My experience of transferring from a home birth

Jennifer Vaudin

Jennifer's first baby, Edward, was born in hospital. Jennifer had planned a home birth, but transferred to hospital for induction due to pre-eclampsia.

I have always been passionate about home birth probably from the age of 5 when my brother and my cousin were born a few months apart - the first at home, the second in hospital. I felt that hospital was where babies were born if something was wrong. I should add that my brother's birth was very traumatic for both my parents, and I never had the idea that home birth was the same thing as “magical” or “easy”. I had no experiences which did anything whatsoever to change my mind (including 3 months' obstetric experience as part of my nursing degree, and working as a health visitor).

So when my turn came at last, I booked a home birth. I wanted a direct midwife booking, and pretty much got that, though cover was arranged through a hospital consultant, who was reasonably laid-back about my plans and, at any rate, said that it was a matter for me and my midwife.

The real problem came when I developed high blood pressure. No-one at this point was talking about changing my plans - technically I was round about their high blood pressure definition (140/90,) but my booking BP had been 130/80 so it was not much of a rise for me. I just had a whole procession of midwives coming to do antenatals at home, and I was pretty happy with the clear guidelines the consultant had written in my notes. One day (at 36 weeks) I had + protein in my urine - ironically, when my BP was 90/50. I persuaded the midwife, and by proxy the consultant, that I did not need to be admitted to hospital to pee into a plastic container for 24 hours. She took blood and told me that if it didn't look good, she would be phoning me to come in immediately. So that was quite scary, but both the 24 hour urine collection and the bloods were fine, and at least it did prompt us to get on with practical preparations.

During this time my named midwife had been away, and initially she was horrified when she came back to hear that my plans had not changed. She continued to oscillate between accepting my decision and putting pressure on me, but she did bring the birth kit, which was important to me. I also bought a BP monitor of my own and was testing my own urine, which really helped me feel in control - and safe. I kept trying to get across that I wasn't being "It can't happen to me"-ish at all, just that there was nothing magic about changing the planned place of birth.

In the final (40th) week of my pregnancy it felt as if things were getting out of control. My blood pressure was absurdly responsive to emotional stress and there were a number of such triggers. I had a very frustrating encounter with a registrar who did not seem to realise that women, unless induced, do part of their labouring at home. One day my blood pressure had reached the consultant's marker. Other things going on were that the head had not engaged and I was expecting a big baby. Oddly enough, at this point I had a really sensible supportive discussion with my midwife. She told me that she felt that I should deliver in hospital and that she would do everything she could to help me feel comfortable with that - arranging early discharge, and she offered to take us round the labour ward again at the weekend. However, she also said that if I decided to continue at home she would support me in that. She asked me to discuss it with my husband, but only for an hour a night, then to forget about it.

The next day or so was pretty miserable. I really did not know what to do. I felt physically very ill, but as I have ME it was hard to know what was going on. I just felt I could not live through the coming days knowing I would have my baby in hospital - transferring in labour seemed preferable if need be.

The day before my due date the relief midwife came to take my blood pressure. As soon as I saw the diastolic figure - 112 I thought "I know where I am going", and it didn't come down, so it was off to hospital for us after phoning my parents to say come NOW and having some lunch.

The afternoon and early evening was spent hanging around being monitored, having blood tests, waiting for results (for which the sister said she had had to 'kick some ass') and seeing a procession of pleasant people. Then we saw the delightful registrar Dr Tan who put his hand on my shoulder and exclaimed in tones of mock? horror "You wanted a home delivery?! Oh my goodness, I couldn't, not even for my wife" as if we were incredibly brave and intrepid. He talked to us at length about pre-eclampsia and advised an induction that day, though he did say that there was an increased risk of a Caesarian especially in the circumstances (big baby, first baby, head not engaged). I felt that if it had to be in hospital I would rather get on with it rather than endure a stressful wait which might only make everything worse, and after they had agreed that John could spend the night with me, we said yes.

The signs were favourable for induction and Dr Tan asked if we would like to start now so we said "Yes please" He warned that it was very unlikely that a first dose of Prostin would do the trick and said the next dose would be at 1.30am (it now being 7.30pm). John phoned my parents with an extensive list of stuff we had forgotten - including a mislaid knitting needle (which Mum thought was something to do with the induction) so it was nice to say Hello to them before things got going.

Then we went up to the ward to await events. Surprise, surprise we didn't sleep! By the time the next dose was due I was in continuous fairly severe pain, so not best fixed to get the news that they would not give it as they were busy with problems on labour ward - and that I might not even get the next dose at 8am. Not a happy chicken... John asked to speak to the registrar who was now on duty, who came up and discussed it with us. We didn't appreciate being told that they didn't do inductions at 7.30pm - doses were at 10pm and 8am, since patently obviously I had been done, but there wasn't much we could do at that stage.

We contemplated going home, but it was 3am. I thought I might was well get the TENS machine on for the pain, and we lay down. I think I'd been asleep about 15 minutes, and John not at all, when I felt uncomfortable and thought I'd walk around a bit to loosen up. Ha! I stood up, felt a pop and there I was in a huge puddle. A moment's puzzlement... and I realised my waters had broken (yippee, I hated the thought of having them broken). It was a bit like a burst water main and every contraction brought more floods. And we were in business, with contractions about a minute long at intervals of a minute or so. It was a quarter to five.

Then down to Labour Ward, where our first (brief) midwife had wanted home deliveries for all her three children, and chatted to us about what happened with them all, sang the praises of health visitors, so I felt generally buttered up. John persuaded them to fetch me a chair I could straddle as it had been so helpful upstairs. I felt in need of breakfast (as ever), but with all the muttering about Caesarians that was ruled out - and anyway I soon started vomiting (and continued much of the day - not a great problem as there was always someone there with a bowl under my chin though it didn't give me a breather between contractions.)

Our first midwife handed over to Vanessa, who was our midwife for much of the rest of the day. She was lovely and quiet, and mostly let us get on with it with just a few suggestions. I tried a bath, but that involved taking the TENS machine off and it wasn't as relaxing as I had thought it would be - probably you need a proper pool to get deep enough and I needed to stay pretty upright to cope with contractions. The worst pain was a sensation like a balloon had been blown up inside my bowel - I hadn't been expecting that kind of pain so early on and couldn't really understand it; it didn't feel like something 'working'. Other than that, contractions were fairly OK, sometimes enjoyable as well as painful, provided I was ready for them and not constrained in what I did about them eg during continuous electronic monitoring. I progressed through rocking on my precious chair, added thigh massage (TENS machine did get in the way of back masage) from John (who was rarely permitted more than inches from me lest he not be in position at the beginning of each contraction or not paying attention to precise instruction!) and then moved on to high volume groaning - best of all, helped keep the breathing right. "Right, I'm going to try whingeing now" I was alternately wearing a rugby shirt of John's or nothing at all, and a coach party could have come in without me batting an eyelid. Unfortunately, however well I was coping, the dilatation of my cervix was going slowly (I'd got to 4cms) and Syntocinon was advised with an epidural.

Annie, our own community midwife, came in to see us which was a nice surprise. I told her I felt I was on a conveyor belt to the exact opposite of what we had hoped for. I think she was surprised to see me coping. Later on she asked if I had read Ina May Gaskin's 'Spiritual Midwifery' - she was afraid I had an idyllic view of childbirth but I assured her I had only looked at the pictures!

Vanessa suggested I could wait longer before accepting Syntocinon and try gas and air meantime. She said she would put it within reach so I could have it whenever I was ready. It was still some time before I reached for it, and than I found the concentration required to get it right detracted from overall coping and it didn't help as much as I thought it would, so I quickly left off. At the next internal I was doing well (6cms), so continued without assistance. However, I was feeling tired - keeping going on something (mostly an overwhelming soppiness about John!) and the contractions were slowing down. We tried standing up and thus began our first ever attempt at dancing together - me slipping in puddles of amniotic fluid in my bare feet as we rocked. But honestly it was very romantic!

It felt as though I was making good progress. At Annie's next visit she said she could tell I was ketotic (John now tells me he has often noticed the same signs in me before) and she suggested trying to get something into me despite all the mutterings about Caesarians. John was permitted a brief dash to the hospital shop whilst she held the massage fort till he got back bearing lucozade tablets. I started feeling restless and thought this might be transition but alas after several hours of seeming good work my cervix had not shifted at all (it was the same midwife doing the VE so I could feel confident about that) and there was a caput (lump) on the baby's head. I really didn't want to be too exhausted to push the baby out myself, so I agreed to the Synotocinon.

Change of midwife to Maggie. The SHO (Senior House Officer - a doctor) came to put the IV line in and informed me that I had a very high pain threshold for a Caucasian (I think I was supposed to scream and squirm over the insertion of the Venflon, but heck, I have had a lot of practice with pain). To start with, nothing much seemed to happen except the pain was harder to cope with stuck on the delivery bed and being continuously monitored with those pesky belts round me. Then the contractions took over and my endurance felt sorely tested. Back on the gas and air - though mostly using the mask to breathe "Oh dear" repeatedly INTO. John was put to work rubbing my legs with lavender oil. I knew I desparately needed to lean forward so tried sitting across the foot of the bed leaning over a bean bag but it didn't really work, After one contraction I suddenly noticed the floral design on the wallpaper looked like female genitalia (I think this was later regarded by the midwife as my 'strange things women say during transition" comment, but John thought it was just my normal rather embarassing behaviour) but all of this hadn't been going on very long I don't think, with me thinking that I really might have to try pethidine or an epidural and not feeling at all happy at either, when in the middle of a contraction came an urge to push - aha! Maggie said "If you want to push, push, just go with it"

There was no way I could cope as I was, so I said I needed to kneel and lean on the back of the bed. Thus began John and Maggie's struggle to shift me as I was utterly unable to assist, with all the wires and tubes and general exhaustion. Another internal and onto the next stage. Even I was rather surprised by the roaring noises that came out of me, but they seemed to work. It all seemed a bit chaotic as the drip which had already started to twist finally came out of my hand and there seem to be blood and IV fluids all over, and John and Maggie were trying to attend to all ends of me at once. Ruth's (the antenatal class midwife) graphic demonstration of second stage came in useful here, so we were not disappointed by the appearance and retreat of the baby's head. I asked Maggie to talk me through each contraction - I knew what to do but needed an external voice. John was stuffing ice cubes at me to suck. Anyway, in no time at all (18 minutes), out came a baby's head. John says Maggie said to him"There's the baby's head" and he expected to see it crowning but no,there was a whole head. And then a whole body (those shoulders felt a tight squeeze!). Maggie said to me "Can you see what you've got?" I looked around and saw a scrotum, with a vaguer impression of the rest of the baby. I'd done it.

Did I feel elated? No, not really - and I'd thought I'd cry - just a very profound sense of quiet satisfaction with all of us. He had had the cord wrapped tightly twice round his neck and took a fair bit of unravelling, Maggie said (she said later the cord was unusually long). She was surprised he had shown no signs of distress on monitoring. He was gurgling a lot, John tells me, so was quickly sucked out, which didn't impress him greatly. Somehow I was turned over, he was wiped and wrapped up and handed to me, a perfect baby. [Later, much later to be named Edward, David George. He weighed in at 4.130kgs, 9lbs 2ozs and was very long with large hands and feet] How on earth had I ended up with the one I would have picked out of a catalogue anyway? He was quiet but alert. John blew his nose. Maggie said Could I feel the placenta? I thought so. One push and it was out - quicker than if I had had syntometrine she said, 5 minutes. Cue more smugness...

Then to inspect the damage...I wasn't surprised to learn I had torn; it had felt like it and it had been so quick. Another midwife came to do the suturing. Apparently she should have got a doctor to suture the anterior tear, but said that the one on that night hadn't much experience - 5 years compared with her 20(!) so she would just get on with it as it was in a vital place, ahem. John's face as he passed by and caught a glimpse of the damage was not encouraging! Still, though it was not painless, it felt as though Louise was doing a good and quick job. She told us she did embroidery for a hobby so John said as long as she didn't do a twee countryside scene down there... [This all healed amazingly quickly]

John got his best night's sleep in months in the hospital bed! I scoffed a large bowl of Jordan's Maple and Pecan Crunchy with milk, more lucozade tablets, bananas, chocolate soya milk, pineapple juice and lots of arnica tablets. Our son suckled and I slept.

In the morning lots of people involved the day before came to congratulate us. My blood pressure was 145/100 and I was advised to stay in hospital but I said I needed to think about that and was treated to a long speech about how everyone hates hospital, how the sister knew exactly how I felt, what my responsibilities were to my husband and my child, fits, strokes etc etc. She said it would be unfair to allow John to stay another night given that no-one else was allowed their partner, but that if it would make me stay then he could. Annie came in a little later and told me that she had told them not to exert any pressure on me to stay if I didn't want to.

Next time they took my BP it had risen further - and now I was worried too. The sister misunderstood my comment that I needed time to come to terms with staying in and started again - I felt like every single alarm button had been pressed and suddenly knew that I had to get home and fast. I was scared and as far as I was concerned needed treatment now and getting out of hospital and home seemed worth trying, with the proviso I'd go straight back in if it didn't work. It was all very ugly - I seem to remember locking the ward doors being mentioned. I stopped feeling able to discuss it and just kept saying that I needed to go home. Fifty yards in the car and I started to feel better... It's a real shame this happened as otherwise both John and I feel very good about the whole experience - yes, we could point to failures and all the things I hate about hospitals and John did have to be assertive for me as well as looking after me very, very well and we did get very special treatment, but as John said, it all seemed natural, positive and noninterventionist.

Jennifer knew that it was her right to discharge herself from hospital whenever she wanted, regardless of the pressure put upon her. If you have a hospital birth and it is suggested that you, or your baby, should remain in hospital for 'monitoring' or 'observation', remember that it is yoru decision, and yours alone, whether you stay there, or go home. You are the expert on your own family, and if you would feel safer at home, you can ask for blood pressure checks etc.. to be done there. - Angela

So that was the easy part.... I'm still a fan of Sheila Kitzinger, an even bigger fan of John Vaudin - and I still don't like hospitals! And our baby is lovely!

So, how do I feel about it now? I feel that I could probably have stayed at home, with a more confident midwife and maybe I wouldn't have had some of the interventions I did have, but I had reached a point of feeling so stressed I could hardly bear it and I had exceeded the criteria I had set for myself (guided by the consultant's opinion, and various non-interventionist midwife contacts) - it felt as if it was *my* decision in the end, so I have no regrets about going in when I did. Having had a birth at home since, there were actually some things about the hospital birth which were better, which was sort of nice. But I do wish I hadn't been bullied so much along the way.

Advice to others? Show that you really do understand that transfer might be necessary, have your bag packed and notes for the birth to accommodate this eventuality, and then carry on with thinking in terms of home birth. Speak to as many people as possible, read as much as you can, and if things start to look dodgy, work out some criteria for yourself (you don't have to stick with them!). Have someone who you trust to advocate for you, and don't feel ashamed of needing that, even if you are usually quite capable of looking after yourself. And if you start to feel bullied, get someone else to read the Riot Act to the bulliers for you - we did this when a similar situation started to unfold in my second pregnancy.

Jennifer Vaudin

jennifer@vaudin.net

Jennifer's second baby, William, was born at home.

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