Solomon's Story
2012
First baby
Lived in: Kaeo, Far North
WHERE WAS YOUR PLANNED PLACE OF BIRTH?
Home Birth
WHERE WAS YOUR ACTUAL PLACE OF BIRTH?
Kawakawa Hospital
SOLOMON'S BIRTH
I was forty one weeks pregnant and waiting for this day. My pregnancy had been problem free, textbook, and I went into labour naturally, feeling positive, excited that things were underway and we were soon to meet our baby.
Signs of early labour
I had wondered if labour would begin today. Unusually I slept in until 11am, got up and went to the toilet, a bit of diahorrea, I heard this could be a sign that labour would soon begin.
By mid- late afternoon I recognised I was in early labour, starting with slight pelvic discomfort, similar to menstrual pain, leading onto mild contractions like braxton hicks, gradually increasing in strength throughout mid afternoon.
I waited until Hubby arrived home from work to tell him the news, labour has started! His face was priceless, beaming. He set about preparing stuff for our homebirth, bean bag, birth pool.
We had decided to try for a homebirth, try being the operative word, we were fully conscious that this is our first baby, and that ultimately the labour and the advice of the midwives would dictate where we birth. We had talked it over with the midwifes before deciding this, and were told they lean on the side of caution, transferring women at the sign of any risk, either by helicopter or ambulance. That approach suited us perfectly as we live in rural Northland (about 110Km from the local obstetric hospital at Whangarei and about 50Km from the maternity hospital at Kawakawa). So bags packed, food made, car gas tank full of petrol, we felt prepared in any eventuality.
7pm
Labour continued. Hubby setup the bean bag and birthing pool as I began making dinner. At about 7pm I had a bloody show. It freaked me out, unsure of how much blood was normal? This was more than the 'mucus plug'. I called the midwife, and was surprised to get the locum midwife on the phone instead of either of our two independent LMC midwives. Locum midwife said she was on call for that night, that the show sounded normal, and to call when I needed her, she would be a fly on the wall.
I got off the phone and tried to let go of the anxious feeling the shock of the blood had provoked and worked to get my head in the right place to cope with labour, assisted by rescue remedy and practicing yoga breathing through each contraction.
Within an hour the contractions began to require my attention, I had to stop cutting veges for dinner and focus through each contraction, things still didn't feel painful, but they needed my concentration. Hubby finished cooking instead, and we ate, mouthfuls for me in between contractions.
9pm
Baby seemed to move around alot. It was about 9pm. That seemed normal, baby was usually very active around that time. But I began to feel uncomfortable in the sense that the contractions seemed to be in a stream, relentless but not painful, so we couldn't time them. With each contraction I began to feel an urge to push a poo! This was so distracting, I just wanted to 'go' so I could get on with labour more comfortably. I couldn't 'go' even though I tried and the feeling persisted throughout the whole labour, along with contractions that were more centred in my lower back.
I had a shower, water running on my back. After hopping out, I felt much better. We timed the contractions, and they seemed more regular, about 5mins apart. The info we had been given by our antenatal class at Kawakawa hospital, and also from our LMC midwives said to call when the contractions were 3mins apart. So we waited. We timed them for over two hours. We dragged a mattress to the lounge and set up bed in front of the fire, resting and waiting for the contractions to get closer together.
We laboured overnight, Hubby slept next to me while I was on all fours, supported by a stack of cushions. I quietly breathed into each contraction, fully conscious of each one, and tried dozing in between. In the morning the contractions were about 7-8mins apart, with the odd one at 5 mins, the odd one at 2 mins. Non-consistent, still waiting for the 3min apart goal (yes our LMC had used the word 'goal').
8.30am
We were glad to get a text from the locum midwife the following morning. It was 8.30am. She was heading to Kawakawa for changeover and advised would call us soon to make a plan for the day. I hadn't replied, distracted by another contaction and expecting to just hear from her. At 10am we still hadn't heard, so Hubby called.
He described our night, my symptoms. Locum midwife said the back pain and 'needing to go poo' were symptomatic of baby being in 'posterior position' (baby's face pointing up toward my tummy), that posterior labours tend to take longer and the biggest concern is that I don't get too tired. She said she had appointments to attend and would come and see us about 3.30pm.
3.30?! We both felt we wanted someone there with us, but didn't insist she come out. Our thoughts were that she knows more about how this all goes than we do, it must be ok. We knew of labours taking up to 48 hours and we felt we had to prepare ourselves, we have to get used to the idea that we must have a long way to go. Besides, our contractions were not yet 3 minutes apart, so we weren't in established labour, it wasn't time to ask her to be there, or so we thought.
12.30pm
At 12.30 she called, an appointment had cancelled and she was glad, she came out to see us. I was quite tired, but ok. She asked me to lay down and tried to feel my tummy, it was hard and tight as I went through another contraction. She monitored baby's heart, hearing that it wasn't recovering to her liking in between contractions, a concern, as she thought I was still in an early labour. She politely yet strongly insisted that we transfer to Kawakawa for better monitoring. Admittedly disappointed, but we were prepared, Hubby threw our bags in our car and we left, locum midwife following behind.
2pm
I began to have the urge to push vaginally on the drive. It was a relief to finally arrive at Kawakawa hospital, it was now about 2pm. I quietly walked in and was helped onto the bed. The locum midwife hooked us to the CTG monitor to watch baby's heart beat, and did a vaginal exam, to find I was fully dialated, to her surprise. She thought I was in an earlier stage of labour since I had coped so quietly with each contraction. This now explained baby's slowed heart recovery, apparently more concurrent with our late stage of labour.
On the drive to Kawakawa she had decided that it would be best for us to transfer to Whangarei and had organised for an ambulance to come and collect us. There was some delay / confusion which delayed the dispatch so we were still waiting for this to arrive. Meanwhile, midwife suggested I have a push. I needed to do so anyway and she felt around baby's head during this contraction to see if there was any descent down the birth canal. Yes, slight descent. She broke my waters, finding there was some meconium. I changed positions a few times, not wanting to lay flat on my back, tried kneeling on the bed, standing, then it was suggested to try pushing whilst on the toilet to encourage baby down the birth canal a bit faster.
The problem with this was that when we were in the bathroom, we were away from the CTG monitor, so monitoring was done by the handheld doppler, not as accurate. So there were a few moves to and fro, from the bed & CTG, back to the bathroom A bit distracting, retrospectively I would have liked to stay in one place, to concentrate on pushing and opening.
The ambulance had arrived meanwhile and was on hold, waiting for the word to transfer us if we needed it. But baby was coming and it was a hard call, should they decide to move us and have baby born in the ambulance on the side of the road? Or stay at the maternity unit, where more help was available if needed?
Baby's heart recovery began to slow further, the midwives began having trouble finding the heartbeat. Three midwives tried, thinking baby could be too low in my pelvis and the doppler could not pick it up through bone. Locum midwife began saying we needed to 'cut and run', to just go to Whangarei. They didn't have the tools to be able to assist the birth at Kawakawa and baby was in distress and needing help. But things were critical as the heartbeat could already not be found. The hospital midwife suggested one last thing to try: I was helped back to the bed, on my back, one knee in her arms, the other in Hubby 's arms, and coached with each contraction. Baby needed to come out, this was our last chance. I pushed and pushed. Baby was so close, but needed to be out now. With the final contraction I pushed and was cut (episiotomy), locum midwife reached her fingers in and pulled baby out in a gush of relief, baby facing up toward the ceiling in persistent posterior position.
4.12pm
He was a boy! He wasn't breathing. The cord was cut immediately and he was taken to the resus table. Hospital doctors and ambulance staff rushed into help. They worked on him for 20 minutes, but his heartbeat could not be found for about 15-30mins prior to birth. In my tired state, I didn't have a true sense of how dire the situation was. I actually had complete faith that he would be fine, he had to be! My heart was completely filled with hope, buoying Hubby even though he saw things weren't looking good. The doctors finally had to say sorry, nothing more they could do. I nodded in reply. Shocked, numb. We had a beautiful boy, but we couldn't keep him.
4.12pm 26th June 2012. Our lives had changed forever.
We opted not to get a post mortem done for our boy. We had some swabs completed in absence of the post mortem, it showed he had a presence of strep-b on his body (strep-b is present in 30% of womens vagina's and can be present on healthy babies as well as stillborn babies) and he had meconium in his waters (a sign of stress that again can be present with both healthy or stillborn babies), and blood tests for me which showed as normal. He was a healthy weight, 7 pounds 13 ounces, 57cms long. We will never truly know what caused our baby's death, though in those moments after birth we already felt we knew where things had gone wrong and that a post mortem would not bring any answers. We got to bring our baby's body home, our families came up to stay, to cuddle him and grieve together. It has been an important step in our healing, taking photos, creating memories.
The time after was filled with disbelief, sadness and haunting what if's. This couldn't be real. He was full term. He was alive at the beginning of labour. I had a perfect pregnancy. I ate organically from our home garden. I took a prenatal vitamin complex. I did yoga. I trusted that "the body that grows the baby know's how to birth it". His room was absolutely ready, we were ready. How could this be OUR truth?
Things you would do the same?
I would try to have a natural, vaginal birth again. I was glad to be fully present as possible, despite our outcome. I found doing yoga breathing through the contractions and using rescue remedy to be enough for me to manage the pain, taking it one contraction at a time. The labour pain for me was completely bearable and the birth beautiful and empowering.
Things you would do differently?
Retrospectively I wish we had planned to stay at home for early labour with a plan to birth at Kawakawa. If we had planned this, we would have been seen that morning and hopefully detected baby's distress earlier. Throughout antenatal care our LMC midwife had portrayed there was no real advantage to birthing at Kawakawa compared at home, ultimately if we needed help in either place we would need to go to Whangarei.
I believe there is a place for a home birth, but for us personally we will now be forever fearful of birthing at home. If you choose a home birth, or even if you are in hospital, you ABSOLUTELY must have the midwife there with you, monitoring your health and baby's THROUGHOUT the labour. This early monitoring is particularly important if you have some distance to travel to if you need to get help.
It seems so naive now that we didn't just say to the midwife 'we want you here now'. But it was our first baby, we thought things were going ok, it is so clear now that we were in established labour, even without 3min apart contractions - restropect is a fine thing.
What advice would you reccommend to other Northland mums / families?
Communicate clearly what you want while you are in labour.
We didn't' ask our midwife to come out even though we wanted her there. We felt assured by the phone call though deep down we knew that something wasn't right. Why was she not coming out until the afternoon? Why did we not insist on being checked earlier?
Seek a second opinion if things don't feel right.
Call the hospital if you if you are at home and have questions or feel you need a second opinion; or if you are in hospital and have any worries, or if things don't seem right, ask to be seen by someone else.
You do need to trust in the professionals, they are the ones with experience and are there to help you, just remain assured you have every right to ask for help if you feel you want it. Ask if there are there any additional risks as things unfold, and be clear about your needs.
Have a support person there who has been through this before.
I wish we had arranged for another mother to be there with us, or even just a phone call away. So hubby had support, someone to discuss decisions with, or in our case ask him ask him 'does this seem right?'
If you are planning a home birth, check when your midwife will realistically be there with you in labour.
Once you give birth to a baby, the details of other families births sink in more, because you can now listen with understanding.
We have heard stories (not just local ones) with midwives diagnosing over the phone, "you are not in enough pain as you can talk through that contraction", or "call me back when you are in pain" only to be called just minutes later to say the baby is coming. Yes your body is designed to birth, but wherever you birth you want to be supported and monitored by a professional. It is one of the most critical time in your lives to have support! You want to know if baby's in distress, if you need help and if you need to move somewhere to get help.
Leaving it until contractions are '3mins apart' seems to us to be a risk especially if you have had a baby before - if something went wrong and you need time to transfer to Whangarei. If you midwife can't be with you through your labour, I recommend to birth at hospital where you can have one-on-one care.
Monitoring in labour seems so essential.
Assumption can be the mother of all stuff-ups. There is no point in guesswork over the phone, things can change and you want to know sooner rather than later, so you can get appropriate help, if necessary. We have been told since our loss that the only way to effectively diagnose the correct stage of labour is by vaginal examination to check cervical dialation. The only way to tell how baby and mum are coping with labour is by being present, observing and listening to mum, and using monitoring equipment to glimpse at baby's health.
Here are some additional things we have learnt since our labour and loss:
- Both the info from our LMC midwives and from our antenatal class stated to call the midwife or to go in to hospital when you were in established labour - this was described as having contractions at 3mins apart. One of our LMC stated several times that 3mins apart contractions is the 'goal', which gives the impression this is what to aim for, 'you will get there'. I still think it is better described as a 'guide'.
The antenatal class tutor even said 'not to come into hospital until you were in established labour, as you would be sent home!'
These both heavily influenced our feelings that the labour must still have some way to go, and made us reluctant to ask to be seen even though we wanted to. - The LMC midwife had said that if we were to transfer from Kaeo this would either be via helicopter or ambulance. Things to note are that the helicopter is only used if:
- there is no local ambulance currently available
- or if the patient needs support to come TO them quickly
- We were also told that the length of time for a helicopter to make its two way journey from Whangarei Hospital, to the patients location, and fly back to Whangarei; is the same length of time as taking an ambulance that is already in your local area, one way from your current location. How long does it take you to drive there? Something to consider when deciding where to birth.
- Depending on availability, some ambulances may be volunteer's or 'drivers' only, as ambulance officers are given authority to practice at different levels, depending on the range of training they have received, so may not be able to provide medical help if your midwife needs additional assistance.
- Babies in posterior position have contractions that are erratic, so contractions do not follow regular timing. This is fitting with our example of 8mins, then one at 2mins, then another at 5mins etc.
- Some babies will labour in the posterior position, though can turn to anterior position (baby's spine facing mums belly, born face down) and be born relatively quickly.
Our LMC's said that posterior babies are considered a normal birth. We since learnt that this depends at which point in labour this is diagnosed - if it is decided early in labour, alot of those babies can turn on their own, cork screwing down the pelvis to be born in anterior position. The problem is, it is hard to predict which of the posterior babies will turn on their own and which will need assistance.
In the book New Zealand Pregancy Guide, 2009, posterior position is mentioned within the section 'complications and interventions'. This does not mean that a baby labouring in posterior will necessarily be problematic, though it certainly increases the need to monitor mum and baby's health and progress throughout labour. - The percentage of babies who are posterior in labour is found to be higher among first-time mothers. We were told that if you look at the causes for slow progress in labour, posteior positioned babies are a often a major one, that the slow progress often ends up with more transfers to hospital from home or a primary birthing unit, more often that if it was anterior, and are associated with a greater numbers of assisted births than with a baby in an anterior position.
- Babies in persistent posterior position (baby's spine facing mums spine, most of whom are born face up) have a 30% chance of turning on their own.This means however that 70% of persistent posterior babies (babies that do not turn and are born face up) need help to be born. This means assistance by a hormone drip to enhance the effectiveness of the contractions, or help by forceps, or ventouse, or if baby or mum are in distress, caesarean. We would have had a different approach had we known there was such a chance that we needed help, we would have gone to hospital that morning.
Reference: Statistics taken from US National Library of Medicine National Institutes of Health View a pdf of this article.
