Anna is a midwife, and her 'inside knowledge' of childbirth made her confident in choosing a homebirth. Her second baby, Samuel, was born breech, at home, weighing 9lb 4oz. Anna's first baby, Jade, was also born at home, under the care of the same independent midwife.
I am an extremely grateful mum that I was able to have both my babies normally and healthily at home without any interference. In hospital, under current hospital protocols, both births would have required intervention. With my first baby, a daughter, my labour would have been augmented as my contractions never got closer than five minutes apart and the second stage was over two hours long. The birth of my son (who was an undiagnosed breech) would have been a very different experience in hospital, probably traumatic, for all of the family. I expect I would have ended up lying on my back, my legs in the lithotomy position with an epidural in situ, with him delivered by forceps or more commonly a ceasarian section and a hospital stay of at least three days. As it was, I never left my home and I have no scars from a caesarean section or an even an episiotomy or tear.
I feel enriched and empowered by the experience and achievement of his birth, and I bounced back very quickly afterwards to be able to care for my children. I think how it happened also allowed the gentlest possible transition for my one year old daughter Jade to becoming a big sister. Although she wasn't present for the actual birth, I did not have to leave her for a stay in hospital.
At the beginning when we were deciding about maternity care for this pregnancy we had considered a home birth under NHS care for financial reasons, and as it was a second baby with an uncomplicated first pregnancy and birth I thought it would probably be straightforward. After a long discussion we decided to go for an independent midwife, Jane, who we had had with our daughter's birth and had built a relationship with. We knew she was skilled and experienced and gave a fantastic quality of midwifery care.
I think sometimes ignorance can be bliss unless something unexpected happens and things go wrong, and being a qualified midwife and knowing the system with (in my view) too many women having traumatic births and caesarean sections and the repercussions afterwards, I was prepared to do anything to finance having Jane. I would have gladly taken out a loan or sacrificed holidays for the next however many years if we hadn't reached an agreement. We felt nothing was more important than my health and the health of our child and we wanted the best possible care. Ironically we had even said we would feel safe in her hands if a situation such as a breech baby arose!
On the whole I found the experience of Samuel's birth much harder than Jade's. The pregnancy had been very straightforward, with far less discomforts than my first pregnancy, I think because I was a lot fitter running around after a toddler and walking miles with her each day. It was very hot towards the last few weeks of pregnancy and Samuel ended up being born on the hottest day on record.
Contractions began about a week before his due date one Wednesday evening, and got stronger and stronger and the waters broke about midnight. I thought he would be arriving in the next day or so I called my mother to come to look after Jade, and she arrived in the early hours. We all went to bed to try and get some sleep, as the contractions had died off to about one every hour. Samuel actually wasn't born for another four days, and I continued to have at least one very painful contraction every hour for this whole duration of time. Every evening they would get up to every four minutes for a few hours and we would think "this is it" and then everything would all peter out in the early hours of the morning.
We were all exhausted, my mother was becoming worn out caring for Jade in the day to allow us to rest as I hadn't really slept and to let me to get into labour. I also felt as if I were going through a lot of the experience alone as I was sending Simon to bed as I tried to keep upright to get the contractions going each evening when it seemed as if things were getting moving. The pain was hard going, the exhaustion was even worse but what I found the most difficult was the frustration of not getting into established labour.
I was frustrated because I wanted a quick easy second birth over in the night, not for myself, but for Jade, so she wouldn't be aware of the birth involving any traumatic separation. A friend of mine had had her second baby overnight, and her daughter just came downstairs and met her new brother in the morning. Those four days were the hardest in my life yet ever and I went through hell emotionally, trying to let go of my expectations and feeling as if I was abandoning my daughter, and it was getting worse with each day passing and the pressure was mounting.
Also I was aware the clock was ticking as my waters had broken and we had decided to give 72 hours (98% of women will go into labour within 72 hours of their membranes rupturing) as I didn't want to be induced or augmented. I was well and in my own environment, not having any vaginal examinations, and monitoring my temperature, which remained normal. Because of all these factors, I did not take antibiotics and risk thrush in the breasts (which I was prone to, and had made breastfeeding agony), or deafness in my newborn.
Jane was so kind when I called her at 4 am a few nights running in desperation to say nothing was happening again. Over the last few weeks I had felt a bit uncomfortable, with Samuel feeling so low down with a lot of pressure - as if he was very close to coming out. She even came over one night to be in the house, in case my nervousness of a quick labour without her getting there on time was holding me up from getting into labour properly. It is known birth is not just a physical process and emotional and psychological issues play a huge part in labour progression. Jane was there for me totally allowing me to work to try to let go and give birth, whilst keeping checks on me and the baby to make sure we were still well.
Saturday came and we felt we had to do something differently so we packed away the birth pool and my mother took Jade off to her home for the day and Simon and I just relaxed, got a video and had a really nice meal and gave up on having the baby even though my waters had broken. We asked my mother to keep Jade overnight which was hard as she had never stayed away overnight before and she was crying as she had just burnt her hand on a hot tap in the bath which had led to her missing home when Simon phoned. She had been with my mum for four days already with me about so the transition was gradual and I knew my mum would not worry and just hold her and let her cry and let her feelings out. She wasn't abandoned, she had my mum who can handle her feelings and nurture her so I knew deep down it was probably worse for me than for her.
The same pattern with the contractions getting closer and more intense into the night occurred and then petered out again. I felt desperate to know what was going on and on Sunday morning I examined myself (better for minimising infection risks than if Jane were to) to find I was 3cms dilated and the forewaters were still intact. However, I was draining liquor and we decided as it was a Sunday that we would think about going into hospital the next morning. Being like a fly on the wall watching myself, I noticed I had begun a "labour walk" pacing round the room, and moving and rocking my hips.
A few hours later the contractions began to get stronger again and got to about 3 minutes apart, and we called Jane. After having been with us a while and the contractions having stepped up a gear becoming much more painful so I'd felt I had to get in the pool but still quite irregular, Jane said she wanted to go outside and sit in the sun and Simon and I were to "smooch" as she called it. I was tense and obviously still struggling with letting go. So Simon got in the pool and began to massage my back and kiss me and laugh and joke with me and became affectionate and passionate. I relaxed, we laughed together and forgot momentarily about labour. Almost immediately my contractions established themselves and were two minutes apart for the rest of my labour, which was only another few hours.
Anna labouring in the pool, while midwife Jane watches quietly
It was a surprise and shock to all of us that Samuel turned out to be breech. I had got out of the pool as I had been pushing and he hadn't appeared as quickly as Jane thought he might. The moment she told me as his bottom was visible was surreal and there was a moment of mis- communication and misunderstanding between us. She wanted me to make the decision about whether to stay at home or go to hospital and had told me not to push. As I knew she was experienced with breech births, and with the stop-start nature of my labour, I read into it there was something terribly wrong and thought I had got to hold this baby in so we could get to hospital and have it delivered by caesarean. How on earth I was going to do that and get onto an ambulance trolley, I didn't know.
I felt at a critical point in my life, on a knife's edge, as the thought crossed my mind that this baby could die. Strangely without any kind of panic or emotion, almost like a daydream, I visualised myself at a cross roads with two forks ahead of me - one fork a life with a healthy child and the other fork life having gone through the loss of a child at birth and thinking I had never imagined I would have to deal with this. With the next contraction there was no more holding him in and I relaxed as Jane was smiling and said it was ok to push, it was just that there had been an anterior lip before. They hauled me over onto all fours and as I leaned over the birth pool I remember a knowing flooding over me and deep into my bones that he would be ok.
"Pull its feet out" I remember yelling, knowing full well it is best to keep hands off the breech, and I painfully felt him wriggle to bring his legs down, first one then the other, then his arms, and then he lifted his feet twice to bring his chin down and then he was born safe and well. He needed a few breaths of oxygen, but within a minute or so he was crying. His cord was left until after the placenta had come out and he was breast-feeding. My friend Laura, a midwife, had arrived to assist Jane and everything seemed to be so normal and un-traumatic with me saying "Hi Laura - so lovely to see you!" Again I had the pleasure of being at home and able to get into my own bed after the birth, relieved it was over.
Samuel was big - 9lbs 4 oz - and he didn't even tear me coming out like that; it was an eye-watering second stage !
Undoubtedly a small minority of births need medical attention and intervention, and some women would want to make different choices to me. However, I don't think I could be far wrong to suggest most women would want the type of midwifery care I received, whatever choices they wish to make about their birth. But unless we can turn it around, this type of midwifery care will die out, with midwifery education primarily hospital based therefore very medicalised, skills not being adequately being passed on, too great workloads, short staffing and stress, litigation and low pay, to name but a few issues.
The birth of any child really is a journey and an unforgettable, major event for a family, and the degree of skilled, personalised intuitive care Jane has given us has truly made our children's arrivals what they were and given all of us the best possible start. We will probably never fully know and appreciate how great an impact she has had on all of our lives and the quality of our relationships well into the future.
Anna Berkley
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