Birth story - A and baby E

Ours was not a totally straightforward situation. After a smooth and healthy pregnancy, at 34 weeks our baby was deemed ‘Small for Gestational Age’ (SGA) with suspected Intrauterine Growth Restriction (IUGR). An obstetrician advised us that induction of labour before 38 weeks would likely be the best course of action, and this was confirmed at 36 weeks. There is no denying that it felt counterintuitive to us to halt our baby’s gestation period; we also couldn’t help but feel sad that our hopes for a natural birth had been dashed before even getting started. However, from a risk analysis perspective, we accepted the offer of induction, as we wouldn’t have been able to live with the outcome had anything gone wrong as a result of our resolve not to do so.

The birth process started with a mechanical induction, and on account of baby’s size, A was admitted as an inpatient to the antenatal ward. With her own room, and the kind and gentle attention of the brilliant maternity support workers and midwives, this meant that she had 36 hours of mental and physical rest and preparation before the start of serious labour. The mechanical induction only brought on light contractions at this stage, which allowed A to practice her breathing (using the Freya app, and KGH Hypnobirthing tracks) and enter into the birthing ‘zone’. Meanwhile, I had a chance to wrap up things at work and sort out the house, so we both ended up in a very good head space for the adventure to come.

Despite bringing on some the light contractions, the mechanical induction did not prompt the start of labour proper, so A was taken down to the Delivery Suite by a very friendly midwife who explained how the process would work therein. We discussed options for pain relief, and met the anaesthetist who would administer the epidural - which A opted not to start immediately, but to remain open to taking it if needed.

An hour after her waters were broken, we agreed with the midwife to start the oxytocin drip to bring on contractions. The first few hours were completely manageable, and A’s main discomfort came from the oxytocin drip which was sore in her arm, and the monitors (albeit wireless) strapped to her tummy – which limited her movements.

Due to baby’s small size, we had to be monitored throughout the labour with the midwife present, but she made every effort to avoid others coming into the room – and if they did, our permission was first sought, and the person was always introduced to us. Since things started slowly, I could sleep for a while as A settled into a rhythm with the early contractions; as they got stronger I helped – including rearranging furniture multiple times to her liking, attaching the tens machine, and helping with gas and air. About 6 hours into labour, A felt her contractions becoming intolerable, and maintaining her breathing pattern became extremely challenging. Once A felt that she could not withstand the pain for much longer she asked for more help, at which point the midwife suggested to do an examination and make a decision about how to proceed based on dilation progress. As requested, the midwife didn’t give us a number but positively explained that there had been “good progress” though we were still “early hours”. So that settled it – time for the epidural!

The epidural arrived wonderfully quickly – within minutes of asking – and with it the pain stopped completely; A even managed to take a nap while I went out for breakfast. From that point A couldn’t move around so much, but settled into a left side sitting position on the bed. A did not top-up the epidural at all, and after some hours the contractions intensified, and it became increasingly necessary to concentrate and breath her way through each contraction - but still nothing like the fire and brimstone of pre-epidural. Overall, those hours of post-epidural and pre-pushing were incredibly calm and pleasant. We had our music playing, and enjoyed chatting and joking with our lovely midwife.

Around five hours after the epidural, the midwife offered an examination and announced with a wry smile that A “might feel the urge to push soon”; an hour later she declared A fully dilated and went to seek the green light from the obstetrician and neonatal doctor to start pushing. The doctors were placed on standby and a resuscitation unit all set up just in case (on account of small baby). A moved onto her hands and knees to push – feeling the surges strongly and an obvious downward pressure by this point.

However, the baby’s heart rate was dropping with each contraction and taking too long to recover, so the midwife helped A move onto her side with a leg in stirrups to see if baby would be more content. But after a few more surges the obstetrician arrived and recommended an instrumental delivery. We agreed together to see how baby would respond during the next couple of contractions before making a final decision, but she did not improve and so we made a joint decision to proceed with a forceps delivery, even though it felt like baby was very close to arriving by this point.

And indeed, with the time it took to set the equipment up, A left both the obstetrician and midwife open-mouthed - barely making a sound, she made some titanic pushes and the only thing the obstetrician had time to do (besides exclaiming ‘“oh wow!”) was to assist minimally with the ventouse to minimize the number of pushes and hence the stress caused to the baby. With just a few pushes baby E was free and opening her lungs and arms for us – what a moment! She shrieked and A burst into tears of utter joy! E ended up weighing 2.43kg, but at 37+5 weeks gestation that put her just around the 10th centile, meaning that – in hindsight – the planned induction was probably unnecessary.

However, little did we know the significance this would have in giving us a positive birth experience – for the following reasons:

First, the IUGR scare meant that we knew with quite some certainty that our baby would arrive between 36 and 38 weeks, which meant A could organise her work to finish a good week before going into hospital – allowing her to rest and focus on the task and major life change ahead. This couldn’t have been guaranteed if we were waiting for a spontaneous labour.

Second, knowing well in advance that A would likely be induced gave us the time to research the process and to make peace with the whole range of scenarios that could unfold – this meant that A felt relaxed and at ease with almost anything that happened in the delivery room.

Finally, having a prescribed birth date allowed us to share the experience with people we love in a way we couldn’t have done otherwise. If you have ever watched the film ‘Big Fish’ you may remember how the main character, Edward Bloom, makes his last steps into the river accompanied by friends and family, full of confidence, calm, and comfort only because he knew when and how he would die. Ignoring the fact that E and Edward are at the opposite ends of their life journey, knowing when the birth was happening allowed us to share the experience with our “tribe”. Our excitement was shared by the neighbours who gave us a beautiful send off, friends and family flooded us with best wishes, and even the postman left us a sweet good luck note. Knowing we had all these positive vibes coming our way helped us to focus on the excitement of our imminent arrival, rather than preoccupying ourselves with exactly how we were arriving at that point.

In summary, despite the fact that a planned induction was far from what we had originally hoped or planned for, we wouldn’t change anything about the birth and the days leading up to it, and will forever remember the experience as some of the most intense, exciting, and happy hours of our lives.