Tuesday, 11 October 2011

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.

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