My due date was Tuesday 16 January, but as it was my first baby I was fully expecting it to be another week or more before I went into labour. I'd even booked another antenatal yoga session for Thursday. I laughed when I read an email on Wednesday from my yoga instructor saying if I went into labour could I let her know as there were other women whod like to come to the class! Well, that wasn't about to happen, was it..?
At 2 a.m. on Thursday morning I felt some wetness. My immediate thought was that I'd wet myself and cursed myself for slacking off lately on the pelvic floor exercises. A few minutes later, the same thing. I was starting to think that this my be my waters breaking, but still wasn't convinced until I saw a little pinkness and realised that this was a show. Thanks to my many hours on the homebirth email group and the hypnobirthing course I'd done, I felt completely calm and not at all worried about what was to come. Somewhere in the back of my mind I also registered that there was no meconium in the waters something I had been concerned about as that was what had led to my sister's hospital transfer and eventual c-section.
I knew that I needed to go to sleep and get as much rest as possible. But over the next hour I started to get mild contractions every 10 minutes, and a gush of amniotic fluid with each one, so sleep was out of the question. Then, around 3 a.m., the fluid started coming out green with black bits in it. Thanks to Angela's brilliant article summarising the various situations involving meconium, I knew immediately what this meant transfer to hospital. Even though this is what I had been dreading, I managed to stay calm, thanks I think to my hypnobirthing preparation. I had an "in case of transfer to hospital" section on my birth plan, and we would just have to make sure the hospital birth was as calm as possible.
Most NHS Trusts have guidelines recommending transfer to hospital if there is any meconium (baby's first poo) present in the waters. It is always the mother's decision whether to follow this recommendation or not. There are different degrees of meconium - old meconium may mean that the baby has been distressed in the past, but doesn't tell us whether he's distressed now. If there are no signs of distress in the baby's heart rate, an experienced midwife might not be too worried about old, well-diluted meconium, although she would certainly observe the baby very carefully. Similarly, if pregnancy goes well past 40 weeks - to 41 or 42 or beyond - meconium may be less significant as it may just mean his gut is mature. But if a baby at term passes fresh meconium in labour, it is a sign that he may be in distress and may need help. This is why Gina immediately anticipated transfer to hospital. For more discussion, see the page on meconium in the waters.
Back to Gina:
I called the community midwife on duty, who confirmed that we should go in and that she would tell them to expect us. We finished packing everything and arrived at the hospital at 5 a.m. We spent around 10 minutes in the cold, waiting for someone to answer the door. I had at least two contractions while we were waiting, and thought that this did not exactly bode well for the care in this hospital. When we got in to the labour ward they had no idea who I was and greeted us with sour faces so different from the home birth I had been hoping for, with my lovely midwife Velma, who had visited me at home for all my antenatal appointments and always greeted me with a smile and a hug, and even a kiss goodbye when she left.
I had been worried about being strapped to a CTG monitor, but one of the community midwives had said that I would still be able to move around. In practice, though, this was not possible. Every time I moved we would lose the trace, so I had to stay put in one position. In the end, this meant that I spent most of my labour standing up, and my legs were killing me afterwards. It also meant that I couldn't kneel down for much of the time, even though I had wanted to.
Around 8 a.m. I was examined and told that I was 2-3cm dilated and effaced. I had hoped to have as few VEs as possible, and found this one to be uncomfortable. In the end I had loads of them, each one worse than the next. This was all good news and the CTG trace was fine. Nevertheless, the doctor felt the need to inform us that I would have to dilate 1cm an hour and, if I didn't, then I would need a drip to speed things up. Thanks for the vote of confidence, I thought.
At 12 p.m. I was examined again and was 5cm. This wasn't the 1cm/hour they were requiring of me, but seemed enough to satisfy them for another four hours. (Apparently at this point my cervix was thick and only partially effaced. How it was that it could have been fully effaced and then later partially effaced has never been explained.) In this time we should have been relaxing and doing our hypnobirthing exercises, but we spent a good hour discussing with the paediatrician what would happen when the baby was born. I had said that I didn't want the cord cut until it had stopped pulsating, but it seemed that they wanted to take the baby straight to the resuscitaire because of the meconium. Eventually we agreed that if he seemed ok and was breathing within a short time then he wouldn't cut the cord straight away. (It has never been clear to me if this was what they would have done anyway or whether it was something we negotiated.)
(For more on the advantages of leaving the cord to pulsate before cutting, see The Third Stage)
Although he was a nice fellow, this was not the way I had intended to labour, and I don't think it helped the labour to progress. And, when they returned at 4.30 p.m. to assess me again, I was only 6-7cm dilated. Now the doctor starting to put the pressure on, reeling through all the possibilities if I didn't progress. She obviously wanted to start me on a drip, although I was happy to keep going and let my body do its own thing. But she seemed to suggest that if we waited another four hours and I hadn't progressed then I might end up with a c-section. I saw no reason to expect not to continue dilating slowly but surely, but in retrospect I think it was because the head was not "well applied" and had not come down that far so she suspected that things would be slow. None of this was explained to me at the time and she just seemed like an unnecessarily negative presence. I felt her attitude was the least conducive to a speedy labour.
Despite the extremely uncomfortable VEs we decided to agree to another one in 2 hours and to reassess at that point. During that time I managed to take a bath and turned the lights off in the bathroom. Up until then I had had my TENS machine on, and it had been great. In the bath, things got more intense, and I felt that things were getting going more, but I had to come back onto the CTG after about 20 minutes. I felt that the contractions were stronger now and closer together so at 7.30 p.m. I was confident that I would be further along. But the person examining me said that I was 6-7cm, stretching to 8cm, but the cervix was still long. I couldn't, and still don't, understand how I could have been fully effaced at 8 a.m. and still have a long cervix at 7.30 p.m.
Things were just as the doctor had "predicted" and we felt that we had better go along with the hormone drip to speed things up though I wasn't happy about this at all. If there hadn't been any meconium, I think I might have decided not to have it, but then again, I would have been at home with no pressure to dilate within an arbitrary timeframe. I was led to believe that I could start at the lowest dose and then stop if it took effect, but actually, once you're on the drip, they want to increase to the highest dose possible to speed things up as much as possible. And once you're on it, you can't really argue.
One concern I had about the drip was that it would mean that I would have to have an epidural, which I really didn't want. But the midwife reassured me that some women don't need one, so I felt I would try to keep going with the TENS machine. Again, I think that my hypnobirthing course gave me the confidence that I would be able to cope with the strong contractions without an epidural.
At first, the drip didn't seem to make much difference, but when they increased the dose things did get going. According to Laurence, I turned into a woman possessed and starting dancing about with each contraction! I spent most of the time holding on to the back of a chair with each one. He had to sit in the chair to stop me from pulling it down and each time I tensed up he would remind me to breathe. Luckily, I remembered the sshhh breath from my yoga sessions, which proved invaluable.
At around 1 am on Friday morning things were pretty intense and I decided to try some gas and air. It did make me feel good, but it meant that I couldn't do my yoga breath, which actually worked better for me. It also made me feel a bit woozy and I suddenly realised that I was really tired. I'd been up all night and all day and was having to stand up. I decided to stop taking the gas and air as I knew I'd need my strength for the actual delivery. At 1.45 a.m. I started to feel the urge to poo. The midwife got all excited as this is usually what happens when women are ready to deliver, but in my case it was just poo and lots of it!
At 3.15 the doctor came in again. Luckily it was the doctor I'd seen when I first arrived and not the one with the unhelpful attitude. She examined me the most painful one I'd had and I shouted at her to stop as I had a contraction during the exam and couldn't stand to be on my back along with the VE. She carried on anyway, saying she just needed to check. I felt horribly violated that she had not stopped when I had asked her to repeatedly. She told me that I was fully dilated...but the baby's head was facing the front! This is obviously why she had ignored me she knew she'd need to do another exam to check the position if she didn't get it in one go, but I still feel that she should have done what I asked.
Throughout my pregnancy the baby had always been ROA (Right Occiput Anterior, ie facing mum's back, crown of the head to the front and towards the right), so I hadn't imagined that he would turn posterior. I also was amazed that no-one could tell from an external exam that he was in this position but apparently it was difficult to tell in my case, although I'm not sure why. (Probably because you had very tight tummy muscles? - Angela ) Incredibly, I had managed a posterior labour with a synto drip with just the aid of a TENS machine and my yoga breathing! I don't remember having any particular pain in my back, perhaps because of the TENS, although I couldn't stand to be on my back at all.
I didn't want to "push" until I felt the urge, and I'd been taught to breathe the baby down in my hypno classes. I didn't try to force anything but did try squatting down a bit. Because of the meconium I was told that they wanted the baby out within 24 hours, and I had one hour to get him out now! If I didn't, then they would have to consider using ventouse...
An hour later I was still going. I reached down and felt the baby's head, a few cms inside me still and a bit squidgy not like a head at all. It seemed so close though. This doctor was a bit more patient than the last and gave me a bit more time. The midwives somehow convinced me to get on the bed and try actively pushing with my legs up on my back. I don't know how they convinced me as I have known for years that's the worst way to give birth, but I somehow believed that it might speed things up and I wanted to avoid the ventouse. Everything they told me to do felt wrong - lie on my back, hold my breath, and puuuuussshhh!!! It wasn't working and at 5 a.m. I insisted on getting off the bed, squatted down and held onto the stirrups with my arms. This felt much better, and I felt sure I could give birth like this. But after about 10 mins of trying, the doctor said it was time to try the ventouse. I might have insisted on keeping going, but I was told that the baby was starting to get tired and his heart rate had been dipping down a bit.
I got back on the bed and was told to push again. I gave it all I had this was my last chance to get the baby out on my own. The doctor and midwives were very encouraging and after a couple of contractions she said: "I'm sure you get this baby out!" But after a few more pushes for dear life, she said that she was going to have to use the ventouse. I gave in - this time grabbed the gas and air, more to make me feel better about what was happening than for pain relief. I was then told that they would need to insert a catheter to drain my bladder before doing the ventouse. I was terrified at this as I once had a catheter inserted for a hospital test and it was one of the most awful experiences of my life. I begged them not to, but was told that without it the ventouse procedure could damage my bladder. Things had really gone downhill first the meconium, then the synto drip, then the ventouse and now a catheter. This was a million miles from the calm relaxed home birth I'd planned.
The catheter turned out not to be too bad. They attached the ventouse, but it wasn't the right type. They tried again with the right one and then got me to push again. After a few pushes the doctor told me that I would need an episiotomy. Yet another intervention I had so hoped to avoid. This done, and another push or two and his head was out. Exhausted, I asked whether I needed to push again to get the rest of the baby out but was told I didn't. The next thing, I saw my baby all purple and looking a bit lifeless. My thoughts suddenly rushed to the conversation with the paediatrician about the cord. Some minutes earlier, when the delivery seemed imminent, a whole team of people had entered the room extra midwives, more doctors, and a paediatrician with his waiting resuscitaire pushed close to the bed. The baby cried weakly and I asked if that was enough to avoid the cord cutting it was and he was handed to me. I don't remember much of this moment except relief that he was born and healthy, his purple body and his big dark eyes looking at me.
One of the midwives asked: "Don't you want to know what it is?" This seemed a funny question. "We know it's a boy," I think I replied. And he was...Jacob Aaron Neville, born at 5.45 a.m. (or thereabouts the midwife forgot to look at the clock). Warm towels were brought in and I held him skin to skin on my chest. I suddenly felt very cold and shivery and was given an extra sheet not quite enough in retrospect as the room just had an electric heater that had been turned off earlier, and it was snowing outside.
I held him for about two hours, during which time he suckled a bit, with some help from mum (I wasn't quite patient enough to let him crawl to the breast). I was desperate to get up as now my back was killing me (perhaps starting to feel the posterior labour?) but had to wait for the doctor to come back and stitch me up, which took around 45 minutes. Jacob was crying quite a bit these first couple of hours more than I had been led to expect as I had been told that newborns have a period of 1 or 2 hours after birth when they are quiet and alert and try to suckle. I don't know if this is because he was in pain from the ventouse or because he was cold (the warmth from the towels might have worn off) or some other reason.
After we got to the postnatal ward we were told that he'd need to be monitored for 24 hours because of the meconium, but I knew from the home birth list that we could monitor him at home, so we left that evening at 8 p.m. After all the disappointments of the birth, I was elated. Here was my beautiful baby. I was so proud of myself for giving birth to him, without an epidural; so relieved not to have had a c-section; and looking forward to spending our first night as a family - at home - in our own bed.
Meconium in the waters - what does it mean? Should you go to hospital?
First Babies and homebirth
Transferring to hospital - why it might be advised.
Get Your Baby Lined Up - what it means when your baby gets in an awkward position, and what you can do about it.
Hypnotherapy for childbirth
The Third Stage of Labour - what are your options, and the pros and cons of each? What are the advantages of leaving the cord to pulsate?
Homebirth UK email group
Home Birth Stories
Home Birth Reference Page