Birth Story Peque – Homebirth transferred to hospital
Maternity leave was getting pretty boring and though I was still trying to finish up some last minute things for work, I was ready to meet my baby. Biking the short 1.5 km to the pool on Thursday, I was truly hoping that this might be the last time. I had Braxton Hicks contractions coming regularly and was feeling very heavy. Swimming helped, but I was not looking forward to feeling like this for another 1-3 weeks.
The first signs of labour began on Saturday when I began to lose my mucus plug. It was cookie baking weekend, the last social event I wanted to join before the baby's birth. I had no painful contractions Saturday and was happy to distract myself with a small cookie baking trial at our house. That evening we decorated the Christmas tree early and hung some Christmas lights. I was having strong feelings that the baby might come early and wanted to do some Christmas things early.
Sunday I was awoken at 6:30 by contractions that hurt. They were coming about 10 minutes apart and to distract myself I ate an early breakfast and read a book. At around 9:00 they began to space out and I went back to sleep. By 11:00 they had stopped completely and I began to work on a paper that I really wanted to finish before the baby came. I got halfway through the revisions before hubby and I headed out for our yearly cookie baking extravaganza. Every year we get together with friends, listen to Christmas music and bake Christmas cookies. Of course this year it is a bit early since we are trying to squeeze it in before baby. In fact it had already been postponed a week and when I first heard about the delay I was pretty convinced that labour would begin during the baking.
It turned out I was right.
At about 17:00 my contractions came back, coming about every 10 minutes. I did my best to ignore them and we continued with our baking. By the time we had finished our cookies and were ready to leave they were coming every 5 minutes. We arrived back at our house around 19:40 and by 20:00 I knew the contractions had been coming every 5 minutes for an hour and were 30 to 40 seconds long. I called the midwife and she startled me by saving that they needed to be a minute long before I was considered in active labour. What! But they hurt already! That was pretty discouraging, but I looked it up on the internet and, indeed, she was right.
So hubby and I distracted ourselves watching “Scrubs” episodes while I breathed through the contractions. Around 23:00 we went to bed and in “spoons” position breathed through the contractions with soft classical music playing in the background. I was able to relax very well between contractions and could still breathe quite well through them. The contractions were coming 3 to 5 minutes apart and were lasting for about a minute. At 1:00 on Monday I decided to call the midwife again and this time she agreed that I was in active labour and they sent someone to our house to check on us. The first midwife of the labour (midwife 1) arrived around 2:15 and performed my first internal exam. I was 4 cm dilated and was told that I going to have the baby that day! The midwife advised us to continue breathing through the contractions and said that someone else would come to check on us in 3 hours.
So hubby and I went back to our “spoons” position and continued to breathe through the contractions. Over the next three hours they came on stronger and stronger and the pain began to radiate from my cervix to my back. Counter pressure helped as did hubby's warm body against my back. I was still able to relax between the contractions and sort of relax and puff through them. The second midwife (midwife 2) and a student arrived at 5:00. They performed my second internal and declared me 6 cm dilated. They also broke my water to speed things up since I had already been in labour quite some time. Since I was used to breathing through the contractions on my side, the internal exams on my back hurt a lot. Of course it didn't help having someone inside me during a contraction! After the exam, the midwife sent me to the shower and inspected my water for signs of meconium. Unfortunately, upon close inspection they found meconium and much to my dismay I was told that I would have to be transferred to the hospital. I must admit that I was disappointed and scared, but the midwives were great about it. They took hubby and I in their private car (since we have only bicycles) and knew exactly where to go and how to get us admitted when we arrived. The contractions in the car were hard to breathe through, but I managed and the midwives were impressed.
We arrived at the hospital around 6:30 and although I had been managing the labour very well at home, in delivery room I began to lose my composure. Monitors were attached to my arms, my chest and my belly and there were was a blur of different people attending us. Because of the stress, my contractions lost their rhythm and began to hurt much more. I was no longer able to breathe through them or to relax between them. There was just too much excitement, too many people, too many monitors. Midwife 2 left to attend another delivery, but her student stayed and she and hubby helped me to puff through the contractions again. But I remained very tense between contractions. Counter pressure no longer helped and the pain radiated along my cervix and across my lower back. I also endured another internal exam and was crushed to hear that I was stuck at 6 cm. Then the attending midwife (midwife 3) decided to attach a fetal scalp monitor rather than the Doppler to monitor the baby's heartbeat. That hurt! And the idea of an electrode and wire attached to the baby's head and coming through my already painful cervix was just too much for me.
I decided that if I was to endure a hospital birth with its attendant interventions, then I wanted pain easing drugs. Luckily, the midwife was happy to honour my request. Although I had heard horror stories of not being able to get pain medicine in Dutch hospitals – in this instance it was really no problem. Unfortunately, the anaesthesiologist was busy and I endured contractions, another internal exam and a failed catheter attempt (also rather painful) before finally getting pain relief at around 9:00. I was offered either an epidural or a PCA-pump that administered analgesic. The anaesthesiologist advised against the epidural since I was already 6 cm dilated and the PCA-pump would be removed for the pushing stage, giving me the best chance to give birth vaginally. I agreed, and was given an IV hooked up to the pump. PCA in this case stands for “patient controlled analgesia” and in my case a very small dose of morphine was administered when I pressed a button as I felt a contraction coming on. The morphine did not stop me from feeling the pain of each contraction and I still needed to breathe through each one. However, it took the edge off the pain and stopped it from radiating to my back. This allowed me to handle the contractions as I had been at home, and more importantly allowed me to relax between them.
Armed with the PCA pump, hubby and I were finally left alone to breathe through contractions without further intervention. I kept up my energy sipping by Gatorade and having a few dextrose pills and hubby had a sandwich. At around 9:45 I had another internal exam and was again crushed to hear I was still stalled at 6-7 cm. By this time there had been a shift change and we had another midwife (midwife 4) and another student. Happily however they assured us they would be there all day and would be delivering my baby. Midwife 4 suggested augmenting my contractions with oxytocin since I was stalled, and the morphine induced relaxation wasn't helping. I got very scared at this and actually started to cry because I had read horror stories about drug augmented transitions that ended up in emergency cesareans. The midwife was understanding and she and her student talked us into accepting the lowest possible dose (2) at 10:00. They then increased the dose by 0.5 every 30 minutes so that at 11:00 I was at 3.5. At first I felt no difference in the contractions, but then suddenly I had three enormous contractions with a very strong urge to push at the end. When the student came to turn up the oxytocin again I begged her not to and described the contractions. It wasn't that I couldn't handle the contractions, but rather that I didn't want them to get worse. Hearing that I was having pushing contractions the midwife did another internal and pronounced me at 9.5cm with a cervical lip. She kept checking for the next contraction and declared that during contractions I was a full 10 cm and that it was time to push.
I was excited and terrified at the same time! For pushing most of the monitors I had been hooked up to were removed and the PCA pump was taken away. I was going to push this baby out the natural way! I was given a quick ultrasound to determine the baby's position (ROA) and I started pushing around 11:00. For the first few contractions I had to get used to pushing effectively, timing my pushes with the huge pushing urges of the contraction. When I got the hang of it, the nurses and midwife commented that I was a very good pusher. At the start of each contraction I grabbed my legs behind my knees, brought them upward and outward and hooked my feet. Then hubby lifted my head and I held my breath and pushed. As long as I didn't breathe out the push was effective. If I got scared or started whimpering from the pain then the push became ineffective. About three contractions into the pushing stage the midwifery student put two fingers into my vagina to stretch the perineum during a contraction. That HURT and I said so between contractions. With the next contraction the stretching burning pain was back and asked that she stop with the fingers. But it was the baby's head I was feeling. The baby was crowning! They told me I could reach down and feel the head. I did so, but what I felt was so much mushier than I expected that I was taken aback and didn't feel again. I pushed through two more crowning contractions. Just before the third the midwife applied a warm compress on my perineum and I was coached on when to push and when to pant. I knew this was to avoid tearing and I followed the instructions to the letter. With that contraction the baby came so close to coming out that when the contraction was over and he slipped back in a bit, I cried out in horror “He's slipped back in!”. Of course I knew that it was common for babies to slide back in a bit between pushing contractions, but I was beyond book knowledge and I wanted it to be over with and him to be out! On the next contraction I pushed and panted and pushed again and then all at once the head was out. I pushed again and I felt his body slip out followed by a gush of warm water. What and amazing, painful, crazy feeling! It was 11:40 and Peque (short for pequeño, his nickname) was born!
I had been in labor for 18 hours, in active labor for over 10 hours, had been pushing for 42 minutes. Now suddenly it was all over and my baby was on my chest, all slippery and warm and perfect. At first I was in shock and too relieved that he was finally out to realize what I had in my arms. Then he cried and opened his eyes and looked at hubby and me, and all at once we understood that this was our son! Amazing! Hubby cut the cord and the baby was taken to the next room for checking. Meanwhile I delivered the placenta (5 minutes after birth). Our baby was perfectly healthy and scored a 10 on his apgar. But the tearing feeling I had when pushing him out was not all in my head. He was delivered with his left hand up over his head and by his right cheek. This meant a second degree tear for me (skin and both muscle layers of the perineum) and a fractured left clavicle for him. Because of this, I was glad we ended up with a hospital birth rather than a homebirth. In hospital it was much easier to learn to care for the fractured clavicle and the nurses could keep a close eye on the baby. I also got pain killers for my stitches and though the stitching still hurt a bit I was very grateful to have the local anesthetic!
Peque and I were kept in the hospital overnight, but by 15:00 Tuesday we were both declared healthy and fit to go home. We had entered the hospital a family of two, but we left a family of three. Everyday I fall more and more in love with little Peque, and for us, even though the birth did not turn out exactly as planned, it was the perfect birth for the circumstances.