By Jane Palmer
I had wanted another child for ages, but the time never seemed right. After Joshua’s birth in 1989, I chose to study and establish my career in midwifery. By the time we decided that we should try for another child, Joshua was nine years old. I was so excited and expected that I would fall pregnant easily. You can image the disappointment when month after month my periods occurred. Ten months later the line on the pregnancy test window appeared. I did not believe it at first. I had to do the test three times before I would allow the positive result to sink in. I was bursting to tell everyone immediately, but being a whole four weeks pregnant, I tried to refrain. This lasted until I was six weeks pregnant – when I could wait no longer.
I approached my chosen midwives (and good friends) to check their availability – their excitement mirrored my own. However I had this feeling that I was not really pregnant – it was odd as I had all the symptoms, but this feeling persisted. By the time I was 12 weeks pregnant, I chided myself for being silly and started to relax. Two days later when I went to the toilet there was a honey coloured discharge on the toilet paper. This sinking, devastating feeling descended. I tried to rationalise what I saw, but I knew something was wrong. I went to bed trying to dismiss it. I did not sleep a wink. The next day I went to work in a daze. I saw one of my midwives and explained what had happened. She offered to try to find the baby’s heart beat with a doppler. She tried and tried but to no avail. I justified to myself that she couldn’t find the heart beat because it was so early in the pregnancy. I took her advise and went home and rested.
The discharge continued, I knew in my heart that the pregnancy was not to be. On the fifth day I decided to have an ultrasound – I had to know for sure what was happening. I bumped into a fabulous obstetrician as I was waiting for the ultrasound. She said if there was any problem to get the ultrasonographer to call her. I can still remember the heightened anxiety I felt as I waited my turn for the ultrasound. The ultrasonographer took 30 seconds to do the ultrasound and she looked at me and confirmed my worse fears. She explained that there was only a gestational sac and no baby present (known as a blighted ovum). I was numb. The obstetrician took me aside and told Frank and I our options. I could have a curette or wait for the pregnancy to end naturally. I chose the later. The obstetrician gave me her personal contact numbers and instructed me to call if I needed to. I informed my midwives I felt supported and safe.
I was now 13 and half weeks pregnant. I went to bed that night and said to myself ‘okay it is time to end this’. I woke in the wee hours to find the bed soaked with blood and fluid. I was experiencing abdominal cramping. I got up several times through the night and passed large blood clots in the toilet. I sent Frank to work – I needed to be alone. The bleeding continued and became heavier. I started to estimate the blood loss as it seemed excessive. I was in floods of tears. One of midwives telephoned to see how I was – we discussed what was happening. On her advise I contacted the obstetrician. The obstetrician confirmed that my blood loss seemed excessive and that a curette was advisable. The obstetrician organised my admission to hospital (without going through emergency), the theatre time and a private room on a ward where I knew the midwives. I couldn’t have asked for better care. I went to the hospital around lunch time and was home in the early evening.
The next day I felt empty. I have never cried so much in my life. Flowers arrived from my midwives – bright and cheery. I looked at them every day and drew some support. The midwives called every day to see how I was going. It was tough going but I got through it. The hardest part being when I returned to work and had to care for pregnant women and women with their babies.
We had a follow up appointment with the obstetrician. The obstetrician debriefed us on our experience, on what she found, the impact on future pregnancies and explained that we could try for another baby when we felt we wanted to. We did not have to wait. As it had taken a while to fall pregnant, I wanted to try again as soon as possible. I took vitamins and herbal preparations and tried to prepare myself emotionally for another pregnancy.
We waited one menstrual cycle before trying again. One month later, around the time when my periods were due, we were having a dinner party. I thought that I might do a pregnancy test as I wanted to drink some wine if I was not pregnant. You can imagine my surprise when the test proved positive. I was in total denial. I waited another 24 hours and then repeated the test, which was of course positive. I then told Frank – I do not think he believed me. He said to me on a couple of occasions that he felt I was not pregnant (perhaps mirroring what I felt with my previous pregnancy). I was exceptionally anxious in early pregnancy. I had continual abdominal cramping, which was quite painful. I was sure this pregnancy to would end in miscarriage. I really wasn’t emotionally ready for the pregnancy. This time I only told my midwives that I was pregnant. We delayed telling others for a while. At nine weeks pregnant I read that you can hear the baby’s heart beat with a doppler. I had never tried to listen so early on a woman before, but I thought I would try. I steeled myself in case I wasn’t able to find it. It took five seconds before I found the heart beat, regular and strong. I couldn’t believe it. It took me until I was 14 weeks pregnant before I started to relax and enjoy being pregnant. I was fit and well. I resumed my exercise program (which I had slowed down in early pregnancy). In fact I continued to do weight training at the Gym right up until just before labour started. My only concern was frequent and painful Braxton Hicks contractions that started when I was around 16 weeks pregnant. Occasionally they would come in sets and I would start to get concerned. After a while I came to realise this was just part of this pregnancy.
The care I received during pregnancy was excellent. The midwives would come to our home, which I found great due to my busy life style. We discussed many issues at great length. Frank and Joshua were both very involved. I visited the obstetrician once as a courtesy. I liked having her as a back up, in the case I needed to be transferred to hospital. She respected my decision to have a homebirth and was open to different ideas for management in the case of complications. Thankfully I did not need her services.
I squeeze a lot into my life (as those that know me would tell you). I left my work at the hospital on the Team Midwifery Program at 34 weeks, but I continued to work at home. I had a number of large projects which I tried in vain to complete before the baby arrived. I also continued with my homebirth practice and running prenatal classes. I was worried that this baby would come early, before I was ready. It got to Sunday (30/09/00) when I was 38, nearly 39, weeks pregnant and I told myself I had done enough and I was now ready if the baby wanted to be born. I felt a real change in myself. I spent time with work colleagues on the Monday night. I was feeling relaxed and happy (though quite uncomfortable from the pregnancy). I went to bed Tuesday night not feeling anything unusual. From midnight I made frequent trips to the toilet (the baby was low down on my bladder). I woke at 4.30 am to my surprise with a contraction. I thought it must have been a strong Braxton Hicks. I got up to go to the toilet yet again and another contraction came within minutes of the other. In denial, I went back to bed where the contractions continued to come at around 3 minute intervals. I couldn’t believe it. I was sure that it was all going to stop soon. The contractions were getting more painful and I couldn’t get comfortable in bed. I had a fear that this labour was going to be fast, but then I did not want to call people too early. In a minor dilemma, I decided to call Nicole one of my support people, at around 5.30 am. I knew Nicole probably had work planned for that day and if I needed her in a hurry she would have to negotiate peak hour traffic. I finally decided that this was probably real labour, so I asked Frank to get the birth pool ready. I rationalised that if everything stopped we could empty it.
At around 6 to 6.30 am I called Karen, my sister, who was going to be Joshua’s support person. I was now convinced that the contractions were here to stay. I contacted Myra, one of my midwives, just before 7 am to let her know what was happening. She said she will have breakfast and for me to call her when I wanted her to come. The contractions continued with good intensity. I paced up and down the house with my hot pack. Not wanting anyone to touch me. Myra telephone back in around one hour. Myra asked if I needed her and I said I wasn’t sure. Myra said she would come over and see how things are going. She said she can always leave it there is not a lot happening. Myra arrived just after 8 am. I was in the shower. It was great. I had privacy and the warm water really helped with the contractions.
The contractions were now coming every two minutes. I longed to hop into the birth pool but I wanted to leave it until at least I was 6 cm. I kept looking at the pool and thought this is ridiculous so I stripped off and hopped in. It was bliss. I felt as if I almost stopped having contractions. They were just like tightenings. During one of my trips to the toilet. I decided I needed to know if I was progressing, so I did my own internal. I estimated I was around 7 cm and I could feel a large bag of waters in front of the baby’s head. It was only 9 am in the morning, I was so pleased with my progress. The contractions picked up in intensity, but I felt totally relaxed between. At around 10.30 am I asked Myra to check my progress (I was actually doubting my own assessment – I imagined that I was not any where near as advanced as I felt the labour wasn’t that bad). Myra announced that I was 9 and half centimetres dilated (just an anterior lip left to go). I couldn’t believe it. I began willing my waters to break, as in my mind when this happened that baby could come soon after. I was starting to feel pressure in my bottom, but no urge to push.
The nature of the contractions then changed and I felt I was not coping with them any more. I started pushing slightly with some contractions – but still really didn’t have the urge. I had to constantly keep telling myself that I could do it, it wasn’t long to go. The pain was incredible, worse than I could possibly imagine. At 11.00 am the waters broke when I gave a decent push with one of the contractions. It was an amazing feeling. I felt the bag of waters come down into my vagina and then burst. I continued to breath through most contractions. I decided about half an hour later that I would push with the contractions as I had continual pressure in my bottom and as I was sure I was fully dilated. After a short time I felt no progress was made so I asked Cathy (my other midwife who had arrived over an hour ago) to check that the cervix had completely gone, of course it had. I was pushing with all my might, but progress seemed slow. I still did not have an urge to push. I kept checking myself for the baby’s head as I had absolutely no sense of the baby’s head moving down. It was very close now, but taking a lot of effort. I was experiencing incredible back and pubic symphysis pain. Cathy and Myra applied hot water bottle and hot towels to the area which helped some what. I was also given homeopathic remedies which also helped slightly.
Once the baby’s head reached the perineum, I just about leaped out of the pool. Who every said that you will experience a burning, stinging pain was joking. I would describe the pain as searing, tearing and excruciating. I had to mentally overcome my reaction to this pain to give birth. Cathy applied hot towels under the water to my perineum which helped me to relax slightly. The baby’s head emerged with agonising slowness. The pain became so intense I was unable to tell when I had a contraction. I asked Cathy to tell me when a contraction came so I could push with it. I cannot tell you how much relief I felt once the baby’s head was born. But then the most bizarre thing happened, the baby tried to pull itself back inside me a couple of times. It was a most violent movement. I knew in myself that the baby had emerged too slowly and there was physiological a reason for this. I also knew I was carrying a large baby. I became concerned about birthing the baby’s shoulders. I thought to myself that I should probably stand up, but the lure of the water was too strong. I then tried to open my legs as wide as possible. Myra and Frank assisted me to flex my legs backwards. I could feel Cathy trying to manoeuvrer the shoulders and I pushed with all my might – Jarred birth was difficult right up until his toes.
I can still remember the moment when I opened my eyes after giving that almighty push. There he was, my baby, under the water. I thought “I DID IT! I REALLY DID IT!”. The thrill of reaching for my baby and bringing him to the surface was overwhelming. There was no rush, I just held him and looked at him. It took me a while before I wanted to discover his sex. He was quite pale and limp at first. I rubbed him and talked to him. The cord was still pulsating and supplying him oxygen. He gradually became nice and pink, although he remained quite floppy. He was breathing nosily, so Myra gently suctioned any secretions. Jarred then received some oxygen. All the while I held him and marvelled at him.
Then the contractions started again. I was quite taken back at their intensity. I tried to push with them to birth the placenta – but it wasn’t ready to come. After about 20 minutes I was concerned that Jarred’s breathing was too fast and noisy. The umbilical cord had stopped pulsating, so I asked for the cord to be cut so he could be warmed up and have some further attention for his breathing. I also had the need to become up-right. Frank cut the cord. I then knelled up, leaning on the side of the pool and the placenta was born with the next contraction.
I was very keen at this point to get out of the pool and to dry off. A bed was made on the floor with towels and blankets, where I gratefully laid down. I needed some time out at this point as I was feeling quite shocked with the pain of the last hour or so of the labour. I asked if they would weigh and dress Jarred for me. I soon found out why his birth had been so difficult, he weighed a descent 4.3 kg (9 and a half pounds). I had quite a long tear that needed stitching (Jarred’s head was a good size as well). Once all this was done, I had a lovely hot shower and tucked up in bed with Jarred, who attached to the breast straight away and sucked contentedly.
It took a few days after the birth to feel able to review comfortably what had happened. The last hour, hour and a half of the labour took me by surprise. I feel in retrospect that body had to work very hard to be able to birth Jarred due to his size. I reviewed everything that happened and decided that there was nothing that could have been done differently. I wished that I had of birthed Jarred without the assistance I received, but I do not feel that I could have done it without that assistance. I also wished that Jarred did not have slight respiratory distress – this interfered with that initial skin to skin contact after birth. But unexpected outcomes occur. I was respected at all times and what eventuated did so with my consent. I feel birthing at home with my midwives enabled me to have a great birth experience. Outcomes would have been very different in hospital. The shoulder dystocia would have been managed, taking away my control. Jarred’s cord would have been clamped and cut quickly and him whisked away for resuscitation. Jarred would have spent the night in a special care nursery under observation (he continued to breath fast and noisily for the next 12 hours). Jarred instead spent the night in my arms being observed by me and had frequent breastfeeds.