Two Birth Stories - At Home and In Hospital, by Kate Cook

Having recently given birth to my second baby, this time at home, I am struck by the extreme improvement in the whole experience, compared to my first delivery in hospital. Whilst there are physiological reasons why first labours are generally more hard-going, I feel sure that being in a normal environment, the midwife's attitude and my own increased knowledge and confidence had a huge part to play. Second time around, the only pain relief I ended up using was a TENS machine, 4 gasps of gas and ¾ of a cheese sandwich!

Apart from producing a healthy baby, there is no way I could say my first labour was a satisfying experience: seemingly interminable (15 ½ hours), agonizing worry, artificial rupture of membranes, epidural, severe tear and stitches in theatre. I felt medical staff and hospital practices had made it far worse than necessary and I was left feeling traumatized, violated and angry. I felt that with an encouraging and supportive midwife, and by allowing my body to do what felt right, I could possibly have managed without an epidural, given birth kneeling up, avoided a bad tear and ultimately been in a fit state to open my eyes and look at my son when he was born - the memory of missing those moments still had me in tears up to a year later.

So, when I became pregnant a second time, I knew I wanted to at least have met the midwife beforehand and have confidence in her supporting me and letting my body do what it's designed to do. A friend suggested I consider a home birth and I started going to the NCT home birth support group, attending Active Birth yoga classes and reading books. I booked in with the midwives from West Middlesex hospital, who are known to actively support home birth.

From a position of trusting naivety, believing that hospital was the safest place to give birth and therefore the best, I started to wonder why I ever went to hospital in the first place. I was fit and healthy and the pregnancies were straightforward. I could always transfer there if I changed my mind during the labour and the midwife could deal with almost all emergencies at home initially, with little being possible even in hospital for the most severe and unusual ones. I would be more likely to have a midwife with me, if I was at home, so more frequent checks could be made on the baby - therefore one would be given warning if a worrying situation began to develop and one could discuss transferring to hospital. What was more, the labour was far more likely to be smoother at home, where subconscious processes allow the body to function properly, so I would be less likely to need intervention anyway.

During the rest of the pregnancy, my ante-natal care was from the community midwife team, usually from my named midwife and I also managed to meet most of the others who might attend me at home. I had therefore talked over my feelings on the matter and felt confident that I was doing the right thing in aiming for a home birth.

When the time came, I was again awoken by "period pains" at 6 a.m. (15 mins apart) and decided to put the TENS on just in case (I'd only picked it up the previous morning). Given that I still had a little over 2 weeks until my due date, I didn't really think this was it and sent my husband off to work and my mother in law took our toddler (J) to pre-school. Everything was fine but I decided not to walk into Kingston to shop since it was a bit uncomfortable. I thought I should get some data for the midwife so at 11 a.m. I started to do more timing and found they were 5 minutes apart. I looked up in the books to see what this signified and didn't really get a useful indication. I didn't believe I was close since I was managing fine just breathing harder and felt totally normal between contractions. I was standing up looking at the view from my bedroom window and listening to some music on the radio.

After a while, however, I became less happy and felt I wanted some company so I rang my named midwife on her mobile phone and she said she'd come straight away to see how I was doing. I phoned my husband (H) and suggested he could come now or wait to see what the midwife said, but when he heard me pausing to breathe he said he'd come straightaway too. By then it was 11.45 a.m. and I did start to get a slight sick feeling which I thought was hunger, and sure enough started to feel much better as I munched pieces of cheese sandwich between contractions.

I was in the bathroom when I heard the midwife being let into the house at 12.10, and was on my way back to the bedroom when the contractions suddenly become pretty all-consuming and I had to stop to lean on the banisters. I made it back to our bedroom, just as far as the bed and sank to my knees next to it. I had 3 more huge contractions, resting my head on the bed in between thinking "crikey" (or words to that effect!) H arrived home and just sat there watching me, unaware that things had changed dramatically. The midwife was still waiting to examine me and I surprisingly had the presence of mind to remember to ask for the gas and air first. H helped her get her equipment from the car, only to find the bottle was empty so H got busy changing that for me (scuba experience essential).

It was 12.30 when I gasped "push", so it was "quick, get her trousers off", H saying "I can see something", "OK, I don't need to examine you then", some frantic spreading of the plastic decorator's sheet and towels, the telephone ringing and me thinking "I think this is one time I don't need to answer that". I had 2 contractions with the gas, which was calming and just let it happen, not pushing as well (feeling the burning sensation which wasn't that bad). Then "that's the head out ... here are the scissors H" and the sound of a baby crying. Another contraction and he was out, at 12.37p.m.. H's mum arrived back in the house, having collected J from preschool, to the sound of a crying baby upstairs, so they came and had a look. Shortly after, the midwife helped with the placenta, which I hardly noticed, and I had very little bleeding and only a slight graze.

As it turned out, the cord had been round his neck - not tight, but not enough to loop over his head, so the midwife had clamped and H cut it. The membranes had not broken (so the baby was born "in the caul") so the midwife had had to snip them when his head was out. Once his face was clear, he started to cry, although his body was still inside.

So really I didn't feel as if my body had been through anything much this time - I can see why people then go on to have 3, 4 or 5 kids!! I was not on a high, as I had been after my first labour, nor did I feel that satisfying extreme tiredness as if I had just climbed a mountain and got to the top. In fact, I was rather shocked and a bit concerned that my body had done this when he wasn't due for 2 weeks. He looked minute with very skinny legs, but I was assured he was of normal size. The midwife said she didn't need to measure him and indeed he was 49 cms. I spent the afternoon in bed with J dancing round the bedroom singing and dancing, so that was nice too (and I got to finish off the cheese sandwich).

I'm really pleased I planned a home birth since there really was no need to go to hospital at all. If we had set off, I might have had him in the car! As it turned out, I was really lucky it all worked out at home since the hospital was having trouble finding a backup midwife to assist at the birth so might have asked me to come in to the hospital after all.

 So to conclude, everyone's different and you have to do what feels right for you, but I can thoroughly recommend the experience of a home birth. Just a couple of words of advice: have it clear in your mind when you need to ring the midwife, and practise unfolding the decorator sheets beforehand!

Compare that with the first time round...

The First Birth - In Hospital

My first son was born at 9.30 p.m. at night after waking with "period pains" at 6 a.m. that morning. I put the TENS machine on at 7 a.m. and occupied my mind fiddling with the buttons at each slight cramping feeling. We timed the contractions and left for the hospital at around 11 a.m., in case this really was labour. On admission, I was advised to have some lunch before they examined me since I wouldn't be allowed food if I was in labour. At 1.30 p.m. I was 4cm dilated. "Great", I thought, "I've done all that already." By 3 p.m. I was on gas and air and hanging on until the next examination for some more encouraging news. However at 5.30 p.m. I was apparently still only 4cm and felt very disappointed. The midwife wanted to break my waters there and then during the examination, to speed things up. This was not a considerate move since her examinations were excruciating but I managed to stick partially to my birth plan and request an epidural first. I didn't feel up to going through another 4 hours with no end in sight and she gave me no encouragement at all.

All of a sudden "medicine" took over; drip and monitor were fitted, etc etc. and I started to feel disheartened. However, the relief from the epidural (6.30 p.m.) was great. I could still feel my legs and wanted to keep upright, even walk about and go for a pee, but the midwife insisted I wouldn't be able to manage it - and didn't suggest she and H trying to help me together. I was kneeling up at the head of the bed breathing hard on the gas and air and floating off at each peak. It seemed to go on for ages and ages. I had my eyes shut a lot of the time, was very tense and hating it and seemed to get no relief between contractions. H was saying words of encouragement in my ear, which helped although I couldn't speak to tell him so.

Anyway, it was extremely painful and I was sure there was something wrong since it was so painful. The midwife offered no words of encouragement or reassurance and spent most of the time standing at the edge of the room writing notes, occasionally pestering me to do something I didn't want to do. She showed me the monitor trace and said my contractions "weren't good enough" and I should have had "3 peaks instead of 2" or something like that. When a temporary replacement came during her tea break and actually came up to talk to me, I immediately started asking questions and found her very reassuring. At one stage, several white-coated doctors came and stood at the foot of my bed and one said "If you carry on like this we'll have to put you on a drip". Other people kept coming in and looking in cupboards and asking for more pillows. The midwife even said to H "she's not going to have this baby soon and I've got to leave by 9.30".

Eventually I suddenly felt myself pushing and thought I had to have another examination to ensure it was alright to push. I really wanted to be on all fours or kneeling up because of pressure in the back passage but she said I "had" to turn round for the examination and then I was stuck there and ended up pushing like that which was really agonizing.

She directed me to take a big breath, hold it and push though my bottom - at the time I was remembering NCT class advice to ignore this unhelpful advice. I could feel the baby moving down, it felt too fast in fact and was really hurting, particularly when I pushed, and I just wanted to ease it down. The midwife told me "the baby's getting tired" (first I'd heard of it) to make me push harder which added to the worry I already felt. I think it was because she wanted the baby out so she could go off shift. The baby came out (9.27p.m.) after only half a dozen pushes.

I was too tired to open my eyes for ages but managed to when they put him in my arms. The unhelpful midwife vanished and an extremely nice one came on shift who was very supportive, coming with me to theatre and helping with breastfeeding. I seemed to be left in stirrups for ages while various people seemed to come and examine the tear (prodding about painfully) and eventually it was decided they should do it in theatre. I asked them to top up the epidural so I couldn't feel anything at all and was on a high while in theatre. I was out of there and in a single room at about 1 a.m. and H stayed a while before going home. I couldn't move my legs or feel anything and had a catheter in place.

I can't remember if I was back to normal when, the next morning, a nurse suggested I might want to go home (wanted the room presumably). She was very shirty when I expressed surprise since I hadn't been there more than a few hours. "Yes, but you had the baby at 9.30 p.m." was her reply. The doctors who came to check me seemed to think it was my idea to go and they wanted me to stay in another night.

To summarize, whilst I know friends of mine who had worse experiences and more unpleasant midwives, I feel there are a number of specific issues which would have been so much better if the hospital had handled them differently. I felt so at the time and I am now even more convinced.

At antenatal appointments in hospital I had asked about "breathing" to ease labour and been told it was nothing special and they'd tell me what to do at the time. Well, they didn't. For the second labour, I'd practised diaphragm/yoga breathing ( ref. Active Birth Centre) and forced myself to relax which made a huge difference - I could feel the pain fading. The more tense you get the more painful it is (a well-known fact).

The internal examinations were exceedingly painful (the worst aspect of the whole birth) - in addition she insisted I get on my back which made contractions much more painful. I have since met midwives who are generally happy to examine in other positions (eg kneeling forward).

On my second examination, the midwife made out that I hadn't progressed, she said "You're 4cm, well, 4-5 cm", and wanted to pressurize me into breaking my membranes. While writing my birth plan I had decided to try and avoid it since it didn't seem natural. I have since learned that if the membranes are broken, contractions are suddenly more powerful and painful and it is probably harder to cope with the pain. Dilation speeds up but then can be slower so overall dilation is no faster than if the membranes are left intact. The pressure on the baby is greater and it is more likely to become distressed. If she'd been encouraging I might have managed to hold out and not gone along with her. Instead I felt I'd been hoodwinked into agreeing and someone having control over your body like that is a violation similar to rape (although not as severe).

I knew all about the classic outdated delivery position (half lying back on the bed) which everyone knows is much harder than when more upright/squatting to allow pelvis to open, the coccyx to move and gravity to assist. I certainly did not want to deliver like that. Nevertheless, I didn't have to push very long, so my body must have been doing it right after all.

 I was very traumatized by having a tear (the one thing I'd been dreading and horrifed when I heard it could happen) and cried at night for days thinking I was permanently damaged because of someone's selfishness, ignorance and outdated training. I think the baby came out too fast because she told me to push as well and, coupled with my lying back position, caused the large tear towards my back passage. Instead, I should have trusted my instincts. Later I tried to discuss this with the midwives, surgeon who stitched me and doctor at the check-up but everyone muttered something fairly vague and non-committal. Discussions with medics during my second pregnancy did seem to suggest it was because he came out too fast. As it turned out, the consultant must have done a good job since I have never noticed any difference to before, which is a huge relief. Due to the tear, I had to spend the precious time after the birth in theatre without my husband or baby. At the time in theatre I was on a high, but during the days afterwards I felt worse and worse about the whole labour and experience in hospital.

I was shocked by the attitude of hospital staff at the postnatal check. I waited over an hour and then the doctor was in a rush wanted to examine me. I explained I'd been traumatized after the midwife's examinations and asked if it was really necessary to have a further examination. The doctor was unnecessarily terse and sarcastic in her reply.

This is what I felt at the time and also looking back, after further reading and discussion. The medical profession may disagree with my thoughts on what happened to me and why. That is not the point. I could have felt quite differently about the whole experience if they had handled it differently, taking time to talk, for example. All these things may seem slight to someone reading this now but they were very important to me and, I believe, to most new mothers. Pregnancy and birth are very emotional times and pain and hormones mean you can't stand up for yourself and are very open to suggestion, let alone strong persuasion. It may be hard for others to understand this when they have not experienced it themselves. Indeed, I was surprized at myself. The medical profession can become hardened to it through overexposure and time pressures. Mismanagement of these precious times can have lasting effects on the mother and family. For example, in the 1960s, mothers in hospital weren't allowed to breastfeed more than once every 4 hours and consequently had difficulty or had to give up. I know women in their sixties even who can't talk without crying about their resultant inability to breastfeed their babies.

With time I have stopped being upset by just thinking about what happened to me, but I still feel angry and amazed that this can happen in this day and age to someone who was relatively well informed and generally in control of their life. Life just gets better, however, and I now have two gorgeous boys who I enjoy enormously and feel exceedingly proud of.

Kate

References

Preparing for Birth: Fathers & Preparing for Birth: Mothers, Andrea Robertson ACE Graphics, 1999.

Yoga for Pregnancy etc. Active Birth Centre. 25 Bickerton Road, London N19 5JT. www.activebirthcentre.com

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