Midwife Hands as Tools :  Being Touched by Breech

Maybe we have to turn things upside down in this world to rediscover it.  These baby’s that are breech are teaching me more about babies that are head down.  They are teaching me about how to feel and touch and feel the changes from being touched.  Touching lightly, with finesse, or even boldly.  There is an environment that I affect in that touch and connection and it just isn’t inside the person I am palpating, but it is reflecting inside of me.  

What is it about working with families with breech presentations that really calls to me?  Is it just that I had a baby that was breech whose feet hit the floor before her head was born?   Is it that I see a lack of resources for these families where many are discounted and some are in trauma groping for answers?   I can sit with that and be present and hear them beyond fixing things.  What are they really looking for beyond the natural or vaginal birth?  How can this experience be a way to connect as a family?

 Is it that I’m rediscovering my hands as tools?  They are tools that may not have been as sensitive.  Tools learning about the body in ways that I wouldn’t otherwise have learned, because I hadn’t been searching for some kind of answer to a puzzle of something that didn’t have to “be fixed” in the first place.  The breech doesn’t need fixing either, and I know that.  There just isn’t cultural support for this option.  People are desperately hoping for change of this baby’s position to make their lives easier and avoid surgery and interventions.  They are having to navigate a system that is typically inadequate for the kind of compassion and skills that are quite useful for all pregnancies much less breech.

What are we really learning when we palpate?  The basics of the baby’s head and bum and back and movement.  Maybe we can find the shoulder and the lie of the baby along with the angle and confirm with a fetascope.   We put it together like a puzzle.  I’ve had several families come in who were in hospital care with midwives recently and they had never had their belly’s touched by having hands feel their bellies.  They may not have had such an experience over their pregnancy.   

Of course. We feel the baby but not just the shape or its location, but we connect.  I still have joy when I touch a belly.  A lightness in my soul.  I still get surprised for that fleeting excitement when I introduce myself even when I’ve been introduced before.  “Hello, little baby.”  I smile.  I can’t help it.  I see you with my fingers and hands.  Yes, I am near or in your space.  How do you feel about this?  It is so nice to meet you.  

But there is something extra going on at this visit with feeling.  Some would call it assessment.  Others tracking.  Tracking down the patterns of space and patterns of restrictions and fluid.  It seems so basic.  Can we feel the restrictions?  Can I feel anything or is it restricted everywhere and tight?   

And then there are still the times of unknowing, and I’m becoming more comfortable with that too.  My hands sometimes don’t know.  And on this journey, I may have actually become less confident with palpation.  Do I assume breech until proven differently or the other way around?  Do I assume absolutely nothing?  I have felt the exceptions for what didn’t feel like breech that I would have missed.  I have been so bold to tell someone the baby was head down when they arrived just to have them come back later after confirming I was wrong.  Those are learning experiences of the trickster breech and the forever learning midwife.

 I don’t have an ultrasound machine to confirm presentation.  I’ve thought about it.  A quick scan to check to verify where the head might be.  But what might I lose?  Will I become deskilled and lose this learning curve and not hone this connection to my touch? Could that space of not knowing be valuable to the parents after leaving the office  I’m not saying that they should worry or not have a piece of mind.  In fact, when I am sure the baby is head down with my hands, the parents many times don’t really believe it until it is confirmed unless they are already in midwifery care.  How does this place of unknowing (yet having more tools for coping after the visit) serve them?  How does it change them to just experience or talk about tools for preparing for a cesarean or know now that vaginal breech birth exists even if it isn’t for them or even just be exposed to the midwifery model of care?

Many come to see me only once.  Some twice.  Some come another time just to talk and be validated.  They may have decided to get off the crazy hamster wheel of trying to turn this baby and just be present.  They’ve decided to come and be witnessed for that choice.  Some will do this and even drive an hour.  They don’t need to be palpated.  At that point, they know where the baby is and will be.  They have come to be heard and celebrated for listening to the baby.  Maybe they are choosing to go into labor before a cesarean or plan a vaginal breech birth.  They come to connect. 

It is through the art of feeling with these traditional tools called my hands that I’m realizing how much I don’t know.  I sometimes think I’m crazy that with touch, movement, the rebozo, and a willingness to engage without judgment that I can affect change….  soften, lengthen, distribute fluids more evenly, warm, hold, connect, feel.   With breech I’m seeing more polyhydramnios, various uterine shapes that are called the same thing but feel nothing alike, restrictions from working out, laxity of tone from previous twins or multiple pregnancies.  These are all opportunities and gifts to learn from babies and parents alike.  It may seem like upside down learning, but really it is all a matter of perspective.