Jessica and Chris planned a home birth in New York City. Their midwife was going to cost $6,750 out of pocket. Then they determined that the baby was breech. The midwife had never attended a breech birth and was reluctant. The doctor in NYC who attends vaginal breech birth charges $15,000+ and doesn’t take insurance. What follows is my interview with Jessica, who had a long, stressful, expensive journey that isn’t even an option for the majority of American families.
Jessica admits that her professional and financial resources played a huge role in her birth, but that didn’t make it easy. She says, “Many women experience birth trauma, but I dodged birth trauma after experiencing pregnancy trauma. It is a terrible failure of the medical system that doctors aren’t trained on breech deliveries and so therefore women are forced into major surgery unnecessarily and without alternative.”
Tell us a little about your birth plans.
I have white coat syndrome and just a general anxiety and fear of doctors so a homebirth was always right for me and my husband was fully on board. I had in my head that the only thing that could prevent my homebirth (given that everything with the pregnancy was perfect) was the baby being breech. At my 31 week appointment with my CNM, she said she thought the baby was breech and I burst into tears.
Oh no. Did you try to turn the baby?
After an ultrasound confirmed [breech], I began taking steps immediately to turn the baby, starting with the chiropractor who did the Webster technique–which conservatively cost me $1,000 out of pocket. I went for massages to relax my hips, reiki to focus my energy, acupuncture to stimulate movement, prenatal yoga, and when all else failed we attempted the ECV (thankfully that was covered by insurance). All of those things easily cost another $2,000. I had been planning a home birth the entire pregnancy so that was $6,750 and I didn’t have out of network benefits at the time. When we looked into a breech hospital delivery, the only doctor in NYC who attends breech births doesn’t take insurance and his fee starts at $15,000. And we seriously considered it.
When I had a breech, doing all the turning stuff, I felt like a ticking time bomb, the whole thing a race against the clock. Did you get that?
I myself was born at 37 weeks and my brother at 36 weeks so I always had in my head that this baby would be early. I knew that hospitals prefer not to schedule the ECV before 38 weeks and I felt panicked that that would be too late. I had my CNM request that it be done at 37 weeks and the hospital reluctantly agreed. When the procedure failed, I used my attorney’s argument skills to convince my CNM to trust my body and my birth and she agreed. My water broke two days later at 38 weeks exactly. I believe that my brain was preventing my body from going into labor until that point.
I can imagine being an attorney really helped. Do you think your professional experience has defined your views on maternity care? Did it affect your decision?
I think maternity care should be mother-centric. I think if a woman feels confident that a c-section is unnecessary then that is her decision. If a woman finds out her baby is breech and feels comfortable scheduling the c-section, then that is the right choice for her. The bottom line is it should be a choice. I understand how this failure of the medical system has taken place. C-sections are considered safe and breech deliveries do involve risks. Insurance companies have reason to push hospitals (and homebirth CNMs) into preventing risk. What I cannot accept is how breech delivery became a lost art and how medical professionals can accept having that gap in their knowledge and training. My CNM has had a few breech deliveries since mine and she doesn’t tell the woman what to do; she presents the options and leaves the decision entirely to the woman. But the fact that my CNM now feels comfortable with breech delivery and offers that choice is a huge victory.
That is awesome. Congratulations! And thank you!
She had never attended a breech delivery before and I didn’t successfully convince her that it was safe until I was nearly 38 weeks pregnant. So even with my financial and personal resources, I still came very close to having major surgery. I felt backed against a wall. It was a nightmare.
Yeah, you said you had pregnancy trauma. Can you say more about that?
In general I suffer from anxiety and the pregnancy hormones did not help with that. I shed endless tears from weeks 31-38. I lost countless hours of sleep and took days off from work to do everything I could to turn the baby. In my head, I could not have a c-section. I could not. So that wasn’t one of the options we were seriously considering. We were considering the hospital based doctor I mentioned earlier, changing care to a CNM who attends home births in the Hudson Valley, or arriving at a local hospital during the third stage of labor (pushing) and essentially forcing them to allow me to deliver my breech baby vaginally. None of those options were the clear winner. In the first scenario, we were spending upwards of $15k to have a vaginal delivery and also it was in a hospital. In the second scenario, I would drive two hours in active labor to give birth with a CNM I had met at most once. In the third scenario, I was putting my safety in the hands of doctors who likely had no training or knowledge of breech delivery and who would try everything to force me into a c-section.
When I say it was a nightmare, it’s such an understatement. If I had been less terrified of a c-section, I could have resigned myself to that and just enjoyed the rest of my pregnancy with that new plan in place. But because I wasn’t willing to do what the medical system told me I must do, I spent every single waking hour either trying to turn the baby or talking through scenarios with my husband on how to move forward.
I can relate. What helped you?
We had a doula who I leaned on a lot in those weeks of panic. I did Hypnobabies to prepare for the birth and that is all about taking away any fear and anxiety. So I can honestly say I felt zero anxiety regarding the birth. I was excited for the big event to finally arrive and I was 100% confident in my body. I truly believed that her being breech was a variation on the normal and practically irrelevant.
That’s awesome that you were so relaxed about the birth. So, why do you think your baby was breech?
My dad was frank breech as was my husband, so maybe it’s genetic. Also, the placenta weighed 2.5 lbs so perhaps she just didn’t have room to turn. In the ECV the doctors said they couldn’t move her even a millimeter so I really don’t know. My amniotic fluid was normal and she was measuring at the 28th percentile so I don’t think those were factors. I joke that she just didn’t want to hang out upside down. My hips and pelvis caused me a great deal of pain throughout the pregnancy and the chiropractor said they were misaligned. It’s possible that the issues with those bones (which still exist, since now I am 25 weeks pregnant and again seeing a chiropractor for that same pain) just made it so the baby couldn’t comfortably be in my pelvis. Although currently this baby is head down.
How did the birth go?
The birth went smoothly. The main thing to know about breech delivery is to not interfere when the baby is being born. Her hips were stuck in my pelvis for a bit so we changed positions to free her which worked instantly. As in many vaginal breech deliveries, I delivered her on my hands and knees. It was beautiful and perfect. My husband and I still talk about it as the best day of our lives. Not just because we brought this wonderful new person into the world, but because we persevered over the system. It was a true victory.
That’s awesome. How did your husband feel about it?
He isn’t an anxious person. So he didn’t approach the situation from a place of anxiety and fear. He did a lot of research and felt strongly that the c-section was unnecessary and that our baby would be born safely vaginally at home. He feels that research was mainly his role after we found out the baby was breech. While I cried and panicked, he did research. He is the one who called the NYC doctor and he is the one who calmly laid out our options. He would never agree to an unassisted homebirth so while my mind was spinning and going to that place, he ruled that out. He knew the c-section was unnecessary but since this was our first child we had no idea how the birth would go and it being unassisted wasn’t reasonable in his mind.
He shared the same feeling of injustice that I had and that was vital to keeping us on the same side. Even though I was approaching it from a place of anxiety, he was approaching it from a place of pure research and fact. We both reached the same conclusion and felt the same way. If we hadn’t been on the same page, I honestly can’t imagine how it would have impacted our partnership if I ended up with a c-section and part of the reason for it was lack of support from my spouse.
Your story is definitely not typical. Most people are backed into surgery. Why was it different for you?
When I tell my story, I stress how expensive it was to try to get the baby to turn and then also how expensive the birth itself was. In the end I convinced our CNM to attend my breech delivery but for her to feel comfortable with the delivery, I went for numerous extra ultrasounds which took me and my husband away from work.
All in I estimate the birth cost us over $11,000. And if we didn’t have that money, if I wasn’t an attorney with countless resources, I would have had a scheduled c-section.
I have a lot of anger toward the medical system. The hemorrhaging of money to try to prevent the c-section is a huge part. Not because I resent spending that money but because of what it means for most of America. What percent of Americans could have done what I did, including convincing a CNM who had never attended a breech birth to attend mine? Perhaps .1%? So when someone says their baby was breech and so they had to have a c-section, I understand what they mean because that is essentially true.
Another major aspect of my anger is the lack of respect for my body and autonomy. The doctors who attempted the ECV were beyond rude and dismissive of my homebirth plan. I felt like I did not matter at all and that I was being pushed kicking and screaming into a surgery I would not ever consent to of free will.
The apathy of doctors and the lack of choice—or even respect for your choices is hard. That’s why I do what I do. Thanks to both of you for helping change maternity care! So are you both breech advocates or activists now?
I would say we are both now advocates for breech delivery/choices in childbirth/mother focused care. We donated to the making of the documentary Heads Up (http://www.informedpregnancy.com/heads-up) and we donate to Choices in Childbirth and Improving Birth on a regular basis. I love to share my story with people at their events. When someone tells me it is “amazing” or some variation of that word it gives me the chance to explain why it shouldn’t be and why that needs to change!
Thanks so much for your time and willingness to buck the system. Your story is amazing, but you’re right, it shouldn’t have happened that way.
That’s why we have #breechweek!