In rare occurrence, S'pore mum delivers breech baby naturally
With more than nine out of 10 breech deliveries done through caesarean section, having a breech baby naturally is rare. JUDITH TAN (firstname.lastname@example.org) speaks to one woman who did last month
The pain was excruciating and Ms Kim Marie Martin, 38, knew baby Natalie Marie Thng was coming.
What she did not expect was her baby's buttocks to come out first, instead of her head.
It was a natural breech birth - so rare, even some of the medical staff in the operating theatre had not seen one before.
Ms Martin, who was third in the international Mrs World contest in 2013, has two other girls, Desiree Christie, eight, and Beverly Estee, seven.
On Sept 17, the former air stewardess was rushed to Gleneagles Hospital, where she delivered her third daughter, Natalie, naturally.
A caesarean operation had been scheduled for the next day. Ms Martin had known for the past 14 weeks that the baby was in a breech position.
But she was not too concerned at first because she had been told that nearing the end of the pregnancy, the baby would change its position.
A baby in breech position means it is poised to come out buttocks or feet first. This is dangerous because the head, which is the biggest part, might get stuck in the birth canal.
The umbilical cord could also exit first and get pressed between baby and the birth canal.
In both cases, oxygen gets cut off and the baby might die. This is why they must be delivered via caesarean operation. (See report, above.)
"It was just over 12 hours before my scheduled C-section. I was worried because she was still in breech," said Ms Martin.
Her gynaecologist, Dr Christopher Chong, said: "Usually, the baby is in breech until around week 30 when she finally settles head-down. But not for this baby. She was adamant to come into the world butt first."
Despite that, it was an easy pregnancy throughout for Ms Martin.
Ms Martin said that leading up to the birth, she tried several methods to get the baby to turn.
She said: "I did the Elkin's manoeuvre, where I spent 15 minutes every two hours in the knee-to-chest position. It didn't work. Then Dr Chong tried ECV (external cephalic version). That didn't work either," she said.
ECV is a procedure used to turn a foetus from a breech position to a head-down position before labour begins. It is carried out when the uterus is relaxed. With both hands on the surface of the abdomen - one on the foetus's head and the other on the buttocks - the doctor pushes and rolls the foetus to a head-down position.
At about 10pm on Sept 17, Ms Martin was preparing her things for her scheduled caesarean operation the next day when she felt "excruciating" pain in her abdomen.
It became more intense so her husband rushed her to the hospital.
Dr Chong and the nurses had prepared the operating theatre for an emergency caesarean operation.
As Ms Martin was being wheeled there, her water bag broke and she felt a very strong urge to push.
Her labour progressed rapidly and before the anaesthetist arrived to administer the epidural, the baby's buttocks could be seen.
Ms Martin said: "Usually, there would only be two or three nurses in the labour ward with Dr Chong. But because it was an emergency, there was a whole team of eight, I think.
"They were cheering me on.
"When Natalie came (out) after about 50 minutes (just after midnight on Sept 18), the nurses were clapping and crying."
Ms Maria Bituin Lood, 31, one of the nurses in the theatre, said that in her 10 years in nursing, it was the first time she had seen a natural breech birth.
She said: "It was scary and exciting. Dr Chong was very calm and that was what kept the team and Ms Martin going. I gave her my hand to hold.
"There was a time when she wanted to stop pushing, but the nurses cheered her on to encourage her to continue. I'm glad to have witnessed this birth."
Dr Chong said: "It is less than 1 per cent of all live births. It is not without its risks."
Ms Martin said that baby Natalie is being fussed over by her two elder sisters like a new toy.
She said: "When she is older, I will tell her how she came into this world, butt first."
Natural breech births highly risky
Natural breech births like Ms Kim Marie Martin's are highly risky, say obstetricians and gynaecologists here.
Dr Christopher Chong said risks for vaginal breech delivery include lack of oxygen to the brain or death when the baby's head is stuck in the birth canal.
The spine or brain can also be injured due to manoeuvring during delivery. There is also the risk of umbilical cord prolapse, where the cord exits before the baby and gets trapped against the baby's body during delivery.
He said: "Once this happens, and if the baby is not delivered within minutes, there will be foetal distress and death can occur."
In the past 20 years, there has been an increasing trend to perform caesarean deliveries for full-term breech babies.
Here, like in the US, more than nine in 10 women with breech babies deliver by caesarean.
Dr Quek Swee Chong said that if a baby is in a breech position at week 37 or more, a caesarean operation is usually advised.
"Very few doctors would allow a vaginal breech delivery and only in women having had a previous vaginal birth," he said.
What is a breech birth?
Breech means the baby is in a bottom-down position and will exit the womb buttocks or feet first.
Only about three per cent of babies remain in a breech position at the end of a pregnancy.
Baby Natalie Marie Thng was in extended breech, that is, she was in a pike position. This means her buttocks were facing the birth canal and her legs were sticking straight up in front of her body, with her feet near her head.
In most cases, a planned caesarean section is safest.
But in rare cases where a breech labour progresses too quickly, a vaginal birth may be the only option.
1. In an extended breech position, the baby's legs are straight up, with its buttocks facing the birth canal.
2. During delivery, the baby's body is carefully supported
3.Then, its head is gently lifted out of the vagina
More risks as mums deliver later
Singapore mothers today tend to have babies when they are financially and emotionally ready.
Last year, almost seven in 10 babies were born to mothers aged 30 or older. Almost one in fourof the 42,232 babies born here had a mum aged 35 or older.
This trend towards delaying motherhood has many drawbacks. Gynaecologists say the older the expectant mother is, the more likely she has conditions such as diabetes, and high blood pressure, which affects how well the pregnancy and birth goes.
The rate of miscarriage also increases.
By the age of 45, the woman has about a one-in-two risk of miscarrying.
Other pregnancy complications include placenta praevia, a condition in which the placenta partially or wholly blocks the neck of the uterus, interfering with normal delivery of a baby; and pre-eclampsia, in which the placenta is not working properly.