Matilda was born in March 2007. Rachael wrote this twelve days later.
I became pregnant in June 2006, around the time of my wedding, after many years of feeling broody. and was delighted when we conceived immediately after me stopping the combined pill.
I knew before I got pregnant that I would be planning a homebirth if I had no medical complications. I was just turned 30 and in good health, but a bit concerned that as I am on the short side,( 5'1" and my mum had a history of 3 caesareans,) that perhaps the doctors/midwives would not be very supportive. My husband and I are both nurses, and have a good idea of how the NHS works!
I saw my GP to tell him I was pregnant, then had a dating scan and then a booking in appointment at 13 weeks, when I first told the Midwife that I wanted a homebirth. She was very neutral about it, just kind of "well, we'll see" - I was a little disappointed because I had hoped she would seem keen but at least she hadn't tried to say I couldn't for some reason.
At each progressive appointment I was asked 'And where are you having the baby?' and each time I would smile and say 'Still having it at home, thanks'. I was very lucky and was very well through the pregnancy, minimal nausea, minimal weight gain but baby growing fine, just a couple of extra checks when I had a fall at 20 weeks, and a little post coital bleeding at 24 weeks - both times all was well.
At no time did I mention to a doctor that I was planning a HB; I was sure that they would try to talk me out of it. The midwives knew and there was no reason not to proceed, as I was having a textbook low-risk pregnancy. At 36 weeks I bought a mini birth pool to use for pain relief, as it seems that pethidine is not used for HBs in this area, which I had hoped to have available but also hoped not to use.
I saw the same Midwife for nearly all my antenatal appointments, which was a nice surprise.
At 37 weeks my kit was delivered. The MW had decided she didn't need to do a 'home assessment' because I had seen her for nearly all my appointments and had developed a good rapport, she felt I was 'sensible' and I reassured her that I lived in an ordinary house with running water, heating and a phone!
Wednesday (40+1)- I saw a different MW for my 40w appointment and we talked about my worries about getting induced. I was convinced I would go overdue and be pressured to accept an induction. We made an appointment for 40 +10 for a sweep and assessment, if needed.
Thursday - 'Well, the baby must have been listening' I thought, as the next morning I was woken by contractions, 15 minutes apart, very brief, maybe 20secs, and very bearable, just a bit 'ouchy' - like braxton hicks with a nip at the end. No others signs though, like a show or diarrhoea, which I was looking out for. The contractions continued until about 12pm than tailed off to just one every 30 -40 mins so I figured it was going to be a while yet but induction was looking like it wouldn't be needed, so I was happy. I pottered around the house and DH popped out to do some errands, then at 7.50pm I bent down to put something away and felt my waters break with a pop and a big warm gush - I was so shocked I laughed and waddled into the bathroom where I stood in the bath with fluid running down my legs, specks of bloody show in it, and kind of thinking, oooh what do I do now?? DH came home 5 minutes later to find me still stood there, still laughing in amazement.
An hour or so later the contractions started to get more frequent and more painful, but not painful enough for me to feel birth was anywhere near imminent, every 6 mins or so for about a minute but not regular and some were worse than others. I rang the labour ward and told them what had happened - at this point I learned that rupture of membranes, ROM, before labour is established is 'not a good thing'. I was asked to attend the unit for a CTG and check that the waters had broken, but I declined, saying I was booked for a home delivery. The MW advised it sounded like early stages of labour, so try a bath, paracetamol, and go to bed. The contractions worsened overnight; at one stage I was having five or six in a twenty minute period and very painful but I was coping well, using my birth ball and breathing techniques. Sleep was out of the question. By next morning they started to reduce in frequency again.
Friday - at 8.30am a MW phoned me to say they had been informed I rang in the night, I was again asked to attend the hospital but I again said I really want to avoid this, given I was planning a home delivery. I was informed that they would want me to be admitted for IV antibiotics and a hospital delivery if still not in established labour within 24 hours of waters breaking - I was quite worried by this and promptly did some research into the NICE guidelines, as I felt it would be a long time yet before the baby was going to make an appearance. Eventually the MW offered to send someone out to check me at home, which I gladly accepted - I was told someone would come later that morning.
3.30pm - No one had attended yet but a midwife phoned to say they didn't have any free just now, but 'IF I could find someone to attend, is there any point in us sending someone out to assess you if you are adamant you will be staying at home anyway? Would you come in if the Midwife asked you to?' I was quite cross and quite offended by this, and at this point I really felt they never had any intention of 'letting me' have a homebirth. I said well it would depend on the nature of her concern, if I agreed there was a problem I would be happy to come in - this wasn't the answer she was looking for but I wasn't going to promise to attend for ?some unspecified reason! She also said that as it was over 18 hours since my waters had broken, I should be admitted for the IV antibiotics anyway. I still declined admission and she reluctantly agreed to send someone out.
A Midwife came at 5pm. This midwife also tried to persuade me to go in for the IV antibiotics, but by now I was confident in my wishes, and had looked into the pros and cons - I said I was happy to monitor my temperature and would make contact if I leaked any discoloured fluid or felt unwell at all, but at the moment I was declining this. I was very firm that I felt my best chance of reducing the risk of infection was to stay at home. She had a listen to the baby and felt my abdomen through a mild contraction, and she felt that because they were very irregular and the intensity varied a lot, I was still in the latent stage. I agreed that if I still wasn't in established labour by the next morning, I would attend the delivery suite for a 20 min CTG, and speculum to check that waters had broken ( I knew they had broken but they didn't seem to believe me, especially as I was not leaking with the contractions) She seemed optimistic that I would likely progress that night.
Saturday - contractions around every 20 mins overnight, very painful but quite short, just often enough to ensure I had another night without sleep. I was starting to feel a bit fed up by now. Between 7am and 9 am they got more frequent but then tailed off once more, and I told my husband that I was going to attend for the check up. I felt that that I had waited as long as I could but the lack of progress was now a concern to me. I felt that if the baby was moving down as it should, I would be in established labour by now.
2pm - attended hospital, has speculum exam which confirmed ROM and clear fluid was seen - and was put on the CTG. Saw a doctor who tried hard to persuade me to have the IV antibiotics, which I continued to refuse; I was happy to have them if there was any sign of infection but not 'just in case'. I was on the verge of being allowed to leave when the monitor started to show some slight dips with the contractions. I agreed to stay on the monitor for longer and the dips continued but the baby seemed to recover very well in between and the staff were not unduly concerned at this time. However my contractions then started to increase in intensity, although they were irregular, and some were very long and painful, up to 2 minutes in length. I was quite disappointed that this was still considered latent stages as I was in a lot of pain with them by now. The monitor started to show worse dips, and the doctor advised that he wanted me to stay in for the delivery, which he proposed to speed up with syntocinon. My husband had dropped me off at the hospital earlier so we asked him to come down and I explained that I had agreed to this. He knew I was concerned simply because I would have insisted on a homebirth if it was safe to do so.
I was devastated and started to cry at this point, because I knew that I could not safely decline now - I understood what was happening and agreed that the baby would need to be delivered soon, but having an augmented labour with syntocinon had been one of my worst fears throughout the pregnancy. I asked the registrar if we could just proceed directly to a c section instead because I felt that if it wasn't progressing it was for a reason, and the baby wasn't going to come out vaginally, and also because if the baby wasn't tolerating these ineffective contractions - how on earth would it tolerate strong synto induced contractions? He said no, we must try this first, but he promised that if the baby wasn't tolerating it, he would stop the drip and take me to theatre. I reluctantly agreed. I am aware that synto can make the contractions much more painful as well as stronger, so I insisted on an epidural being sited before it was started. I popped home to collect some things and ring people, then came back to stay until baby was born. My husband was with me and he was a fantastic support. Luckily, the midwife who had done almost all my antenatal care was on duty and so she stayed with me all night; it was a huge relief to have someone I knew and I felt really supported by her - although we both knew things weren't going to plan, she was aware of my wishes and did her best to help.
An enormous-looking cannula and iv fluids were started, and the anaesthetist came to put in the epidural - I was using some gas and air for the pain while he did this. It only seemed to be working on one side so they rolled me over to try to improve things, at which point the monitor on the baby started to alarm and I heard someone ask my husband to press the emergency bell. I started to panic, as I knew this was not a good sign. They rolled me from one side to another to try to get the baby's heartbeat to recover but it was coping less and less well with the contractions by this time. I was given a VE and heard the MW say 'meconium' at which point I started to panic rather a lot. The registrar then told me I would have to have a c-section right away, there wasn't time to get the epidural working so I was having a GA. I was rushed into theatre for the GA, (it felt like being in an episode of ER) I signed the consent form, someone shaved me, and I was awake when they put the mask on my face and pressure on the front of my neck. It was 3am. Because of having a general anaesthetic, my husband couldn't stay with me, which we were both very upset about.
At 5am I started to come round and found I had a beautiful daughter, just 6lb 4.5 ounces, born at 3.16am on Mothers Day. She had been reserved a SCBU bed but didn't need it in the end as she was in good condition when she was delivered - her Apgars were 7 at 1min, and 10 at 5 mins.
I woke to hear the Midwives saying that she was hungry, she had been out for over an hour, and they wanted to give her some formula. Even in my dopey state I wasn't going to cave in now, (my birth plan stated no formula to be given without my explicit consent) and I asked/slurred 'is she hypoglycaemic?' They sounded a bit surprised and said no, so I said ' well she can wait a bit then!' Shortly after, a MW put her to my breast where she latched on really well! At last one bit of my birth plan where I got my wish.
It turned out that she had the cord around her neck and was a brow presentation - in a way I felt relieved that the c-section had been truly necessary and I am still glad that I refused some of the proposed interventions when I disagreed. I am still glad I planned the homebirth, it was just unlucky that with coming down brow first there was no way I could have given birth vaginally whether I was at home or in hospital. I am recovering very well from the c-section, and our lovely daughter Matilda Grace is doing well. She is 12 days old today, is breastfeeding like a pro and has gained 8.5 oz already.
Rachael K
First Babies and homebirth
Transferring to hospital - why it might be advised.
Get Your Baby Lined Up - what it means when your baby gets in an awkward position, and what you can do about it.
UK VBAC/HBAC (Home Birth After Caesarean/ Vaginal Birth after Caesarean}) group: http://groups.yahoo.com/group/ukvbachbac
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