed toward the birthing mother, from mothers who have heard over and over again that breech birth is simply not possible. The first comment directed toward me as a midwife asked what the baby’s Apgar scores were. It’s so important for us as health professionals to be aware of our feelings while watching births like this, and find the right balance when intervention is necessary.

      I am visiting the Netherlands soon. I will PM you some more information because I am always pleased to continue learning in dialogue with other breech practitioners. This is one video, one moment in time, but more context about the programme we teach may interest you.

      Warm regards,
      Shawn

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  7. Hannah

    Eeeeeeeeewwwwwwwww! It was extra bothersome to me because even as the baby was substantially emerged she was just dangling in/out there when she could’ve been helped along a little quicker with just some gentle pulling from whoever was right there. But anyways eeeewwwwwwwwwwww! Nature in its rawest of forms….brutal shit!

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  8. Jessica

    Random question: Is that meconium coming out in the beginning and when the baby was emerging?
    This is amazing though!

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