I've been up since 5am when a stronger than usual contraction woke me. I've been awakened two or three times during the night. But, since these are no stronger than what I've been feeling the past four weeks, I try to ignore them.
By 7.30 I'm up and reading e-mails at the computer. Contractions are still coming, nothing regular or strong, around once every 9 or 10 minutes. Just before 8 am, I get a contraction that starts out no stronger than any other, but in the middle of it I get a sharp twisting pain right in the middle of my cervix, then feel a sharp snap. When I stand up, fluid comes gushing out. The membranes have ruptured. While I go and get cleaned up and find a pad to wear, Paul phones the midwives.
Contractions start coming a tiny bit stronger, but no more regular than before. Now, they're about six to nine minutes apart. There are phone calls to check on how I am doing, and the on-call midwife (Mary) says she'll come over around about 10 am to see.
When she gets there, contractions are slightly stronger, I have to stop and breathe through them. They are not coming any closer together. She gives me a check over, then arranges to come back to check on me around 1 pm. There is no sense her sticking around at that point.
Nothing much has changed at 1pm. But at least this time the contractions haven't stopped. And we know that something is going to happen within the next 48 hours. She leaves again to get some lunch and arranges to come back again around 3.30 pm. I have a phone call at 3.30 pm to let us know she is assisting the other on-call midwife with a home birth (another woman having an HBAC) and will be over as soon as she can.
By this time the contractions are strong enough that I have to give a low moaning intonation during each one. I'm spending lots of time in the shower with the hot water flowing over my lower back. I'm getting lots of back pain during each contraction. By the time Mary gets there around 4 or 4.30 pm (I'm fuzzy on clock times after this) I'm leaning on Paul during contractions and invoking deities. After a period of time, Mary suggests gas and air and I eagerly agree to it.
She does a vaginal exam at some point in here (not sure when, but she only did two) and tells me that I am dilated to 4 and she can stretch the cervix up to 7 or 8. Baby is at a negative 2 station. He's been holding up no problem for the entire time without any changes in his heart rate.
Contractions are getting stronger, but remain slightly irregular with 1-2 every 10 minutes.
The second midwife (Caroline) arrives at some point and the two of them take it in turns to support me. I'm getting excruciating back pain, worse than the contraction itself during each contraction. This is eased somewhat with water, so I spend lots of time in the shower. Paul has put the birthing ball in the tub with me and I lean over it while the hot water flows over my back. The other thing that helps is pressure on my lower back. So Paul and Caroline rub my back and press hard into it during each contraction. Pressing into my back moves the contraction pain from my back to the front of my uterus. I've gone past invoking deities and am now cursing them.
They do a second vaginal exam around 10 pm. I am now dilated to 6 cm with stretching up to 10 cm. But the head has not budged. It's still sitting at negative 2. He's doing fine though. He has had absolutely no problem with heart rate or rhythm.
All three of them start pushing water, herbal tea with honey, and sports drinks into me. I'm encouraged to eat, but have no desire for food. I think I took two tiny nibbles of a slice of bread.
At about 2 am I'm completely exhausted. My urine is showing the presence of ketones. Mary and Caroline talk to Paul and me about transferring into hospital. They let us know that it is our decision though and they will support us either way. Paul and I talk it over, we agree that once I am there the obstetrician will more than likely want to go for an immediate caesarean section. I am so very tired; I tell Paul that I am okay with this, if it happens.
Mary phones for an ambulance and they prepare for our trip in. Caroline stays by my side to support me. I can tell that both Mary and Caroline are disappointed somewhat that I have not been able to do this at home.
We get to the hospital sometime around 4 am. The registrar does a VE. I'm still at 6, very stretchy up to 10. Baby is still at negative 2. Either the membranes have re-formed or I had lost the hind waters earlier. He asks, and then ruptures the membranes. He suggests giving me an epidural so that I can rest and re-examining me in four hours to see how things are going. He's tells me that he's certain I can birth this baby vaginally.
An IV drip is started. I'm so dehydrated that the anaesthetist has them run in a litre of fluid in 20 minutes. The epidural is started. She gets it in first try. I'm sucking down gas and air the entire time until it's in place and the drugs are given.
Bliss. I'm feeling the pressure of each contraction, but they no longer are painful. I am able to get some sleep.
8:30 am. I am examined again by another registrar. The first has gone off duty. There is no change. After discussing things with us, he suggests either trying syntocinon to augment labour or a caesarean section. We tell him of our concerns about using drugs to augment given my previous history of caesarean section. He goes off to discuss things with the consultant. The consultant agrees that, given my history, a caesarean section would be the better option, but leaves the decision to us.
We decide to have the caesarean section.
The registrar and the anaesthetist both read through the emergency caesarean section plan I had written up, and discuss it with us. Where hospital policy conflicts, or where they don't feel comfortable they discuss it with us, rather than just saying they can't do it. We're fine with the minor alterations. Things like wanting baby to nurse immediately - the registrar was concerned there wouldn't be enough room on my chest for him to do his work and for me to nurse. The midwife however states that she will make sure I am able to breastfeed as soon as possible in recovery. Fair enough.
My epidural is topped up with a stronger dose. I'm no longer able to move my legs or feel anything from the top of my breasts. I'm taken to theatre. All of the people there are extremely supportive, making sure that Paul has a seat right next to my head, making sure I am comfortable. The anaesthetist checks twice to make sure that I cannot feel anything.
I feel tugging and pushing, and hear the sound of something being suctioned. (It wasn't the baby, but the amniotic fluid.) Then I hear crying. The anaesthetist lowers the screen so that Paul can see, and the midwife brings a little baby around to his side where we both can see.
She says something about seeing what we have, and uncovers the baby so that Paul can see. He gets all tearful and says - "It's a boy!". They lay the baby across my shoulder and Paul holds him in place. I am able to touch him with my hands and give him kisses. I had not said anything about not announcing the sex but letting us find out for ourselves in my birth plans, so this is a nice and welcome surprise for us.
I'm pretty much oblivious to anything else being done to me after this, though the anaesthetist is telling me everything they will do beforehand.
Finally, I'm stitched up and they move me into a bed, then around the corner to the recovery area. The midwife is true to her word and first thing she does is prop me up on my side slightly so that I can breastfeed.
We have a bit of problem at first as John keeps trying to stick his tongue out, but eventually we get things figured out. He'd been crying the entire time, but now settles down and is calm.
His skin is dry and flaking a bit at the hands and feet, so he was definitely a bit post-due. The placenta, I am told, was perfect though with no signs of calcification. Apgar scores were 9 and 10.
During my first day in hospital, every midwife who provided care during my labour has come up to see me. Caroline and Mary are still a bit disappointed that I was not able to deliver at home. So am I, but I am okay with the decision we made. In big part because it was our decision.
John gave us a clue as to why he didn't come down during labour. He fell asleep while lying on Paul's chest and immediately moved himself into a position that makes my back hurt just looking at him, though he is completely comfortable and relaxed. His head is tilted back so that he is looking straight up, back arched and twisted, legs drawn up. We speculate that this was how he was lying in the uterus. Mary took one look at the video we took of him sleeping this way and said "He had a brow presentation! No wonder he wasn't coming out." She is completely confident that had his head been better positioned, once I had a bit of pressure from his head on my cervix, I'd have opened right up and he would have slipped right out. Even at 9 pounds 1.5 ounces. Even though contractions never came closer than 2 in 10 minutes and remained irregular.
We're now doubly glad we did not opt to try augmentation. All that would have accomplished would have been to force his head into my pelvis, inevitably causing distress to baby, and to me. But, given his head malposition he'd have just gotten stuck.
The surgical notes give the reason for the caesarean as being failure to progress, but I am confident that the true reason was malposition. I'd done all the work I could to get him into a nice anterior position for birth, and that part worked, he was anterior. Just anterior with his head back so he could see where he was going!
First published MIDWIFERY MATTERS, Issue No.95, Winter 2002