Anya Cutler had originally planned to give birth at a birth center with midwives, then at nearly 37 weeks (and after trying practically everything possible to encourage her baby to flip) she ended up transferring care to an OB/GYN experienced in vaginal breech delivery. Anya shares with Adriana how even though this challenged her need for control, having an OB that was comfortable with breech and confident in her ability to give birth made all the difference.
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- Mode of Term Singleton Breech Delivery committee opinion, American College of Obstetricians and Gynecologists
- Heads Up: The Disappearing Art of Vaginal Breech Delivery movie
- Up against a wall: A patient and obstetrician’s perspective on the mode of breech delivery, Birth: Issues in Perinatal Care
- Spinning Babies website
- What Are Leopold’s Maneuvers? VeryWell Family
- Obstetric Analgesia and Anesthesia, from Science Direct
- Paracervical Block, Military Obstetrics & Gynecology
- Latch: A Handbook for Breastfeeding with Confidence at Every Stage, by Robin Kaplan
- Why Breastfeeding Grief and Trauma Matter, by Amy Brown
Related Birthful episodes:
- Baby’s Position And Labor Flow
- What You Need To Know About Birth Models (Birth What?)
- How To Know If You And Your Provider Are Truly A Good Fit
- Cesarean Risk: What’s Your Place Of Birth Got To Do With It?
- Family-Centered Cesareans
- Getting A Good Latch
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[Birth Stories] Discovering That A Breech Vaginal Birth Was Possible For Her
Welcome to Birthful, Mighty Parent or Parent-To-Be. As always, I’m Adriana Lozada, and as we chug right along with our Movement and Body Wellness series, today we’re gonna have a birth story, courtesy of Anya Cutler.
And when Anya reached out saying she wanted to share her story, I was delighted to make it happen because Anya had a vaginal breech birth. If you listened to my conversation with Dr. Elliot Berlin, you know how rare vaginal breech birth has become, since fewer and fewer providers have the necessary skills, even though the American College of Obstetricians and Gynecologists (so, ACOG) have an updated Committee Opinion from 2018 that says that, “Planned vaginal delivery of a term singleton breech fetus may be reasonable under hospital‐specific protocol guidelines for eligibility and labor management. The decision regarding the mode of delivery should consider patient wishes and the experience of the health care provider.” And then also, the Society of Obstetricians and Gynecologists (of Canada) and the Royal College of Obstetricians and Gynaecologists (of the UK) have similar positions. So really the biggest issue is the lack of skilled providers, and because expertise around vaginal breech deliveries is so low, this often means that people don’t have much of a choice and end up with a cesarean. That ends up being their only choice.
Fortunately for Anya though, there were several doctors experienced in vaginal breech birth near where she lived, and so— as you will hear— she was encouraged and very well-supported in her choice.
During our conversation, Anya said that when she was fully dilated, or close to it, her OB gave her “paracervical blocks,” which is an anesthetic to take the edge off the contractions, and that is something that I was not familiar with at all. So of course, I did a little bit of research and found out that these are not necessarily connected to the breech delivery, but rather a more old-school option of pain relief that is very rarely done since epidurals have taken over and are seen as “more effective.” One of the reasons for that is that paracervical blocks only last for an hour or two, where if you have an epidural that is working well, you kind of “set it and forget it.”
Paracervical blocks are not commonly done, but since Anya’s OB was definitely old-school he knew how to do them, so they were a pain option for Anya, and she really enjoyed it. I found it so interesting to hear her share the pros and cons of that experience. I also added a couple of links to the show notes about this practice, in case you want to know more.
You may also remember that I briefly mentioned in Dr. Elliot Berlin’s episode that I had an external cephalic version during my pregnancy? Well, since we were talking about breech babies again in this episode, the topic of external version came up and so this time you’re really going to get all the details of that experience.
You’re listening to Birthful. Here to inform your intuition.
Adriana: Anya, welcome to the show. I am so happy to have you here today!
Anya: Thank you so much for having me.
Adriana: So take us back to when you first found out you were pregnant and you were thinking about, “Oh my gosh, I’m gonna give birth!” What was your attitude towards birth, and what were you hoping for this experience?
Anya: Yeah. So I think I treated birth and pregnancy and parenting like the only way I knew how, which was just to study it intensively. And I think, y’know, while I superficially understood that it’s a process that’s out of our control for the most part, I felt like if I could just read all the books, then I could still control it.
So I read, like, everything I could get my hands on when we got pregnant. And I had, y’know, I think, for the last few years, as I learned more and more about the birth world and modern birthing, I was interested in some alternatives to just the sort of standard medical model of hospital births, particularly with the really high c-section rates.
And because I am a researcher, I did a fair amount of reproductive epidemiology research as a student. And then just in my own sort of personal exploration, read a lot of work on cesarean sections, and risks associated with those, and, y’know, why it is that the c-section rates are so high.
And I just was looking for something that would… I felt would be medically safe, but still let me sort of birth the way that I think I should be able to, in the way that my body has evolved to do. So, y’know, I was looking at the birth center that’s in Atlanta that’s run by midwives as sort of my “ideal” birth set-up.
And I originally started in the hospital, really just for sort of insurance reasons, and they had all the fancy technology to get the best of the ultrasounds and the clearest images of my tiny little fetus… And then I transferred to the birth center at 20 weeks. So I was really planning on an unmedicated vaginal birth in the birth center with midwives and wanted, y’know, lots and lots of time to just let labor happen the way it was gonna happen, and, y’know, let my body push the way it wanted to push. That was the goal.
Adriana: Yeah! And I’m curious because you dove deep and read so many books— were there any that stand out as your favorite?
Anya: Yeah, y’know, it was, it was interesting. I was sort of expecting to really like Ina May’s books and the more sort of “crunchy” Birthing from Within kinds of books, but what I found with those was it actually made me feel like if I didn’t get the birth that they talk about (the unmedicated vaginal birth), that I would really feel like I couldn’t do what my body was meant to do, and that I was somehow sort of a, y’know, a “failure” or a “disappointment.”
And I know that’s not what they’re trying to do— it’s very much supposed to be, like, a, y’know, “empowering”— all of those books are supposed to be very empowering. But I found them for me, personally, to do the opposite, because what I really wanted was just, like, direct information about all the different techniques available and what risks and benefits are of all of those (without any sort of bias to one direction). So I actually found just, like, the straight, y’know, Mayo Guide to Pregnancy, to be the best for me personally.
Adriana: And I had the Mayo Guide to Pregnancy and that was I found it was very much, like, nuggets of information.
Anya: Yeah. Yep, and that’s really what I wanted. And I mean, same for breastfeeding. The one that I liked the best was Latch, which— I learned about Robin Kaplan’s book, that I learned about through this podcast— because I felt like it was just so well laid-out and to the point and non-judgmental. I really liked her book a lot.
Anya: I would definitely recommend that one.
Adriana: Awesome. I’ll link it in the show notes and her episode too.
Adriana: Yes, I’m so happy she wrote that book.
Anya: Yeah, it’s a great one!
Adriana: So then you were set up to do unmedicated vaginal birth— with all the ample time for laboring and pushing however you want— in a birth center with midwives. And you were reading all the books and reading about breastfeeding as well. What else were you doing?
Anya: So I was staying very active. I think that was one of the most important things for me. I walk my dog extensively every day, so I think just staying on top of that, and continuing to get outside was really important for me to be able to enjoy being pregnant because, as my body changed and I became less able to physically do the things that I was used to doing, that became more and more difficult.
So I did prenatal yoga. I jogged through the second trimester and then switched to just walking a lot and yeah. And those were the main things, other than just sort of reading, reading everything.
Adriana: And so then you’re getting further along. Was your baby always breech or was it a big turn towards the end? How did that happen?
Anya: We don’t… Yeah, it’s the big question. So, I would go into my prenatal checkups and when she got big enough for them to start checking the position, they would just, y’know, feel around and say, “Okay, there’s her spine. It feels like her head is down. Those are her feet.”
And they were just super quick checkups and I would go home and sort of be feeling like, “Yes, that’s definitely her spine. Definitely feel her feet over there.” And there was something round, like, down by my pelvis— but at the same time there’s like this big bulge underneath my ribs that would move in a way that, like, if that were her butt, it would just not move that way! And so I never really understood how she was head down, even when they were saying that they were pretty confident that she was just— because, y’know, as I would go throughout my day, it just didn’t feel that way, even though I didn’t know what to feel for. So I just figured… I just was… I had no idea what I was doing and whatever.
And then at 36 ½ weeks, I went in and they just do a routine ultrasound. And I was telling the midwife, like, “I’m not convinced that,” y’know, “she’s in a head-down position, because it just feels weird to me.” And she was feeling a little more closely after I said that and she was like, “Yeah,” y’know, “I think I’m not really sure either.” And so she did the ultrasound, and sure enough, she was breech.
And so then it was just like… it was pretty late at that point. It was 36 ½ weeks. And the longer you wait, the more difficult it is to get them to turn. So, I sort of just went into kind of full-on panic mode to think about what my options were. And the midwife sat us down and she was really great and sort of did her spiel on breech births. And she mentioned that there were two people in Atlanta that did vaginal breech births, and both my husband and I were like, “Oh, no. We don’t wanna do that. That’s dangerous, right?” I think we don’t really know anything about it, but nobody does it, so it must be dangerous. And she was like, “Well, y’know, you can talk to, y’know, one of the docs that does it, and see what they say.”
If we were to stay at the birth center, we would’ve basically been just scheduled for a c-section at their partnering hospital and they would’ve been able to be in the room and do the family-centered cesarean that they do— which, y’know, if I were to have a cesarean, I definitely wanted it to be with them.
So that’s where we were, and it was just kind of trying to figure out if I wanted to just try to get her to turn by doing things like Spinning Babies and lying upside down on the ironing board. Or try an external cephalic version, which is another thing—
Adriana: And let’s talk about “that other thing,” because I had one of those other things!
Anya: You did?
Adriana: I want us to talk about that. We had a similar situation, in that my daughter was always head-up. She was kind of squirmy. And then around the same thing, 35 weeks, she was still head-up and still head-up and my midwife suggested, “Hey, how about a version?” I didn’t get the option, or there wasn’t the conversation about “There are these doctors that do breech.” It was more of, “Well, she needs to flip, or you have a cesarean.” Yeah.
Anya: So the version… I had some sort of conflicting information about it, because my husband was in medical school and he had seen some versions and the ones that he had seen were basically like mom was term and she was breech and they were going to try to do a version, and if the version wasn’t successful, she immediately went to c-section. So it was all done in the OR on the day the baby was born, regardless of, y’know, if the version was successful, they would induce and try and have a vaginal, or they would just go straight to c-section.
But the version I tried was with one of the two doctors that does vaginal breech births and he was a private practitioner who had privileges in the big academic hospital in Atlanta. And he would try versions just in his office, so he was very conservative with, y’know, when he wouldn’t try to push anything where he felt like it could rupture the sac or anything like that.
So he… I went into his office originally thinking I would just try for the version, and if it wasn’t successful, regardless of the outcome, would go back to the birth center. But he felt around and was like, “This kid is just totally stuck in your pelvis. There’s no way she’s turning.” She was, like, way wedged in there. And he knew that, y’know, there he could push a little bit, but there was no way that she was gonna turn.
Adriana: And I think that that’s one of those things with a version, similar to the art of breech— I find that the providers that do them more, have more success rate. And, so the one that I had was because she was always head-up— I think we ended up doing it at 36 or 37 weeks— and it was by an OB who did them often. So he had quite a high success rate for version; I think it was like 60%. And yeah, right, and we went, it was at the hospital, but not in the OR, just in a regular room. And there was the ultrasound just to keep making sure you’d be able to see everything and fetal heart rate monitors to make sure that you could hear the heartbeat and see how she was doing. And I did not… I wasn’t offered an epidural. Well, no, I was offered an epidural— I didn’t want it. I figured “This is fine. Let’s just do this.” And he did it and she turned 360°; like, he pushed her a bit…
Anya: I’m like, “Oh, no.” No, baby. Go back!
Adriana: He was like, “I have never seen this before.” Of course! And so once she settled, they did it the other way. And then she did stay, and then I walked out. I went home and she stayed head down until she was born. She was late a week; so she was at 41 weeks. So, you know this idea of like, “If you have it, let’s induce.”
Adriana: Yeah, I just went home and was fine, y’know, she stayed down.
Adriana: So it’s very… “There is no one way” I think is the important takeaway there, yeah.
Anya: Yep, yep. Yeah.
Adriana: Yeah, he’s in there, “We are not doing this.”
Anya: Yeah, so he… And he was the one that convinced me to do vaginal breech birth— or actually his RN that worked with him, that our first appointment was with, she was saying, I was like, y’know, “I’m open to talking about it,” but I just didn’t think they happen that often. And she was like, “They happen all the time.”
And he had strict criteria that he wanted met in order to try a vaginal breech. So he wanted me to go in and get an ultrasound at the hospital, to look at her head-to-abdomen ratio, because my understanding is that the major risk with breech is the head is the biggest part of the baby, and so if the head comes out, then everything else can come out. And so if you’re head first, you’re good, nothing will get stuck part way out. And if they’re breech, then you might be able to get the torso out, but if the head is that much bigger than the torso, then the head can get stuck, and that’s where you can run into some problems. There are some other things too, but this is my general understanding of, sort of, the major risk of vaginal breech births.
Anya: So, we got an ultrasound and her head-to-abdomen ratio was about 1:1, which is his cutoff for trying a vaginal breech. And just after talking with him, y’know, it seems like he was… he has done lots and lots of them. He is, like, y’know, in his mid-seventies; he’s been practicing for a long, long time.
And I just… I felt very comfortable with him and he just was very confident in my ability to do it, which I think was a big difference, in sort of the way he treated me and how my fear of giving birth in that hospital was, y’know, that I would be a patient told what to do, and he was very much like, y’know, “I’m not going to do this. You are going to do this. This is your birth and you can do it.” And that made a huge difference for me. Yeah, so.
Adriana: Because this meant there was the… not only the switching providers, but also switching facilities—
Anya: Right, right.
Adriana: —with him, it was to the hospital.
Anya: Yeah. And it was… So it was a hospital that my husband has rotated through— and this isn’t, y’know, anything against the hospital— but it was just a very different environment from the one that I sort of imagined delivering my daughter in. It’s just, y’know… it’s very fast-paced, it’s very geared towards higher-risk pregnancies (which, of course, because I was having a breech, I was considered a higher-risk pregnancy at that point).
But it, y’know, it was really nice to have a provider who had privileges in the hospital, but he is known for doing things his own way. Like, I had a lot of friends that had worked with him, during their rotations on the OB/GYN floor, and they said, y’know, “Everyone knows that if it’s one of his patients, you don’t do the vaginal checks every hour,” y’know, “You can have cameras in the room. He just has his own sort of set of rules and is very well-respected.” And so that made me feel much more at ease.
Adriana: And it seems like he practices a bit more of what the midwifery model of care— and not all people who practice midwifery model of care are midwives— and the other way, right? Yeah, I just always need a different name for it. But, yeah.
Adriana: And I find older OBs do that, yeah.
Anya: Yeah, it was funny, y’know— he has elements of midwifery care and then he has elements that are like very… like, he is a big user of forceps, and not vacuum forceps ’cause he’s sort of learned that way and that’s what he’s comfortable with. And he didn’t use forceps with me, but I think, y’know, he doesn’t have any problems, sort of, assisting women.
And he is very, like, y’know, “I can’t let you push in any position you want. I need to be able to do the things that I need to be able to do.” So, y’know, he is certainly… he was very different from the midwives that I worked with at the birth center, but at the same time I still felt like he respected the process, and the fact that this was my process and not his, if that makes sense.
Adriana: Mhm, that does. So when did you decide, “Okay, we’re gonna… We’re all in. We’re doing breech”?
Anya: I think just having the conversation with him and his RN, that made it clear that he knew what to do and he was confident that it could work, given, y’know, that I met these particular criteria, or that it was at least safe to try. And the fact that he has his own way of doing things in the hospital.
Adriana: Does he have a backup? Like, what if he wasn’t available?
Anya: He does not. He is an insane person. So he is his own… He’s the only person in his practice. He has never taken a vacation day. He works seven days a week, all hours. I don’t know how he does it, but he seems to do it. He’s actually really well-known. He’s an Orthodox Jew and he’s delivered pretty much the entire Orthodox Jewish population in Atlanta. And women travel from New York City to deliver with him, because he is sort of so good at what he does, and he’s really well-known for VBACs as well. And so he, y’know, partly is really well-trusted within his religious community, but also with women that are seeking other VBACs or vaginal breech. It’s sort of amazing.
Adriana: Well, I hope that he’s mentoring somebody so that all that knowledge doesn’t get lost.
Anya: He is, yeah. So, he is big. He works with all of the residents that come through. And so he always has a, y’know, a big team of people that he’s teaching for every birth. And so hopefully he will pass on some of this knowledge and skill set to the next generation in that hospital.
Adriana: So you decided you were gonna do this breech procedure with this doctor, and then you talked to him, all of that. The version, y’know, went in for a version, he’s like, “Nope, this is not… I don’t feel comfortable doing this. However, let’s do breech.” So that was around, what, 37 weeks?
Anya: That was it. Yeah, about 37— yeah, almost 38 weeks.
Adriana: Okay. And then you went home and what?
Anya: So we went home and just waited. And then at 39 weeks and one day, I went into labor. So that was… It was, let’s see, the… yeah, exactly, at 39 weeks. That night, I started having just sort of some stomach pain while I was sleeping, and I was in and out of sleep— and for whatever reason I decided in my head that they were gas pains, not contractions. And so I— because that’s just what it felt like to me, for some, I thought that contractions would feel different— and so I was thinking like, “Oh, I’m just constipated.” And so this went on…
Adriana: That’s so you can get more sleep!
Anya: Yeah. Yeah, and it worked. I was able to rest and, y’know, go in and out of sleep because of that. And I’m so grateful, because I had kept hearing, y’know, that the most important thing in early labor is to rest. And I kept thinking, like, “Once I know I’m in labor, I am not gonna be able to rest. There’s just no way.” So I’m really glad that I just had no idea that I was in labor.
And this went into the morning and then around 7:00 in the morning, I woke my husband up and I was like, “We have to take the dog for a walk. I need to see if I can walk through this.” And so we start walking and I’m able to kind of walk through these pains and I was like, “Yeah, these are,” y’know, “This is definitely just gas pain. This isn’t labor.” And I was saying to him, “But it’s good practice. It’s good practice for when I’m actually in labor.” And he was like, “I’m really not convinced that you’re not just in labor…” And so this went on throughout the morning and then I started timing them, these pains, just to see what the pattern was. And sure enough, they were coming, like, every three to four minutes and lasting about 60 seconds or so.
Adriana: So a good pattern! Like, what? What time of day? What time of day are we talking about here, on you?
Anya: So this was like 11:00 in the morning, yeah. So I had, y’know, started having the beginnings of these pains probably about 1:00 in the morning, and then by 11:00 it was like a very consistent pattern.
And we called the doctor and he said to come in. And our friend came over who was sort of— she’s not a doula, she’s had some doula training, but she was sort of acting/serving as my doula-type person— so she came over and we all went to the hospital together, they brought me into triage and checked me and I was seven centimeters dilated and 90% effaced.
Anya: So I was pretty far along, for not… especially for not having realized that I was really in labor.
Adriana: Those gas pains, man.
Anya: Yeah, those gas pains, there were some intense gas pains. But by the— I mean, before they checked me, I was pretty sure that this was the real thing. And then it was just, y’know, probably about that they admitted me around 11:30/12:00.
And then it was, like, probably four-ish hours of just laboring in the hospital room. I had a peanut ball. I had music, which was probably the biggest thing for me that was helpful. I had a playlist that I had worked on for months and months, on of just sort of music that was nostalgic for me. I would really only recommend to people I think that, like, have not, like, just to find whatever music you think will be peaceful, but music that, like, it can be, y’know, rock music or whatever, but just something that is grounding and comforting and you have positive associations with. So I had a whole playlist full of that and it was just so helpful for keeping me calm through the contractions. And I think just being able to stay calm was so helpful for keeping the pain manageable.
Adriana: And so were things… Was it just slowly progressing?
Anya: Yeah. I mean, yeah, not so slowly progressing. So, I mean, after a few hours I was fully-dilated around, maybe four o’clock and ready to start pushing. But my bag hadn’t broken, so the doc had me just try like a small push to see if it would rupture on its own, which it did. So I pushed once and it ruptured, and then contractions got way more intense.
And he uses paracervical blocks a lot. He’s the only person in the hospital that does them and—
Adriana: So what are those?
Anya: Yeah, so that is a long needle that just… you get one injection on each side of the cervix and it just is, like, a local anesthetic that numbs the cervical pain. But you can still walk, you can still feel all the pressure for pushing, and it just takes the edge off of contractions. But when you’re pushing, it doesn’t do anything for feeling all of the pressure in the ring of fire and all of that stuff.
So he had mentioned that as a possibility. And just because I wasn’t gonna be able to move around while pushing because I had to be in the OR to push— the hospital won’t, if it’s a vaginal breech, won’t let you deliver in the regular hospital room— you have to deliver in the OR, and the doc wanted me to be on my back, to be able… so that he could maneuver the baby as she came out, which is, I think, pretty pretty important for vaginal breech births.
So because I wasn’t… I… y’know, it had gotten a lot more painful and I hadn’t started the pushing phase yet. I decided to go for the paracervical block just to take the edge off, and it was amazing. I really wish they were more commonly used because it just made it so much more enjoyable. And I could still feel everything for pushing, and, y’know, I really felt good after getting that. So I definitely would encourage women to ask their providers about it!
Adriana: So tell me more about how the sensations changed once you got it.
Anya: Yeah. So I had my… the pain of my contractions was primarily in, like, my lower back and the sides of my pelvis. And when I got the paracervical block, those just went away. So I couldn’t… When I had a contraction, I felt tightening, but I didn’t feel pain. So I feel sort of all the pressure in my stomach, of her moving down the canal, but the cervix itself was not in pain during contractions.
It’s… That’s sort of the best way that I can explain it. And then as she was coming down, I could feel her getting lower and lower. And then during pushing, I can feel her… I could still feel all of the pressure for her coming out. So it’s really just, like, a very local to the cervix.
Adriana: How long does it last? Does it wear off after a certain amount of time?
Anya: So I think it starts to wear off after about an hour, one to two hours. So I… She was out within an hour of me getting the paracervical block, because I got the block and then basically started pushing immediately and she was out in about 45 minutes. So it was still… I mean, it’s hard to know if it was actually still having much of an effect when I was pushing her out, because at that point it’s not doing a whole lot during the, like, y’know, when they’re really low down and just pushing out, because it’s no longer really, like, the cervical pain you’re feeling.
So what I remember him telling me was (I think) it was about one to two hours that it lasts. And it’s a really long needle and getting the sort of injection and having it actually done was probably the most painful part of labor for me, ’cause the needle itself was really painful, but it was very just very brief during a contraction. He went in and did a shot on each side, and so that really hurt— but it was only, like, y’know, 30 seconds and then it was over.
Adriana: So then are you in the OR by now, or are you still in the labor room?
Anya: Yeah. Shortly after I got the injections, I pushed for maybe about 10 minutes ’til— I can’t say “crowning,” ’cause it wasn’t her head!— but her butt started showing (or close to showing), and then they rolled me into the OR really quickly so I could just push her out. And I was probably pushing for 20-30 minutes in the OR, yeah.
Adriana: And it was that you were gonna be wheeled over to the OR to deliver?
Anya: I didn’t. I did not know that until I was in the hospital, like, once I was admitted, he told me that. And I think… I don’t think he meant to not tell me ahead of time, but just because I transferred to him so late, we didn’t have the sort of time to have a lot of those conversations that he would typically have with people.
And so that was a detail that I was not aware of— and I’m actually glad I wasn’t aware of it, because I think I would’ve been really upset about it ahead of time. But once it was there and it was happening and I could, like, feel her coming out, I didn’t care if I was in the OR at all. I was just really excited and happy and I had had a great labor experience up until then, and really enjoyed the whole process that, like, it just didn’t matter to me that, y’know, everyone was in scrubs and there was a whole team of people running all around.
Adriana: Were you able to still have your playlist playing?
Anya: Yeah, my husband snuck the— I mean, I don’t think it was, like, supposed to not be allowed— but he snuck the speaker in my pillow as we were rolling out of the hospital room, into the OR, so that nobody else in the room could really hear the music except for me, ’cause it was just right under my head. And so I had the music there, but it was, like, very faint to everybody but me.
Adriana: Oh, that’s so great. Good for you!
Adriana: Yes. And was your friend-slash-doula able to go into the OR as well?
Anya: She was, yeah. He was… Normally, it was only one person allowed in the OR at the time, but I think also because they were both medical students and very used to that environment, he was fine with letting both of them in.
Adriana: Mhm. So then the actual birthing, how… I’m curious, well, I mean, you haven’t had another baby, so I can’t, y’know, we can’t compare, like, “Well, how different was it?” or “How did…?” but yeah. How was the experience of her actually coming out?
Anya: It was good. I mean, it wasn’t, y’know, like, I felt all of the pressure— I hadn’t, y’know, had an epidural or anything, so I could feel her come out, but it wasn’t that painful for me. I think my body was just kind of ready to get her out. And y’know, I was… had been really worried about having to push in my back, ’cause I kept reading all these books about how that’s not really the ideal birthing position, but I had no problem pushing her out that way. And you know, like you said, I don’t have anything to compare it to, but it’s still, like, pretty similar to what I would expect with a regular, head-down birth— y’know, there was pressure and then a couple pushes, and then she was out!
Adriana: Yay! Did she get to come directly to your chest afterwards?
Anya: Well, her umbilical cord was pretty short. I don’t know if that had any effect on whether or not she was breech, but, like, they had to… She… I was holding her basically on my stomach and I wanted to lift her up to my chest, but they had to wait for the placenta to come out because her umbilical cord, like, wouldn’t reach up to my chest, for whatever reason! So they… Yeah, they waited to cut the cord, and then I was able to do skin-to-skin briefly. They did a quick newborn exam and then she came back to me,
Adriana: When did you get out of the OR?
Anya: I got out of the OR pretty much immediately. So they did the quick newborn exam. They brought her to me. I don’t know, we were probably in there 10-15 minutes while they stitched me up. I had a second degree perineal tear, and then once I was stitched up, I got to go back to the regular hospital room.
Adriana: So that first hour, even though you were going from one place to another, you guys were still together quite a bit?
Anya: Yeah. Yeah, we were together the whole time, basically. Yep. They never took her more than, like, five feet from me. And that was for a very, very brief period of time.
Adriana: So how were you feeling?
Anya: I was feeling amazing. I felt… Yeah, I felt really good. It was such a… like, such a high. There’s nothing really quite like it. And I was just so, so happy that I had been able to have the vaginal birth. I was really feeling really proud and relieved.
And, y’know, I’d done so much reading and heard so many stories, I kept wondering what it was gonna be like for me— if I was gonna be able to handle the pain and everything. And I just felt really lucky that I had had, y’know, a really positive experience despite having to change to the hospital and everything like that. So just a lot of relief, a lot of happiness, a lot of excitement.
Adriana: What would you say was the hardest part of this whole process?
Anya: I think, y’know, going into it feeling like it was… I had had a really easy pregnancy and everything was going really smoothly, and then all of a sudden having to switch to the hospital that I had been trying to get out of, and to a male OB/GYN, which I never thought I would use— y’know, I really wanted to birth with female midwives originally! And I think just sort of letting go of the idea that this process was under my control and learning to still try to feel positive and like it was still my birth and my experience, despite these changes.
Adriana: Do you have some words for other people who are out there, y’know, facing a similar situation?
Anya: Yeah, I mean, so I think my experience with switching to… having to switch to the hospital, I had struggled with similar issues when I had problems with breastfeeding, which is another sort of story where I expected things to go one way and they went another way. And y’know, I think probably my best… What I’ve learned myself is just to understand that there’s so much variation in everyone’s experience, and just because it’s sort of different from the traditional ideal birth that you sort of come up with in your head, does not mean that it can’t be a totally beautiful, incredible experience, and exactly sort of what you imagined just in a, y’know… with slightly different lights and a slightly different team around you. And, y’know, I… yeah, I think that it’s just important to know, that it’s not the details that matter.
Adriana: Yeah, and I completely agree in the sense that one of the things that I tend to do with my doula clients during prenatal is we, y’know, do the birth plan and we go through all that process, but even more important, one of the exercises we go through is— and I ask this of both the birthing person and their partner— of to give me three words of how they want to feel during the experience.
And then we talk about what are some ways we can get them to go back to feeling that way if things aren’t going as they’d like? And because at the end, it’s how you feel, how you’re treated, how you know that’s what you’re gonna remember of the experience more than, “Oh, I was in this room or the other room, where I got in the tub, where I didn’t.”
Anya: Right. Exactly. Yep.
Adriana: Was there any other part of your story that you wanted to make sure we got to that we didn’t?
Anya: Yes. So one of the other major things I did want to talk about was the breastfeeding piece. Just because that was actually— y’know, you asked me what the hardest part about everything was, and if you’re including postpartum in that, that would be by and large the hardest part of all of this for me.
So when my daughter was born, she was born hungry, and she latched immediately, which was really exciting. And I think I was just so enthusiastic about that, I was happy to just kind of let her hang out for as long as she wanted. And her latch was just slightly shallow. And I think also just because I wasn’t used to it, she ended up staying on for like six hours, without really much of a break. And I ended up having a lot of nipple damage because of that. I was… had cracking and bleeding. And I did not have a lactation consultant work with me right away; they didn’t come in until the next day after she was born. And by that point I was, like, pretty badly injured. And they were able to sort of deepen her latch just enough that it didn’t hurt after sort of the initial latch.
But I was… I had so much damage done at that point that I really needed a break to let my nipples heal, without having to feed her every, y’know, two to three hours as you do for newborns. So what ended up happening was I went to a lot of lactation consultant appointments over the next couple weeks and saw, yeah, five different lactation consultants.
And they had me go to exclusive pumping in order to let my nipples heal, and then give her what I could pump, and then supplement with formula, And the pump wasn’t properly fitted for me, and so it wasn’t efficiently extracting milk. And I got mastitis, and I ended up never really being able to build up my supply the way I needed to because of all these various barriers. And she was sort of getting more and more used to formula, and we were having to feed her more and more. I also tried the supplemental nutrition system— where there was a tube from a bottle of formula that went, and one end was in a bottle and the other end was attached by the nipple and she would breastfeed— but she would basically mostly just get formula. So she would still down her full two ounces of formula without actually getting much from me.
And so it just ended up being a situation where I ended up having to exclusively formula feed her ’cause I just kind of dried up after, oh gosh, two and a half, three weeks after she was born? And so that was, I think, the hardest part for me, because I was really sort of counting on breastfeeding as being a huge part of my bonding experience with my baby and was really looking forward to it. I, y’know, had… That was the one part of all the books I read that I skipped, was the formula part because I was like, “I know breastfeeding’s hard, but I’ll do, it so I don’t need to read this.” And so that was a huge, huge emotional adjustment and challenge for me during the first month, was sort of coming to terms with that.
Adriana: I can totally hear and appreciate that this was very emotionally difficult, because yeah, breastfeeding is, like, the biggest second hurdle. That, and sleep, right?
Adriana: It’s the hurdle, of that we think, “Oh, it’s just gonna happen.” And it would just happen if we were living in conditions that supported that biology: y’know, like, sleeping all together and didn’t have to go to work and, y’know, just with our baby. And we would see breastfeeding happening around us all the time. And we would have people around us go like, “Oh, no. Wait, let’s scoot this baby in.” But we don’t, so there’s a gap there, and it doesn’t just flow.
But you were counting on this to be part of a bonding experience. How were you able to shift that and what were other ways that were helpful to bond with your child?
Anya: Yeah, I love that question. So I mean, for me, I think a big part of what helped me through it was also… was understanding just the science of breastfeeding and what the studies show, because she happened to be born right before breastfeeding month kicked in. And so every morning I would get like an e-mail talking about how breastfeeding is so much better than formula feeding— which was not fun when I was going through that.
And so I just sort of went back to the original studies— and this is not at all to say that breastfeeding isn’t great— but to realize that formula feeding your child is not going to automatically make them at super high risk of, y’know, all of these things that they say that breastfeeding improves (so, y’know, obesity and all of this stuff). There are lots and lots of studies showing great benefits of breastfeeding for, y’know, ear infections and allergies and all of that stuff, but it’s such a small relative risk that it doesn’t mean that your baby’s not gonna be a perfect, happy, healthy baby if they’re formula-fed. And so that was just a really good resource for me, to realize that, y’know, my child was not gonna be at a huge disadvantage just because she was formula-fed. So that was a big thing.
Adriana: Yeah. And there’s a lot of guilt associated with that. And it’s… I think it’s just how you were talking initially about Ina May’s book and Pam England’s book— like, it’s not intentional. Biologically, breastfeeding provides all these other things— but that doesn’t mean if you don’t get it, that we are not resilient beings and able to adapt. And there’s so much that goes into it, and epigenetics and microbiome and other bonding relationships.
Like, yeah, it would’ve been better if she got breastmilk. And I feel, like, confident saying that, not to guilt you into it, but because I had a very similar experience with my child and I ended up exclusively pumping, which was the worst. The worst!
Anya: Yeah, yeah, yeah.
Adriana: And my cutoff was at six months. I was like, “Okay.” When she started eating solids, I was like, “Okay, I’m done!”
Anya: “We’re done.” Yep!
Adriana: “This is my boundary. This is as far as I’m gonna go.” So yeah, I can totally appreciate all the feelings that come with that.
Anya: Mhm, yeah. Yeah. And, y’know, you’re asking about sort of other ways of bonding with her. And I think for me, y’know, I was having trouble bonding with her even when I was breastfeeding, ’cause I was in so much pain! And we were doing this crazy thing where I would try and breastfeed and then my husband would give her a bottle while I pumped every two to three hours around the clock. And I just was either pumping or breastfeeding all day long— like, I never got a break. And that was just… That was so difficult, and it really interfered with my ability to bond with her because I just couldn’t enjoy any time with her, because I just felt like I was sort of a dairy cow.
And y’know… and then my supply was just going down and down and down. So every time I would pump, I would see the volume decrease and that was just so depressing. And so I think, y’know, just being able to switch to the bottle, even though I felt really guilty, but at least that gave… that freed up time where I could just, like, look at my child and be like, “Oh, look at this,” y’know, “beautiful child that I made.” And that in itself, just having the time to be able to do that and the freedom to do that, made a huge difference in being able to bond with her.
Adriana: Oh, absolutely. It’s so tough. It is so emotional, the whole thing. What have been three sanity savers for you?
Anya: Oh, just getting outside, I think, was the biggest thing. So, I mean, that kind of went hand-in-hand with the carrier, but, like, we went camping and I think I was really nervous about that, just because I felt like we shouldn’t be camping with a two month old… But we just did it and it went great! She, like, slept through the night in the tent better than she sleeps at home and, y’know, we just did the things that we needed to do and, y’know, worked her into it. And I am so grateful that we took that risk at a young age, because I feel like the older they get, the more into a routine you get and the more scary it is to break that routine.
Adriana: I’m so glad you had that experience because, yeah, during those first three months, they’re way more portable and fall asleep more, y’know, anywhere— easier than they do when they get older and start being more mobile. Yes, absolutely.
Anya: Right? Yeah. So I think just, y’know, taking that time to get out when they’re that age is so important. So I think… Yeah, I mean that’s been the biggest thing. Getting outside has been a huge help for mental health.
Another thing is family visiting— coming and visiting and helping. I’m a person that really likes to have full control of what I’m doing, and my house. And, y’know, I love having family come to visit, but I, like, oftentimes want things done sort of my way and whatever. And the idea of having a lot of family come in to help was very overwhelming to me when I was pregnant, ’cause I was like, “Well, what if,” y’know, “I think I’m just going to want to bond with the baby,” and, y’know, just… and, y’know, do vacuuming my way and do dishes my way, or whatever. But especially with the breastfeeding struggles, like, it was such a lifesaver to have people around. So I think, y’know, not being afraid to take people up on their offers— like, my mother-in-law kept saying, y’know, “I’m happy to come down anytime you want,” and, y’know, “Just let me know and I’ll fly down,” which was so nice of her. And it got to a point where I was like, “Yeah, actually, can you come down, like, tomorrow?” And she did! She came; she had just been there, like, the last week, but she got right back on a plane and came down for, like, five days when we were sort of in the middle of, like, the hardest of the breastfeeding stuff. And it made all of the difference just to have that extra set of hands there, to, y’know, hold her and change her and help with dishes and buy food and stuff like that. So taking people up on their help when they offer it, y’know, and just relinquish control was a big thing!
And then the other big thing was letting people bring food. Instead of a baby registry, with our friends here, they did a meal train. And just having people stop in and say “hi” and having some social interaction— just really brief social interaction— and having them bring food was such a nice also just emotional relief, y’know, that’s more also a physical thing (the food part). But also just being able to have those, like, little conversations with friends and see them sort of throughout those first few weeks was huge.
Adriana: Yeah, and without any obligation to it, of, like “Yay, thanks for the food! Bye!”
Anya: Yeah. Yeah, exactly. And, y’know, they knew that that’s what… y’know, they were here to drop off the food. They talked quickly and then, y’know, they were on their way! And it was great.
Adriana: Well, thank you so much, Anya, for doing this today. It was so good talking!
Anya: Oh, thank you. It’s been such a pleasure. I really enjoyed your podcast all through pregnancy, and so it’s so fun to be able to share my story with you. And I really appreciate all that you do for women in birth and their experience, and all birthworkers. So thank you.
That was research analyst Anya Cutler, who studies health disparities in marginalized populations, effective communication of scientific findings and uncertainty to the general public, and colorful data visualization. Since we spoke, Anya has had a second daughter, so big congratulations to her!
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Come back for more ways to inform your intuition.
Lozada, Adriana, host. “[Birth Stories] Discovering That A Breech Vaginal Birth Was Possible For Her.” Birthful, Birthful. January 18, 2023. Birthful.com.
About Anya Cutler
Anya Cutler currently lives in Portland, Maine with her medical provider husband and two little girls. Since Anya first shared her birth story, baby Ada has grown into a very energetic, active, and happy… big sister! They welcomed Ada’s favorite human, Lena, into the world in July 2022. Lena also had an eventful birth, but in quite a different way. She was not breech, and though Anya had planned on delivering at a local hospital with a midwifery group, after a month of intense Braxton-Hicks and a few days of prodromal labor, Lena was born by unplanned cesarean two weeks early. Baby Lena weighed 4lb 6oz (despite Anya’s fundal height having measured small, ultrasound had not provoked cause for concern), and the placenta showed signs of damage, possibly from when Anya had SARS-CoV-2 around 30 weeks of of pregnancy. Lena had to spend two weeks in the NICU to put on some weight and get her blood glucose and oxygen levels stabilized, but has since been doing great, and is growing well! Anya did have some lactation challenges again, having struggled to establish a full milk supply, but was able to meet her goal of primarily feeding her baby human milk, with some formula supplementation.
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