Birth story - Libby and baby Finley

*Potential triggers* - previous shoulder dystocia, previous induction of labour, previous ventouse, previous epidural, suspected macrosomia, suspected gestational diabetes, large abdominal circumference at growth scan, use of words contractions and pain.

So, my previous birth meant that I had to make some difficult decisions with regards to this one which put a very different spin on the lead up to the labour and the labour itself so I’ll start with what happened with my daughter for the background context.

H was born 3 years ago. I’d practiced hypnobirthing and read the positive birth book in the lead up to the birth and both were brilliant. My waters spontaneously ruptured with her at 11.30pm and contractions started about 30 minutes later. Because she was back to back the only position I felt reasonably comfortable in was on my knees leaning forward (on one surface or another). The contractions were mostly felt in my back and were about 5-10 minutes apart. One trip to the hospital after about 15 hours and was only a few cms dilated so was sent home. After a few more hours my temperature was a little elevated and because of the increased risk of infection I returned to the hospital. All this time I’d been doing my breathing and hypnobirthing practice which was awesome. I was in my own world and it was only the transitions to and from the hospital and monitoring, that meant I was on my back , that were difficult to manage.

A long story short I ended up being induced when I got to 24 hours - it seem more like a “you have to be” rather than an option which I wished I’d been better informed about. By this point I’d been awake for 36 hours, labouring for 24, and was just exhausted so said if I had to be induced I needed an epidural. I think that was the right decision for me given the induction but I wish I hadn’t had the induction in the first place. After a few hours I got to 10cm and started the pushing phase which I really struggled with because I couldn’t feel anything. Ultimately I was taken to theatre and they used ventouse and in the third and final attempt my daughters head was born. Unfortunately her shoulders got stuck and she had a shoulder dystocia. It was resolved quickly with the first McRoberts manoeuvre. She was a little large at 8lbs 2oz but not enormous.

So to summarise she was back to back, I was induced and on my back with a epidural and had an induction and instrumental - ventouse - delivery. All likely to have contributed to her shoulder dystocia.

So take us to this pregnancy and because the risk is 1 in 10 of a second shoulder dystocia they have much more of an eye on you and essentially try to medicalise your delivery much earlier than if your first one is straightforward.

This time round I was under increased monitoring during pregnancy. At 38+4 one urine test came back with increased sugar in my urine (I did try to explain it was a few days after Christmas!). I had a growth scan and despite these often being very inaccurate it was the only way they would dismiss the sugar in my urine otherwise I would automatically get diagnosed with gestational diabetes because I was already over 38 weeks.

The growth scan was problematic, the sonographer struggled to get his abdominal circumference which it turns out a diagnosis of gestational diabetes is hinged on. She finally decided it was good enough. That measurement came back in the 97th percentile with all the other measurements in line with the previous 20 week scan (over 50th percentile but not enormous). They estimated he was already 8lbs 10oz and a large abdominal circumference meant he was more likely to get stuck.

This put me in the difficult position of having to decide whether to continue to go for a natural birth, be induced early or book in for a c section. I decided to use my BRAIN. The risks were still small for the time being so I asked for more monitoring. I had to monitor my blood sugars 6 times a day which were always normal so I started to dispute the gestational diabetes diagnosis and asked for another growth scan to be carried out at 40+4 before my next appointment with the midwife where I was going to have to meet with multiple consultants.

I realised I needed to relax and started doing twice daily hypnobirthing practice and some nipple stimulation (which was possible to bring on contractions with so only do if you know you’re low risk or with advice). At exactly 40 weeks I went into latent/early labour. I got excited and stayed up most of the night doing my hypnobirthing before realising I wasn’t progressing much so went to sleep. The next 48 hours this continued. I had contractions every ten minutes if I was on my feet but they would almost disappear when I sat down. They were very manageable though and I barely had to breathe through them so it wasn’t a problem. On Monday 40+3 morning I was woken up by them. The intensity had increased slightly and they were coming while I was lying down and asleep but they still were 10-20 minutes apart. This carried on all day. I put my daughter to sleep at 7.30 and thought ok I’d like it to get going now. Within a few minutes the intensity increased and I called the birth centre. As I was talking to them to ask about coming in, the contractions increased to every 2-3 minutes and in intensity. 20 minutes later at 8.30 I was in the car.

At this point, I was asked if I was happy to go to the labour ward as I’d said, if the birth pool there was free, I would. They were keen for me to go to the ward as being in the birth centre goes against NICE guidelines for anyone who has had a shoulder dystocia. This was also compounded by the gestational diabetes diagnosis. When it turned out the birth pool room was not free I insisted on the birth centre. I knew being mobile and upright was my best chance to reduce complications and that the pool was the place I’d likely be most comfortable. I had intended to get out of the water before delivery.

By the time I arrived at the birth centre I was experiencing crippling pain in my legs with every contraction. They think the baby’s head or part of his body was pressing on my sciatic nerve. It took some time to do different checks but eventually I was allowed in the water. I was using my up breathing the entire time but I was struggling to really get into the zone in the same way I had in my previous labour. I think the speed at which everything had ramped up made it so different. My husband put on some music and luckily I managed to get him to change it to the one I’d been using during my hypnobirthing practice and that really made a huge difference. I managed to relax more. By this time I was using gas and air as well, although sparingly as at first it made me very dizzy.

I became very anxious just before the shift to the pushing stage and started to question all my decisions, ‘was I doing the right thing for my baby? why was I going against medical guidelines? what if I caused him harm?’ Particularly asking myself, ‘what was the point when I was in pain? and ‘should I just have had an epidural?’ (despite firmly believing the medical interventions as a result of this last time had at the least contributed to my daughters shoulder dystocia if not been the entire reason for it). This was when the hypnobirthing came into its own. I refocused on my breathing, my husband reminded me to take one contraction at a time. Soon the pushing phase started and within about 20 minutes the baby’s head crowned. I felt a huge sense of relief even with the ring of fire which I felt was totally manageable. After a few contractions, and just allowing my body to take over with pushing, my baby was born into the water, head and shoulders in one go.

It’s been over a week now and, the fears of whether I was making the right choice have left me, I am so grateful for having the tools that I learnt from the PBC and hypnobirthing more widely. My decisions were all well informed and based in evidence not in a reaction to the worst case scenario or over medicalisation that we can be bullied into by well meaning professionals. Consequently my son was delivered safely and gently into the world, for that I am very grateful.