Born 30 May 2003
This is the story of my planned home birth, which didn't go according to plan. I had a trouble-free pregnancy and was very fit and healthy. I had done all the suggested prenatal exercises for optimal foetal positioning (these help get the baby into the best position for birth), including using a birth ball. I'd also done daily deep relaxation exercises with visualisations of an easy and pain-free labour and I'd read everything I could find about pregnancy and birth. I felt sure that all these preparations, combined with my general health, would ensure that I had a straightforward labour and would fully understand everything that was happening to me and the baby.
I had decided I wanted a home birth about half way through my pregnancy. I wasn't keen on going into hospital, but hadn't considered alternatives until a friend mentioned that she'd had her baby at home. I began to read everything I could about the safety aspects and discovered that giving birth at home was statistically just as safe as in hospital, if not safer, provided the pregnancy was normal and there were no risk factors present. Unfortunately my GP was not supportive of home births in general and I had a bit of a battle getting the home birth booked. However, eventually it was all sorted out and I felt very relaxed and positive about the labour and birth and my ability to cope with the pain.
My due date came and went and, despite my exercises, the baby was lying in a posterior position with his back to my right side (the left side or an anterior position is preferable). Also, his head had not yet engaged, which is unusual for a first baby. Luckily he was cephalic (head down), following some exercises I'd done a few weeks previously to turn him from a breech position.
On the fifth day past my due date I was very weepy and irrational. I slept badly, but felt quite energetic the next day (Tuesday) and went for a brisk walk at 4pm. My waters broke and I had a show while I was cooking dinner that evening and contractions began at 10pm. I began using the TENS machine and found it to be quite effective, although the contractions were painful if I lay down. All the pain was in my lower abdomen, not in my back, and felt like strong crampy period pains. The contractions were regular from the start and ten minutes apart. They then increased to five minutes apart by about 3am. At this point I asked my husband to phone the midwife.
The midwife arrived at 4.30am and discovered that I was 1cm dilated, which was a bit disappointing. She also said she could still feel the membranes over the baby's head, so questioned whether they had fully ruptured. The midwife left, with instructions for us to call her again when things had progressed further. I had previously booked an antenatal appointment for 2pm that day, so I decided to go along to that and see if there had been any progress. The contractions had slowed down to ten minutes apart and had continued all day. They were painful, but I was coping well.
During the appointment, there was a new gush of waters and the midwife decided that this was the first evidence of my waters breaking. The local hospital policy was that a woman should deliver her baby within 24 hours of her waters breaking to minimise the risk of infection. If the baby isn't born within 24 hours, an induction is recommended. This meant I had until Thursday afternoon to deliver naturally and I felt certain I could still have the baby at home, even though I was still only 1cm dilated and the head had only just begun to engage (the baby was still in the right-posterior position).
The midwife decided that I should go to the hospital for some foetal heart monitoring, just to check all was well, and then go home again. I decided to bring my hospital bag just in case. It turned out to be just as well I did as I wasn't to see the outside world for another 10 days...
While I was on the foetal heart monitor the doctor noticed an occasional slowing of the baby's heart rate (decelerations), consistent with the cord being around the baby's neck. It is quite common for the cord to be around the baby's neck and this is not generally a cause for concern. However, the doctor said he couldn't be sure it was the cord so recommended that I stay in hospital to be monitored further. I wanted to know what else could be causing the decelerations, but was not given an answer.
Obviously the baby's health was my top priority, but I could not see any reason for me to be in hospital. I felt that I would be more relaxed and just as safe at home, so I told the doctor that I was leaving. This announcement didn't go down too well and my husband and I spent a long time arguing with the doctor (who openly admitted he was against home birth in general and couldn't give me any convincing reason to stay in hospital). Two midwives were also involved in the argument. They were more supportive of home birth, but were taking the doctor's side of the argument. This was very stressful and the worst part of the whole labour. As a result, my contractions slowed and became irregular.
Eventually we relented and decided to stay in hospital. I was regularly put on the foetal heart monitor for an hour at a time, which was frustrating as I was trying to keep active to encourage the baby to turn into an anterior position. This was difficult while I was attached to the monitor, but I did manage to stand up and move about a bit within the limits of the monitor's leads. We were left alone for a lot of the time and the contractions resumed a regular pattern, although they fluctuated when the medical staff were around. My husband managed to sleep most of the night, while I rocked on my birth ball and tried to hide from the doctors!
The following day I was examined again. I had dilated to 2cm and the baby's head was 3/5 engaged (not exactly fast progress). There had also been very few decelerations overnight and it was decided that I should be moved from the labour ward to the antenatal ward, which was noisy and uncomfortable. I spent a day and night in there, with practically no care or monitoring at all and still having regular contractions. I hadn't slept for three nights by this point. I was examined again on Friday morning and found to be 3cm dilated, the point at which established labour is said to have begun. This made my progress 3cm in three days. However, I was determined to remain positive and felt sure things would suddenly speed up.
Unfortunately I was not given the chance to continue naturally and I was given some prostaglandin gel to move things along a bit. I had been allowed to continue without an induction for well over 24 hours since my waters broke, perhaps because of the fuss I made on the first day. At this stage, I was in agreement with the decision to induce labour, but felt disappointed that it had become necessary. Following application of the prostaglandin gel, the contractions increased slightly in intensity and frequency and I was moved back to the labour ward.
With the shift change after lunch I got the most amazing midwife who actually read my birth plan and was fantastically supportive of all my wishes (within the confines of the doctor's plans for induction). She kept the atmosphere really calm and let my husband and I continue with our coping strategy for the contractions, which was working really well.
I had abandoned the TENS machine by this stage as it was feeling too tingly after all this time. I found that it was best to lean forward on the foot of the bed and have my husband run his hand slowly down my spine as I breathed out. We did this several times during each contraction and I felt very much in control, although I was barely able to speak during the contractions and they were coming at the rate of three every ten minutes.
After a few hours of this, it was decided that things were still happening too slowly and that I should be placed on a syntocinon (synthetic oxytocin) drip to really speed things up. I was disappointed, but believed that this was the right decision, given the length of time since my waters had broken. I was told that the drip would be increased to a very high level in a short time and, after having endured three sleepless nights, I decided it would be difficult to cope without an epidural. This was a very difficult decision as my dreams of a natural birth were shattered even further. However, in retrospect, I think the epidural was a good idea as the contractions became extremely strong and painful.
So, with the epidural and syntocinon drip in place, I was ready for little Liam to engage properly and turn around. I wasn't able to stand even though it was supposed to be a mobile epidural, so I lay on my left side (the optimum position) and hoped for the best. The syntocinon was increased every 15 minutes and I could feel the contractions coming very strongly and uncomfortably even with the epidural. The atmosphere was very calm. The lights were dim and we were just chatting with the midwife and I was dozing a bit.
After a while the doctor decided another examination would be a good idea. At this point he was contemplating a caesarian as nothing much seemed to have happened. However, when the midwife examined me she was amazed. She excitedly told us that I was fully dilated and the baby had turned into the correct position. This was the highlight of the whole labour and really lifted our spirits.
It was decided that we would allow the contractions to move the baby down the birth canal as I had no urge to push (due to the epidural). I was given an hour for this to take place. The heart rate was continually monitored during this time and after a while the midwife became concerned that the baby was becoming distressed again (more decelerations). It was quite incredible to listen to the monitor as the heart rate slowed to a stop every time there was a contraction. This is apparently normal, but was very disconcerting to hear.
The doctor was called again and made a snap decision that the baby had to come out there and then by ventouse delivery. The room went from being completely calm to having the lights blazing and people everywhere. I was put in stirrups and told to PUSH. "Get angry with the pain" they shouted (something I was not prepared to do, so I just remained as calm as possible and pushed with all my might).
Liam was born within about five minutes (72 hours after my contractions first started) and put on my chest for just a few seconds. I was completely bewildered as everything had suddenly happened so fast. The cord had been around Liam's neck at birth, so it had probably been this that had caused the decelerations all along. The paediatrician then whisked Liam away and examined him while my husband watched. I had sustained a small second degree tear so was being stitched. I felt very left out, especially when I heard the paediatrician quietly tell my husband that there was a 'difficulty'. I was straining to hear what she said, but couldn't. It turned out that Liam had coughed a bit after delivery, which could be a sign of infection, but I was imagining all sorts of other terrible possibilities.
I was allowed to breast feed Liam for a few minutes before he was whisked off again to be given antibiotics as a precaution against infection. I was given some too. Eventually he was brought back and I could finally hold him properly for a few hours.
We were transferred to the Transitional Care ward, which is for babies who need special care, but who are not sick enough for intensive care. We spent the next week in there being monitored and with Liam being poked and prodded from every angle. It was terrible. Liam was being given antibiotics via a hand cannula every 12 hours.
I felt fine and was recovering really well. I also think Liam was fine, but was being messed about with so much that he began to have trouble breastfeeding, after initially feeding beautifully (there is anecdotal evidence that antibiotics can cause this problem). His blood glucose then began to drop and, despite my best efforts to express gallons of colostrum, was told that he had to be supplemented with formula for one day. I made sure he wasn't given anything by bottle, as this can affect a baby's ability to breastfeed. Luckily my milk came in the next day and I expressed enough for all Liam's feeds, which were largely by nose tube.
On the third day, the doctors decided that they needed to test for meningitis and took Liam to intensive care for a lumbar puncture. This was the most horrendous day. I cried all day and sat with Liam amongst all these other tiny sick babies. Luckily he was allowed back into Transitional Care later that day. A few days later when all the results of numerous blood tests and the lumbar puncture came back it turned out that nothing had ever been wrong. This was a huge relief, but it was hard to accept everything the doctors had put Liam through in the meantime.
Anyway, by the following Saturday (eight days after Liam was born), we were pronounced fit and well and allowed home. Liam has since gone from strength to strength and is feeding so much that I can almost see him growing before my eyes. He is absolutely gorgeous and we are very proud parents!
Three weeks on, I still feel very disappointed that the birth was so different from what I'd hoped for and expected. In retrospect, I feel that the intervention I had was necessary, not because there was a problem, but because it was important to avoid one. Had I left the hospital that first evening, I would have had to go back for an induction anyway, which makes it easier to accept my decision to stay. However, given that nothing was ever wrong with Liam or me, I can't help wondering whether I could have done it on my own at home (although this would have been very risky).
Lastly, I hope my experience hasn't put anyone off planning a home birth (or giving birth at all) as I was ready to do it all again immediately after he was born - seriously!
Note from Angela: I have a friend whose baby had a similar experience to Liam's. After a hospital induction, the baby breastfed beautifully immediately after birth. He had a short episode of slightly fast breathing after a few hours, and a paediatrician was worried that this could be an early sign of infection - eg Group B Strep. Blood samples were taken and he was put on antibiotics 'just in case'. He had a bad reaction to the antibiotics and became ill and very sleepy. He would not breastfeed again - he was too sleepy and showed no desire to suck. Midwives tried to 'help' by forcing the baby's head onto the breast. He then became scared of breastfeeding, and despite his mother's efforts over the next eight weeks, he never breastfed again. Fortunately his mother was able to express milk for him, for several months, but this episode still made his first few days a time of worry, upset and hard work, when they should have been a time of bonding and celebration. When the blood results came back, they showed no sign of infection - but by then, the damage had been done.
If a mother is not able to establsh breastfeeding, or to express milk, as a result of medication and disruption in the neonatal period, then the baby's health will inevitably be compromised. Missing out on breastmilk has repercussions over the child's whole life - eg increasing an adult's risk of heart disease, and increasing a female baby's risk of breast cancer (as well as increasing the mother's risk of breast cancer). Neonoatal infections can be very dangerous, so I can understand why the paediatrician wanted to be careful, but having heard a number of stories like this, one has to ask whether the physician's first directive - 'First, do no harm' - is being respected in these cases. No easy answers, but I'd hate to be a paediatrician and have to give advice on this!
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