27 Feb

Book Review: Why Homebirth Matters, by Natalie Meddings

Natalie Meddings is a doula and the founder of Tell Me A Good Birth Story, so sharing positive tales of birth is her way of life. She knows this subject extremely well, and has already covered it extensively in her previous book, How To Have A Baby. Her latest book fits nicely into the Why It Matters series, adding a good helping of How It Works so that this handy little text is both political and practical.

Meddings examines current attitudes to birth generally, and homebirth in particular, both from the medical perspective and that of the general public. However her own perspective, that “birth has never been safer” (p17) guides the reader as she explains the how and why of homebirth in a way that makes both logical and intuitive sense.

For expectant women and their partners, this book has a useful level of detail, making homebirth a realistic possibility, and without neglecting potential “forks in the road” (p109). This is a good resource for getting informed, and for navigating the various faces of the health service in a positive and productive way. This is the kind of little manual that you really could carry around with your pregnancy notes, dipping in as needed or wanted, to really immerse yourself in the way of birth.

[Disclosure: I was sent a free review copy of How To Have A Baby. I’d recommend it, and you can get a copy from the publisher, with a 10% discount if you use the code SPROGCAST at the checkout]

18 Oct

Maggie’s Birth Story

Maggie’s daughter turns 13 next week; here’s the story of her birth:

I had quite a traumatic birth experience with my son, so when I found out that I was expecting my second baby I was pleased, but partly worried that we would have to go through a similar experience again. My son’s birth had been a planned home water birth, but my blood pressure had become high in the last month of pregnancy and at the onset of labour he had become distressed, leading to an augmented labour, followed by a failed ventouse and then forceps delivery. I had the same community midwife with this second pregnancy, and at my booking-in appointment, she told me that I would have to be checked by the consultant, and strongly advised against having a home birth, given what had happened previously.

This second pregnancy went very well, until six weeks before my due date when my blood pressure went up to 130/90. At this point I started to worry about history repeating itself. Over the next six weeks, however, it stayed more or less constant at 130/90, which although high, was what it had been at my booking-in appointment, so the midwife and consultant weren’t unduly worried.

On the day after my due date I went to bed at 10pm and fell asleep very quickly. Two hours later I woke up as I realised that my waters had broken. My first labour had started the same way, but this time the fluid was clear – so far so good. An hour later we arrived at the Royal Berks Hospital. In the car, the contractions had been pretty mild, but coming about every 5 minutes. The midwife on duty gave me all the routine checks, told me I was about 1cm dilated and that everything seemed to be going normally. She just had to check on my contractions and the baby’s heartbeat and then I could go home and wait for the contractions to start in earnest.

On went the monitoring belts for the obligatory 20 minutes. At the end of this time the midwife looked worried, and told me that she wanted to leave the belts on for a bit longer and get the registrar to look at the trace. The baby’s heartbeat was apparently too steady – not enough variability, which meant that the baby was either asleep or distressed. At the end of 50 minutes the trace hadn’t changed much and the registrar was also worried. She told me that it was very likely that I would have to have a caesarean if the baby was distressed this early in labour, and even if not, they would have to speed things up with a drip. When we were asked what our feelings were about this my husband said angrily “I’m just afraid of the whole bloody thing going balls-up like it did last time”

In the meantime we were moved to a delivery room in order that they could attach a scalp electrode to the baby’s head to give a better indication of the heart rate. By now it was about 2.30am and my contractions were slowly gaining in strength and still coming regularly. Once the readings started coming through the scalp electrode the output from the monitor was faxed through to the on-duty consultant to determine whether the caesarean was required or not. The trace had improved somewhat, but was still considered suspicious. In the meantime my midwife took some blood samples from me as there was some concern regarding my blood pressure and the anaesthetic for the caesarean.

The reply from the consultant came back – no need to do a caesarean yet, but certainly augment the labour with a drip. When I was told this, I asked for an epidural to coincide with the drip going up, as I knew from my first labour that I didn’t want to have to deal with the more painful contractions that would result. However, it wasn’t possible to have either the drip or the epidural until the blood test results came back. By this time the contractions were beginning to get stronger and I was using the breathing technique to get through them, standing next to the bed and leaning on the monitoring machine. They were lasting about 45 seconds and coming every three minutes. I was beginning to think that I should have put my TENS machine on, but under the circumstances I hadn’t bothered as I’d thought I’d probably be on the operating table by now! I debated whether to use gas and air, but somehow I didn’t think I wanted it just yet as the breathing on its own was making a difference.

Eventually the blood test results came back just after 6am, they were fine, and by that time everything was set up ready for the drip to go in and the anaesthetist to do his work. Just before though, I asked for an internal examination to see how things were progressing on their own. I was 3cm dilated by this time, and having been up all night was glad to lie down on the bed for a while.

I had the epidural and up went the drip. Down went my blood pressure to about 70/40 as I reacted to the anaesthetic, felt extremely light headed and debated whether or not to be sick. This reaction passed fairly quickly, and I was pleased to discover that the anaesthetist had got the dose on the epidural spot on. It dulled the pain of the contractions, but I was able to stand up next to the bed and move around to a limited extent. My real fear was that I would end up having to lie still on the bed and give birth in that position. The midwife who had been with me all night went off duty shortly afterwards at 7.30 and another midwife took over.

After another hour and a half the registrar returned and at the same time I realised that the epidural was beginning to wear off, so I asked for a top-up. This was administered just before the registrar announced that they wanted to take blood samples from the baby’s scalp to gauge how distressed it might be. So, back on the bed I went and the registrar started to try and take the blood samples. In passing she told me that I was now 4cm dilated. In the end she had to take three samples as there wasn’t enough in the first two samples to do an accurate blood test. Once she had taken the third she told me I was now dilated to 7cm. At this point I was beginning to suspect that the top-up epidural wasn’t working as not only was I feeling uncomfortable from the internal examinations, but the contractions were getting more painful rather than less. Whilst waiting for the blood results to come back (normal again) the registrar performed a stretch and sweep and told me I was 9cm dilated – quarter of an hour after I’d been 4cm!

The registrar then left my husband and I alone with the midwife. By this time the initial epidural had completely worn off and the top-up hadn’t done anything so I could turn round on the bed so I was kneeling and leaning against the head of the bed, and very shortly I started getting the urge to push. My new midwife was great at this point, she stood back and told me to go with my body, and do whatever felt right.

As the urge to push got stronger I went with it and started pushing. Four minutes and four contractions later at 9.30am the baby’s head appeared, followed at the next contraction by the rest of her body – a little girl! After an eleven minute third stage and some oxygen for the baby she was put to the breast to feed and stayed there for half an hour! After everything that had gone before it was an extremely positive birth experience in the end.

Three and a half hours after the birth we left hospital and brought our daughter home to meet her brother. My mum, who had been babysitting, was amazed to see us – the last update she’d had from my husband had been when we were preparing to have a c-section!

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.

20 May

Tropes about homebirth

I like Alice Roberts, she is interesting and clever. Some of the things she has written about birth have given me plenty to think about, and it’s good for me to think. This evening twitter drew my attention to an article in which she claims to take a “scientific approach to having a baby.” The article may be a year old, but it is relevant in the light of new guidance from NICE recommending that more women should give birth at home.

This of course has flushed all the extreme advocates of both hospital and homebirth right out of the woodwork, so here’s trope number one:

We all have to be for one thing and against the other.
Surely it’s a little more nuanced than that.

And it’s those nuances that make up the rest of the tropes.

Human birth is difficult and dangerous.
Except, not for everyone. Where does this information come from? What’s the evidence for that statement, as made by Roberts in the above article, and followed up by this statistic: “about five per 100,000 women die in childbirth and four per 1,000 babies” So, we’re not dropping like flies. And yes, in some cases that’s because modern medical intervention improves outcomes. But it’s also because in many cases, women’s bodies are apparently surprisingly good at giving birth. Up to date medical knowledge, high standards of midwifery training, and modern cleanliness are also factors, but these things are not exclusive to hospitals.

A healthy baby is the only important outcome.
Postnatal trauma is a real thing. Where the risk of a poor outcome to the baby is very small, maternal satisfaction with the birth process is actually highly relevant. The “healthy baby” trope buys into the patriarchal system where women must be compliant and put her unquestioning trust in the doctors; furthermore she should be grateful that they “deliver” her healthy live baby, no matter what they did to her, often without fully informed consent, in order to achieve that. The draft NICE guidelines acknowledge the importance of maternal satisfaction with the process; this is not the same as prioritising the process of birth over the goal of a healthy baby; it is simply stating that birth is a process. Giving birth is a huge physical and psychological event, and to reduce women to precious vessels whose only role is to produce live offspring is patronising at best.

A high proportion of women planning a homebirth end up transferring into hospital, so why bother?
Roberts quotes a 45% transfer rate for first time mothers, 12% for subsequent births. Of course, nobody goes into hospital before actually going into labour unless they’re suffering some severe condition such as pre-eclampsia. This is not an argument against labouring at home, and does not necessarily mean that those mothers who transfer in have less satisfaction. If we could take the value judgement out of home vs hospital, we could look at this as encouraging women to labour at home and only go in if necessary, rather than framing it as failure to birth at home.

If you need intervention, it’s instantly available in hospital.
Not true. You may have to wait a couple of hours for an anaesthetist to be available, or for the previous woman to move out of theatre. So plenty of time for that transfer.

Well duh, of course there’s a lower risk of intervention at home, because you can only carry out intervention in hospital.
This still isn’t an argument against homebirth, and it is one of the main reasons women might choose to birth at home. Yes, obviously, the tools are not available. If an intervention is necessary, then a transfer is going to be needed. But an intervention is less likely to be necessary where women give birth in a calm home-like environment. Statistics demonstrating a lower incidence of intervention in planned homebirths include those who transferred and then experienced intervention, because that happens.

Homebirth advocates present the research findings with the wrong priorities because they have An Agenda.
And by “wrong priorities,” we mean priorities that differ from hospital birth advocates. From Roberts’ article:

look up “home birth” on the National Childbirth Trust (NCT) website, […] the findings are laid out in exactly the opposite order to that in the original research paper and the RCOG’s statement: women having a home birth are more likely to have a “normal birth” without intervention; home births are safe for women having a second or subsequent baby; lastly: home birth increases the risk to the baby for first-time mums. The main outcome investigated by the study is the last to be mentioned.

What NCT are doing here is normalising straightforward birth. It’s all semantics, innit? If you do follow Roberts’ link to NCT, you will see that the risks are clearly mentioned. In fact, it took me several attempts to replicate Roberts’ results by searching NCT’s website; the first few articles I came up with were clearer, more accessible, and included links to relevant information from The Birthplace Study and the NHS.
I would argue that hospital birth advocates also have An Agenda.

Homebirth is unethical and dangerous
In January The Independent headline claimed that homebirth was “as dangerous as ‘driving without putting your child’s seatbelt on’.”
The always excellent NHS Choices website responded to this with the conclusion:

A case could be made that rather than discouraging home births, we should instead be improving the levels of support to women who choose to home birth and so reduce the risk of complications.

Perhaps that’s where we should leave it. This isn’t about our different choices making us good or bad people, or our different experiences making us successful or failures. It’s about informing and supporting families, even those whose priorities aren’t the same as yours.

Views expressed here are my own, and do not represent the views of NCT.

04 Apr

The science of birthplace

My work now includes talking to parents-to-be about where they choose to give birth, and so this subject is of increasing interest, particularly since the skeptics I hang out with suck their teeth a little when we get on to the subject. To be quite frank, I suck my own teeth. It’s very hard to weigh up the pros and cons of a subject in which even the most scientifically minded get rather emotionally invested. I will conclude, perhaps, that we all give different weight to different outcomes, and that’s parenting for you, which means that I am as usual chasing my tail and asking “why can’t we all just get along?”

This is a complex and emotive topic, and few people seem able to write about it without their passion leaking through. So let’s state upfront that my passion is to support parents to make their own informed decisions, decisions they will have to live through, and live with, about an event that is in many cases earthshattering in the experience itself, and in its ramifications. Giving birth is a very big deal. Yes, it’s a normal physiological process and women’s bodies are well-adapted to perform it; but let’s bear in mind two very important provisos here:

  • It’s 2014. We give birth in very different conditions than those to which our bodies are adapted; and
  • Birth is safer in England than it has ever been, and this is down to a range of factors including modern techonology and hygiene.

But giving birth is not simply a physiological process. It is a profound life event affecting our bodies and our view of our bodies, affecting our families and other relationships, affecting us in social, financial and psychological ways that cannot possibly be accounted for in a simple birthplace study. Therefore birthplace studies tend to base their conclusions on measurable outcomes, usually neonatal death, injury, or oxygen deprivation to the baby. Some studies also consider some physical outcomes for the mothers, such as whether she experienced medical interventions or whether she went on to breastfeed. Very few studies consider birth trauma as an outcome.

Which? Birth Choice has a very clear set of tables comparing outcomes for hospital obstetric units, midwife-led birth centres, and homebirth. This is based on the 2011 study Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study BMJ 2011;343:d7400. If you click through to the tables in the report you find risks for ALL births reported as 4.3 adverse outcomes per 1000 births. This is then broken down to show the differences for first births (5.3/1000) compared with second or subsequent births (3.1/1000), and broken down still further to show risks according to place of birth. As has been reported, the risk of an adverse outcome at a planned homebirth for a first baby shoots up to 9.3/1000. As has not been reported, the risk of an adverse outcome at a planned homebirth for second or subsequent baby drops to 2.3/1000. The study concludes that “The incidence of adverse perinatal outcomes was low in all settings.” The headlines, meanwhile, focus on the relative risk: 9.3/1000 is more than twice as high as 4.3/1000, therefore homebirth is twice as dangerous as hospital birth.

Parents need to be given these numbers along with a little bit of information about how to make sense of them, which is where the Which? page is useful. But they also need the opportunity to consider what other outcomes are important to them, given that the absolute risk of adverse outcomes is so low. The Which? page gives information about the likelihood of intervention in various settings, and parents may want to consider this as a factor in their decision making.

Meanwhile, all this pitting of hospital birth against homebirth results in Birth Centres being overlooked. Birth Centres are intended to offer a home-like setting, with midwife-led care. They are often located within hospital settings, so the obstetric facilities are on hand. Our birthplace study referenced above shows that the risk of adverse outcomes is comparable to an obstetric unit, while the likelihood of intervention such as instrumental birth or caesarean birth is lower. A 2012 Cochrane Review of Home-like versus conventional institutional settings for birth by Hodnett et al supports this:

Home-like institutional birth settings reduce the chances of medical interventions and increase maternal satisfaction, but it is important to watch for signs of complications.

One thing that is important to beware of is using data originating in the US, since the model of midwifery care in the US is very different to the UK. This perhaps is a subject for a later post, and probably not by me.

Finally I want to come back to the definition of an adverse outcome, where once again women are reduced to the precious vessels, solely charged with but not entirely trusted to bring this baby to the world unharmed and perfect in every way. What about outcomes for mothers? I have heard Sheila Kitzinger speak on the subject and read some harrowing accounts of childbirth:

one reason why many women have low self-esteem and cannot enjoy their babies is that care in childbirth often denies them honest information, the possibility of choice, and simple human respect…..

Studies from 2003 and 2004 found that up to 6% of women show full PTSD symptoms following an experience of birth where they felt scared, helpless and vulnerable. While all the focus is on outcomes for the baby, women’s lived experience is belittled and ignored as a decision-making factor. This is why parents need to be given all the information, and not frightened into seeing hospital birth as the only safe choice for their babies, regardless of how it will feel for them; and the information given needs to include more than just the risk of adverse outcomes for the baby.

23 May

Fiona’s (Second) Birth Story

Fiona is a thirty-something mother of 2 from Oxford; she was a teacher pre-children, but had to stop work due to post-natal depression after the birth of her first child 5 years ago. She is now a full-time, baby-wearing, breastfeeding mum, attempting to juggle the demands of parenthood with interests in music, writing and sewing, and also squeezing in time to make jewellery (www.morganandpink.co.uk).

My second pregnancy was a pain, frankly, with SPD discomfort, and lots of small indignities, anaemia, iron tablets (and their side effects) and so on. It was also marked by me doing lots of planning and thinking about the birth, and the days immediately afterwards, in a desperate attempt to avoid the miserable car-crash-type experience of my first child’s birth (I’ll try to get round to writing that story too…) So from fairly early on, I had planned to give birth in a midwife led unit where I would feel relatively safe, with a doula or birthing partner (so that someone was there just for me as a person, rather than me feeling like a body on a slab) and we planned all sorts of contingencies, right down to the kind of food my husband would bring to the hospital for me. I also watched “One Born Every Minute” every week, usually reduced to tears by the end, and I felt that this boosted my confidence in my ability, as a woman, to do this crazy thing (this is important, as I was in complete denial during my first pregnancy, and I’m sure it contributed to some of the difficulties I encountered first time round in labour). We eventually decided against a birth doula (too expensive, sadly), but one of my best friends offered to be my birthing partner – it felt wonderful to know I’d have her there. And we did hire a post-natal doula for the few months after the birth.

Despite all these preparations, or perhaps because of them, I was impatient, and spent most of the last trimester hoping my baby would be early, mostly to end the discomfort of pregnancy, but also because
I was keen to meet the little one. I didn’t know if it would be boy or a girl, as the cord was between the baby’s legs during the 20wk scan, so there was no way of telling what it might have been hiding! My first child was born at 38wks and 3 days, so I was quite confident I wouldn’t have to wait until full term. At 36 weeks and 4 days, I started having a slightly funny tummy, which I remembered being one of the signs in the last few days before my first child’s birth. I told myself it couldn’t be that, as I was only 36 weeks
etc. On Wednesday 9th February (36wks, 7days) I began to get a lot more Braxton Hicks, enough to make me feel like I was really waddling up the road to fetch my older one from nursery in the afternoon, and by suppertime enough to make me catch my breath a little. But, as I wrote in an email to my sister that evening, “I’m not 37 weeks yet, so I’m sure it’s nothing.”

By 9pm, when my husband got home, I wasn’t so sure, and told him I thought there was a chance I might be in labour. He naturally thought this was unlikely, and suggested I went to bed to get some rest. By 9.30 I had had two pretty painful contractions, couldn’t sleep, and was sure. We had a cup of tea, and tried to phone my sister, who lived across town, and had agreed to come and baby-sit our 3 year-old when I went into hospital. She didn’t answer – but why would she? She wasn’t expecting the call for another three weeks! After half an hour or so, I was having contractions every 10 minutes, so I rang the hospital. The midwife there said, yes, it did sound as if I was in labour, and that I should wait until I’d had
contractions about 5 minutes apart for an hour or so, and then come into the unit. I rang my birthing partner, but she was on her way home from performing in London, and her partner said to ring again
when we went in to hospital. My husband rang my sister again, and eventually she answered, and he set off to fetch her. They got back at about 11.15ish (I think), by which time I had begun having contractions every 5 minutes or so, but only perhaps for 20 minutes or so – I’d been trying to write them down, but it was all a bit fuzzy! I had a swiss ball in the living room, which I leant over and moaned; the rocking movement helped the pain, and my sister rubbed my back which was lovely.

After a few more of these contractions, I said to my husband that we ought to get going, as it was a 20 minute drive to the hospital. My bags were packed, so all we had to do was hunt for change for the car-park. Even though I said we should go, I had a gut feeling that I didn’t want to go anywhere. I needed to go to the loo before we left; while I was sat there, I had another contraction and my waters
broke with an audible pop. I felt the most overwhelming urge to push really hard, and suddenly felt that burning feeling. I reached down, and felt the baby’s head and hair. I screamed at my husband to
phone an ambulance –he said “Are you sure?” He came to look, and went visibly pale. The ambulance telephone operator told him to get me lying down on the floor, so I staggered into the living room and
lay down on a waterproof bed mat (I’d bought them without really believing anyone ever used them!).
They told him that if I had another contraction, he should push back – I’m still not sure how that would have worked exactly, but in any case the ambulance arrived in less than 4 minutes. The first paramedic came in and said “I’ll just pop back to the van for some entonox, shall I?” and I said, “No – I’m having another contraction”. He came and knelt down, I felt another massive push and stretching feeling, and another sort of “pop”, and that was the head. My sister was sent upstairs to fetch towels, three more
ambulance crew arrived (in a back-up vehicle), and with the next contraction, I delivered the rest, and the ambulance man caught her. He afterwards said that in 25 years of being an ambulance paramedic,
he’d never had to catch a baby before! The time of birth was recorded as 11.57pm. The baby was placed on my stomach, and they told me it was a girl. I remember saying , several times, “Oh my gosh, I just had a baby!” I was able to give her a first feed, which was wonderful, and I’m pretty sure we all cried. I have no idea what my sister thought – she is in her early 20s, and thought she had just come to babysit a sleeping child, instead of which she had a ring-side seat at the business end, as it were, for the birth

I then went into shock, and don’t remember much of the next hour or so, except that I was freezing cold, shivering uncontrollably, and feeling utterly drained. My husband and sister took care of the baby,
and I just lay there feeling miserable. Apparently this is not uncommon after such a quick labour. I didn’t feel I could push anymore, and it took a long time (maybe 45 minutes?) for the placenta to deliver as the ambulance crew didn’t have any drugs with them to speed it up. I remember one of the paramedics becoming a bit anxious about that, and the on-call midwife didn’t arrive for more than an hour so she could do no more than check it when she arrived to make sure it was all there. Eventually I was able to sit up and have some sweet tea, which really helped, and then the midwife helped to clean me up, check that I didn’t need any stitches, and help me change my clothes and get onto the sofa, rather than
lying on the floor. I was able to feed my baby again, and began to get vicious after-pains, so I took some paracetomol, and then threw up. I felt better after that, and had some more tea. After a good feed, I handed the baby over to my husband, and went up to have a bath, which was utterly wonderful. I think it was about this point the happy hormones kicked in, and I remained on a complete high for weeks! It was so glorious to be at home, to be able to have a bath, and then curl up and sleep in my own house.
The midwife was wonderful too, staying with us for several hours to make sure everything was ok. She then went to the hospital to register the birth on their systems, before coming back to see us again at

about 7am. She said she was happy for us to remain at home, unless we wanted to go into hospital to be checked – we said no thanks, we’re very happy here! In every way (apart from the shock) it was a
fantastic experience, and so much better than my first labour.

21 May

Anna’s Birth Story

Anna is currently learning how to manage a small curious baby and a horrific stinking cold.

I had decided some point midway through pregnancy that my baby was going to arrive 6 days before my due date, on December the 29th 2011. It seemed like the kind of date a baby of mine would like to arrive, and seemed like something I could look forward to, hold on to, and have some control over. I liked the idea that if I picked a date, and aimed for it hard enough, that’s when my baby would arrive.

I was, of course, wrong.

Not only had my baby decided not to turn up on December 29th, he’d also decided against turning up on my due date of January 4th, even though we tried to tempt fate by arranging to go to the theatre that night. And the days ticked by, with frequent phone calls from family and IMs from friends online. Nothing. So in the afternoon of January 9th, we went for my 40-week midwife appointment. She’d performed an exam, declared me to be 1cm dilated, done a sweep, and given me a sheaf of photocopied leaflets about the induction that I’d be needing to book in for unless things got moving by themselves within a few days. Having planned a home birth, and having everything in place and set up for it, we wanted to avoid that as much as possible. Not that I have anything against hospitals – as with any home birth, I knew there was a fair chance we’d end up there – but given that we live in a health authority where home births are relatively common and extremely well supported, there seemed no reason not to try for one – I’d be more relaxed at home, I’d feel less intimidated about moving around and making noise, and, most importantly, no one would separate my partner and I after the birth; no one would send him home and leave me lying in a hospital bed with no idea what to do with this new baby.

We’d walked home, briskly, carried on with some work.

My waters broke on Monday evening, at 7pm. My partner Bobbie had just, ten minutes before, phoned for a curry. I’d been sitting on the birthing ball (well, exercise ball) in my living room, gently bouncing up and down watching television when suddenly, something popped. B fetched towels, and I stood there, in the middle of the floor, not knowing what to do. Stand up? Sit down? Clench? Still have the curry?

I knew I was supposed to phone the labour ward when my waters broke, but also knew the 36-hour-to-induction clock was ticking from whenever I did. So we decided to wait until later in the evening. Boj walked to the curry place to pick it up. I stood there, stunned and excited and scared and aware that this was it. Our baby, Doozer (as we’d been calling him) would be arriving. And soon. I grabbed some towels that B had thrown to me on his way out. Tried sitting down. Standing up. Sitting down. I phoned my mum, my sister. I phoned our doula, just to keep her informed. I tried to remember everything I’d been taught in birth classes, and everything I’d read. I couldn’t remember a thing. But here we were. This was it.

But, of course, this wasn’t it, though. In my NCT class we’d been warned that, unlike in the movies, waters often didn’t break until way after labour was established – but hadn’t really thought through the information that waters can break way, way before labour starts. so while there was a gush of water, and my stomach felt flatter and emptier than in months, there were no contractions. Nothing. So we ate the curry, phoned the labour ward, went to bed, and slept for 8 hours. This was not what I was expecting from labour.

At 8am on the Tuesday, the community midwife came round. She asked about the waters breaking, and checked the pad I was wearing to see if there was any discolouration to the waters. Then she booked me in at the hospital for an induction the next morning at 11. The clock was ticking.

The rest of the day was spent in the spare room, the room we’d already started setting up for labour. Lights dim, curtains drawn, a candle lit and a floor mostly covered in tarpaulin, I spent my time sending emails that I didn’t know when I’d next get the opportunity to send, napping, nippling, bouncing on the birth ball, mainlining raspberry leaf tea and listening to labour-inducing music. As night fell, we went for a march down to the silent seafront, one man and his very large companion from the ministry of silly walks, raising her knees high and stepping hard, feet outturned with each downstep, trying to encourage Doozer downward.

I started feeling Braxton HIcks type twinges regularly at about 11pm on Tuesday. Or rather, soft cramps, like gentle period pains – not painful, but noticeable. By midnight we realised they were coming in a pattern, every 12 minutes or so. We went to bed, and slept, lightly, too excited to sleep much, but knowing that, if this was it, we’d be able to stay at home rather than attend our booked 11am induction. And, whatever happened, Doozer was on his way.

By 4.30 I couldn’t sleep in our bed any more – the contractions, if that’s what they were (I was never convinced, although the eventual arrival of a baby should have tipped me off) though not painful or much more frequent, were noticeable enough to raise my excitement and deny me any more sleep. We moved into the spare room, put music on, and lay on the bed, waterproof covers crinkling under the old sheets. At 6 or thereabouts we called the labour ward, to ask for a community midwife to come and check that we didn’t need to turn up for the induction.

At 7.30am or so, she arrived, first visit of the day. She did an exam, declared me to be 4cm dilated – did a painful sweep (“And now you’re 5cm!” “Ow. Thanks.”) dropped the useful tip of using a breast-pump rather than fingers for nipple stimulation in order to help labour along (“Quicker, and FAR less boring.”), then she phoned the labour ward to let them know we wouldn’t be coming in for induction, and left again.

The contractions, still milder than I ever expected, kept coming, every 10 minutes, then every nine. We broke out the breast pump. It noticeably increased the intensity of the contractions, but still not to anything I thought “real”. I kept thinking a midwife would turn up and say “Oh no, you’re just making it up, these aren’t proper contractions at all”. I don’t know what I was expecting, but rather than being painful, per se, they were like waves – the main indication that was one was arrving was that I’d feel the need to move. And I just kept moving: swaying from side to side, rocking back and forth on the ball, crouching on all fours rotating my pelvis. Having been informed by the midwife that Doozer was still lying with his back on the right rather than the left, I spent time between contractions trying to swing him – crab-walking up and down the stairs, doing handstands on the stairs while B held me steady, leaning on the ball and bouncing gently, getting B to use a scarf to lift the weight of the bump and try and shuggle Doozer round (I forget what this is called, but it’s bloody lovely and very, very comfortable).

At lunchtime, when the contractions were closer to 7 minutes apart, and both of us were feeling a bit tired, having been at it a while, we called Agnes, our doula, and told her we were ready for her to come now. We’d met Agnes through our NCT classes – she was our teacher for the birth class – and feeling that she was the right mix of sensible, rational, funny and supportive, we engaged her as our birth doula.

Though she’d been in hospital for two nights with another client (whose due date had been a safe distance from mine, but apparently our babies had not been informed of this), the other baby was literally just arriving as I rang. Half an hour later, Agnes arrived and sat with me while Bobbie slept a while, then went through the birthplan with Bobbie while I catnapped between contractions.

That was one of the surprises, to me. The fact that I wanted time on my own, and that that was ok. I had imagined labour as being a time surrounded by people very closely all DOING things and being very engaged with me ALL THE TIME (which isn’t something I like at all) – but I was able to say “I want some time alone, just to concentrate.” – and everyone would disappear down to the kitchen to have a cup of tea. Of course, there were also a couple of times when Agnes, having presented at some other point the theory that the natural chemicals found in semen might help to open the cervix even more effectively if swallowed, tried to leave us alone for some ‘private time’, although stopped after being assured, very firmly, that, frankly, no one was in the mood for a blow job.

Labour seemed to be progressing, in that the contractions were getting closer together, but they weren’t getting noticably more intense. They made me want to move around, to squat, shift around, walk the stairs. but not hurt. I realise now – as I realised then – but it seemed to me as if something wasn’t correct. It was so far from what I’d been told, and what I’d been expecting, I thought that somehow, this must be wrong.

Still, the frequency of the contractions continued to increase. When it got to 5 minutes, we called the labour ward, and they said the community midwife would be with us shortly. She arrived around 3.30, I believe. After asking a few questions, observing a couple of contractions and excusing herself to read my notes and birth plan, I asked Agnes if she could take the community midwife downstairs and give her some tea. We carried on labouring upstairs, B and I, just taking contractions one at a time, walking the stairs often, and relaxing inbetween curled up on the bed. At some point in here Agnes brought me a wholewheat pancake with maple syrup – the only food I’d seen since breakfast – which I initially refused, then inhaled as soon as I’d taken a first bite.

Some time between 4.30 and 5, the pain started. That pain that I’d been complaining about lacking earlier, plus some extra, just for good measure, arrived. It was like someone was firing a laser directly at the small of my back, and it was burning through the skin, and the flesh, and searing through the bone. It wasn’t very nice. I didn’t like it. I wanted the other, less hurty contractions back. Suddenly I realised what people had meant about using the downtime between contractions to pause, and collect, and ready yourself for the next one.

My memories from this bit are jaggedy. I was suddenly ravenous, and demanded food. A jar of peanut butter, to be precise, which was brought with a spoon. There was a fruit bowl in the spare room, and I remember peeling a banana, sticking it straight into the jar, and eating the whole thing in a small number of bites, while gearing up for the next laser attack.

While I was collecting myself between contractions, bobbie went and got Agnes and the community midwife from the kitchen. They came up and checked out the new developments – Agnes helping me find new positions and getting out the tens machine, the community midwife … frankly I have no idea. I can’t remember. I know it said in my birth plan that I wished for midwives to leave me to get on with things as much as possible, and talk to Bobbie first about medical developments, so it could be she was doing that, and heart rate, BP checks etc.

She was soon to go off shift, however. There’s a shift change around 6pm in Brighton, when the community midwives of the day are replaced by hospital midwives sent straight from the labour ward.

Before this happened, the community midwife did an internal exam. I’d wanted to know the results of it, as finding out I was 4/5cm dilated at 7.30am had been a great encouragement. But she didn’t tell me. She left the room, went to make her notes and, as the hospital midwife arrived, to hand over.

(I found out later I was still 4/5cm dilated during the exam at 5.45pm. Nine hours of labouring, and my labour was apparently no further along than it had been when I woke up. As far as I was concerned, that was how it worked. You went from 0-10cm dilated slowly but gradually, and then, BAM, a baby! Apparently not. I was angry at the time that no one was telling me the results of the internal, but I can see why they weren’t. As encouraged I’d been by going from 1cm-4cm dilated apparently without knowing, it seemed likely, especially as the intense pain was wearing me out fast, that I might be as discouraged by the fact it hadn’t advanced any more. I think I knew this was the case from the fact no one was telling me, but still wished I’d known something – anything – at that point. I had nothing firm to hold on to – I wanted information about ANYTHING at that point)

The tens machine helped, but not as much as it might have done if I’d started earlier and ramped it up more gradually. But the onset of the painful contractions was so sudden, the tens machine could barely keep up. Once the hospital midwife, Katrina, had spent an apparent eternity reading through my notes and having her handover, she offered me some gas and air – probably around 6.15pm – but though I had it for a couple of contractions, I didn’t like it. It was like being drunk – which was great, obviously, but meant I couldn’t concentrate on the contractions, and that was all I wanted to do, focus on them completely from the second they began till the moment they faded away.

Every contraction was piercing at this point. Fire burning in the base of my spine, it was hard to imagine how I’d get through each one, let alone the next one. Around this time, I started viewing Katrina, the hospital midwife, as some kind of angel of medical intervention. “Katrina: How long will this last? What’s happening to me, Katrina? When will it end?” I begged her, making sure I inserted her name as frequently as possible, to make my argument seem more reasonable, more rational, and ingratiate myself to her more quickly. “How can you let this happen to me, Katrina?”. “Please, Katrina,” I said at some point “isn’t it time for me to go to hospital, perhaps? Wouldn’t that seem like a good idea? Katrina. Please: Take me away from these fucking hippies”. (I’m not sure who I meant by that. My partner, my doula, the community midwife – even myself. Whoever, basically, had decided that this crazy homebirth thing had been a good idea. I wanted removing from them all, being attached to an epidural needle with greatest haste, and all of this business taken out of my hands. Luckily, Katrina didn’t listen).

It appears that, without anyone realising – perhaps due to shift change, perhaps because I wasn’t being as clear as I might have hoped – I was in transition. The baby was turning, and heading down.

I think some time around 7, I announced that I needed to go to the toilet. I needed to poo, I said, and took myself off to the toilet, closing the door behind me. After the next contraction shocked me – it felt weird, and different, I called Bobbie in.

Agnes came in to the bathroom, after asking permission. “Ok.” she said. “Katrina and I have been talking, and perhaps, you know, it wouldn’t be such a bad idea to maybe go into hospital, you’re getting very tired, and you need to have enough energy for the journey ahead…” etc, or something like.

“Oh NOW you say that” I said, foul in temper and short of gratitude. “NOW it’s too late, I think. NOW I have to push. I want to push. I have to push.”


Katrina was called and, after doing a quick exam, and confirming that yes, pushing wasn’t out of the question, started to try to persuade me to leave the toilet. Agnes ran and fetched some warm water with honey dissolved in it, I remember that. I downed it, and that, I think, gave me the energy to get up and move. Well, that and not wanting my son to be born on the bog.

There are four steps between the bathroom and the spare room. I stopped halfway up them to have a contraction. One person behind me, one person in front, I was guided back into the room, where the lights were still low and my wall of photos and maps and drawings looked down on the bed that I’d covered in waterproof bedding, the quilt I’d laid out the day before as a contraction mat in the bay window, and the tarpaulin that covered the floorboards between the two.

I made it just through the door. A spot I hadn’t thought to cover in tarpaulin. I heard the midwife asking someone to phone the labour ward – how it works in Brighton is that you have one midwife with you from the point of established labour, one to help with the birth – and, as I went into another push, I heard her say “Oh, tell them not to bother, he’s coming now, they’ll never get here in time.”

And then another push, standing by the door, leaning on the bed, and with a whoosh, he arrived. At 7.21pm. Swept up straight into my arms as I moved onto the bed. As requested, the umbilical cord was left until it had stopped pulsing, allowing Doozer to get the last bit of lifegivingness from the amazing placenta that had kept him alive for nine months. When it stopped pulsing, Bobbie cut the cord. And there we were. Lying on the bed, a tiny, long-limbed creature on my chest, breathing, wet, staring up at me. The official notes we got sent a few days later had the pushing stage at 6 minutes, but I think it was more like 11. Or 13. Not very long, anyway.

25 minutes later, Katrina got me to stand up again and deliver the placenta just as I’d delivered Doozer – except instead of being caught by waiting arms, it fell, into a waiting metal tray.

This was the point at which I was really pleased for having Agnes. In the relatively painfree bit, having a doula had seemed more luxury than necessity. But now with the midwife running in and out doing the important medical checks on the placenta etc and filling in paperwork, and no second midwife on the scene to help, it was good to have someone supporting as we lay there, skin on skin, trying to encourage Doozer to latch on. More importantly, when Katrina came in saying that she couldn’t piece together the whole of the placenta and that there seemed to be a bit missing – which would have meant a trip into hospital and a series of internal exams to find it – Agnes got her to check again, and then again, and all the time asserted that she was sure she’d seen another piece as well, and eventually Katrina agreed that I should just monitor for any extra pain or blood loss and didn’t have to go into hospital then and there. If we’d been on our own, I know we wouldn’t have had the energy to argue this.

By 9.30pm, everyone had left. Well, Katrina and Agnes – Bobbie and Doozer and I stayed. The house was still and quiet, and we were ringing round family, doing facetime on mobile phones with those who could, and introducing Doozer to his new extended family.

We tried feeding again, we moved from the spare room into our bedroom and, amazingly, by about 11pm, both father and son were fast asleep, one in bed and one in the bedside crib (for the last time in 12 weeks, but that’s another story). And I was wide awake, hormones pulsing through me, no one to expend them on for another couple of hours. So I went online. I was looking back through archives the other day, alarmed to see myself chatting away on twitter five hours after giving birth, nowhere else to put my energy. Even the next morning, when the community midwife arrived to do her check and finally weigh Doozer (he was 7lb1oz the morning after his birth, and by the next day, when he was alarmingly orange and jaundicey, we had decided on a name, and he was called Linus Benedict) I bounced down the stairs with baby in arms to let her in. There were some rough weeks ahead – but the birth itself was a good start.

It was good. My experience of giving birth. It was really good. We were lucky, and I’m very grateful. I’d go as far as to say I enjoyed it. Though of course that may be something to do with those hormones. If anyone knows where I can get some of those hormones on a recreational basis, that would be brilliant.

13 May

Mia’s Birth Story

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.

09 May

Lisa’s [third] birth story

Lisa is frequently interrupted by one of her three children.

It started with a few nights of what felt like proper contractions, nice regular intervals, strong enough that I needed to move, for a couple of hours…which petered out just about when I was starting to think maybe I should get up. Very tired, very grumpy. On Friday, the last day of term, the pains continued every 20 minutes or so all morning, through a trip to the market and coffee at Cathy’s house – not bad enough to even make me catch my breath but distinctly uncomfortable. Cameron had his work Christmas lunch so I dropped him into town with strict instructions that he was to have his phone where he could see it at all times, and was not to drink too much. No need though, as I watched Dirty Dancing, had a glass of wine and wrapped all our Christmas presents then went to bed as normal ready for a re-run that night: up at 5 blah de blah.

Very fed up, I texted Verena, our midwife. She suggested I pop in to the clinic later for a spot of reflexology, maybe a sweep, see what was what. Arranged for Sara and Ian to have Maggie and Tamsin for a bit in the afternoon, and, eventually, over we went. Pains were coming and going, nothing to get excited about until we were on our way to the clinic when I found myself gripping the dashboard for a good breathe every 10 minutes by the clock and getting very narked at bumps in the road. Arrived at the clinic, things settled again. Sarah had a bit of a poke of my feet; we were offered a bit of homeopathy (“does it still work if you don’t believe in it?” – “probably not”); tried for a sweep but cervix still too far back. Sarah could see I was starting to get pains though, and suggested I might get hold of a TENS machine to give me a decent night’s sleep if necessary. Drove to Boots; retail park heaving, it being 5 days before Christmas so C had to drop me to limp into Boots then drive round to pick me up; they had none. (Pharmacist – we can’t let you have it until you are 36 weeks. Me, through gritted teeth – I am 12 days overdue and need it now!) Texted Verena who had one in her pocket (?!) and said she’d pop it round later.

Went to Sara’s to collect some very messy children and eat the baking they had done, all the while having pains but not Pains. Fully expecting it all to fizzle out. Came home, had tea – then things started to kick in properly such that I had to walk around and hold bits of kitchen work surface every so often. C put the girls to bed and I texted Verena again. V arrived around 8, having skipped her pudding, to find me kneeling in front of the sofa so I could shove my head in the cushions when I felt the need. She put C straight to work filling the pool and got the TENS machine out which worked like a dream; all backache soothed away. Cameron, all practical assistance, lit the fire. Around 10, we put the hypnosis music on. Very odd effect: drifty drifty drifty then when the track ended, about every 20 minutes, I spring back to alertness. Pool! Hooray. Ahh, relax. Well sort of. You know. Water feels amazing. Second midwife, Sarah, arrives. Hello again. Horrible horrible pain in one hip (which is later explained by the baby keeping one hand up by her face!) and lower back: Sarah rubs it which helps enormously. Starting to get a bit pushy: panicky about pushing too early (see previous births) but hell what can you do. If you need to push you need to push. Also, you puke. And you shout a bit: if you shout too loud then you wake next-door’s dogs! (Sarah says she’ll throw them a bit of placenta later.) Struggling with hip/back pain; gas and air offered and gratefully accepted then everybody went away! Presumably to get canisters from car but C was fannying about with the kettle in the kitchen: I have a very clear memory of shouting to him because a big contraction was coming and I was scared on my own. Lovely lovely entonox. Tum te tum. Still not quite convinced it does anything but it gives a lovely focus. Conversation; V: do you feel you absolutely have to push? me: mmmm (confused mumbling). Next contraction: ok now I am properly pushing. Soon don’t need entonox any more. Midwives can see membranes over baby’s head and I can feel it moving down.

(from my notes:)

01.11 head born into water

01.12 birth of a beautiful water baby!

01.16 Cameron went to wake up girls to meet their new sister. Two tired girls peeped over the pool to say hello little sister and gave mummy a big kiss.

01.25 baby is very content filling pool with poo!

01.36 cord cut and clamped. Baby keen to feed.

Eventually I got out of the pool which is when I realised I had no energy or strength left. Very shaky, very glad for the intensely chocolatey cake the children had made with Sara that afternoon! Cameron took her off for a wander about, during which time he dreamt up a name for her – although we didn’t agree until the next morning. Eventually (after another hour) managed to get rid of placenta, was asked what I wanted to do and said I just want to go to bed! Took paracetamol (better late than never ha ha) Next day, could barely move. Legs hurt from kneeling, arms from holding onto the side of the pool. Girls piled down and into our bed “is the baby here?” – they wanted to call her Lily.

A harder birth than Tamsin, though my shortest. I blame that pesky hand up by her face because she weighed precisely the same (and just an oz or so different from Maggie). First things I noticed: small ears and elegant fingernails (and oh yes it is a girl).

Originally posted on Turquoise

27 Apr

In the red tent

I will be spending this weekend on study days all about processing ideas of birth and motherhood, and in preparation for that [and to avoid doing my tax return], I have been collecting up some bits and pieces to take with me.

The first thing I was asked for was easy: a poem or short piece of prose about birth or parenting. I’ve chosen an extract from Naomi Wolf’s book Misconceptions. The review linked here is rather critical, which makes me interested to re-read the book, as it has been a long time since I looked at it. However there is a page describing the experience of breastfeeding which I found graphically accurate the first time I read it. It’s too long to quote the whole thing here, but it ends: I had never in my life been able to make someone so happy so simply. That gives the impression of an idyllic description, but the entire quote is far from that.

The second thing I have to bring is a favourite short birth story that makes a point, and this I had to think about. I hear lots of birth stories and on reflection I find it hard to pull out a whole story in any kind of coherent detail. I thought I could use my own story, or a fictional birth story that I wrote, but both felt a bit like cheating. Then I remembered reading the story when my son was just over a year old, of journalist Leo Hickman supporting the birth of his third child at home, with the help of the ambulance operator. From the transcript you can tell that the operator is reading instructions from her screen, but she is so calm, clear and encouraging throughout, even when Hickman reports to her that the baby is still inside the sac, and then that there is a large quantity of meconium. She remains cool but not detached, and steers him through an unimaginably alarming experience. If you’re brave, you can listen to the whole call here.

Finally, I need a picture or a small object that holds special meaning for me in relation to birth or parenting. That I am going to have to think about.

I’m looking forward to spending the weekend with my colleagues talking about birth and motherhood in a supportive and safe environment. I think it will be both motivating and educational, and best of all, we are encouraged to bring our knitting!