Thursday 15 September 2016

A Birth Story Part III: 14 Hours & 41 Minutes

I can only apologise for writing the world’s longest birth story. I promise this will be the final chapter. By the time you finish reading this post, I will have a baby in my arms and a very sore vagina. You can find Part I here and Part II here.

I started having tightenings on Friday night and though the hospital midwife seemed only vaguely excited, I was beside myself because I knew things were finally happening. I was very worried that the tightenings might ease off, so I felt like I needed to do something constructive. It was quite late and the ward lights were off so I decided to go and sit on the sofas at the entrance to the ward where I would be guaranteed some privacy. On the way, I called by the midwife’s desk to ask whether the birth centre was busy. If I couldn’t have the home birth I had my heart set on, I definitely wanted to give birth on the birth centre.

“It’s closed tonight. There aren’t enough midwives to keep it open.” This was said very matter of factly, as if such a thing was commonplace. Goodbye home birth, goodbye birth centre. It felt like I had absolutely no control over my own birth.

I went to ring Laurie and sobbed down the phone. I just wanted to go home. I didn’t want to give birth on the delivery suite with all the doctors and interventions and bright lights. I wanted to go home to my husband, my hot tub and my four year old. I wanted privacy and love and to feel in control. Being in hospital was making me feel completely panicked about what the birth was going to be like. I decided to listen to music on my headphones and try walking around to keep the contractions going. I think I spent an hour or so in the darkened reception area to the ward, walking, bouncing and trying to pretend I wasn’t panicked about the birth.

It was after midnight and I’d been awake since 6am so I was feeling pretty tired. I decided to go and lie down and see if I could get some sleep. I was having contractions every few minutes but I wasn’t in established labour yet. On my way back to my room, the midwife said that the birth centre had reopened. They had one midwife up there, one woman had just given birth and another was labouring. What a relief!

I tried to sleep, but the contractions were keeping me awake. I knew I wasn’t in established labour yet, but I was worried that being in a ward and not having any privacy was going to stop my contractions. I eventually gave up on sleep and went to find the midwife to ask if I could move to the mobilisation room. The birth centre at Stepping Hill Hospital has four birthing rooms and a mobilisation room. The mobilisation room is for women who aren’t yet in established labour but might be soon. There are birthing balls, sofas and, most importantly, a bath. The birth centre midwife said it was fine for me to go up there so I headed upstairs to the birth centre.

As soon as I was in there, I ran a nice warm bath. I honestly don’t know how people can cope with contractions without the aid of warm water. It provides instant pain relief. I got straight in the bath as soon as labour started with my first child so I was glad to be able to do the same this time. Obviously, it’s not quite the same when that bath isn’t yours and you’re stuck in a hospital, but it was better than nothing. Laurie called my mum and asked her to drive to ours to watch Ebony so that he could come to the hospital. The midwives had said Ebony could be present at the birth, but I wanted to make sure everything was going smoothly before we invited her down.

I was in the bath focusing on my breathing for a long time. I’m not sure how long. The birth centre midwife was called to the delivery suite not long after my arrival so it was just me and a maternity assistant on the ward. Every so often, a midwife from the ward would appear and suggest that I go back to the ward because there was no midwife to look after me on the birth centre so it wasn’t safe for me to labour there. I declined this kind offer and explained I wasn’t in labour, I was just in the bath and wanted to stay there. Laurie arrived sometime after 4am and found me in the bath. There was still no midwife so I kept being asked to get out of the bath. I kept declining.

At around 6am, the birth centre midwife was back on the ward and she came to check on my progress. I was 4cm, though she said that wasn’t necessarily established labour for a second time mum. The contractions were feeling quite intense and the bath didn’t feel deep enough to cover my back and ease the contractions so I asked if I could get in the pool. She explained that I could, but there was a risk that my contractions would ease off and because I was so far past my due date (16 days by this point), she would recommend holding off a little longer. I ended up back in the bath. For the next hour or so, I kept asking if I could go in the pool and she kept convincing me to wait a little longer. I was worried that the birth centre would get busy and suddenly there would be no pools available to me. The midwife kept explaining that the birth centre was empty so this was very unlikely but I would not be convinced. She offered to write my name on the door of a room so that that pool would be ‘mine’ and I could stop worrying about it.

Eventually, I decided I couldn’t bathe any longer and I needed the pool now. The midwife went off to start filling the pool. The problem with a hospital birth is that the midwives disappear a lot and don’t come back for ages. This doesn’t happen at a home birth. It was now 8am and time for the midwives to handover. We knew this might take a while and I was in established labour so Laurie and I took it upon ourselves to find our birthing room. I wasn’t planning to get into the pool, but it looked so inviting when I walked into the room that I couldn’t help myself (my notes read: ‘couldn’t find Fiona in the mobilisation room. Found her in the pool).

The pools they have in hospitals are pretty big and it was nice finally being able to submerge my back under the warm water. I was leaning against the side, drifting off between contractions (I’d now been awake for 26 hours) when all of the midwives came in. My midwife was called Vicky and she was lovely. There was another midwife milling around with aromatherapy oils. And they asked if we’d be happy for a student midwife to attend. We said yes and it turned out to be the student midwife called Paris who had been shadowing my community midwife throughout my pregnancy so that was nice. I can remember feeling quite overwhelmed at this point, there was a lot of chatting going on and I was half asleep.

Laurie was pouring warm water on my back during contractions and this turned out to be the best thing ever. I was falling asleep between contractions and every time I woke up Laurie looked scared that I was about to drown. I think I stayed this way for a few hours. There was a clock in the room and I couldn’t stop looking at it. They really shouldn’t have clocks in delivery rooms. Midwives should just have very good watches. Like they do at home births. Le sigh. I can remember seeing that it was 10am and wondering why the fuck the baby wasn’t here yet (if the first birth was six hours, this one would surely only be three, right?). Then eight hours later it was 10:15am and I wanted to die. Time was passing so slowly. Mostly because I was asleep a lot, I think.

People kept telling me to eat and drink, but I really didn’t feel like I could. Every time a new member of staff came into the room, they went through the risk of polyhydramnios with me again. This was really great and calming because it meant every thirty minutes or so somebody would say the words ‘crash section’ to me, which is exactly what you need when you’re trying to have a calm water birth. It felt a bit like the birth centre staff were quite stressed to have a high-risk woman under their care, and that they were already planning how they would hoist me out of the pool when something went wrong.

My maternity notes had the notes from the scan stapled into them. These included information that my amniotic fluid levels were above the 97th percentile. At one point, my midwife came and explained that because my baby was above the 97th percentile, there was a risk of shoulder dystocia (I had read lots about this during pregnancy and this made me absolutely terrified) and other complications. As soon as she left the room, I burst into tears and told Laurie that nobody had warned me I was having a giant baby. Eventually, it turned out it was the fluid that was above the 97th percentile, not the baby, so that was a relief.

I started using gas and air at about noon. I was really hoping I’d be able to skip the gas and air the second time around. I used gas and air for just under two hours at Ebony’s birth but I just wasn’t coping as well this time. I felt really panicked. I couldn’t stay calm and I didn’t feel in control. All of the good things about Ebony’s birth just weren’t working out for me in the hospital.

I kept having to get out of the pool so they could check my progress. This didn’t happen at my home birth where I was checked once and then left to progress in the pool. This birth felt much more interfered with simply because we were in a hospital. In hindsight, I wish I’d refused at least a few of those checks because I think getting out of the pool and being examined could have potentially slowed labour down. I did refuse CTG monitoring, opting instead for doppler checks every fifteen minutes. If it’s good enough for a home birth, it’s good enough for a high -isk birth in a birth centre, right? One check I really really wish I had refused is the urine test. Nobody checked my urine at my home birth. I hadn’t slept for days, I didn’t eat anything but ice pops during labour and yet nobody cared, they just left me to get on with giving birth. No such luck in hospital.

Ketones were found in my urine and this meant I was in a lot of trouble for not eating and drinking. All of a sudden I was being force fed orange juice like there was no tomorrow. Each time they checked my urine, more ketones appeared. A consultant appeared and said I needed to go to delivery for an ARM (artificial rupture of the membranes), to be constantly monitored and to have fluid to rectify my ketones. I think we disagreed about all of this. Vicky said my progress had slowed, two hours had passed and I was still just 6cm dilated and she felt that having fluids would sort this out. Eventually, I agreed on the condition that they wouldn’t leave the cannula in. I am very scared of needles and the thought of having a drip is horrifying to me.

Vicky decided she would get the midwife most skilled in cannulas to do my drip because I was so petrified (this birth was in no way inspiring or empowering for me). She found said midwife and then Vicky went for her lunch break. What Vicky didn’t mention was that the midwife most skilled in cannulas was also really mean. She tried twice to insert the cannula but it didn’t work. This was super fun for me because I am terrified of needles and drips and veins and all things medical. They can only try twice so then she called for a junior doctor. The junior doctor famed for her cannula skills arrived and tried a few more times. This was quite horrifying, as was hearing sentences like “You have great veins, but I’m getting no blood.” Eventually, the horror was over and I had a cannula in my arm and fluids heading into my veins. And it was at this moment that the mean midwife told me they wouldn’t be taking the cannula out because it was so hard to get in. This. Was. Not. The. Deal.

I had to have two bags of fluids, this took bloody ages. I was sat upright on the bed whilst this was being done, I think it took a few hours. I could have gotten back in the pool or walked around but I was majorly freaked out by the drip so I just needed to stay still. Once the drips were finished, I decided to get back in the pool. I found it really difficult to get comfortable in the pool. If I knelt up and leant against the side of the pool, this helped with the contractions. But it also meant my leg went dead. If I sat any other way, the contractions felt unbearable. I have concluded that the hospital pools and just too rigid. I longed for the cushioned floor of the inflatable hot tub I had waiting at home.

I was feeling really worried about the risk of cord prolapse. It feels silly now because it was always such a small risk, but it was literally all anyone had said to me since Monday and I was scared. I knew that I would be too scared to push. I started saying I couldn’t do it. Vicky looked hopeful and I could tell she thought I was in transition. But I also knew that I wasn’t. That I really couldn’t do this. That I was too scared to push. I think they spent quite a while trying to convince me that I could do this, but I just felt like I couldn’t. I felt completely helpless and weak and pathetic. This whole experience was so far removed from what birth was last time.

After my leg went dead for the eight millionth time, I decided to get out of the pool. I went back to the bed but my contractions were stronger and the backache was terrible. Everything felt so much more intense than it did last time. I don’t know if that’s because it was a different labour or because I couldn’t relax in a hospital setting. At about 6pm, I decided to have some pethidine. They only give a very small dose now so it doesn’t affect the baby’s breathing after the birth anymore. I thought it would offer something in the form of pain relief. It didn’t. It just sent me to sleep between contractions and I’d been doing that pretty much all day anyway. Laurie said I spent an hour and a half drifting off between contractions. The pethidine meant I couldn’t go back in the pool for two hours but, to be honest, the dead leg had made me give up on my dream of a pool birth anyway. There is nothing relaxing about having a dead leg.

I felt like I was too scared to push because of the risk of cord prolapse. As soon as your waters break, either the baby’s head comes down or a bit of cord does. If it’s the cord, your baby needs to be born as quickly as possible. And, even though the risk was TINY, I couldn’t stop worrying about it. I decided I wanted a controlled rupture of the membranes. This meant the baby would be held in place during the rupture to reduce the risk of the cord slipping past. I felt like this was safer. It also meant there would be a doctor present at the time my waters broke so if anything did go wrong, help was at hand. In order to have my membranes ruptured, I would have to move to the delivery ward and leave the birth centre behind. But by this stage in the labour, I felt it was my only option. I just didn’t feel like I was ever going to be brave enough to push otherwise.

Vicky was really lovely, she kept checking and double checking that I was absolutely positive I wanted to go to the delivery ward. She told me that, because my baby was so late, there was a very high chance that there would be meconium in the waters. That this was normal for postdate babies, but that the doctors would see it as a sign of fetal distress. I was really glad she took the time to explain this to me. Things move quite fast in hospital and there isn’t time to do research so having a midwife I trusted was really helpful.

At 7:30pm, I was taken downstairs to the delivery ward. 8pm is staff changeover in a hospital setting so it meant Vicky would be leaving soon. It also meant all the doctors were handing over so I ended up meeting two teams of medical staff. This was a whole lot more risk talk and the risks of a crash section were explained to me. I was completely asleep by this point and kept waking up to hear phrases like “...and that could result in death…” or “...and then your bladder wouldn’t work anymore…”. Luckily, the pethidine meant I was too tired to be scared by any of this. It did mean, however, that I sleepily agreed to an unnecessary epidural just before the membrane rupture ‘just in case’ they needed to do a section. When the anaesthetist left the room, Laurie and the midwives turned to me in horror and asked if I knew what I’d just agreed to. Er, yeah, that they might need to do an epidural if they have to do a section. But apparently not, I’d just agreed to the epidural anyway. This was quickly resolved. Thank fuck.

The midwives changed over, Vicky left and a new midwife called Helen appeared. I don’t remember her saying anything to me but then I had just agreed to an unnecessary epidural without realising so who knows what was happening. Not me. At some point, a team of doctors entered the room. I was relieved to see the induction-happy consultant wasn’t there. There had been talk of moving me to theatre for the ARM, but the registrar quickly explained he wasn’t bothering with that. He ruptured the membranes immediately and announced I was 9cm dilated. There was no meconium in sight and I agreed to go on the monitor for a short while just to check that the baby was happy and the cord wasn’t being compressed.

The midwife said she was going to write some notes and that I should let her know if I needed to push. I don’t remember this, but Laurie said I waited for her to get to the other side of the room and then I whispered to Laurie that I needed to push. The midwife was setting up her equipment and I was sitting upright in the bed with my gas and air. The midwife told me to just go with my body and she told Laurie he was in charge of pulling the cord when the baby was about to be born.

I spent the first 10 minutes sitting on the bed before realising that that was a terrible position to give birth in and I wanted to move. There weren’t many options for birthing aids on the delivery ward so I decided to kneel up and lean against the back of the bed. I’d spent a lot of the pregnancy reading Ina May Gaskin and knew this was a good position for birth. Laurie was stationed behind the bed, so I was sort of leaning against him during contractions.

I still felt like I wouldn’t be able to get the baby out, that eventually it would all end in an inevitable intervention. The midwife sounded pretty keen to hurry up and get this baby out which made me worried that something might be wrong so I pushed as hard as I could. I was hoping to have a more relaxed second stage this time after pushing stupidly hard during my first birth, but alas the panic took over and I just pushed as hard as I could. I could feel the baby twisting as she moved down and it was pretty painful. The midwife kept saying the baby would be here any minute. It felt way more intense than my first birth, I seemed to be more aware of the baby’s movements. The midwife told Laurie to pull the cord (to be clear, the cord to alert the second midwife, not the umbilical cord) and seconds later the baby was born just as the second midwife and a healthcare assistant strolled into the room. My second stage lasted 26 minutes.

At this point, I was still leaning against the back of the bed. The baby was out and I could see the baby’s head if I peered backwards, but she felt very far away from me. I think I kept saying in a panicked voice that I couldn’t see the baby and then Laurie said “It’s a girl” and I burst into tears. I think the midwives were trying to figure out a way of getting the baby to me, but a short cord meant they couldn’t pass her through my legs as they usually would in that situation. The cord was cut and clamped and I was able to turn around and finally hold my daughter. I cannot put into words how amazing this felt. I really didn’t think my baby was ever going to come out, I definitely didn’t think I’d manage to get the baby out myself and I certainly wasn't expecting another daughter. I was just overjoyed to meet her at long, long last. She arrived 17 days after her due date and she was perfect. And huge. 10lb7, to be precise. Ember Rose, my beautiful giant little baby, here at last.

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