Saturday, 7 April 2012

When you've won the fight and the course changes

I'm very blessed to work with some really amazing women.  One of my recent ladies is one such woman.  She had a crash caesarean with her firstborn after an induction led to the hyperstimulation of her uterus.  This caused her son's foetal heart rate to plummet and she was rushed into surgery.  This was very far from her hopes and plans to have a vaginal birth.  During this pregnancy, she had done her research and knew that she wanted to be mobile during the labour and that she would trust her body and react accordingly.  She studied and practised hypnobirthing with her partner and was careful to practise optimal foetal positioning.  All of this went out of the window and there was no time or chance of a Plan B.  This baby needed to be born.  

When we met, she had very clear ideas as to how she wanted to birth this second baby.  Her plan was to have a VBAC - Vaginal Birth After Caesarean.  Now, understandably the hospital was keen that she should be aware of the risks and took the opportunity to tell her often.  Her plan was to have as natural a birth as possible, with minimal intervention. It was for this reason that, together with her partner, she decided to look for a Doula.  As soon as I met her, I knew that there would be nothing for me to say or do but be there with her.  Suggesting options, unnecessary.  Yet my role was not redundant.  I remember the email telling me that the baby was breech and that might mean a Caesarean Section, something she dearly wanted to avoid.  My first thought was Spinning Babies, but she beat me to it.  Co-incidentally, Doula UK were hosting a Spinning Babies workshop with Gail Tully just as I was due to go on call.  Doula UK were in need of a model and so my lady stepped up.  Of course within a couple of days of being told that her baby was breech, she was scanned and told that her baby was now cephalic.  She was very happy to demonstrate the different Spinning Babies techniques that she had used.  It was a wonderful workshop because being as shy as me (read that as talks plenty), she was full of information about how she used the techniques and the ways in which she had informed herself.

The reason my lady was induced for her first birth was that she had gone to 42 weeks gestation.  She comes from a family who carry their babies to 43 weeks, so we were all prepared for the long wait.  In fact I felt confident enough to book theatre tickets for plays that would be performed in her 41st week.  2 days past her EDD I got a text to say that she was feeling a few twinges, but nothing to write home about and that she was having a show.  Now I was due to go to lunch with friends the next day, and I had really been looking forward to it.  I resigned myself to the fact that I would miss it, but hey... new life was coming into the world and that makes up for everything.  I got a call around 3.30am and I went over to see how they were doing.  The contractions seemed steady  and manageable so I sent her and her partner back to bed whilst I bedded down on the couch.  They got a couple of hours rest before it all began to ramp up.  Dad went out to collect their babysitter and then we set off for the hospital. It had been agreed (after some negotiation) that my lady could use the Birth Centre.  

We arrived at hospital at 6.30am to be told that there weren't enough midwives on the Birthing Centre, but that if we were able to wait until 8am, a new shift would start and there would be the requisite number of midwives.  A vaginal exam showed her to be 2cm.  The SHO told her that she wouldn't be sent home because she was a VBAC.  8am arrived pretty quickly and we went downstairs and began to get settled in the Birth Centre.  The very lovely midwife was smiling and welcoming.  She began her observations: blood pressure check, quick read through of my lady's medical history and then left the room to get a couple of bits.  My lady went to the bathroom and when she came out she looked crushed.  Her maternity pad was stained green.  This meant that the baby had passed meconium.  That put paid to all hopes of birthing in the Birth Centre.  I smiled as my lady reminded herself that dilation wasn't linear, things could change.  We went back upstairs to the labour ward where she would need continual foetal monitoring.  The Birth Centre midwife asked if she could give a quick vaginal exam as she felt the baby was coming quickly.  My lady was found to be at 8cm.  A new midwife came in to relieve the first midwife and she was just as lovely.  By 10.15am my lady was spontaneously pushing, but for some reason she had a sudden onset of fear and seemed unable to push her baby out.  The senior midwife apologised for becoming bossy, but she knew that the baby had meconium behind it and with a dipping heart rate wanted the baby out quickly.  The doctors were called in and an episiotomy was given.  As they attempted to attach a ventouse cap, my lady pushed her daughter out herself.  The baby was followed by a flood of meconium.

Was it a successful VBAC?  Yes.  She birthed her baby vaginally.  Was the birth what she had envisioned?  No, but she was grateful for the help that the midwives and doctors had given her when all that she fought for had changed course.

Oh and for those interested... I made it to lunch :D

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