Continuity of Care
When I got pregnant with my first baby, I knew how I wanted to be cared for; I wanted to be looked after by midwives that I got to know during my pregnancy, who would attend my baby’s birth and care for us post birth. Living in Brisbane, we decided on a major public hospital, and applied for the birth centre as their model of care ticked all our boxes. My husband and I had an incredible journey, and our first daughter was born with two out of three of our midwives present and our midwifery student. We had developed a great rapport with all three of the midwives, so much so, that when we got pregnant with our second I knew who I wanted to be cared for by. We were blessed to not only be accepted by the birth centre again, but we were also placed with the same team (at our request). Continuity of care exactly how I had wanted! Each time we saw the girls, it felt like we were talking with old friends, and I felt so comfortable and happy, especially as I felt that this pregnancy was completely different to my last and felt very nervous all over again. We also requested to have a student midwife again, as I had found the experience was great last time for both me and the student.
As a side note, last pregnancy, I had put on nearly 20 kilos, taking me into triple figures which meant that I was unable to use the birthing pool (due to weight restrictions). I didn’t want to put on that much weight again, so before I got pregnant this time, I got in contact with a dietician who met with me and began re-education about healthy eating. As my pregnancy progressed I was tracking along very well, and by the time I went into labour I was under the limit!
Unexpected Labour
The night I went into labour, it took me and my husband by surprise. I had had a feeling that I would be going early but ignored it, and at 37 weeks and three days, I found that evening that I could fit my whole hand between my ribcage and my belly. A few hours later, my waters broke! We called my midwife, and given that I hadn’t had any contractions, I decided to wait until morning before coming in unless something changed. Contractions really kicked off only 45 minutes later around midnight, and with our daughter having been picked up, my husband and I were able to try and rest as much as we could before labour really took off. I ended up needing my TENS machine fairly soon after the contractions started, and around 3am, my husband was calling my midwife again as the contractions were now coming hard and fast. I knew that my labour was progressing quickly, and requested that we come into the birth centre straight away. The car ride was painful, and walking through the hospital to the birth centre was interesting as I was contracting all the way. Thank heavens it was the middle of the night!
Our lovely midwife greeted us there, and took us into our room where I continued to labour. Once our student midwife arrived, we found the baby’s heart beat with the Doppler way down low, and my midwife couldn’t feel a head and thought that it must have been well engaged. I was also feeling hiccups in my bottom in between contractions, another indication to me that things were progressing nicely! Just after 4:30am, I asked if I could use the pool as I was starting to struggle with the intensity of the contractions. Once it was filled, my midwife asked if I would like an internal examination, and I very nearly declined as I just wanted to get into the water! My husband convinced me that it would be a good idea to see where we were so I reluctantly agreed. Just after a contraction, I quickly laid down on the bed, and felt incredibly uncomfortable being on my back. I kept visualising sinking into the water, until I heard my midwife's voice interrupt my thoughts… ‘and baby’s breech’. “WHAAAAAT!!!” Was my verbal reaction, and straight away another contraction hit and I flew out of the bed to get through it. By this time I was using every tool I could think of for distracting myself from the pain, but the word ‘breech’ was starting to make me panic. I kept saying ‘it can’t be breech! It just can’t!’ As I thought that meant that I would be taken for a caesarean and that thought terrified me! I am a nurse myself, and have done a lot of research into birth seeing as I was having children, and I knew that a caesarean was not ideal unless it was an emergency.
A one-sided story
I had noticed that my midwife had popped out of the room, presumably to inform medical staff, who then accompanied her back into the room when she returned, saying that we needed to take a little walk (over to the birth suite about 40 metres away). As we all (slowly) walked into the birth suite room, my first image was a wall of light blue scrubs and a very bright room. There seemed to be a few people in there, and my worry increased. I was hooked up to CTG monitoring while they did an ultrasound to confirm my baby’s position; that swoosh swoosh sound of the heart beat was a little bit reassuring. The obstetric registrar came to my bedside, and began to explain to me my options. She told me that none of the staff in the room were experienced with breech births, and that her consultant had recommended to her an epidural and preferably a caesarean. While she was explaining the risks of a vaginal birth, in between contractions, including my baby getting stuck and the danger that could occur including death of my baby, I kept feeling that I was being given no other choice (afterwards, my husband said he felt the same thing). I felt so powerless, understanding that if my baby needed it then a surgical birth was truly necessary…. But was it necessary at present?
The registrar continued to say that she couldn’t force me to do anything I didn’t want to do, and I started to search for my midwife. I found her at the back of the room, shaking her head as the registrar talked further about an epidural. Seeing her shake her head, I felt confident enough to ask to try and gas and air first rather than go straight for the epidural. I was then told that ‘this isn’t about pain relief; it’s about the safety of your baby’. I nearly crumbled, and in a last ditch effort called out for my midwife and asked her opinion as I really wanted to hear it from someone I truly trusted. She confirmed for me what was already in my head, but hadn’t heard from the registrar – the risks of having the epidural; that it could slow down labour and lead to further interventions like caesarean which was a new set of risks in itself. She then explained to me the favourable parts of my situation – my labour had been progressing very well, this was my second baby, at two and a half weeks early the baby was unlikely to be over four kilos, and bub was a complete breech. She also said that she was experienced in breech births, and told me that I could do this naturally; I just needed to get up on all fours and continue. I think there may have been a little pause in the room before I made my decision and I decided to put all my trust into my midwife and my body and give natural birth a go. As soon as I said that, I felt better and slightly calmer although very apprehensive in wondering if I was going to be able to birth this baby backside first.
Can I do this?
Once they put an IV in my hand, my midwife encouraged me to get upright and lean over the bedhead to help progress my labour. Once I was up, I kept asking if I was allowed to push yet, as the contractions were so close and overwhelming I wanted to push to get some relief! Being told I wasn’t allowed to push, I requested some gas and air to try and get through the last of the contractions. I felt awful on the gas, and the pain was still there, but I no longer felt like I wanted to push. I started to lose faith in myself at one point, and called out to my midwife asking her ‘can I do this??’ and calmly and confidently she replied ‘of course you can!’ It was the encouragement that I needed. Things were a bit fuzzy for a short while but after another request from me to push, my midwife asked to examine me to check for any cervical lip and ensure I was fully dilated. Thankfully I was able to remain upright, and as she checked me my body took over and I remember apologising as I pushed as I just couldn’t help it! My midwife then told me to listen to my body and to go with it, and all I wanted to do during those contractions was push, it felt so good to be doing something! I realised that as I was pushing, I felt my baby descending really well, but wasn’t sure if that was just in my head. I do remember when bub was half way out, thinking how much it was stinging and my heart sunk realising I still had the head to go. However, much to mine and everyone else’s surprise, a couple of pushes later our first son, Alexander was born! That split second of relief, was replaced by ‘OMG I can’t believe I just did that!!!’ and he was then passed to me through my legs and into my arms, and euphoria took over. I laughed in disbelief at what had just happened, so happy that my baby was here safely, that I’d been able to have him the way I wanted with the people I wanted. By the time I was able to turn around, the ‘wall of scrubs’ was gone, and the only people who remained were our midwife, our midwifery student (who had never seen a natural birth let alone a breech) and another midwife from the birth suite. An hour later, we were taken back to the birth centre to recover and just enjoy our new baby.
When I got pregnant with my first baby, I knew how I wanted to be cared for; I wanted to be looked after by midwives that I got to know during my pregnancy, who would attend my baby’s birth and care for us post birth. Living in Brisbane, we decided on a major public hospital, and applied for the birth centre as their model of care ticked all our boxes. My husband and I had an incredible journey, and our first daughter was born with two out of three of our midwives present and our midwifery student. We had developed a great rapport with all three of the midwives, so much so, that when we got pregnant with our second I knew who I wanted to be cared for by. We were blessed to not only be accepted by the birth centre again, but we were also placed with the same team (at our request). Continuity of care exactly how I had wanted! Each time we saw the girls, it felt like we were talking with old friends, and I felt so comfortable and happy, especially as I felt that this pregnancy was completely different to my last and felt very nervous all over again. We also requested to have a student midwife again, as I had found the experience was great last time for both me and the student.
As a side note, last pregnancy, I had put on nearly 20 kilos, taking me into triple figures which meant that I was unable to use the birthing pool (due to weight restrictions). I didn’t want to put on that much weight again, so before I got pregnant this time, I got in contact with a dietician who met with me and began re-education about healthy eating. As my pregnancy progressed I was tracking along very well, and by the time I went into labour I was under the limit!
Unexpected Labour
The night I went into labour, it took me and my husband by surprise. I had had a feeling that I would be going early but ignored it, and at 37 weeks and three days, I found that evening that I could fit my whole hand between my ribcage and my belly. A few hours later, my waters broke! We called my midwife, and given that I hadn’t had any contractions, I decided to wait until morning before coming in unless something changed. Contractions really kicked off only 45 minutes later around midnight, and with our daughter having been picked up, my husband and I were able to try and rest as much as we could before labour really took off. I ended up needing my TENS machine fairly soon after the contractions started, and around 3am, my husband was calling my midwife again as the contractions were now coming hard and fast. I knew that my labour was progressing quickly, and requested that we come into the birth centre straight away. The car ride was painful, and walking through the hospital to the birth centre was interesting as I was contracting all the way. Thank heavens it was the middle of the night!
Our lovely midwife greeted us there, and took us into our room where I continued to labour. Once our student midwife arrived, we found the baby’s heart beat with the Doppler way down low, and my midwife couldn’t feel a head and thought that it must have been well engaged. I was also feeling hiccups in my bottom in between contractions, another indication to me that things were progressing nicely! Just after 4:30am, I asked if I could use the pool as I was starting to struggle with the intensity of the contractions. Once it was filled, my midwife asked if I would like an internal examination, and I very nearly declined as I just wanted to get into the water! My husband convinced me that it would be a good idea to see where we were so I reluctantly agreed. Just after a contraction, I quickly laid down on the bed, and felt incredibly uncomfortable being on my back. I kept visualising sinking into the water, until I heard my midwife's voice interrupt my thoughts… ‘and baby’s breech’. “WHAAAAAT!!!” Was my verbal reaction, and straight away another contraction hit and I flew out of the bed to get through it. By this time I was using every tool I could think of for distracting myself from the pain, but the word ‘breech’ was starting to make me panic. I kept saying ‘it can’t be breech! It just can’t!’ As I thought that meant that I would be taken for a caesarean and that thought terrified me! I am a nurse myself, and have done a lot of research into birth seeing as I was having children, and I knew that a caesarean was not ideal unless it was an emergency.
A one-sided story
I had noticed that my midwife had popped out of the room, presumably to inform medical staff, who then accompanied her back into the room when she returned, saying that we needed to take a little walk (over to the birth suite about 40 metres away). As we all (slowly) walked into the birth suite room, my first image was a wall of light blue scrubs and a very bright room. There seemed to be a few people in there, and my worry increased. I was hooked up to CTG monitoring while they did an ultrasound to confirm my baby’s position; that swoosh swoosh sound of the heart beat was a little bit reassuring. The obstetric registrar came to my bedside, and began to explain to me my options. She told me that none of the staff in the room were experienced with breech births, and that her consultant had recommended to her an epidural and preferably a caesarean. While she was explaining the risks of a vaginal birth, in between contractions, including my baby getting stuck and the danger that could occur including death of my baby, I kept feeling that I was being given no other choice (afterwards, my husband said he felt the same thing). I felt so powerless, understanding that if my baby needed it then a surgical birth was truly necessary…. But was it necessary at present?
The registrar continued to say that she couldn’t force me to do anything I didn’t want to do, and I started to search for my midwife. I found her at the back of the room, shaking her head as the registrar talked further about an epidural. Seeing her shake her head, I felt confident enough to ask to try and gas and air first rather than go straight for the epidural. I was then told that ‘this isn’t about pain relief; it’s about the safety of your baby’. I nearly crumbled, and in a last ditch effort called out for my midwife and asked her opinion as I really wanted to hear it from someone I truly trusted. She confirmed for me what was already in my head, but hadn’t heard from the registrar – the risks of having the epidural; that it could slow down labour and lead to further interventions like caesarean which was a new set of risks in itself. She then explained to me the favourable parts of my situation – my labour had been progressing very well, this was my second baby, at two and a half weeks early the baby was unlikely to be over four kilos, and bub was a complete breech. She also said that she was experienced in breech births, and told me that I could do this naturally; I just needed to get up on all fours and continue. I think there may have been a little pause in the room before I made my decision and I decided to put all my trust into my midwife and my body and give natural birth a go. As soon as I said that, I felt better and slightly calmer although very apprehensive in wondering if I was going to be able to birth this baby backside first.
Can I do this?
Once they put an IV in my hand, my midwife encouraged me to get upright and lean over the bedhead to help progress my labour. Once I was up, I kept asking if I was allowed to push yet, as the contractions were so close and overwhelming I wanted to push to get some relief! Being told I wasn’t allowed to push, I requested some gas and air to try and get through the last of the contractions. I felt awful on the gas, and the pain was still there, but I no longer felt like I wanted to push. I started to lose faith in myself at one point, and called out to my midwife asking her ‘can I do this??’ and calmly and confidently she replied ‘of course you can!’ It was the encouragement that I needed. Things were a bit fuzzy for a short while but after another request from me to push, my midwife asked to examine me to check for any cervical lip and ensure I was fully dilated. Thankfully I was able to remain upright, and as she checked me my body took over and I remember apologising as I pushed as I just couldn’t help it! My midwife then told me to listen to my body and to go with it, and all I wanted to do during those contractions was push, it felt so good to be doing something! I realised that as I was pushing, I felt my baby descending really well, but wasn’t sure if that was just in my head. I do remember when bub was half way out, thinking how much it was stinging and my heart sunk realising I still had the head to go. However, much to mine and everyone else’s surprise, a couple of pushes later our first son, Alexander was born! That split second of relief, was replaced by ‘OMG I can’t believe I just did that!!!’ and he was then passed to me through my legs and into my arms, and euphoria took over. I laughed in disbelief at what had just happened, so happy that my baby was here safely, that I’d been able to have him the way I wanted with the people I wanted. By the time I was able to turn around, the ‘wall of scrubs’ was gone, and the only people who remained were our midwife, our midwifery student (who had never seen a natural birth let alone a breech) and another midwife from the birth suite. An hour later, we were taken back to the birth centre to recover and just enjoy our new baby.
12 hours later, we prepared to take our baby home having had no complications, and thankfully (despite feeling that I had split in two) I came away with an intact perineum and was feeling very spritely! As we were preparing to leave, I looked over the birthing pool, and saw that it was still filled. I was so disappointed at not being able to use the pool, but it was for obvious reasons that we couldn’t and I was happy with that. My dietician and I had been working so hard to use the pool, but when I couldn’t, I found something else to be positive about… on leaving the birth centre, I was back to my pre-baby weight… something I never thought I would ever be able to do.
Reflection
During the next couple of weeks, I spoke to all three of my midwives during their home visits and/or phone calls about my experience, and through this was able to start reflecting and processing my birth. My first thought was, as a nurse I understand informed consent, and felt that the registrar was not giving me complete information to allow me to make an informed decision. I also felt disappointed as I found that the consultant who supported her did not support breech birth naturally, which was a shame as she had no support herself.
I then had another thought, feeling I was being a bit selfish when I realised that none of the doctors had actually congratulated me, but I think that I was more upset that they didn’t thank or congratulate my midwife!
Since having Alexander, I have been doing research about breech births, and also joined a Facebook page to further my research and to give support to those who are having/had a breech baby (www.breechbirth.net) . I have found that there is such a lack of skill and knowledge about breech birth, not just in the professional area, but also in that of the public. I have had many comments made to me when people hear of my birth story, ‘you mean you didn’t have to have a caesarean?’ and this confirms to me that there needs to be more awareness made so women don’t feel cornered into a single option. Women should understand that it is their body, their baby, their birth, and they have a right to make an informed decision and be supported in that decision. I was incredibly blessed to have an experienced person caring for me, but also she was someone who encouraged me and supported me in every way. I would love to hear birth stories in future, of women who have whatever birth they choose, with someone who they know and trust, and come out of it feeling that they were in control, informed and that their birth was a great experience. My midwife fought for me, and although she shouldn’t have had to I am forever grateful that she did, not only for me, but to also show those who were inexperienced that it can be done. I sincerely hope that those doctors present were able to learn from my midwife, and perhaps be able to give other breech births a chance at a natural delivery when requested and where possible.
Anna (27)
Wife to Chris (32), mother to Elizabeth (2 yrs) and Alexander (10 weeks). A Paediatric ICU nurse and lactation consultant (in training), and becoming more interested in birth choices!
During the next couple of weeks, I spoke to all three of my midwives during their home visits and/or phone calls about my experience, and through this was able to start reflecting and processing my birth. My first thought was, as a nurse I understand informed consent, and felt that the registrar was not giving me complete information to allow me to make an informed decision. I also felt disappointed as I found that the consultant who supported her did not support breech birth naturally, which was a shame as she had no support herself.
I then had another thought, feeling I was being a bit selfish when I realised that none of the doctors had actually congratulated me, but I think that I was more upset that they didn’t thank or congratulate my midwife!
Since having Alexander, I have been doing research about breech births, and also joined a Facebook page to further my research and to give support to those who are having/had a breech baby (www.breechbirth.net) . I have found that there is such a lack of skill and knowledge about breech birth, not just in the professional area, but also in that of the public. I have had many comments made to me when people hear of my birth story, ‘you mean you didn’t have to have a caesarean?’ and this confirms to me that there needs to be more awareness made so women don’t feel cornered into a single option. Women should understand that it is their body, their baby, their birth, and they have a right to make an informed decision and be supported in that decision. I was incredibly blessed to have an experienced person caring for me, but also she was someone who encouraged me and supported me in every way. I would love to hear birth stories in future, of women who have whatever birth they choose, with someone who they know and trust, and come out of it feeling that they were in control, informed and that their birth was a great experience. My midwife fought for me, and although she shouldn’t have had to I am forever grateful that she did, not only for me, but to also show those who were inexperienced that it can be done. I sincerely hope that those doctors present were able to learn from my midwife, and perhaps be able to give other breech births a chance at a natural delivery when requested and where possible.
Anna (27)
Wife to Chris (32), mother to Elizabeth (2 yrs) and Alexander (10 weeks). A Paediatric ICU nurse and lactation consultant (in training), and becoming more interested in birth choices!
