Caleb and big brother Morgan, waiting to go home from hospital.
Gemma planned a homebirth for her first baby, Morgan, but transferred to hospital during a difficult labour. For her second baby, Caleb, all seemed set for a homebirth until she developed Obstetric Cholestasis (also called Intrahepatic Cholestasis of Pregnancy). This is a liver condition which can cause the baby to die suddenly in the uterus, before or during labour. It is thought that the deaths may be caused by sudden heart arrhythmias. However, relatively little is known about its cause, or the exact way that babies can be affected. Standard management is to deliver the baby by 37 weeks; with this approach, the risk of stillbirth is approximately 1%, which compares to other pregnancies. After 37 weeks the death rate rises, although it is difficult to find statistics which tell us how much. There are links to sources of further information below.
Here is Gemma's story:
After my traumatic birth experience with Morgan and pretty poor treatment at the same hospital during and after a miscarriage in February 2007, I was 100% sure that when I fell pregnant for a 3rd time (in Autumn 2007) that I wanted a homebirth ...no question about it.
At my booking in appointment at 10 weeks I 'told' my midwife that I was going to have a homebirth. I was happily surprised that she was fine with this. I was expecting an argument as I'd had a very difficult labour with Morgan and he was born with the help of a ventouse.
I did lots of research as to why Morgan's birth didn't go to plan and put a plan of action together on how I would make it different this time. I attended reflexology and yoga, watched my posture, hired a doula and bought a new birth pool (there was a hole in our old one).
I had a really good pregnancy. Had to have a bit of physiotherapy for my back, but it really helped and everything else was fine.
At my 12 week scan my due date was brought forward from the 8th April to the 2nd April. I was sure it was the 8th, but was going to fight that battle when we came to it.
At our 20 week scan we found out that we were having another little boy which we were very happy with.
The first of my problems started when I was about 35 weeks pregnant. I went to the hospital after experiencing a decrease in movements. Monitoring showed that baby was fine, but when they sent me for a scan just to double check it showed that I had increased waters. The doctor didn't seem concerned as everything else on the scan seemed fine, but it was mentioned in my notes.
Then at around 38 weeks my feet began to itch. My midwife had warned me that if I had any kind of itching, especially to my hands and feet that I needed to phone the hospital straight away because it was a sign of Obstetric Cholestasis. It was Good Friday and I decided to phone the labour ward expecting to be asked to go in for some blood tests. I was flabbergasted when the midwife who answered the phone told me that there was nothing they could do as it was a bank holiday and advised me to go to my doctors (which wasn't open until Tuesday) to get some piriton!
On the Tuesday after Easter I went to my docs for the liver function blood test. My doctor advised me to chase the results up at the hospital the next day... so I did! I rang them at 11am and the midwife that answered said that she would find my results and phone me back. 4pm came and I still hadn't heard anything so I phoned them back and refused to put the phone down until I had my results... the midwife pottered off to get them. By this point I wasn't itching anymore and I presumed that no-one had phoned me because the results were fine... so I was shocked when the midwife came back to the phone and said that there was a problem and that a doc was going to phone me in about ten minutes! I went into panic ..I knew it was the end of my homebirth yet again..I was in that much of a state that I had to call my sister to go and pick Morgan up from nursery..
The doc phoned me back and explained that my liver function tests had come back with some worrying results. I was asked to go to the hospital for 9am the next day with my bags!!!
I hardly slept the night before. I hate hospitals! I'd re-packed my bag about 10 times and tossed and turned all night. My partner Slawek decided to go to work until he heard from me and so my sister came with me to the hospital.
I saw a really nice doctor who explained to me what Obstetric Cholestasis was and showed my liver function results... all I remember is that one of the results that isn't supposed to go over 31 was over 500! She said that I needed to be induced asap (I was 39+1 weeks), but that the labour ward was full and so she gave me a stretch a sweep, told me I was 3-4cm dilated already and that tomorrow a bed would be booked for me and that I would just need my waters breaking!!
Me and Slawek arrive at the hospital at 7am as instructed and very nervous! I was expecting just to have my waters broken and so me and Slawek both estimated what time the baby will be born. After Morgan's long labour I estimated 8pm and Slawek estimated 11pm (I wasn't very happy with his guess)!
I was shown to a bed on the ward and put on a monitor. At around 10am a midwife came back and said that she was going to give me a pessary!! I explained that the doc had said that I would just need my waters breaking and she said 'I doubt it' ... she then gave me an internal and told me my cervix was too far back and not open enough and so gave me a pessary! She said she would check me again 6 hours later. I didn't even feel a twinge from the pessary.
By 8pm she still hadn't come back and I was starting to lose my cool! Slawek went to reception and told the receptionist that either someone comes and sees me or we are going home. We were quickly joined by a midwife saying that they were sorry and that they were really busy. She examined me to find I was 4cm dilated and the waters were bulging (like the doc the day before had said)..BUT..they don't break waters in the evening... and I wasn't allowed home because of the pessary. I was getting so annoyed by this point and begged Slawek to take me home.... but I had to stay.
After the day before I was expecting a dragon on a midwife again, but when Sharon introduced herself I was so glad that I wasn't induced the day before...she was lovely! I had breakfast at 8am and was taken to a labour suite and monitored for 30mins! Slawek came at about 10am and then Sharon came and broke my waters at 11.30am (it would have been earlier, but I could hear that she was dealing with another birth).
It didn't hurt at all but was really funny, I had been told before that I had got increased waters and they weren't wrong ...tsunami! Sharon said it was the most she had ever seen and it kept coming out for hours afterwards...my bump was 1/2 the size after and i started to wonder if there was a baby in there!
Sharon said they would give me 3-4 hours to go into labour naturally before they put me on the drip..which I really wanted to avoid (bad experience from Morgan's birth), so I started marching around the hospital, sniffing clary sage, bouncing on a ball and eventually started to feel some contractions a few hours later. They started mild, but were 2 minutes apart from the start. Time-wise I can't really remember what happened, but I eventually headed back to my room because I wanted some gas and air... that stuff is great!
Then the bad news came... the doc on duty (who I never actually saw) decided that due to my 'condition' that I would need to stay on the monitor now that I was in established labour until the baby was born. I started to really panic as I wanted to stay upright. Swav and Sharon were great at calming me down.
By this stage I had started to get those tell tale 'back to back' pains in my back and so I actually lay on my side to be monitored. I didn't mind the pains in my tummy, but my back started to feel like it was going to explode every time I had a contraction and Swav ended up holding the G&A in my mouth whilst I physically lifted my whole body off the bed with my arms every time I had a contraction (my arms hurt for days after).
I started thinking that I couldn't cope and became very vocal. I asked for an epidural about 50 times, but Sharon just completely ignored me (glad I put that in my birth plan now). I then really felt like I needed a poo and Sharon trying to encourage me to push, but I was convinced that I was only about 6cm and just thought I wanted a poo so I held back for ages (I didn't have any internal examinations once my waters were broken... again something I was glad I put in my birth plan). In the end I decided that I wasn't going to get on a commode and that I was going to just poo on the bed. I was back on my left hand side by now and Sharon pushed back on my left leg and as I started to push I realised that it actually was the baby and not a poo (I'm convinced that I did poo, but Slawek said he didn't see anything).
After the first push Sharon said that the head had crowned and the head came out (with a nasty ripping sound) with the second push and Sharon was shocked to tell me that the baby was looking up and was being born back-to-back (I hadn't realised ... even with the back pain ...Morgan was also back-to-back, but turned before the birth).
It seemed to be ages before the next contraction...Slawek kept looking at the baby's head and was crying his eyes out. I then had another contraction and the rest of the body slipped our easily. (4 hours after established labour started... second stage just 10 minutes) He was put straight on me and cried straight away. I took my top off and had some skin to skin and he had a bit of a nibble whilst we waited for the 3rd stage. Slawek cut the cord ..he was never sure if he would want to, but he did in the end.
I had a natural 3rd stage, which didn't hurt at all. I think it was about 15 minutes before the placenta came away and the mw asked me to just give a little push and it slipped out. She left me Slawek and Caleb together for a while and then Swav dressed him whilst I got stitched up. I made a bit of a mess down there with him being in a funny position and coming out so fast and having a previous episiotomy, but ripping and being stitched up didn't hurt too much. I had some more G&A whilst I was stitched up and then had something put up my bum to kill the pain for the night.
Caleb was born at 18.43 on 29th March 2008 weighing 7lb 11.5oz. He was covered in thick white goo when he came out and has a lot of hair down his back and so Sharon said that my due date was probably more the 8th rather than the 2nd and so he was about 2 weeks early.
I stayed in the hospital for one night as it was late by the time I was cleaned up. I had to sign my own discharge forms in the end because my liver function tests weren't as good as they hoped in the morning, but they have eventually come down... There was no way I was going to sit in hospital for days waiting for them to come down.
So all in all a very positive birth story and a far cry from Morgan's birth. I don't mind that it wasn't a homebirth as I still got everything I wanted, my midwife really stuck to my birth plan. In an ideal world I would still have preferred a water birth because of the back pain, but he is out now and I really did need to be induced because of my condition.
Caleb now 13 days old and gorgeous, he is feeding really well.
I know that if I get pregnant again I am at high risk of getting OC again and so it's highly unlikely that I will ever get the homebirth I wanted. I will keep looking out for more research and I am more than happy for people to contact me regarding this: mummygemma.allen at sky.com
Transferring to hospital - why it might be advised.
Obstetric Cholestasis Support Website - UK group
Itchy Moms - US website supporting women with OC
RCOG guideline on Obstetric Cholestasis - from the UK's Royal College of Obstetricians and Gynaecologists. It is clear, well-referenced
and quite honest about how little is known.
Home Birth Stories
Home Birth Reference Page