Positive High Risk / Induced Birth

THE BIRTH OF JACK.

When I had my daughter Evelyn 2.5 years ago, I was classed as 'High Risk' due to a raised BMI, slightly higher than the 'recommended allowed level' for a non labour ward / consultant led birth & my age being above 35. Due to this it was procedure for me to birth on the consultant led labour ward, however I really wanted to be in the birth centre environment for personal reasons. Evelyn had tracked the 50th percentile throughout & her birth went really well, with me being induced at 40+14 with the pessary. I used the hypnobirthing tools I had learned in an audio book along with a few pain killers and a little gas and air at the end. I had to be admitted to be induced and remained there until delivery, but we did get permission to birth in the birth centre, as long as there were no complications and my waters broke with the pessary. However, on the day of induction my husband and I had to push to be 'checked' to be able to transfer to the birth centre as they didn't think from my responses that I was actually in labour, stating I was 'too calm,’ when I was finally checked I was over 6cm. For some reason the permission we had been given for the birth centre hadn't been documented on my notes, so we had to fight in the middle of established labour to follow the original plan. Thankfully a lovely midwife agreed to take us to the birth centre but once there I didn't have chance to even be checked or get into the pool as it all happened very quickly and I started to bare down, I ended up laid on my back / in a W position leaning back on my husband for the whole of the last stage, which wasn't actually very comfortable. I had a small tear and graze but regardless I was so proud of myself and happy that I got to where I wanted to be & Evelyn was a healthy 8lb 2oz.

With this pregnancy I decided to do an actual hypnobirthing course to see if I could arm myself with more skills and knowledge to be able to advocate for myself, especially due to the pandemic, my husband Simon joined me on the course. I wanted to be able to go into labour at home and then go to the birth centre at the last second this time and I really wanted to try a water birth if I could. Again I had the same risk factors, only this time I was slightly older at 38. I was so empowered all the way through and my hypnobirthing instructor Hannah helped me put down on paper my BRAIN analysis for my decisions and I printed them out and took them to every appointment. I actually found everyone really accepting of my wishes and needs, likely due to my confidence, and I made sure all medical people documented permissions for things on my notes.

Baby was being classed as 'big' throughout my pregnancy, people were advising we take steps to bring him early from 37 weeks and at one point I agreed to a few stretch and sweeps, but I bled as a result from one of them which saw me have a nights monitoring in hospital. From there, we continued to check our facts and requested to keep going as we were without intervention, until at least our due date, other than being big there were no actual concerns for either of us.

On 20.06.21 it was our due date and also father's day. My daughter and I gave Daddy his gifts and card and had a lovely family day filled with oxytocin.

On 21.06.21 it was our 7 year wedding anniversary. We let Evelyn sleep in and then took her to nursery after breakfast together. We exchanged cards as Simon was working at home. We had builders in finishing our new ensuite, they had been there for quite a few weeks, well since I had finished for maternity and I was convinced baby would likely come once they had gone & I had privacy aound the house. I did my best to relax & when we collected Evelyn I had extended cuddles with her before bed and we watched videos of when she was a baby. Evelyn blew raspberries on my baby bump & told me baby was going to 'come down the slide' soon (no idea where she got this from).

On 22.06.21 (40+2) we dropped Evelyn at nursery and went for our growth scan and to see the consultant for the last time. This scan confirmed that baby was still tracking the 90th percentile, with some areas in the 97th, with a predicted weight of 9lb 8oz. After consideration of all the facts, we agreed that I would stick to induction the following day (40+3) so I could remain within the permissions of going to the birth centre. Having said this, I explained my BRAIN analogy as to why being at home would be better for me and baby and how I wanted the option to go home after the pessary induction this time and not have to sit on a ward / in triage. To my suprise the consultant agreed, which showed that it's sometimes just a case of asking and being confident with what you know is right for you. I'm so glad my husband prompted me to do this as the 'usual process' would be to be admitted, so it shows that 'process' doesn't have to be the case all of the time.

That night my husband took Evelyn to sleep at her Grandparents. Simon told the builders not to come the next day and that evening he suggested that I watch the Friends Reunion I had been saving for 'labour day' to help me relax, he felt it would release positive emotions & take my mind off thinking too much around the 'what if,’ he was right. I did this whilst bouncing on my ball & also felt the need to do bits of sorting / cleaning in our bedroom in preparation for baby coming home. My husband and I laughed a lot and I went to sleep whilst listening to the fear release track with Hannah’s voice which made me feel more confident and reassured.

The next day (23.06.21) I got a call from the hospital and went for the pessary inserting at 12pm & covid tests. The midwife had a small discussion with us about me being 'outside of the guidelines' for this kind of thing and that really I should have been admitted, but she was nice about it and seemed to respect that I had researched everything and had a detailed plan & permission from the consultant and head of the birth centre which I again made sure was clear on my notes.

I was slightly uncomfortable when they put the pessary in but this was due to my pelvic gurdle pain and having to lay on my right side for 30 minutes, which I had found difficult to do for several months up to this point. I used this as an opportunity to practice my breathing and get myself in a zone. This worked well and soon they were shouting through the curtain that I could go home. The plan was to go to hospital at 12pm the following day if I didn't start with contractions or my waters hadn’t broken and they would discuss next steps. I was informed that it could be a very long process and may require more than one pessary attempt. I stayed positive in the fact that my waters broke with my daughter after just 8 hours with the pessary in and I manifested that it would be similar this time.

We went to get my favourite sandwich wrap on the way home and once home my husband suggested a nap, which I did whilst listening to the fear release track again. I was woken up at 3.30pm to a facetime from my daughter where Grandad had asked me to translate what 'pop pop' means... this is what she calls her comfort blanket and it was nice to see her being comforted and happy. I bounced on my ball for a while and then had a bath with a candle & listened to my birth affirmation tracks. I then realised my pessary had fallen out.

I was having some tightenings but I'd been having them for weeks so wasn't sure it meant anything. Simon suggested calling the hospital, so I called them from the bath as I was comfortable. They said to come in and prepare to wait to be seen, they would check to see if the pessary had done anything to my cervix. As I was on the phone to them (about 4.30pm) I had two really big tightnings and Simon commented that they seemed different, unbeknown to me he was timing them and they were 6 minutes apart. The hospital said this was a result of hormone from the pessary and not to rush. As I put the phone down I had another, again 6 minutes later. Simon suggested we just head straight out to the hospital / birth centre but I wanted to have a wash and do my hair incase they kept me in, which I was convinced they would try and do and got a bit teary and irrational. I didn’t realise at the time, but this was likely due to a quick change in progression. Simon helped me pull myself together with kind & positive words. The tightening grew more intense so I had a quick wash and got out of the shower whilst concentrating on my breathing. Luckily all the bags were already in the car and we set off.

We had a 30 minute drive to Pinderfields hospital in rush hour traffic to complete. Someone was looking down on us as we didn't get stuck in traffic. I had my eyes closed the whole journey, I was listening to meditation music and practising my breathing whilst Simon was verbally telling me positive affirmations all the way and also repeating funny stories from what our daughter had said and done recently. The surges continued to intensify throughout but I was managing well with my breathing and counting and positive thinking. By the time we arrived my surges were 3 minutes apart. Simon dropped me at the main entrance and went to park the car.

I walked through the packed hospital having surges every 3 minutes and now doing some sort of primal noise on my out breath (Simon said it was like a bulls mating call), I just went with it rather than over thinking as it’s what my body was naturally doing. I lent on whatever was near me each time I had a surge and closed my eyes and did what I needed, imagining that I was the only one there! I even lent on the bar stool of a table at the cafe where people were having their coffees and just chose not to look up or make eye contact. Two people came up to me with wheel chairs to help, but I knew I couldn't sit down as all the sensations were in my bum and lower back so I just kept walking.

By the time I made it to the doors of the maternity unit / birth centre, Simon was running down the hall to me with the main bag that had the hypnobirthing tools in it which was a relief for me to see. When we pressed the buzzer the midwives wouldn't let us in as there was a wait and we had to stand in the hall as they were so busy in triage. At this point my surges had ramped up to almost 2 minutes apart and Simon told them he thought the situation had changed and we needed to be let in to the birth centre rather than triage as I was progressing quickly.

After 10 minutes of me basically mooing in the corridor every 2 minutes, Simon pressed the buzzer again and told the midwife that I was in established labour and needed to be let in. They came to the door and saw me having a surge and then another straight after before I could even say anything to them, so they just asked if I had permission to be in the birth centre and I said yes and that it was on my notes and thankfully they let Simon in with me.

We got to a room and it didn't have a pool in AGAIN, it was just one of the spare rooms, Simon asked if we would be staying in there or being transferred to a room with a pool. The midwife said she didn't know as obviously they weren't expecting us to stay so they would let us know once they knew what the situation was. Regardless of this Simon wanted me to be able to have the full experience as I had wished, so turned the lights down, sprayed my essential oil sprays (lavender for the first part and frankcinsence for later, that my dad had made for me with natural ingredients) got my comfy outfit out and put my hypnobirthing music on. I told the midwife I wanted to be checked so I knew what I was dealing with as I was starting to feel tired and felt I might need some form of pain relief soon. The midwife said they were having handover so the next midwife would be with us within half an hour and it would be best to leave it to her to check me as she would be with us for the whole time if we stayed in.

Within that half an hour my surges started coming every minute, I asked for the gas and air which was a MASSIVE relief and even though my surges were very intense, I was able to use the gas and air tube to help me concentrate on my breathing. Simon kept encouraging me to sip water.

My husband tried counter pressure on my lower back which had helped in my first birth, but this time it didn't, so he switched to the soft touch massage on my arms and that worked well. He also danced with me in-between the surges to help me stay on my feet and the swaying motion and leaning over his shoulders helped (other than our first dance at our wedding, he doesn't usually dance).

I had my eyes closed when someone came in and said 'protocol is for Kirsten to now come with us and go on the ECG machine for 30 minutes as she's had the pessary in'. I heard them but I was not shifting out of my zone, leaning on the wall with gas and air in hand breathing through very regular surges with very little break inbetwen. Simon said 'she's not going anywhere' and they tried to explain again, but Simon just repeated 'she's not going anywhere'. After observing my every minute surges I heard them reply 'yes your right, I don't think she is going anywhere is she'.

Due to not having an ECG monitor check and wanting to stay in the birth centre, Simon agreed for the hospital staff to take my blood pressure and listen in to baby with the wireless monitor.. Babys checks showed he was nice and happy and the checks were done whilst I just stood doing my thing with very little interruption, this was until the blood pressure machine came out. I just managed to say 'I can't sit down' when the staff member explained how it won't get an accurate reading if I don't sit down. Simon helped me sit on the low foam type bed that was in the room, with it being extremely uncomfortable to get down to a seated position and once down there the machine wouldn't work!! I kept feeling I needed to stand back up with every surge, which Simon helped me do and the lady kept trying to make the macine work. I heard Simon say 'it's not working' and the lady said 'well it did before, I'll try again' and after 3 or 4 attempts Simon told them I wasn't sitting back down and to get a different machine, which I was pleased with as I could feel myself progressing & coming out of my zone but I did my best to use the skills I'd learned to just keep counting my breaths and shut everyone else out.

At this point I think I was transitioning but didn't quite realise due to the distraction and when the new midwife came to introduce herself I told her I needed some other form of pain relief, 'something to take the edge off' as I was exhausted. She agreed to check me and then we could discuss what options were available. Again it was difficult trying to lay down to be checked but she then said 'your 9.5, perhaps even 10cm and your waters are just sat there with baby waiting to go, there's no pain relief to be had now, you’re having your baby'. This filled me with confidence as I was so chuffed I'd got that far, I forgot all about wanting to get in the pool and just wanted to find a comfortable position to birth in.

Simon was trying to make some suggestions of positions from our hypnobirthing course and brought the birthing ball over for me to kneel and learn on, but before I could really concentrate on what felt best, someone came in with a new blood pressure machine, so I had to try sit down again for them to take it in-between surges. Like some sort of comedy sketch the battery on the macine was low and it wouldn't work, so Simon stood me back up and continued to communicate with the hospital staff as I just concentrating on my breathing.

At this point my surges were less than a minute and I said out loud that I was 'baring down'. I had a surge one straight after the other & my waters popped all over. It was like some sort of tsunami, Simon and the midwife got absolutely drenched. I had another surge and could feel I was fully baring down / breathing baby’s head out on my out breath, the midwife quickly called for a second midwife. The midwife was trying to tell me she needed me in a better position than just stood against the wall as she couldn't see, but as she was talking I could feel baby’s head coming out and I just said 'his heads there, his heads there' and I couldn't stop baring down. The midwife began explaining why my current position wasn't good as I wasn't giving baby enough room and Simon said to the midwife 'just tell Kirsten what you need her to do' and she said 'lay down'. I couldn't sit down to lay down as babys head was half way out so I kind of body flipped onto the foam bed as the second midwife walked in. I remember thinking 'for goodness sake I'm on my back again' when I heard them say 'you need to give your baby room' and I was doing the same as I had done with my daughters labour and pushing my legs together not apart, so they took hold of my legs to help open them, as they did that I had another long baring down surge and my son was laying on the bed and then in my arms in seconds. Jack’s cord wasn't long enough to reach my chest so he laid on my belly until his cord had stopped pulsating and then Simon cut it.

Baby 'Jack' was breast feeding within about 10 minutes and I felt amazing! I cried as I was so proud of myself. He was indeed a big baby too, very long & 9lb 7oz!

From my waters breaking to Jack being born was only 2 minutes, the length of time actually on my back was very minimal and I suppose necessary at that point to help me give baby some space. He was born at 8.12pm so from my first surge at 4.30pm ish it was only 3 hours 45 minutes in total.

I did end up with a tear, the exact same one as I had with Evelyn, I had a graze but this is quite common with subsequent births and I don't think was necessarily a matter of positioning, but it could have been. This is why practicing positions is important and having a distraction free environment to do this too and even if it is distracting, having the tools to block that out.

I was so happy that I didn't have to fight anyone to get to the birth centre this time and the hypnobirthing group course definitely filled me with more confidence and knowledge to advocate on my own behalf (Simon to also advocate for me) than the audio book did the first time round. Yes I again may not have had time to move to a pool room, but even if that room had a pool, I don't think I'd have had time for them to fill it and me to get in before I gave birth.

When they brought me my toast and hot chocolate, I sent Hannah a video where I was eating my toast, turned the camera to face baby Jack and then back to me where I said 'bossed it'... and that's how I truly felt.

I had my isotonic drink to give me energy to birth the placenta without the need for the injection as I had wanted. Not many people talk about the first wee and poo after birth, but the breathing techniques helped me through that too.

Kirsten and Simon, Leeds, 2021