Mia is a midwife, which did not put her off trying the whole labour thing for herself in the slightest…
I am a midwife – originally from and trained in Britain, but now living and working in Canada – and as such I have been attending women in labour since 2000. I work as a caseload midwife, so look after women from the moment they find out they’re pregnant through to six weeks postnatal, and I’m on call 24/7 for their births. I’ve seen every kind of birther, from the screamer to the joker, and always wondered what I’d be like when it was my turn. As a self-confessed talker, I never expected I’d be rendered speechless!
My pregnancy had been great and despite my age (37) we’d chosen not to have any antenatal testing or ultrasounds – if an indication had arose we would have been happy to change our minds on this, but we both felt confident and happy with our decision. There was something really lovely about the thought that the first time anyone saw our baby would be at the birth. My boyfriend was convinced we were having a boy and was excited to be able to have a small companion to go off-roading with! I was secretly hoping it would be a girl, because I knew that, despite his reservations, in the event he’d go all gooey over her. Well, we’d see.
One week and a day before my due date – which I’d deliberately kept secret from everyone but my boyfriend Isaac and my midwife Megan (who was also my work partner and best friend) – we were sat watching telly on the sofa in the evening. I had been having frequent, painless Braxton Hicks for weeks and noticed that they were feeling a little more crampy than usual. I didn’t mention anything to Isaac, as I didn’t want him to be worried unnecessarily, but went to bed that night half expecting something to happen. That said, as a first-time mum, I was anticipating a long slow build up and planned to try to rest as much as possible. Within an hour or so of going to bed, Isaac snoring in happy ignorance next to me, it became clear that they were actually getting stronger fairly quickly, though still fairly spaced out; I decided to take a trip downstairs to get a drink and see if moving around helped. Almost as soon as I got downstairs I realised that they were speeding up and getting even stronger. I tried to time them but I couldn’t seem to focus on the clock. My head was still telling me that it had to be early on in proceedings, but I downloaded a contraction timing app for my iPhone so I could get an idea of where I was. Within a short period of timing them I was shocked to realise that they were already 2-3 minutes apart and they were taking everything I had to breathe through them.
I had planned to labour by myself for as long as I could before calling Megan but suddenly decided that I needed to call her asap. I made the call and was unable to talk due to a strong contraction – as I breathed heavily into the phone I heard Megan say ‘Oh my God Mia, are you having this baby now?’ I finished the contraction before replying ‘It would certainly seem so!’ That was when Megan told me that she as actually at another birth – another first-time mum, so unlikely to be finished any time soon – and so she told me that she would call Noreen, the back up midwife, to come to me straight away. My head registered the disappointment that my best friend wouldn’t be at my birth, but was hit by another contraction straight away and just had to get my head down and deal with the steam train of a labour that was hitting me. I later found out she had burst into tears at the thought of missing my birth as soon as she had hung up the phone.
Next move was to wake Isaac up; easier said than done. I tried once gently: ‘Isaac, can you wake up please, I’m in labour.’ Nothing. ‘Isaac’ I said a little more sharply. This time I got an opening eye as a response. ‘I’m in labour.’ ‘Seriously?’ ‘Seriously.’ A moment later I realised he’d passed back out. ‘Isaac! I need you to wake up!’ ‘Yes!’ he said, passing back out seconds later. So this time I turned all the lights and managed to say ‘Get up – I need you now’ before another contraction hit. Hearing and seeing me breathing through a contraction seemed to give him the kick up the arse he needed and he leapt out of bed. I shouted a few instructions for him: put the dishes away, get me a drink and start getting the pool ready, and he began doing everything in a state of apparent panic. After a few minutes he ran up to me, in tears, and gave me a big hug, holding on to me as though his life depended on it. I reassured him I was okay – I was after all very familiar with labour, but this was his first time witnessing it first hand, and he was quietly freaking out. He then went back to his tasks, which gave him some focus. I called our former student from our midwifery practice – now finished her training but not yet registered as a midwife here – who is also confusingly called Megan, and asked her to come. I also apparently asked her to call Hailey, our office assistant and birth photographer, though I don’t remember doing so! I carried on breathing through the contractions, each one getting stronger and taking more out of me to manage. It suddenly occurred to me that if I wasn’t at home, wasn’t able to walk around, squat and lean on my kitchen counters when they hit, if I was instead at a hospital being made to lie on a bed, tied to a monitor, I would be asking for an epidural by now. My admiration for any woman who manages a ‘traditional’ hospital birth without pain relief increased in that moment, along with relief at being able to labour and birth in my own home.
By now I was approaching a deeply non-communicative place. I closed my eyes, knelt on the sofa, made low noises and went into myself. People arrived, the pool was being filled, I was largely unaware of what was going on outside my own head. Occasionally I heard phrases or words – it was funny to hear the usual labour conversations between midwives from the ‘other’ perspective. I would estimate around 5-10% of my head remained a midwife, it is impossible to switch that off entirely, but the rest was completely a labouring woman who could do nothing but deal with the rise and fall of the waves of contractions.
At some point, the pool was ready and I threw off my nightgown and settled into the water. It felt great, and I quickly found my head welded into a towel on the side of the pool. I hadn’t opened my eyes for more than a few seconds for some time by then, and continued not to do so until after the baby was born. I was totally unaware of the passage of time. Suddenly I felt a pushy feeling, and heard myself make the grunty noise that any midwife associates with the onset of second stage. Thank goodness for that, I found myself thinking. I let the pushy feeling build and after a little while I decided to do an examination on myself – possibly prompted by Noreen or Megan but my recollection is a little hazy. I felt a tiny bit of cervix at the front (an ‘anterior lip’ of cervix) and tried to push it away, though found it hard from that angle. Megan also tried at my behest, before I yelled at her to stop! The lip went away fairly quickly however and I began pushing in earnest.
Many women over the years have told me that the pushing stage is, in many respects, a relief for them. Women have even told me it feels good – it feels as if the body takes over and you are able to use the contraction, rather than just trying to get through it. Sadly, and to my surprise, this was NOT my experience. Every push felt like my pelvis was splitting open, it hurt, it really really hurt, and it took everything I had to put aside the pain and push anyway. I could hear, though my closed-eye fug, the usual midwives’ expressions of ‘Oh good push, lots of progress that time, good for you’ etc., but because I knew my midwives so well having worked with them, I could tell from their tone every time there really was progress, and when it was just their patter! Isaac was being amazing – he was physically and emotionally supporting me as I squatted, knelt, side lay – constantly changing position to try to bring the head down that little bit more – constantly whispering in my ear, telling me I could do it and allowing me to wrench his thumbs with every push! In between contractions I swore continually: ‘f*ck, f*ck, f*ck, f*ck’, trying to build up the courage to push again.
I wanted to say ‘I can’t do this’ so many times, but having heard so many women before me say the same thing, and knowing they could, I tried to bite my tongue. I felt I had to find the strength from somewhere. I had a ‘birth altar’ right next to the pool with gifts, beads, cards and pictures given to me by friends, that I had planned to use as a focus during the labour – since my eyes were to all intents and purposes welded shut, I did not use it. However, in amongst them was a framed picture of my mother, who had died just over two months before. At one point my eyes opened briefly and I saw my mother’s face; I said to myself that if she could do this for me, I could do this for my own child. It gave me that little bit more energy for the task that I needed.
The head came down and began to stretch everything, but my perineum is apparently made of titanium, and just wouldn’t budge out of the way. I found myself saying the immortal words ‘I’m about THIS close to asking you for an episiotomy!’ I heard Megan and Noreen reluctantly discussing it – we are all VERY non-interventionist! – but in the meantime I just tried to find that extra 10% any way I could. Eventually after 3 hours of pushing, and with a bit of encouragement from my team, I got out of the pool, ostensibly to go and sit on the toilet but couldn’t get more than a step or two so lay down next to the pool on my right side and gave it my all. I started yelling with the contractions – not because I was losing control, but just because I wanted to see if it would help. Slowly, slowly the head advanced but not as quickly as I wanted it to, or felt was warranted by my extreme efforts. I suddenly noticed that Isaac was in tears again and realised I was scaring him with my loudly vocalising effort, so in between the contractions I found myself reassured him I was in fact okay, though I really didn’t feel it at the time! Suddenly I heard the front door open and in came the other Megan, my best friend. She had finished up at the other birth and raced across town to be with me. As she knelt down in front of me, my eyes flickered open briefly enough to lock gaze with her, she took my hand, and I felt a rush of relief that she’d made it in time. I redoubled my efforts and gave it all I’d got. Twenty minutes later however I suddenly had a moment of clarity and realised that the only thing holding this birth back was my damn stupid titanium perineum. ‘Give me the f*cking episiotomy!’ I found myself yelling. This time I heard people leaping to it and I heard, but did not feel, a tiny cut being made. It was no more than a tiny knick in the skin – nothing like the whacking great episiotomies I’ve seen doctors do – but it did the trick and the head came out with the next push. The relief was overwhelming. My midwifery head kicked in again at this point and told me that a slow second stage can sometimes pre-empt a shoulder dystocia. I could almost hear this thought ticking through the brains of the three other midwives in the room, so we all held our breaths while waiting for the next contraction, running through what we’d need to do if she appeared stuck. I felt the baby squirming and trying to breathe, with the body still inside me; a very strange sensation. Happily, when the next contraction came, the baby slithered out with no problems and Megan and Megan both passed it up to me for immediate skin-to-skin. I lay there in shock and relief and grabbed on tight to this wriggling screaming thing on my chest, while getting my breath back. Isaac was by now a blubbering mess, as were most of the people in the room! After a few minutes I said to Isaac ‘Right, you have to tell me if we have a boy or a girl’, at which I moved the blanket over us and opened up the baby’s legs without looking. ‘We have a girl!’ he proclaimed, prompting a fresh flood of tears. Gooey already, I thought to myself smugly.
Eventually the cord had stopped pulsating so I cut it – Isaac politely declined – and he gently took our daughter while I knelt up and pushed out the placenta with a lot more ease than the baby; but then as I always say, there are no bones in a placenta! I was helped to the sofa to lie down and heard my daughter smacking her lips – I took her in my arms again and she latched on immediately to my breast, which was the start of an almost professional ability to breastfeed. A while later we headed upstairs, I had a tiny repair for my tiny episiotomy and snuggled up in bed with our gorgeous daughter.
I’ve since been asked if my experience will change the way I care for my women. Absolutely not! I still believe 100% that homebirth is a fabulous and empowering experience for the women that want it, and when the circumstances mean that it’s safe to stay there. I’m not, and never have been, about homebirth at all costs. But I know that the only reason I found my quick and intense 4 hour first stage, and my difficult and exhausting 3 ½ hour second stage, manageable, was because I was in my own home and able to cope with it in a way that my body was telling me I needed to. I know that if I’d been in the hospital (and not been a midwife who was able to assert herself) I’d probably have ended up with an epidural, with a ventouse or forceps birth to boot. Although it was hard and painful, I am over the moon that things worked out the way they did. Even the episiotomy! It is funny to me that a midwife who had done one episiotomy in her whole 12 year career (and that was an African woman who had had a circumcision) would beg for one at her own birth, but I felt like I was totally in control of that decision and I knew the pros and cons; this is always the cornerstone of informed choice and feeling good about your birth experience, rather than what ends up happening per se. Plus one of the first things you learn as a midwife is that you need to be open-minded and respond to individual circumstances! So if a 3 ½ pushing stage was the price I paid for my beautiful daughter, I’m very happy with that. She really is the apple of my eye – and her daddy is still totally gooey over her.