Ella Hope's birth story, by Amy Driver

Amy's first baby, Ella Hope, was born at home after a straightforward labour, with a very supportive birth partner. Amy transferred to hospital after the birth because of heavy bleeding.

My daughter Ella Hope was born on 18th December (at 37+ 6). I had initially booked for a hospital birth, but was not entirely comfortable as it is a large consultant unit attached to a general hospital (Warrington), and I felt it would be a bit clinical. I had to visit my grandmother at a different hospital at around 5 months pregnant, and decided that I really did not want a hospital birth. I did some research and decided to request a home confinement. Having read some of the birth stories on the Home Birth website, and as Ella is my first baby, I expected some resistance.

The first midwife I talked to broke into a big smile when I suggested it (which she quickly suppressed and started talking about the risks), but she seemed happy enough. My normal community midwife came to visit at home and discussed the procedure and the risks involved. The only one that really worried her was shoulder dystocia, as she considered that most other problems could be dealt with by a transfer to hospital (around 20 mins away). After some further discussion with my husband, Graham, we decided to go ahead and this was agreed.

It was suggested that I discuss it with the consultant, but since I had had no complications whatever in pregnancy and one midwife suggested that he would be less positive, I turned down this idea. I continued to plan the birth, including ordering a birthing pool to have at home, and began to feel very positive - convinced I had made the right decision. I felt confident in the midwives, and hoped that all the negative stories I had read would not apply to me!

About 4 weeks before due date, the supervisor of midwives came out to see us to explain the way things are organised - who to phone etc. She was generally positive, but raised the issue that only 2 midwives are on call for a home confinement at any time, and if my labour coincided with another home confinement I would have to go into hospital. This really annoyed me, but as I was feeling emotionally fragile, and thought that if I made a fuss I would become "that woman who kicked up a fuss", I decided to keep my fingers crossed that I would be the only one and not take any action. It did upset the last weeks of my pregnancy, however, and I found it difficult to accept when they said that they were trying to encourage home births - as the numbers increase, the number of "clashes" is bound to increase, and who wants to plan a home birth if the chances are they will have to go into hospital anyway (again, this word "have to" which is so often raised in other stories).

The birth pool was booked from the Wednesday but fortunately they phoned to ask us to collect on the Tuesday as they had their Christmas party on the Wednesday - so when I went into labour on Wednesday morning we had already got it at home. Here was another "have to" - the midwives insisted that I would not be able to give birth in the pool before 38 weeks, and must not get in before 5cm - both disputed by the pool people - the midwives suggest getting in a bath in the early stages but insist you can't get in the pool, which seems very illogical to me.

I started feeling contractions at 10:30am on the Wednesday and initally felt very unconvinced, as I had had no other signs that labour was imminent. Once I began to think that these might not be just Braxton Hicks, I phoned Graham to get him to come home from work and called the midwives. They agreed to come out at 3pm, which I was very happy with. I strapped on the TENS machine and Graham assembled the pool, between massaging my back. The contractions were about 7 mins apart when the midwife arrived, and I was 1cm on examination. She agreed to leave us to it, and we would phone again when we felt we needed someone.

The pool was beginning to fill just after 7pm when we decided a midwife would be a good idea and the contractions were 5 mins apart. When she arrived at 7:50 I was 3-4cm, which dissappointed me, but the contractions then started to come thick and fast. I used a bit of entonox, the midwife called for her second backup midwife and by 8:25 was feeling a very strong urge to push. Since it was so soon the midwife examined me again and agreed that I was fully dilated. By this time the second midwife had arrived, and Ella was delivered at 9:05, giving me a small tear. The only problem I had had during the second stage was when the midwife wanted me to lie on my back as she couldn't hear the heartbeat with me on all fours. I was happy to do this, but she was keen for me to stay there to push. Fortunately Graham knew how keen I was to deliver in a different position, so he was very firm with them and I ended up delivering on my side. The midwife had not had time to read my birth plan, and so was unaware of this desire, or of the fact that I was capable of squatting - which she had stopped me doing earlier. Perhaps we should have been more insistent that she read the plan, but it was all going very fast, and there wasn't really time. They did ask me as the head was delivered if I wanted to have syntometrine, which I declined. In my birth plan I had requested a physiological 3rd stage.

We were both overwhelmed by the baby, and suddenly realised that they had clamped the cord - which we had decided not to do until it stopped pulsating. We only realised when they asked Graham if he wanted to cut it, when it was already too late. He cut the cord and we cuddled her, only later realising that the midwife was applying cord traction. The placenta arrived after around 5 minutes, and was intact. The midwives insisted on dressing Ella, as she was a little chilly. I will certainly be much more assertive when I have another child (touch wood) and will explain exactly what I want to happen. I assumed that they would promote skin-to-skin contact and would leave her close to me, which I would have thought would have been more effective in warming her up than wrapping her in layers of clothes, but I was not really in a state to protest.

After a while and a short breastfeed, Graham helped me into a bath, and then one of the midwives helped him make the bed (my only nesting instinct had been to strip and wash the bedclothes in the morning, and I had never got round to remaking the bed!). I got out of the bath and by midnight was sitting in bed with Ella in the cot beside me. The midwives cleared away their equipment and got ready to leave, when I passed a large clot. I continued to bleed in a trickle, and so it was decided to call an ambulance. Due to the speed of the delivery, they were concerned that I may have torn my cervix. I sat up in the ambulance and chatted to the paramedic, but when I went to go to the loo on the labour ward, I knew I was going to pass out. I will draw a veil over the following few hours, suffice it to say that it involved a catheter, two IV lines and significant use of a speculum - along with copious quantities of gas & air.

As my iron levels had obviously dropped they wanted me to stay in hospital until the following morning, when they could re-test and make sure I didnt need a transfusion. The following 24 hours were not at all pleasant, and totally reinforced my desire to avoid hospitals. When I had told people I was planning a home birth, a few said that they would want to go to hospital for the rest. Rest was not a description I would use - when you've got 4 new babies in one ward you dont get a lot of sleep! At last I was able to come home on Friday morning, after a few more conversations about "have to" - such as the fact that they cannot let the baby go home if they havent had a wet nappy - what if I'd been at home in the first place?

I am extremely happy that I decided to have a home birth, it was a wonderful experience, with very little of the fear or lack of control that many of my friends who had hospital births described. I have managed to separate the two experiences in my mind and remember the birth of my daughter with a feeling of pleasure I never thought would be possible.

My next challenge will be to persuade the midwives/consultant that I can have a home birth when I have another child (touch wood). I have talked through the experience with both of them, and despite the fact that the consultant told me that bleeding is reduced/eliminated in the majority of women who have oxytocins administered with the shoulders, and that he said that he is not in a position to insist anything - that any future birth would be a matter for discussion, when he asked me if I would be happy to have another home birth and I said yes, he gave me a look that suggested that he thought I was barking mad. I think I'm just going to have to keep my fingers crossed and expect to have to be firm when the time comes.

Questions from Angela: I couldn't help a few exasperated sighs at the policies about use of pool before 38 weeks, midwife wanting you to push on your back, not being 'allowed' to go home from hospital, etc, etc, though! Did you get to use the birth pool at all in the end?

I didn't get to use the birth pool during labour - it all went a bit fast at the end and I didn't get the chance, but we had two lovely baths in it afterwards - bliss to be able to bob around for ages & share it with Graham, rather than feeling cramped in our normal bath & having to get out quite quickly when the water cooled. Even though we didn't use it I still think it was worth the money for the hire. It was much easier to use than I had inticipated - filling and empying very quickly. We got it from Blue Lagoon, who were extremely helpful & supportive.

Do you know what caused your bleeding afterwards - was it a torn cervix, or was it your uterus not contracting down? I have heard speculation that where midwives mix techniques of managed and physiological third stages, ie clamp the cord early and use cord traction where syntometrine has not been given, the risks of haemorrhage are increased. I don't think that this is proven, but it is widely written in midwifery articles that a physiological third stage does not mean just not giving drugs, but doing everything else exactly as if it were a managed third stage. It sounds like you were aware of this, as you commented on the cord traction, but perhaps your midwives had very little experience of alternative third stage management.

I believe my uterus relaxed after initially contracting, causing the bleeding, and once clots were caught in the cervix it just kept going. I had also heard about the problems with physiological/managed 3rd stages, and am waiting for a leaflet from AIMS to confirm this. The consultant insists that if this were the case I would have bled profusely, but I'm not convinced. I have friends who are vets and they would never touch the cord of a labouring animal. I will probably use the information when preparing for my next baby. When I asked the midwives about it (making sure I was not putting them on a defensive footing) they merely avoided the question.

It seems ludicrous to 'insist' that you stay in hospital for re-testing iron levels if your bleeding had stopped by then - why couldn't the midwives take blood from you at home? After all, they routinely do that a couple of days after birth if you've lost a reasonable amount of blood anyway. As you probably found out, when blood transfusions are given after birth, it is vanishingly rare for it to be a case of "Quick, get blood into that woman now, or she'll die" - nearly always it's a case of testing Hb levels and, after thinking about it for a day or two, giving you a transfusion then.

I think if I end up transferring again I would insist on coming home after the procedures, but it was all new and I was tired & in pain & not really in the mood for an argument. They did threaten to put me under general anaesthetic to complete their investigations, and I was so relieved when they listened to my pleading not to that I didn't question the rest. I was on a drip for most of the Thursday - so I suppose it would have been difficult, but I would definitely argue the case another time & not go through a night like the one I had in hospital again - I didn't realise how unpleasant it would be until it was over. On the Friday morning I took a shower and got dressed in proper clothes rather than pyjamas - just to make sure they didn't think I was staying any longer!

 Amy Driver
amy&graham@homebirth_antispam.driver.dabsol.co.uk (remove "homebirth_antispam." to get the correct email address)

Update: Amy's second baby, Lucy, was born at home... no problems at all, and a lovely birth story. Well done!

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