Last year, at 37 1/2 weeks pregnant, I had what would be my second-to-last prenatal appointment. I didn’t know it then, but I would later revisit this day and the subsequent decision I made with much regret.
A little back story: When we were interviewing midwives, I expressed my desire to have as little medical intervention during the pregnancy as possible, which included my wish to avoid unnecessary ultrasounds. My midwives (M & C) agreed, noting that they may recommend one toward the end of the pregnancy to determine fetal position if the external manual examination was uncertain.* They noted that this was rare, although throughout the course of the pregnancy, they commented that my [apparently] uber-tight abdominal muscles made it difficult to determine what was where, baby-part-wise.
Anyhow, somewhere around the beginning of the third trimester, M, the midwife I saw for most of my prenatal appointments indicated that baby was head down, just like he/she should be.
And then came the visit at 37 1/2 weeks, and M said that she was uncertain of baby’s position. She went as far as doing a vaginal exam, trying to feel for some prominent part of the skull. When that was also inconclusive, we talked about the possibility of an ultrasound.
Since I wasn’t seeing an OB or working within the traditional medical system, it wasn’t as simple as having the doctor order one, and it wouldn’t be covered by insurance. M gave me a brochure of an independent company that works with midwifery clients who want ultrasounds (I believe this is the place).
As was the case with most of my prenatal care (and as was my wish), M left the decision on the ultrasound up to me, saying I could take a wait-and-see approach, continuing the basic “optimal fetal positioning” exercises and assuming that the baby was already head-down.
I left the appointment feeling disoriented and uncertain. It was one of the few appointments that Matthew didn’t attend with me, and getting and processing the news on my own didn’t help (though I called him immediately after). Two-and-a-half weeks until my due date, and we think the baby is head-down? I wanted to believe that all was right, but . . .
Later that day, I contacted the ultrasound place. They were very accommodating and informed me that I could get a quick, basic 2D ultrasound (plenty of information for determining fetal position) for sixty dollars, and for just a quick peek (and understanding that I was near the end of the pregnancy), they could work me in almost any time.
I said I was still deciding and I would call back if I wanted to make an appointment. I didn’t call back.
A week-and-a -half later, my water broke. Twenty-four hours after that, after transferring to the hospital due to an irregular fetal heart beat, I had that ultrasound. It showed that baby was breech, and over the following twelve hours, I watched my careful plans and preparations for a natural home birth turn into my worst fear: a Cesarean section.
So here’s the thing: if I’d known the baby was breech before I was actually IN labor, we could have tried a variety of methods to turn him. And I could have had that information.
A relatively small step (sixty dollars and less than two hours of my time), could have resulted in a dramatically different outcome and a birth experience that was inline with my hopes. Nearly a year later, I can’t stop ruminating on the what-ifs, even though I know it’s not healthy.
Looking back, I wondered what I was thinking, not scheduling the ultrasound immediately after the uncertain prenatal visit. Was I being excessively frugal? Just lazy?
After more time to reflect, I believe it was a combination of factors. One, I trusted M & C; I guess I thought that if they were REALLY worried that the baby was breech, they would strongly advise the ultrasound, rather than handing me a brochure and leaving it up to me. Two, I wanted to believe that all was well — overall, I’d had a very easy pregnancy and I’d stayed relatively active and done all the things that should have allowed the baby to assume a head-down position (less than 4% of health, full-term babies are breech). Three, I was tired — between work, last-minute baby preparations, and just living life, we were pretty busy in those last few weeks, and I wasn’t feeling the greatest.
Legitimate reasons or no, at the end of the day, I have to live with the consequences and the what-ifs of my decision, and for the past eleven months, that has been a hard place to be.
*Not their real initials
Her Green Life 
we are looking into homebirths now for our 2nd child, and have recently met with a CNM who does homebirths. where did you go to learn more about homebirths? were your midwives CNM or CPM?
I don’t know much about home births in Iowa. We went to a local Friends of Missouri Midwives meeting when we were looking into things. As far as I understand it in Missouri, CNMs only practice in hospitals, they don’t do home births. Our midwife was a CPM. If I had the option for a home birth with a CNM (which it sounds like you do in Iowa), that would probably be my first choice.
Here’s the thing… Hindsight is always 20/20. And it’s not as if something terrible happened. I mean, I know the birth did not go as you wanted or had planned, but you and Gabriel are both healthy and (at least physically) unscathed from the experience.
It’s really easy to kick yourself for something you “coulda – shoulda – woulda” done, but the truth is, even if you had chosen to have the ultrasound, there’s no guarantee that you would have been able to get him turned around, and the outcome could quite likely have been exactly the same.
As difficult as it is, I think that sometimes we just have to accept that some things are simply out of our control. You made the best decision that you could given the information that you had. Sure, maybe you’d make a different choice now if you had it to do over again, but I just don’t think you can or should hold yourself responsible for something that is ultimately out of your control.
I think at some point you just have to “let go and let God” as the saying goes. I mean when it comes right down to it, life is not safe. But you can’t spend your entire life trying to guard against every possibility – because what kind of a life would that be?
And I also have to say it again… it turned out fine. You are OK. Gabriel is OK. Certainly it wasn’t the experience that you wanted, but when you look at the broad scheme of things that can and do go wrong in life, this one is pretty minor.
Hi ho! Just discovered your blog via Simply Bike. Guilt can be a powerful thing for a mom. I have a lot of guilt about the newborn stage of my son’s life when I experienced postpartum depression. He’s 5 now and thriving and I rarely think about the issues I had. Long story short, you’ll get over it eventually :). Looking forward to following you!
Thanks for visiting. I’m sure this will fade with time (and it already has somewhat), but the one year anniversary is bringing some things to the surface. Nothing quite like mommy guilt!
Our mutual friend, Sam, sent me the link to this post. She said thought of me when she read it, and I’m not surprised. I labored at home for a total of about 24 hours, the last four in pushing labor. My midwives couldn’t determine why I couldn’t push the baby past 1 or 2 station. Well, after the surgeon cut me open, turns out my daughter was completely posterior. Despite all the vaginal checks during my labor (which was long but totally typical), nobody caught that she wasn’t in a good position. I’d been in and out of a birthing pool for hours, doing nothing to correct her position, because we didn’t know. To add insult to injury, the doctor, anesthesiologist and one of the nurses were verbally abusive to me and my husband both before and after the c-section.
Yes, we were fine. Yes my baby was healthy. Yes, it was totally traumatic and possibly totally preventable.
I had a really hard time as my daughter’s first birthday approached. And I still worry how the story will shape up when she’s old enough to want to know about the day she was born, because it’s still such a difficult memory for me. I mean, how can the start of her life–something so exciting and wonderful–be tied up with such horrible memories?
It was not minor. In my case or yours. I absolutely hated it when people pulled the “You had a healthy baby, that’s ALL that matters” card. Yes, it’s the most important thing, but it’s not the ONLY important thing. It’s okay to feel bad about it. It’s okay to feel guilt. It’s okay to be completely pissed off. You have a right to feel all the negative feelings, along with the good, about the birth of your baby.
It has gotten better. Time and distance are really all that’s made it better. Attending meetings of the local chapter of International Caesarian Awareness Network has also helped, to a degree. Sadie is 3 now, and each birthday has been easier. I am confident the same will happen for you, with time.
Thanks, Brooke. I’m glad Sam made the connection. Writing this was good for me, but I had doubts about hitting “publish” — it helps to hear from people who understand, though I hate that it means that others have been through a similar experience (I dug up your story on your blog). Though I suspected that time would help, it’s good to have that confirmed.