Saturday, January 21, 2006

Birth Story

This picture is not of the baby in the story - but was another one of my catches from last year. I drew baby Jozef in charcoal... this needed an illustration and he'll do just fine.

The first birth of 2006 was lovely - even though I did give me enough rope to hang myself~

I got paged at a very civilised time - about 2pm - I hadn't seen Kate* at all during this pregnancy and I didn't realise I knew her until I stepped through the door. She'd got married since her first baby and changed her name. It was lovely to see her and her husband Chris again - they've moved into a much bigger place at the top of town and their relationship is flourishing. Her first baby had been a big surprise - he has Down's syndrome and this had been missed despite all the screening, probably because she was only 21yrs at the time. Anyway, he is a lovely chap now at 3 and a half years of age though I didn't meet him on this birthday because he was at Grandma's. Kate had had a very quick birth first time round and I remember suggesting then that she ought to consider staying at home the next time. All this came flooding back as I stepped into the sitting room.

Kate looked very calm: she was contracting about once in every 10 minutes and still very chatty. I did a complete check of all her observations and was very alarmed to find the baby's heartbeat was bradycardic (much slower than normal) - thinking this might be connected to her position at the time (she was lying very flat on the sofa so I could feel her tummy and check the position of her baby) she sat up. I was muttering about cancelling the planned home birth and transferring in when the heartbeat returned to normal - and we all breathed a sigh of relief. Kate agree to have a vaginal examination just to check what was going on - good news! Her cervix was 4-5 cm dilated (though posterior) and the baby's head was very low in her pelvis (at spines or even +1, though, like many NHS midwives, I have a dreadful tendency to underestimate everything so as not to get tangled up in arbitrary time limits and policies). The baby was moving around well and I decided the umbilical cord must have been compressed and that it was OK now. But just in case we all agreed I could do a CTG (cardiotocograph monitoring) just to make sure there wasn't anything awful going on. I wouldn't hang about, but it was also agreed I would nip out and get the homebirth emergency equipment from the Community hospital (Oxygen, suction and entonox - I have everything else in my car) - drop off Syd my dog at home, bless him, so he wouldn't have to spend the next 8 hours or whatever cooped up in the car, and pick up some lunch (late lunch - it was already 3pm, but I had left over chicken and rice in the fridge). Managed to accomplish all that and get back to Kate and Chris inside half an hour - I'm tending to caution this year as I had 3 'born before arrivals' in 2005 and I don't want to get caught out again.

When I got back, Chris had prepared the room for the birth - plastic and blankets draped over the sofa, which was pushed back against a wall to make plenty of room, baby clothes and towels warming by the gas fire. The Fetal heart was still fine but we did the CTG anyway - Kate was contracting about 1:8 now, and the heart beat showed a slight deceleration with some of the contractions, but this was the only suspicious feature I could see - it was otherwise very normal and I scored it 6 out of 8 on our '5-alert' scale.

After this, Kate decided to have a bath while I discussed everything with the Labour Ward co-ordinator. I downloaded the trace to LabourWard which was a MISTAKE! A Registrar looked at it and thought a section of the recording looked sinusoidal. He thought Kate ought to transfer in for closer observation and should not have her home birth. 'Sinusoidal' my ass, I thought, but didn't say - I actually said I disagreed with his findings but I would inform the parents of the doctor's advice. I'd put myself in an invidious position if anything went wrong at the birth now! I went upstairs to tell Kate and Chris - Kate announced the contractions had really picked up and this was it - she couldn't contemplate going anywhere. Isn't it wonderful when the mum knows what's happening with her body and tells you what's going on instead of vise versa. She climbed out of the bath and I could see great crashing contractions every couple of minutes (4-5:10).

I said I was happy to look after her - I was monitoring that baby's heartbeat very regularly as you can imagine - and everything looked very normal from where I stood. I documented it all.

Kate paced up and down the room like a tiger, pausing only to hang on to Chris every time another surge rolled over her. I didn't need to any more vaginal checks to know it was time to call for a second midwife - oh bliss, it was our old student, Liz, who would be coming out, and I knew she would be supportive. Kate was holding on to a towel draped over her hips like a sarong - she looked magnificent and I told her so. I got all the equipment ready and sat and waited like a midwife does. (There's always so much bl**dy paperwork).

Kate wanted a pee, so I suggested she go up to the bathroom and sit on the loo, facing the wall - it's a bit more private and the lighting was very bright downstairs. Chris took some oil to massage her back. Meanwhile Liz had made great progress coming from the general hospital and arrived within the hour - so I updated her.

There was a shout from upstairs - Kate's waters had burst - this was it! Typical - we'd prepared a lovely nest downstairs, so the baby decides to arrive on the bare boards of the bathroom floor! The Fetal heart had been absolutely fine through all this, so I felt justified in putting my neck out.

We helped Kate off the loo onto her knees (we hauled the blankets and resus stuff upstairs very quickly) leaning over the side of the bath - it was fairly cosy in there - Chris had to climb into the bath. Kate was a bit reluctant to push - but I praised her and encouraged her to move the noise she was making in her chest downwards. She didn't have to push much - her body was pushing the baby out for her, and just three contractions later the head was born. The baby made faces at me on the perineum before punching his way out into the world like superman (he had a nuchal fist).

He also had the cord very loosely wrapped around his neck which unravelled as he slithered out.

Having caught him I posted him through his mum's legs so she could sit back and check him out (Yes, it was a boy!). Kate and Chris were quite overcome and the baby looked deliciously normal and yelled to let us know he was definitely here. The cord stopped pulsing relatively quickly, and Chris clamped and cut it as he'd asked to do. Their son was on his own! Kate pushed the placenta out only 12 minutes after he was born - they didn't want to keep it. Kate was helped downstairs to the sofa so she could get more comfortable - fortunately she only had superficial labial grazes despite her boy's fist. The baby took a while to settle down (he yelled a LOT) and go to the breast but when he did he fed for ages. I left them some hours later all snuggled up together.

It was a beautiful birth and a great one to start the year with.

*all names changed in this account.


ra said...

crumbs, going through all that on a regular basis, you're a braver woman than me.

HazelNutcluster said...

You can't beat a birth story! Although I'm not telling you mine because it still gives me nightmares, lol.

'Labial grazing' indeed, they don't know anything the women who only get that, lol *laughs through remembered agony*

Good on you for doing a grand job! :)

TutleyMutley said...

Grazing still stings like fury though - 'specially that first pee :-/
I think this birth story could have been very different if we'd transferred in.
I love my job (most of the time) - it's a huge responsibility but the rewards are great too.

Sue said...

That is a really lovely story!

Thanks for visiting my blog and leaving comments! You asked if I did bookcrossing - what is that? It sounds like something I'd find interesting!


missmandymoomoo24 said...

Your story brought a tear to my eye. I qualified as a midwife in 1991, but for various reasons haven't practised for a long while.Oh how I miss it !!!

Nic said...

Such a lovely birth story and so nice to see a homebirth. I had my second at home, nearly two years ago now, and it was such a lovely experiance. The midwives were lovely. Sooo much better than a hospital birth. And yay to you sticking your neck out.

TutleyMutley said...

Thanks Nic, and Mandymoomoo...
We have one of the highest home birth rates in the UK around here. Reason? because we can visit all women at home in labour regardless of where they want to give birth. And we accompany them in to hospital if that's what they choose.

Anglers Rest said...

That is lovely. Great sketch!