Friday, 1 June 2012

My birth story, as promised!

I am delighted to announce that baby Theodore William was born at 11:46pm on Monday May 14th after a relatively short but intense labour! Many apologies for taking an age to blog again, but it turns out that tiny babies are really quite time consuming!

In keeping with the theme of my blog, I would like to share my birth story and relate it back to the pregnancy, birth and parenting philosophies I am so passionate about. One of my favourite other parenting blogs to follow is Birth Without Fear, primarily a collection of birth stories focusing on giving birth back to women as opposed to it being the highly medicalised, intervention-driven phenomenon we often see it as today. Although the majority of the experiences shared within are drug-free home births, there are also stories of caesarean section, hospital deliveries and birth following induction of labour. The focus isn't so much on "all natural" birth, but more about empowering women to feel in control of their birth, no matter what shape it takes. I have found over the last 7 years as a mother that it is very easy to have decisions taken out of your hands and governed by hospital policies and common medical practices, even if that doesn't fit with your own ethos and comfort zone. Rebelling against these practices can be very frightening, especially when you are essentially arguing with a highly qualified medical professional about what they do for a living. One of the most helpful tools I was given at antenatal classes in my second pregnancy was the B.R.A.I.N acronym to use when questioning proposed procedures during pregnancy and birth. 

B = benefits What are the positive outcomes from this course of action?
R = risks What potential negative consequences are there?
A = alternatives What else could we do instead?
I =  intuition What does my gut tell me about this?
N = nothing What happens if we do nothing now and let things continue as they are?

I used that when it came to my second son's birth and the result was a very calm labour during which I felt entirely in charge and had nothing but good feelings when looking back on it. Unfortunately I lost that grip when it came to the birth of my daughter two and a half years later, and wound up with a very frightening experience, with hospital staff intimidating me into accepting procedures that I didn't want (or, on reflection, actually need) and at one point going as far as making me cry. Coming to terms with that birth took me a long time, and I was determined this time to recreate the birth of my second son as much as I could. The details needn't necessarily be the same - I had a lovely drug-free water birth then, which was easy to arrange because I had no complications during the pregnancy at all. My logical head knew that things may not go the same way this time if I was at all unwell through the pregnancy, but the important thing when preparing emotionally to give birth again was to feel that the birth was MINE, not the midwife or doctor's; the decisions made about my care would come from what I wanted, not what I felt pushed into; and I wouldn't be afraid to challenge any proposals that I didn't feel comfortable about. Beyond that, I didn't have much of a birth plan. When the midwife asked me about it, my answer was simply that I wished to be left alone as much as possible and have as few interventions as I could.

And now for the confession part... My promise from 3 weeks ago was, after all, to be honest about how far my preaching lives up to my practices! 

My birth this time didn't really go the way I wanted. It wasn't intervention-free, I wasn't relaxed and calm throughout and at times I was very frightened - too frightened to refuse having my labour induced or to articulate why I didn't want to be put on an IV drip to intensify my contractions later on. Everything I had practiced about B.R.A.I.N. and feeling in control of my labour went out of the window and I quite literally hid behind my husband at one stage! 

Everything started on Sunday afternoon when my waters broke spontaneously and in epic fashion whilst I was folding laundry. That's never happened to me before so I was quite taken aback and not too sure what to do! I'd been experiencing bouts of contractions for weeks, although they always stopped after a few hours and I'd settled into a mindset of just not thinking about when labour might start. This was different though, because waters breaking means that labour is very imminent! According to the midwife, 60% of women go into labour within 18 hours of their waters breaking so I got very, very excited and called the labour ward. They asked me to come in and be checked over, which I did and then chatted about how things would go from here. They said that if I hadn't gone into natural labour by 8am the following morning, I should phone again to discuss induction. That's the first point at which I panicked. I've never been induced before... my labours have always started by themselves - two of them were before 40 weeks, so I have limited experience of going overdue at all. I have heard stories of induction though, none of which sounded very appealing, and from reading lots about the mechanics of labour, I understood that the artifice of inducing contractions meant that it would all hurt a lot more. Without the natural accompaniment of endorphins with the oxytocin release that governs natural labour, I would feel everything much more intensely. Bizarrely, that didn't fill me with much joy! I went home, determined to bounce around on my birth ball all evening, drink raspberry leaf tea 'til it came out of my ears, walk around as much as my achey hips would permit and eat the spiciest curry I could tolerate, all in the name of getting labour to start by itself! Did ANY of it work? Did it heck. Just as most nights of the preceding few weeks, I had contractions, they hurt quite a lot, they stayed regular and increased in frequency to every 8 minutes.... and then by 3am it all stopped and I cried. This time I cried because I knew the next day would bring a lot of examinations and procedures I didn't want, and would most likely culminate in me having the sort of labour I'd been afraid of all along.

At 8am I rang the labour ward as discussed and was advised to call back again at 11am to arrange a time to go back in. I tried to stay calm all morning and discussed my feelings with my husband, reminding him in particular that I remembered how much the Fear had affected my last labour and how much I regretted the epidural I had begged for when the midwife snapped at me and told me I'd be labouring for hours and was putting my baby at risk by refusing more interventions. I told him that I needed him to be my advocate this time, that if things went the same way and I couldn't cope, that I would need him to make me question myself if I started to waver on my faith in myself: "Remind me how much I hated the epidural, don't let me beg for one again". I googled frantically, rang midwife friends, posted on the Analytical Armadillo's facebook wall - all to find out as much as I could about what induction of labour would involve and what I needed to know about my alternative options. What I learned was reassuring - namely, I could go as far as refusing the induction and waiting up to a further 72 hours for labour to start spontaneously. The NICE guidelines accommodate that and have advisements in place for how to monitor pregnant women for any sign of infection which would indicate an urgent need to get the baby out. That appealed to me a lot more than having pessaries inserted or being hooked up to IV drips! The thought of being able to retrieve my natural labour after all calmed me down and we toddled off to the hospital to talk to the midwives.

Something very strange happens to me when I enter a hospital building. I'm not in my house anymore... I'm in the doctors' house. This is their territory, not mine. I have no right to question their opinions with my own amateur knowledge informed by Google and entry-level Biology textbooks. It might be hard to believe, but my bolshy-ness does a complete runner and in place is a meek and frightened girl, not a strong and determined woman. So I sat in the delivery room, pondering what would happen and trying to scramble together my recollections of the information I'd gathered that day. 

A lovely, lovely midwife came into the room and we started talking through the various paths ahead. She was smiley and reassuring, matter of fact in answering my questions and respectful of my worries. I don't recall exactly how, but the decision I made was to accept the induction there and then, not wait for the next 72 hours to pass then reassess. I'm aware that I felt apprehensive about deviating from the hospital's usual practice and defying the wishes of my - albeit lovely - healthcare professional. Without a team of like-minded people physically around me, urging me to push forward with me desire not to be interfered with, I'm afraid I didn't have the inner strength to go against the grain. It was a mixed feeling... on the one hand, happy to be a step closer to meeting my baby, at the same time deflated at my birth no longer being "mine" but instead morphing into the property of the doctors, to be assessed and evaluated according to their rigid checklist of events that would determine whether or not the progress I made over the coming hours was to their satisfaction. 

The midwife explained that step one would involve inserting a pessary containing synthetic prostaglandins to help my cervix soften and begin to dilate. Hopefully this would be all that was needed to get labour going into full swing, but if not I would then be given an intravenous drip of more synthetic hormones intended to either start contractions or to make existing ones stronger. If that happened, I would need to be hooked up to a machine to have my baby's heart rate constantly monitored, and this would ideally take place with me lying down... for the entire duration of my labour. THAT completely freaked me out. I don't *do* lying down in labour. The geography of it just doesn't work! Forget everything you've seen on tv - labouring lying down is the least convenient position for a baby to try and exit the womb. The birth canal slants in such a way that you would end up trying to push the baby out uphill, all the while with the weight of said baby pressing back against you, limiting your blood flow through the arteries running along your spine. ICK. No way, Jose. I've done that once in my first labour when I didn't know any better and it was evil. Furthermore my son then needed to be resuscitated after the birth, something I'm confident wouldn't have happened if I'd been in a better position when labouring and pushing. 

With fingers crossed and prayers said, we toddled off to the antenatal ward to wait for the pessary gel to take effect and hopefully get labour moving. I sent my husband home at this point to see our other children because I didn't think there was much point him mooching around the ward waiting for something or nothing to happen. I had my tens machine (borrowed at the eleventh hour from a friend!), Jaffa cakes, birth ball and - most importantly - the whole bay to myself! Six beds on the ward and none occupied. I was very relieved to have a big open space to myself, so I set about bopping on the ball, snacking to get some energy back and chatting to the two student midwives who were pottering around. After a very short while, the contractions ramped up and I was confident things were moving as I'd prayed for. Two hours after the gel had been done, the senior midwife on the ward started to flap a bit and asked if I'd like to be examined to see if I'd progressed and should be moved back to the delivery room. I was ok with that (more anxious to know if all the pain was finally getting me somewhere!) so they checked me over and cheerfully announced I'd reached the magical 4cm dilated which indicated I was now in Active Labour. This was it, all hands on deck, no going back now - and more importantly, I had escaped the dreaded IV drip. The thought occurred that I should probably call my husband to come back to the hospital as we had originally agreed that he wouldn't return until after our kids were in bed, but the midwife and I suspected things may be moving faster than that! 

When we got back to the labour ward, husband dutifully in tow, I met with the midwife who was to care for me throughout the rest of my labour and the birth (assuming her shift didn't end first anyway!). I wasn't sure if I liked her to start with... She was very pretty, beautifully made up and quite glamorous looking. When you're in the throes of labour and feeling at your least dignified, it smarts to see someone looking lovely at you! Fortunately she was absolutely delightful, made me giggle and put me at ease. We were furnished with a radio to listen to Classic FM, jugs of ice water to keep me refreshed (although my husband qualified for several cups of coffee throughout the evening, hmmph) another birth ball and extra pillows so I could experiment with moving around and getting comfortable. At this point, I felt fantastic... I had defied the doctors' expectations by responding so quickly to the induction, I was in control of my labour, I was mobile, lucid and very excited about meeting my baby soon. My husband took a photo on his phone of me beaming with the gas & air pipe in one hand and a cup of water (held aloft like a chalice of fine wine!) in the other, and sent it to my Mum, who had been fretting about how I was coping. The pain increased and my contractions were 2 minutes apart from here on in. I leaned on my husband for support, taking great comfort in burying my head in his shoulder whilst standing on my tip toes (goodness knows why that was more comfortable than just standing!), pressing the BOOST button on the tens machine and going for gold with the gas and air. I had tried the ball, kneeling on the bed, leaning on pillows etc, but everything other than standing upright was unbearable agony.

I had last been examined just after 6pm, so the midwife said they would check again around 10pm if I consented. By 9pm, I was certain I felt the sort of pressure that indicated being ready to push, so we decided to check again and see how things had gone. My heart sank when she paused before telling me I was still only 4cm. After 3 hours of utter agony, nothing had happened. My body wasn't cooperating with me after all. Weeks and weeks of slow latent labour, of promising myself that it would mean that, when the time came, the groundwork would have already been done and the birth would be smooth sailing, then gradual realisation that my body and I were no longer in tune. All that pain and frustration just to get my hopes up for those few hours in the delivery room, only then to feel utterly crushed and like we were back at square one. To add insult to injury, the midwife then had to break the news that she was duty bound to inform the doctors of the outcome of the examination, and that they would certainly press for me to have the drip to intensify the labour. At that point, I had a complete meltdown. The idea of making an already unbearable labour more intense after taking away the faith I had only just restored in my body... I'd felt that Fear before, in my last labour. I had had maybe 10 hours sleep in total that entire week and didn't have the energy to deal with the pain any longer. I felt the words "please, please make it stop" leave my lips before I burst into tears and begged for them to call the anaesthetist. If I was going to be labouring for hours, I may as well lessen the pain. The labour wasn't mine anymore anyway. The doctors would shortly be arriving to take over and mould it into THEIR delivery, according to their specifications of how a labour should progress. Why should I fight and embrace the pain of a labour that didn't belong to me. 

As he'd promised that morning, my husband started to remind me how I felt last time after the epidural - that I had regretted it instantly, that I mourned the pain from the birth because I no longer felt it, that my daughter had been born half an hour after it had been administered so I always felt that it had been a pointless intervention. The midwife stepped in and held my hand. After that contraction passed and I was back in the room, she talked to me about what my husband had said. I expected her to come down on the side of knocking me out, but to my amazement she really took on board how I had felt last time and started talking me through other ideas. She suggested pethidine as an interim measure, saying that at the least it would relax me a bit and stop me panicking. If we were lucky, I may even be able to sleep a little while and regain some energy to face the rest of the labour. I fell in love with her a little when she then also promised that she would do her best to fight my corner and delay the doctors putting up the IV drip to give me time to get back in control. I was reluctant to accept the pethidine because I had had it in my first labour and felt very sick, but by this stage I knew I needed to make A decision and regain my control, so I told her to get it over and done with before I changed my mind.

After that, everything is a blur.  I vaguely remember stripping off the gown I'd put on over my vest earlier in the evening and climbing up onto the bed. The next thing I recall is the final two pushes before my son was born, and then leaning face down into the pillow for a couple of minutes asking myself if that really was it, was it really all over! The midwife then pointed out that it had only been 25 minutes between the pethidine injection and me getting into position to push! I had gone from just 5cm dilated with half my labour still to go and in absolute emotional breakdown, to pushing my baby out in less than half an hour! I remember murmuring "is it really over?" half a dozen times and feeling incredibly relieved that the pain had finally stopped. Even so, I really didn't want to let go of the tens machine controls! It had become such a comfort to me that I needed to hang onto it for a few moments until it really sank in that the hurty bit was done with. In truth, I felt a little shell-shocked. I hadn't expected such a managed birth, or to feel so frightened and small especially as this was my fourth birth and I've researched so much about relaxed birthing techniques!

So that was it. It didn't go the way I had wanted, but I can say that I felt in tune with my midwife and that she respected what I was trying to achieve with my birth and did everything she could given the circumstances. It's difficult to say out loud that your birth didn't go to plan, because very often people's response is to say that it shouldn't matter because you still have a healthy baby from it. Actually, it DOES matter. Can you imagine responding to a crestfallen bride on her wedding day that it didn't matter that everything had gone wrong on the day because she still had her husband out of it? We afford women the right to demand their perfect wedding day and we should do the same for their perfect birth, and moreover we should accommodate women needing to work through the barrage of emotions that comes around if they wind up with a birth that feels completely alien to them. I have been offered the Birth Afterthoughts service from my midwife since being discharged from hospital, which I declined because writing everything out here has been therapeutic enough and I feel at peace with how things went now. I know women who've had really traumatic births though and who still need a lot of support to deal with that.

I won't be having any more children but all my experiences of childbirth have reinforced my passion for giving birth back to women, empowering women to feel in charge of and in tune with their own bodies and not to feel afraid of the frankly awesome things we do whilst bringing new life into the world.

Quite frankly, we women rock!

No comments:

Post a comment