My family is overrun with medics. My mum is a nurse, my father-in-law is a neurologist, my mother-in-law is a GP and my brother-in-law is a doctor. So when I first started to look into the prospect of having a home birth, there were some raised eyebrows in my family.
I'd been happy to go to the hospital to give birth to my son until we went for the visit. With just four weeks to go, my world fell apart. The water pool was broken, the room was on the ground flooor and so had to have the blinds drawn all the time, and the room was dominated by a huge hospital bed. Only three of the delivery suites had bathrooms and I had visions of myself waddling down a corridor to have a wee. It was big, scary and impersonal - not the relaxed environment I'd imagined when I visualised my birth.
At home, in tears, it was my husband who said "well why don't we consider a home birth?" It was an idea I'd had when we first found out I was pregnant but, like many other couples, we read that it wasn't a good idea for first babies and put the idea out of our mind.
Initial research on the web threw up lots of reports and statistice that reassured us; it seemed that as long as you were prepared for a home birth, then there were no more risks than having your baby normally in hospital. We decided to plan for a home birth but have the option of going in - there was protein in my urine and an increasing danger that I would suddenly develop pre-eclampsia.
My parents were supportive immediately but my husband knew that his family would need winning over. Even though we didn't need their approval, it would have been nice! But nothing we could say would change their mind. Evidence from the World Health Organisation and leading gyneacologists fell on deaf ears. They were medics and as far as they were concerned, birth was a medical process.
Note from Angela: Hopefully Faye's experience will have opened their minds a bit! There are an increasing number of medics who are highly supportive of homebirth, including high-profile obstetricians such as Rick Porter, Michel Odent and Yehudi Gordon. I also hear about quite a few female doctors who choose homebirths themselves, especially GPs, but they tend to keep quiet about it in case it upsets their colleagues!
Nevertheless, we got everything set up - plastic sheeting from B&Q, lots of buckets and spare sheets and towels...we were prepared! However, my protein went up again and we decided that, following a hospital appointment on the Monday, we'd make an 'executive decision' as to where we would have the baby as we didn't want to risk him in any way.
He had ideas of his own though. At midnight two days before the appointment, my husband complained of a dodgy belly which he put down to the curry we'd eaten. I agreed that my stomach was funny too, but when it carried on being funny for two minutes, every fve minutes apart we knew something was up! I had a paracetamol to help with the pain and tried to get to sleep. But two hours later, the contractions were coming every three minutes and we called the midwife.
She was loth to come - I'd been in labour only two hours - but when we explained about the situation, she said she'd come out and assess it. On her arrival half an hour later I managed a 'hello' before I was sick everywhere. She immediately knew things were moving faster than she thought and did an internal exam. I was six centimetres dilated and thrilled as I'd forgotten to pick up my prescription for pethidine and was panicking that I'd have to keep it up for hours yet! The second midwife came out and things carried on brilliantly.
My son Conor's heartbeat never faltered; in fact at one point, they were wondering how he could be so chilled out with all that was happening to him. The contractions were strong and I rode them out leaning against my bedroom cupboard. My husband and I climb mountains and he helped me see each contraction as a step closer to the top of a particularly difficult peak. It really helped me see that the pain was just progress.
By 6am, I was 9cm dilated but things started to slow down from then. My husband has a daughter aged 11 who was asleep in the other room and I was so worried that she'd wake and that he'd have to go to her to comfort her that it interfered with my progress. In the end, she popped her head out of her room as I was being walked up and down the stairs which my second midwife swore would bring the contractions back (boy, it did!) After an initial gulp, she was fine and wondered whether she could go on the computer downstairs to tell her friends on MSN what was happening!
After that, I was fine. My waters went at exactly 8am and then I got the urge to push. It's hard to describe it, the most intense and powerful feeling, you just have to go with it. But I couldn't get the hang of it, kept feeling him move down, only to slip back up again! It was so frustrating. After an hour, I realised that it was like body surfing; when you're waiting for a wave to woosh you into shore, you start kicking before it reaches you so that you've got enough momentum to be swept forward by it. And after that, I was away!
After a few good pushes, the midwives told me I'd need an episiotomy but I didn't care - I was enjoying myself so much! Still Conor wouldn't be born.Note from Angela: It's vanishingly rare for an episiotomy to be done at a homebirth - in fact, in progressive hospitals nowadays it is mostly only done for an assisted delivery (forceps or ventouse). Statistics for episiotomy vary a lot between hospitals - eg in our area, the last data I saw showed episiotomy rates varying from 5% to 21% of vaginal births.
At 9.45am, they called an ambulance, worried about infection as two hours had passed since my waters broke.
Note from Angela: The UK guidelines from NICE (National Institute for Clinical Excellence) are that it is perfectly acceptable to wait for up to 96 hours after the waters break without intervening, if there are no signs of infection in mother or baby. Before these guidelines were issued, it was common for some Trusts to recommend induction 24 hours after waters breaking. I wonder if Faye's midwives were really more concerned about her being technically in second stage for two hours, because many Trusts do recommend transfer to hospital after two hours of pushing. However, if mother and baby are well then it is perfectly reasonable to remain at home, and it should be made clear that it is always the mother's choice whether she transfers to hospital or not.
Midwives can be in a difficult position as they have to recommend that mothers follow their Trust's policies, but their duty of care is to the woman. For instance, in Faye's case, it sounds like her midwife probably did believe that Faye could deliver her baby at home, but her employer's policies may have dictated that she call an ambulance to be on standby for hospital transfer at this stage. Recent guidelines issued by the Nursing and Midwifery Council make it clear that midwives must continue to support a woman who wishes to remain at home, even if this conflicts with the wishes or policies of their employer.
Back to Faye:
My midwife said to me "If you don't get that baby out, you'll probably have him in the back of an ambulance and your husband will miss it, or they'll take you in and maybe use forceps - now push like buggery."
I thought "After all this, there's no bloody way I'm having my baby in that hospital" I gathered all my strength and WOOSH, there he was. He cried a little, looked up and me then went quiet as though he was studying me. And I cried buckets.
Three seconds later, the ambulance arrived!
They hung around until I delivered the placenta and that was where the pain came.....I'd given birth lying on my bed with my legs on my midwives' shoulders. When I got up, I got serious cramp!
Then it was bacon butties all round. Well deserved after ten hours hard work, helped by a paracetamol, a wonderful husband and two fantastic midwives.
Faye Galvin, mum of Conor Galvin, born 05.06.05
Faye wrote that "I'd given birth lying on my bed with my legs on my midwives' shoulders."
When a woman has a long second stage and is having trouble pushing her baby out, many midwives (and all active birth teachers!) would recommend that she assume an upright position - kneeling upright, maybe leaning over a bedhead or sofa, or on all-fours, or if there is a real need to speed things up, in a supported squat.
All of these positions substantially increase the available space of the pelvic outlet which the baby has to pass through, because they allow the tailbone to flex backwards. A famous study in radiography found that squatting positions increased pelvic outlet diameters by around 30% compared to lying on the back, and there have been a number of recent studies which have confirmed that upright positions increase pelvic dimensions and are likely to make birth easier - eg see Michel et al, 2002 (PMID: 12239066). Upright positions also allow gravity to help move the baby downwards.
If the mother feels too tired to be upright and her birth attendants can't support her, then another position which allows the baby plenty of space to move down is lying on the left side (not the right side, which risks compressing major blood vessels). On the other hand, occasionally a woman does find that she can push most effectively on her back, and if that is the position you feel strongly is working for you, then that's fine. Problems sometimes occur when women lie back to allow the midwife to do an internal examination, and then find it difficult to get back up. This is where your birth partner can really help - reminding you, and helping you, to get into whatever position you find most effective.
A detailed discussion of the physiology of labour can be found in an online issue of Midwifery Matters magazine: A re-evaluation of the mechanism of labour for contemporary midwifery practice, by Maren Dietze
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