midwife – Winnie Wagtail

Birth Story: Baby P

A midwife shares her complicated pregnancy journey and the lessons learnt along the way.

An old colleague of mine sent me her birth story recently. Here’s a midwife’s perspective on the birth of her beautiful baby girl.

I debated about whether to share this, but realised that sometimes it is cathartic to express yourself after going through a stressful time.

Basically, I started off with a VERY complicated pregnancy. I’m not going to go into details here, but it required hospitalisation and a lot of time off work until 20 weeks. Being a first time mum and a midwife, I found this time very hard mentally. I think many first time mums focus on the birth and concerns about that, but I was NEVER concerned about the birth. Being a Birthing Unit midwife means that I am well informed and would have been confident to make the best birthing decisions given whatever circumstances came my way! Ideally, I would have wanted a natural drug-free birth (while always being open to pain relief if I needed it), but my main concern would always have been the safety of my baby. From a midwife’s perspective of not always seeing happy stories, and a history of anxiety, I was burdened with worry from the beginning about getting through a pregnancy safely. 35 weeks + 5 days is a LONG time to be feeling constantly worried.

I had a few weeks where everything was going smoothly. I was having regular scans, and then at 29 weeks we found out that our baby had asymmetrical IUGR (intrauterine growth restriction). This means that the baby isn’t growing properly for gestation. I was at least thankful that it was the asymmetrical kind – if you have IUGR this is the one you want! It means that the placenta isn’t functioning optimally to provide nutrients, but the baby is preserving brain/head growth, resulting in other areas such as the abdominal circumference not growing well. The baby had dropped from having her abdomen growing at approx 40% to 3% in a matter of 3 weeks – so pretty drastic!

Being a full time midwife while having a complicated pregnancy is HARD. I know work is hard for anyone who is pregnant and working shift work or a physical job (or any job at all), but it is harder with complications! I was so thankful to have my manager and colleagues support me where possible. However, it is SO strange to be treating women who may have come in with a growth restricted baby and concerns about their baby’s movement. Obviously, I didn’t share my own story with them for professional reasons, but on some really busy shifts where I was on my feet all day, it was hard to deal with. I hadn’t even had the chance to know if my baby had even been moving normally on those days (which is really important in the context of IUGR).

Towards the end, the plan for my birth had been an induction at around 37 weeks. I was covered with steroids to improve baby’s lungs (thankfully – given she ended up being born early by caesarean section).

Steroids are given in 2 doses 24 hours apart. I had these on a Friday and Saturday as well as having CTG monitoring of her heart rate – both days this was absolutely textbook perfect. On the Sunday we sold our car and were meant to pick up our new one on Monday. We joked with the friend we sold it to on Sunday that we hoped we didn’t need it for anything on that one night. Well, it turns out we did. At about lunch time I realised that I hadn’t really been feeling the baby move much. I lay down and prodded and poked her myself and nothing was happening. I was thinking to myself “am I imagining things? / I don’t want to go in to hospital to be annoying,” but ended up deciding to have a large coffee. If her movement wasn’t normal in an hour, I would call my midwife to go and get checked. We ended up getting an uber into hospital sooner than an hour due to my gut instinct that something wasn’t right.

I knew as soon as I was put on the CTG that the baby’s heart rate was a lot different to the two previous days, and was abnormal. I got scanned by a doctor and she wasn’t moving on ultrasound either, despite being prodded quite vigorously. The labour ward was busy that evening and the doctors had to come in and out, but I knew what was going to happen when I was asked “when did you last eat?” by the doctor. My midwife confirmed that the doctors wanted to do a caesarean section, and asked if I was ok with that. My response was “I just want my baby out safely”. My poor husband was a bit shell shocked. I think that I subconsciously knew what the outcome would be going in that day if everything wasn’t ok, but he was completely surprised and had to very quickly wrap his head around the idea that our baby was coming!

I’m so grateful that I knew the doctors who saw me/performed my caesarean from working with them previously – it made that part a whole lot easier for me!

As soon as our baby was born it was like instant relief for me mentally – I hadn’t quite realised beforehand the extent that the pregnancy had affected me. Since her birth I’ve felt amazing. She did have to go to the nursery for 9 days because she was a tiny 2.166kg, and also needed help with her breathing for the first 4 hours. I wasn’t worried about this at all, because again from experience I knew she would be absolutely fine, and my husband got to go with her to the nursery.

I was so grateful for the amazing support I got in hospital. I was expecting to not see her until the next morning when the anaesthetic had worn off and I could walk. However, the midwife looking after me arranged for me to get taken down in my bed at about 3am when she was off the breathing support, and we got to have our first cuddle. There is truly nothing better than the first cuddle with your baby!

Take home messages:

Maternal instinct is so important! I’m even more aware of how important fetal movements are after this experience. I went in 3 times in the pregnancy with movement concerns (while being a typical midwife and second guessing myself for fear of being annoying/creating a workload). I went in first at 26 weeks, and it was at the next scan that she was found to be IUGR. The second time was at 32 weeks after I’d had a lot of vomiting. I knew the reduced movements were dehydration related, but I still needed to get checked out. The third time was when she needed to be born!

I think more can be done to support the mental health of women with early pregnancy complications. It is a really lonely and scary time being in limbo.

I think there should be a discussion about leave entitlements for working women with pregnancy complications. I have always been vocal about maternity leave rights for women before I was even pregnant. We have created a capitalist society that requires 2 incomes to service a household, and for women to also support the economy. Women don’t choose complicated pregnancies. If women do have complications, I think there should be leave entitlements that don’t require them to use annual leave or leave without pay. I don’t buy into opinions of “it’s your choice to have a baby – deal with it”. As I’ve said before, there would be riots if women went on strike and stopped having babies.

Was my birth experience positive given the circumstances? YES! I feel like I recovered really well from the caesarean. The only thing I didn’t like was the spinal anaesthetic. The actual procedure was completely fine, but it is the weirdest feeling when you go completely numb from the waist down.

Would I do it all again for our daughter? YES!!!

Midwife to Mama – my birth story

The story of the day/night/morning I became a Mama

So many of you have shared your birth stories with me, and I’ve been blessed and honoured to have witnessed many strong women and their families become mamas and parents – so it seemed like a no brainer that I would one day share my journey in becoming a mama with you guys, and what a journey it was!

When thinking back chronologically on the two day saga I couldn’t have imagined the rollercoaster of twists and turns that were ahead for me. I did know this was a possibility heading in, which definitely made it easier mentally, but boy was it looooong. And yet, looking back, I’d say I have an amazingly positive birth story, and loved the wild ride it took to meet Syd.

TUESDAY FEBRUARY 20, 2018

40 weeks and 5 days in the throws of a February heatwave, a woman can only handle so much thigh chafe before shit starts getting real (TMI?). I’d had a couple of stretch and sweeps, was 3cm dilated and over it! I booked in for some labour inducing acupuncture with a fabulous woman in Brisbane (if you want her details, DM me on Insty), and a few hours later started feeling niggles.

That afternoon I started having regular, but not strong, tightenings lasting 50 seconds straight off the bat. I could talk, walk and smile through them so I did my best to ignore them and we went for our regular 9pm walk (to beat the heat!).

When I got home they ramped up. The were 3 minutely, lasting 50 seconds and I had lots of back ache (munchkin was direct OP, meaning his spine was on my spine, not ideal). My midwife was kept in the loop and the plan was to call when I was ready to come in to be reassessed etc…..

WEDNESDAY 21st FEBRUARY, 2018

4am rolled around, I hadn’t slept and I was ready for either some pain relief, a good ol’ bath, or something! I was assessed at 6am in the Birth Centre at RBWH and was STILL 3cm and effaced (kill me), his head was very low (good!). My contractions had not increased in strength but were lasting a good length and still 2-3 minutely, so we decided to break my waters and get this show on the road.

It worked a treat – contractions stayed consistent in timing and length, and improved in strength.

I laboured in the shower for two hours ( and smashed two bananas) and loved the water on my back. Sitting on the ball and bouncing away under the water was my JAM! To spice things up and keep things moving along (or I hoped would) I laboured on the birth mat, bean bag, used the TENS machine I had hired and the Gas and Air to good effect. Throughout labouring, my Calmbirth breathing that had been a big part of my later pregnancy daily routine was EVERYTHING. I didn’t see it as a coping mechanism in the end and more of a necessity in getting the job (having a baby!) done!

approx. 2pm on Feb 21st

Being reassessed that afternoon, I was 4cm, Bub was still direct OP and his head had started to swell (this is called caput). He was super happy in there, going off his heart rate, so we moved across to the Birth Suite and I got an epidural (I was 6cm by this point) and planned to have a caesarean in the coming hours.

I surprisingly wasn’t disappointed by this plan. I thought I would’ve been, but I wasn’t. When you’re in the moment, labouring away, you realise that birth doesn’t discriminate, you can only control so much, and you really just need to go with the flow.

After labouring all day, 4pm rolled around, I was 4cm, Syd was still direct OP and his head had started swelling, so I got an epidural and the plan was a caesarean

Epidural in time for Married at First Sight (he was thrilled!)

The epidural was a God send for me. It allowed me to relax, take a second and relax my body for a bit. It also was perfectly timed for Married at First Sight (see top right pic – shameful, I know…to my defence, Raoul loved it more than I did).

The birth suite was having one of those mental nights when all babies decide to kick a stink and all want out, so our caesarean kept getting bumped for Bubs’ that warranted a faster exit.

I was reassessed maybe an hour before we went for the caesar and was 6-7cm, he was still around the wrong way and the plan for the caesar was still in place.

THURSDAY FEBRUARY 22, 2018

Midnight came around and it was our turn – Raoul got into his scrubs (the most animated I’d seen him in a few hours, I think he was fantasising Greys Anatomy style) and we were off.

My epidural was topped up in the anaesthetic bay before entering theatres and then we moved in, and I was transferred (I remember feeling it was more a ‘heave’ ‘ho’ type situation) to the operating table. I remember wanting Raoul and being nervous. Nervous excited, but nervous.

The clip that had been attached to our baby’s head (called a fetal scalp electrode – helps to monitor the baby’s heart rate accurately when they’re on the inside) was being removed by the registrar that was to perform my caesar.
She was quiet and then said, “do you want the good news or the bad news?”

I said bad news. She responded “the bad news is that we’ve just topped up your epidural, the good news is that you’re 9cm and your baby is lower and in an OA position” (this is a perfect pozzy!). I was then asked “what do you want to do? You’re prepped for a caesar, so you can still have the caesarean now if you want it….or….if you want to try for a vaginal birth I will support you in that decision…it’s up to you. I can’t guarantee that you won’t be back here in a few hours, but if you want to give it a go, I’ll support that”. – What a legend Doctor right there, yeah? Looking back I’m still so amazed and grateful that I had a Registrar on that night that was so woman-centred (it would’ve been 1000 times easier for her to have just done the caesar, I would’ve never been the wiser). I’m forever grateful to her.

I was swirling. I remember just wanting Raoul to make the decision for me. I wanted the caesarean because I was over it and wanted to meet our baby, and had mentally seen the finish line, but I also wanted the natural birth…for the recovery, for the babies of the future etc.

Raoul came into the room, beaming like a cheshire cat in his scrub hat, and I broke the latest news. He smiled and said, “the ideal was for a natural birth, let’s give it a go- I’ll support you if you want to go for it”. He made it sound simple, and easy to process, and he was right, we did want it. So we gave it a go.

I waited 50 mins on the table in theatres for the epidural block to come down to a safe level to leave theatres, to then spend 1.5hours in recovery being monitored further.

By 3am we were being wheeled back to Birth Suite and I started to vomit – fully dilated!

They gave me an hour for passive descent (meaning just keep doing what you’re doing, no directed pushing etc., and let baby’s head come down low enough that I then had the urge to push).

My epidural had in the meantime stopped working. Now from a midwife’s perspective, this is perfect timing to regain sensation so you can feel where to channel your energy when pushing and being able to listen to your body. I didn’t feel this way at all!!! I was furious!!! I felt I had been able to handle the ‘pain’ throughout the day well, working my way up with pain relief options. To go from 0-100000 on the pain scale didn’t seem fair and it was a real mind-fuck for me.

The anaesthetist came back but no luck. So with the epidural in situ, I was standing next to the bed and pushing upright – it definitely wasn’t working!

This is going to sounds horrif as a midwife, but I just wanted to get Bub low enough for the vacuum birth. I was beyond exhausted and ready to meet him. My midwife in the following days said I did exactly that, that I got him low enough and then demanded a vacuum (what a nightmare I would’ve been to look after!)

I did end up having a vacuum, and little Syd born at 5:16am. I’d cooked up quite the temperature at 38.6, and Syd was 38.8 so he went straight off to the nursery after a very quick little snuggle.

He’s here! In his own time and totally worth the wait!

A few hours later, after a shower, I met him again, and he had a feed.

Cooked him up with a temp, Syd went to special care for a few hours, skin-to-skin and first feed here

We left hospital 2 days later.

Leaving with Syd Vincent – February 24th

It was an eventful few days but looking back I feel so incredibly lucky to have had the information, the preparation and the support to head into the unknown that is birth.
We all just want the best outcome possible at the end of the day.
My ideals changed so quickly in the moment – and I was okay with that. However I stand by my original ethos that the best birth plan is no birth plan at all and rather an informed pregnancy to make the best decisions you can in the moment. In the end, that’s what we did, and whether I’d had the caesar or not, I was happy that I had given it my all, and that’s all you really can do at the end of the day.

To that doctor – I have met woman-centred medical staff over the years, but never have I felt I’ve seen one so in the woman’s corner. Thankyou. You literally have changed my birth journey moving forward.

Raoul was also a champ – he gave a cracker massage, never wavered in support and knew exactly what to say at the right time. A+ !

To VBAC or not to VBAC?

The benefits and risks here…

There’s been lots of VBAC discussion on our Instagram feed over the past couple of days. I wanted to have a greater handle on the recent facts and stats, so I was read an article on The Conversation by Hannah Dahlen last night on vaginal births after caesarean sections (VBAC) (read it here).

With nearly one in three women in Australia giving birth via caesarean, I feel like I am only really just now starting to hear more and more about VBAC’s. Yes, as Midwives we are taught and study this but anecdotally I hadn’t come in contact with many women asking for a VBAC, but more so of midwives asking women if they knew about a VBAC being an option and did they want to consider it.
It’s lovely to hear more women, through the channels and power of social media discussing topics like this, sharing birth stories and channelling positive empowering pregnancy energy.

It is important to mention that “most Australian women (84.4%) have a caesarean for subsequent births after a caesarean. Only 15.5% of women have a VBAC. In private hospitals, this rate is even lower, at 11% “(Hannah Dahlen)… however of the women that do attempt a VBAC, 70% of these women are successful in giving birth vaginally and do not need a repeat caesarean section. Which is nothing to sneeze at, right?

Yes, a repeat caesarean section is a decision that is solely that of the couple after an informed conversation with their health practitioner, and fabulous advancements in research now mean that babies are not separated from their mamas (health of mum and bub permitting) and there are things like seeding available for women (vaginal microbes wiped onto babies as they are born via caesarean so to simulate as best possible the antimicrobial goodness bubs receive from the birth canal) and skin-to-skin and breastfeeding support happening in theatres and recovery; facilitating the mother-infant dyad.

But if you’re a low risk, healthy mama, and want the option of a VBAC, and want to know more, continue reading!
It’s a conversation worth having antenatally with your midwife or obstetrician!

Benefits of a VBAC?

Greater chance of uncomplicated births in the future
Recovery is a lot quicker – due to no abdominal surgery
Reduced risk of blot clots
Skin-to-skin, mother-infant bonding, breastfeeding etc. may be established quicker.
Shorter stay in hospital

Risks of a VBAC?

uterine rupture may occur. Statistics are about 1 in 200 VBAC’s there will be a uterine rupture (the scale of which varies drastically from slight rupture to the uterus opening up completely…which is very much cause for concern and can have dire outcomes).
“In terms of the baby’s safety, guidelines on VBAC just released by the United Kingdom’s Royal College of Obstetricians and Gynaecologists (RCOG) state that the risk of a baby dying during labour and birth is extremely low and is similar to the risk for women having their first baby”(Hannah Dahlen).

Do VBAC outcomes differ based on hospital setting?

Some hospitals in Australia offer VBAC programs for mothers that have had 1 caesarean section…other hospitals have programs that offer women the option of a VBAC after 2 caesarean sections.

Does a VBAC mean I have to labour differently?

Continuous cardiotocograph monitoring (CTG) may be implemented to keep a close eye of the wellbeing of bub. Protocols may vary from hospital, state, obstetrician etc., so this is a good question to ask your midwife of doctor so you know what to expect.

So if you’ve had a previous caesarean section and are unsure as to your personal situation and your options, asking lots of questions to you midwife or obstetrician, and regardless of whether you choose to try for a VBAC or choose an elective caesarean, just asking questions helps to make informed decisions.

Image via Hannah Tallo of a VBAC mama
Resource: hyperlinked article (first paragraph) The Conversation, Hannah Dahlen

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