Athena's Birth, by Angela Horn

Athena at 6 days old

My fifth baby, Athena.

Athena Violet McKenzie Horn was born at home in February 2007, weighing 8lb 7oz, at 40 weeks and 5 days' gestation. The birth was attended by Virginia Howes of Kent Independent Midwives, and my birth companion was my au pair, Anamaria!

This was my sixth pregnancy, and my fifth baby. Lee was born in 1998, and Bobby in 2000. I miscarried a baby at 12 weeks in January 2002, and then had Teàrlach and Lachlan.

I woke up vaguely at about quarter to three thinking that these contractions were quite 'powerful', but they weren't difficult. I'd been using Maggie Howell's Natal Hypnotherapy birth preparation CDs and she talks about thinking of your contractions as feelings of 'pressure, warmth and power', and really they did seem to fit that description, so I was just dozing, then I vaguely realised that I wasn't getting that much dozing in between these nice squeezes. I looked at my watch and found they were actually every 3 mins or so and lasting for about a minute. Got up to see if they went away when I had a wee, but they didn't. Tried to wake up DH but he was in a very deep sleep as he'd only gone to bed an hour or so before, and I didn't have the heart to use the Wet Flannel Trick just yet.

At about 3.15 I thought that, even though this wasn't hard to handle, I possibly should phone my midwife, Virginia Howes (of Kent Midwifery Practice) , just in case. As I had an independent midwife this time I didn't feel quite so guilty about phoning her in the night on a possible false alarm as I did with the community midwives ;-) When I went to phone her, I hoped she wouldn't try to keep me talking long enough to time a contraction, which is what normally happens with the community midwives in this area. They keep you chatting until you have a contraction so they can see how long and intense it is, whether you can talk through it, and they use that information to guage how quickly they need to get to you. Well, even though these ctx weren't that hard to deal with, they were going on a minute and I didn't fancy trying to talk while dealing with one. I was very relieved when Virginia didn't make me stay on the phone, just asked if I wanted her to come now, or was just letting her know things were moving. I said I wanted her to come now.

Had another go at waking up DH but he was basically talking in his sleep! "Get up!" "Why?" "Because we're going to have a baby." "Can't you come back to bed and do it sitting up next to me?" "No I bloody well can't. Get up" "OK, I am getting up" (he said this while actually lying down). I thought I'd leave him to get some more kip as there was bound to be a while yet, and woke up Anamaria, our au pair, who had said she was desperate to be around when the baby was born. We get on really well and I knew that I would have someone with me just in case things did speed up.

I decided I needed music by this stage - that's been very important in my labours before, having something to focus on. I had the relaxing birth music tracks from the natal hypnotherapy, but I was saving those for 'when I needed them'. Right now I needed Jefferson Starship's St Charles and Song to the Sun, so I got them on.

Virginia arrived at 4 AM and I was starting to have to lean over and sway my hips a bit during contractions, but was fine in between. However, when she arrived the 'in between' bit disappeared and I had about 3, one after the other. Virginia checked the baby's heart and said it was fine, and checked the position and said the head was fully engaged. I knew baby was LOA - the benefit of being a grand multip with knackered abdominal muscles is that it is *very* easy to tell the baby's position; I could almost count her fingers and toes through my tummy! Far cry from baby 1 when I felt so smug because the midwives used to comment that my abs were so tight they couldn't feel where the baby was. Serves me right...

Virginia gave me a bit of a knowing look after I had these 3 ctx right on top of each other and asked when I normally got in the pool. "Before this!" I said - because these ctx were feeling quite strong and in my previous labours I'd spent at least the last 2 hours in the pool. Of course, at this stage I still thought I had that long or more to go. Sent Anamaria off to have another go at waking Graham up, but she didn't have any more luck than me. I don't think she felt able to be as 'forceful' as I would have been!

Fortunately the birth pool was all set up and ready to go - I had the large hexagonal pool from Hello Baby and it had a heater and filter unit, so the water was all ready. For two of my previous births I'd not bothered with a heated pool because I felt confident that I'd always have plenty of time to get a pool filled - I'd had steady labours of around 8 hours, so there was never any rush, and I thought it highly unlikely that my labour pattern was going to change significantly. How wrong I was... there's no way I'd have been able to concentrate on getting a pool ready in this labour, let alone have time to fill it. Having a birth pool has been a 'security blanket' for me in all of my labours - comforting, supportive, and a great help. If I had known that I couldn't use the pool I think I would have felt panicky.

Got in the pool and thought 'That's more like it!'. I vaguely wondered if it was significant that I felt I had to be kneeling upright, leaning on the side, for ctx as before this was how I'd had to be right at the end, but I'd lounged around in other ways earlier on. Then Jefferson Starship got past the tracks I liked and on to one which was really annoying, so I thought it was time for the birth music. Virginia didn't know how to drive the iPod so I asked her to bring it over to me so I could sort the tracks out, put the right one on, then Anamaria put it back on the speakers. Hearing the special birth music was a bit like getting in the pool - a "That's more like it!" feeling.

I had a really strong contraction and was trying very hard to think of it as "Pressure, warmth and power" and not as any other P- word (you know, the one which ends in '-ain'), and visualising a golden bubble stretching my cervix open with every contraction, and concentrating on the image of breathing in 'golden breaths' and breathing out tension etc. I felt a contraction very strongly at the back of my pelvis. I 'd talked to Virginia about this in pregnancy as I had felt a lot of pain here in my prior labours and I was worried it was my loose ligaments allowing my sacro-iliac joints or hips to stretch too much, but Virginia had said that the place I identified was actually where there was a bundle of nerves rather than joints, and what I was feeling was probably just the intensity of contractions here rather than round the front. This made me feel much better about the forthcoming labour as I felt more able to deal with the sensation of contractions in a positive manner, than I did for joint pain.

Anyway, I felt this familiar, intense feeling around the back of my pelvis and in my hips, and I remember thinking "Here we go, now I've got a couple of hours of this to deal with. Bloody hell, this will be a challenge for the hypnotherapy - I hope I can hold it together - I know Virginia's got Entonox in her car, so maybe I'll give it a try this time, but see how I get on with this contraction" . I've never managed to actually try Entonox - with my first two I didn't want to try any drugs, and with the third by the time I got to thinking it might be worth a go, I was unable to ask. With baby 4 I thought I'd try when things seemed to be hotting up, but the midwife had the wrong key for her cylinders and couldn't make it work. That turned out to be a very gentle labour so it didn't matter anyway. This time I thought I might give it a go just to see what it was like, but I was thwarted again...

With the next contraction I thought "Hang on, I recognise that feeling... I think this baby's moving down, but surely it can't be doing it yet". I hadn't felt the need to vocalise before this but I did find myself moaning a bit, and then there was the familiar 'point of no return' when I knew that it was only going to be a matter of minutes; I think it's when the head comes down low enough that Ferguson's Reflex kicks in and your body is just going to push this baby out regardless of what you consciously try to do - that expulsive reflex that's like vomiting and you can't stop it, but it's not the same as consciously pushing. I concentrated on breathing out through the stinging of crowning and on NOT giving a conscious shove, because while I knew that it would get things over with quickly, I also knew that not tearing is really worth working for! I put my hand down so I could cup it over her head as it emerged - this felt instinctive and was soothing against all the stinging, stretching tissues, and also allowed me to control the birth of the head a bit. It's just come automatically do do that with all my babies' births. I concentrated on this and on breathing through as my body pushed the baby's head out bit by bit. I couldn't tell you how many contractions it took as the feeling wasn't really like distinct, discrete contractions - just my body edging this baby's head out bit by bit.

Once the baby's head was out, I was more aware of the sensations of the body being born than I have ever been before. Everything really ached and I just wanted the baby out. I felt her wriggling her shoulders to be born; I know babies do this, but I've never been aware of it happening. I could feel her doing a little shoulder shuffle with my hands, outside, as well as inside! I felt her just wriggle out one shoulder and then the other, all the time with my body edging her out, again not consciously. A little more edging out after the shoulders, and then she was born! The second stage was about 3 minutes, which is about what it has been for babies 2, 3 and 4 as well. I think my first baby, who was 9lb 6oz, blazed such a trail through my pelvis that there is little hold-up now. It's also the upside of having pelvic ligament and SPD issues - those stretchy ligaments may make pregnancy uncomfortable, but they can do a wonderful job of making birth easier.

Athena was born at 4.31 - Virginia had been here half an hour, and I'd got less than 5 minutes of my relaxing birth music! And to think last week I was emailing Natal Hypnotherapy asking if it was OK to have the music playing on a loop for several hours ... ha ha!

I brought the baby to the surface, but she had a short cord so she only just reached up to my breast. She was spluttering a bit with some fluid coming out of her mouth, so I put her face-downwards leaning over my forearm to hold her steady for a while. She was clearly breathing and just had a little cry, then settled down. My four previous babies had all come to the surface, screamed, turned bright red and shaken their fists at this point, so it all seemed very calm!

But hang on - where I was holding under the baby's bum, my hand seemed suspiciously empty - usually I would be in no doubt about the baby's sex at this point! I had a little feel and nope, there was no tackle. I thought it was a girl! I tried to turn her round and asked Virginia if it was a girl because it felt like one, but she said let's untangle her and you can look for yourself. It was! Quite a surprise! I adore my four boys and was certainly not "carrying on until I got a girl", but it is exciting to have a different sort of baby. It was also special because my gran, who I adored and was very close to, had died just 12 days earlier, and she'd thought I was having a girl.

I waited in the pool for a couple of minutes because it was so nice and warm, and I was a bit achey still, then hopped out and got on the sofa. Anamaria went off to tell Graham that seriously, he HAD to wake up now. He came down looking a bit dazed, walked in the door and did a double-take. He still hasn't recovered from the shock - waking up to find a baby, and a girl! I had a lovely cup of tea and showed Graham the baby. She was rooting a bit so I offered her the breast - she had a bit of a nuzzle, but the cord was too short to latch her on easily. I wriggled forward and had a go at pushing the placenta out. It came out very easily with just a bit of a push - no pain. Virginia got her gloves on and supported the cord because she was worried that it would pull on the baby as it came out, as the cord was short. It was a very tough cord and was hard to cut through. When that was over I had another lovely cup of tea and baby latched on nicely and fed properly.

Graham and I are both OK about him missing the birth - this time I didn't need him there as I have before, as I trusted my midwife 100% and knew I would not need him to be my advocate 'against the system'. I love him and wouldn't exchange him for anyone else, but I was confident enough to go with the flow of the birth - it just wasn't worth the disturbance of waking him up earlier! In previous labours I've needed his calmness there, his faith in birth and in me, in case the midwives started to flap or didn't know what I wanted, but this time I didn't need to worry about that. And he did not feel any compulsion to be there for his own benefit - he has always been clear that it was to support me, rather than for his own 'birth experience'. In some ways it was nice giving birth with only women present - it was a different, sisterly sort of experience that women have had throughout history. Anamaria was clearly buzzing on the birth - she had been a brilliant birth supporter and I was really glad she was there. She was quiet, calm, helpful, but clearly excited, and she says now that when she has a baby, she wants to have it at home too!

My mum says I should ask Virginia for a discount because she didn't have to do much! That's not the issue for me though - I wanted an independent midwife this time because a) I wanted someone who was happy NOT to do too much, and b) if there was a problem, I wanted to know that I had someone who was not just competent, but also confident handling it outside of hospital, and who was up-to-date in resuscitation techniques without cutting the cord. I knew enough from emailing with Virginia and reading things she'd written over the past 8 years, to know that we were singing from the same hymn sheet. She had been recommended by other midwives for her 'assertiveness', and I felt sure that, if I did end up transferring to hospital, she would not be intimidated by any hierarchy. I knew she wouldn't mince words with me either; it had to be somebody who I respected, not just liked. So I still feel it was money well spent, despite having had four home waterbirths on the NHS beforehand, and three of those with midwives I really liked.

As it happens, again things worked out perfectly because our local midwives might well not have got there in time - unless you are sure things are cracking on it's common for it to take an hour for someone to come out to you while they sort out who's on duty, and I wasn't actually sure how much things were 'cracking on' until about 20 minutes before the baby was born, so she could have been born before the midwives turned up. That would have been OK, but not the totally stress-free experience that I had. And the point for me of booking with an IM this time was not so much the birth, as the antenatal period - I didn't want to have to 'discuss issues' at every antenatal, or have to be assertive or prove again and again, to each different midwife I met, that I did in fact know what I was talking about and was making informed choices. It was for peace of mind, and in case of complications - and it was worth it.

It's the day after now, and I still can't believe I got away with it so lightly. It was such a positive, gentle labour - yes, there was hard work, but this time the hard work bit was so short! I didn't feel shocked by the speed of it - just relieved. I felt very positive about the labour both before and during. I think the hypnotherapy may well have helped - maybe it would have been a shorter labour anyway, but I'm sure it made the earlier contractions easier to handle. And even if it had made no difference at all to the birth, it would have been worth the effort of doing it many, many times over, because it made me so much more relaxed in the lead-up to the birth.

I'm really glad I had the pool, even though I only got in it for 20 minutes, because it was so soothing for that last, sore bit, and I love the way a pool supports you in upright positions so it's easy to catch your own baby. I feel totally spoiled and very, very lucky; I had everything I wanted for this labour, everything organised, baby was considerate enough to wait until I'd got all my odd jobs done, and it all worked out so well. I can't believe I was so lucky and I'm a bit dazed by it all! I mean, I occasionally put somebody's birth story on my website and think "Lucky so-and-so!", but now I've had one of those myself!

Afterthought:

I chose an Independent midwife because the NHS in my area cannot offer the standard of maternity care that I felt was safe. I would have little chance of knowing the midwife who attended me in labour, and many NHS employees still use some practices in neonatal care resuscitation which current evidence suggests are harmful - specifically early cord clamping. I chose to pay for what I believed to be the best care; many families make sacrifices to do likewise. The UK government is proposing to take this option away. Please see the page on Independent midwives for more information.

In the Kent and South-East London area, we are fortunate to have a number of independent midwives who practice locally. I had met several independent midwives and each midwife brought a different mix of skills and attitude. I was spoiled for choice. In the past, my local NHS team had operated in a way which meant the birth would normally be attended by one of six midwives who I knew, and they knew me, and I believed this would make it easier for us to communicate if an emergency arose, as well as giving me some reassurance about the level of experience each midwife had. However, the way in which the midwives were organised changed, and the new system meant that the midwife called to my labour would probably be someone I'd never met before. She wouldn't know anything about me, and I wouldn't know if she was up to speed with recent research on resus, which was very important to me. This was my main reason for choosing an independent midwife. Like nearly all women, my top priority was a healthy baby, and while I would be delighted to have a healthy baby wherever it was born, being at home with a known midwife was my preferred choice. I did not need to worry that my midwife was overseeing three births at once, for instance, and therefore might not be fully alert.

Virginia Howes, and her colleague Kay Hardie at Kent Midwifery Practice, have supported many women who made an informed choice for a home birth, sometimes when there were factors which made it hard for them to get support on the NHS. I was impressed by Virginia's depth and breadth of knowledge - I've spoken to, and corresponded with, a lot of midwives in the last 10 years, as well as quite a few doctors, and Virginia's commitment to continually learning, and to thoroughly researching her topics, was outstanding. I knew that Virginia could be outspoken, that she can ruffle people's feathers, and I knew that she would not just tell me what I wanted to hear. I'd seen enough of her reasoning to know that she didn't go against received wisdom just to be awkward, nor from some spiritual belief that birth always went right - she read the research and she knew her stuff. I was also confident that, if I ended up in hospital, Virginia would help me to make sure my baby received evidence-based care and not just 'we do this because it's what we've always done'- based care. I have no reservations about recommending the Kent Midwifery Practice.

Midwife Virginia Howes of Kent Midwifery Practice, with Athena, Angela and Lachlan.

Midwife Virginia Howes with Athena, Angela and Lachlan.

Virginia's website - Kent Midwifery Practice

Kent Midwifery Practice

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