[I read with interest the reporting of a major study on midwife-led care in NZ major study on midwife-led care in NZ, and of course it got me thinking about my own births… again… you can prob skip this piece if you’ve been following me a while]
My second labour was awesome. Perfect. Beautiful.
Around 5am on Thursday morning I woke up with strong Braxton Hicks, almost painful, like moderate period pain. Thursday was the estimated due date, so I thought, oh, this might be it. I got up, lumbered to the loo, had a drink of water and went back to bed. The pain subsided and I fell asleep again. I was on maternity leave already, and my husband took the little dude to creche, and I went about my day. Patches of strong Braxton Hicks came and went. I Skyped a friend in New York. I napped. In the early afternoon, the contractions geared up a bit and I called my mum and my husband, arranged for mum to get the little dude from creche. She brought him home to pack his overnight bag. The Braxton Hicks seemed to be turning into real contractions, getting regular, stronger. After the little dude was dispatched, my husband and I went for a walk around the block and ordered pizza. Tried to watch something on Netflix, but I kept interrupting our show to turn around and kneel against the couch and moan through the contractions.
I called my midwife’s cellphone. My lead maternity carer was an obstetrician, but she practised with three midwives, and the prenatal appointments alternated between midwife and doctor. The birth would be attended by both. But the midwife who had seen me during pregnancy wasn’t available – this was the Thursday before Easter weekend and she was going on holiday. We’d joked about the timing, how my first baby was late and she’d probably deliver my second when she got back from holiday. Instead I was introducing myself over the phone to the on-call midwife, saying my contractions were starting to get stronger, but I didn’t think anything would necessarily happen soon. They were still short, and still not ten minutes apart, I’d had a long long long first stage in my previous birth, this is just a heads up. She lived on the Kapiti Coast though so said to call again with an update if they kept getting stronger and more frequent. An hour or so later I called back. A contraction came while I was on the phone, I dropped it and moaned, and she said “yeah, I could hear you vocalising through that, I’ll come in now and will call the obstetrician to meet you at the hospital in half an hour.” It was 8.30pm; at 6pm I was happily eating pizza.
As I got into the car, another contraction came. My husband started the ignition and I shot him a death glare “FUCKING DON’T START THE CAR YOU LUNATIC WAIT UNTIL THIS ONE IS OVER”. The next contraction came in the hospital carpark, as I was going into the after-hours entrance while my husband parked the car. A passer by asked “are you alright”, and I wanted to swat her away like a fly.
The obstetrician examined me at the hospital. Four centimetres dilated. I was over the fucking moon, this baby was being BORN, folks! The obstetrician broke my waters “it’ll help speed it up”. A thought passed through my mind, my grandfather had been born in caul, and my great-grandmother, highly superstitious, always found this comforting later when he became a ship’s pilot – the legend is that babies born with waters intact will never drown. But hell yeah, speed things up, break those waters. The obstetrician left again, I laboured in the birthing pool supported by this amazing midwife I’d only just met and who felt like an embodiment of peace and solidity; and my husband, who was anxious as a bag of cats. I did what I felt would be most comfortable. Laboured in the pool. Decided I wanted a shower, wanted the drumming rain on my back and shoulders. The midwife rubbed my back, just so, as I held the rail of the shower and groaned, and thought how nice these birthing units are. Decided I wanted a rest, climbed onto the bed, curled onto my side. The obstetrician popped back in to examine me again. I’d gone two centimetres further and I was like yusss. The next contraction was STRONG, and I couldn’t lie down through it, I turned round. Back in the shower for the next few contractions. Remembering my yoga teacher’s visualisation about the crest of the wave, staying on the crest, riding the contraction. I thought how my baby must be hearing the loud animal noises I was making, hearing that call through my body and into his. Then, another contraction came and I felt an overwhelming urge to push. I got a bit flustered and said “AHHHHHHHH I FEEL LIKE I WANNA PUSH”. The midwife said “probably not yet, let’s get back on the bed and take another look at you.”All the calm. She called the obstetrician through as well. I was examined and found to be 9cm. A+ dilation! Fucking yeah. And I pushed, right there on the bed only seconds later, and the obstetrician and the midwife talked me through it. There was a big push and the midwife said “even bigger, even bigger” and I thought to myself, yeah, I was holding back, and this time I won’t. The next contraction I really pushed, and the midwife smiled, and said “that’s it, that’s it, next one just a little half push”, and before I knew it they were handing me my baby and he was lying on my chest looking up at me with his old soul newborn eyes, finding the nipple, snuggling in, and it was perfect, behold the flesh of my flesh, brought forth, here he is, my baby. It was just after midnight. I’d only been in the hospital three hours.
My first birth was quite a different story.
It never occurred to me to use a private obstetrician. I was the lowest risk pregnant person imaginable. Fit and healthy and young and non-smoker and stuff and financially sweet and in a stable relationship. There were no confounding factors. No health issues with the baby in any of the scans. I had good blood pressure, good everything.
I was a week past the estimated dude date and a few days out from being induced. I started getting contractions around 6pm. My midwife had said to call her when they were about a minute long every five or ten minutes, the standard advice. They didn’t get to that stage, but by 10pm, they were every 15 – 20 minutes for about 20 seconds, and too strong for me to sleep properly. My husband went to bed and I tried to doze on the couch in the crazy arrangement of cushions that I preferred. It was fitful, all night, and I kept thinking – will they get stronger? More frequent? How can you sleep when every 20 minutes your abdomen seizes up with pain?
In the morning I called the midwife. She arranged for me to meet her at the hospital at 10am.
I was only 1-2cm dilated and was told to go home again, call when they got stronger and longer and more frequent.
I went home. Every contraction I would stand up, groan, moan, and then it would pass and I’d sit down again and chat normally.
They didn’t get stronger, longer, or more frequent. At all. They stayed patchy.
At 8pm or so my mum called the midwife while I was in the shower. She needs to come in, said my mum. The contractions are still 15 to 20 minutes apart but she needs to come in. She’s exhausted already and it’s not even the real deal yet.
We went to the hospital. I was only 2-3cm dilated. I was almost too over it to care. Well, now, they do something right? I get some drugs now to speed things up?
No. I couldn’t have anything to speed things up. The baby’s signs were fine. They couldn’t give me syntocinon when I was only 2 – 3 dilated, that’d be considered an unscheduled induction. I couldn’t have an unscheduled induction unless it was an emergency. I could stay and have pethidine or I could go home. The couldn’t give me an unscheduled induction because there needs to be an obstetrician on the floor for an induction.
I stayed and had pethidine, had a two hour nap.
When I woke, I was examined again. Barely any progress. Contractions kept coming, 12 minutes, 10 minutes, whatever. I tried the gas and vomited. Vomited, vomited, vomited, arching my back with pain in the birthing pool wallowing in my own stomach acid, too hazy, can’t remember, never could remember this bit very well, there were ice chips and I wanted more but someone said I shouldn’t because I would vomit again. At some point I’m examined again and I’m told that they’re going to start the syntocinon now because I’m 4cm along so it’s an augmented natural labour now not an induction and they’ll give me an epidural too. It’s been so many hours. They ask me to rate the pain and I say, over and over, that the pain is fine but I’m exhausted, I’m worried I won’t have energy to push later.
The syntocinon gets things going in a flash. The drip starts at about 4am, which is 34 hours after contractions first began, in those 34 hours I reached 4cm dilated and then in the next two hours I zipped straight to full dilation. No-one expected it to be so fast. The epidural was too strong. I couldn’t feel anything, each contraction was a vague pressure but there was no urge to push. I might as well have been in a different room to my body. My midwife and the hospital midwife started talking me through the pushing. The baby was coming out at an inconvenient angle, slightly to one side. “You’ll have a baby soon!” said my midwife. And I pushed. And I pushed. And I pushed. And I pushed. And three hours fucking later I was still fucking pushing. The monitor showed the baby’s heart rate was dropping. The hospital midwife said they would do an episiotomy now. They cut me. I pushed. I pushed. I pushed. They said they needed to expand the incision, and they cut further, as far as they could without reaching the anus. The baby came out, limp, floppy. They didn’t give him to me, he was taken immediately, they were talking. I barely noticed any of this. He was given to me glancingly, seconds, and he was gone, a little mask on him, oxygen, straight to NICU, my husband – his dad! – went with him.
My midwife stayed with me. Someone else came to sew up the episiotomy. It took over an hour. I had a lemonade popsical and some toast with marmite. My mother came in. She was shaken. I didn’t know what was going on with the baby. I felt like I did when I woke up from having my wisdom teeth removed, what’s going on now? I’m not sure? My husband called my cellphone. The baby was going to be fine. The baby was going to be fine, I thought, pondering, so hazy. Was the baby ever not going to be fine? The baby came out remember! Could I come and feed him, they wanted to know if I could come and feed him or if they should give him formula. I was confused. I was busy. They were still stitching me. I couldn’t come yet.
I was taken through to NICU in a wheelchair, to see the baby, who was going to be fine, the baby who came out, remember. He was so beautiful. I held him, and fed him, and then he went back in the box, all the little monitors on him. I thought, many many weeks later, did they give him to me for those few seconds just in case he wasn’t fine? Oh God.
It was more than two years ago and I might have moved on, be past it, this birth, this bad birth, except for one thing. A three and half hour second stage and an episiotomy the entire length of my perineum have had some lasting effects.
A cystocele is a form of vaginal prolapse where the bladder falls backwards against the anterior vaginal wall, causing the opening of the vagina to become eclipsed by the bladder, or in some cases the bladder protrudes outside the vagina. A rectocele is a prolapse of the other vaginal wall, where the rectum falls forward against the posterior vaginal wall, and can also protrude. I have both a cystocele and rectocele prolapse. They were apparent the first time I used a mirror to check out how the stitches were healing. What, what on earth, what is that. What happenened?! My GP referred me to a physiotherapist who specialised in pelvic floor rehabilitation. I had months of one-on-one physio, and it’s manageable now, by which I mean, it doesn’t cause acute pain and discomfort all the time. It causes moderate discomfort sometimes. This is worsened by standing, even for fairly short periods, lifting things (children, especially), walking while carrying things (again, children), defecating, moving from sitting to standing, coughing and sneezing, and yelling. There are some activities that the physio told me to avoid for the rest of my life – running, jumping, some of the more vigorous types of yoga. I don’t know whether I’ll be able to go tramping with a pack on my back again, I will need to wait and see how much it improves across the next couple of years if I keep doing my exercises. This used to get me down more than it does now. Coming to terms with a damaged body was definitely a factor in how rough I found the first year of the little dude’s life. I still get sad about it sometimes, today at Tiny Town watching another mum jump on the bouncy castle, sighhhh. The other day, someone was saying how much they enjoyed baby wearing, which is not something I’ve been able to do once they’re more than about 6.5kg.
I will never know whether this outcome could have been prevented with different care. I tend to think it probably could have. I don’t blame my midwife: when she wanted an obstetrician to step in, there was no-one on the floor.