June | 2014 | Motherworldly

30 Jun

Holly’s birth story

I started losing plug Wed morning and then getting cramps late afternoon and evening. I felt really agitated and hyper all day so I just knew it was starting. We set up the birthing pool and went to bed at 1am. The pains were much worse when I lay down so I left hubby to sleep and paced around the spare room.
At 3am I eventually tried to lay down again to get some rest but just as I drifted off my pelvis audibly popped and my waters broke. I went to the toilet expecting a cascade but it stopped only for me to sit back on the bed and loads pour out. I woke OH who started filing the pool whilst I contacted my doula. My waters were very green in colour so I knew baby had pooed at some point but not recently as there were no meconium chunks. I called triage and they said the homebirth MW was out at another birth but would come over soon. I had a bath and OH poured water over my belly to soothe me.

My contractions got very intense very quickly and soon no amount of pacing or swaying helped. I kept spilling out more waters as I moved about much to my amusement/horror. I was so desperate to get into my pool but it wasn’t hot enough for ages it was like torture sitting looking at the full pool, having serious contractions and not able to get in. My doula was amazing and helped me through each contraction.

1st MW turned up at 5ish and was very worried about meconium and wanted me straight into hospital. My doula and husband talked through the risks and it was agreed I could continue to labour at home and they’d keep monitoring baby. I knew she was a big strong girl so I wasn’t too worried.

I got into the pool finally at around 6 and the contractions went mad, at times overlapping into one another and so intense they were making me convulse. New MW took over at 7 and I agreed to my first VE and I was 9cm! She was pleased but also a bit shocked and so an ambulance was called to take me the whole 2 min ride to hospital as I had agreed that for baby’s sake I would birth her there. By this time I was delirious; I could hardly take a step without contracting and I was at the animal noise stage by now. What a sight for my neighbours haha!

In the ambulance it was like having an out of body experience, I felt like I was asleep and watching myself as I lay there making these insane noises. We arrived at roughly 8:30/9.

The next 2 hrs are a blur with random periods of lucidity between contractions. I tried so many positions: squatting, standing, on toilet, kneeling over back of bed, holding legs open….. But in hindsight I was allowing too much of the power to go into the noises I was making and not into the pushing. So we got her to the point where her head was visible but it keep slipping back inside. Although she had constant monitoring via the little pin on her head she didn’t get distressed but the meconium was still a concern so they didn’t want her stuck down there for too long. Around 10:30 the doctor said she would need to use a suction cup to stop baby sliding back and asked if she could cut me rather than allow me to tear. She was calm and explained all my options and I felt sure that she was only doing what was best for me and baby so I agreed. So after little local anaesthetic and a cut and some serous suctioning, my baby came into the world at 11:05.

I am so pleased with the actions of the hospital. I was tired and getting a little worried and couldn’t have pushed this little chunk out on my own. In the end, her meconium has caused her no problems but we have stayed in overnight for 4 hr obs.

I have vaginal stitches but they are to the side so no damage to perineum. So far no pain from them either.

I have had a brilliant experience and only truly now appreciate how a plan is only a plan and that the medics really do know their stuff. I would definitely labour at home again but would probably birth in hospital or midwife led clinic in the future.

I have a cuddly little lady in my life now, she was worth the wait and we are learning from each other already. She’s latching well but not taking very much each time, she is sleeping a good 3hrs straight each time too so I’m a happy and contented for the moment.

23 Jun

Baby Shock

I meet a lot of new parents, and have come to recognise the glazed stare of someone at the height of sleep deprivation, and anxiety, coming to terms with the reality of life with a newborn baby.

Of course my sample is skewed by the fact that my job entails being there to help when there are difficulties. Many new parents have strong support networks, realistic expectations, and enough confidence in their own instincts, to enjoy these first weeks and sail off into the parenthood sunset.

Feedback from antenatal sessions tells me that parents-to-be sometimes feel they would like more preparation for parenthood. They request practical things: nappy changing always evaluates well but clients would like antenatal teachers to tell them how to get their babies to sleep. Everyone tells you about the sleepless nights to come, usually with a wry smile; but nobody tells you what it feels like. It isn’t like working shifts or travelling across timezones, because of the emotional and hormonal whirlwind going on around you, the physical recovery from birth, and the realisation of immense, relentless responsibility. You can’t sleep this off, and anyway, opportunities to do so are rare.

New parenthood is such an unpredictable and chaotic time, but gradually instincts emerge and you start building knowledge and confidence in yourself. You get to know your baby, and perhaps start to see why we can’t tell you, in advance, how to manage this little person. Your family and your baby are unique, and things are going to shape up in their own way. Only a tiny percentage of babies are “in a routine” by six months of age, but more than half are sleeping through the night. At a recent Introducing Solids session, mothers of four and five month old babies talked about how their babies had slipped into natural rhythms, whether they as parents had tried to manage this, or not.

Life with a new baby might be a big unknown, but you can prepare for it by gathering around you the people you trust to give you care and support, by not expecting too much in terms of “normal” life, and preparing mentally for meeting and getting to know your unique little one when he or she arrives.

19 Jun

Book Review: Optimal Care in Childbirth, by Henci Goer and Amy Romano

This dense and fascinating book presents a huge amount of evidence and a highly articulate argument for a physiological model of birth, starting from the premise that pregnancy and birth are healthy, normal experiences for the majority of women, and only where risk exists, does medical management become appropriate.

This approach fits nicely with my own philosophy of pregnancy and birth, and is well-supported by short analyses of the research in each chapter. Other reviewers have pointed out that the evidence is somewhat cherry-picked, as is always the way in the context of books on birth. It seems to be categorically impossible to have a truly objective reading of the evidence on this subject, and few people with any real knowledge seem to occupy a middle ground on the spectrum from hardline birth skeptics who can only allow the medical model, and advocates of straightforward physiological birth. Both groups tend to be very blinkered about research that contradicts their point of view.

Optimal Care in Childbirth gives a good insight into the source of this deep opposition between the two philosophies. Within the medical model, pregnancy and birth are presented as intrinsically dangerous and difficult. The historical background to this assumption is well documented. In the 21st Century western world, overall levels of risk, particularly to the mother, are very low; and this results in a narrow focus where almost the sole positive outcome to be achieved is a live baby and mother. Strategies are therefore devised to minimise the maximum potential risks, and preventative procedures become routine. This leads to an assumption that the medical approach is the norm, which has a knock-on effect on the research available. The more women who give birth by caesarean section, for example, the greater the belief in the medical community that birth is difficult and dangerous, and the more deskilled midwifery becomes.

There is no doubt that childbirth is complex, variable, and human; and the outcomes of childbirth are soft, complex and variable too. Goer and Romano define the optimal outcome as:

“the highest probability of spontaneous birth of a healthy baby to a healthy mother who feels pleased with herself and her caregivers, ready for the challenges of motherhood, attached to her baby, and who goes on to breastfeed successfully.” [p21]

However since the language and thinking of research is based in the medical model, the basic assumption is that non-intervention in childbirth equals risk, rather than the other way around. Optimal Care in Childbirth recommends reserving medical intervention for those women who would genuinely face greater difficulty without it, rather than protocols that offer it routinely in order to reduce risks that are already small.

The chapters of the book cover all the main topics of relevance to anyone working in childbirth (it is probably not a book aimed at pregnant women, who might get similar but more accessible information from Ina May Gaskin’s books). The chapters cover caesarean birth, induction of labour, care during labour, birth, postnatal care, and midwifery practice. Each chapter includes a mini-review of research and strategies for optimal care. It is a very practical book and an important resource for midwives, obstetricians, doulas and antenatal educators.