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Amelie's homebirth, by Michelle

Our First Baby - Born at Home in a Birthing Pool

michelle and amelie

Weight - 2.7 Kgs (5.9 Lbs)

Mum - Michelle (age 34)

Dad - James (age 34)

Michelle tells a lovely story of a first labour and home waterbirth. She wrote this story just four days after Amelie's birth, and she was very generous towards her midwives. However, my overriding impression is that of a very strong and good-natured woman who managed to have a good homebirth despite the midwives, rather than with their help. She was told to leave the birthpool because of arbitrary guidelines about temperature which were not evidence-based, then endured two hours of backache as a result. She was threatened with having an ambulance called to take her to hospital, even though her labour was progressing well and both she and the baby were well. Even with all of this hassle, Michelle still did it on her own - she had prepared well, and she had a great birth. What an achievement!

This is going to be a long story - so I hope you are all prepared. I loved reading birth stories when I was pregnant - especially the home birth stories and water births. I read so many inspiring and beautiful ones about water birth I hardly dared dream that I might be able to have one myself.

I had thought about a home birth very early on in my pregnancy after reading Shiela Kitzinger's book "The New Experience of Childbirth". The amount of reading and research I did was mind-boggling. Amazingly, this desire to know everything, came from a very long held, deep fear of childbirth. I came across the website for Beautiful Birth (www.gentlewater.co.uk) soon into this research and started to plan a home water birth shortly after my booking in appointment with my community midwife. Despite initial concerns, James was easily persuaded that if my pregnancy went smoothly then a home water birth might be a good option.

I found that the more I knew, the more confident I became and the less I worried about it all. You would have thought that my fear of childbirth would have meant me choosing a hospital birth and an epidural, but the more I found out the more I thought this might not be for me. On the internet I found research and statistics that showed that epidurals often lead to assisted deliveries (i.e. with forceps or ventouse) because the mother does not know when to push and cannot push as effectively as when she can feel the strong contractions of a natural birth. In my mind nobody was fooling me by telling me that the baby would be gently guided out by forceps or ventouse. I had seen Desperate Midwives on BBC3 and seen the doctors using brute force to get these little mites out. I even wrote on my birth plan that if I ended up in this situation I would much rather have a caesarean than have my poor baby's head squashed and bruised.

I am writing this story as Amelie is not quite 4 days old and I feel like the luckiest person in the world not only because I have the most beautiful daughter and perfect husband but also because Amelie's birth was a dream come true.

Amelie's due date was not until the 22 October - but she arrived 11 days early. This was another secret hope of mine. My mum gave birth to me and my brother both about two weeks early and James's mum gave birth to two of her children a couple of weeks or so early too so I was hoping it might indicate that I wouldn't have to wait around too long for Amelie to arrive.

The birthing pool arrived, as planned, on Friday afternoon (about 2 weeks before my due date). James and I set it up on Saturday afternoon - straight after the midwife did her last visit to say that Amelie was in a good position - head down and back facing outwards slightly to my left. Her head was engaged (by about 1/5th). We were all set from then on - the midwife told us to get busy with using the "natural prostaglandin". We both knew what that meant, so Sunday morning we got busy!

On Monday morning I researched "DIY Induction" on the internet and decided to a) eat pineapple b) to go for a long walk and c) book lots of hairdressers and massages for the forthcoming week - on the basis that if I did that then sod's law would prevail and I would have to cancel them all!!

My long walk around Richmond Park on Monday afternoon was very peaceful - most of my walks on my own would be round the shops so this one was a novelty for me.

Tuesday morning at 5.15am, fast asleep in bed, I felt a gentle popping sensation and a trickle of water. I said to James "I think my waters have broken" then I jumped out of bed - somehow managing not to drench the mattress and making it to the bathroom in time for the trickle to turn into a bit more of a steady flow.

Still not quite believing it was happening, I went back to bed but with towels underneath me. By 7.00am we were up and started to fill the pool with water. I rang my mum and James's mum at 8.00am - both of whom immediately caught trains that morning. I rang the midwife at 8.30am too.

The Braxton Hicks contractions that I had had more and more in the previous few days started again after my waters broke and then turned into mild crampy period-like pains. I sent James off to work and said I'd call if things changed - knowing he could be back in half an hour if need be. (If I'd have known how quickly "things change" I probably would have kept him at home. We are first time parents remember though, so I was setting myself up for a long day and night ahead).

By the time the midwife arrived to check my blood pressure again at about 10.30am the pains were still "no big deal". The midwife left after making a provisional booking for me in at the hospital for an induction 3 days later (in case I had not delivered naturally by then.)

Things really started to kick off from the point that my mum and James's mum arrived at the flat at about 2pm. The next hour was spent with me arguing with my mum as to when the appropriate time was to call the midwife. She was timing the contractions and wanted to hold off calling her too soon. I was keen to get her on her way - also knowing that the community midwives might like to be kept up to date with how things are progressing at least.

We eventually called the midwife at around 3pm. By that time the contractions had sped up so much that I was having difficulty having a telephone conversation with anyone who asked too many questions!

I was pretty keen to get into the pool just for some relief. I had used the TENS machine until then. The water in the pool was quite cool which was good because I had started to strip off by then as I was so hot. I lost all sense of modesty (i.e. James's mum was around and so were a load of builders outside our flat - but I don't remember even thinking about closing the blinds!) James had left for work after having filled the pool with water but he had told me not to switch the heater on until he got home. I was happy not to as I hadn't read the instructions as much as he had.

I got in the pool and from that point on I think I turned into a screaming banshee. I think the water - whilst it was a great relief to get in a bob around in there - brought the contractions on - a very good thing if you don't want a long labour. They seemed to be much stronger and closer together when I was in the pool.

James came home around 3pm to find me making an awful lot of noise in the pool. He is convinced I have a high pain threshold (based on the fact that I am so clumsy and I'm forever injuring myself and bumping into things - I am a not-very-good snowboarder who does some spectacular falls on the slopes). So he was quite scared to hear the amount of noise I was making. He had thought I might be quiet when giving birth!

James started to panic that the midwife hadn't arrived and was calling her to find out where she was. Unfortunately she was stuck in traffic and a little bit lost - but actually only just around the corner. She asked James where I was now - he told her I was in the pool. She said I had to get out of the pool until a medical person arrived. I did so and stuck the TENS machine back on and went and sat on the loo.

Note from Angela: The midwife's attitude here was ridiculous. If Michelle had been in the bath, nobody would expect her to get out until the midwife arrived! Many women labour in baths or birthpools without any midwife or doctor in attendance. It *is* important that the water is not too hot, as high temperatures can cause foetal distress - but this goes for any bath in pregnancy, and is why pregnant women are advised not to use hot tubs. Wouldn't it have been more respectful of Michelle and James if the midwife had simply asked James to check that the water was a comfortable temperature, and then got herself round ASAP? And if the midwife was afraid that the baby would be born in the water without her in attendance - well, Michelle or James would just have picked their baby up, of course! Bah humbug.

Back to Michelle:

I was half in between sitting on the loo and kneeling over the bed in the room next door - shouting at my mum to get more towels "NOOOOO - NOT THE NEW ONES!!!" (I was dripping blood on our cream carpets). My poor mum - it was she, not James in the end that had to suffer my personality change whilst in labour and bore the brunt of my temper!

James in the meantime, in a bid to get the midwife here asap, had ran around the corner to find her. He spotted her stuck in traffic and directed her to our flat - whilst running along side her car - which she had to weave in between oncoming cars in a rush to get here with that all important gas and air. Apparently she had misheard and thought I was delivering baby no 3 - not baby no 1 - and so didn't appreciate, until she arrived, that James was panicking unnecessarily.

She arrived about 4.30pm, examined me quickly, calmly and efficiently then said "Do you want to know the good news?" I said go on then..

"You are fully dilated!"

I can't remember but I think I gave her a massive hug!

Whilst I was really keen to get back into the pool the midwife would not let me until the water was heated to 37 degrees. I really wish we had filled it and turned it on over the weekend like we had originally planned! The next 2 hours was spent James, my mum and his mum constantly boiling pans and kettles of hot water to get the temperature right.

Note from Angela:

Oh, for crying out loud! This midwife sounds like a real fusspot. Perhaps a nice fusspot, but still, this unnecessary flapping can't have made things easier for Michelle. Many women would find water at 37 degrees uncomfortably hot to labour in during the first stage, although often people do like warmer water in second stage. The second stage for a first-time mother is often around an hour or more, so it's hard to see why Michelle could not have remained in the pool if she was happy with the temperature. Michelle comments below that she had horrible backache for the two hours that she was out of the pool; if her midwives had been more confident with waterbirth, that would not have been necessary.

It is usually preferred that the water is around body temperature when the baby is born, so that the baby does not either a) get cold, or b) in significantly colder water, the shock of the temperature change might *theoretically* cause it to breathe before it was brought to the surface, although I am not aware of any case where this is known to have actually happened, and there have been cases of babies born in the sea without ill-effect!

If the water temperature is too cold when the baby is born, you can just get out of the water quickly, rather than hanging around in there. Many women prefer to leave the pool fairly soon after the birth, although others like to stay there for the third stage. There may be an increased risk of delayed third stage, and of the baby becoming jaundiced, if you stay in the pool for third stage, but many women do so with no apparent problems. See Waterbirth at home for more discussions.

Back to Michelle:

Meanwhile I used the gas and air for a short while in the bedroom with the midwife encouraging me and trying to make me believe that the feeling I was having of wanting to do a big poo was in actual fact what I should be feeling and was the baby's head descending. It took me a while to get my head around that - I really didn't believe that that's where I would feel anything.

Apparently I only used about one third of a canister of gas and air as I did get to the pushing stage very quickly after the midwife arrived and I was encouraged not to use it for the pushing stage.

At about 5pm two more midwives turned up. The first one stayed for the delivery too so I actually got spoilt with 3 midwives - you don't often get that service at hospital do you?!

By about 6.30pm the water was getting warm enough so the midwives were then happy for me to get back into the pool. It was now about 36.5 degrees and James carried on filling it with more hot water whilst I was in it to get it to 37 degrees (body temperature).

The relief from the horrible back ache I had developed whilst on all fours over the bed was amazing. I absolutely loved being in the pool. The warmer water felt the right comforting temperature at that time too.

All the while I had been in the bedroom - in the pushing stage of labour - I had still had this fear of pushing too hard. I had, at this point, been pushing for about an hour. My fear of a really bad tear was still there. The water definitely gave me the confidence to push harder and for much longer (I believe that the water lubricates and softens the perineum).

After another 15 minutes or so of pushing in the water the midwives tried a new tactic that worked for me. They told me that if I didn't get the baby out within the next 10 minutes they would have to call an ambulance and take me to hospital. I wasn't tired at all - it was only 6.30pm the evening after all - its not like I had been awake all night in labour. Although I knew deep down they didn't really mean it, I also couldn't picture me walking anywhere when I had a baby's head between my legs. I had had a little feel with my finger - only about 2 cms in I could feel a soft spongy area about the size of a 50p piece inside which was her head. Got James to have a feel too - AMAZING!

Note from Angela: Michelle is very forgiving about this 'tactic' from her midwives, but many people would have called it "outrageous" and an abuse of the midwives' position. Having made her second stage much harder than it needed to be by insisting she stay out of the water until the temperature reached an arbitrary lower limit, they then tried to insist that she labour to arbitrary time limits even though she and the baby were both fine. If they had called an ambulance, Michelle would have been under no obligation to transfer to hospital - but can you imagine how difficult it would have been to argue that point, while in the late second stage of labour? And maybe the midwife thought it was just a little incentive to help Michelle to push, but it is possible it could have caused her to panic or become very upset. Surely she could have thought of a better way of 'supporting' a first-time mother who was clearly doing such a great job.

So I gave it my all - I thought sod it, it hurts anyway, its not going to go away, I shall just have to get on with it. So I pushed with all my might and within another 10 minutes and two contractions she was out!

Amelie was born into the water. I had the urge to touch her and bring her to the surface myself but I didn't want to stimulate her so I left this to the midwife who caught her and brought her up to my arms.

Note from Angela: It is thought to be safer in a waterbirth not to stimulate the baby unecessarily underwater, in case it prompts the baby to breathe. However, it's hard to see why a midwife reaching in and picking the baby up should be any less stimulating than the mother, who knows exactly where her baby is, doing it. It's not exactly hard to just reach down and pick your baby up. I have never heard of a mother being told not to bring her own baby to the surface before. What a shame that Michelle was not supported in following her instincts.

She was so calm when she came up that we weren't actually sure if she was breathing or not for the first few seconds. She was though and I blew on her forehead to make sure she was breathing. James then cut the cord and after a few minutes of me holding her I passed her to James who held her skin-to-skin. He had the most enormous smile I have ever seen on his face. I fully expected that I would be crying my eyes out at this point (given that every birth I have seen on TV I always well up at the point that the baby is delivered). Funnily enough I didn't cry though - I can only imagine that all the endorphins and adrenalin rushing through my body at that point held any tears of emotion at bay.

The second she was out I said "Was that it then?!" Everyone laughed so much after all the noise I was making. Apparently I was shouting up the hall way to my mum who was on the phone to one of my best friends "Tell her not to worry - it isn't that bad!"

I must admit the pain was out of this world but for me it seemed to be all over so quickly. That old cliché definitely applies - I did forget all the pain the minute I held my brand-spanking-new baby daughter in my arms and the pain is so NOT important compared to that.

That stinging sensation was there the whole time from crowning through the two contractions. It was pretty bad but I knew vaguely what it would feel like. I had prepared for this bit too! Not many people seem to have heard of it but there is a little gadget you can buy called an Epi-No. It is a birth trainer and pelvic floor muscle exerciser. It is a small balloon which is pumped up slowly and gently as you train with the device in the 3 weeks up to your due date. The development of the Epi-No originates from Africa where they gently insert a calabash / gourd into the entrance to the vagina to stretch the perineum to facilitate a natural birth and reduce the risk of perineal injury. I won't go into it here but if you want to know more about it their website is www.epi-no.com.

As it turned out I didn't get to use the device that much before the birth (only for one week or so as Amelie was 11 days early). It gave me an idea of what to expect re the stinging sensation with the crowning. I managed to use the device enough that week to get to 6 cm diameter - the ideal is 10 cm.

I intend to use it as a pelvic floor muscle exerciser though after the birth too. The good news is that my perineum is intact and I got off very lightly with a minor graze and a couple of stitches. So my little plan seems to have worked!

I got out of the pool shortly after (it was a bit murky at this point so I didn't encourage James to get in with me). Lying next to the pool and propped up by the sideboard and cushions, I attempted the first breastfeed - I say attempted because it didn't last very long - I really didn't have a clue what I was doing, especially as I lay in that awkward position on our hard wooden floor. Having practiced this in the NCT breastfeeding class I had been able to sit upright on my bottom without wincing!

The placenta was delivered about half an hour later with a gentle tug (no injection) - all very straight forward and easy.

Amelie, just like most babies born into water in a calm environment, scored highly on her APGAR tests - 8/10 at 1 minute and 9/10 at 2 minutes.

I still can't quite believe I got what I wanted. Whilst I was pregnant whenever people asked which hospital I was going to I would tentatively say that I was hoping to have a home water birth. James would say - "We are having a home water birth" and I would always correct him and say "We were hoping for one - but we quite expected to end up going to hospital." I really didn't want to get my hopes up and jinx anything and I always wanted to keep an open mind.

We had such a great time at home - at least I did as much as anyone can do when having a baby. But my mum, James, his mum and the 3 midwives all had such a laugh. Amelie was born into a house full of laughter and joy. Everyone had champagne (someone forgot to give me one!!) I had a cup of tea instead.

Michelle

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