After her first baby was born in hospital at 35 weeks, Kirsty was 'desperate to avoid having another early baby'. Be careful what you wish for......
When I was pregnant with my first child, homebirth was not an option I ever considered and my daughter was born in the maternity unit of the newly opened big hospital nearby. The birth was straightforward, and frankly far easier than I had expected. I remember thinking that I had had worse visits to the dentist! I coped well on just gas and air. I agreed reluctantly to continuous foetal monitoring, which seems to have played a part in why I ended up on my back on the bed. I had a very bad tear, which I guess healed OK, though I gave it barely a second's thought in the days that followed. My daughter was five weeks early, struggled with various issues including feeding, and it was days before she was discharged. By then I'd grown weary of a system which meant that we received widely differing care and advice with every change of shift.
It was a relief to get back to the care of my community midwives. I had liked what I had seen of them antenatally, and now they provided just the sort of attentive, consistent and supportive care we needed. I knew then that there was no-one else I would rather have for me during any subsequent pregnancy and birth.
By the time I was pregnant again I had retrained as an NCT Breastfeeding Counsellor. I lot more about how breastfeeding and a relaxed birth work well together, and I was desperate to avoid having another early baby, and missing out once again on those early feeding experiences.
I also knew that my community team had one of the highest homebirth rates in the country, and a reputation for genuine support for homebirths: for instance through their popular 'meet the team' popular homebirth support group. My plan for a homebirth was met with enthusiasm from its first mention, and I also received acceptance for my decision to refuse dating scans and technological monitoring (such as the use of doppler for listening to the foetal heartbeat).
By 38 weeks I had passed the date when my first baby had been born, and the gas canisters and homebirth equipment box were delivered to my house. I'd joined the HomebirthUK Yahoo group, and found that, and www.homebirth.org.uk, to be a great source of information and support. Everyone was certain my baby would be born very soon indeed...
40 weeks... and still no baby. I'd been so focussed on avoiding prematurity that I'd given no thought to 'going over'. And I felt I'd been ready for this baby for a loooong time by then. I started reading the 'overdue' section on homebirth website, and I sent hubby out for some raspberry leaf tea. Plenty of time yet...
Just before 41 weeks, my midwife first asked me what I thought of having a membrane sweep. It was an explorative question, but I was just not ready for it. I didn't want interventions!
I began to feel that I was failing by not going into labour. I'm the sort of person who gets on and does anything she commits to: I find a way to make it work. But now I felt pretty helpless. I worked my way through the list of home induction remedies:
- raspberry leaf tea
- lots of walking and climbing hills and stairs
- Clary sage in the oil burner and bath
- nipple stimulation (as a breastfeeding counsellor, I had an impressive range of breastpumps, plus a good repertoire of massage techniques)
- fresh pineapple - yeuch!
- curry - I'm a curry coward, so I started with a korma and worked my way upward
- sex - rather impressed that we managed this one!
I chose to steer clear of the homeopathy at this stage, because I had heard such varying reports.
Maybe some of these were helping things to progress inside: all I knew was that nothing seemed to be happening. I began to avoid going out and having the same "still pregnant?" conversation everywhere I went. I'd told relatives that we'd let them know when anything happened, but even so I stopped answering the phone: we were beginning to get calls from people who thought the baby must have arrived and we'd forgotten to tell them. Everybody seemed to be watching me and waiting for me to perform: like I was a freakshow. I felt some understanding for what impotence must be like for a man. It was toughest of all to cope with my daughter, who had been primed that the new baby might arrive at Easter, and it was now July. School had finished for the summer and her friends had disappeared on holiday, but I couldn't promise her any activities in advance, because I never knew what the next day held. It broke my heart.
I agreed - very reluctantly - to a CTG (foetal monitoring for heart rate, movement and contractions) and an LV (checking the amount of amniotic fluid) at 41+5. This was part of the NICE guidelines, and my midwives' attitude was that this testing was from a 'why not?' rather than a 'why?' perspective: continuing the pregnancy was the expected line, and induction a deviation only to be considered in the light of any anomalies. The tests showed a healthy baby, regular little contractions, and lots of amniotic fluid, so I was shocked when the midwifery team leader came on quite strongly for me to have a sweep: it seemed the opposite of why I'd agreed to the tests. A chat with my own midwife gave me some breathing space, but I was beginning to feel I was slipping into the cycle of monitoring and health professional input that I had so wanted to avoid. On the plus side, my midwife had talked through my situation with the consultant obstetrician, who was happy with my situation, and said I sounded like a 'very sensible woman'!
The HomebirthUK Yahoo group was a lifeline at this time. Going over dates is treated by some as if you are sailing off the edge of the map into unknown territory. Those 'pregnancy week by week' articles in magazine often stop at 40 weeks. Obstetric wheels stop at 42 weeks. Online I could talk with women who knew what this felt like. Both online and offlist I received so much encouragement and so many positive messages, from someone in the next village to as far away as New Zealand! Waiting beyond your due date can be a real psychological journey, and support is a crucial part of coping.
For the next round of tests at 42+1, I asked my midwife to make it clear to the staff that I was to be put under no pressure for induction or a sweep, and that the results were for me to discuss with my midwife, and not anyone there. I decided to take hubby along for moral support, but the staff were lovely after all: CTG just fine, although those little contractions had disappeared. We arranged to meet my midwife afterwards to discuss the results and to consider some options: I was finding it hard to cope with the feeling of living from day to day without knowing what might happen: we wanted to consider what options the next week might hold. If I did go for induction, could I go to the smaller country hospital some distance away? Could I still have the pool, the active birth room, wireless monitoring if I was induced? Looking induction full in the face, and considering how to make it more acceptable for me, was a big help. Facing up to fears can make them less scary. We also talked about how the long gestation might affect a homebirth: there was an increased chance of meconium in the waters, and that might cause the midwife to recommend a hospital transfer.
I decided that if there was no sign of the baby by 43 weeks, I would go to the smaller hospital for induction. I would have a sweep at the next CTG appointment at 42+5 to see if that would work first. I then thought long and hard and decided to have a sweep right then. One reason I had said no so far was because if the cervix was unfavourable, I would feel very depressed, and feared I would be dispirited enough to be 'bounced' into an induction. But now that I had agreed a timetable with induction 6 days away, I didn't feel that risk. I could have a sweep now at 42+1 (Thursday), and repeat it if necessary at 42+5 (Monday). That way if I did go for induction at 43 weeks, I could feel that I really had given the alternatives a good try. I was 1-2cm dilated, and with a Bishops Score of 9/12. My midwife was confident I would go into labour in "24 hours or so" and staked her professional reputation on me not getting to Monday's CTG appointment.
We went home elated and arranged for my daughter's 'birth-sitter' to spend the night nearby... but nothing happened. Hubby went of to work and the birth sitter went home. I was even further in the dumps than before. Somehow my body was faulty. Labour would never get triggered. My husband's attitude was that I should relax. Stop trying to have the baby. Stop pacing around to get the baby's head in contact with the cervix. Stop drinking that funny tea. I had a nice bath, we had a last curry (Marks & Spencers Chicken Jalfrezi, if anyone wants to take a note) and we slumped in front of some trashy telly with a bar of chocolate and a glass of wine. Then off to bed.
I remember waking twice with a strange feeling, but for some reason didn't register it more than that - just turned over and went to sleep again. But the third time (3.16am) it was enough to shoot me out of bed and have me pacing the house. I told hubby I was just going to the loo until I felt more certain something was happening, and his immediate reaction - "When should we call the midwife?" - was enough to slow things right down: it's true, then, that too much rational thought gets in the way of labour! We got out the TENS machine and I was surprised and pleased to find that it really did work.
With my first labour, I'd had hours of mild indigestion-feelings, and I'd thought that this would happen again, giving me plenty of time to tidy the house before the midwife was called. But these contractions were far more businesslike from the start, and less than an hour later, Hubby was making the call to the midwife, and to ask my daughter's birth-sitter to make the 50-mile journey once more.
I was delighted to realise that a midwife from my own local team, one I trusted and respected more than almost anyone I've ever met, and who had been so helpful through both pregnancies, was to be my 'First-On'. She also lived within five miles and was here within ten minutes.
It was around 4 o'clock on a high summer morning - already fully light and the birds were singing. I'd swithered between my living room and conservatory as the likely place to labour, but the conservatory was still chilly at that time of the morning, and shifting furniture was going to be a big hassle as I simply wasn't getting enough of a gap between contractions to help or even direct hubby! By the time the midwife arrived, I had found that the (unused) dining table in the corner of the living room gave me a perfect place to lean and brace while I rolled my hips with each contraction.
The midwife set up the gas and air, and we chatted between contractions and slugs of entonox. She was happy to leave me to find my own way to work with labour, and only commented to admire my technique. Soon she called the Second-On midwife - another one I knew and liked, so I felt I could relax back with trust, knowing that the support was there if ever it was needed. Little things about homebirth make life easy: I had an endless range of familiar props and items to use: chairs and stools, cushions and mats. Even going to the bathroom is easier when it's your own familiar space, although that was a rather funny experience. I wasn't going without my gas and air, so it was an entire procession: me with a supporter, someone holding the pipe, someone pushing the canister, all heading down the hall then waiting outside the door for me to finish!
At around 7am I took another slug from the gas and air... and nothing happened. The midwife adjusted the pipe and told me to try again: nothing, fiddled with the canister: still nothing. It was empty even though the display had not been showing it was running out. The midwife tried to call for a new one, but the phone number wasn't operational. Soon both midwives were calling round and trying to sort out what was clearly a bit of a confusion about how to get a new canister out of hours at a weekend. I was beginning to panic. I couldn't imagine how I was going to cope without entonox. After a while one midwife told me she'd arranged it and within ten minutes a canister was being wheeled in. It was only later that I really appreciated what had happened. The midwife had called the husband of a recent nearby homebirther, who had brought their canister to my house, and without this option the midwives would have had to recommend a hospital transfer (ie Kirsty would have had to choose between staying at home with no Entonox, or going to hospital to get some). I'm shocked to realise how close my homebirth came to be derailed, and for no good medical reason, just an administrative glitch. I'll always be indebted to that other homebirth couple for their help, and to my midwife who had both the local know-how and the gumption to implement such a maverick solution. I don't know what would have happened without that canister - whether I would have transferred or not. I did not want to be without the gas and air.
But from the moment I had realised there was no gas and air left, my contractions had completely stopped. I've heard stories of how this can happen but I never thought I'd experience it myself. I took the homeopathic aconitum that my midwife suggested (to cope with panic/doubt etc) and just fell asleep on the sofa. This coincided with my four-year-old's getting-up time. I was oblivious to hubby leaving to wake her and setting her and the birth-sitter up with somewhere to head off to for the morning. Very gradually, the contractions started again, until I couldn't carry on lying down. The next little while was a confusing combination: labour had to get re-established, but as I was near the end of Stage 1, that meant it didn't seem too long before I was into transition: everyone starting commenting how grumpy I became! Soon I was beginning to feel 'pushy', and by now I was kneeling over an old dining chair, leaning my elbows on cushions on the seat and holding onto the struts at the back. Hubby went round the other side to hold the chair in place and stop me pushing it across the room, and to offer me a sips of water through a straw poked through the chairback.
Each coming push had me whimpering with its intensity, but I worked with them as my baby started to move steadily downwards. My waters had not fully broken yet, although there had been trickles and gushes all along. Now I could feel they were ready to go - a sort of blockage - and with one push seemed to send them flying. With my first in-breath I demanded to know if there was post-dates meconium in them as I'd worried. But no, they were clear.
It was obvious from my bump that this was likely to be a largish baby, and this didn't worry me: I'd learnt enough during my training to feel that size was rarely a real issue. But as the head began to crown somehow things ceased to progress. Maybe because the baby had a long gestation the head bones were more calcified and less malleable? My midwife told me later that at this point she could see bright red blood beginning to appear, and knew she had to act to avoid some nasty tearing.
Both midwives helped to turn me onto my back, and hubby nipped round the far side to support me. This was awkward because despite being in a big room, we were all jammed against the edge of the sofa! I could feel a tremendous heat where the baby was stuck, and asked for something cool. I thought I'd get a cold compress - my midwife later told me it was the KY Jelly she kept in her kitbag! I didn't care - it was a blessed relief. I could hear my midwife apologising to me, and saying she knew this wasn't what I'd wanted but that it would get the baby out. I thought she must be doing an episiotomy, but she later explained that changing my position gave her the chance to ease the baby out with only a small second degree tear that did not require stitching. She was apologising for invading my autonomy: up to that point everything was my choice. But I trusted her so much that I felt completely in tune with responding to her: no apology required.
Anyway: within a push or two - and me half out of it with the intensity of the feeling - I had an enormous purple baby on my tummy, moving strongly and breathing well with an Apgar of 9. Baby Beatrice was born at 11.30am, at 42+3, weighing 9lb 4oz.
I would have happily held that moment forever, but we were all still crammed against the foot of the sofa! We shifted so I was more comfortable, cleaned up a bit and started to think about the 3rd stage. Beatrice was happy to feed straight away: a great joy, something I'd regretted missing with my first baby. But as with that first time, the placenta just didn't seem to want to budge, and after kneeling up at one point, I suddenly felt hot and dizzy. Quickly the midwives had me lying down, and I was feeling willing to go for the assisted 3rd stage after all. I took the chance to look at the placenta with the midwife. There was no sign of any ageing or deterioration, as feared in a long gestation. Other than a bit of peeling skin, Beatrice seemed to have managed just fine by arriving in her own good time.
Getting into my own shower afterwards was bliss! One of the best reasons for a homebirth! And within a very short time, my first daughter was home and we were all four snuggled up on the sofa together.
I'd been offered an inflatable birth pool early in my pregnancy, and at one stage had been quite keen to try a waterbirth. My big square living room seemed the perfect setting. But I was put off by concerns about the strength of our elderly floorboards (I've since seen the weight of the pool compared to a number of adults standing together in the room, and realise we'd probably have been OK). But I don't regret not labouring in water. At the time, I was too focussed on working with the contractions to even think of moving to the bath that hubby had run for me - eventually the midwives used it to wash their hands!
One reason I'd wanted a homebirth was because I'd had a four-hour labour last time, and knew things might be quicker. As it was, everything was 'more' this time round: an eight-hour labour, a baby nearly half as big again, a larger blood loss (getting on for 500ml). After the birth I had an uncomfortable couple of nights, with muscle damage, sore undercarriage and afterpains (using the TENS machine helped) and I took longer to recover than I'd anticipated. One piece of advice I would give is: don't let being at home mean you settle too easily into the rut of household chores unless you really feel ready! But my new daughter had a tremendous start to life, fed well and exceeded her birthweight by day four. My homebirth was a deeply satisfying experience.
I'm just a bog-standard asthmatic.
Home Birth Stories
Pain relief - what are your options at home?
The Third Stage of Labour - what are your options, and the pros and cons of each?
Overdue - what are the risks? What are your options?
Big babies and homebirth
Meconium - what does it mean if your baby passes meconium? Should you transfer to hospital?
Homebirth UK email group
Home Birth Reference Page