Posts Tagged ‘Childbirth’

A couple of months after DD’s birth I wrote a post called Things they don’t tell you before or during a pregnancy which has been far and away my most viewed post. I still like it because I still think the things I wrote about aren’t talked about enough, and I still think knowledge is empowering! With that in mind, I thought I might write a follow up. For my second baby, I had some definite ideas about what to expect and also about what would be acceptable to me during pregnancy and birth, so this one feels a bit more serious. Here goes.

1. The professionals have your best interests at heart, but they also have their own best interests at heart. And your best interests, in the opinion of most midwives and consultants I’ve spoken to, are to have a healthy baby and be a healthy mother. Of course! You wouldn’t expect anything less. So their priority list goes: healthy baby, healthy mother, don’t get sued. Which is completely fine, but your own priority list might go: healthy baby, establish breastfeeding, look after mental health, be at home, etc etc. Or: healthy baby, be left alone. Or: healthy baby, don’t be left alone. Or whatever. Whichever way you look at it, your list of your own best interests is going to be longer and more complicated than the list your caregivers have, and sometimes that means there’s a clash of priorities, because their ‘don’t get sued’ is fighting for space with your ‘have a water birth despite being advised against it due to factors x, y and z.’ And of course, they’re professionals, and if they advise you to do something or not do something then you’d be stupid not to listen to them – but, and here’s the bit that makes me and other similarly-thinking mothers like me a giant pain in the midwife’s arse, you don’t have to take their advice. How you give birth is up to you. That means if you want an elective caesarean they cannot say no. And if you want to have a home birth, they cannot refuse to attend you. These, and any number of other things, are up to you.

Listen to the advice from your midwife and/or consultant, take it seriously, do your own research, talk to independent midwives, talk to a doula, talk to people you trust, make lists of pros and cons, decide on your own level of risk that you’re comfortable with or not, and make your own decision based on being informed and knowledgable, not scared. I was dead set on a home birth this time around. I saw a terrifying consultant who refused to go through DD’s birth notes with me but simply said no, and couldn’t or wouldn’t give me a reason other than ‘it would be dangerous’ while quoting anecdotes at me about babies that had died. I did masses of my own research and eventually my lovely community midwife got my notes from DD’s birth and went through them in her own time and explained them to me. My doula sat with me in the meeting because, frankly, I was an emotional wreck, and asked pertinent questions that I hadn’t thought of, and I asked more questions of my own. There was no pressure either way and eventually I decided, based on the facts that I wanted to go to hospital. So I came to the same conclusion as the terrifying consultant, and in terms of NHS time I’m sure she would have said I wasted it, but I felt a hell of a lot more confident in knowing that I had made an informed choice, and when I gave birth I was comfortable birthing in the place I’d chosen to be. So here’s a middle finger for Ms M the consultant. You were a cow.

2. A doula could change your life. Truly, madly, deeply. Our doula gave me confidence in my body, managed the birthing space, ensured I had the things I needed to feel comfortable, gave DH the space to do nothing but exactly what he and I wanted rather than having to worry about anything, and generally made me feel like an incredible goddess, doing a normal but wonderful, magical thing. She held my hand and said encouraging things and cried when our son swam into the world, and then she left us to our new bliss at the right time and came back a couple of days later to debrief, feed me homemade granola bars, kindly and gently support me and not judge me about how difficult I was finding breastfeeding (again), give our baby a bottle while I had a little cry and give me many hugs. I still see her occasionally and I am amazed every time at how good she makes me feel. I am convinced that my positive mental health and bonding with DS are in no small part down to how much compassion she showed me before, during and after labour. Not everyone wants a doula with them in labour and some people are horrified at the thought of a non-medical professional seeing them in such an intimate way, but if it’s something that interests you, do some research and find someone you click with. If finances are an issue then look into hiring a trainee (as we did) or apply for funding. Lots of information can be found at Doula UK.

3. Your body is strong but it is also delicate and needs to be taken care of. If you think you have any kind of prolapse, hernia or other pregnancy/birth related injury, don’t suffer in silence. There is a whole community of professionals out there who know how to help, but these are issues that people feel uncomfortable talking about and so many women are in pain as a result. Start with your GP and if they’re not helpful for any reason, look into physio, post-natal fitness specialists etc. There is so much help available. MuTu, which I’ve already written about, is one option for post-natal fitness, or a specialist personal trainer like Vanessa Barker (who is a friend of mine – there are many people like her though so look for someone local to you if she isn’t!). You would be surprised how many people have incontinence issues, pain during sex, spasms, tears that don’t heal etc etc. They’re not so common that pregnant women need to worry about them excessively, but they do happen, and if they’ve happened to you, you are not alone. I’ve been lucky with both pregnancies and births in physical terms, having a second degree tear with both that healed easily. I know several people who weren’t so lucky and getting help as early as possible is key to a swift recovery!

4. In many parts of the world the post-natal woman is positively tended to hand and foot for a significant chunk of time – up to three months in places. After DD’s birth as soon as I was released from hospital I was UP, entertaining, making cups of tea for visitors, keeping busy, keeping in charge, keeping in control. This was all despite my husband and mother both being there – I had no need to be out of bed, but I felt that somehow I must. In retrospect, this made my physical healing harder and it made my mental state more shaky. This time around one of the women leading our ante-natal Mindful Breath Birthing course said something that really resonated with me – that post-natal women who have had straightforward births need to try to spend roughly five days in bed, five days on the bed and five days near the bed. I did. It was bliss. I stretched, I did my pelvic floor exercises, I pottered a very little around the house (to the bathroom and back mostly!), but mostly I – and the baby – were in bed. If anyone wanted to see us, they came to us. I didn’t make a single cup of tea or a single meal. I just recovered, stayed mostly naked with my mostly naked baby and, as far as possible with a tiny, fragile, up all night newborn, relaxed!

5. Babies are different to each other, including to their siblings. DD arrived after an awful labour experience, screamed a LOT as a newborn and then slept through the night and self settled from 3 months. DS arrived after an amazing labour experience, doesn’t cry very much but also doesn’t sleep for longer than a couple of hours or self settle, and he’s 6 months now. If you’ve got one and you think you’ve got parenting nailed, you may be in for a shock when the next arrives! But they’re different in wonderful ways too. They have their own personalities and their own wondrous gazes and their own amazing ability to poo at 40mph. Even when you’re at the end of your tether and just. want. to. go. the. fuck. to. sleep. they will surprise you and make you laugh through your gritted teeth. Babies are hilarious, tiny dictators. And even if you’re sure you never want to go through it again and you’ve decided you’re definitely done with having children, the sight of a tiny new one will make you ache.

That’s it really. If I ever have a no. 3 I’ll write another list!

Advertisements

Read Full Post »

So while I’m here I thought I’d put up my birth story, which I wrote recently.  It’s long.  Sorry.

When I gave birth to E it was quite traumatic: it started with my waters going, I contracted for about 3 days, was eventually induced via the drip with a failed epidural and she got stuck at the shoulders and had to be hauled out in an emergency procedure. As well as the fact that she almost died, which was completely terrifying, the more I looked back on it the more I found the whole ordeal humiliating and infantilising. I didn’t trust my body and neither did the medical professionals, rightly or wrongly, and despite learning hypnobirthing exercises while pregnant, in the event I only found them useful for the early stages of labour, before I was told I had to be induced. I was determined that with my second birth things would be different!

We attended an antenatal class called Mindful Breath Birthing which at first seemed extremely hippyish but which we ended up finding invaluable. The basic premise was that if you were mindful and in the moment, experiencing each contraction and breathing through it without engaging through thinking, things would unfold as easily as they could as all the right hormones would be present. Calm and relaxed equals oxytocin flowing and a body that does what it’s made to do, while stressed, fearful and thinking equals a body that’s hampered by too much adrenaline and less likely to work properly. Obviously none of this accounts for emergencies with the baby, but I definitely felt that with E’s birth I had felt under so much pressure to give birth within a certain time frame due to my waters having gone that I was almost certainly too stressed and frightened for it to happen. If I hadn’t been so stressed, perhaps I would have laboured more quickly, not been induced, not been on my back with an epidural and not had shoulder dystocia.

The other thing we did differently this time around was to hire a doula, M. E’s birth had been traumatic for all of us, not just me, and at one point J had ended up literally shoved into a corner by doctors and midwives where he was left to try and see what was happening, convinced our baby had died or was dying. We wanted to have someone else there who we could trust had our best interests, and only our best interests, at heart. Midwives and doctors and nurses are amazing but they’re bound by the legal interests of the hospital as well as their commitment to the patient. Doulas are there purely to offer emotional and practical support. They don’t offer medical advice or get in the way of the professionals, but they protect the birthing mother’s space in a way that it’s difficult for the parents themselves to do when under pressure, in pain, or frightened. Over the weeks before the birth M helped me as I battled the hospital’s (wrong) diagnosis of gestational diabetes, attended emotional meetings with me where I was talked out of a home birth by midwives convinced this birth too would end in shoulder dystocia, hugged me when I was upset and provided constant, gentle support.

I had awful PGP in the final weeks of my pregnancy and on the 12th I had slipped in the bathroom and done the splits, which would have been painful enough at the best of times, much less when 41 weeks pregnant and suffering pelvic girdle pain. On the morning of the 13th I had been very relieved to get E into nursery for an extra day, so I could take the day off from toddler duty and just lie down attempting to get comfy. At about 5.30pm, lying on our bed I suddenly felt the tell tale ‘pop’, stood up and felt a familiar gush of waters. I managed to waddle to the bathroom but had forgotten that once they go, they keep going! I called J to tell him that things were starting, and he was about to finish work anyway and pick up E so he did that and got home by 6.30. I also texted M to alert her as she had her own childcare to sort out, but said that I didn’t know how quickly things would progress so not to come round yet. At 6 my contractions started but they were very mild and easily breathed through, so I didn’t consider them ‘real’ labour. When J got home he put the TENS machine on for me, as it works better if it’s on from early labour, and I called A, who was going to come and look after E for us if we had to go to hospital in the night. I told her not to come yet as we didn’t know whether we’d be going in that night at all, and it was her husband’s birthday! She completely ignored me and got in the car, so was with us by about 7.15, which turned out to be a very good instinct of hers. She and J gave E tea and put her to bed and at 8 I moved into the bathroom as the contractions were coming quite regularly now, about 3 in 10 minutes, though they were still relatively mild. I wanted to kneel and lean over my ball so the bathroom seemed the easiest place to be, as well as easily wipeable! I texted M again to say they were coming quite regularly now and she was with us by 8.15.

I was using the boost button during contractions and M brought candles, rubbed my back and gave me Clary Sage and Frankincense on flannels to sniff, as they’re both supposed to encourage the body to stay in labour once it’s started. She talked when I wanted to but was otherwise a quiet, calm presence. It was really comforting for me to have her there, and it also meant J could go off and do things like eat, pack up what we needed and not have to be with me all the time. At about 8.45 she asked whether I thought I’d like to go hospital but I was convinced that I wasn’t in full blown labour, despite the now very regular contractions, purely because the pain was so manageable. I remembered with E feeling like I was going to die of pain (!) and this was nothing like that. I said that I really didn’t want to go in only to be sent home again, and that I’d rather stay at home for as long as possible. At 9, with me getting quite a lot more vocal as I was doing a sort of loud hum through the contractions by now, she said that she thought if we were going to go to hospital, we should really go soon. In retrospect I realise that she and J were trying to convince me for a little while! I agreed as the contractions were feeling more intense now, and J called to tell them we were coming and packed the car while I went to the loo (which I was relieved about as a full bladder can get in the way of labour) and rocked through the contractions.

The drive to hospital was only 10 minutes (over a million speed bumps) and we were there by about 9.30. I was slightly annoyed because they initially took us into one room and then changed their minds because the lights didn’t work well enough – which I rather thought they could have checked out before we arrived – but very quickly we were in another room and M had turned the lights out for me anyway! One of the reasons I’m so glad we had her with us is that she made our birth plan just happen. It all seemed to fall into place and I didn’t even have to say a word; I had been worried that I would have to argue for some of it but she just quietly made things happen and I didn’t have to think about them at all. So the lights were extremely low, there were candles, everybody whispered, I had no vaginal examinations (something I had been certain I’d have to have an argument with the midwife about), I wasn’t coached to push and the midwife, F, barely spoke. I was completely free to focus on my breath and be mindful and in the moment. The contractions really stepped up as soon as we were in the room (testament to how relaxed I was feeling I think) and I was leaning over the back of a sofa, beginning to feel a bit ‘pushy.’ There was one moment in particular where I felt like I was getting out of control and I shouted ‘I can’t do it!’ and M was right there, pushing down firmly on my lower back and saying quietly, ‘you are doing it.’ It was exactly what I needed to hear and I had a funny little out of body moment where I suddenly thought, ‘I am in transition!’ Which was quite encouraging really, as it meant I had to finally realise that this really was labour.

By 9.45ish the pool was ready and I asked J and M to take off my TENS pads. I didn’t realise at the time, but they actually managed to electrocute themselves while doing this as they forgot to turn it off first – and it was up at full whack by this point! Once it was off I got in the pool and was able to start using gas and air to help with the pain. I don’t think it actually dulls the pain but it does a good job of distracting from it and it made me feel a bit woozy in quite a pleasant way. I tried a few different positions in the pool, which was a bit disappointingly shallow. I wanted to be on all fours as much as possible so I leant on the edge and kneeled. The next day my chin really hurt and I realised that when I was pushing in that position I’d managed to bruise it on the tiles. M was there with cool flannels and sips of water whenever I needed them, and J held my hand and kept whispering encouragement. The midwife wanted to check the baby’s heartbeat between contractions (and in retrospect was clearly quite scared about me being in the pool, given E’s birth, but she didn’t say a word at the time which I’m very grateful for) and I got a bit irritated because it meant I kept having to move back so she could get the doppler onto my stomach, so I switched to a sort of lying on my back position, where J and M held one hand on either side and I floated, pushing and squeezing their hands for support and something to press against. Each time I pushed my whole body and head bobbed down under the water a bit and M said afterwards that at one point she and J looked at each other and shared a ‘hope she doesn’t drown’ look! I still had the gas and air at this point and after I’d been pushing for a bit the midwife suggested I stop using it as it was making my pushing less effective. I was a bit reluctant to give it up but she was absolutely right because as soon as I stopped using it I was able to be much more mindful again and really focus on pushing. Part of me wishes I hadn’t used it at all as I think he’d have been born sooner, but it was nice at the time so I don’t regret it.

My pushing got a lot stronger and, just like with E, I felt that my body was sort of doing it without me. I could feel everything moving him down and the midwife could see his head but he wasn’t actually moving out. I didn’t think about shoulder dystocia at all (thankfully, as I’m sure if I’d thought about it I’d have freaked out and it would have all gone wrong) but I think J, M and F were all thinking about it. If it had happened I’d have had to get out of the pool to attempt to deliver. A woman from the antenatal course had told us the story that when she had her second baby he wasn’t moving out and she turned onto her left side and he was born, which suddenly popped into my head and I turned onto my left. J was holding both my hands, M was holding my right knee up and F had her little torch out but wasn’t touching me when all of a sudden, with one big push and me shouting ‘it stings!’ H swam into the world at 11.07pm. I couldn’t believe it! F guided him to the surface and into my arms. At some point a second midwife had come into the room and sat quietly in a corner; I only noticed when she just as quietly got up and left. No shoulder dystocia, no trauma, no emergency at all – I don’t think I’d really believed it was possible until it happened. The whole thing took less than 6 hours.

M continued to work her magic and J, H and I were left alone in the peaceful, calm dark for a good while, just staring at each other, having skin to skin and laughing and crying, just as we’d asked to happen on our birth plan. Eventually F came over and said the cord had stopped pulsating so we could cut it now if we were ready – she did ask if J or I wanted to but neither of us could quite bring ourselves to! The lights were all left low and the atmosphere was lovely. After I guess about half an hour I wanted to get out, so she helped me out of the pool and I sat on a recliner chair with H. She was doing some paperwork, M was tidying up her bits and pieces and J was picking up my clothes from the floor when I suddenly felt a bit pushy again so I just shifted slightly to the front of the chair and all of a sudden the placenta pretty much fell out of me – absolutely perfectly into a cardboard bowl that F had left there. It was weirdly funny at the time as it was so quick and I don’t think anyone expected me to accidentally ‘aim’ so well! She was quite excited by the fact that the third stage was natural as she was newly qualified and in her whole training she’d only ever seen women birth the placenta with the injection. It was also the first birth at which she’d ever met a doula, and it was her birthday! Once the placenta was out and we’d turned the lights up she got quite chatty and was absolutely lovely. I’m so grateful to her that she was willing to go with our hippyish ways and take the lead from M in terms of the birth plan – I think we were very lucky to get someone so amenable and so kind.

After a little more cuddling and some initial attempts to get H to breastfeed F examined me where I was sitting in the chair and said I’d need some stitches, so we ‘transferred’ across the corridor to the more medicalised rooms with beds, and she said I had a second degree tear and stitched me up. As with E’s birth the local anaesthetic didn’t work so I had gas and air for the stitching, which wasn’t too bad. M held my hand and J held baby H! Then M gave me a banana and a breakfast type bar, as it was about 2am and I hadn’t eaten tea and was starving, and we had lots more skin to skin and breastfeeding attempts. We could hear a woman next door screaming in pain and F said she was having a difficult birth but had a needle aversion so wasn’t having any pain relief. I felt awful for her – I wish she’d had a doula to calm her! M went home to get some sleep after giving me a witch hazel spray for my maternity pads and some herbal stuff for the bath to promote healing, F cleaned up and weighed H in at 8lbs 15ozs (on our birth plan we’d asked for him to not be taken off for cleaning and weighing until there had been lots of opportunity for skin to skin) and I had a shower while J had more baby cuddles. Then H had his first dose of vitamin K, which we wanted him to have orally rather than by injection. The final thing on our birth plan was that we didn’t want to be in hospital for any longer than absolutely necessary, and at about 4am F came and said we could go home once she’d finished up the paperwork. By 5am we were at home and at 7am E woke up, came into our room and said, ‘that’s my baby brother!’

Read Full Post »

20120217-100646.jpg

I’ve been thinking for a while that I’d like to write my birth story, as it’s one of those things you don’t want to bore people with in real life too often but it percolates around your own head for a long, long time after the event. There have been two shoulder dystocia births on One Born Every Minute recently and it’s been quite upsetting to watch them as it’s been a reminder of just how lucky we were. This story might be a bit gory but it has a happy ending, promise.

Just over a week before my due date on a Saturday evening I was sitting on the loo at home, trying to wee quickly so I wouldn’t miss the start of X Factor, when there was a very audible popping sound, quickly followed by a gush of water. I called out to DH that my waters had broken and his response, ‘Are you sure?’ made me laugh-there was definitely no mistaking it. Contrary to popular belief fuelled by Hollywood, labour doesn’t often start with your waters breaking but there was no way this could be anything else. I put on one of those giant maternity pads that only add to your inability to walk properly at that stage in a pregnancy, realised it was full within seconds of standing up, sat back down, tried again and repeated the process a few more times. (Yep, still gushing. I thank God I was on the loo when this happened. I’d been having nightmares over the previous few weeks that it would happen in the middle of Waitrose.) Eventually I managed to get up to call Triage. They like you to go in to be checked out as lots of people think their waters have gone when they’ve actually just had an accident, though I was pretty confident I was right about this one! We went in, giant maternity pads strewn all over the car, and a midwife had a look at a pad. (Given the rest of their job I’m sure they don’t mind doing this but the idea of examining someone else’s maternity pad is pretty gross to me. She didn’t seem to mind though.) She confirmed it was my waters and sent us home to wait for the contractions to start. She warned us that if nothing had happened by Monday morning I’d have to go in to be induced, as once the waters have gone the risk of infection for the baby goes up significantly.

We got home, settled back in front of X Factor (that’s a looooong show) and wondered excitedly whether we’d have a baby by morning. At about 11pm I started to get a few contractions. They weren’t bad and felt just like strong period pains that came and went every 20 minutes or so. We went to bed and I managed to sleep a bit but not much, as every time I started to drift off I’d have another contraction and wake up. At some point in the small hours I fell asleep properly and when I woke up in the morning I realised it was because the contractions had stopped.

By about 11am they’d started up again and this time they didn’t stop. They built up over the course of the day but never got past a rate of about 2 every 15 minutes which, I can tell you, is the precise rate of contractions that will annoy the hell out of you as you’re unable to do or think about anything else, but not a rate that a midwife will care about as you need 3 every 10 minutes to be deemed interesting. We spent about 2 hours walking round and round the block to try and encourage them along but it didn’t do much. FINALLY by bedtime they started heating up and I spent another night awake, but this time pacing around the sitting room timing contractions and willing them to speed up. My Hypnobirthing classes were pretty useful by this point and I was breathing and walking, breathing and walking. DH went to bed (I sent him to be honest-one of us needed some sleep!) and I woke him up at about 4am as the contractions were upping in intensity and were finally coming 3 in 10. The breathing was still working and I was feeling pretty good, if knackered.

We grabbed our bags (which had been packed for a fortnight!) and drove to the hospital. They put us in a room with an ensuite bath and gave me a birthing ball to bounce on too, and after a little bit came to examine me. By this point we’d reached the point where if I wasn’t in full blown labour they’d want to induce me as it had been 36 hours since my waters had broken. I’d been contracting for most of the weekend so I was fairly confident I’d be quite dilated…erm, WRONG. I had dilated by a measly 2cm. IN 36 HOURS.

Midwife no 1 told us I couldn’t have a water birth (which I was really upset by) as it had been too long since my waters had gone and that I needed to be induced by a drip. We said we’d rather wait. She got annoyed. We got annoyed. For the record, we didn’t want to be induced for a couple of reasons:

1) if you’re induced you’re statistically likely to have more interventions such as forceps/c section etc, which didn’t fit with our idea of a hypno/waterbirth.

2) I had heard that because induction ramps up your contractions so swiftly the pain increases exponentially and I wanted to avoid an epidural as I wanted an active birth and didn’t want to be on my back.

She agreed to give us another few hours to see if my body could get going on its own (and probably went to warn the other midwives that I was a grumpy cow!). By about 4pm I was still only 2cm dilated and had started to go into shock, I think due to the length of time I’d been awake and the worry that my body wasn’t playing ball. At one point I was in the bath and my whole body was shaking uncontrollably which was quite scary. When the midwife said I needed to be induced now, we agreed. We were taken into a labour room, handed over to midwife no 2 and I was given the dreaded epidural.

Unfortunately the person trying to do my epidural (who must have been a student, looking back) hit bone the first couple of times she tried and eventually had to call a consultant to come and guide her through the process. The whole thing was terrifying and very stressful as all I could think about was the fact that an incorrectly administered epidural can paralyse you! In the end it was in and they started up the drip in my hand. (Same lady-and she messed that one up too so the bruising was pretty bad and I couldn’t move my fingers properly for a couple of days. Lovely.)

The epidural was an interesting experience. Midwife no 2 asked whether I could feel anything and kept topping it up because I could still feel pain in various parts of my stomach. The contractions weren’t painful for a couple of hours and then it wore off and they were really fucking painful. The midwife kept telling me it was normal to feel pressure but not pain and I don’t think quite believed me when I said it was real pain I could feel. I was using my breathing again and also gas and air to get through them. (Awesome stuff. Makes you feel like you’re floating.)

I’d always thought that pushing was something you had to actively do, and that with an epidural you’d have to be told when to do it as you wouldn’t feel your contractions. This wasn’t the case at all for me-for a start I could feel everything and, in addition, I couldn’t have stopped the pushing if I’d tried. My body just did it. It was bloody painful but the breathing and gas helped, and it didn’t take long before the midwife (no 3 by now) said she could see the baby’s head. Within a couple of pushes the head was out and she was telling me that just one more push and we’d meet our baby. It took a few minutes, however, of big pushes and nothing changing before she went a bit pale and asked DH to press a button on the wall. Another midwife quickly came in, had a quick look and pressed the button again. Within seconds there were about 15 people in the room, plus a tiny baby crash cart. DH was pushed into the corner of the room (and left there, not knowing what was going on-something he said was the most terrifying thing that’s ever happened to him as he was convinced DD was dying or dead) and two midwives grabbed my knees and held them down by my ears while someone else made a fist and punched hard on my lower stomach several times. At this point I’d been awake and contracting for about 50 hours so I was pretty out of it and didn’t really register what was going on. With one final punch DD was yanked out and whisked onto the cart where she spent a hideous minute not breathing. Once she’d been resuscitated and checked for broken bones and paralysis (both common injuries due to the pressure put on the shoulder by the punches) she was finally given to me to hold and everyone left us alone. The midwife was very shaken and said to us that we’d been very lucky as if the McRoberts manoeuvre and suprapubic pressure hadn’t worked I’d have needed an emergency c-section, which there probably wouldn’t have been time for. (Given that DD’s head was out it would have been bloody difficult too! Given also that I could feel everything due to the epidural having worn off I try not to think about the possibility of a c-section. I’m sure they’d have topped it up, but it generally didn’t seem to work well on my body.)

Shoulder dystocia, where the baby’s shoulder is stuck behind the mother’s pelvis, is pretty rare and can be deadly. Babies don’t start to breathe until their lungs have been squeezed out and as the baby’s head is out but the lungs aren’t that can’t happen in these instances-combine that with a squashed placenta and you quickly have a baby with no oxygen supply. However, although it’s an emergency, and a pretty terrifying one at that, midwives in this country are very well trained and we were so grateful to have the wonderful, speedy, efficient, calm and careful care that we had. Midwife Pam, you are our hero.

It’s more likely to happen if a) the baby is very large (she wasn’t), b) it’s happened to you before (nope-first baby) or c) you have a very long labour and are induced.

This website, American Family Physician, has some good info:

Shoulder dystocia can be one of the most frightening emergencies in the delivery room. Although many factors have been associated with shoulder dystocia, most cases occur with no warning. Calm and effective management of this emergency is possible with recognition of the impaction and institution of specified maneuvers, such as the McRoberts maneuver, suprapubic pressure, internal rotation, or removal of the posterior arm, to relieve the impacted shoulder and allow for spontaneous delivery of the infant. The “HELPERR” mnemonic from the Advanced Life Support in Obstetrics course can be a useful tool for addressing this emergency. Although no ideal manipulation or treatment exists, all maneuvers in the HELPERR mnemonic aid physicians in completing one of three actions: enlarging the maternal pelvis through cephalad rotation of the symphysis and flattening of the sacrum; collapsing the fetal shoulder width; or altering the orientation of the longitudinal axis of the fetus to the plane of the obstruction. In rare cases in which these interventions are unsuccessful, additional management options, such as intentional clavicle fracture, symphysiotomy, and the Zavanelli maneuver, are described.

Shoulder dystocia is one of the most anxiety-provoking emergencies encountered by physicians practicing maternity care. Typically defined as a delivery in which additional maneuvers are required to deliver the fetus after normal gentle downward traction has failed, shoulder dystocia occurs when the fetal anterior shoulder impacts against the maternal symphysis following delivery of the vertex. Less commonly, shoulder dystocia results from impaction of the posterior shoulder on the sacral promontory.1

The overall incidence of shoulder dystocia varies based on fetal weight, occurring in 0.6 to 1.4 percent of all infants with a birth weight of 2,500 g (5 lb, 8 oz) to 4,000 g (8 lb, 13 oz), increasing to a rate of 5 to 9 percent among fetuses weighing 4,000 to 4,500 g (9 lb, 14 oz) born to mothers without diabetes.2–4 Shoulder dystocia occurs with equal frequency in primigravid and multigravid women, although it is more common in infants born to women with diabetes.2,5 Several additional prenatal and intrapartum factors have been associated with an increased incidence of shoulder dystocia (Table 1). The single most common risk factor for shoulder dystocia is the use of a vacuum extractor or forceps during delivery.2 However, most cases occur in fetuses of normal birth weight and are unanticipated, limiting the clinical usefulness of risk-factor identification.6

We were so lucky to have a healthy baby at the end of it all, and I was also very lucky to only have a 2nd degree tear (3rd or 4th degree can happen with shoulder dystocia) which was easily stitched. I’m fairly sure that the reason DD refused point blank to breast feed (for 10 heart wrenching and exhausting days before we cut our losses and switched to formula) was because of the trauma of the birth, though I’ll never know for sure. I’m very nervous that if we have a second baby it’ll be more likely to happen again, and one of the suggestions is to have an elected c-section, but I’m pretty much petrified of those too (it makes me think of medieval torture, which I’m aware is ridiculous) so there’s a lot of thinking to be done! Ultimately though, we’re so privileged to have one happy, healthy child, and we’re so grateful for that.

Read Full Post »

Inspired by a previous post I thought I’d take the opportunity to get down the many things about pregnancy, birth and early parenthood that noone tells you while you’re trying to conceive.  Not that they would necessarily put you off, but they can be a bit of a shock, and people deserve to know!

Pregnancy:

1.  It might take you a lot longer to get pregnant than you expected.  Years of teachers, health care professionals and magazines telling you that it only takes one ‘accident’ to get up-duffed mean that it can be a bit of a surprise when you work out that you’re actually only fertile for a couple of days a month, and you could quite easily do the deed every other day for six months and not get pregnant.  The chances are there’s nothing wrong with you: don’t panic.  If you’ve got to a year with no joy, go and see your GP.  But before you do that, read Toni Weschler’s ‘Taking Charge Of Your Fertility’ which will teach you more than you ever thought there was to know about cervical mucus and basal body temperatures.

2.  Skin tags will grow in the most unexpected places.  I got two on my neck and one right in the middle of my tummy button – it appeared when my tummy button popped out.  They might fall off after you’ve had the baby, which is pretty gross in itself, or they might not.  A GP can take them off for you.  Don’t accidentally scratch one off because it will hurt like hell.  (Bitter experience.)

3.  Your tummy button is likely to pop out.  If you’ve always had an inny, this is a bit weird.  It’ll probably go back in afterwards though.

4.  Stretchmarks affect different people differently.  I’ve read that how your body was affected as a teenager can suggest how you’ll be affected during pregnancy but I’m not sure how true this is.  I did get some as a teenager on my boobs and hips, but not particularly badly.  I was discussing pregnancy stretchmarks with a friend who’d recently had a baby and she said, ‘Oh they’re dreadful aren’t they?  Look at this!’  and revealed ONE stretchmark on ONE boob.  Well, my stomach looks like multiple traintracks going round a roundabout.  They start just by my tummy button and go round in circles all the way to my sides.  I mean my WHOLE stomach.  Also covered are my inner thighs right down to my knees, my hips right up my sides to about 6 inches under my arms, and my whole lower back.  I look like some kind of alien life form when naked.  I don’t love them, but as the weeks have passed I’ve come to hate them less.  They’re sort of battle scars.  Oh, and the Bio-oil/Cocoa Butter/blah blah blah crap that pregnancy magazines tell you to slather on are all rubbish.  (As are all pregnancy magazines.)  The only thing that worked for me at all was Neal’s Yard Mothers Balm (the lack of apostrophe is theirs – it drives me nuts), and all that did was make them slightly less angry.  If you’re going to get them, you’re going to get them.  (Your mother’s experience isn’t necessarily anything to go on either – my Mum remarked in surprise when she saw my stomach, ‘Oh gosh, I didn’t get ANY stretchmarks…’  Thanks, Mum.)

5.  While you’re pregnant perfect strangers will come up to you and touch your stomach without you asking, and they will probably make a comment about how huge/tiny you are.  It is perfectly ok to grope their boobs/other socially-unacceptable-to-touch-in-public places and make an offensive remark in return.

6.  The same strangers, plus your colleagues, friends of friends, etc, will tell you their birth horror story with utter glee, repeatedly.  It’s like they forget they’ve already scared you half to death, and need to repeat themselves over and over again for maximum enjoyment.  The best I had ended with the priceless line, ‘…and then I broke the stirrups!’  IGNORE them.  Yes, you need to be prepared, but you will be better off reading ‘What To Expect When You’re Expecting,’ going to a friendly ante-natal class and talking to a couple of close friends you trust (and your Mum).

7.  Your hair gets gorgeously glossy and thick while you’re pregnant.  Then it all falls out.  Well, not all of it, but the excess you didn’t shed while pregnant.  Enjoy your glorious barnet while you can.

8.  Pregnancy makes you very emotional.  You will cry at any charity advert that shows hungry or ill children, any story anyone tells you about babies, any celebrity who has a baby, any particularly manipulative advert such as the gorgeous John Lewis one, plus pretty much anything else to do with babies or children.  You will also cry at the news, because you can’t believe the world’s such a terrible place and you’re bringing a child into it.

9.  There will come a point where you can’t see your own legs to shave them, much less your toe nails to cut.  Make sure you’ve picked a good man to have a baby with because he’s going to get better acquainted with these areas than he might have been before.

Birth:

10.  In the actual moment of having your baby you will feel like you need to have a very big poo.  You don’t.  That’s your body wanting you to push (or doing it by itself in some cases).  And if you do poo on the table, which you might, you won’t notice, nobody will comment, and the midwife will have it whisked away in seconds.  Everybody panics about this but while you’re pushing out a 7 or 8 lb baby, you won’t care.  Honestly.

11.  Giving birth is an absolutely extraordinary feeling that you can’t possibly describe to someone who hasn’t done it.  It also hurts.  If you want to have pain relief, for God’s sake have it and don’t feel guilty.  If you don’t want it, don’t have it and don’t be bullied into having it.  If you don’t want it and then you change your mind and you do want it, don’t feel bad.  Your body, your choice.  There are no medals.

12.  Giving birth is also immensely personal.  Some people want their Mums plus partners plus second cousins there, some people want to be left alone with the midwife, some people want to be at home, in a pool, on top of a mountain, doing Hypnobirthing, having a c-section, whatever, wherever.  Do your research, make sure your choices are safe, and then stick with them and ignore the crap everyone gives you.

13.  In your hospital bag make sure that you have moist toilet tissue or, at the very least, a small jug to pour water over your bits while you wee.  Going to the loo after giving birth is not pleasant.  Going in the bath can help, if you can get over the grossness.  And for God’s sake eat a lot of fibre because you will think you’re going to die from constipation.

14.  Take a lot of food into the hospital with you.  The food in the post-natal ward will be hideous and you might not be up to going and foraging in a vending machine in the middle of the night.  However, as a back up, take a lot of change, well hidden.  You can always send your DH to the vending machine when you run out of nutri-grain bars.  You’ll probably also need it for parking, which is ludicrously expensive.

15.  Take a water bottle and a straw.  This will be useful during labour when you don’t have the energy to drink from a cup and later on the ward when you’re holding your baby and can’t reach the bedside table.

16.  Lochia can go on for up to about 6 weeks after you’ve given birth.  It’s far heavier than your heaviest ever period.  Sanitary pads are useless and you won’t be able to wear anything other than pyjama bottoms to cover up the fact that you’re using giant maternity pads.  Also, there will be clots.  You had a baby, so these aren’t that big a deal in the grand scheme of things, but be prepared.  They will be gross.

17.  Tampons are likely to hurt for a long time.  Don’t try.  Don’t let your DH fixate on the magical ‘six week’ mark either.  Have sex when you’re ready, not before.  Be prepared for it to hurt – a lot – if your body’s not ready.  Be sensible.  (Edit:  DH would like a disclaimer in here that he didn’t ‘fixate’ on the six week mark!)

18.  You will still look six months pregnant for at least a week after giving birth, and for some people, considerably longer.  Don’t hit the man in the coffee shop who asks you when the baby’s due while you’re very obviously holding your newborn.  Smile sweetly and say, ‘I’ve already had her.’  Then walk away and try not to cry in public.

19.  It will hurt to sit down for a good week, if not two.  Longer if they’ve bodged your stitches.  Have a lot of baths, with salt if you can stand it.  It will hurt to walk too – don’t overdo it.

20.  If you tear or have an episiotomy you will have to have the stitches that will make it hard to sit down.  One friend asked me, ‘Did you have stitches?  Where?  Wait, I don’t want to know…’  Well, firstly, they’re not that big a deal at the time.  You’ll have anaesthetic and you’ll probably be holding your snuggly newborn which is quite a distraction.  If you’re lucky they’ll do them in the delivery room and you won’t have to go to theatre.  If you’ve torn you’ll have one of the following: 1st degree tear, which is just a little tear to the edge of your ‘where the baby comes out’.  2nd degree tear which is from there almost to ‘where your poo comes out’.  3rd degree tear which joins the two.  (Yes, really.)  Just be glad you’re not a poor African lady giving birth by herself in the bush – no medical care = no stitches = fecal incontinence = social exclusion and possible death.  Seriously, you’re lucky to have the NHS, no matter how much they may piss you off at other times.  Please excuse my coyness with language – I’m already getting spam comments and I imagine they’d get worse if I used anatomically correct vocab!

21.  Breastfeeding is natural, normal, lovely and best for your baby.  It may be easy, with baby latching on immediately after birth and feeding well.  It may also be the hardest thing you’ve ever done, and I’m including pushing out a baby in that.  If it’s agony or not happening, get help.  And if you use formula, don’t feel guilty.  As my DH put it after two weeks of me crying every time I tried (and failed) to feed DD, ‘it’s called parenting, not breastfeeding’.  Try and keep some perspective.  You are a mum no matter how you feed your baby.  And she won’t remember anyway.

Early parenthood:

22.  The touchy-feely-ness from the general public will carry on once you’ve had your baby, but people will want to touch the baby.  Again, feel free to tell them to fuck off in no uncertain terms.

23.  They will also tell you – constantly – what you’re doing wrong.  So far I’ve heard from passers by, ‘That baby needs a hat,’ ‘She’ll spoil that baby carrying it around all day,’ ‘Ooh, that’s a hungry cry,’ and many more.  They are not right.  You’re right.  It’s your baby.  Fuck em.

24.  You will get fed up with your family telling you how to raise your child.  Listen politely, thank them, take on board the bits that sound sensible, and then do what you want.

25.  Don’t be too proud to accept hand-me-down clothes, toys and baby equipment.  The baby market is as bad as the wedding market – there are a lot of vultures out there ready to tell you that your baby will DIE if you don’t spend £200 on the latest, snazziest, ugliest contraption they’re selling.  Your baby will probably decide her favourite toy is an old shoe and never look at said contraption.

26.  Babies grow FAST.  Newborn clothes are adorable and almost entirely a waste of time and money (unless you have a very little one).  I’d say at a push you need 6 newborn vests, 6 newborn sleepsuits with integrated scratchmitts (try Mothercare or Next), a cardigan, a hat and something warm for the pram.  They’ll be out of them within a few weeks and into 0-3 clothes, which will then last much longer.  Scratchmitts were designed to infuriate parents and invoke domestics.  They will fall off.  Instantly and repeatedly.  Similarly, sleepsuits without them built in are the devil’s work because they mean you need the bloody things.  Without them your baby will scratch her little face and probably yours too.  Throw them all out and get sleepsuits with them integrated.

27.  Slings are awesome.  The Moby wrap (try Amazon) was the only thing that sent DD to sleep for weeks.  They’re cheap (much, much cheaper than a pram), easy, don’t hurt your back and are an absolute godsend as they mean you have both hands free.  Don’t bother with papooses, babaslings and other rubbish on the market.  Just get a simple, stretchy fabric wrap and breathe a sigh of relief.  Lots of cities have sling libraries – go and try one out first if you’re not sure.

28.  You can survive on far, far less sleep than you thought you could.

29.  Sometimes you’ll be exhausted, furious, upset and terrified all at the same time.  You’ll shout at your partner, convince yourself you’re doing everything wrong, worry terribly and cry buckets.  (Baby blues are horrible but if you feel that it’s worse than feeling ‘blue’ then you should go to see your GP about potential post-natal depression.  Noone will take your baby away from you, they will just help you feel better.)  All parents struggle though, and if it’s not pnd but just (just!) sheer exhaustion you should try to tell yourself that this moment too will pass.

30.  The moment of looking at your teeny, beautiful, extraordinary baby and falling in love happens again and again.

Read Full Post »