External Version Day

At my 37 week midwife appointment, I was still breech. So, after much research and discussion between ourselves and with our midwives, Tim and I decided to schedule an external cephalic version at the hospital for Tuesday morning. We knew the risks. I read all the statistics and studied the drug that would be involved. I watched videos of the procedure being done on other women, and we felt confident that we were making the right decision, especially for the long-term of our family, this baby, and our future babies. 

We checked into the hospital at 8am. I tried to push down negative feelings about the intimidation of the triage room and the mystery stains on the hospital gown I had to wear. 

Being in a hospital is kind of like landing on a foreign planet. Everything is unfamiliar and so many factors remain unexplained because the staff is just too busy to help you understand. I had to get a blood typing test even though my blood type was written on my chart. I couldn't drink water but had to get an IV put in my arm just for fluids. I brought my own tank top that covered much less surface area than the baggy hospital gown but couldn't wear it...not sure why. And all of this comes under the bigger umbrella of the thought: "what are they really going to do to me?"

I knew that for this particular procedure to actually work, I was going to have to relax my mind and muscles and be as docile and compliant as possible to let the powers that be put their hands on me and move my baby within me. Oh, the tug of war in my mind as we waited. I got hooked up to a fetal heart monitor and we started the mandatory two hours of monitoring before the procedure.

Thankfully, I had Tim with me. I held onto his arm and his good-natured optimism and light heart. We drew on what we learned in our birth class about deep breathing and relaxation techniques. He talked to me about happier things and the beach and made me laugh so hard I gave myself contractions that went off the grid of the monitor (exhibit A right above). 

Eventually our Obstetrician came in and we got some real human interaction with her, which was awesome. She did an ultrasound and together we learned some good details: no part of the baby was engaged in my pelvis, and I still had pockets of amniotic fluid to give them some free room in maneuvering the baby around. I knew these factors contributed significantly to the success rate of the external version, so knowing this really helped me feel better.

Our doctor had to rush off but we soon got a visit from a kindred soul. Gayle, one of my midwives, was having a crazy morning delivering babies too but she came to check on us and talk to us about what was going to happen. She let me know that they were going to give me an injection of Terbutaline, a drug to relax my uterus, immediately before they started the procedure. It would make me shaky and anxious and increase mine and the baby's heart rates and I might find it hard to breathe...yikes. Since I was going to have three people working on my stomach, the only place for Tim was at my feet and he could give me a foot massage to try to help me stay relaxed throughout the version.

Suddenly, the tiny room was full of people. Gayle, our obstetrician, a nurse, and a new male doctor I had never met before. And another unidentified woman who came and left a few times. I quickly figured out that the man in the room was a medical student who was learning this procedure from our OB. Deep breath...I so didn't want me and my baby to be a practice subject under these circumstances, but there was no time to talk about it and I really do value the education process that doctors have to go through. We need good, experienced doctors so badly in this country. So I forced a smile and shook his hand. He took my left side, and the women stood on my right. They lowered the head of the bed until I was totally flat and gave me the shot of Terbutaline in my thigh.

I've wondered how much to share about what happened next. It was very difficult for me to endure, and it's a painful memory now. Suffice it to say that I had three people pushing down, pulling, fisting, and wrenching on my abdomen and my baby with all their might for about six minutes. It was much more painful than I expected and very frightening, and it just felt wrong for them to be handling my baby like that. I didn't make it to the end without breaking down into big embarrassing sobs. It was so hard to stay relaxed for them, to even stay still on the table for them, but I knew it was so important to try to breathe deeply for me and the baby until it was over. I was aware that it was working, the direction of their hands on the baby told me that. I felt so bad for Tim having to watch it all happen, because if it had been me at the end of the table I wouldn't have been able to hold myself together while watching him go through that.

Finally, they let up and confirmed with ultrasound that the baby was head down, but the baby's heart rate was not good. I heard little snippets like "he's not happy", "put her on her side", "get the oxygen" and I just knew we were headed next door to the operating room for an emergency c-section. But we didn't. Within seconds (that felt more like minutes) of me taking long deep breaths into the oxygen mask, the baby's heart rate was back to normal and everyone relaxed and started celebrating the success of the version. There were high fives with the staff as a nurse wrapped my torso with a corset-style velcro binder to keep the baby in place. I tried to be happy, but in the moments after the procedure I just kept thinking "I made the wrong decision. I shouldn't have put my baby through that. A c-section would have been easier for him or her."

Gayle stayed back for a while to comfort me and outwardly validate what I had been thinking. "It's so hard...I know you're normally so gentle with your baby...it just seems wrong...I know...but your baby is already fine, look at this awesome heart rate...you're going to have bruises..." I appreciated her care more than I can say. As soon as she left and it was just me and Tim again, I fell apart in his arms and just wept. Why couldn't I feel happy that we got exactly what we hoped for? I started to realize that I was trembling all over and I couldn't catch my breath through all the crying. It was the Terbutaline. I was anxious, my heart was racing, I was having every side effect that Gayle had prepared me for. It helped a little bit to know that I was feeling the effects of a drug, not necessarily all of my own faculties. So I just laid there and cried it out and waited for the tremors to pass. They let me drink water so I tried to flood and flush out the Terbutaline.

We had to do two more hours of monitoring to make sure the baby held on to his/her good heart rate. It was really comforting to hear the steady beat through the monitor. Slowly, I started to feel better and come back to being my real self. Our nurse brought me some food and encouraged me to eat, and I did. 

By the time we were ready to leave, I was able to smile again and sincerely thank Gayle and our nurse (the doctors were long gone) for everything. I could walk, get myself dressed, leave the hospital, and climb the three flights of stairs back up to our apartment all on my own strength. By the evening, I was feeling the positive effects of having the baby in the right position. I could breathe easier since the baby's head wasn't pushing up on my lungs. I was feeling kicks and little feet poking into my side, which was so welcome. I started to think again about how we could have a natural birth.

I'm still very sore from the actual procedure, but the all-day every-day Braxton Hicks I've been having since 34 weeks are basically gone. Last night Tim and I went out to dinner and then Christmas shopping until 10pm, something I haven't felt like doing for the last month because the contractions were so strong at night that sometimes I couldn't stand up straight. I'm glad now that we did the external version and I can stay pregnant as long as the baby needs me to (we would have been scheduled for a c-section at 39 weeks). I don't feel like Tim, me, or the baby is ready for birth before my due date and I even hope we go a little over. I'm not sure why, it's just the general sense I have about it.

If you or someone you love is considering doing an external version, I have some really useless advice: if it works, it's totally worth it, and if it doesn't work, it's not worth it at all. On the day it happened, I told my sister that I wasn't sure I would recommend this procedure to her if she was in my position, just because I wouldn't want her to go through the fear and pain of the procedure, but the farther away I get from the experience, the happier I feel about the outcome...it was just really hard while we were going through it.