Picture: labour 1, by Alexis EBP, copyright 2013
I’m expecting our third child, second daughter, at some point soonish. My official date is 16th August. Preparing myself for this birth has been an entirely different, and more relaxed experience than the last two. I hope that it will my finale of child bearing: smooth, straightforward, and positive. It’s comforting knowing that stats are on my side, showing that birth is easier for many women by the time they are on their third and I have never been so well informed or experienced. Fingers crossed.
My daughter, Rosie, was born in a hospital in the UK, with interventions in the form of epidural, oxytocin drip, and forceps. I ended up with a 3rd degree tear. That is, quite a big one.
My son, Sam, was born at home in Portugal. It was a drug free birth attended by a private midwife. I used Natal Hypnotherapy. I had a small tear and a few stitches.
This is not going to be a short post. Birth stories take time. So, this is not for everyone. I wanted to write about my births because I have learnt a lot and derived a lot of comfort from reading other people’s stories. Here, I add my own to the canon, just in case it does the same for someone else.
The first time I wasn’t so much worried as apprehensive. I read the relevant chapter in ‘what to expect when you’re expecting’ and leafed through some other tomes on the subject. I did prenatal yoga and tried to work out how warrior position would actually apply to birth. I did kegel exercises to strengthen my then, rock solid, pelvic floor. I watched some DVDs with titles like ‘Holy Crap! I’m having a baby!’ I skipped over the stuff about inductions, forceps, ventouse, and c- sections as it made me feel panicky and I felt optimistic about my body’s ability to push out a bub, hopefully in a lavender scented bath. I decided to keep an open mind about epidurals. Friend’s birth stories took on a new fascination and I listened to their encouraging tones. The ones who had had a fairly crap time were sensitive enough to not scare me. I flew to England at 32 weeks, to stay at my mum and dad’s in Middlesbrough, while my husband was working in London. He planned to join us when I reached a spherical and splendiferous 38 weeks. As we know, first babies are always late.
Lesson 1: first babies are not always late.
As with many other things in life, there are no guarantees that you will make it to your due date. In a way, I am glad to be spared the waiting and watching as due date comes and goes. I had no warning signs that Rosie would show up early, so it was a bit of a shock.
I woke up at 1am on week 36, day 6 of my pregnancy to discover I was lying in a puddle of water. I stumbled, somewhat dazed, into my mum and dad’s room rousing them with a call of ‘I think my water just broke’. We phoned the hospital and they said we should come in, though there was a chance I had ‘had an accident’. I pulled on clothes, jumped in the car, and crampy feelings started up. On arrival at hospital I was found to be 4 cm dilated and in established labour. Got my dad to phone husband, as just couldn’t muster the words ‘hi honey, I’m in labour’. Dad passed me the phone and we had a shaky ‘are you ok honey? Yes, I think so’ conversation. Husband started packing and heading for car, I headed for a birthing ball. I had to go to the high dependency unit because daughter was 24 hrs away from being classed as full term. No bath and no lavender. Boo.
As the contractions got stronger I held my mum’s hand and squeezed with each one. She managed not to squeal in pain. My dad read the posters on the delivery room wall advising birth partners what to do. He made eye contact with me and said slowly and clearly ‘you’re doing very well’. We all fervently hoped husband would arrive.
Lesson 2: Relaxation is ALL
The trouble of preparing for something you have never done is that you can miss glaring details which turn out to be very important. I had been told to welcome, not fight my contractions and to relax my body through them. I had also seen hundreds of images of birthing women in soap operas, TV shows, and movies doing the opposite. I modelled what I was doing on the latter approach. After my second birth, where I took option 1 and relaxed my body as much as possible, I realised how much this helps manage pain. No hand squeezing at all. Now, when I have to do anything uncomfortable, like dental work, I relax and focus on breathing slow, calm, breaths. It really does work.
Memory becomes hazy, but I think at this point my blood pressure was found to be a bit high, so the midwives moved me through to another room where I and baby’s head could be attached to monitors. I changed into a hospital gown and sat on the bed. My contractions kept going steadily. I was encouraged to try gas and air, but wasn’t really sucking it in hard enough to have an effect. I started feeling nauseous. A midwife appeared to check me and said ‘oh you’re almost there’. What! But my husband isn’t here. Besides I couldn’t be possibly be about to have a baby- it’s just not the kind of thing I do. There must be some sort of mistake. Unfortunately this turned out to be the case. She had another look and gave a ‘silly me’ sort of laugh and then said ‘oops, no I was wrong. You’re actually five centimetres.’ What? So I’ve been doing all this work for one lousy centimetre.
This was the point that I freaked out. Yes, I was in pain, but the thing that was really getting to me was the lack of control and the nausea. I couldn’t leave the bed easily because of the monitor, and I don’t know why, but I just would not let myself be sick. I didn’t ask for a bowl. It was as if I thought, by controlling that I was controlling my body.
Lesson 3: if you need to be sick, be sick
I know now that this is part of the body’s mission to expel a baby and void everything else in the process. It can also be a sign that labour is progressing well. By the time I had my second birth I was fine with yelling for a bowl and accepting this as another part of the process.
Lesson 4: don’t be a control freak
I realise now that all one can do in labour is go with it. There is no time when going against the flow is less productive. Accepting that it is happening and a baby is coming out one way or another is another big lesson I took onto my second birth. Not only did this speed up the whole process A LOT, it also helped with lesson 2. By just letting things happen, I could let go of tension and anxiety associated with futile control attempts.
I said ‘I want an epidural’. An anaesthetist arrived presently and explained the process of injecting drugs into my spine, and the potential things that could go wrong. I wasn’t really able to wrap my brain around a conversation anyway, so didn’t take in much of this. He looked at me with pity in his eyes. ‘Do you still want one?’ Yup. As the drugs kicked in, I felt a new sense of calm and control. Things were looking up.
Even better, my wild eyed husband showed up after his invigorating 265 mile drive. I filled him in, he told me about the drive. This was surreal time: a civilised unreality. We chatted and waited to be pronounced fully dilated. I couldn’t believe that i would be pushing a baby out today. I could no longer make a connection between myself and the images of childbirth which I’d only a short time ago been enacting.
The midwife eventually told me it was time to try pushing. I could still feel contractions, but they weren’t painful, so I sat on the bed with my legs up to either side of me and pushed with the sensations. And pushed. And pushed. Nothing seemed to be happening. The attending staff said they thought the contractions were not strong enough and they started me on an oxytocin drip to rev things up. The contractions picked up. Rosie was still ok and didn’t seem stressed by the change of pace, but neither did she seem to be moving. We kept going. Still nothing. The obstetrician said that she needed to be born NOW and it was time to assist her with forceps.
Lesson 5: Learn about typical medical interventions and hospital policy before giving birth, so you can have an informed discussion about them if recommended
Many UK hospitals have a policy of intervening if the second stage of labour has gone beyond an hour in a first birth. Rosie’s heartrate was fine, so the decision to go for an assisted birth may or may not have been essential at that moment. Had we been better informed it would have been possible to have some sort of dialogue about why and whether the intervention was needed immediately. Each birth intervention has risks as well as benefits, and you have a right to understand how they apply in your situation. If delay poses no threat to mother and baby, it may make for a better, safer, birth to wait. Having a discussion will at least reassure you that it was absolutely necessary to have something done. Ideally, birth partners would be prepared well for this, because they are not in the middle of giving birth and therefore, are better able to talk through options and try to make your wishes felt. I wish we had been in a position to do this when Rosie was born because I am not totally confident that we needed the forceps. Rosie might have started moving down on her own with a little more time.
I was laid down and my legs put in stirrups. The obstetrician gave Rosie a little tug with the forceps, then retreated. I was prepared for an episiotomy so they could get better access. By now there were several people gathered around my nethers and it seemed that, to them, everything from the waist up ceased to exist, including my husband who was standing by my head. Because of this lack of dialogue and my muddled mental state, I did not communicate to anyone my perspective on what was happening. The contractions were quite violent. Though I felt only a subdued pain, they must have been huge, moved up a notch or 5 by the oxytocin drip. I suddenly felt pressure, as if I needed a big poo. On some level, I realised this was Rosie moving down, but this was still a bit too abstract, and I was more concentrated on getting the whole thing over and done with. I pushed as hard as I could and felt her budge. Her head shot out of me. My husband remembers the collective expression of surprise on the hospital staff’s faces, followed by a flurry of activity as she turned and exited my body.
Lesson 6: Try to communicate
Communication is something which I have found tricky during both my births and this is a well documented part of the natural labour state. The huge dose of drugs I had had may well have been more to blame the first time round. If I had said that I could feel something, the birth attendants might have been able to help me clarify what was happening and to better control the birth of my daughter’s head.
The good, nay wonderful news at this point was that Rosie was born and pronounced in good health. She was only 2.4 kg, but otherwise there were no concerns. Every cliche about holding your baby for the first time was true. We admired the miraculous child we had produced, while I was given a shot to move along the third stage. We managed a first, brief, breastfeed. Wonderful!
The bad news was that I had a third degree tear. I was given a spinal block and taken off to surgery, while my shellshocked husband cuddled up with Rosie. The stitching up took a long time, but it went well. I was totally out of it at this point and exhausted. I was wheeled to a recovery ward and reunited with husband, daughter, mum and dad. I was so glad to see everyone again and to have another cuddle with Rosie.
After this, I don’t remember anything until waking up after everyone had gone home for the night, which makes me sad. I can see that I was ‘awake’ at some points from the truly horrendous photos but it’s just a blank. That night I remember staring at Rosie as she slept, chatting to the midwives while trying and failing to breast feed. Someone brought me a cup of tea. Finally!
Lesson 7: Drugs do not necessarily lead to ‘pain free’ ease
I don’t know how things would have gone if I hadn’t opted for an epidural with Rosie’s birth. Third and fourth degree tears happen with natural births too, albeit less frequently. There were other factors like it being my first birth, and not having Husband around from the beginning, which complicated things. However, looking at statistics, I would have been less likely to sustain serious damage had I not opted for this kind of pain relief. I do believe that epidurals are a blessing in some cases. In this particular instance though, I suspect that having drugs did complicate a straightforward birth. Had I been up and moving during labour gravity would have assisted more, and my contractions may not have lost their momentum so much. Things would probably have progressed more quickly and I would have been a bit more with it. Ironically, the epidural had given me a sense of control, but actually removed my ability to birth Rosie’s head with control. Luck also plays a part in these things, so I’ll never know for sure how things might have gone.
With hindsight, a nasty perineal tear and longer recovery time, wasn’t the best trade off for a bit of pain relief during labour, and left me with greater sense of doubt and fear when it came to my next birth. I know plenty of people have uncomplicated, positive births using this intervention. So, I would not discourage people from making use of the epidural option where necessary, but I think it should be used advisedly rather than automatically. Fear of what is to come is not the best reason to have one and neither is the illusion of control.
In the morning, another midwife came and removed my catheter, helped me to sit up, then I could finally wash and have something to eat. I wasn’t in much pain thanks to ibuprofen, but still was at a bit of a loss to understand what had happened the day before. A doctor appeared at some point and told me I had had a 3rd degree tear. She gave me a leaflet to read. Really, this was just part of the blur of tests and visits from various staff in between more frustrating attempts to breastfeed. I didn’t have time to digest any information until much later, and by then I just wanted to forget about birth and focus on my little girl. After three days i was pronounced fit to leave, but we stayed an extra two days to get extra support with breastfeeding. Learning to breastfeed was a much bigger deal at the time and I am pleased to say that we did get there in the end and Rosie breastfed for 11 months.
So, overall, this birth and the immediate postpartum period was a real rollercoaster with definite highs and lows. Reading other people’s accounts leads me to believe this is quite a common experience the first time, as there is so much that is new. Any negative feelings I had were eclipsed by the absolute joy of meeting Rosie and becoming a mother. It was a mad, special time, and I have a lot of happy memories to offset the difficult moments. I knew, though, that I wanted my next birth to be different, so I took forward all these lessons when Sam was born. See part 2.