I am writing to tell you the story of the home birth of my second daughter, Lucy Joy Driver, on 17th October. You included the more traumatic birth story of my first daughter, Ella Hope in December 2002, but I am delighted to say that my second labour was just as every home birth should be.
When I went to book in with the Midwife I expected some resistance to the idea of a home birth, as I had a post-partum haemorrhage (PPH) last time, necessitating a transfer to hospital. This experience had left me even more determined to avoid hospitals wherever possible, but the consultant I saw after Ella was born left me in no doubt that he thought I would be mad to even consider a home birth a second time. I was convinced that the PPH had been caused by the midwife applying cord traction even though I had requested a physiological third stage, and had not had syntometrine. As I had expected, no-one in authority had acknowledged this at the time. (Compensation culture has a lot to answer for - I only wanted answers, I had no intention of suing!) As a result of my communications with the head of midwives, I am now a user rep on the Maternity Services Liaison Committee at the hospital, which has been very interesting.
Note from Angela: See Third Stage Choices for pros and cons of managed and natural third stages, and also'What if you have a PPH at home?'.
However, as I walked into the surgery Sue said "I didn't think it would be long before we saw you again, are we going for another home confinement?" with a big grin on her face! Sue had been my community midwife during my first pregnancy but had been off for a couple of months around the time of Ella's birth, so had no knowledge of the details. I discussed Ella's birth with her and she said that privately she had no doubt the PPH was caused by mismanagement, and did I want her to discuss it with anyone. I very nearly wept! Finally someone within the system admitting that it probably wasn't a "natural" PPH.
Sue said that she was happy for me to go ahead with a home birth, but as I had had a PPH she would be happier if I discussed it with a consultant as well. She referred me to a different consultant to last time, who would hopefully be more positive. As she was being so supportive I was happy to go along with this.
As I anticipated, the consultant was not convinced and, although she was very sympathetic, insisted that I should have a venflon inserted in my hand at the beginning of labour, so that, should I bleed, they would have immediate access (to give intravenous drugs and fluids). Since the midwives are not qualified to do this, I would have to go into hospital. She insisted that there was an increased risk of a recurrence, and a possibility of a dramatic one. Again, she didn't even take on board my suggestion that the midwives actions may have contributed to the bleed.
She suggested that she would talk to the head of midwives, and I would talk to my midwife again, and I should make an appointment for 37 weeks, when "we" would make a final decision. Why do these consultations leave me so compliant? I am an educated woman who can hold her own in most situations, but put me in front of a consultant during pregnancy and I seem to become unable to argue coherently. Anyway, I left knowing that I would go for a home birth, and that I had no intention of turning up at 37 weeks. By then I would be far too emotional, and would need to have settled it way before then so that I could plan for labour in my own mind. Since Ella was born at 37+6, it would be cutting it a bit fine.
Sue was quite happy for me to continue - I had since discovered that 1 in 8 PPH's go on to have a further PPH (which means that 7 in 8 don't), and that the risk of a catastrophic bleed is not significantly increased by a previous PPH. These statistics don't allow for the fact that there was a cause for my bleed, which would not (hopefully) be repeated.
Apart from some pubic symphysis problems (ouch), my pregnancy continued without a hitch and all the home birth arrangements were in place. I found, as expected, that there is still a caveat that if another mum to be has gone into labour at home and then I too start and call in, there will be no-one else on call and I would have to go into hospital. I do know from the committee at the hospital that this is in the process of being remedied, just not in time for me. Fortunately I have an optimistic outlook, and was able to put that to one side.
37+6 came and went, and I then discovered just how much more uncomfortable the last two weeks of pregnancy are, and how lucky I was to miss out the first time around - with the addition of pelvic pain, I was extremely keen to give birth at the earliest opportunity! I had two due dates, the scan showing the 18th Oct, but my dates showing the 13th. I am extremely irregular, so was inclined to go with the 18th, but the records showed the 13th, since they don't alter the date if it is within 5 days. With a home birth "window" that had narrowed since Ella's birth to between 2 weeks early to 10 days late, I was a little concerned. This is something I will be following up with the hospital as I don't understand the reasons for the change (it was 3 weeks early & 2 weeks late 2 years ago). The only explanation I have had is that it brings Warrington into line with the other surrounding hospitals - which strikes me as an unconvincing argument.
Rant from Angela: Full term for a 'normal' pregnancy is defined by the World Health Organization as 37 - 42 weeks. Until recently most health authorities would support bookings for home births between those dates. For more on the issues surrounding 'early' homebirth, see 'Homebirth before 38 weeks'. Many health authorities continue to support homebirth from 37 weeks, and many women have homebirths from 36 or 37 weeks regardless of their health authority's policy. If you are told that you 'can't' have a homebirth before 38 weeks, you can make it clear, preferably in writing, to the Head of Maternity that you intend to stay at home if you go into labour from, say, 37 weeks, and that you expect a home birth service to be provided. Please contact the Homebirth UK email group for support, and also AIMS, if you wish to take this further.
Back to Amy...
I had a scare at 37+4, when I thought my waters had gone, but nothing happened. They stopped quite quickly, but the midwives are allowed to leave 48 hours before they induce - in hospital - so it was a great relief when they did a speculum exam and found no evidence of ruptured membranes.
At last, at 39+6, my waters went, all over the hall floor. I couldn't have asked for better timing - It was a Sunday lunchtime, Graham was home and just giving Ella her lunch, after which she would have a sleep for an hour or to, giving us time to get sorted out.
I was just wondering how long it would be before anything happened, when the contractions started. They were 6 mins apart but very manageable. Graham strapped on my TENS machine, only to find that one pair of contacts was not working (why did I ignore the instructions to test in advance?). One pair was still better than none, and I did find it useful.
I called labour ward and the midwife was there within 20 minutes - I was very pleased to see that it was Julia, who I knew and had met a few times. She knew I had had a PPH last time, and was very thorough in reading my birth plan (unlike last time). In the meantime Ella had obviously realised something was up (the mad grins on our faces might have given something away), and decided not to have a nap. My parents were due to visit that afternoon, with my brother & his girlfriend, so I had called and asked them to come and take Ella out somewhere, but as they live an hour away and thought Ella would be sleeping, they didn't arrive until just after 3pm. I was pleasantly surprised at how easy it seemed to have Ella there, helped by the fact that Julia rubbed my back whenever Ella needed Graham's attention. Ella amused herself by copying my actions of leaning forward over the edge of a chair whenever I had a contraction. Having had much less leisure time to prepare myself this time, and my pelvic problems putting paid to any antenatal yoga, I was pleasantly surprised how easily I fell back into exactly the same breathing & movement to cope with each contraction. It was only after I had put on a CD that I remembered it was exactly the same one I chose last time. (Kirsty MacColl, if you're interested). Mum & Dad arrived and took Ella out, and almost immediately the contractions went up a level. Before long I had given up walking around - they were coming thick & fast and I ended up on my knees leaning onto the settee. Julia was very relaxed. The second midwife was due to arrive with all the equipment, but Julia reassured me that she had her emergency kit and it didn't matter if the 2nd midwife didn't get there in time. She was a very calming presence - in contrast to last time when I felt an air of panic when everything started to move faster. The second midwife was my community midwife - I was very lucky to be giving birth during the day when I could be attended by two midwives I knew well, rather than random on-call ones. She arrived in good time, however, and brought all the paraphernalia with her. I could feel that the urge to push was not too far away, and the contractions were getting very intense, so I took advantage of gas and air for about the last three - which was a very welcome relief. In the end I was pushing for about 20 minutes, but it felt like less, and Lucy was born onto a blanket behind me 3 hours and 40 minutes after my waters broke. She had the cord wrapped around her neck and was a bit purple, but Julia reassured us that her heartbeat was strong as they wafted her with a bit of oxygen, and before long she yelled. With a bit of assistance I moved round to sit on the floor (ouch, that pelvis) and cuddled her. Julia was just about to check if the placenta had detached (syntometrine having been administered - I was taking no risks this time), when I pushed it out involuntarily, about 10 mins after Lucy's arrival. I had a tear, but in view of my pelvis, Julia was unwilling to ask me to move my legs apart to stitch it, so she waited to make sure it was not actively bleeding before confirming that it could be left to heal naturally. 3 weeks later, I would say that this is the better solution. Although the initial stinging lasted longer than after Ella's birth, now it is better healed I feel much more comfortable "down there" than I did last time. The midwives cleared up the mess (much more this time - there was remarkably little mess at Ella's birth), helped to hoist me onto the sofa and left us 3 to have a cuddle and ring people. They both retreated into the kitchen to write up their notes & phone the hospital - a very welcome touch, that did not happen last time. My Mum was in the middle of changing Ella's nappy in a public toilet when I rang and she promptly burst into tears, much to Ella's confusion. They all brought Ella home & introduced her to Lucy less than two hours after she was born. Ella couldn't stop grinning. The four of them then took Ella out for tea at the local Pizzeria while I had a bath & got cleaned up. The midwife checked my uterus to make sure it was well contracted - which was a great relief. I hadn't realised how apprehensive I was about bleeding again. Satisfied, she left us to it. The family soon came back, carrying take-away Pizza for me & Graham and we all sat round and toasted Lucy with a glass of champagne (2 sips of which gave Ella the hiccups!). Although, obviously, the birth itself was agony (I subsequentially discovered that Lucy's head measured 37cm, in contrast to Ella's 33cm, and I could tell!), I couldn't have asked for better care from the midwives. They were both relaxed, and when they couldn't find the heartbeat, just before I started pushing, they were happy for me to continue, whereas last time they had insisted that I roll onto my back so they could find it. Their confidence was infectious, and even when Lucy was not breathing initially, I knew everything would be fine. They judged the balance between support & intrusion really well, and gave us plenty of time to ourselves afterwards. It was so lovely to have the family around so soon after the birth, which could never have happened in hospital, and it all added up to a wonderful birth experience. Graham even remembered to put the bin out for the binmen before we went to bed, which perhaps shows how straightforward it all was. Lucy is now 3 weeks old, and I have been constantly amazed by how well I feel. I don't think I had realised last time how much of my feeling rotten was down to blood loss rather than childbirth itself, but having gone through labour in such a short time - not missing a meal, let alone a night's sleep, must have contributed to my general well-being. Lucy is a dream, and only cries when she has good reason to. We even had five nights when she slept for 6 hours at a stretch, although that has settled back to being up to feed twice a night, which is pretty good going. She gained a pound in weight in her first 10 days, and I have to stop myself from going round with a great big grin on my face. It's hard not to feel smug when you talk to people who had traumatic hospital births! Having been evangelical about home births after Ella's arrival, I will be even more of a bore on the subject now. So many women seem to be caught up in the medical model of childbirth, and couldn't even contemplate the idea of staying at home - how have we gone so quickly from 2 generations ago when practically everyone was born at home to the current situation where it is seen as something very "brave"? - to me the brave thing would have been to face going into hospital & an increased risk of intervention. Why can't people view childbirth as something entirely normal, which has been done for millennia - I'm sure mental attitude is half the battle in experiencing a "normal" birth. When labour is all hormone-driven, it seems obvious that the state of mind of the mother is crucial. Having written to the head of midwives to complain after Ella's birth, I will now be writing again to thank them for a wonderful experience - just how childbirth should be.Amy
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