Sunday, 30 October 2011

A sad day for birth

I have had two Caesarean Sections and, particularly with the second, I am glad that that operation is there.  However, today I feel is a sad day for birth.  Women are now to be told that they have the right to a Caesarean Section, whether medically indicated or not.

Why does this make me sad?  Well it's simple really.  We were made to birth.  We carry our babies throughout their gestation and then we birth them.  More and more we are being told that women aren't able to birth their own babies.  Our bodies aren't strong enough, clever enough, intuitive enough, big enough, small enough, perfect enough for us to give birth.  Who can help save us, the helpless woman, to do the thing that we have done for millennia, since the dawn of time?  Doctors.  Doctors who train to save our lives and to spot and stop problems.  They don't always succeed, but they give it a good go and on the whole are mighty successful.  Our lovely midwives that know and recognise normal birth are being sidelined.  Why have a midwife when you can have an Obstetric Nurse? 

Birth has been slowly, slowly drawn into the medical sphere.  Out of the home and into the hospital.  We all know or have heard someone say "if I hadn't have been in hospital, my baby would have died!", and there are some of us who wonder, why it got to that point and what happened in the run up to the lifesaving situation.  I know that I'm not the only one wondering how the caesarean rate has climbed to 25%.  Surely it can't be true that 25% of women are unable to birth their babies vaginally.

My firstborn was born via Caesarean section.  He was due mid December and it had never occurred to me that being so close to the Christmas season this would make his birth date inconvenient.  I was told that I would be induced on 15th December.  Four days past his EDD (Estimated Due Date).  I was young and uninformed.  So when I woke on the morning of 15th December at 7.15am and felt the beginnings of labour, I high-tailed it into hospital.  One brutal VE (Vaginal Exam) later and the Midwife pronounced that I was only half a centimetre and that I had no reason to say I was in pain.  She read through my notes and said, "Oh, I see we're inducing you today.  I will get the pessary."  My young, foolish, 'uneducated in the ways of birth' self simply waited for her to do what needed to be done.  I didn't know that I had gone to the hospital far too soon.  I didn't know that I was within my rights to refuse an induction.  I didn't know the risks or how it might not benefit me and my baby.  Another brutal insertion and the pessary was in.  I was told to stop making a noise and abandoned in the antenatal ward.  Now this isn't about how my first birth experience scarred me etc, but this is about how lack of information led me towards a major, surgical operation.  When I finally hit active labour I was told that I would need an epidural.  So I agreed, but my baby didn't like it.  His heart rate dropped and suddenly I was being wheeled into theatre to have an operation.  I lost 2L of blood during that operation.  How does that happen?  This is a safe operation.  I never lost that amount of blood with my vaginal births.  I had a blood transfusion and now, almost 20 years later, I am unable to donate blood.

Was I unable to birth my baby vaginally, or had mitigating factors prevented me?

The Wee Weapons (my twins) were born by Caesarean Section.  They were a transverse lie which meant that a vaginal birth was off the table.

So I'm grateful that there was the option to birth my babies safely. I truly am, but this doesn't stop this feeling of dread and sadness I have in learning that women can routinely choose a Caesarean Section.  My mind can't help but skip back to the doctor who told me that he was going to America to learn how to do a tummy tuck at the same time as a Caesarean.  Nor can I forget the risk factor and I hope that these women are being told the risks and making decisions with informed consent.

Ultimately, however we decide to birth our babies, there is no right or wrong way.  We make decisions, we forgive ourselves if it doesn't turn out the way that we had hoped, or if we were led 'the wrong way'.

Tuesday, 11 October 2011

4:4:1 (part 2)

Birth three came out of nowhere.  Having barely recovered from births one and two, I was looking foward to a bit of down time before the next of my ladies laboured.

I was on my way home at about 9pm on Thursday.  I was tired and hungry, and looking forward to communing with my bed.  It was not to be.

Lady Three had attended my antenatal classes for multiples three years ago.  That birth had ended as a caesarean section, so for this next baby she had a caesarean booked.  She had had talks with her consultant who advised her that whilst it was 50/50 having a VBAC, as an older mum (41), a section would be safer.  It also helped her and her husband to plan, as he travelled a lot and they were able to ensure that his work commitments left him free for the birth. 

I arrived at hospital three to find my lady contracting nicely and using gas n air.  She was in a state of semi-panic, understandable really.  Baby Three was just over five weeks early.  Suddenly, all their plans had gone out of the window.  They had gotten off of a long flight from New Zealand and on arriving home her waters had gone.  Here she was contracting and yet she didn't know whether she wanted to proceed with the caesarean or go for a VBAC.  It's not my role to advise, but she badly wanted me to advise her.  So I simply said, "You are doing beautifully, darling.  What do you want to do?" A lovely registrar came in and asked what she wanted to do.  The midwife (lovely as she was) assumed she would proceed with the section and was prepared to get things moving.  The registrar explained how she positively encouraged VBACs and because my lady was doing so well, she said that she was happy to support her whatever her decision.  The registrar and midwife left.  Lady Three asked me what I thought.  I said that the registrar was right and that she could stop it at any time and request a section.  Mum looked to Dad, they both took on a look of excitement.  "We're doing this.  We're really doing this!"  

The gas n air was a godsend.  Mum was 2cm dilated.  The midwife was keen for Mum to take on some Diamorphine but neither Mum nor Dad wanted anything that would cross the placenta to the baby.  The registrar was keen that she didn't get an epidural too early and the decision was taken to give another internal exam in four hours and review.  Dad and I worked hard distracting Mum from the slow turn of the clock. She was convinced that we were lying to her and told us in no uncertain terms that she wouldn't be able to cope for eighteen hours with this level of pain.  She wanted her epidural and the midwife had better not be late with the exam.  

As the fourth hour ended the midwife came back and gave my lady a second vaginal exam.  She was 6cm but, for a moment, the midwife thought that she was fully dilated.  My lady was filled with joy, she could have her epidural.  The midwife left the room and my lady said, "I'm pushing!"  I looked and she was.  I pressed the call button and the midwife came back.  She saw no evidence of pushing, but called for another midwife and a birthing pack.  As she left the room I saw gaping and the first signs on a head beginning to emerge.  Mum was in shock. She couldn't believe that she was pushing out a baby.  Dad was over the moon with joy.  "She's doing it!  My girl is doing it!"

A beautiful baby girl was breathed into the world.  Mum's first words.. "I knew you wouldn't let me have an epidural" and then she kissed her daughter and the joy that filled the labour room was amazing.  A planned section that ended as a surprise VBAC!

Lady Four had been showing signs of going into labour for a few days.  Things went off and she waited for me to be less busy.  Got to love a client like that.

On Saturday night, I fell into bed, late.  I had meant to sleep earlier but the previous three births had messed with my sleep patterns somewhat.  As I slipped into deep sleep the phone rang. I had had texts from her over the days running up to her labour so I was expecting the call. I spoke to her husband who told me that her contractions were coming every three minutes.  I got into a cab and headed over. It was 1.00am.  She was contracting nicely but there was no need to move to hospital.  I left her and her husband together and I went to bed in the spare room.  Eventually her contractions built and I stood with her whilst she laboured.  She found it hard to have her husband beside her and so he busied himself with other things and I waited with her.  Soon it was time to go.  When the taxi arrived the driver told him that he didn't take labouring women and that an ambulance needed to be called.  I stepped forward and put on my mother of five voice. "This lady is fine.  She will NOT give birth in your cab.  I travel with women to hospital all the time.  An ambulance will NOT come." I turned to Dad and asked him to put their stuff in the cab, collected Mum and we set off.

We arrived in the birthing centre.  It was a quiet night and so my lady got the pool room.  She had been assessed in triage and found to be 6-7cm dilated.  Wonderful progress.  She didn't get on with the TENs machine and so had progressed nicely alone.  Unfortunately the Midwife hadn't had any training with waterbirths and went off to find someone who had.  Meanwhile my Lady was contracting continually and eventually put herself into the pool.  When the midwife came back she tried to hint that it would be better if she were out of the pool.  After a while the triage midwife came in to take over.  She had a lot of experience.  She was a calm and quietly spoken midwife who told the initial midwife that talking wasn't necessary and that sometimes the best thing was to remain silent.

By the time the shift changed at 8.30am my lady was making involuntary pushes.  Two calm and confident midwives took over and all was well.  Sadly my lady was too tired and after an hour and a half pushing, the baby was really low and sitting in the mouth of the vagina, but despite her best efforts, my lady couldn't push hard enough to get her baby out.  The baby's heart rate began dropping and we were moved across the hall to the labour ward.  There, a lovely doctor came in and after speaking calmly to my lady told her about ventouse and forceps.  The doctor decided to go for a ventouse delivery and gave my lady an episiotomy.  In less than three minutes, her daughter was out.  My poor lady was convinced that she was a failure, something that the doctor and I were at pains to refute.

She found it hard to have her husband there, though she wanted and needed him there.  She found the experience too intense whilst looking at him, but he was everything that she wanted.  A strong, silent support.

Four births, four hospitals, two boys, two girls, four very different birthing experiences and one very tired but supremely happy doula.

4:4:1 (part 1)

No, it's not a football formation!  It is the interesting week that I have just had.  4 births, 4 hospitals and all in 1 week. 4:4:1.

Now, I know that I'm a busy doula, but this wasn't the kind of busy I had envisaged!  What the week has reminded me of is the very different birthing experiences women have.

Take 4 hospitals.  The way that the individual hospitals treat women play quite a role in the way these women birth.  Of course within the hospitals are the individual doctors and midwives.  There will always be the ones that give you pause and the ones you want to praise to the heavens. 

So, a quick look back at the week I didn't see coming.

Birth one.  Considered an older mum and therefore high risk.  A history of surgery, including back surgery.  High risk.   A fuller figured woman.  High risk.  The birth centre said that they couldn't take her, but they did promise to bring the birthing centre to the labour ward.  They were happy to move beds, balls and equipment.  A lovely compromise.

This was a woman who made sure that she was informed.  She did her research, changed her mind about a few things that she thought she wanted and went into her birth prepared.  Having an epidural wasn't a preferred option because of her back surgeries and so she opted to use remifentanil which is something that I had never seen in action before.  She was able to self-medicate as there was a timed, limited dose release.  This came in handy when baby boy decided that he wanted to stay inside a little longer than most.  This birth was an induced birth, something that my first lady hadn't wanted, but she felt that it was the right thing to do.  

It was a long long labour.  Baby boy was clearly content where he was.  The pessary gel worked up until a point, but the contractions failed to build and remain steady.  So the next step was syntocinon.  This was hard for my lady.  So she stepped up the pain management and began using the remifentanil.  In the end, baby boy wasn't in the best position for birth and both he and mum were getting tired.  So birth one ended as a caesarean section.  

Birth two came along two days after birth one.  Another baby that decided to ignore all mention of estimated due dates.  Mum asked me if I would visit her in the circus.  She would be the 'Woman pregnant forever'. I promised to take the children and to feed her popcorn.  

She refused sweeps, though as she approached 42 weeks she began to become tempted.  Perhaps the stint in the circus wasn't what it was cracked up to be.  She was in a different hospital to Lady One.  This second hospital didn't have the best of reputations, but there had been a change in staff and things were turning around.  Lady Two was grateful to hear this and no longer worried about the care that she would get.  This was a second baby for her.  The first was an induction that spiralled down the intervention path.  She was desperate to avoid this for the second birth. 

We made a plan to meet for coffee and sinfully good cake on the Wednesday to talk through her options.  She would be 42 weeks on the Friday.  I think it was a conspiracy to keep me from cake.  She went into labour on the Tuesday.  Her contractions started but they were spaced out.  After hours of labour she called the hospital who advised her to go in as she was post dates.  She went in and called me to join her and her husband.  She apologised for probably calling me in too soon.  She laboured beautifully and her husband was great support. We ate chocolate and waited.  She didn't progress beyond 4cm.  Things were moving slowly.  The decision was taken to break her waters.  She knew from past experience that it would make her contractions stronger and she wanted to be sure that she had her pain management on board.  She agreed to an epidural, but she wasn't happy that she'd made that decision.  She had been managing well with a TENs machine, until she dropped it, twice.  It gave up the ghost and so she, together with her husband, spent the next half an hour calling all the local department stores to see if she could get another one.  

We talked through the pros and cons of the epidural.  The biggest pro was that she would get some sleep.  She had not slept for at least 20 hours and she was seriously flagging.  A tired mum doesn't tend to labour well.  As she slept, the contractions built and did their work.  She made steady progress until finally she was fully dilated.  She was told that the Midwife would wait an hour before getting her to push.  Fortunately the epidural was just beginning to wear off as she got to the pushing stage and so she was able to feel her body enough to send her baby down.  A very very gentle Midwife encouraged her pushing.  Suddenly it was 8am and there was about to be a shift change.  The incoming Midwife caused Lady Two some panic because she began shouting "hold your breath, put your chin on your chest and PUSSSSSSSSSSSSSSSSH!"  "No!" replied my lady and continued to breathe her baby down.  I was so proud of her.  Her son was born shortly afterwards.  She was so proud of herself for not having the same birth that she had with her first.

Friday, 7 October 2011

Nip and tuck

I'm not really sure how to write this blog post today.  I'm a little tired from doing 3 births in less than 1 week with another gently brewing in the background, but I have to share my conversation with a doctor who was stitching up my client (lovely birth, small tear).  Or maybe it would be easier to bullet point his comments and leave you to stare in shock or scream at the screen.

  • Women should only have one or two babies, especially if they are planning to have caesareans
  • Women shouldn't get pregnant.  It is an awful thing to be pregnant.
  • My wife and I have one child.  I don't think that she should have any more babies.
  • Midwives don't know how to stitch up vaginal tears very well.  It should be left to doctors.
  • Women's bodies aren't very good at giving birth.  They need our interventions. 
  • That said, one intervention leads to another so don't pretend to do it naturally if you want to let us break your waters.
  • I don't understand why any woman would have more than one child.
  • I'm planning on studying in America for a year so that I can learn to do a tummy tuck at the same time as a caesarean.

My lady, her husband and I all stood open mouthed as he spoke.  I told him that I couldn't wait to see him in a few years and hoped that when I did, he had four children.  We don't think he likes daughters.  Is it wicked to hope he has girl triplets? (The answer to that by the way is, YES, wicked to the daughters)

With my mum and my children (of which I appear to have too many eh Doc?)