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.

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