Pregnancy, birth and post-partum does not follow a linear progression, or so we were to find out.
At 31 weeks, our little person had flipped to a frank breech position. My sister was born frank breech so to me vaginal breech births weren’t something to be scared of. Unfortunately, our care provider was not supportive of breech deliveries and advised us we would need to change providers if wanting to deliver vaginally. This stressed me, as we were late in our pregnancy and had already built good rapport with our provider so I got cracking with regular inversions, Spinning Babies, float tanks, avoided reclining, using fit balls instead of a normal chair, acupuncture and moxibustion and chiropractic treatment. A growth scan at 33 weeks showed he was still firmly breech with a 97th percentile head. I didn’t take this too seriously knowing late scans can be unreliable at predicting measurements. Large heads also run in our family with no history of labour or birth concerns.
At 35 weeks, both Jared and I tested positive for Covid. We spent the week together at home and it was a blessing in disguise as we would later come to see. During this time, I scoured research databases for information comparing the safety of delivery methods for breech babies. The benefits of a caesarean outweighed the risks of both the surgery and delivering vaginally. This upset me as I wanted to deliver vaginally, but I sat in my feelings and allowed myself the space to go over our delivery options.
We booked in for an external cephalic version (ECV). I was willing accept the risks of an ECV in an attempt to avoid a caesarean and it was successfully completed at 37 weeks. Jared videoed the ECV which took just under 30 seconds. Up until this point, I felt as though I hadn’t really been practicing much of what we had learnt in our Hypnobirthing course. However, watching the video afterwards (which is now one of my most favourite videos!) I can see how I used breathing and visualisation techniques to deal with the discomfort. I started gaining confidence about my ability to handle labour and had a new found energy and excitement about birth. I relaxed into the ‘what will be, will be’ notion and felt ready and excited for whatever was coming. I finalised our birth preferences. I made an affirmation board. I set up gentle lighting on top of our dresser in anticipation of labouring in our bedroom; a safe space. I listened to hypnobirthing tracks and made a labour playlist on Spotify while sitting in our nursing chair in bub’s room. I enjoyed being with him while he was still on the inside.
At 41w5d 5am (Wednesday), I woke up to what felt like gentle period cramps lasting 20 seconds. Coupled with a bit of discoloured discharge, I thought it might have been go time and remembered what Jess and Kirby had said about your first surge – go back to bed; sleep, in anticipation of the marathon ahead. I started timing these feelings which were very irregular and varied in duration. Jared went to work while I slept for a couple of hours before asking him to come home at lunch as the surges were becoming stronger, despite their irregularity. Our midwife asked me to get checked at the hospital as she was concerned my discharge was meconium. A quick swab told us my membranes were still intact and the surges I was feeling were most likely an ‘irritable uterus’. We headed home that evening and made sure everything was ready for a mad dash to the hospital if required. The surges continued irregularly and varied in intensity but I was able to get some sleep. I woke just after midnight on Thursday morning and knew we were now talking business with regular surges. Jared woke to me tensed in bed after a particularly intense ‘triple’ surge so we put my TENS machine on. I turned on my mood lighting which lit our bedroom and affirmation board with an ambient blue glow, but still kept the space dark. It was beautiful and I still think about how calm it made me feel.
We moved our fit ball to the bedroom where I was able to sit and lean forward onto our bed. This position allowed me to move my hips in figure 8s on the ball, have my knees pointing out, hang my big belly and rest my head and arms on a soft surface – upright, forward and open. We called our doula, Kirby, to let her know we were in labour, very mindful that she had been at an induction the day before and likely had not much sleep. She had actually just arrived home, hopping out of the shower to answer our phone call. She talked me through a surge, reassured us what we were doing was perfect and to call her back when we were heading into the hospital. Around 8am, we moved into our dining room so I could lean on the table and be more upright. I started using wooden combs in each hand. With each surge, I’d push the comb teeth into the palm of my hands along the acupressure points which really helped with distracting me from my discomfort. I also started using deep breathing techniques. I believe this is when I started repeating in my mind ‘loose lips, loose hips’. The surges were getting longer in length, stronger in intensity and closer together. I tried to hold off calling Kirby for as long as possible as I wanted her to get some good sleep however I was getting anxious about my discomfort and felt the need to start heading into hospital. I am a nurse so am comfortable with hospital environments and wanted to set up a comfortable space before things ramped up.
We called Kirby at 10am-ish and met her at the hospital by 11.30am-ish. I had an internal exam as I wanted to confirm there were no concerns and also to confirm that I was progressing. I was still thinking there may be a chance it might’ve been an ’irritable uterus’. I was 4cm! Once we were admitted to the birth suite, I went straight back to gentle hip movements on the fit ball and leaning up against the bed where I felt most comfortable. Jared and Kirby set up the LED candles and had gentle labouring music playing in the background (Labour Hits by One Mama Midwife on Spotify - so good!). The next couple of hours are a bit of a blur to me but I remember someone tickling my back, running their hands over my braided hair, Kirby telling me to relax my shoulders and Jared eating most of my lollies! At one point, Jared and Kirby were both on trigger points at my hips and ankles. These were so intense I needed to take a break from them. We were so lucky to have been allocated a midwife (Katrina) who had previously been a Calm Birth instructor with an equally involved student midwife (Hannah). Both ladies were amazingly hands on and I feel like they hardly left our room.
I initially went into our labour experience with the view to deliver with as limited medical intervention as possible. However, it got to the point where the surges were so intense that I was holding my breath, tensing up and forgetting to use the TENS and most of our coping strategies. I was still lucid enough to use the gas which definitely helped in taking the edge off, forced me to focus on my breathing, and allowed a faster recovery between surges.
Around 5pm, the surges started coming back-to-back and I was struggling despite all the techniques we had been using. I silently considered an epidural for a while before asking if it was too late to get one. An internal was completed and I was at 8cm, but I couldn’t fathom continuing without some kind of major pain relief as I was terribly exhausted. I was also aware that I may have had to potentially wait a couple of hours for the anaesthetist to arrive. While we were waiting, Kirby suggested moving into the shower to try to get relief from warm water. I took the gas with me, and although I’m not sure whether the shower itself helped much, the getting up and moving and doing something different helped pass the time. I remember having such a strong surge I threw one of my combs and begged ‘I just want the epi! I just want the epi!’. I needed a break from the never ending exhaustion after labouring for so long. I was pleasantly surprised when the anaesthetist arrived within 10 minutes later. He struggled to place a cannula as I was so dehydrated from labouring and using the gas. Just as he was about to insert the needle, I had a three-minute surge which reaffirmed to me that getting the epidural was what I needed in that moment. The epidural was inserted and I started feeling the effects within 10 minutes. It. Was. Amazing.
I felt like a massive weight lifted off me. I could breathe normally, I was relaxed and started to really enjoy being in the moment. I was a new woman. Hannah was also able to complete her first ever internal exam – because I was numb and felt nothing, I thought there was no better time for her to take her time and learn. If you’re ever in this situation and feel comfortable, please consider allowing your student midwife to get involved. After starting the epidural, my surges started slowing down and Katrina floated the idea of starting syntocinon to maintain them. I was open to this as I didn’t want anything to go backwards, considering how far we had come.
Unfortunately, my cervix had started to swell. I agreed to an artificial membrane rupture to help keep my surges productive. When Katrina touched them with her finger, they were so thin they ruptured immediately. The colour was slightly meconium stained but Katrina believed it was old meconium that had started being broken down and therefore was not a concern. Katrina had Jared and Kirby help with a few side lying releases to help relax my legs and pelvis. It felt odd not being able to feel the effects, but I could see the benefits with my legs hanging lower over the bed with each manoeuvre. Unfortunately, we had to say goodbye to Katrina and Hannah at the end of their shift, but welcomed midwife Toni to the show. We were now onto our third shift of midwives and we were all starting to get fatigued.
With the epidural, I had a catheter inserted and was on the CTG which showed bub responding well with each surge. After some rest, Toni did another internal which showed my cervix had relaxed, I was at 10cm and bub was slowly descending but still not putting pressure on my cervix. Toni suggested we start practice pushing in preparation for when he did. As anyone with an effective epidural will tell you, it’s hard to know where to push and if you are doing it right. I gauged the effectiveness of my pushing attempts on how many times I soiled the bed – a couple of times, so I knew I was in the right spot!
In total, I pushed for nearly 2 hours without bub hitting my cervix. Toni suggested a foetal scalp electrode as the CTG was not able to keep a trace of bub’s heart rate. Normally I would’ve held off, however given the circumstances I thought her request was justified. My urine had starting turning a bright red colour indicating bub may have been causing urethral trauma. Our obstetrician was updated about our progress. In a nice twist of fate, this OB was the same specialist who completed my ECV. The final phone call to him was just before 2am. He told Toni he would do an internal when he got to the hospital to determine if we could continue with attempting a vaginal delivery. I pushed my little heart out to try and get bub into a better position by his arrival. When the OB arrived, he completed the internal whilst I was pushing during a surge. Although he kept an excellent poker face, I knew from his lack of reaction we weren’t getting anywhere. I appreciate and praise him for his bedside manner when he presented his concerns and recommended a caesarean. As neither bub nor I were in distress and it was safe to take our time, the OB was patient and respectfully allowed us to discuss our options as a team. With my medical knowledge, I knew the blood in my urine had to be taken seriously and I was 100% confident we had exhausted all options in attempting a vaginal delivery. Bub was still much too high to use forceps or the vacuum, both of which would have caused significant damage to both of us because of his positioning. I happily consented to a caesarean and felt relief that the end was in sight. I felt so grounded and looked forward to meeting our baby.
As soon as the decision was made, things moved fast but like an efficient well-oiled machine. We were wheeled into theatre within 30 minutes. Although it was an ‘emergency caesarean’, everything felt extremely calm, safe and welcoming. At no point did Jared or I feel nervous or pushed into making a decision without informed consent or against our will. I firmly believe the research I did regarding caesarean delivery for breech presentations helped me remain as calm as I did. Jared was amazing and stayed by my head the whole time. The nurse in me would’ve loved to have a clear drape to watch the surgery – but that’s something to consider for next time. We had the same anaesthetist that placed my epidural and he was also an excellent support in talking us through the procedure. When bub arrivedthe OB held him up Lion King style. Bub needed a few minutes of CPAP and oxygen so unfortunately we were unable to delay cord clamping or have skin to skin like we had planned. I have no concerns about this though, as I feel as though the care of both bub and I was justified and in our best interests at all times.
Our beautiful Walter was born 3:06am Friday May 6th 2022 at 41 weeks exactly after a 46 hour labour. Jared and I are finding the newborn bubble to be one of the best experiences of our lives. Although long, exhausting and very different to our original birth preferences, Jared and I felt Baby Walt’s birth was an extremely positive experience and we wouldn’t change anything (except maybe grow babies with smaller heads?!).
The post-partum period has brought its own challenges for us with miscommunications leading to delayed phototherapy treatment for jaundice, nipple trauma, DMER (breastfeeding aversions), high blood pressure with a post-natal pre-eclampsia diagnosis and low iron with an accompanying allergic reaction to a transfusion. This period is where I mentally struggled the most and still get emotional thinking about it. I guess I hadn’t considered the possibility things might ‘go wrong’ post-partum if the birth was straight forward (and in reality, it was relatively straight forward). I’m still working on changing my mindset from thinking things went wrong to acceptance. Unplanned medical disruptions can be a test at the best of times, let alone coupled with caring for a newborn and a massive fluctuation in hormones during surgery recover. This is where ‘the village’ comes into play. I really had to learn to be okay with asking for and accepting help.
A huge thanks to Jess for allowing me the space to share our story as I feel it’s the beginning of my healing process.
There are two main points from Jess’s course that stand out to me now that we’ve been through the labour and delivery experience. The first is obviously the coping strategies for dealing with surges and labour and how different positioning and natural preparation can help prior to medical interventions. The second being you need to take responsibility for informing yourself of birth options with consideration for the fact this may need to change at the drop of a hat. Knowing alternative options in advance will help reduce stress in the moment and potential medical trauma.
A huge thank you to everybody who was involved in both our pre- and post-partum lives. We’ve been through the most physically and mentally taxing time of our lives and know it is only the start of a beautiful life as a little family.
Mama Ellie and Dad Jared Hypnobirthing Mother Moon Hypnobirthing
Doula Olive Juice Lifestyle