Hospital-land birth – Guest post from Morag

Newborn child, seconds after birth. The umbili...

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On Monday 4 December 2000, I had my second son Tom at Maidstone Hospital. His was not a planned hospital birth, as we had intended a home waterbirth, as I had for Bob two years previously.

My community midwife is called Gwyn, and it is entirely due to her that I have had two excellent births, even though the second did not go to our original plan.
I have complete and utter confidence in Gwyn’s judgement, and so when she suggested a growth scan at week 38 and week 40 because the baby appeared not to be getting any longer, I did so willingly. She knew how strongly I felt about being in control of the birth process (hence the home births), and I know she would not have asked for a scan without very good reasons.

While I was at the hospital on Thursday 30 November, I saw the consultant as well. Although the radiographer had made a point of saying how good the umbilical blood flow was and that the slight apparent weight loss could well be due to inter observer error, I fully understand the consultant’s reasons for wanting me to deliver in hospital.

The last thing I wanted was an emergency transfer to hospital part way through labour. I did, however, insist on delaying the induction (which she wanted in the next day or two) until I had had a chance to talk to Gwyn. In the meantime I had a CTG which showed not just good but excellent results (as the experienced midwife who took it made a point of saying).

I had been feeling very close to going into labour for the previous week anyway, and hoped that a few days’ grace would enable me to avoid an induction.

On Thursday I spoke to Gwyn and we agreed that I should have daily CTGs over the weekend to monitor the situation, with a view to induction on Monday if I had not gone into labour spontaneously by then. I was then going to have a domino delivery (in with my own midwife then straight out after the birth), which Gwyn would do, despite the fact that she was technically on holiday.

We both felt that while the baby’s apparent size gave cause for concern (my first had been 8lbs 1oz and this one appeared to be 5lbs), the umbilical blood flow was good, the CTG was excellent, my blood pressure was normal and the baby showed no signs of being anything other than perfectly content. As Gwyn was unable to get hold of the consultant for her to confirm this course of action as acceptable, I was to attend fetal assessment on Friday for the CTG and then speak to the doctor on duty.

This is what I did and on Friday saw the registrar after another good CTG. When she turned up, she seemed quite uninterested in why I was there, and was all ready to do an internal followed by an induction. She even said to me “I don’t understand what is going on, but I’ll do an internal and then induce you”.

Had I not been as well informed on my own pregnancy as I was (or a less assertive kind of person!), there is no doubt that I would have been induced there and then. However, I explained to her that the whole point of talking to her was to obtain her consent to delay the induction until Monday, which she then gave, although she was pretty put out, I think!

On both Saturday and Sunday, I had more good CTGs, which I felt confirmed Gwyn’s view that this was simply a small baby. On Sunday evening I went in overnight with a view to having a Prostin the next morning. The Sunday evening CTG was also good.

The next morning, I was given a Prostin at 7am and immediately started having contractions about 10 minutes apart, as the CTG showed. It seemed clear to me that I had just needed something to kick start the labour.

The same registrar as before came around about 9am and informed me that she planned to give another Prostin at midday, reassess and break my waters “if possible”. Since not having my waters broken unless medically essential was a major part of my birth plan, and given the fact that I was clearly in labour by then, I failed to understand why she should have thought either of these steps were necessary. It seemed to me more like that was her usual “modus operandus” rather than a consideration of my particular circumstances. I also made it clear that as I was now in labour, in my opinion my care was now to be taken over by my own midwife. I don’t think I made a friend, shall we say.

I made a point of seeing the midwifery sister on duty after the registrar had gone, to stress to her that Gwyn was coming in to take over my case, and she was very helpful and understanding. Overall, I found the midwives to be very helpful and sympathetic to my wish to have as natural and non-interventionist a labour as possible. I only wish I could say the same about the registrar.

I went for a walk around the hospital as my contractions started to get stronger and closer. I was in reception waiting for my husband at 10.30, and we had a cup of tea before making our way back up to the labour ward about 11am. By this time, the contractions were getting to be about 5 minutes apart, and I had not been able to get through to my midwife – the phone was constantly engaged.

We hung around for another 3/4 hour or so, with Brian happily reading the Sunday papers from the day before, while I wandered around the bed, occasionally pressing against the bed frame or on all fours resting my head on the cool floor (I had seen it being cleaned a few minutes’ earlier, but wouldn’t really have cared if it had not been!) while pressing hard against the floor with my hands when the contractions came.

The other people in the ward must have thought us a very strange sight, but I was busy dealing with the contractions while Brian knew better than to try to help! I can’t imagine anything worse than just lying in bed waiting for the next contraction, which was what the woman in the bed by the window did.

I was wandering around in just a T shirt and knickers, but my husband suggested a longer nightie would be more decorous (as if I cared … if wandering around in the nude would have helped, I’d have done that without a second thought!). So on went the long T shirt, so my visits to the phone would not cause offence. Still engaged. I was starting to get worried that Gwyn was going to miss the delivery after all.

By 11.30, I had still not been able to get through, so I sent Brian off to find her. It turns out that the kitten had knocked the upstairs phone off the hook, and Gwyn herself had been thinking it strange not to have heard from me yet…

Eventually, she arrived at 12.30, so I marched up as she entered the room and said “right, let’s get the pool filled”. She then told me she had been told by the registrar I was not allowed to have the waterbirth I wanted, and that I was to be monitored during my labour. She did not comment on either of these constraints, but I have to say I did feel (possibly not entirely rationally, given that I was in labour) that the registrar was deliberately trying to deny me the labour I wanted.

Well, if that was the way it was, so be it – time to get the gas and air going, and fast. I bet not many midwives get frogmarched into the delivery suite!

Anyway, I believe that in Gwyn’s personal judgement there was no need for either of these two constraints, even if we needed to compromise and get out of the water for delivery itself. It was only many months later that I realised I could have insisted on a waterbirth and no monitoring just by accepting the words “against medical advice” in my book. But to do that I would have had to have been pretty certain about Gwyn’s own judgement, which I could not be as she was unable to tell me. If only we had thought to work out a secret signalling system!

I got onto the bed (kneeling against the pillows) and got down to having contractions. It was 12.35, and things moved pretty quickly after that. My notes make pretty funny reading, as my second stage happened so fast: only 4 minutes from thinking of pushing to baby boy in hand. Just as Gwyn stepped away to put gloves on to do an internal, to check if I was ready to push, I decided to go for it: she literally caught Tom on the way out, still with his waters round him. It was 1.46pm.

Afterwards Brian made me laugh (very difficult while breastfeeding a newborn) by saying that the last time he had seen a similar sight was on Crimewatch (as he did an impression of a burglar in a stocking). Anyway, I’m sure it helped Tom to slip out easily, as I had only a tiny tear with no bleeding, and no stitches were needed. He came out so clean, he didn’t even need a wash, which was fine by me.

Ironically, despite all the fears about his size, he was 6lbs 1oz at birth, not the predicted 5lbs. With the benefit of hindsight, my midwife would have been happy to do a home waterbirth, had we known it was all going to go so easily and that the baby would be a reasonable size. But hindsight is a marvellous thing, and she made the decision she felt was best at the time.

Unlike his older brother, Tom took to breastfeeding with great gusto straight away, and fed for an hour (ouch!) within an hour of being born. After that, I had a shower, got dressed and the two of us went for a chat with the midwives on duty. Trust me to start talking nappies at the earliest possible opportunity!

I was supposed to stay in 6 hours after the birth, but wanted to get home as soon as possible. Gwyn spoke to the paediatrician, and he agreed to come round early and discharge me, so I was allowed home after 4 hours (having twiddled my thumbs for what seemed ages).

Daddy, older brother Bob and Nanny all came to collect me, and we all went home together – I was pleased to avoid the scenario of Bob coming to see us and leaving Mummy and the new baby behind, because I felt that this would encourage sibling jealousy. Instead, he adapted to Tom very well from the moment he first saw him.

I fully trusted my midwife’s judgement based on her 20+ years of experience and the understanding we have built up over the last three years. She would never have taken any decision that would have posed a risk to my baby, and I felt fully confident in her care. And yet, because of medical hierarchy, her right to make appropriate decisions was removed from her by someone who had no knowledge of my case and who appeared to have even less interest in it. Had we been in a home birth situation, that would not have happened.

I found it very interesting that there were three other deliveries while I was in hospital, and every one of these turned out to be an “emergency” caesarian.

While I was in labour, my baby’s baseline was comparatively low (although accelerating well and very consistent). At one point, as he passed through the pelvis, his heartbeat dropped momentarily to about 90 but picked up as soon as he was through. Although Gwyn did take the precaution (to cover herself) of conferring on the baseline with another experienced midwife, she was happy that neither of these two “anomalies” represented a risk to the baby. I was aware of both during my labour and fully trusted her decision.

However, I do believe that I too would have been an emergency C-section had any other midwife been attending me that day, because there is no doubt in my mind that that would have been the call the registrar would have made if she had been asked to comment.

To my mind, nothing beats the knowledge of the experienced midwife who knows your case and is confident enough to treat birth as a natural process rather than a medical event.

It is exactly for this reason that I fully support the plans to change our local maternity unit to a midwife-led unit, as long as there are acute facilities available elsewhere in the hospital for genuine emergencies. What a move to a midwife-led unit will do is restore to midwives a sense of control over the births they are responsible for without someone undermining their medical judgement.

I believe the rate of intervention will drop enormously, and maybe birth will once again be treated as a natural process in which the mother can take an active and informed part, rather than as some kind of medical procedure where all a woman can do is lie on a bed and wait to be handed drugs etc.

Overall, it was a useful experience to be able to compare a hospital birth with a home birth, although there is no doubt in my mind which I prefer! And I do feel strongly that the attitude you take to giving birth, especially as regards feeling in control throughout the whole process, has a huge influence on the outcome.

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  • Jo

    Hi – well you did it and that’s the major thing! It’s a real roller coaster isnt’ it. I speak as a mum of 4, 2 births induced, 2 at home (the last one the midwife didn’t even turn up!) and what i have learned is that you can do exactly what you want despite what they say, you can refuse induction dates, refuse to take thier iron tablets if you don’t think you need them, refuse their blood tests etc. onthe other hand circs will naturally dictae the course of events, what i mean by this is that you are often not in a postition to communicate effectively esp if you’re on all fours panting during labour! however if your baseline is not having waters broken or whatever you can try and find a path of passive’s only afterwards that you think “hang on a minute that shoudln’t have happened” but it’s essentially a human experience and even the peopel dealing with you are just humans having good or bad days….

  • Morag Gaherty

    You are so right, Jo, that circumstances will naturally dictate the course of events. Any form of intervention is – very often – the start of a slippery slope which can lead to a C section. On the other hand, I’m also reminded of women who make a birth plan with their partner which demands a natural birth at all costs … and then their partner piously tries to refuse drugs etc when they are begging for them! (My husband knew better than to try and take charge, but would have supported me if he felt I was being browbeaten).

    My birth with Tom (above) went nothing like the planned relaxed home waterbirth I had had with Bob two years previously. But we went with the changed situation, still retaining control by keeping our supportive midwife with us. And that’s the thing: retaining a feeling of control. As a result, Tom’s birth wasn’t as I’d have chosen it to be, but it was still a positive and life-affirming experience, about as good a hospital birth as you could hope for.

  • Morag Gaherty

    If you’re interested, do a search on here for waterbirth and my experience of delivering Bob (in two parts) comes up.

  • Jo

    Hi Morag – interesting isn’t it. I had a similar experience back in 1997. I still think – having had more recent births – you often get treated like a number, i remember being convinced that one of the midwives who found me crying in the corner of a private room (they’d sent my husband home as it was outside visiting hours adn i was suffering those “induction” contractions) – that she was taking notes on me as she “listened” to me moaning. turns out she was doing a sudoku!! agh. anyway no more kids. xx Jo

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