Sunday 25 April 2010

Baby the fourth is born!

For my fourth baby I was planning a home birth having had two previous caesarean sections - one an elective for breech twins and one an 'emergency' caesarean for failure to progress beyond 4cm dilated. I felt very let down by the hospital and staff during my first VBAC attempt and felt planning a home birth was the best way to ensure I got support and continuity of care this time around. I came up against a lot of opposition from practically every midwife, doctor and obstetrician I dealt with which did not make for a happy, stress free pregnancy! At about 36 weeks I attended an appointment for a placental site scan only to be ambushed by the supervisor of midwives and a senior obstetrician who spent a good hour telling me that I was endangering both myself and my baby, that I had had my chance and failed, that I had a 'very, very low chance of successful VBAC' and that I probably just couldn't give birth. Based on information from my previous VBAC attempt they determined that my pelvis was probably inadequate to have birthed my 7lb baby. I left with my confidence decidedly shaken but wrote a follow up letter complaining about their treatment of me and confirming that I was still going ahead with my home birth plans. By 37 weeks everything seemed to be falling into place. The midwives were on call for me and my home birth kit had been delivered.

Until 39 weeks. I had a routine midwife appointment at home where they felt that baby had moved into a transverse position - despite having been cephalic for weeks! I went to the hospital for an urgent scan which confirmed that baby was transverse with it's back against my cervix. This seemed to give real credence to the supervisor of midwives assertion that I was incapable of giving birth naturally. I started to doubt myself and agreed to be admitted to the hospital for observation over the weekend. Twenty four hours and several 'talks' with a remarkably arrogant obstetrician later and baby was once again head down - though now considered to be 'unstable lie'. My own consultant came to visit me to discuss her serious concerns over my home birth plans and to try the usual scare tactics. I refused to be booked in for a caesarean on the Monday and discharged myself.

At 39+5 I attended another appointment with my consultant, the SoM and 3 community midwives to discuss my birth plan. Baby was now oblique. The meeting was long and tedious and probably not particularly helpful to any of the attendees. Over the next week or so baby continued to move between oblique, transverse and cephalic. I spent most of my time upright, on hands and knees or my birth ball. I started to really miss my lovely, comfy sofa! On Friday at 41 weeks I went for a scan to check baby's position etc. All was fine and I agreed to a quick internal. In my notes my cervix was described as being thick, high and 'very, very posterior'. I assumed it would be another couple of days before anything happened. That night I had a few mild tightenings while I was bouncing on my ball but they stopped when I went to bed and I got a decent night's sleep.

Saturday was a beautiful sunny day. I was really hoping that maybe baby would decide to arrive before the weekend was over. At about midday I persuaded Ryan to come out for a walk along the towpath by the river with the children. We took some bread to feed the ducks and walked until I decided not bringing a drink was a mistake and suggested we turn around and head home. We stopped at the shop for drinks on the way back and I bought an ice lolly that I thought was going to be strawberry flavoured but turned out to be cola! Yuck! I'd had a few mild contractions since leaving the house but didn't think too much of them.
It was about 2.30pm when we got home and I made the boys a light lunch. I had a big bowl of melon, banana and grapes which I ate whilst doing some more bouncing on my ball. I had another couple of contractions and told Ryan he might want to let his Mum know that she'd probably need to take the children that evening. Then I took the boys upstairs to watch a film so that Ryan could get some studying done. It was about 4pm when I suddenly started getting what felt like 'proper' contractions as I realised I was starting to want to move onto my hands and knees every time one came. Joseph and Ben were wrestling rather than watching the film and I was finding their boisterous behaviour increasingly difficult to deal with. Ryan heard me snapping at them and came upstairs to see if I was ok. I told him that maybe he should ask his Mum to come down sooner rather than later. He rang her and I packed overnight bags for the boys.
Contractions were very regular - about every 3 minutes - but easy to cope with and I could still talk through them. I went to use the bathroom and noticed that my plug had come away and a bit of blood too. I went back into our bedroom where Ryan was keeping the boys entertained and kneeled on the floor to lean over the bed. Ryan asked me to take the boys downstairs to wait for his mum while he went to the bathroom. I stood up to move and felt a gush of fluid. I thought maybe it was more blood and felt a little worried. I moved again and felt another gush. It slowly dawned on me that my waters must have broken! I grabbed a pad and saw that my waters were full of meconium. I waddled downstairs, grabbed some bed mats from the home birth kit and kneeled over them on the living room floor. The boys were all completely fascinated by the mess I was making and asked if I was doing a poo!
I was feeling a little bit panicked at this point. There seemed to be an awful lot of meconium and I was worried about my unstable lie baby being in the right position. I was desperate to get the boys out of the house and a midwife round so I could hear baby's heart beat and be reassured. When Ryan got down the stairs I insisted that he ring both the on call midwife and his Mother IMMEDIATELY! Contractions were still every 2-3 minutes but easily tolerable. It was now about 5pm. The midwife arrived about 15 minutes later to the rather surreal image of me on my hands and knees leaking amniotic fluid onto an incontinence pad while Ryan played Final Fantasy 13 on the playstation with the children watching! She listened to baby's heart which sounded fine and then asked if she could do an internal. I agreed and hopped onto the sofa. I should add that my children have left the room by now and are being loaded into their Nanny's car! The VE found me to be about 2cm dilated and my cervix about 80% effaced. Baby was thankfully cephalic but the head was still very high and far back. In light of the thick meconium staining and the fact that I wasn't very far progressed my midwife suggested I transfer into hospital. I was still feeling quite panicked about baby's wellbeing and agreed. She called an ambulance for me as Ryan doesn't drive and I resumed my position of choice on the living room floor - hands and knees rocking my pelvis. Shortly afterwards a rapid response vehicle arrived! The second midwife - who had also turned up - went outside (with my underwear in her hand!) to point out that we actually needed an ambulance transfer. Said ambulance eventually turned up and after getting Ryan to throw some things into a bag for me we set off - though not before giving all the nosy neighbours a good bit of excitement.

I tried to stay on my hands and knees in the ambulance but quickly realised that wasn't going to be possible. I lay on my left side instead and closed my eyes to relax and block everyone else out. I felt quite detached from everything outside of my own body and what was happening to it if that makes sense. I was aware that we were moving quite quickly and I was in fact being blue lighted to hospital (albeit completely unnecessarily!). I know we arrived at the hospital at 18.14pm as the paramedic needed to know for his records and asked Ryan to read out the time. I stayed on the bed with my eyes closed as they moved me up to a delivery room. I was officially admitted to the delivery suite at 18.35pm.

After vacating the bed and returning it to the paramedics with a cheery thanks for the lift I spent a few contractions leaning over the bed in the delivery suite swaying my hips while the community midwives handed over my care. I was a little disappointed by this as I thought maybe one of them would choose to stay with me. It was fairly obvious that they thought I was going to end up with another caesarean. A midwife introduced herself to me. I asked for water and she said no - 'in case you need to have surgery'. I'd been drinking an isotonic drink in the ambulance! Fortunately I didn't end up with this midwife after all. The ward sister - who was absolutely fantastic - took on my care instead. I sipped water freely throughout labour and she didn't once try to place ridiculous time limits or targets on my labour.
The contractions were a lot more intense now though they had stuck with the every 2 minutes or so pattern. Being on my hands and knees wasn't comfortable any more so I lay on my left hand side on the bed. I agreed to a CTG trace much against my better judgement as they had noted some decelerations during contractions when I was in the ambulance. Ryan questioned the care I was receiving repeatedly and ensured everything was explained in minute detail. I was so glad to have him there. I was coping now by holding onto the side of the bed and rocking myself from side to side which made the CTG trace somewhat unreliable as it kept losing contact. They were very close together now and I was starting to moan through them a little bit. I was given the entonox mouth piece and had a brief suck but it seemed very distracting so I just held it instead. I felt sick and asked for a bowl to throw up into. Breda - our midwife - asked if I was getting any pressure but I said no. A few contractions later and I was feeling some pressure in my bottom! I thought I must be imagining it and it was only towards the very end of a contraction so I didn't say anything. After all, I'd only been 2cm dilated 1.5 hours ago. However it persisted and got stronger so I mentioned it to Breda.
Contractions were almost constant now with very little let up in between. I started to think that an epidural sounded really appealing as I didn't think I could cope with this if it was going to be hours yet! I remember the alarm on Ryan's iphone going off to tell us it was the boys bedtime. The pressure was getting quite intense now and I heard myself starting to make 'bearing down' noises. I was still in denial that I was having a baby though! A Doctor arrived to take blood from me (!) and I heard Breda say 'she's pushing away there'. She asked if she could examine me and I agreed. My baby's head was right there! I was going to have a baby!
Bizarrely at this point the Doctor was taking blood from me and inserting a venflon! I was both incredibly irritated by this and completely oblivious as I was in the middle of giving birth. I was pushing with each contraction now and the pressure was very intense. Suddenly the break between contractions wasn't relief any more and I was desperate for the next one to arrive so I could get on with pushing this baby out! It took about 3 contractions and baby's head was crowning - one of the strangest sensations I have ever felt though I didn't experience the famous 'ring of fire'. I heard Breda telling Ryan to look as his baby's head was born. She commented that it was a big head with lots of dark hair which I found hard to believe! All of our children have been little baldies. One more contraction and the body was born. It was 19.47pm. Ryan looked and told me we had our fourth little boy! Gabriel James. He was held up - absolutely covered in meconium and blood - and he looked just beautiful. And so big! I did it. I had a baby! I felt completely exhausted and couldn't believe how quickly it had happened. The second stage only took 12 minutes which I thought was quite impressive for a first time birth. I think everyone was shocked at how quickly everything progressed.
Gabriel was checked over and was absolutely fine. He had apgars of 9 and 10 and weighed in at an impressive 8lb 5oz. I didn't feel able to hold him so Ryan had cuddles. It turns out that I lost quite a lot of blood as Gabriel was born. I felt weak and dizzy and almost passed out as my blood pressure dipped to 70/39. They stuck some sort of a drip up and put an oxygen mask on and I was gradually 'revived'. I was investigated for damage. I had two large labial tears - one on either side - which were stitched up. I think this was more painful than the entire labour and birth experience and I hit the gas and air hard!
Finally I got to have a cuddle with my gorgeous new son. He breastfed straight away and was alert and content.
Although a lot of Gabriel's birth experience didn't go to plan it was fantastic and I am so incredibly pleased to have given birth naturally. I can't even begin to describe the sense of accomplishment - nor the smug delight at proving all those health professionals wrong after they came so close to making me lose faith in my own body. I would do it again in a heartbeat!