When you have three, why not go for a fourth one?
After our third child was born, we felt that our family was complete. However, much to our surprise, I became pregnant again and for a week we adjusted to the thought of having four children, before I miscarried the baby. Suddenly there was this empty space that should have been a little person. Having already booked my husband's 'snip' as the perfect family-planning solution, this suddenly seemed too final. We'd let the appointment stand but if anything happened beforehand, then so be it, and if not, then that was o.k. too. A week later I fell pregnant! We sailed through the dating scan – baby was smaller than expected, so my due date was put back by a week. Two days after the scan, David had his vasectomy.
At 22 weeks, we went for the anomaly scan and all was not well. The baby was much smaller than expected, and there was very little amniotic fluid- a condition called oligohydramnios. Baby appeared to be healthy, and thankfully the consultant said I seemed to have had enough fluid for the development of baby's lungs, but he was concerned. He recommended one of his NHS colleages to take over my care and I also asked the head midwife for her opinion on the consultant, because I wanted someone who in the face of difficulties would be most pro- natural birth. I was also referred to the Fetal Assessment Unit (FAU).
At 23 weeks I went for my first FAU scan and saw the consultant, and baby's growth was on the 5th centile so it was diagnosed as Inter-Uterine Growth Restricted (IUGR), and the fluid levels were also on 5th centile, and they found some notches in my placental blood vessels, a potential marker for pre-eclampsia. Baby's growth remained exactly the same as I continued to go for fortnightly scans at the FAU, and the amniotic fluid levels even went up into the normal range in the end! Somewhere along the lines we decided we did want to know the sex of the baby and found out it was a little girl.
Having had a very traumatic hospital birth first time round (a failed NHS home birth), followed by two mellow home water births with an independent midwife, (Kay Hardie of Kent Independent Midwives), I was very keen to try for another NHS home birth. The consultant and the consultant midwife advised me of the risks of having a small baby at home, but they were very supportive of my plans of a natural birth. I started preparing myself for all eventualities and I wrote birth plans for home, hospital and c-section, just so that whatever happened, I would be in control of the situation. I was very sure my body could birth this baby if only I was left to get on with it without worrying.
It was agreed that I could have a home birth if the baby was over 2 kg in weight, remained healthy and stayed put until 37 weeks. I knew that it was my right to have a home birth regardless of whether I met those criteria, but I was grateful that I had their full support for a home birth under borderline conditions and I did not want to push it any further. To combat my fear of a hospital birth, I went for hypnobirthing classes, which taught me lots of new strategies of dealing with pain and fear. My plan was to visualise waves and keep my body as relaxed and open as possible, and to breathe this baby out into the world.
We decided to have an extra birth partner – I knew Anne through the NCT and liked her very much, and as an experienced midwife and antenatal teacher she was an ideal person to deal with the medical decisions I might have to face in labour.
Having had strong and regular Braxton Hicks contractions since 30 weeks, I had a gut feeling that the baby would be here earlier. At 36 + 3, I felt very odd all day and did not go to work, and lo and behold, my waters broke in the afternoon. All practice contractions stopped and the next day I met with the consulatnt midwife and a consultant to discuss my options. As I was classified as pre-term rupture of membranes, hospital policy was giving me 24 hours before I should be induced. Had my waters broken 4 days later, at 37 weeks, I would have had 96 hours! I refused to be induced and the consultant agreed that as long as I was aware of the risks, I could go home again for the weekend and if nothing had happened by Monday, we could meet again to discuss my options. The consultant midwife also showed me round the delivery suite so that I could familiarise myself with the surroundings, and surprisingly, I was o.k. about being there. I did not want to fight for a home birth now, especially as I began having doubts whether home was the safest place for baby to be born – the chances of baby transferring into hospital afterwards were high anyway.
Within the space of two days, my elaborate birth plans were reduced to just a few things – I wanted my baby to be born safely, and naturally, with the least amount of emotional trauma to myself – nothing else mattered really. I wanted my last birth experience to be something I could own and be proud of. Following long discussions with David, we chose to have the baby in hospital.
In the early hours of Saturday, I woke with contractions every 3 minutes and went along to the hospital – I chose the nicest room and was quite happy, until they stuck me on the monitor and all the contractions stopped. Feeling a bit disappointed, we went home again. A community midwife came round and felt the baby's position- LOA, perfect for birth. I slept and woke up with horrendous backache a while later, and the only thing I could do was pace the garden in circles. The pain was relentless and something I had never experienced before, and soon we were back in the nice delivery room for some gas and air.
The baby had moved into posterior position, back-to-back. Anne now became my advisor on positions to turn this baby – mainly staying on all fours, which was excruciating. Because of the level of pain I was in, everyone including me thought I was further on in labour, so when I agreed to an examination before getting into the birth pool and I was only two centimeters dilated, my cervix not effaced and the baby's head still high, the word 'gutted' doesn't even come close to how I was feeling then. I could not get into the pool yet, I was not coping with the pain even though I was only in 'early labour', and I was convinced I could not do this for much longer. I think I cried. I could not go home again due to the pain, so I was put in a side room on the antenatal ward. I felt very vulnerable and I had no idea how to deal with this kind of labour, but I was just so glad David and Anne were there and I was not alone.
Although I listened to my hypnobirthing music on earphones, I could not visualise 'waves' when it felt as though someone was ripping my spine apart – I did not feel any tightenings in the front. As I was eating my dinner (I will forever associate bad rice pudding with giving birth...), dreading every new surge of back pain, I was aware that my midwife wanted to monitor the baby again. She tried with a handheld sonicaid with flat batteries, and it did not pick up a heartbeat – and that's when I started to fear for my baby and just thought 'I need to get her out!'. She then wheeled in the monitor, David recorded the contractions as the machine could not pick them up, and baby's heartbeat was very low when I sat on the birth ball, but when I stood up it went back to normal.
I don't know how much time had elapsed since I went into hospital, but whilst being absorbed by pain I was vaguely aware of discussions around hormone drips to speed up my progress as they were concerned about the heartbeat. I think I said I wanted more pain relief if they were going to make my contractions any stronger, which would have meant an epidural – at this stage, I was ready to agree to anything to make the pain stop. But I knew that the baby was still in the wrong position, and that by choosing a hormone drip and an epidural, I was setting myself up for a caesarean, and I also knew that I needed the pain to stop NOW - I could simply not wait for an anaethetist to be found to do the epidural.
Whilst Anne and David discussed things with my midwife, I resolved to have one last try to get this baby to turn into the right position for birth, and I went into my own little world. In my mind, I called the baby by her name for the first time, and spoke to her in German, my mother tongue – I just kept repeating 'Hanna, you will turn round, look, there is so much space for you to turn, you need to come out now!' whilst visualising that my tummy was a big balloon and with every contraction I extended my stomach as much as I could. I was now being asked to walk back to the delivery suite so that I could be monitored more closely, with everyone including me still thinking I was just in early labour. I walked with my eyes closed and needed to go on all fours several times during that walk – it seemed to last forever, and the pain was unbearable by now. I kept on talking to Hanna in my mind, but I was also convinced that this time I would not be able to give birth naturally and I would need a c-section, I had no idea what was happening to me really!
Having made it into the delivery suite, I went on all fours on the floor and buried my head in pillows, and my midwife had obviously realised that something was going to happen very soon, but I could still not feel anything other than back pain and an urge to scream into the pillow (ha ha, so much for my plans of breathing this baby out gently...). When the midwife told me to slow down I can remember thinking 'why? I am only in early labour!'. I did not even realise the baby was out, I was in shock I suppose at the speed of things, and so was the baby. She was rushed to the resuscitaire and I could not see her, but when I got to hold her after a few minutes it was very bizarre because part of me still thought I needed a c-section and I could not do it this time! I was so confused I even asked to have the injection to deliver the placenta, even though I had expressly declined this in my birth plan – luckily Anne and David realised that I was not thinking straight and they refused it for me.
Hanna weighed 4lb 15 oz, and we stayed in hospital for 5 days to establish feeding. It was a shock having Hanna early and so quickly in the end. Although I did have my moments of being frightened, I knew that David and Anne were there for me and that they believed in my ability to give birth even if I did not. My midwife respected my birth choices as much as possible and I had the support of the consultant midwife and my consultant to have as natural a birth as possible – even a waterbirth would have been an option had it not been for the speed of birth in the end. If I was to have another child (which I am not, and I repeat, NOT), and all was well with baby, my first choice would still be a home birth. However, given the circumstances this time, I was glad I was in hospital. I dealt with my fear of a hospital birth, and achieved a natural birth that I will look back on with pride – and with bewilderment at how I ever managed to get through it all. I feel so blessed that Hanna was fine, despite all the concerns in pregnancy and her early arrival. Of my four births, this was the hardest and weirdest one. I have done my bit for humanity now, and I am very glad I don't ever have to do it again!
Birth stories of Judith's other babies:- Lukas, Esther and Leah
Home Birth Stories
Home Birth Before 38 weeks
You may be expecting a small baby - what are the issues regarding homebirth?
Kay Hardie - Kent Independent Midwives
Home Birth Reference Page