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Jamie's birth story, by Suzanne Williams

The birth story of Jamie Jules Packer - born at home at 00:41 hrs 19th July 2003 weighing in at 6lb 9 1/2 oz (2.990kg) and around 50cm long.

Jamie is our 2nd child. I gave birth to his sister Kira in May 2002 at home, as planned, after a normal and uneventful pregnancy. The labour itself was very quick for a first labour but not perfectly straightforward, although it was a positive and empowering experience.

After having such a wonderful experience giving birth at home with Kira there was no question of where our 2nd child would be born. Once the initial round of blood tests, scans etc..were over I declined any further blood tests and just got on with being pregnant. I had all my antenatal appointments with same community mw that I'd had when pregnant with my daughter and she wasn't at all fazed by the fact that I declined certain blood tests and the glucose tolerance test which is usually routine in my area (despite NICE guidelines saying that GTT should not be done routinely!).

Towards the end of my pregnancy my mw informed me that it was policy for mothers who had had previous small babies to be offered a sizing scan and an appointment with an obstetrician, but she wasn't at all bothered when I declined the offer. She agreed with me that the scan wouldn't be able to tell me much since they are so inaccurate in late pregnancy and since nothing the obstetrician could say would change my mind about having a homebirth it was pointless seeing one. Both of us thought that this baby would be small, but that he would be a bit bigger than Kira (she'd been 5lb 8oz and we guessed that Jamie would be around 6lbs)

Apart from a small scare at 25 weeks, when I had a stomach bug and went to the maternity unit just to check that I wasn't in premature labour, I had another straightforward pregnancy.

With Kira I had worked up until I was 37 weeks pregnant and then had her on my first day of maternity leave. This time I finished work at 36+5 weeks pregnant and was hoping to have a week or two at home spending time with Kira before the baby arrived, although I was on "red alert" for signs that something was happening from around 36 weeks given my past history! (as were my work collegues!)

Friday 18th July - 37+5 weeks pregnant.

Our 14-month-old daughter Kira had been ill with sky-high temperatures for 3 days and my partner Vinne was working a night shift that night. I had jokingly said to someone that day that I was keeping my legs closed as it wasn't the right time to go into labour. There had been no signs of baby wanting to make an appearance soon until :-

20:30 - I was sitting down just about to watch Big Brother when I felt my waters starting to go. So although it was 8 hours last time between waters going and labour starting, I thought I had better warn people in case it was quicker this time. I phoned Vinnie at work - he wasn't sure how quickly he could get away as he had to arrange cover, but said he would be home as soon as he could. I phoned my friend Georgina who was going to be there to look after Kira and support me and Vinnie - she immediately dropped everything, including her 9 month old baby, into her husband's lap and got a taxi to our house - she knew Kira was not well and that it could be a while before Vinnie came home. I phoned the hospital to ask them to contact the community midwife on call so I could warn her things might start happening.

20.50 - Midwife turns up on the doorstep - she only lives around the corner so didn't bother phoning first. She was one of the community midwives from my team but I had never met her before. She confirmed that it was my waters and decided to stay to see if labour would start. Georgina arrived very soon after the midwife and Vinnie arrived not long after that. We spent the next hour or so getting everything set up.

It was at this point that I started to get the feeling that I wasn't totally happy with the midwife's general attitude. I hadn't got around to printing off my birth plan so we sat down and discussed what I wanted. When I mentioned that we were not going to have a plastic clamp put on the baby's cord, but that we were going to use sterile umbilical tape she immediately said she had never heard of it and that she wouldn't know how to do it! I did tell her that I had discussed it with my named midwife and that it was perfectly ok - my midwife actually carries some of the tape in her bag!

Apart from that there was nothing really I could put my finger on but talking it over afterwards with Georgina and Vinnie they both said they had misgivings about her attitude from the moment they met her too. Apparently she didn't even acknowledge Vinnie when he came home (I had been too busy pottering around getting things ready to notice this at the time).

The midwife kept asking me if I was having any contractions, but all I could feel was a bit of pressure very low down in my pelvis, so I continued to potter around the house and using the computer to let various groups know that things had started.

21:30 - First mild contractions started and I was still wandering around the house trying to get things organised. Well actually just giving the orders and telling Vinnie and Georgina where everything was, they were doing all the work!

22:15 - contractions getting painful so the midwife suggests a VE to see how things were progressing. She said my cervix was very soft (floppy in fact!) and that she could feel the baby's head on my cervix, but there was no dilation.

Around 22.30 I suddenly realise that I hadn't phoned my parents, and my mother had had ideas of actually travelling the 200 odd miles to be with me for this birth. I had warned her that I didn't think she would make it (I'd had a 5 hour labour from 1st contraction to birth with my first baby so the chances were that this one would be even quicker) and at this point I knew she wouldn't make it. It turned out that my parents were out and I couldn't get through on their mobile phones, so I just had to leave a message on their answerphone. I then rang my brother to let him know what was happening. By this time the contractions were coming every 5 minutes and I just managed to speak to my brother long enough to explain the situation before a contraction hit me and I had to end the call to deal with the contraction.

The next hour and a half is rather a blur to me - the contractions were coming thick and fast and the vomiting started, but it didn't seem to last as long as it did in my previous labour. I tried various positions, sitting on the birth ball, kneeling over the birth ball, kneeling upright but my favourite position was kneeling in front of the sofa with my head buried in the sofa or Vinnie's lap. At some point during this time I decided I needed to use the toilet and made my way upstairs with Vinnie's help - having a couple of contractions on the stairs and a few while I was in the bathroom. During my last labour I had spent quite a bit of time sitting on the toilet, but this time it didn't feel right, so back downstairs we went.

I had warned the midwife and Georgina that at some point (probably at transition) I would start to talk about c-sections and not wanting to have another baby and sure enough I started to babble away about how nice a c-section must be and how I wasn't going to have any more babies! I can remember the midwife asking me to tell her when I felt the need to push and saying she thought it was time I took my knickers off (I was still wearing a pad and knickers to catch the waters, but I had changed into my "giving birth" nightie as I like to think of it - I had it on when I gave birth to Kira) and I remember thinking she can't possibly think I am nearly fully dilated - I had no idea of the time at that point.

00:00 - I felt the contractions change and felt the urge to push. So I told the midwife and asked her the time. She told me it was midnight and it struck me that that was exactly the same time as I had gone into the 2nd stage when I was having Kira. I was expecting the midwife to want to do a VE to ensure I was fully dilated - her overall attitude had given me the impression that that was the way she would want to play it, but I was pleasantly surprised when she said "Go for it then".

I must have spent around 15 minutes pushing with each contraction before feeling the urge to lie down. At this point the midwife had been trying to monitor the baby's heart rate after each contraction with a hand held doppler and to be honest I was finding it intrusive and getting in the way of me concentrating on what I was doing, but I was unable to tell her this as I find that once in hard labour I just can't speak.

Vinnie and the midwife got me lying down in the left lateral position and I tried pushing there. It was at this point the midwife suggested a VE to see what was happening - I think she and I were both thinking the same - another cervical lip (I'd had one with Kira too) and sure enough that's what she found. She offered to hold it down as I pushed and I agreed as this was how we had managed it with Kira. However, this time it didn't work and I can remember her saying "it's a big fatty lump and I can't get it out of the way".

Then she listened in to the baby's heart rate and even I could tell that it was slower than it should be. From here on in things seems to get out of hand and there was an air of panic. The term "headless chicken" springs to mind when I think of the mw's attitude at this point! The midwife said she thought I needed to be transferred into hospital to have an assisted delivery and was straight on the phone to the hospital asking for an ambulance.

I just couldn't think straight - I wanted this baby out of me as soon as possible, but the thought of going into hospital and having an instrumental delivery was freaking me out.

The midwife was telling me to lie still and not to push otherwise I'd have to have a c-section, but another contraction came along and I pushed because I couldn't do anything else, and lo and behold the baby started to move down.

At some point during all this the midwife brought out the gas and air and told me to take a deep breath of it, but I remembered how horrible it made me feel last time I tried it and so just used the mouth piece as something to bite down on and breathe out through.

Vinnie suggested I changed position, so I got up and went back to the kneeling in front of him while he sat on the sofa. Once in this position the baby's heart rate was back up to normal after each contraction but I wasn't sure if I could feel the baby moving down or not. Vinnie then suggested we get into the same position that we had used in the end with Kira - the supported squat. That seemed to do the trick - each time I pushed I could feel the baby moving down and it wasn't long before he was crowning.

It took a few pushes to actually get his head out and during that time I could feel him wriggling inside me - it was a very strange feeling, but I wasn't worried as I had heard other women saying they had felt this, but it worried DP as he didn't know this could happen. Once his head was out the midwife said something about the cord being around his neck and it seems ages until his body was finally born at 00:41hrs. Apparently the cord was quite tight around his neck and because the cord was really short the midwife was not able to loop it over his head like they usually do when this happens, so she had to cut the cord before his body was fully out.

I looked down and saw this pale grey body lying on my tummy. I wanted to pick him up and cuddle him, but the 2nd midwife had to get him breathing. She had to bag him while he was still lying on my stomach, but I can't actually remember this part (Vinnie told me afterwards). Then he was whisked away to the other end of the room while I tried to deliver the placenta.

By this time the ambulance had turned up and it felt rather like being in the middle of Piccadilly Circus. One of the ambulance men helped the 2nd midwife with Jamie, while the other one helped the main midwife with me. She was getting impatient at waiting for my placenta to arrive and to be honest I felt she bullied me into having the injection of Syntometrine. Once she had given me the injection she started to press down on the top of my uterus (very painful!) and pull the cord - it was a bit frightening at this point as she mentioned to me that the cord was very fragile and I had visions of it snapping off and me being left with a retained placenta. Luckily it didn't snap, and the placenta came away intact.

Once the placenta was out, all the midwife wanted to do was get us in the ambulance so that Jamie could be checked out at the hospital. He was breathing on his own, but he was grunting as he breathed - his Apgar scores were 5,7, and 9. Georgina and Vinnie managed to pack a bag for Jamie and me and get me changed into some clean pyjamas. I was in a state of shock, very wobbly and couldn't think straight, but I managed to think straight enough to get Georgina to bring Kira into the room and introduce her to her baby brother before we were bundled off into the ambulance.

Once in the ambulance the midwife said to me that Jamie's breathing had really improved and he had virtually stopped grunting. She said we would probably be discharged from hospital as soon as we got there. By this time I was feeling really sick (side effect from the Syntometrine) and didn't have the presence of mind to query why we were bothering to go to the hospital in that case! Personally I think the midwife felt that as she had called the ambulance out she needed to use it to "save face". Had she not called the ambulance in the first place and just got me to move into a different position like she should have done, then I doubt she would have actually called out an ambulance to take us into hospital after the birth, but just waited and watched Jamie's breathing for a little while longer.

When we got to the hospital we had a lovely surprise - the midwife assigned to looking after us was the wonderful midwife, Sally, who had attended Kira's birth. I remember flinging my arms around her neck as soon as I saw her and saying "Where were you when I needed you?" - I knew instinctively that had she been the midwife with me for this birth it would have all been a lot calmer and we wouldn't have ended up in the hospital (something which she later confirmed when we talked over what had gone on - it was almost an exact re-run of Kira's birth, but that had been such a different experience due to her remaining totally calm and supportive).

Once we were settled in a room on the labour ward Sally checked Jamie over and pronounced him fit and well and that we could be discharged. She encouraged us to have some skin to skin contact and to try breastfeeding. It was only later that we realised that neither Vinnie or I had actually properly held Jamie until then - they had offered him to me in the ambulance but I was feeling so sick and weak that I thought I would drop him and so refused!

I was checked over and found to have an intact perineum with just a slight graze and Jamie started to feed once Vinnie had reminded me how you breastfeed a newborn - I had only stopped feeding Kira a few months before but it's very different feeding a 11 month old who knows what to do compared to a newborn. Once he'd finished feeding we made our way home and introduced Jamie to his big sister properly.

Although Jamie's birth wasn't the calm positive experience I had hoped for, I still got that "post-birth high" that I'd had after giving birth to Kira, in fact it actually lasted a la few days longer after this birth. Maybe it was the fact that I had achieved a natural homebirth despite the midwife that made me feel even more empowered.

It has occurred to me since, that had we transferred into the hospital before Jamie was born, it would have been Sally who would have caught Jamie, but both Vinnie and I agree that would not have been a good enough reason to have had a hospital birth. While we were there I looked around the room and thought that there was no way I would have felt comfortable giving birth in a room like that and the screaming that the woman in the next room was doing would have driven me mad!

I am grateful that I've had 2 homebirths, both very short labours - this time I was probably in established labour for around 2 hours before Jamie was born - it's just a shame that this birth was not so calm and relaxed as my first one. It just goes to show how important it is to have a good midwife with you and the difference it can make to the whole experience.

I am also grateful that by being at home Vinnie felt assertive enough to override the mw's instructions for me to lie still and not push. He was able to do the right thing and get me to change position which is what the mw should have done. Without Vinnie's presence of mind I could have very well ended up with an instrumental birth or even a c-section as, had we been in hospital, I can imagine that he wouldn't have felt able to get so involved with the whole process.

What would I do differently next time? Well the idea of an independant midwife is appealing as that way I would get to choose who attends the birth and ensure she is the right midwife for me. If I did decide to carry on with NHS midwives I think I would insist on meeting the whole team and then trying to weed out anyone that I felt would not be a good midwife for me. One thing is for sure, I wouldn't allow the same midwife within 100 miles of me ever again!

I would definitely print out my birth plan, in which I would have very specific instructions on what I did and did not want - even down to the lighting - during Jamie's birth I found the room was too light, but I was unable to express this to anyone as I just can't speak when I am in full-blown labour.

I would ensure that all my birth partners knew my birthplan back to front and I would give them full authority to speak for me if they thought that I needed that help. I know my friend Georgina felt at times she wanted to say something, but didn't feel she had the authority to do so because I hadn't specifically given her that authority beforehand.

The thought of having a midwife present in the house but not involved with the actual labour unless we asked her to be is very appealing and I certainly wouldn't want a midwife hanging around just waiting for my labour to start! I know we could have asked the midwife to leave at any point, but things seemed to be on a rollercoaster from the minute she arrived and we didn't have the presence of mind to just tell her to go away for a while.

Ahh well, hindsight is a wonderful thing, but for me the bottom line is that my baby was born at home with a intervention-free labour and birth.

Suzanne Williams

suzanne at packerwilliams dot plus dot com


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