Foot first: A breech home birth from the perspectives of mother and midwife

AIMS Journal, 2026, Vol 38, No 3 AIMS Journal, 2026, Vol 38, No 3

When Hannah found that her second baby was breech she was forced to reconsider her home birth plan. After doing all she could to turn her baby and an unsuccessful ECV, Hannah weighed the evidence and decided to have her baby at home. With the support of Frankie, a consultant midwife, they talked everything through, followed all of the safeguards, and made careful plans. In this article, Hannah and Frankie recount what happened on the night of the birth.

^{Frankie (left) and Hannah (right)}

By Hannah Northern Thakur and Frankie Kilmurray

Hannah’s perspective

I woke up the day of the birth yet again feeling disappointed that my baby hadn't arrived overnight. This had been a pattern for about a week.

That morning I had a bit of time to myself and I sat for a while in the ‘birth room’ reading the affirmation cards I’d made with friends. I meditated and practised breath work for quite a while, trying to relax and connect to my baby. I practised breathing patterns that might be useful in labour, visualising myself giving birth there in that space, and then I got up and did quite a physical yoga practice, lots of stretching, hip opening and squats.

Later, I went for an appointment at the maternity day assessment unit to recheck the baby’s position. I remember feeling very crampy. I wasn’t able to sit comfortably so I paced up and down, quite uncomfortable but feeling happy. The cramps were really ramping up again, which was good news. During the scan I asked quite a few times about where the feet were. I felt that was important to know before labour but it wasn’t really obvious - noted as complete breech.

I asked for a vaginal examination because I just wanted to know where things were at. I was found to be two centimeters and soft stretchy. I felt good about that, but at the same time worried that, because I’d been having cramps on and off for a week by that point, labour may never properly kick off and this would be as far as it got.

When I got home, I spoke with Frankie to update her after my appointment and confirm I still wanted to plan for home birth. To tell the truth, at that point I was feeling in two minds about staying home or going into a midwife-led unit and in a sense looked for reassurance from her. I really wanted someone to tell me I wasn’t completely mad to stick to the homebirth plan. I remember Frankie confirming that a home birth would be supported but also saying, “I can't promote your homebirth” and at that point I thought “okay, I get it”. I found that helpful and accepted that no one can tell you “you’re not crazy”, you just have to know that yourself.

We had dinner and then got my three year old daughter ready for bed. I lay with her for a while and fell asleep but was woken up by a very sharp stabbing sensation in my cervix. This was different from the cramps up to that point, a sharp almost popping sensation that seemed actually audible. It literally jerked me out of my doze. I thought my waters had gone so I jumped out of bed to check, and felt mystified to find no evidence of this.

8.30 pm

Another pain hit me so I went downstairs to speak to my husband, Bittu. “This is different. I think maybe it's happening”, I said, and then another one came. These were sharp pains, not crampy more like ‘sudden pain’ that took my breath away. I couldn't really speak through them and paced around the kitchen feeling restless and anxious about what was to come. Then I went to the bathroom. I remember shouting for Bittu to come in because I just felt really afraid to be alone. The contractions were taking me by surprise; they were so intense that I felt scared of them and I didn't want to be alone in case another one hit. Then back to pacing the kitchen and standing at the kitchen island (where I think I spent about 2 hours bent over in total).

9.00 pm

We timed a few contractions but only 3 or 4 because it was so clear they were a couple of minutes apart and roughly a minute each. We called my parents and they came to get our daughter. I was leaning over the island and I remember my dad standing at the bottom of the stairs behind the glass door. Even though he was only there for a moment, he glanced at me and I think I was in the middle of a contraction; I remember an odd and uncomfortable feeling of being ‘seen’. It really brought home to me the importance of feeling unobserved in labour because even Dad’s fleeting glance made me feel very exposed and vulnerable. It was a relief when they left because I didn't feel very in control by then. I was already quite vocal through contractions and had been worried about my daughter waking up and finding it stressful.

I remember not wanting Bittu to go anywhere. I asked him to tidy up some of the building things in the corner before people arrived, and then no sooner had he started doing that, I summoned him back to hold me or to put counter pressure on my back! He contacted our doulas, Miri and Letty, saying “Hannah is scaring me now, please come”, and Miri was there by 9.30, helping to bring some calm. Around that time we called triage. I was standing at the island; things were very intense by that point and I was struggling with the pain. I threw up in the kitchen sink and was feeling very out of control. I couldn't breathe through the contractions, it was so different from my first birth which had been a slower build, very well managed with breathing. This time around, there had been a very long latent phase and now it was ‘all systems go’ as if a switch had been flicked on. I certainly couldn't do my timed breathing as before, just very vocal exhales. I fixated on this a bit and I kept saying “why can't I breathe through them why can't I breathe?”. I found that quite stressful because it wasn't what I’d expected. I felt like I was doing a bad job and as if I was failing and succumbing to overwhelm.

When we were on the phone to triage I was leaning over the kitchen sink and I couldn’t really talk. There was some reference to an ambulance and the midwife asked if I was pushing. That snapped me out of my other world and I panicked a bit. I shouted to Bittu “Tell them I'm not pushing, just tell them that they don't need to send an ambulance, just midwives, I'm definitely not pushing. I’m fine, not pushing!!” Soon after that, the first community midwife arrived. She helped to calm me down and reassured me I was doing fine.

Interestingly, despite feeling stressed and anxious, I don't think I ever questioned being at home. As soon as established labour began I felt I was in the right place. Things were happening pretty quickly and I certainly didn't feel any desire to change location, but I did feel nervous and scared of how things were going to go.

10pm

Frankie arrived and gave me a hug when she got there. I remember that moment so clearly, a point of real human connection. I was in a place of pain and anxiety, and I felt myself regrounding. A contraction hit at the same time so I couldn't even return the hug properly, but I really remember how much that hug mattered in that moment. After that, I could see Frankie there on the other side of the island looking at my birth plan and I thought to myself, “Okay let's do this….I'm here, I'm most definitely in labour. Frankie’s here. It’s time to stop thinking and to just get on with this. We’ve created the conditions, done our best, my body knows what it’s doing and the rest is up to baby”. It was a moment of internal calm, gratitude for getting to that point, for being at home, and surrender to whatever would happen next. A ‘time to let go’ moment.

Bittu and Miri were preparing the pool and I had heard them say something about blowing it up more and asked a bit irritably, “Is there actually any water in the pool yet or are you just blowing it up?” There was a suggestion that it would be a good idea to go upstairs. As they gently ushered me away from the island, I knew that I was ready to be in the pool.

10.30 pm

By this time I realised that the number of people and the different voices downstairs was making it hard to focus and that I needed minimal disturbance. When I got into the pool, we limited the number of people in the room and I often found myself shushing, either to anyone speaking or even just to myself, a sort of self-soothing. I also remember a huge relief when someone turned off the main light in the room, leaving just the calming glow of my Himalayan Salt Lamp.

I did feel better in the pool and I’m told my labour seemed more manageable there - but when I first got in I remember feeling so overwhelmed and the contractions were so intense. I don't really remember much of the time in the pool. I think I got in around 10:30pm and I definitely enjoyed the water, particularly the warmth on my back. I told Bittu to put his swimming trunks on and get in so he could keep up the counter pressure. He was standing in the water behind me and I said, “Why are you standing up, take your top off and get in properly”. He’s since told me I was very bossy. Still, at least I knew what I wanted!

I remember a bit of banter with Bittu, I kept telling him to be quiet. I said “Bittu I love you, I really do, but you talk too much”. Then some time later Frankie said, “Shhh or you'll get told off again!” I don't think I could laugh out loud, it was like I was in another dimension and hearing the conversation at the end of a tunnel, but I did find this really funny and I was laughing inside.

Transition hit me in the pool - it was very intense. I remember saying, “I really can’t do it anymore”, and Letty commented, “ I like it when I hear that”. Even though I knew that I was getting close - and thought “I know this is transition talk”, I said, “Why?” because I just wanted her to say it and to hear that my baby was not far away. Somehow I needed to hear it from someone outside of myself in that moment.

I could feel myself getting pushy. On the first contraction with involuntary pushing I thought, “Oh no, I’ve got to get out of the pool now” and then, “I wonder if Frankie noticed that, maybe I can stay in here for another contraction at least. I really don't want to get out”. But no sooner had that thought popped into my head when Frankie was there saying quite firmly that I needed to get out. I might have tried to protest “just a little bit longer” but she pointed out, “You won't be able to get out if you don't get out now”. Anyway I knew it was the plan, I was really committed to that, and I already knew in myself that it was time, so out I got.

The moment I stood up was a kind of liminal moment - it felt like getting onto a stage to do a presentation. I had a dry mouth and thought, “This is it! Now you've actually got to push a baby out bottom first… can you do that? It’s the moment of truth”. A feeling of slight panic and blood running cold, and a really cognisant moment that this was a breech birth - followed by a determination in myself to get on with it.

23.40 pm

As I got out of the pool I found myself stressing about maybe being cold and asking for a robe.

The adrenaline rush of getting out of the pool, and moments of fear at this point, may have slowed things down. I felt I wasn't progressing. It was a really peak transition time. I wasn't feeling pushy anymore so I wonder if things regressed a bit. My baby may have been born ‘a day’ earlier if there hadn’t been this shift in position or moments of fear. This part was so intense, just so much more intense than in my first birth. I really felt I couldn't do it; that this birth was asking too much of me, and that I didn't want to do it anymore. I was saying every transition cliché in the book, “No, no, no”, “I don’t want to have a baby any more”, “Please someone help”, and of course “I can’t do it any more”.

I was offered gas and air but I'd not had it in the pool because I really wanted to save it for back up, as a last resort, and I continued to hold off. I think psychologically I wanted to feel there was something ‘back pocket’ if I really needed it.

23.55 pm

After around 15 mins, the pushing urge returned. I was kneeling and leaning forwards, supported by Bittu. I found pushing less unpleasant in this birth than in my first, maybe because it was for a shorter time and felt more productive. I was just relieved to know that the baby wasn't that far away.

23.59 pm

The next thing I remember was when Frankie said a foot had emerged. My first thought was “ONLY a foot??? I feel like I've just birthed a hippopotamus!!!” And then I thought, “Oh! A foot? It wasn't supposed to be a foot… that's supposed to be a bottom. Oh dear, footling, that's not good”. [Read Hannah's reflection on whether ‘footling breech’ in term births is the feared complication it is often presented as.] There was a bit of a lull in contractions at this point but the knowledge that a foot had been born gave me a bit of an adrenaline rush. I knew that I really needed to get the baby out to avoid any issues and also to avoid panic in the room because we weren’t expecting to see foot first. So on the next contraction I really pushed as hard as I could and finally reached for the gas and air. And out came the rest of the first leg in full. And then the bottom and the second and leg emerged together in a cross legged or ‘half lotus’ position (I know this from the footage rather than my memory. The time was 12:04am).

00:05 am

Then there was a nice lull. I was complaining of the burning, and feeling dizzy from the gas and air, but once that passed there was my favourite moment of the birth. I can so clearly remember looking down between my legs and the first part of him I saw were his two little feet and I thought, “Wow! That’s my baby, that’s my baby’s feet”.

I didn't know he was a boy yet, but then I put my hand down to touch him and the first part of him that I felt was his bottom and testicles! I wasn't 100% sure but I thought, “Either that’s some very weird jelly mucus I've got coming out of me, or that’s a boy!” So I vaguely identified that he was a boy by touch rather than sight when he was still half inside me, it's funny to think back to that.

Then the next contraction came and it was time to get the rest of him out. He emerged up to his neck in one push, but then the feeling changed and I lost some of the urgency to push. Someone had said to me before the labour that once most of the body is out that I'd need to keep pushing even if there weren't contractions, so I wasn't surprised at needing to do that. I could really feel the difference between pushing to birth his bottom and torso, versus his head, as there was nothing left inside to push against. This sensation felt slightly panicked and like I needed to move my body in other ways to help him out.

00.07 am

And, with some assistance from Frankie, his head came out with a pop. Feeling such a sense of release and relief to have got him out, I just collapsed to my side. I had done it, it was finished, the pain was going to stop now. And then I saw him, and said , “Oh Baby! Hello! Oh wow…I can’t believe we’ve got a baby…and you're okay”. After nearly a month of anxiety, decision-making, wondering how the birth would be, and worrying about whether I was making the right choice to have him at home, to see him looking up at me and here safely was just the most enormous relief. It felt so amazing to hold him there.

I'd planned to have a physiological third stage, I don't really remember how long it took for the placenta to come; around 20 minutes maybe. I was wrapped up warm. We discussed whether my second degree tear needed suturing. I was just so done by that point and wanted to settle down, relax and enjoy holding and feeding my baby. I didn't want stitches so decided to let it heal naturally.

It was so nice to get into my own shower and then bed. Something that felt poignant is that when I got out of the shower, Miri had put an inco-pad into my bed. It’s a small thing but at the end of such a challenging and overwhelming evening, I felt so seen and looked after. Even to this day it brings tears to my eyes when I remember that and the moment of getting into my own bed with my baby. It’s a feeling of care, love and post-birth joy that I wish all women could experience.

This birth was honestly the hardest thing I have ever done. It was also the most extraordinary and empowering experience of my life. I came away from it feeling changed in ways I still struggle to articulate, deeply grateful to those who supported me, and, if I’m honest, very proud of myself!

Frankie’s perspective

By Frankie Kilmurray

Supporting births like this is why I do my job. It’s why I come to work; it truly is the best bit of my job and why I love being a Consultant Midwife.

It was lovely to have met Hannah a few times before the birth and built up a rapport while we collaborated on her birth plan and discussed her options.

From my perspective Hannah‘s choice of birth was completely her decision, and in true choice, responsibility sits with the woman making decisions about her body, her baby, and her birth. So I don’t feel uneasy in supporting complex births outside of guidance and many experienced homebirth midwives see breech as another variation of ‘normal’. I was there to support, counsel, offer options and alternatives to ensure she was aware of all the evidenced risks and benefits, and after that to enjoy being there.

The on-call period was long as we prepared in the weeks before and waited to see what would happen. I felt quite invested in attending the birth. I wanted to support the community midwives who had volunteered to be on call and to bring their breech skills. But I trained and practised as well to make sure Hannah was supported in the best way possible.

When the day came, I was already in my pyjamas; however, as soon as I received a text from Bittu, I threw on some rough clothes and went as quickly as possible to Hannah’s house. I rang the labour ward (triage) to let them know I was going out and there was some talk about considering sending an ambulance as it sounded like Hannah was in advanced labour so I felt quite committed to getting there as quickly as possible to support her, and not have to interrupt the birth.

I arrived and there was already another community midwife I knew well there. We informed the labour ward and prepared for a homebirth. Hannah was supported by her husband, doulas, myself, and two community midwives from the volunteer on call group.

It is a privilege to look after someone you’ve built a relationship with and you know the birth plan of - I could enter Hannah’s home without interrupting too much as she was already focusing inwardly in labour.

It went like most homebirths and the pool was being set up. We had discussed getting in the pool and using the pool for labour. However, the mechanisms for supporting breech birth we had been trained in were designed for use on land. None of us had experience with a breech birth in the pool so when planning the home birth we suggested considering birth on land.

Hannah was progressing well; however, in my midwife senses, this “second baby” didn’t seem to be coming as quickly as many second babies typically come at a homebirth, once the midwife is there. I could see it was challenging for Hannah at some points - so between myself and her doulas we tried to create space and support for her.

Hannah was aiming for physiological labour and as there was no indication at the time for offering a vaginal examination, and as she didn’t request one, we simply observed the signs of labour. She was a multiparous (a woman who had given birth before) who was contracting strongly and regularly, making the sounds of established labour and the contractions were demanding her full attention. She was at the stage where she was benefiting from encouragement and support. In my experience when a physiological birth is underway, especially in the home environment when labour is as established as this appeared to be, it's not long after midwives arrive that we meet a baby.

When it seemed that Hannah was in transition by watching her behaviour and seeing external signs, we discussed getting out of the pool with the aim of getting out before that thought became unbearable, and we started to prepare for the birth on land where we could offer support as needed I could tell it was hard for Hannah to get out, she had the option of entonox available, but I could see it was not the easiest birth for Hannah. This baby was not coming flying out. Hannah decided to get out and set up on land and the entourage of doulas and midwives crept into the room, crouching in corners, even lying on the ground to observe progress in the dark room.

After a rest in the contractions they became more expulsive again and Hannah started pushing, we waited to catch a baby by torchlight. The first bit of baby we saw was his foot; I remember it appearing at the introitus seeing the little toes and thinking it was so cute. We shared that we could see his foot and encouraged Hannah to look in the mirror if she wanted. At this stage I expected his foot to be tucked by his bottom and we waited as usual but a few minutes later on the next contraction, his foot was born without his bottom being visible. As we were in a home environment, I started to ponder the fact that what we could see was currently a footling breech as the bottom wasn’t just tucked behind the toes. I could see a foot with space behind where I wanted to see his bottom presenting, I weighed up in my head at what point we might need to intervene.

I turned to the midwife behind me and whispered that it looked to be a footling. As his heart rate was fine my thought process was an old midwife adage, ‘see what happens with the next contraction’. It is also important to not underestimate how much of an intervention an interruption is in the birth room. We waited and I think I encouraged Hannah to move a leg to make lots of room for the baby and to keep giving her efforts as the next contractions continued. I think she picked up that we needed to help this baby out, as from my perspective I wouldn’t have been speaking to her if all was proceeding in the most ideal way. While waiting, the interventions I was pondering would have been: a vaginal assessment to see if the baby was engaged, and considering calling an ambulance as we potentially were seeing a footling breech in the home environment, so needed to consider transfer or support if the birth was not straightforward and imminent.

During the next contraction we were very pleased to see a bottom descending along with ‘toothpaste meconium’ characteristic of a breech. We had to keep secret the now very obvious gender of Hannah‘s baby.

After the bottom was visible the rest of the breech birth went quickly and smoothly from my perspective. It felt very serendipitous. I had imagined the birth so much in the proceeding weeks, and provided training for our on call midwives, that facilitating the breech birth on the day felt very familiar.

Hannah’s baby didn’t need much help, the second leg was born during the same contraction that his bottom appeared. It was well flexed and moving with a good tone which was reassuring. We just supported limbs from not being born too quickly, noting ‘cleavage’ as another reassuring sign (that his arms were to the front of his head), and on cue his arms then were born spontaneously followed by his chin. I helped to flex his head at the end when his forehead was held up and he did not ‘plop out’ just to release his ‘perennial hat’. There was great joy and relief that he was here but I could also see that it was one of those births that had given Mum an intense time, and which takes that little bit longer to catch their breath from. I did need a good shower afterwards but myself and the midwifery team were thrilled to have supported Hannah’s birth as she had planned it and that her baby was here safely.

Meeting Hannah afterwards to discharge her and debrief on the birth was also a lovely opportunity to reflect on how everything had played out during her pregnancy and birth. I’d been really careful not to share my own feelings and to remain as neutral as possible so that the choices Hannah made were truly hers and not influenced by me.

Hannah was able to share how, being the decision maker and having the responsibility for the choice with all the research and planning that went into it, had taken a psychological toll on her, which was a really interesting reflection. I could also finally share that I was actually really excited to attend her home birth which I had held back before, to avoid influencing her choice. It is a birth I will always remember and I was delighted and honoured to have been there.

---

Author Bios:

Hannah Northern Thakur: Hannah is passionate about physiological birth having had two challenging but empowering and transformative experiences bringing her children into the world. She is committed to supporting women in their choices, changing public perceptions around birth, and campaigning for much needed improvements in maternity services. Hannah is a trained doula and a trustee of AIMS. You can find her at www.hannahnorthernthakur.com

Frankie Kilmurray: Frankie Kilmurray, BSc (Hons), RM, MSc, is a Consultant Midwife with clinical experience in the NHS whose clinical work includes running birth options clinics for women planning care outside of guidance and supporting complex birth planning. She has research interests in informed consent, women's autonomy, and care outside of maternity guidelines. Her particular interests include human rights in maternity care, birth trauma and respectful humanised maternity care.