Lachlan's Birth, by Angela Horn

Lachlan, a few hours old

Lachlan Christopher McKenzie Horn arrived at 6AM on Tuesday 7th September 2004, at home, at 39 weeks + 4 days gestation, weighing 3.3 Kg (7lb 5oz).

This was my fifth pregnancy, and my fourth baby. Lee was born in 1998, and Bobby in 2000. I miscarried a baby at 12 weeks in January 2002, and then Teàrlach made me feel much better when he arrived in December 2002. This fifth one had been a remarkably good pregnancy, which I did not expect after a couple of 'mother's complaints' made the end of my last pregnancy quite tough. I had none of the trouble with my pelvic joints which had made me so uncomfortable before (see the UK midwifery archives on symphysis pubis dysfunction), and although I had varicose veins in my left leg, they did not get any worse in the last couple of months. They looked horrible, but hey, it was fun seeing the horrified looks on the faces of teenage girls at the swimming pool! I felt full of energy, and couldn't believe how lucky I was. Just as well as I had three boys to look after and we were moving home...

Having had three home waterbirths already, I was, of course, planning the same again. There was a slight complication when I found out that a routine swab taken just before I got pregnant had been positive for Group B Streptococcus (GBS). This is a bacteria which up to 30% of women carry, usually with no symptoms and no problems, but very occasionally it can cause a serious infection in the newborn baby. Standard policy in most hospitals is that women who carry GBS have a hospital birth with intravenous antibiotics during labour. After researching the subject thoroughly, I felt that, for me personally, the risks of this approach would outweigh the benefits unless my situation changed, eg I went into premature labour. See 'GBS and Home Birth' for more info.

I wrote to my midwife team explaining the reasons for my decision, and they agreed to support me in my home birth plans. I was booked with the same NHS team which had cared for me in all my previous pregnancies, and although there were only two midwives left on the team who I already knew, one of those was the team leader, who I really liked and respected. All the other members of the team who I met seemed great too - so it was a real shame that none of them were available when I went into labour!

I had a repeat swab taken at 36 weeks which was negative for GBS, so in the event I did not have to give the matter any more thought. However, because it is common to get false negative results from GBS tests - ie the test reads negative but the bacteria is still present - many obstetricians prefer to treat you as positive for GBS if you have ever had a positive test result, no matter what your most recent test said.

Lachlan arrived later than I'd thought he would. I'd had several false starts the week before, when I'd had mild contractions every 5 minutes for a couple of hours in the morning while in bed, but when I got up, they spaced out and then stopped. I'd been having contractions about every 10 minutes through most of Monday, which were moderately strong - about the sort I have previously had at the start of established labour, but would expect to be having them every 5 mins.

We had the builders in, and there were usually up to 6 people working outside or in the house in the day. They were all apparently terrified that I would go into labour while they were there - not sure what they thought they would have to do!

I thought that I would probably not get into established labour until the night when all the blokes had gone home and the children were in bed. Sure enough, after about midnight they stepped up a bit and were coming every 8-ish minutes.

Still a bit strange as my three previous labours have always had a clear start and middle and end, starting with contractions every 5 mins and then stepping up to 1 every 2 minutes towards the end. In this labour they were only 1 in 5 minutes for most of it, even right towards the end. There was a period when they were 1 every 3--4 mins but only about 30 seconds long - that would have been from about 1 AM to 3 AM. Then they went down to about every 5 mins again, and I was having some nice dozes in between them.

I called for a midwife at about 12 midnight or 1AM but the hospital had been overrun with labouring women and had 6 midwives off sick. The maternity ward had been turning people away in the day because of the staffing problems, and nobody from my community midwife team was available.

I was sent a bank midwife who, whilst being happy to remain hands-off, clearly was exhausted and had little enthusiasm for her job. She was very experienced and had recently resigned from her regular, quite senior, midwifery job, and I think wanted out altogether. On the positive side, she was happy to just do whatever I asked her and not to interfere, but on the negative side, it was the first time I'd laboured with a midwife who just didn't seem to have any interest in, or enthusiasm for, the job, or indeed for my baby's birth.

The midwife read through my birthplan and kept asking things like "But you'd be OK about it if I had to dial 999 if I needed to call an ambulance?" Duh - of course I would..... and "What about transferring in?" "Well, you can just talk to me if you think it's necessary, and we'll discuss it..." and "What if you have a PPH, because you're higher-risk now it's your fourth" I started to go into why I didn't think I was and that actually latest research suggested not at all higher-risk, and was about to go through to my study and get out my research file to show her, but thought sod it - this wasn't the time for an argument, so I just said "Surely that's exactly the sort of thing that we can discuss *if* it becomes an issue, not now". It was no big deal, but I did feel taken aback at all this discussion of problems - almost as if she expected there to be a transfer. I don't think that she did expect that, but I could imagine that the discussion might sap your confidence, especially if you'd never given birth at home before.

I was also a bit sad that I'd previously always had midwives who seemed excited about the birth, and this poor woman just seemed shattered and dispirited. Perhaps that was the downside to liking my community midwives so much - I knew that I could give birth on my own, with no moral support, regardless of who was attending, but I was disappointed that the midwives I knew and liked were not there.

I woke Graham up earlier than I otherwise would have, just to have someone about me who seemed a bit positive. Unfortunately he was going down with a rotten cold, so he just sat cradling his head for a while!

Used the birth pool, as in all my previous labours. Unfortunately the boiler was not working and the immersion heater couldn't provide enough water, so for a while I was in a lukewarm pool while Graham boiled kettles to top it up. I was surprised to find that, although the water was colder than I wanted, and shallow, I still wanted to be in there. Maybe it was just habit as I'd had three water labours and births already.

Asked midwife to examine me as I was a bit confused about progress of labour - contractions seeming quite effective but so spaced out. She said my cervix was so stretchy it could be anything, and she would need to examine me during a contraction to really tell. I didn't like the sound of that, so asked her to stop the exam on the grounds that it could get uncomfortable and I was clearly in established labour.

Later asked her to check again as I was getting bored and, whilst I appreciated the fact that it wasn't the hard work, rollercoaster that I'd expected, I wanted my baby, my cup of tea and my bed! She said I was about 8cm - I think at about 5AM. I was still only having ctx every 5 mins and, while they hurt, they were manageable and I think not quite as strong as those I'd had in previous labours at about that stage. I kept feeling my own cervix and it was nice to feel the baby's head, and feel the progress, although I found I was completely unable to judge dilation myself.

I wanted to move things along as I didn't want to still be in labour when all the builders arrived for work at 8AM, but on the other hand didn't want to step up the pain! I asked to try the Entonox, which I've never used before, but the midwife couldn't get it to work as she had the wrong sort of valve or something, so it was a good job I wasn't relying on it. I have heard so many stories of Entonox running out or not working at home births that I would advise anyone who really wants it to ask the midwives to double-check it as soon as they arrive!

Anyway, stepped in and out of the birth pool a bit, did a quick squat and then jumped into the pool to deal with the resulting contraction. Did this a few times. Then found that, although I didn't feel fully dilated, it made the contractions easier if I sort of pushed a bit with them. Didn't want to discuss this with midwife, but thought that, as she'd said my cervix was very stretchy, maybe I could stretch it by doing this.

I was still only getting contractions every 5 mins or so, but as I was 8cms I knew it couldn't be too much longer. I warned the midwife that the second stage was likely to be very fast when it happened, but she didn't call for a backup. After the birth I asked her why - she said there was no point as she knew there wouldn't be another midwife available.

I wondered when the really hard work was going to start - the stage I'd had in my previous labours when contractions came every two minutes and lasted nearly a minute each, when my hips really hurt, and I felt like I was riding out a storm. I was worried that the labour was dragging on, but I still had an hour or two of that tough stage to go through. It never came. I did have some tough contractions, and I did get the pain in my hips, but there weren't many of these contractions and the pain was never quite as intense as it had been before.

At one point I was moaning and rocking my hips, the same way I had in all my previous labours, when I suddenly thought - hang on - it's actually not that bad! I don't actually need to be making this much noise!

It's strange that this was my easiest labour, when it was the one I'd prepared for least. Maybe that's no coincidence, or maybe it's just because it was my fourth! We had moved house 6 weeks before, and despite promising myself that this time I would do a Hypnobirthing course, I'd not done any such thing. In previous pregnancies I'd done yoga, but not this time. I'd hardly looked at my childbirth books. The birth pool was cold, and I hadn't managed to sort out any music. In my other labours, it had been very important to me to have music playing - I focussed on the songs rather than on the labour, and for each labour there were specific tracks I *had* to have. I just didn't get round to it this time, and Graham was looking so awful that I felt I couldn't ask him to do anything else - he was busy boiling kettles, anyway. But I did have music in my head - I don't know what it was, and it wasn't a track I was familiar with, but I do remember that a song was in my head throughout the labour.

One thing I did this time - feeling a bit panicky that I hadn't done the hypnobirthing, or much preparation at all, I had skim-read a book on hypnobirthing techniques a few weeks earlier. Only got through a few pages, but there were some interesting ideas for creative visualisation which inspired me. The image I came up with was a golden bubble which was expanding inside my cervix, pushing it open. When I felt pain during a contraction, I thought of capturing that pain and pushing it inside the golden bubble, making it work to open my cervix - turning the negative pain into a positive force.

After a while I felt a slight pressure in my rear which told me baby was starting to move down, so I pushed a bit, and then I felt it happen. My waters broke and I knew the rollercoaster second stage was starting. This one was even shorter than the last two times - 3 minutes! Couple of good pushes to bring baby down, which I didn't have much control over, then I held off with all my might (aaaarrrgh - that ring of fire!) while he was crowning, to protect my perineum, then pushed him out. As with my other three, I was kneeling upright in the pool, and caught the baby myself, with the midwife and my husband just watching. Another boy, looking beautiful and healthy, who demonstrated his healthy lungs straight away!

Third stage was straightforward and physiological. Had a gush of blood a few mins after baby, but couldn't push placenta out yet. Tried again about 10 mins after the birth and it came out easily. I did bleed a little bit afterwards, but nothing worrying. More than my last two births but not as much as first. Midwife estimated 300mls which was probably about right - I did feel a bit breathless the next day and took some Floradix iron supplement, and felt great the day after that.

Baby had hardly any moulding on his head and was not at all squashed-looking, just gorgeous, and very, very calm. His three big brothers all love holding him and stroking him, although 20-month-old Teàrlach also wants to poke and prod a bit!

At 7lb 5oz, Lachlan was a titch compared to his big brothers, Lee (9lb 6oz), Bobby (8lb), and Teàrlach (8lb 9oz). His length and head circumference were all in proportion, and he clearly was not malnourished. He took to breastfeeding beautifully and had not only regained his birthweight at a week old, but had gained a few extra ounces as well. He is three weeks old at the time of writing and is remarkably calm.

Lachlan

Lachlan a few hours after birth.

So, all in all, a bit of a funny labour. I would describe it as gentle - the contractions were effective, but it was like there was no great urgency about it. My body was labouring very efficiently, and with no drama. To her credit, the midwife did not seem to be at all bothered about this. I was a little bit concerned in case it meant the baby's head was in an awkward position, but apparently all was fine. I did enjoy those rest periods between contractions, but was a little bit worried about slow progress. Evidently I had nothing to worry about! Overall it seems that the labour took about the same time as my previous ones, but involved about half the work.

Bobby and Lachlan

Bobby holding Lachlan

 

Tearlach and Lachlan

Teàrlach and Lachlan

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