Birth story - Emily and baby Beatrice

Triggers - miscarriage, transverse lie, contractions, ventouse, caesarean

Background:

I am a midwife and have nearly 10 years experience working in a high risk inner city hospital with an on-site MLU. For this reason I actually feel very comfortable in a hospital environment and opted to have my first at the hospital I work in because I knew that the familiar people and surroundings would help me and reassure my husband. I was very keen to have a water birth on the MLU but despite several sweeps nothing happened and I ended up being induced at 40+4. I was very happy with this decision because I was very uncomfortable and a little too aware of the risks associated with going too far overdue. I had the pessary which was very effective and I delivered 12 hours later almost to the minute. During the latent phase of labour I used a tens machine (which was amazing), cocodamol, entonox and pethidine. My waters broke immediately after the pethidine injection and I slept for over an hour and then woke up in intense pain (I had progressed quickly to active labour) and asking for an epidural. My very good friend was my allocated midwife and she encouraged me to avoid the epidural and to use the pool instead. As soon as I got in the water my pain stopped completely and all I felt was intense pressure with the contractions. I was able to relax in the water between contractions and got to fully dilated within a few hours. I had wireless monitoring throughout and when it came to pushing it was clear that the baby was in distress so they got me out of the water and a registrar did an episiotomy and ventouse delivery on the bed in the room, which I still remember as just being a huge relief that it was all over and not remotely unpleasant. The whole experience was very positive and I was really hoping that with my second I would labour spontaneously and be able to actually give birth in the pool.

This pregnancy:

In October 2020 I had a missed miscarriage and because of this I was very nervous about attending my scans, especially as due to Covid restrictions with both the miscarriage and this pregnancy, my husband couldn’t come with me. I felt better when I started feeling movements at 16 weeks and once the 20 week scan confirmed that everything seemed ok I relaxed into the pregnancy. From 22 weeks I began suffering with pelvic girdle pain which got progressively worse as the pregnancy continued. I went to physio which helped and due to Covid I had to stop working clinically from 28 weeks, which made a big difference until the last few weeks when I was just really uncomfortable. I had mild Braxton Hicks from 26 weeks which got more frequent and more intense as the pregnancy progressed but never painful. Other than that I had a very straight forward pregnancy. I kept in touch with my friends at work who told me all about the staffing issues caused by Covid which regularly led to the MLU being closed. I was also aware that the only pool on delivery suite was out of action due to the emergency hoist to get people out being broken. I began to get very anxious about labour because being able to get in the water was the only thing that had stopped me from losing the plot during my first labour and the thought of not having access to a pool was therefore frightening.

I knew a lot of people (friends and families I’d cared for) who had done hypnobirthing and had had wonderful experiences and managed to stay calm and in control regardless of what happened. So at 33 weeks we signed up to PBC and I found that the course, doing the relaxation exercises with my husband and reading all these positive birth stories really helped to change my mindset about labour and to believe I could cope even without the water. It also really helped my husband to focus on and get excited about meeting our baby too because although he was very happy about the pregnancy, he’d been focusing so much of his energy on our toddler and helping me that he’d almost forgotten that we were actually about to have another baby. It also made me realise that were I to go into spontaneous labour the water was more important to me than the familiar surroundings of the hospital I worked at and we therefore decided that if I did labour spontaneously, we would go to our local hospital which had more pools and was closer to home so would be an easier journey. It was still part of the same hospital Trust and was where I’d had all my antenatal care so didn’t require me to re-register and still allowed me to change my mind if I wanted to.

At 39+1 I felt like baby wasn’t moving as much overnight and after having only one kick after breakfast instead of my usual flurry of movements I phoned our local hospital and they invited me in for a monitoring. I arrived about 8.30 and a lovely student midwife palpated my abdomen and put me on the monitor. She couldn’t feel a head in the pelvis but also couldn’t feel one anywhere else and all other markers suggested baby was head down. I reassured her that although baby had been transverse until 34 weeks my community midwife thought baby had turned and she just thought the head was really far engaged. Once the straps were on for the monitoring the baby started moving like crazy and the heart rate was consistently high. The midwives weren’t concerned and said it was more than likely due to baby moving so much and encouraged me to drink plenty of water in case dehydration was a factor too. They also mentioned that because I was having reduced movements so close to my due date they would recommend induction, but I discussed this with my husband on the phone and we both decided we would decline because the baby was now moving fine and we would rather wait and see for a while longer.

When the heartbeat didn’t settle they asked the registrar to come and review me. She wasn’t overly concerned with the trace because the baby was moving so much, but she wasn’t happy with the shape of my abdomen and when she also couldn’t palpate a head in the pelvis she scanned me with a handheld scanner. This revealed that baby wasn’t head down but was still transverse. I knew immediately that I was too far into the pregnancy for them to attempt an ECV and the registrar confirmed that my only option was a Caesarean section. I thought I’d feel really scared about this but I actually felt very calm because I knew categorically that this was the safest option for me and the baby. I was also incredibly relieved that I’d followed my gut instinct and gone into hospital that morning. The registrar spoke to the consultant and they gave me the option of waiting until the following day to see if baby turned on its own or to go for the Caesarean section the same day. She explained that if the heart rate didn’t settle they would want operate that day anyway. I knew in my heart that baby had never been head down because they’d never been able to feel the head in the pelvis and therefore the likelihood of it turning overnight was almost zero so I called my husband to update him and we opted to go ahead with the section that day.

The midwives gave me a break from the monitor to go to the toilet, then restarted it (even knowing that baby was transverse they found it difficult to work out what position she was in), then they cannulated me and started some fluids. Within half an hour the heart rate had settled back to normal and the monitoring was discontinued. My dad dropped my husband off at the hospital and took my son back to their house for the rest of the day.

I was moved to delivery suite, and assisted into a gown and stockings and was told we just had to wait until I’d been nil by mouth for 6 hours and my rapid Covid swab result was back before going to theatre. When they were ready they got my husband into scrubs and completed all the pre-op checks and I was seen by the anaesthetist. The registrar then came in with a larger scan machine than before so that she could work out exactly which way baby was lying so she knew how best to get her out. She discovered that baby had her back down towards my cervix with all her limbs curled up above her which the registrar said was the worst possible position for delivery because there would be nothing to hold onto to rotate the baby in order to deliver. She spoke to the on call consultant on the phone who told her not to attempt the caesarean without her present because it was going to be a “difficult extraction” and may need extra expertise. It was a Saturday and the consultant wasn’t prepared to come in because it wasn’t an emergency but said she’d come in first thing in the morning to do it. The staff seemed surprised that we took the news so well but while we were obviously disappointed because we were all ready to go, we also knew that we would be safer waiting for the consultant to be present. I was moved to a side room on the ward (staff perks) because they weren’t happy to let me go home in case I went into labour or my waters broke and I had a cord prolapse. My husband went home, collected my son and spent the evening keeping things as normal as possible for him. I had monitorings in the evening and the following morning and everything remained stable.

The next morning my husband dropped my son back with my parents and came up to join me as soon as he was allowed in. I’d had a terrible night’s sleep because of the nerves but was excited to meet my baby. We got ready and were taken to delivery suite and my husband waited outside theatre while I had the spinal inserted. I was very nervous but the midwife was coincidentally a friend who had been pulled from the hospital I work at due to staffing issues and she reassured me throughout. My husband then came in to join me and counted me through up breathing while they delivered our baby.

The team really struggled to turn her to a breech position in order to get her out so there was a lot of pulling and pushing which, although not painful, was really uncomfortable, but the up breathing really helped to stop me panicking. They discovered I had excess fluid (polyhydramnious) which explained how she’d been able to stay sideways for so long. When they finally delivered our baby girl she needed resuscitation so was taken straight to the midwives and paediatrician without delayed cord clamping and we continued with the up breathing which kept me calm until we heard her cry. Once they’d done all her checks and her oxygen levels were normal I had skin to skin in theatre and then my husband had skin to skin while I was transferred from the theatre table onto the bed. After an hour of uninterrupted skin to skin and breastfeeding support in recovery we were transferred back to the ward and into the same side room as before, where I was treated like royalty for the rest of my stay.

They’d found Group B Strep in my urine at the beginning of pregnancy so they monitored the baby for signs of infection for 12 hours but all observations were fine. When the catheter was removed my bladder still hadn’t woken up from the spinal and I couldn’t wee and became very uncomfortable so I had to be re-catheterised for an extra 24 hours. This turned out to be just what I needed because I had an extra 24 hours to get breastfeeding established and to recover a bit before heading home to a bouncy toddler (even though I was missing him like crazy). The only downside being that my husband could only technically visit for 2 hours a day although they let him stay for 3.5.

The whole experience was incredibly positive and I’m so glad I followed my gut instinct and went in that day. It scares me to think what could have happened if I had gone into labour and I’m just so glad we’re both safe. The PBC really helped both me and my husband to remain calm and to reassure ourselves that we were making the best decisions for our family and the safety of our baby and the up breathing was amazing for keeping us from panicking. It may not have been anything close to what we were expecting but I wouldn’t change a thing.