Tuesday, 26 July 2011

Birth Story Special: Induction

This week on the blog I'm running a Birth Story Special.  Yesterday I published Michelle's story, of a planned home birth that ended in an emergency caesarian. Today I have decided to share the story of my own first birth, also a planned home birth, that evolved into a hospital induction and forceps delivery.  

NICE guidelines state that induction is likely to lead to a labour that is more painful, and more likely to end in epidural, instrumental delivery or caesarian. And yet in the UK today around 20% of births are induced.  Many women find that they are coming under pressure to accept induction from around 40 weeks, and often there are confusing messages regarding the safety of continuing the pregnancy beyond their due date.  Of course, there is not a great deal of hard evidence about what happens if women are left to go into labour spontaneously beyond 
41 or even 42 weeks, as most women are not 'allowed' or encouraged to get this far.

Many women do not realise that they have a choice about induction and that they can delay or
refuse this intervention until they labour spontaneously or decide they wish to be induced.  Others like myself are aware that they have a choice but still feel under enormous pressure to comply with the status quo.  More information and evidence is needed to help women make truly informed decisions when they 'go overdue'. 

My First Birth

My baby was due just before Christmas, on the 21st December.  That much anticipated day arrived, and nothing happened.  Once you reach your due date, people start ringing and texting constantly, as if you are a cake that needs to be taken out of the oven at a precise time.  Anxiety builds.  I felt as every day went by that I was keeping a lot of people waiting.  But you also feel totally powerless.  The whole situation is completely beyond your control, and you just have to live with that.  For a few days, I didn’t feel that bothered.

A few days after my due date, I got a phonecall from my local midwife.  She said the consultants wanted to see me at the hospital.  I went to the appointment willingly, as I thought that they would examine me or scan me or something useful.  In fact, they didn’t do anything like that.  An Obstetrician looked at my notes, and worked out my due date (well done!).  He then said that I was over due and that it was policy to induce at 41+2 or 3.  He wanted me to book in for induction the following Monday or Tuesday.  I said I didn’t want to be induced until at least 42 weeks and also that I was booked for a home birth, and he went to fetch his superior.  I then had to ‘get permission’ from this next guy to wait til 42 weeks.  He explained the risks to me, not very well I might add.  He then left and the first guy came back and offered to do a ‘sweep’.  By this stage I had already had one sweep from a midwife and I really didn’t want this strange bloke poking around in my body.  I felt really vulnerable though, as I was already feeling like a naughty school girl who had not handed in her homework on time.  I thought I might cry.  Somehow I managed to find the strength to refuse a sweep from him.  I am really glad to this day that I was able to say no to his kind offer.  I’m quite proud of myself for doing this as I found it really hard and in some ways it would have been easier to comply and ‘be a good girl’.

So I was a week overdue, and already I had learnt a few new things!:
Don’t tell anyone your precise due date when you are pregnant.
Don’t bother going to meet the Obs when you go overdue.
Don’t EVER be afraid to say No to authority figures, even if this is really hard.

After this meeting it really felt like the clock was ticking.  There was something really negative about having a date in the diary for induction as well, it made it seem so inevitable that I would not go into labour naturally.

As the days went by we tried every trick in the book to get things started.  I had a few sweeps at home from various midwives.  I ate whole pineapples.  I bathed in jasmine and clary sage oil, rubbed it on my bump, and burnt it in the oil burner.  We went for bumpy car journeys, and my partner made me run up and down the stairs.  I meditated and focused on my cervix dilating.  I had acupuncture almost every day from a lovely woman called Jane who mothered me and tried to help so much and treated me for free.  We even, and this shows how desperate I was, tried sex.  And finally I drank castor oil, which made me shit through the eye of a needle, but – no baby! 

We then reached the day of 42 weeks, when I was booked for induction.  We decided not to agree to be induced that day.  It took ages and lots of talking to come to this decision and we felt really stressed about phoning the hospital and telling them we wanted to just be monitored.  Then finally when we rang up, they said, ok, that’s great, we can’t induce you today anyway as we are too busy!! 

So on the Friday evening we went in to be monitored.  I had to lie on the bed and have two ‘belts’ round my bump, one to measure the heartbeat and another to measure any contractions.  We did this on Friday, Saturday and Sunday evening.  

The first time we were monitored I could feel that I was having quite powerful ‘tightenings’ in my bump and the machine picked these up.  I was having two every ten minutes and everyone seemed to think this was very promising!  Before we left, I was given another ‘sweep’ by one of the midwives.  This was really uncomfortable and much worse than the others I had had at home (I think this was my fourth!!!).  The midwife said she had been especially ‘vigorous’ to try and get me started.  Because of this, and the tightenings they had seen on the machine, they pretty much waved us off and said, ‘Go home and have your baby’.

Looking back on it, I wish I hadn’t bothered to have that sweep.  I was having some good tightenings and I wish I had just left well alone.  It was so unpleasant that I feel it ‘frightened’ my cervix, it made that deep animal part of myself that was preparing to give birth feel unsafe, and change its mind.  I cannot prove this of course, but it feels true to me.

So over the weekend we waited and hoped, getting more and more insane and desperate.  I never got any tightenings as strong as the Friday night ones, they just fizzled out and didn’t return.

On Monday, after much talking and tears, we decided we had had enough, and that we would go to hospital. 

One of the few advantages of going in for induction is that you can take as much tat as you like to the hospital with you.  So we packed the car with cushions, a favourite pillow, rugs, essential oils, music, candles, yoga mats, birthing ball, you name it!  I took down photos I had stuck on the bedroom wall especially for my home birth and stuck them on a big piece of card.  I can remember peeling them off with a really deep sense of sadness and loss that I was not to have the birth at home that I had planned.  I had put so much thought and planning into it and it felt so desperately frustrating not to be able to do anything else to start my labour, and to have to ‘give up’ on that dream.

Nevertheless, I also felt desperate to have the baby as I was so huge and uncomfortable!  So nice to know that there was an end in sight!

We checked in to the hospital on the Monday evening, after eating supper at home.  I felt very anxious and afraid.  Firstly I was ‘monitored’ again.  We were in a small room and we stuck our photos on the wall and tried to feel positive.  At one point we heard the sounds of someone else giving birth and my partner said, ‘doesn’t that make you feel excited?’, and I said no, quite the opposite, it makes me feel terrified!

Later on the same midwife who had done the ‘vigorous’ sweep put a prostaglandin pessary inside me, this was a new induction technique that they were trialling, the drug was on a string so that, if and when you went into labour, they could remove it straight away.

I remember being quite tearful at this point as I had a real reality check and realised there was no going back.  Maybe somehow I had hoped I would suddenly go into labour at the 11th hour without their drugs!  I was asked what I was afraid of and I said, of being cut, of having a caesarean, of intervention.  I think also, though I didn’t voice it at the time, I was also full of doubt in myself, not quite convinced that I could do it, it somehow seemed impossible to me.

A new midwife came on to her shift and offered to move us to a different, and bigger room.  This new room was totally fantastic, with an en suite bathroom, lots more space, and a sofa for my partner to sleep on (although he ended up on the floor).  It was late in the evening by this stage, so we pottered around in the room for a while and had a cup of tea.  We found some ‘stirrups’, and hid them behind a curtain!

Eventually we decided to try and get some sleep, myself in the single hospital bed and my partner on the floor.  I was so glad he was able to stay, I would have been absolutely desolate on my own in that situation.  Somehow he felt like such a strong ‘anchor’ through the whole process, I felt that as long as he was there, I was safe.

I woke up at about 5am and felt that I was having some tightenings.  However, having been to this place so many times before, we decided to just go back to sleep, thinking it was probably nothing.  I slept for a few more hours, and I think it was about 7 or 8 when I woke again, and felt that there was probably something happening.  It was when I stood up to go to the loo that things suddenly felt quite strong and we fetched the midwife.  She examined me and removed the ‘teabag’ as they called it.  She said I was 3cm dilated.  This was it!

We were then on our own for a bit and I continued to have contractions.  They were quite powerful right from the start but in between I felt totally fine and my partner and I exchanged ‘ohmygodthisisit!’ words and faces.  I was on the floor with him and just moving around normally at this point.  A midwife we knew personally came, then left us alone for a bit.  We tried some different positions and at some point my partner played two Ray La Montagne albums on the ipod.   I have to be honest but after the first song I barely noticed the music!  But I guessed it must have been nice for my partner and the midwife, who by now had come back. 

I had not planned to ‘chant’ through contractions, but once I started, quite early on, I just couldn’t stop!  It felt so good to release my voice in this way, and kept me feeling steady and grounded.  If I stopped chanting I found I was liable to ‘lose my grip’ on the contraction, suddenly it would feel overwhelming and I would panic.  This only happened once or twice, the rest of the time I chanted, and stayed on top of them.  It was like trying to stay in charge of a wild horse, you had to focus every atom you had on keeping calm and keeping the horse under control; every so often the horse would explode with a burst of energy and run away with you, and you would have to work even harder to rein it in, calm it down, get back in charge.

The midwife listened to the heartbeat every 15 minutes.  I found this a bit annoying and distracting.  It seemed to pull me back to reality - when I was quite happy drifting off into a trance like state – suddenly it would remind me of time and the hospital and possible dangers, all things I did not want to have my attention drawn to.  But necessary I guess.  Certainly it seemed non negotiable.

However, after I was declared ‘in labour’ and had the induction pessary removed, I didn’t have any more vaginal exams which was great.  I believe these happen as a matter of routine unless you specifically request not to have them, so luckily I did make that request.  My labour was quite clearly cracking along at a pace anyway, so they would have been totally pointless.

I remember asking the midwife if it would get more and more painful, or if this was as painful as it got.  I think I felt at that stage that I could just about handle it but was afraid that we were just at the tip of the iceburg and I really didn’t feel I would be able to do it without drugs if it got any more intense.  I also remember that I often talked about being afraid.  Once I was in labour, my fear almost intensified.  There was no going back!  Our midwife wondered afterwards if it was this fear that had stopped me going in to labour.  I suppose it could have been.  But I also think that in these matters, we are not that powerful.  Nothing we think, consciously or unconsciously, can influence things, as it is not in our hands, not in our power, we are in the hands of fate, mother nature, or whatever you choose to name the forces of life and death.  When you are actually in labour, you feel this most intensely.  It is as if you are a paper boat being tossed on a raging sea.  You are small, insignificant, and at the mercy of something far greater than yourself.  Paradoxically, you also feel at your most powerful.  When things are going well, and you are riding the waves, it is the most exhilarating experience of your life.

Back to the story… after a while of chanting and moving on the floor, the midwife suggested I get in the bath.  To be honest I wasn’t sure if I felt like it, but said I would give it a go.  The bathroom had a really deep and wide bath, not quite a birth pool, but almost!  And actually, once I got in the water, it felt really nice, it kind of took the edge off the beginning and end of each contraction.  I just lay on my left side in the bath, and my partner rubbed my back during contractions.  That massage was wonderful.  I almost needed him to rub so hard that it hurt me, as this somehow distracted my brain from the other pain!

The contractions were still coming fast with little break between them.  I remember thinking about trying to let go of my rational brain and just go with my ‘monkey brain’, and musing to myself on how absolutely impossible this was, almost laughing at myself – Mule, you are actually in labour and STILL you are analysing everything and wondering what other people think of you!

I have no idea how long I was in the bath, but I guess it must have been quite a long time.   Maybe even hours?  Then the midwife suggested I get out.  I had no idea why but went along with it.  Once out of the water, I felt freezing cold and I remember being on all fours on a rug.  It was at this point that my waters broke.  I can only say that your waters breaking feels exactly as you imagine it would feel.

After this, I then had a contraction that felt totally different to all that had gone before.  It was as if it had another layer on top, and this layer felt like being possessed by spirits.  Let me try and explain – there was the contraction and all the usual pain and sensations etc, but then on top of this, it felt like a wave passing through me, I thought I would wet myself, poo myself and be sick, all at once.  I found it really hard and didn’t like the feeling that I might lose control of myself completely.  It was one thing being naked on the floor but another to contemplate simultaneously shitting and puking in front of an audience!  Every contraction after this was the same and I felt like I was holding on tight to my body to keep all of its atoms roughly in the right place.   I don’t suppose this can have helped me to give birth but it also felt like the only natural thing to do.  I also don’t recall ever feeling an ‘urge to push’, instead I just felt an urge to try not to be sick!  During this time, I sniffed Clary Sage oil on a tissue and when I smell it now, my body instantly recalls these amazing and intense physical sensations. 

During the contractions, I absolutely HAD to have hold of my partner’s hand, and after they were over, I absolutely HAD to have some water, as my mouth felt like a desert.  When each one was coming, I would say, ‘hand hand hand’ and then hold it as tightly as I could.  It felt like an anchor, as if I might drown if I did not clutch it. 

This went on for some time and I felt weaker and weaker.  I had not eaten much, fatal for me and my low blood sugar.  I wanted very much to get up on all fours but I just could not physically sustain it.  The only way to survive was just to lie on the floor on my blankets. 

Then I started to get pain BETWEEN the contractions!   Anyone who has ever been in labour will tell you this is NOT what you want to happen!  The time in between contractions is the golden time when you gather yourself and come up for air.  The pain between the contractions also felt like ‘bad pain’; whereas the contractions had a purposeful energetic feeling to them, this pain felt destructive.  I began to feel a bit desperate. 

The midwife then left the room.  I can’t remember exactly the order of what happened next, but I think she came back, and then a man in a suit came in.  I had no idea what he was doing in what I felt to be a very personal space.  I found his entry to be a very shocking experience in itself.  If either he or the midwife introduced him or explained why he was there, I don't remember this at all.

The next part was pretty awful and is still hard to write about.  He said he wanted to examine me and I still have a very lasting visual image of him rolling up his sleeves.  I felt utterly at his mercy and very humiliated.  Most of all I felt discomfort at the contrast between our states, he in his pristine suit, speaking calmly and quietly if at all, and me, naked, sweaty, dirty, exposed, chanting – I felt like an animal at the vets.  He examined me and it was incredibly painful and horrible.  This was an awful experience; there is no getting away from this fact.

He told me that the baby was OP and there was some discussion.  It was agreed that I could have fifteen more minutes.  For the first time I became very aware of the clock over the door.  I really started trying to push!  The time seemed to go so fast.  Then he was back.  I don’t know how the verbal side of the next bit went.  I remember protesting.  I must have been consulted in some way and I must have consented in some way, otherwise I suppose they would not have been able to continue.  I also must have refused an epidural. 

They walked me to the bed and there was some panic as they could not find the stirrups anywhere, until my partner remembered we had hidden them behind the curtain the night before!

I put on an old shirt of my partner’s that we had brought with us.  I have no idea why it was felt that I should put it on!   I sometimes feel as if at that point I was being ‘made decent’; taken from my animal state, naked exposed and groaning on the floor, and somehow ‘sanitised’ and made to fit our culture’s view of how birth should be, on a bed, on my back, my breasts covered…I was even convinced to have gas and air at this point, and I really didn’t want it!  But again I sometimes wonder if they wanted me to have it to make me quieter.  These are perhaps dark and cynical thoughts.  Nevertheless I wish to record them.

Inevitably my feet were placed in the stirrups.  Feminists and natural birth campaigners everywhere can cringe when I say this, but I have to be honest – putting my feet in those stirrups actually felt like a relief!  Something was supporting my legs and so I no longer had to.  I was so utterly exhausted.  I still kept trying to push really hard during contractions while they got things ready. 

I was given three injections in my perineum, which I felt, but which were insignificant sensations compared to those of labour.  I then must have been cut but I didn’t feel this at all.  The doctor wanted to know when a contraction was coming and so, for a few minutes, we became a team.  I did not feel the forceps go in, or if I did it was lost amongst all the other things that were happening to my body.  I gave a push, and for the first time felt that the push actually did something!  I was told, that’s the head out!  I was astounded by this piece of information and sent my poor partner to go and have a look!  This was probably the last thing he felt like doing but was hardly in a position to argue!  Then came another contraction and the most fantastic feeling of the body coming out. 

As she was born, I remember saying, ‘oh yes!’, as it felt so so SO good.   Then suddenly I heard the midwife say it was a girl and this bright red body came towards me through the air, it seemed!  I was so shocked to see a baby!  I know that I had spent the last 9 months being pregnant, and the last few hours in labour, but somehow, the last thing I expected to see in that room was a baby, particularly not my own baby!  It was 3.20pm.

They cut the cord straight away and I felt immediately disappointed that my partner did not get to do this.

I was given syntometrine (again I protested, but they could not leave me to a physiological third stage as I had been cut…the cascade of intervention I had read about was in action.)  I didn’t like this part either as the doctor was pushing on my tummy and again I had the feeling of being an animal at the vets, or, dare I say it, a piece of meat at the butchers.  The placenta came out fairly quickly but I did not get to see it, which also disappointed me.  I actually felt quite upset about this – to the point of tears - for a long time after the birth.  I had wanted to see it and possibly even keep it and plant it under a special tree, so I felt quite literally robbed that they just took it away without consulting me!  It was part of my body!  This might sound ridiculous but some people keep their kidney stones so maybe it is not so mad after all.

They set about stitching me up, which took quite a long time.  I found it very unpleasant and could feel the needle going in and out.  I told the doctor and he said something a long the lines of ‘well you should have had an epidural’.  I am so utterly glad to this day that I didn’t!  It would have only served to make me even more passive and uninvolved in the birth of my child, and even more incapacitated afterwards.  At least I got to feel that wonderful climactic rush of the moment of birth! 

I had more gas and air while he stitched me and my partner held her, as I did not want her first memories of me to be of a crying woman with a tube stuck in her mouth.  She was so alert and seemed to be looking at everything with such curiosity.  My memories of this part of the story are quite hazy, perhaps due to the gas and air.  I remember of course breastfeeding for the first time, and I guess this must have been after the stitching.  She latched on with no problem and it was a wonderful moment.  I also remember phoning a few people and I think I spoke to my parents.  After a while we got moved to a different room, a private room on the post natal ward, and I sat holding her and breastfeeding while my partner tried to gather all our stuff and load it into the car.  We were trying to decide whether to stay the night.  If I stayed, my partner could not stay with me.  To be without him that night, after sharing the most intense and mind blowing day of our entire lives, seemed unthinkable!  On the other hand I was very weak.  However, I was brought some cold roast beef, bread and butter and salad, which I wolfed down, and which almost completely fixed me!  In retrospect I think a lot of my weakness and exhaustion during and after labour was due to my low blood sugar, but it was so very hard to eat with contractions coming so close together. 

So we decided to opt for the ‘6 hour discharge’.  Everything felt so bizarre.  We had to dress our baby and get her in the car seat, and we had to ask a midwife to show us how to do this!  She seemed so tiny and fragile!  The journey home scared us both, driving along in the dark with such precious cargo. 

Back at home my partner took some photos and rushed around in a state of panic.  He was on his own adrenaline trip and could not sit still!  Eventually we went to bed although I spent most of the night sitting in the armchair breastfeeding.  I think a lot of the time she was sleeping with my nipple in her mouth, but I didn’t know this, I had no idea what I was doing.

But that I suppose is where a new story begins, the story of my birth as a mother!

1 comment:

  1. I began to read this post with a great deal of trepidation as pretty much every story I have heard involving induction has not ended well... and that certainly does not mean that I view a forceps delivery as well...

    Although you have told me your story before (I think!) I couldnt remember how long the induction took. So many women end up on a sytocin drip and having horrendous contractions for an unbarable amount of time... This can cause so much harm to Mum and Baby - I am so glad the pessary worked for you.

    Its interesting what both you and Michelle have raised about examinations... We have become so knoweldge obsessed that we really let it blind us. Well done for declining further ones in labour. Maybe you should do a whole blog entry on the topic... I was given a stretch and sweep without permission during an examination... cannot believe her naive I was back then.. If that happened again I think I would have them arrested for assult! Seriously though - there is a whole load of women who feel intensly damaged by rough, uneccessary exam's expecially by men (or women) who just show up in the room...

    I really want to do some study into forceps - Michel Odent stopped using Forceps years ago at Pithiviers and instead encouraged natural birth and if that didnt work it was ventouse or Section.. I think knowing what I do now I would probably take a section over forceps... How do you feel about forceps deliveries now?

    Oh and well done lots and lots for refusing the induction - I had my 2nd child 13 days over at home and that was 6 hours after a consultant said there was no way on this earth I was going to go into labour naturally. I indeed pulled out all the stops that night, including sex and he shot out after a two hour labour (including pushing). When I was with the consultant he even asked me which profession I was in as I seemed to know so much about birth and my body... How sad that a women having a real knowledge about induction is a rare event....

    Jx

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