Antonia's first baby, Hugo, was born naturally at home, in a birth pool. Hugo's head was asynclitic - tilted to one side - which meant that the second stage was long, and Antonia sustained a third-degree tear which was repaired in hospital.
Hugo was born at home at 3:53pm after a 13 hour labour on Thursday 14th March 2002, three days after his due date based on ovulation. The labour was hard work from the start - there were no gentle 'warning' or 'warm-up' contractions - I was jolted from sleep straight into full-on labour, which was a bit of a shock. I worked through the contractions - taking a hot bath, walking, climbing the stairs, singing, dancing - doing whatever it took to get by. It took hours before I accepted that I was 'properly' in labour - I wanted to go swimming and run errands that day, and wasn't prepared to be inconvenienced by a labour that I wasn't ready for. I even wrote a list of reasons why I couldn't be in labour, and tried to send my husband to work - despite being unable to talk through the contractions!
Although I had woken up somewhere between 2-3am in labour, I didn't wake my husband Paul until his alarm went off at 6am, nor did I phone my midwife until about 10:30am: I didn't see the point in ringing her if I was in "early labour". I had had it drummed into me that first labours are at *least* 24 hours long, so I assumed that I had ages to go. Rather than assuming that I was well into established labour, I simply assumed that I was 'wimping out' on the 'easy' early contractions, when I was actually heading into transition. When I did phone my midwife I insisted, between contractions, that I was fine, and asked her to ring me later that afternoon for an update.
I had also insisted that Paul drive into work to pick up his laptop so that he could work from home, and then run a few errands (picking up a hot water bottle etc.). This kept him away from home until 11:30am by which point even I couldn't deny that the baby was well on its way: had Hugo not had a difficult presentation (he was asynclitic) he would likely have been born around lunchtime, possibly before the midwife arrived! On arriving home Paul immediately phoned our midwife and asked her to come ASAP. He then set up the birth pool which I couldn't wait to use.
Dorothy, our (independent) midwife, arrived just before 1pm. "How far along do you think I am - 4 or 5 cm?" I gasped. "Oh, I think you're a little further than that" was her reply. When I asked her, largely in gestures, if she thought it was too early to get into the pool, her reply was: "not if you want a waterbirth".
I got into the pool when it was only a few inches full. The water was amazing, it felt like home. I couldn't imagine being anywhere else. I was completely turned inwards, allowing my body to work as it knew best. I just concentrated on riding the contractions, and worked very, very hard to NOT push in addition to the strong pushing that my body was doing. I had the feeling that something wasn't right, and for that reason felt strongly that despite the huge urge I had to push, and the massive expulsive contractions that my body was having, I shouldn't push with them, but let my body do its work without "my" help. In between contractions I rested my head on the side of the pool. Time seemed to stop. I felt that I had been in that pool forever. I lost track of myself, and just rode the contractions.
I knew that a second stage was supposed to last 30-60 minutes for a first labour: although I had no conception of time, I was certain that more than an hour must have passed. Dorothy was watching me intently, but not interfering. Occasionally she took my BP and foetal heart rate. Baby and I were both fine, but working hard.
On more than one occasion I heard Dorothy say and/or gesture to Paul "it's coming now" and I thought "NO IT'S BLOODY NOT!! YOU'LL BE WAITING A LONG TIME BEFORE YOU SEE THIS BABY SO DON'T GET EXCITED" but I wasn't capable of speech, and didn't want to talk, so said nothing. I don't know how I knew, but I just knew that the baby wasn't coming - to me it was blindingly obvious. Eventually I noticed the time from reading Dorothy's notes upside down and realised that my body had been pushing hard for well over 2 hours without budging the baby. Around this time Dorothy asked me if I was pushing voluntarily with the involuntary contractions and I said "no". When she asked why not I replied "because I don't want to tear." This wasn't me wimping out over a potential graze: somehow I knew instinctively that if I pushed Hugo out under my own steam, it would mean having one hell of a tear. About 2h 15m into the 2nd stage my contractions stopped altogether. My body was exhausted. I felt that it had run out of energy and was 'recharging' but had no idea how long it would take before contractions started again - if indeed they would. I got in and out of the pool, squatted, changed positions, to try and restart contractions. Dorothy could see the baby's caput. I could feel the baby's head, but knew that the baby hadn't moved down the birth canal at all in well over an hour, and possibly much longer.
I got back into the pool and thought "OK, let's do this - If I don't push my baby out, someone's going to pull my baby out, and that's not acceptable". I waited until the next weak contraction and pushed with all my might. A second push with all my reserves and my baby's head was born. I felt as though the sky split open and the stars rained out. The head was smooth and fuzzy like a large pebble in a stream. I paused for a minute or two, then pushed again - Hugo George James was born with his cord wrapped twice around him. He was gorgeous. He was perfect. It was love. "Hello baby! Hello my love! He's a boy! He's Hugo! Hello Hugo!" I babbled as I brought him up to the surface and held him to me.
I knew that I had a third degree tear - I told Dorothy this within minutes of the birth. And when, much later, she was able to have a look, she saw that I was right. But that was the last thing on my mind as I held my beautiful son and our eyes met, intoxicated by love. Despite the prolonged second stage Hugo was a healthy little boy from the first, his APGAR scores were 9 then 10. This alone made the effort all worthwhile: it is highly unlikely that he would have been born in such good condition had I had to transfer to Hospital and have an assisted delivery or caesarean. I held Hugo close to me in the pool, and put him to my right breast. He didn't latch on, but I kept him close and stroked his cheek with my nipple and with my finger hoping to stimulate his rooting reflex. Paul joined us in the pool and the three of us spent the next two hours marvelling at each other. I held Hugo close, and hoped that he'd nurse - like many first time mums I probably held him less adeptly than I would now, and it didn't occur to me to offer him the left breast. I wasn't concerned - I was confident that he would latch on. I'd had a drug-free relatively straightforward labour and had a healthy, alert baby: and that was the best possible start to a nursing relationship right?
I was also waiting for the placenta: I hadn't had a contraction since I'd birthed Hugo, and eventually started trying to push the placenta out myself to no avail. After 2 hours I accepted that I would have to cut the cord in order to be able to move around more freely to try to deliver the placenta. I had also had a moderate-to-heavy post partum haemorrhage; the pale blue pool made the water appear completely black with blood. I was unhappy about cutting the cord, but knew that it was important to deliver the placenta as soon as I could. Finally it occurred to us to get out of the pool; I felt really, really weak. I was sad that things were not as straightforward as I'd expected that they would be - after a normal physiological birth I expected no problems nursing and hoped that nursing would help stimulate a normal physiological third stage. In the end I conceded that we needed to use syntomectrine; Paul took Hugo and cuddled him on a sofa at the other end of the room. After a catheter (I hadn't urinated for over 12 hours, oh the relief!) Dorothy administered the syntometrine shot: nothing happened, not even a flutter of a contraction. Urgently (and to my surprise as I'd specifically requested no cord traction) Dorothy used controlled cord traction to deliver the placenta. It came away easily and intact, but with an extra lobe. I have since found out that the extra lobe may have been responsible for the delayed third stage. There was relief all around - and I was glad to be able to take Hugo into my arms again, cuddled skin-to-skin with me.
Dorothy and Paul made me some food - hot sweet tea and natural live yoghurt and placenta. I had intended to eat some of my placenta, but wasn't prepared by how right it felt to do so. Fortunately I enjoy raw meat - and Dorothy showed Paul how to separate the 'meat' from the membranes. Over the next 3-4 days I finished off my placenta, and am convinced that this helped me recover from a difficult labour and significant post-partum-haemorrhage. I didn't suffer from "baby blues" despite the stressful events of the hours and days after my birth, and I have often wondered if I had my placenta to thank for that as well
I then rang my Mum briefly, had a bath, and then went into the bedroom for Dorothy to examine my perineum. As I had expected (known really) she found that it was either a bad second or third-degree tear (which the surgeon later confirmed as a third-degree tear), which would require surgery beyond her skills at home. She phoned Kings who 'guaranteed' that we could be in and out within 40 minutes, and they sent an ambulance which arrived within 10 minutes. We set off some time after 8:30pm.
At this point I think that exhaustion and blood loss started to interfere with my thought process - I can find no other explanation for what followed. As soon as it was decided that I would go into Kings for a repair, I became adamant that my beautiful son was NOT to be exposed to hospital-borne infection, and insisted that he stay home with Paul. I was determined that I hadn't gone through all that hard work to have him at home drug-free only to take him into hospital. It was completely irrational - I needed him and he needed me - but I only wanted fiercely to protect him from harm. I wish that someone had pointed out that I wasn't making sense, that Paul and Hugo and I should all go together in the ambulance, but I think we were all a bit shell-shocked. It had been a harder day than any of us had expected. So following my insistence, Dorothy and I went in the ambulance, leaving Paul and Hugo at home.
The ambulance men were lovely - albeit a bit freaked when they had to fill in their notes as to what the patient had eaten ("yoghurt and placenta"). We arrived at Kings after 25 minutes (I live a 5 minute drive from Kings so I don't know what route they took!) and I was pushed on a trolley into a filthy lift and up to the post-natal floor. After about half an hour an obstetrician came in. He gave me a cursory glance and addressed all of his remarks to my midwife. When she mentioned homebirth he muttered something, then proceeded to give me an unnecessarily rough examination, complaining that I "kept wriggling". He went on to say that I would need at least a spinal anaesthesia, but that he would recommend a general anaesthetic, and that I would not be allowed to leave hospital for at least 3 days. Suddenly I found my strength again. I was incandescent. "Allowed," I said, "is not appropriate language to use when addressing a mentally competent adult." I asked him to leave the room so that I could speak to my midwife in private, and advised that he rethink his words while he was waiting for us. He looked at Dorothy who gestured towards the door, and with a helpless shrug he left the room. Dorothy, who had given me a thumbs-up behind the obstetrician's back while I was addressing him, asked me what I wanted to do. I asked her to ring a taxi so that we could go to the Queen Elizabeth. There was no way that I was going to allow someone with such a appalling lack of respect to do a repair that could influence my continence, sex-life, and future childbirth. I knew that a third-degree tear was serious, but that complications and long lasting effects were rare if a skilful repair was made. Dorothy went out, and came back some time later. Horrified that a woman needing medical care felt forced to decline it because of the attitude of a registrar, the night manager had contacted the Senior Consultant on duty who was going to come in to see me - she was at home, but was on her way in (it was already 10:30pm by this point): would I wait to see her? I agreed to and asked Dorothy to ring Paul and get him to come in with Hugo. She also rang our friend Angie to come over to the house - an extra set of hands was needed to set up the baby seat in the car.
Maggie Blott, consultant Obstetrician and all around star swept into my room with a smile around 11pm. The first thing that she said was "where's your baby?" and I knew then that I'd be fine in her hands. She was more concerned about Hugo being separated from me than anything else "you NEED your baby" she said, and was thrilled when he and Paul showed up a few minutes later. She gave me a deft and painless examination, and confirmed that I had a serious third-degree tear that would require surgery in theatre under spinal anaesthesia. She said that I could go home when I could feel my legs again well enough to walk, and we agreed on 6am as an 'earliest' release time.
Some time later I went into surgery, and we spent almost 2 hours there. The team was wonderful - lovely, positive people. Paul was there in scrubs with Hugo right beside me. I remember joking that the last place I had expected to be that day was in an operating theatre with my feet up in stirrups!
After what seemed like forever I was taken back to my room on the post-natal ward, and Hugo and I curled up together in bed. I put him to the breast (always the right breast as I remember it - it's the only way that I held him the first day or so after his birth) but he didn't latch on. Paul got us all sandwiches, then around 4am Dorothy went home, and Hugo and I tried to sleep cuddled up in the narrow hospital bed. I remember a nurse coming in and wanting to look at Hugo under a bright light because she thought he looked jaundiced. Eventually I got the feeling back in my lower body. At 8am I was discharged, and Paul drove us home. It was all very dreamlike and surreal. Except for the time in surgery I didn't let go of Hugo for an instant once we were reunited.
I slept on and off for much of the next day, Friday - as did Hugo. I continually put him to the breast, but he didn't latch on. I didn't panic - I knew that babies were born with enough brown fat to provide them with several days' energy. Hugo was a little more jaundiced on that second day, but nobody seemed enormously concerned. Dorothy visited and said that she wasn't worried about Hugo not nursing as he seemed normal and alert when he wasn't asleep. I felt reassured - probably more so than I should have. But I kept putting him to the (right) breast at every opportunity. He slept beside me in our over-sized family bed, and I refused to be separated from him for even a moment.
My third-degree tear probably didn't help nursing much either, as it meant that I was essentially confined to bed (and couldn't walk up or down stairs for two weeks), where I was unable to sit comfortably. I don't remember being in pain per se, but I wonder if my concern over Hugo not nursing blocked the pain out for those first few difficult weeks. I rented a valley-cushion from the NCT, which didn't make an enormous difference.
By Saturday Hugo still hadn't latched on. We'd agreed to a visit from a different midwife, someone who was over from the US for a few months shadowing my independent midwives. I had met her several times at an antenatal group and got on with her extremely well, so I was really looking forward to her visit. Dorothy had told me that she was also quite a "breastfeeding expert" so might be able to help Hugo and I with nursing. The visit was disastrous. For nearly 2 hours she drove me to distraction with well-intended "advice" and so much hands-on help that I had to consciously restrain myself as my instinct was to hit out as she came again and again to grab my baby's head and shove it onto my breast. Eventually I asked her to leave, thanking her for her help, but it was clear to us both that the visit was a disaster. If I hadn't felt bad enough at not being able to nourish my own child before, I felt bereft after her visit. How could it be that someone who hadn't even had children could know so much more about nursing than I did - yet even with her help I couldn't get it right. But it felt SO WRONG to be pulled and pummelled into position after position, and eventually I couldn't bear to watch her pushing Hugo's head onto my breast. I had been worried before, and now I felt devastated. Hugo grew more and more jaundiced and sleepy.
My milk still hadn't come in, but my friend Angela had encouraged me to express my colostrum, and had dropped a hand-pump and cup and feeding spoon around to the house. I started expressing and keeping a journal of how much I expressed and how often and how much Hugo would take. Paul and I were awake for 24h non-stop expressing (I was expressing, he was keeping me company). I was expressing the colostrum literally one drop at a time. Each drop was a small victory; once we'd collected several precious drops in the cup we'd feed them to Hugo with the spoon. One spilled drop felt like an enormous, unjust tragedy. Over the 24hrs I managed to get 60 mls of colostrum, almost all of which we got into Hugo by cup and spoon 5-10mls at a time.
In between 'feeds' Hugo slept - he was becoming increasingly sleepy, even though he was wonderfully alert the small amount of time that he was awake. He didn't cry, just nuzzled into me. He still didn't latch on. He learned to drink from the clear plastic spoon, which had a measured reservoir in the handle so that we knew how much he was drinking. He would seem very keen for the first few millilitres, then after taking in 8 or 9 mls would lose interest, and we had to coax the last few drops in. I just prayed that the tiny amounts that I was able to express would help him.
The next day (Sunday) I asked Paul to ring Jill Dye, a lactation consultant whose name we had been given by Angie that morning via Liz Cleary of LLL. To my surprise Jill agreed to come as soon as she could. That day was my lowest day. I remember that I couldn't even be bothered to get dressed before Jill came. I couldn't feed my baby. I had been bombarded with "no one would blame you for giving him a bottle, you've done your best" from my midwives, but I was SURE that we could succeed. At least I hoped that I was right I was worried about Hugo's jaundice which was getting worse - and I had read enough research to know that bottles of water or formula would make it worse. What Hugo needed was my milk, or at least human milk. My friend Angela had offered to donate some of her breastmilk if mine didn't come in and I needed to supplement. This was some consolation, but I felt a failure to even have to consider such options.
Jill Dye came in with a smile and sat and talked to me all afternoon. I don't remember many specifics from our conversation. I do remember that she told me that she had faced challenges as a new mother with a very premature baby; I remember her showing me how to wake a sleepy baby by walking my fingers up his back; I remember an amazing rebirthing video that she showed us, I remember her encouraging unlimited skin-to-skin contact, and explaining that Hugo wouldn't get cold snuggled up to me. But most of all I remember how I felt after she left. Calmer. More positive. I felt that we could do it. But I also realised that this wasn't make or break, that if Hugo didn't latch on soon he would need to be supplemented, but that this didn't mean we couldn't have the nursing relationship that I had taken for granted. Jill had made it clear that Hugo needed food and needed it quickly, and that that was the most important thing at this point. However she tempered realism with hope, and that hope carried me through the next few days.
I continued to express - by late Sunday my milk had started to come in! We woke Hugo regularly to cup and/or spoon feed him. I found it upsetting, I didn't want to Hugo to associate my milk with a plastic spoon or cup, and we found it easier for Paul to cup and spoon feed Hugo. By the Monday morning I was engorged, and unable to express enough make my breasts feel comfortable. Dorothy suggested that Paul 'nurse' to try and disengorge my breasts, which neither of us were keen on: even the thought of it was enough to make me want to thump him. My friend Angela had a more novel solution - I could borrow her toddler son who would be glad to oblige! Her children are our Godchildren and we're very close to them (we'd been living with Angie's family for four months while waiting to complete on the house we were buying; we only moved out from them a few days before the birth); this was a funny solution, but not really ideal. As it was I got the hang of the hand-pump, so little Bobby was disappointed! Ultimately the problem of being engorged with milk was still preferable to having no milk at all; but the fundamental problem was still with us: the milk may have been there, but Hugo still wasn't taking the breast. But then something happened. That afternoon, just as Dorothy was visiting and saying that if I didn't give Hugo a bottle he would have to be admitted to Special Care Baby Unit, he latched on and fed furiously for forty minutes. It was an act of defiance if I ever saw one. I don't know who was the most relieved - me, Paul, Hugo, or Dorothy (who no longer had to worry about me savaging her!). He'd waited four full days. I started to laugh uncontrollably - I had never felt such elation in my life. YESSSSSSSS!
It wasn't all easy from there on in. For a start I could only get Hugo to latch onto my left breast, and had to pump off the right. This was fine - I could live quite happily with differently-sized breasts as long as my baby was eating! His jaundice continued to get worse, and we had to do a biliruben test - we did this 48 hours after he had properly latched on. His biliruben levels were high, but nowhere near dangerous levels. As he was eating and pooing normally, we were assured that everything was fine. We continued to keep records of how long he nursed for and each wet and dirty nappy for the next two and a half weeks. When one day I completely forgot to fill in the "paperwork" I knew that we had turned a corner. We also had problems with positioning, which lasted a couple of months. This was partially because once Hugo latched on, I was loathe to change whatever position I was in - I didn't care if I suffered excruciating pain, as long as he could nurse.
Eventually he grew stronger, and I didn't need to twist my back and body to nurse him. But Hugo's growing strength brought its own set of challenges: at around 10 days of age Hugo began to refuse the breast. We spoke to Jill Dye and between us we figured out that he didn't want his head or body to be touched while nursing: most likely a reaction to the hands-on "help" that we had received in the first few days. I learned to nurse with Hugo propped on pillows in a way that meant that I didn't need to hold him. Within a few days he stopped arching away and refusing the breast if I touched his head, and after a week or so of avoiding "handling" him while nursing he stopped reacting negatively to touch: he had learned that Mummy wasn't going to "make" him do anything he didn't want to - certainly not force his head onto her breast!
Eventually the piles of pillows that I needed in order to nurse grew smaller. I'm sure that my tear didn't help this either: it was quite a long time before I sat comfortably (but that day came as well - thanks to a skilled and sensitive obstetrician my 'bits' eventually healed to the point that they were at least as good as before!). Then one day when Hugo was about four weeks old we went out for a whole day and in the John Lewis' nursing room at Bluewater we managed to feed without a single pillow - and on both breasts. Then a few weeks later we figured out how to nurse lying down. From then on things just continued to improve.
Would I do anything differently the next time? Well I'm pregnant again at time of writing (12/03 - due c. 02/04/04) and am planning another home waterbirth. As with my first pregnancy I haven't had any scans this time around, although I have had blood tests to check my antibodies (I'm rhesus negative, my husband is Rh+, and we don't know what Hugo is because the hospital lost his cord blood!). Again I plan to labour with a minimum of interference, although this time around I may request one internal examination to check the baby's position - I say 'may' because I'm not convinced that knowing that Hugo was asynclitic would have made a positive difference last time - I was instinctively going up and down stairs, had done leg raises by stepping in and out of the pool, and so forth - and I wonder whether knowing that he was malpositioned might simply have added an element of fear to the proceedings.
One thing that I'm fairly sure about is that I'll be getting out of the pool as soon as possible after the birth this time: although it was *lovely* to spend a couple of hours in the warm water as a family after Hugo's birth (despite the 'Shark Attack' water colour!) I have since wondered whether staying in the pool exacerbated either the delay of my third stage and/or Hugo's jaundice (by overtransfusion). It's impossible to say for certain that staying in the pool contributed to either of these, but my instinct this time is - assuming that I feel like staying in the pool to birth my baby - to leave the water as soon as comfortably possible after the birth.
I'm grateful for the wonderful unintrusive care that my midwife provided - I'm also incredibly thankful that I was able to labour at home: I know that there's no way that I could have laboured the way I did in hospital (as actively, uninhibitedly, and loudly - I mean, would you break into a loud rendition of 'YMCA' to sing and dance your way through a contraction in hospital?), and know that there's no way that I could have given birth unassisted to Hugo anywhere else but home.
I also know that although I had a bad tear, I would likely have suffered as bad or worse injury through an assisted delivery or caesarean had we been in hospital, and, most importantly, Hugo would not have been in as good condition. I also learned that the 'worst case scenario' (I had always been terrified of even minor pelvic floor damage) isn't the end of the world - perhaps I've been lucky, but a skillful repair and several months of physiotherapy mean that I'm back to 'normal'. Obviously I would like to avoid another serious tear (who wouldn't!) but I'm also aware of the amazing healing abilities of my body.
Birth's a funny thing - I got the lovely natural unassisted (but attended) home waterbirth that I wanted and that I had worked hard for during my pregnancy (lots of yoga, swimming, good nutrition etc.) - I just hadn't counted on having complications after a natural second stage. I hadn't thought beyond birthing my baby: I had assumed that a natural drug-free birth would mean that everything following the birth would be straightforward. When things did go wrong - when I had to have a managed third stage and transfer into hospital to repair the third-degree tear - I had the memory of Hugo's wonderful birth to keep me going. It had been very, very hard physical work, and I felt (and still feel!) immensely proud of myself. That made everything that came afterwards bearable. It also allowed me to continue to feel positive about future births - after all I now KNOW that my body can give birth, even to the most stubbornly positioned baby. I'm hoping things will be more straightforward next time around
Antonia gave birth to a beautiful baby girl, Beatrix, on 26 March 2004. Beatrix was born naturally, and rapidly, at home. She decided to come out with her hand on her head, an so Antonia had a second-degree tear, but this was left to heal naturally. Beatrix breastfed like an expert on her first day, and continues to do so!
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