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Positive Birth Story – A Gentle and Welcoming Caesarean Birth

Planning Our First Birth
We had planned a homebirth for the birth of our first child. At first my husband wasn’t terribly keen on the idea, but we spoke about the benefits for both of us to receive continuity of care and support by one midwife. I didn’t want to be ‘just another woman having a baby’ to the hospital staff, with my husband barely figuring in the equation.

Once we met our midwife Marie, there was no going back. When I knew I was pregnant, we spoke on the phone and we talked about the need to ‘own our births’. This was important to me, because I did not want to be controlled by hospital policy. I wanted to have my feelings and wishes respected. With an independent midwife, the emotional, mental and physical welfare of myself, my husband and our baby were considered with the utmost importance.

Giving birth in a hospital was not out of the question; there would be no hesitation if the need arose. But continuity of care with someone that knew us and truly cared about us was our priority and we couldn’t get the kind of care we wanted in the hospital. In the end this continuity of care is exactly what made the birth of our son a positive experience, even though his birth was everything I did not want.

Phe and baby Donald Phe and baby Donald[/caption]

I started reading Ina May Gaskin’s books Guide to Childbirth and Spiritual Midwifery before I was even pregnant and they got me so excited about being pregnant and giving birth. I just wanted it to happen NOW! They were so positive and made birth seem so normal, yet monumental and incredible at the same time. Thankfully I got pregnant very easily and it was a very breezy pregnancy. I had no morning sickness, although I was ridiculously tired for the first few months and fell asleep as soon as I got home from work every day.

I was fit and continued with Pilates twice a week up until the week before I was due. Watching my tummy grow was exciting and I felt great. We saw Marie every four weeks and then weekly as the due date approached. We only had one ultrasound at 20 weeks for curiosities sake, as we wanted a peak at the little person growing in there.

During Marie’s visits she felt my stomach to assess baby’s position and we would listen to the heartbeat and just chat over a cup of tea. We discussed fears, hopes and concerns about the labour and birth and how we could work together to ensure we felt supported by each other. Ultimately I was really looking forward to labour and just getting to experience it all.

Something Unusual
Each appointment when she looked at my stomach, Marie would shake her head in amazement at the strange shape my stomach made; it was so lopsided! As we knew I had a bicornuate uterus[1] uterus she suspected the baby just preferred being in one side rather than the other, but was still vertex. Indeed at 36 weeks baby was Left Occiput Anterior[2], textbook perfect.

However, at our 38 week appointment Marie was having trouble figuring out what position the baby was in. She decided that if we were still having trouble at the 39 week appointment we would have an ultrasound to ensure we were properly prepared.

So at 38 weeks and 6 days we had another appointment and baby was giving Marie a hard time again so an ultrasound was scheduled for that afternoon. During that scan we discovered the baby was transverse[3]. Spine down, head in the right horn and feet in the left. The ultrasound also showed an exceedingly long wall (septum) extending down the middle of my uterus.[4] It was a pretty upsetting result!

That evening, Marie reviewed the scans and the report and contacted Dr Ken at the Foetal Medicine Unit in our city. He arranged for us to see him the next day. Marie would come with us. At the appointment, we had an ultrasound that confirmed what we had seen the previous day. We then had a 4D diagnostic scan which showed that the septum was not as big as first suspected and it was decided to attempt an external cephalic version (ECV) to turn baby. It was quite quick and not too uncomfortable and baby’s head moved down with relative ease.

Ken arranged for us to come back and see him on the Friday to reassess. By Thursday however, I knew that baby had reverted back to transverse and at the next appointment this was confirmed. Another ECV was performed and baby again went head down with ease. But again within hours, I knew that baby had moved back!

Ken was such a lovely doctor. He truly empathised with us as the situation unfolded during the week leading up to the birth. He was softly spoken and gentle and always very respectful. Not only to Tim and myself, but also to Marie, as he recognised that she was our primary caregiver. He did not to try to ‘take over’ at any stage, but consulted with Marie and ourselves at every appointment.

We had another appointment on the following Monday and this time we discovered that baby was again transverse, this time with head on the left and feet on the right. I remember Ken just looking at Marie with a really sad expression and he left it to Marie as our caregiver to break the news of the need to perform a caesarean. As the due date was the Wednesday and the baby was in a very unstable lie, we decided to deliver the baby by caesarean the next day. I think all four of us, Ken, Marie, Tim and I felt pretty devastated.

While we were in Ken’s office getting all the paperwork underway I asked him if he would be able to perform the operation. He told me that his shifts meant that he would not be able to. The upside that day was that we were able to arrange to have my aunty (a midwife) to be the supporting midwife in the operating theatre. Ken personally called Aunty Rozzie to tell her that I had asked for her and together they arranged for her to be in theatre as the assisting midwife. My mother also drove up to be with us for the two weeks after the birth to help. We knew that I would not be able to do much after the surgery for some time.

That afternoon Marie and Aunty Rozzie discussed how the caesarean could be made as calm, loving, and respectful as possible. They helped us put together a caesarean birth plan:
• Tim and Marie were to be with me for the entire procedure, including pre-op and recovery;
• No one was to announce the sex of the baby; we were to be able to discover for ourselves;
• Immediate skin to skin and breastfeed opportunity after the birth;
• The baby was not to be separated from me after the birth at any point;
• The placenta was to be retained so that we could see it afterwards and keep it if we so desired;
• The theatre was to be as quiet and lights as dim as possible for the moment of birth.

For the rest of the day and night I was angry and inconsolable. I sat for an hour in the bottom of the shower that night crying. I was broken hearted. Despite having a great pregnancy and positive attitude about birth, my chance to give birth naturally had been taken away. I was never to know what contractions or labour felt like.

Caesarean Birth
On Tuesday morning, Tim, Mum and I went to the hospital to meet Marie and our little baby. I was still angry and upset, and even refused to have Mum take a photo of me the day our baby was born, despite taking a photographic record of the entire pregnancy. When I had to change out of my clothes in triage into the surgery gown I broke down into tears in the change cubicle. After such a breezy nine months and feeling so prepared and excited to experience labour and birth, having to put on tie-up paper underwear for a caesarean section was like the ultimate smack in the face.

The triage nurse was so lovely and caring though. She hugged me and told me she understood how confusing and disappointing it all was. Tim and I hung out together waiting to go in to theatre while Marie and Rozzie were preparing together. We found out that Ken had changed his schedule around just so he could be there for me. That made me feel so cared for.

Once I was finally in theatre it was incredibly emotional. After the epidural was in, I found it difficult feeling so physically disconnected from the birth. I could feel my legs being manoeuvred and knew a catheter was being put it. I tried not to cry and Marie was with me, getting me to focus on her rather than the necessary unpleasantness. She was a physical, mental and emotional support the whole time.

Ken, Aunty Rozzie and the theatre staff told us what was happening and constantly checked to make sure I was feeling all right. Marie was able to photograph the entire birth so I also have an incredible record of how it unfolded.

Time was strange during the operation. I felt tugging and pulling. There was the buzz of all the staff in the operating theatre…and then quite suddenly a beautiful little boy was held up over the partition for us to see.

No one told us what he was; we got to discover for ourselves. No one whisked him away, but instead he was placed on my chest with his face against mine. There was so much encouragement and joy from the midwives. I blew gently in his face to help him take his first breaths. I remember smelling him for the first time and it was the most beautiful creamy scent I will never forget.

Aunty Rozzie then took him away to clean him up and Tim was able to cut the cord. Once he was brought back he was never taken from me again. He attached straight away and didn’t stop feeding for over two hours.

Looking at the incredible photos Marie took of Don’s birth while I write this still makes me want to cry. The operation itself is quite amazing to see and I can tell Ken is grinning like crazy behind his mask as he lifts my tiny baby up for me to see for the first time. I remember constantly being asked if I was OK or if I was uncomfortable. Everyone knew what our birth plans had been, so they made sure that despite our baby having to be born via caesarean, it was as good as a caesarean could be. The birth was as caring, gentle and respectful as possible. It was not rushed, it was not an ‘emergency’ and my husband, my baby and myself were looked after to very high standards. Ken came to visit me the night after Don was born to see how I was and to tell me “You can birth vaginally next time. You will do it”! He was a genuinely caring and gentle doctor.

Healing
For a long time afterwards, despite having a beautiful boy and a ‘good’ caesarean birth, I still felt like a failure. I felt like my body had let me down. I felt cheated and that I hadn’t really given birth as I did not feel a single sensation during his birth, or one contraction to let me know that my baby would soon be here. I felt let down by myself and just very confused.

Some people kept telling me that I needed to “Get over it” as I was fine and Don was fine and “If you were in Africa you’d both be dead”. But Marie completely supported me in my feelings of disappointment and grief for what I didn’t get to have. She did not allow me to wallow, but she never once made me feel that my hurt was unwarranted. She let me vent and be angry and upset, but she helped me relinquish those negative feelings as well.

As time moved on and I was able to talk things over with Marie, my sister who has had two caesareans and two VBACs, and other friends, I saw that it was a positive experience and one to be cherished. Even now I wish I could go back and do it again, just so I could take more of it in and see my little boy being born all over again. It was positive because I had the best care in my midwife. I know that if I had gone though the public system, or even through a private obstetrician, I would not have received the same level of support or respect that I received from her. Terms would have been dictated and I would have had little to no control over events. She was as sad and disappointed as I was that things didn’t eventuate the way we had originally planned, but she also had a positive attitude that I definitely needed as well.

Despite being born by caesarean birth in hospital, Don’s birth was an amazing day that I wish I could experience all over again. We were cared for, loved, respected and consulted. He was delivered by people who loved him before he was even born; people who couldn’t wait to meet this crazy little personality that had refused to head in the right direction! His first moments were shared with our wonderful midwife Marie and his Great Aunty Rozzie. Sadly Rozzie died less than two years later, and just three days before the birth of my second child. I am forever thankful for sharing something so precious with someone so special to me.

Ultimately Don’s birth paved the way for an amazing achievement: the breech HVBAC (a vaginal breech birth after a caesarean – at home) of my little girl 20 months later with Marie as my midwife. Adwen is now three months old and her big brother loves her to pieces. If Don’s birth hadn’t been what it was, her birth would have also probably been very different.

Donald was born 6 September 2011, 3:19 pm, measuring 7lb 2oz (3.2 kg) and 49cm in length.

Phe lives in Canberra with her husband Tim, two children Donald and Adwen, and two puppies, Oberon and Hermione. Her days are mostly spent at home looking after all four little ones, and trying to make sure Donnie doesn’t terrorise the puppies too much! She loves gardening and cross stitching and as many catch ups and coffees with friends as possible.

Glossary
[1] A bicornuate uterus is has a heart shape with a deep indentation in the top middle, making two horns. It is possible to have a normal pregnancy and labour with a bicornuate uterus, however it is also common for the baby to settle in an unusual position such as bottom down (breech) or transverse. In some of these cases the safest option may be to have a caesarean birth. http://pinterest.com/pin/371617406723121402/

[2] LOA or Left Occiput Anterior is considered to be the most favourable position for babies to be in for birth. LOA means baby is on your left side with the back of their head facing towards your belly, their back is aligned with your belly. Occiput means head (specifically the back part of the head), anterior means front (your belly).

[3] Transverse babies lie across the mother’s belly. Unless the baby turns a caesarean is considered the safest birth in this situation. http://spinningbabies.com/baby-positions/all-positions/sideways

[4] A septum is a muscular or fibrous wall extending down the middle of the uterus http://pinterest.com/pin/371617406723121454/

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Positive Birth Story – A Mother’s Love: becoming an advocate for my children

Elaine & childrenThe following is a series of extracts from Elaine’s story “A Mother’s Love” – a beautiful story for Mother’s Day. The complete story of “A Mother’s Love” is published in the Birth Journeys book.

Pregnancy, birth and the experience of motherhood changes Elaine, giving her new confidence, trust in herself and trust in birth. Elaine’s love for her children drives her to speak out and become an advocate for her family. Elaine shares the story of her second birth and the hurdles she overcomes to have the birth she wants: missing out on her preferred model of care, disagreement over the estimated due date, and a transverse baby.

Elaine handles each situation with confidence and calm determination. She takes an active role in her care, trusting her body, her knowledge and her experience.

During labour, Elaine is supported by a gentle, encouraging midwife, who reminds her to trust and let go. Kiah’s birth in hospital is calm and peaceful. 

Disagreement over the Estimated Due Date

I had learnt in the two years since Kiran’s birth that I was more than capable of dealing with anything and everything. I had realised that I owed it to my children to look after myself and to be their advocates. It was amazing really, because the ‘old me’ hated confrontation. I would usually back down and go with the flow. Since becoming a parent, I have found that I will not compromise on things involving my children.

Kiran’s (my first baby) induction played on my mind and continued to niggle at me. When he was induced (13 days post-dates) he didn’t appear to be ‘overdue’ at all. I’m sure my baby did not like this forced exit from the womb before his time. I certainly didn’t!

This time I had done my research. I knew my dates and I was prepared to stand my ground. I had kept a diary with my cycles in it. My periods were like clockwork, exactly 31 days apart, and had been for six months. I also knew exactly when we conceived – we didn’t have many opportunities with a toddler in the family!

When my calculations put the estimated due date a full week later than the ultrasound dating scan, we made our views clear.

“No, we are adamant the estimated due date is February 20 and not February 13 as the ultrasound suggests.”

“No, we aren’t budging. We know that there is a margin of error of a week anyway.”

“We do not wish for an induction based on dates as with Kiran’s birth.”

They listened and they agreed. The obstetrician even changed the estimated due date. I felt at peace and empowered. I had done my part and the rest was up to bub!

A Transverse Baby

The weeks flew past and my belly grew. Kiran thought it was hilarious when the baby kicked out at him and he loved stroking my tummy and talking to ‘his’ baby. Week 34 came and all was well. My bub was in position – head down. Week 36 came and she had turned to lie sideways. There was talk of a caesarean if she didn’t turn.

I was scared. The thought of having a caesarean and needing to be in hospital for more than one night was awful. I was so nervous about being away from Kiran. I had never been away from him before.

We were scheduled for an external cephalic version (ECV), where the obstetrician would manually coax my baby to turn. It was explained to us that there was a very small window for them to perform the ECV and be successful. We had less than 48 hours!

I jumped on to the internet, spoke to my friends and found the Spinning Babies website that had information and techniques to encourage baby to move. It was the funniest thing. I had to kneel on the couch and lean over the edge with my hands on the floor. Then I had to crawl forward on my hands so that my bottom would be higher than the rest of my body. The idea was to give bub the extra space needed to turn.

This was not easy with a pregnant belly, and even less so with a helpful toddler who thought climbing on top of me was a wonderful game. I did a few sessions of these acrobatics and we did lots of praying and prodding to encourage bub to move. I just kept talking to bub trying to persuade her to turn.

We arrived for the ECV. The midwife hooked us up for monitoring and then she said, “Hmmm, that’s funny. The heart isn’t where I expected.” The obstetrician confirmed that bub had indeed turned and was now head down. No ECV was necessary! Apparently, it was quite a rare occurrence to have a baby turn in such a short time.

I was overwhelmed with joy when I realised that no intervention was needed. Together my body and my baby were firmly in control and we were on the home stretch now.

The Birth

I focused on every breath and surge bringing my baby closer to being in my arms. There were no words. I was aware of my surroundings, but I was in a world of my own.

Soon I felt the need to bear down, so I got upright onto my knees. I visualised my uterus contracting and pushing downwards as I breathed out. With Kiran, the midwife had told me when to breathe and push. This time, I was the boss and it worked much better.

I’m pretty sure it only took five or six pushes for Kiah to be born. From the first contraction to her entrance into this world, barely two and a half hours had passed.

When Rohit caught her and told me we had a girl, I was a blubbering mess of pure joy. I wanted to call my sister and ask her to bring something pink for Kiah to wear home! I had always imagined myself with boys and never dared to believe that I might have a daughter, so much so that I had not even prepared for the possibility.

Kiah was placed on my chest and we had our first cuddles. There was a lovely sense of peace and tranquillity in the room. We started our breastfeeding journey together soon after.

Kiah did not leave my side for a single minute. We stayed in hospital for only one night and Kiran coped beautifully without me. We went home the following day – our little family of four!

Throughout my pregnancy, I doubted if I had any room left for more love, but the minute I saw my beautiful girl, I knew that love has no boundaries or limitations.