Hayley planned a homebirth for her first baby and had to investigate several obstacles which cropped up in late pregnancy - Group B Strep, and a baby who appeared small for dates, with possible low fluid levels. She had an active labour at home for twelve hours, managing some difficult situations along the way. She transferred to hospital for help when her labour slowed and she was exhausted, but still managed to deliver her baby by her own efforts. A detailed story with lots of observations which may help other first-time mothers.
Throughout my pregnancy we'd been keen on a home birth. I hate hospitals and don't view childbirth as an illness that needs to be treated or managed in a medical environment. We wanted to have as natural a birth as possible and felt that home would empower us to do this. We opted for midwifery-led care and left our place of birth option open until closer to the time.
We had a couple of glitches. At 24 weeks, I had a swab to double check for thrush. The swab came back positive for Group B Strep. The midwife said that I'd have to have the baby at hospital, as I'd need IV antibiotics administered throughout labour. I was mortified and only then realised how strongly I felt about birthing at home. Knowing nothing about Group B Strep, I did some research and found it is intermittent and a negative test at 36+ weeks is highly likely to mean you won't carry the bacteria during labour. I asked for another swab at 36 weeks and went to see a homeopath to try to clear the Strep B. At 36 weeks I was referred to a hospital consultant for advice on Strep B and because, for the first time, a midwife measured my bump and deemed it small for dates. To prepare for the consultant appointment I did more Strep B research and found that there were 2 private labs in the UK that do a more reliable Strep B test for about £30. A negative result using this test is 95% reliable.
Note from Angela:
"See Group B Strep and Homebirth for more discussion of this topic and links on tests etc..
Needless to say, the consultant advised a hospital birth with IV antibiotics to safeguard against Strep B. She also confirmed I was small for dates and sent me for a scan. This flagged up 'low' amniotic fluid levels of 7.5. To my dismay the consultant said this could adversely affect the baby and I may need to be induced. An internal showed my membranes hadn't ruptured and an ECG showed the baby's heartbeat was perfectly normal. She asked for all these tests to be performed again after the weekend and, if the fluid was still low, I would have to be induced. We had a horrible weekend of worry about the baby and stress about being induced. Our home birth seemed impossible. More research into low fluid levels showed that dehydration could impact results so I drank gallons of water to try to improve the next result. I also found that measurements of fluid can be grossly inaccurate and don't necessarily mean anything at all at this stage of pregnancy. Luckily, the next scan showed fluid levels of 7.8 so I was happy and decided not seek any more advice from the consultant.
Note from Angela: see 'Small babies and homebirth' for more discussion of these issues.
As long as the Strep B result was OK we decided to go ahead with a home birth. I used garlic clove 'tampons' for a couple of nights before the Strep B swab and at 38 weeks my midwife did the test. After 2 days the results came back as negative. We were thrilled to be able to plan for a homebirth and ordered a Birth Pool in a Box. Instead of dreading the birth as I had been, I found I was excited and actually looking forward to it!
My due date was 17th Sept. For some reason Ken and I had got it into our heads that I would be late, as most first timers are. On 14th, the birth pool arrived and sat in the corner of the dining room in its box. On 15th, I thought we'd better get the few bits and pieces we needed. To prepare for our home birth we bought 2 plastic tablecloths from the £ shop (turned out to be very flimsy but I guess you get what you pay for!) to save the carpet/bed from stains, a large bucket to add/ take water out of pool and a sieve to remove any gunge and poop from the pool. We had virtually no food in the house as we planned a big shop the next day and we had a meal out with some friends. We were not prepared!!!!!
After sliding one of the tablecloths on top of the mattress, we went to bed at about 10pm and at 10.15pm I started having stomach cramps. They seemed to be quite regular so at 10.30pm I thought I'd better time them. They were lasting about 60s and coming every 3-5 mins. We still didn't really think much of it but a few minutes later I felt a small 'pop' and my waters had broken. I started to worry a little as there really wasn't very much water and I thought perhaps the consultant was right and the baby didn't have enough fluid after all. Ken suggested we try to get some sleep but then the contractions starting getting painful.
We got up and decided to set up the birth pool in the dining/ kitchen as it has a tiled floor. In between contractions, I read out the instructions and Ken put the thing together. It was huge! This passed a bit of time but we still didn't really know what to do and whether it was too early to ring the midwife. After I'd had a clear out on the toilet and been sick we thought it was about time we rang the hospital (about 12pm) and the midwife arrived about an hour later. By this point I was 5cm dilated and Ken started to fill the pool. I've no idea how long this took as we seemed to be in some kind of time warp.
Although I'd been to antenatal yoga and had definite views on coping with labour, for some reason during the event I forgot everything I'd learnt and planned. I had a yoga ball and knew how to use it to assist labour and for relaxing in between contractions, but when the midwife advised me to rest leaning forwards against the futon I did that instead. I should have used the yoga ball. I used a tens machine that helped with the pain of early contractions, but after a couple of hours I felt I needed gas and air. Once up and running, I found the gas and air really helped at first, mainly because it forces you to focus on your breathing, but on the downside it sometimes made me dizzy and feel slightly out of control. At ante-natal class we were told to drink plenty and eat high energy snacks. I wasn't in the mood for food or drink (even if we had any in the house) and only managed a few sips of water, a square of chocolate, a spoonful of honey and a bite of apple throughout the whole of my labour. This was a bad move.
I had intended only to use the pool for the birth itself and not for pain relief but when I was 6cm dilated the midwife suggested I could get in the pool. I was in much more pain and so got in the pool for a change of scene and to see if it helped. I was glad to take the tens machine off as the higher settings felt like electric shocks and didn't help at all. Getting in the pool meant moving from the comfy, warm atmosphere of the living room to the dining room/ kitchen that has a cold floor and is not so cosy. By this point I was in a bad way, enjoying the warmth of the water but sucking on the gas and air to help the pain. I felt slightly out of it, but could hear Ken and the midwife chatting and busying themselves. We had the heating on but the room was still chilly. The midwife said the room was too cold for a baby to be born in and got Ken to put on the oven, hob and grill to try to warm it up! The day before we'd grilled burgers and I remember saying to Ken he could at least take the grill pan out to stop the smell of beef fat!
The midwife must have thought the baby would be born fairly soon as she called for back-up and started to get ready. She had no apron but fashioned one out of one of the Council recycling bags! She used more bags to cover the easy chair for me to sit in once the baby was born. Ken was running round like an idiot fetching and carrying things while back and fore the toilet with a dicky tummy. The midwife eventually got everything she needed to make a suitable surface to put all the birth kit on. I found it really distracting having Ken and the midwife busy organising things as they didn't know where anything was and I had to keep telling them so lost focus on the birth altogether. All the while they kept checking the temperature of the pool and Ken kept adding more hot water.
Meanwhile the second midwife arrived. Ken got in the pool to help me out as I was standing up to try and get things moving and now both midwives were busy updating each other and discussing my progress. The second midwife said as it was the weekend, after the baby was born I'd have to go to hospital anyway for an Anti D injection as I was Rhesus negative and it was NHS policy to do this rather than to wait until Monday. I was furious as I had no intention of having the baby at home only to be shipped off to hospital for an injection just because it was 'policy'. Ken told the second midwife to shut up (in not so many words). I asked her to leave the room as at the time I found her incredibly irritating and I felt overcrowded.
By this point, I'd totally lost focus and my contractions had slowed right down. I was boiling hot and there was condensation running down the walls. The midwife suggested I get out of the pool to see if things would speed up again and to check my progress. For some unknown reason, rather than going back to the comfy warm living room I ended up wailing on some blankets on the floor of the cold dining room. What a hideous place that would have been to give birth what were we all thinking of? Although I was 9cm dilated there was a cervical lip and I suddenly remembered that you could try to shift this by getting on all fours and rotating your hips. I should have stayed out of the pool and in the warm living room.
Eventually, the midwife suggested I move back to the living room. By 10am the cervical lip had not moved and my contractions had not picked back up. They were only lasting 30s and only coming every 5mins or so. I tried a homeopathic remedy but this didn't seem to work. After 12 hours the midwife advised I transfer to hospital to go on a hormone drip to bring the contractions back. Making no progress, being tired, dehydrated and in pain we agreed and the ambulance was called. At this point my community midwife arrived to take over the shift and made the journey with us in the ambulance holding my hand. My worst fear was that I'd left it so late and would have to be given a general anaesthetic to have a CS. I also thought that I'd be starting labour all over again from scratch and I didn't know how I'd cope. The community midwife was excellent and reassured me as best she could. The trip to hospital was not the most comfortable as many of the streets en route have speed bumps but I got through it sucking on the gas and air and Ken rang my parents to let them know we wouldn't be up for Sunday dinner sirens a blaring!
The registrar at the hospital came to assess me and I have never been so relieved when she said 'you will deliver this baby naturally'. I could have kissed her! I had a very sensible conversation with her about my choice not to have IV antibiotics in case of Strep B and apologised to her in case I should subsequently swear (that gas and air is good stuff!). The cervical lip had gone thought probably due to the bumpy ambulance journey over the speed bumps!
I was hooked up to a baby heart monitor and a drip to administer the hormones and fluid to rehydrate me and bring back the contractions. A few minutes later it started again and I used gas and air for a short while until the midwife advised me to stop and concentrate on what was happening. This was much better as, although in pain, I felt a bit more in control of what was going on. Every time a contraction came I was pushing as hard as I could and trying different positions to assist progress. I was able to move about on the bed despite being hooked up to the monitors and drip and the bed was specially designed to assist labour. By this point I had very little energy left in me. I wanted an active birth but this was physically impossible the state I was in.
The registrar was called again and I was advised to put my legs in the stirrups and to push against my thighs as this would open up my pelvis to its widest. I never thought I would be happy giving birth in this position but strange things happen to you during labour. The baby was almost out but I couldn't seem to push hard enough and her heart rate dipped to 70. The registrar recommended an episiotomy to help the baby out quicker and to make stitching easier as she felt I would tear. I remember saying wouldn't it help if I stood up but to be honest I couldn't have managed it even if I wanted to. I agreed to the episiotomy as I just wanted the baby to be born as quickly as possible and to be safe. One final push and cut and Daisy Rebecca Moon was born fit and healthy 7lb 8oz (not so small for dates) at 13.45pm. Whew!
Despite all my fears about hospitals the staff were fantastic. It really helped that my community midwife was able to come with me and coach me through the birth. At every stage I was told what was happening and asked what I wanted to do. Although we didn't get the birth we wanted, when Daisy was born safe and well it didn't matter a jot. It was still an amazing experience and we learnt such a lot. If there is a next time I'm sure we'll be better prepared and successful in our home birth. I was pleased we managed 12 hours at home rather than a long labour at hospital and humbled by the amazing dedication and caring of the hospital staff we met.
Home Birth Stories
Pain relief - what are your options at home?
Waterbirth at home
First Babies and homebirth
Transferring to hospital - why it might be advised.
Group B Strep - your options for homebirth, and choices regarding antibiotics.
You may be expecting a small baby - what are the issues regarding homebirth?
Home Birth Reference Page