So, birth story at last, if Hugo sleeps long enough for me to type! This one-handed typing is too much for me. It?s not the most upbeat of birth stories, but I think it will be helpful for me to type it out! A lot of it is a bit of a haze, so I?m afraid it?s going to be bullet points referring back to my notes rather than beautiful prose! Apologies for the extreme length ? lots of unnecessary detail, probably, but I need to go through it step by step.
So, the background:
We were planned for a home water birth. In the early stages of pg I had envisioned the birth would be at the hospital where I work, with all the drugs I could muster. I then started to swing towards the local MLU, and then in the last few weeks of pg suddenly decided that the way I wanted to go was very active, low intervention HB, and all was arranged accordingly. I have no major aversion to hospitals/ medical intervention/ drugs etc, but deciding on the HB was the first time I felt really comfortable with my birth plans. H
However, the best-laid plans aft gang agley, as they say, and Hugo went 2 weeks overdue with no signs of early labour at all, despite 2 sweeps and all the usual old wives remedies. Induction was booked for Tuesday AM, and as disappointed as I was to lose the HB, my dedication to it was not strong enough to go with the risks of waiting even longer.
We arrived at the hospital (so now consultant unit, not MLU) at 7.30am, ready for Prostin gel. But at first VE, MW found that I was 2-3cm dilated and so no need for gel. She whipped put a crochet hook, and had it up my fanjo and membrane ruptured before I could blink. Cue almighty gush of surprisingly hot liquid, followed by a hilarious half an hour of me trying to stand up and get pants and a pad on in order to go for a stroll. Don?t think DH ever thought he?d have to stand and watch whilst I stood over an inco-pad leaking uncontrollably and laughing like a maniac (hope I didn?t irritate the other ladies in the bay!)! MW had said that if I hadn?t progressed satisfactorily 2 hours post ARM they would start Synto drip. Desperately trying to hang onto some vestige of my birth plan I explained I would really like to avoid Sytno, so we agreed to give it at least 4 hours.
DH and I headed off for a stroll around the hospital grounds and after about an hour, I started to get some pains, though they weren?t very strong, and didn?t have a very clearly defined start and finish, though we timed them as best we could with Contraction Master.
Headed back to labour ward about 10.30am, and shortly after started getting much more powerful pains (aka ?mild tightenings? according to my notes!) which I had to breathe through. Strapped on the TENS machine (almost a complete waste of time I?m afraid). Contractions increased in length and frequency quite swiftly and we moved to the labour room at 1145. This I where it all starts to get a bit hazy. I think I had zoned into myself. I remember DH steering me to delivery room and me clambering onto the bed. I remember mooing like crazy, and some inside part of me being very annoyed that I could only moo in a single, monotonous note! Started using the G&A. I don?t really remember the pain, but it obviously looked and sounded awful as poor DH was in tears at this stage.
Next VE was at 1210 ? fully effaced and 4cm dilated now. The pain was increasing and when they offered an epidural, I gladly accepted. Lovely DH asked me, as per birth plan, if I wanted to try and get through a few more contractions first, but as I was still only 4cm dilated, I knew I wouldn?t be able to take the pain for as long as was necessary, and so wanted epidural now. So venflon sited, bloods drawn, fluids hung and anaesthetist arrived at 1255. Epidural sited and pain decreasing by 1330 ? Juwesm was back in the room!
1340 ? had first epi top-up. Pain was still difficult, so I continued to use the G&A with contractions. The lovely midwife who covered for lunchtime kindly explained how to use it more effectively, which no one had done up to this point, and this helped a lot. I was able to count my breaths, anticipate when a contraction was coming, and start on the G&A in anticipation of it.
1400 ? CTG showed a bradycardia with slow recovery. MW did another VE ? 5 cm dilated, heavy blood-stained show and baby query now in OP position. Obstetric reg came to review ? CTG had now recovered, so just for careful observation.
1420 ? dropped my BP a bit, but nothing major. Otherwise pottering along as before, and plan is for another VE at 1800. More epidural top-ups though the afternoon. Contractions consistently strong and 4 in 10 mins. Tried passing urine around 1600, but necessary control now gone, so catheterised ? what joy! Next VE moved forward to assess potential need for Synto to get things moving ? now 6-7cm dilated ? hurrah!
1655 ? Still need G&A despite further epidural top-ups. Anaesthetist came along to review, and gave an additional top-up with a stronger concentration of bupivacaine ? lovely man! Pottered along quite merrily through the rest of the afternoon. The midwife was quite surprised to find me sitting up in bed happily reading a magazine and eating a Ripple at one stage. It all felt quite surreal around now, as I was apparently in labour, and the contractions were fairly hefty on the CTG, but I could just as well have been sat on the sofa at home, with no feeling of contractions at all. Still able to move feet and legs to some extent too.
2025 ? Handed over to night staff ? had just had to start using G&A again, so had another top-up. Examined by MW and lovely student MW. Contracting 3-4 in 10. MW was going to do a VE, but as I was struggling with the pain again at this stage, she put it off until the top-up kicked in ? which never happened! Continued to have strong pains in my right side, and, weirdly, across the surface of my right thigh. Top-up failure number 1. Reviewed by obstetric reg and still only 7cm dilated, so the plan now was to try to sort the epidural and cautiously start the Synto to try and get things moving, despite already having good, regular, strong contractions. Noted at this stage possible need for C-section ? boooo! Had another top-up and moved to my right side to try and get more effective relief on that side ? effective after about 20 mins.
2130 ? Synto infusion commenced, to be titrated upwards gradually with close monitoring of CTG.
2215 ? Epi top-up ? failed again ? no pain relief from it, continued close relationship with G&A.
2250 ? Further epi top-up ? also failed. Now agonising pain down both thighs, which continues even when not contracting, as well as contraction pain. I remember at this stage grabbing the infusion pump to find out what rate it was going at, being surprised that it had been increased from the initial rate, as I had not been aware of that, trying to work out in my muzzy head how to turn the pump off! Couldn?t do it, so told DH that I wanted it off, as I (with all my insight!) believed that this was causing the unbearable pain. I think at this stage I was starting to moo a little bit again, and poor DH was looking terrified, so I told him that the ?me inside? was still fine, despite outward appearance. It?s funny how lucid I felt inside, but how difficult it was to express through the pain and the entonox stupor!
2340 ? Reviewed by doc again. Now fully dilated! At last! And I?ve only just remembered this, looking back at my notes, but they did a quick ultrasound to confirm position and baby was OA, not OP! New plan at this stage was ?sort out epidural? (again) and encourage to push in around one hour. Anaesthetist came along again to discuss pain relief possibilities. Basically, he didn?t know why the epi wasn?t working, and the two options were either to re-site the epidural, or to give the stronger concentration again, but with the risk of no longer having any movement in my legs etc. The stupid man kept asking me which one I wanted, as if I was in any position to know which option was better! He wouldn?t make a recommendation; I think he thought that neither option was going to do any good. DH wanted to punch him! In the end, I selected the higher conc. again, as this had given good relief before.
0000 ? Midwife makes the decision to give up trying to wait for the hour before pushing, as the pain relief was still not working, and I was getting more and more distressed. So, pushing began. I think this was the worst part. I could manage a first push okay, but as soon as I stopped that, there was a burst of pain and I couldn?t bear to push again. I wanted to yell whilst pushing, but the MW kept telling me off and making me put all my energy into the pushes ? no yelling allowed ? ?Juwesm just about coping? it says here! Was very sick ? the pushing seemed to have more effect there than down below! After 50 minutes of pushing, no progress made, so obstetrician called in again. New plan ? ?trial of instrumental delivery in theatre under spinal?.
0100 ? Prep?d for theatre. IV anti-emetics and ranitidine! At last (had still been having heartburn)! I gave my ?informed consent? to the procedure (sooooo laughable!). Stripped off (oh the indignities!) ? I was still wearing the nice black dress in which I had arrived and laboured in ? never had chance to change. Epidural removed ? I still managed an ?ouch? when all the sticky tape was pulled off! Taken to theatre, mooing down the corridor. It seemed to take them an age to get ready to put the spinal in. Every time a contraction finished, I hoped someone would leap in and insert the needle, but then another one would come ? queue me hanging off the midwife in desperation, and more yelling. Someone in the room was talking about red onions ? this was obviously just another day at the office for them ? so surreal! Spinal finally came and managed to stay still for the insertion.
Glorious pain relief! It took a few moments, but fairly swiftly all feeling pretty much below the waist gone. For most of the rest of the time I just lay back with my eyes closed enjoying the relief. I had no idea my legs were in stirrups. I had no idea that they then did a McRoberts manoeuvre, which involved my legs being pulled back on either side so they were against my abdomen! I do remember, at the end, looking up and realising that the two things raised high in the air and draped in greens were my legs, and not really believing I was that flexible!
Synto restarted at 0120, forceps applied at 0140, head delivered at 0150, episiotomy somewhere along the line. Midwife had to guide me through pushing. She would fell my belly for a contraction and then I had to push which is nigh on impossible with no sensation at all from the waist down! I?m sure I can?t have been doing anything at all ? just pressing my chin to my chest, closing my eyes and holding my breath. Baby had cord around his neck, and his head did not rotate as it should have, so his shoulders didn?t rotate around to be delivered. Baby eventually delivered, after some struggle by the doc, at 0155. He was delivered onto my tummy, albeit briefly, and I caught a quick glimpse of a head full of hair. He was pale and floppy, and was whizzed off to the paed to be resuscitated. AGPAR was 5 at 1 minute, 6 at 5 minutes and up to 9 by 10 minutes. DH was with him whilst he was being looked after, and I was being repaired down below. They cleaned and wrapped him, and eventually my beautiful baby boy was brought over to me, and laid on my chest. Apart from the brief moment after delivery, we weren?t able to do any skin-to-skin contact, but I was able to breast-feed him shortly after delivery. Poor little soul was very bruised, and had a great big spoon shaped forceps mark on his cheek, going right across his eye.
So, all told, 1st stage = 12 hours 10 mins, 2nd stage = 2 hours 15 mins and placenta was delivered within 10 mins. It was a very difficult day for me, for DH and for baby Hugo, but this was obviously the way things were meant to be. It was the only way that our lovely baby was coming into the world. The thought of what would have happened had my home birth proceeded terrifies me. Even if the bulk of the labour had been less painful without ARM and with the use of a birth pool, once we got to the stage where his shoulders could not be delivered?..best not to dwell on it. I don?t know whether the experience would put me off considering a HB again, or conversely, whether it would make me even keener to avoid a hospital birth because of the cascade of interventions.
They say that the pain is forgotten the instant your baby is with you. I?m still dwelling on it, on how unprepared I was for it, and about whether there was anything I could have done to have dealt with it more successfully. But I would go through it all again in a heartbeat to bring my baby into the world safely. He?s lying on the bed next to me without a care in the world, and although his entry into our lives was not the peaceful, natural event we would have wished for him, and it has given him a tricky few days at the beginning of his life, I know that we can move forwards together now, and that his presence here is all I need to make the whole experience worth it.