Monday, June 04, 2018

A birth story and the first two weeks of parenthood.

I've been writing this post on and off for the last two months! Babies eh?


Lydia is 13 days old today.

We've been home since last Tuesday, and we're managing well so far. She is feeding like a champ and mainly only screams if I'm not quick enough getting my boobs out or when we change her nappy or clothes.

Tom's off work for three weeks with a combination of statutory paternity leave and annual leave, and we're spending lovely times just worshipping the baby when she's awake. She's learnt to follow your face when you're talking, and stares at the high contrast between the wall colour and the picture rail.

As I use this blog as a memory repository, and I'm pro- honest sharing, here's our birth story. It was a complicated birth, but I do feel like I've had a really positive experience.

Our Birth Story

As I was approaching two weeks overdue, the NHS prefers you are induced as the risks of stillbirth or placental deterioration increase marginally. You can choose to be monitored daily rather than going for an induction. I had tried nearly everything else I could before agreeing to a chemical induction, including all the old wives tales, accupuncture, two sweeps and an NHS aromatherapy massage. I had been really well right up to the last week of my pregnancy, but at 41 weeks + I was getting very bored of being pregnant and physically much less able.

I had been dilated slightly at my sweep appointments, so Tom and I decided to have the examination at the induction and then decide how to proceed. If I had progressed and it looked like things might start naturally soon, we'd wait and go for the monitoring, if I hadn't progressed, we'd see if I could go for the Propess induction pessary, which is the more gentle of the two induction pessaries, and in our NHS Trust, means you don't have to be monitored, can go home and wait for contractions to start, and still go to a birth centre and have access to a pool etc...

So on Wed 28 March, we went off to the induction suite bright and early. After my examinations, I hadn't got any more dilated and the baby wasn't any more engaged. I was one day over their limit for using Propess, but the midwife discussed this with the consultant, and as I had been fit and healthy and low risk throughout my pregnancy, and was only there after the time limit as they didn't have an appointment on the Tuesday, we were ok to proceed. Insertion was painful, as it seems to have scratchy, sharp edges where it's a flat tape, so I used my Clary Sage oil hanky and my yoga breathing to get through. I was then monitored to see how I was responding. We had to wait a while as it took time for my heart rate to stabilise. Once they were happy, we were released.

After being in the heat of the hospital, we stopped on the way home for a walk around the Common to try and get things going. As it started to rain about 4:30pm, I started to feel my first non-Braxton Hicks contractions. These continued sporadically throughout the evening. I managed to eat a good portion of a tasty curry Tom had made - which was good as it was the last food I'd eat for a while!

By about 8:30pm, the contractions were getting more intense, and over the course of the rest of the evening, we strapped on the Tens machine we'd been lent by a friend and I paced around, spending lots of time on my hands and knees and using my yoga breathing again. About 10:30pm we went to bed. I only managed an hour of sleep before needing to pace around again, but Tom got a bit more sleep which was again a good thing based on what was ahead.

At 1.00am, the contractions whilst not regular were very close to the 3 in 10 mins when you're supposed to call Labour Line, so that's what we did. They could tell over the phone that I was definitely in pain and in labour and needed to move to the next stage. I was managing with the Tens and the breathing, but something was changing. Because I'd had the Propess, I couldn't go to the New Forest Birth Centre, but I could do to Broadlands, which is the alongside midwife led birth centre at the Princess Anne maternity hospital.

We probably arrived just about 2.00am and were ushered in to a nice, warm and dimly lit room. We handed over the colostrum I'd been expressing antenatally in case I had problems breastfeeding with my PCOS to go in their fridge . I continued to labour using the Tens and my breathing, and found standing up clinging on to Tom's arm to be one of the most comfortable positions for me. He was very good about reminding me to drink and use the loo! My pains started to go into my back at this point. Having been examined, I was reacting too well to the Propess and was over stimulated, so this had to be removed. After it had been removed, the pain eased off a little, but I still wasn't in established labour, so couldn't go into the birth pool yet. Tori, our midwife suggested a bath instead at this point which was genius. So off with the Tens and away we went to the bathroom.

The bath totally worked for me. I got in with Tom's help, and ended up lying on my left side with just my head poking out the water, holding Tom's hand over the side of the bath. As the contraction surges came, I would shake my legs and wiggle my toes, remembering something my mum had said about wiggling my toes if initial latching on whilst breastfeeding hurt. I don't know why I connected the two in this situation, but I worked for me! I almost fell asleep between contractions, and Tom dozed too. Even though the contractions were painful, this time felt restful and peaceful. We topped up the hot water a couple of times and I think we were in there for a couple of hours.

At some point I decided I'd had enough of the bath, and Tom helped me out and helped me get dry. We put the Tens machine back on, and went back to our room. I continued to labour mainly standing up and also started on the gas and air, which was brilliant, but the bath had done it's trick and I was in established labour - hurrah! This was just in time for shift change when we met our two new midwives who would look after us for the rest of the day.

So now it was time for the birth pool. We spent all day in here, with the gas and air and the water, I felt strong and powerful. The lovely midwives made up aromatherapy oils for Tom to rub in my hands and everything. I could have spent my whole labour in here. I thought I'd want music on whilst in here, but the first thing I asked for in the room was for the radio to be  turned off. I just wanted the peace and quiet and dim light. Something in this crawling into your cave to give birth thing. I would cling on to the handles during a contraction and push against them or cling on to Tom's hand and then sink back into the warm water to recover.

 But as time was passing, and I didn't seem to be progressing, I agreed to be examined and to have my waters broken.  They said that if they found meconium in the waters, I'd have to be transferred to labour ward and couldn't go back in the water. Little miss had indeed pooed everywhere, so about 2pm we were transferred to labour ward. I also was dilating more on one side, and the baby didn't feel very engaged externally.

Without my coping mechanism of water and the shock of the transfer made my contractions much more intense than I could cope with with the gas and air and I could not find a good position to labour in, not even on my hands and knees.I ended up lying on my side for most of this period as my NCT classes had drummed into me that lying on my back was the worst thing I could do for making space for the baby to come out. There was a lot of loud noise from me, I was convinced I would never give birth and I asked/begged for more pain relief. Tom and I had agreed in advance that if it got to this point we'd go straight to the epidural rather than trying the various opiates available, so it was the case of waiting for the anesthesist, which mercifully wasn't very long a wait. At some point I had a catheter fitted too, as I'd not gone to the loo since before I'd gone in the birth pool, and having a full bladder can slow labour. I can vaguely remember Tom being quite upset at this point too, but still checking our birth preferences plan to make sure we were following it as much as we could.

Through all this, our brilliant midwives Kate and Lynda had been coaching me through contractions, making sure we were well informed, always asking what we wanted to do next, and supporting Tom in making decisions based on my birth preferences when I was too out of it. They were amazing. I did ask if I could have the kind of epidural where its possible to be moved into a kneeling position to birth, but I was told they didn't do that in this hospital. Our midwives had to have a lunch break at this point, so a different one came in to look after us. She was very good at massaging my back whilst I clung on to Tom's hand whilst we waited for the anaesthetist.

I managed to get myself into a calm head space for the epidural and stay still for the insertion, I think knowing relief was coming helped me focus. I was intrigued by the cold spray they used to test where on my body I still had feeling.

For me, once I had the epidural, I couldn't feel my contractions, and only used the gas and air when the obstetricians were examining me as they had big hands! I could easily chat and joke with our midwives. The epidural made my contractions slow right down, and I agreed to have the oxytocin drip as they were concerned about the baby getting further distressed with the length of the labour, and I was by this point getting impatient to meet the baby! I had asked in our preferences plan for any drips I might need to be in my left hand to make sure my dominant right hand was free for wrangling babies.

Once we were hooked up, and contacting again, the baby's heart rate suddenly dropped. Lots of doctors and nurses appeared in the room, and the bottom of my bed disappeared so that it was easy to examine me or deliver the baby. Upon examination again, I was fully dilated, and so we agreed to try to push  and if that didn't work to go to theater. She had a fetal heart rate monitor clipped on her head around now. I was coached through how to push with the contractions I couldn't feel and she did come down some but then she changed positions and stopped. The obstetrician tried to rotate her manually, but she rotated back. Then her heart rate went back to normal. The obstetrician said that never happens, but as she seemed ok, we were ok to wait a bit longer.

Things get a bit hazy again for me after that, I think I was quite tired by this point. But after waiting for the synthetic oxytocin to do it's thing and a bit more pushing I think, the team felt it had all been going on long enough and were worrying about the baby swallowing the mecononium. So we were told that it was time to go to theatre where they'd try an assisted delivery first, and then move to a c-section if that didn't work.

There was then the scary quick ride down to theatre as the realisation hit me that everything was hotting up a bit. Up till then, I had kind of felt we had choices and were in control, just waiting for labour to kick in properly, but now it was medically imperative to get the baby out. Our lovely midwives were coming to the end of their shift but kindly stayed to see us into theatre which helped make us feel a bit calmer. Tom was sent to a side room to change into scrubs and I really struggled to stay cool without him in the theatre. We were very blessed by Osgar, our anaesthetist in theatre. Whilst I was on the bed freaking out without Tom he was reassuring me saying things like "My wife has had two c-sections, she thinks they're the best way to give birth, don't worry your partner will be let in soon, if you don't feel very well or something hurts, you just tell me, I'll be right by your head" and so on. I was also slightly reassured listening to the nurses and doctors going through their preflight checks, and for some reason by the obstetrician making sure everyone in the room knew everyone else. I know that was standard practice but it was comforting.

Once Tom was let in, he was sat by my head with the anaesthetist holding my hand. I was so grateful to have him back with me. We'd asked for the drapes to be up in the birth preferences plan as we didn't want to see any of the action. I had considered what I wanted to happen with a C section or an assisted delivery with Tom when we were writing our preferences plan, so I was less freaked out by the process than I might I have been and it meant in this more emergency situation we already had answers for things like "drapes up or down?"

They tried two times to deliver with forceps. The obstetrician warned us that I would be able to feel tugging internally and that it would look like he was being very forceful. Tom and I looked at each other rather than at what he was up to. After the second unsuccessful attempt it was time for the c-section. I'm not sure if they had to re-position the baby before the c-section but there was more rummaging internally which made me feel very sick and I vomited at this point. It didn't hurt but the sensation was very strange. I also had the shakes which is apparently very common. The anesthetist was able to give me an anti-emetic to stop me feeling so awful. He was also still reassuring Tom and I throughout. We were warned that where the baby had pooed, she might need suction to remove it from her airways after she was born, so Osgar was saying to Tom things like "Have you got your phone ready to take a picture of her" and was reassuringly talking us through each stage. And she arrived at 20:35!

She did indeed need suction immediately after birth, so was moved to the Resussitaire. This was a bit scary, but Osgar the anesthetist kept up his running commentary, telling us to be listen as she was crying which was a good sign, and getting a picture of her on Tom's phone and saying she was very big and pink which was also a good sign. I remember saying to Tom "a daughter!" and praying very hard "please let her be ok" and the Lord's Prayer over and over. We didn't name her then and there as we both wanted to have seen her before giving her a name in case she didn't look like a Lydia.

Tom had to go whilst they stitched me up, which neither of us was very happy about. Whilst this was happening the team from the NeoNatal ward came down with an incubator as they wanted to take her to the ward in case she needed more help breathing. She hadn't been intubated in theatre as she seemed to be doing ok, but they weren't sure if she might need to be later on. They bought her over to say hello to me before she went in the incubator and they'd put a very very bright pink hat on her. She was a bit swollen, bruised and cut up from the forceps, but I got to stroke her very soft cheek, and see she was actually nice and pink like Osgar said. With the birth ending up as an unplanned c-section with worries over her airways, there wasn't any skin on skin time or delayed cord clamping, but I'm not worried about that now as she was well which is the most important thing. Amusingly, I managed to make sure the NeoNatal team knew I had colostrum for her somewhere in the hospital.

After she had been taken to the neonatal ward, and I had been stitched up and topped up with lovely lovely drugs, I was introduced to the night midwife and taken back to my room on labour ward to be cleaned up and after a while Tom reappeared looking comical in his scrubs. About 11pm he was allowed to the NeoNatal ward to see her, and took some more photos for me.

I treasure the memory of sitting in recovery post labour after Tom had been to see her in NeoNatal talking about her curly hair and chin dimple just like Tom's and messaging friends and family to say she'd arrived.The curly hair turned out to be where she was covered in gunk, but we didn't know that yet! Our midwife suggested we tuck some muslins down our tops to smell like us to send down to neonatal which we duly did.

About 1am, they wheeled my bed down to NeoNatal, and as her bed was by the door, I could lie right next to her.Lydia hadn't needed to be intubated and was recieving oxygen through a tube. They did think she might need to be on the ward for a week, but in the end she was only there for 24 hours, and thanks to my antenatally expressed colostrum, only ever had my milk. I was so glad I did that. She also was on a bed rather than in an incubator which made me happy. They had her on her front to help with the breathing, and she had a lot of wires and monitors on her. It did all look a bit scary but the nurses explained what everything was and I got to stroke her. She just had her nappy on, and was using our muslins as a sheet. I felt so much better for having seen her.

After a while I was very tired, and though I didn't want to leave her, I asked to be taken back to the ward. Tom reluctantly went home to sleep, and I had a lovely strip wash with the help of the midwife as I was sweaty disgusting mess at this point. I also had the famous best tasting cup of tea and toast, as I was starving! I'd not eaten for over 24 hours bar some orange juice and water. Shortly after I was transferred to a ward with other mums who had babies in NeoNatal, was helped into my pjs and slept.

Tom arrived the following morning and we went down to see Lydia again. I was asked if I wanted to try breastfeeding and we gave it a go despite all the wires. Holding a wiggly naked bar a nappy baby with lots of wires and a cannula was hard word, but the clever girl knew exactly what she was doing, rooting around and latching on right away. Breastfeeding for me was an odd and tender sensation, but I was lucky that it wasn't very painful and soon all pain went away. Both my parents and Tom's Mum came to visit her in NeoNatal on that first day and where she was managing her breathing just fine, she came up to the ward in the evening, meaning we were apart for only 24 hours. Tom and I had a lovely hour or so with her before his visiting time was up.

My first night alone with her was a bit of a shock, and I could have done with a briefing on what to expect as I couldn't remember anything from my antenatal classes and was sore and wobbly from the c-section. I could only remember to keep her at the boob and that she'd fall asleep whilst feeding from the effort of sucking the sticky colostrum, so to try one side, change her nappy, and give her the other side and tickle her whilst feeding. If I was going to remember one thing, that was the right one as she took to feeding well, for which I am very grateful. She woke every hour and a half that first night which left me feeling drained and exhausted and counting down the hours till Tom arrived. The staff told me off for not buzzing enough for help lifting her, so I took their advice for the rest of the stay and buzzed for help getting her in and out the cot which helped with my c-section recovery. Especially as I found it more comfortable to feed in a chair, and so needed both hands to get out the chair.

We soon got into the swing of hospital life as she was kept in for 5 days for antibiotics to prevent a meconium induced infection catching on. I had my baby blues on day 2 and cried a lot for mainly happy reasons, like how adorable my husband looked holding the baby. My milk came in on day three, and my boobs were enormous and hard which freaked me out until she fed. As an extrovert I felt better for having visitors. I was also glad that our lovely midwives and anesthetist popped by to check on me so I was able to thank them in person. We're so grateful for their kindness and support and blessed by how they went beyond their duty for us. I don't think we'd feel so positive if it wasn't for them. Tom was an amazing support to me too, and I want to thank him for taking such good care of me, from helping advocate for me to helping me wash. You're the best.

Here's a link to my birth preferences plan in case anyone find it useful. I used the positive birth icons. I found thinking through all the possible scenarios helpful such as what I might want in instance of a caesarean and so on helped me feel calmer.

Other highlights from these early weeks:

Tom cuddling her on her quiet morning of being alert and telling her about all the things she could see out the window.

Watching Tom examine and adore her. Feeling overwhelmed and happy that he was bonding with her.

How smitten all her family is with her. Wanting to be near her and to touch her.

Coping with poo splosions on my own in the night

Working out that feed a bit then change a nappy then feed a bit would make for a good long feed

Little furry ears and back

Her little turtle neck stretching out when she's milk drunk

Trying to suck the hand in a splint with a cannula in

Headbutting you when she wants things like burping or feeding

Happiness being Lying on the hospital bed with Tom in the last half an hour of visiting time, with the baby asleep just holding each other, absolutely exhausted.

Other tips:
Tena lady maximum strength pads much nicer and better at staying put for post partum bleeding than other brands or hospital issue.

Take orange juice and prunes in your hospital bag and drink all the water going to prevent post partum constipation.

Antenally expressing colostrum is probably good for everyone, but seems to be especially good for people with PCOS or Gestational Diabetes.

Think through all reasonable possibilities on your birth preferences plan. Especially if you're a first time mum, as you're more likely to be overdue, be induced, and therefore need interventions. That's one of the reasons I decided to go for an epidural if the pain became too unbearable, as I knew I statistically more likely to have interventions and I didn't want to fanny around waiting for opiates to leave my system. 

Some thoughts on the early days of breastfeeding

Before the milk comes in, just keep feeding as much as possible. You will feel like you don't have enough colostrum, but you do. The more you feed the more comes in.

Swap sides each time, and tickle their neck or feet or change their nappy if they seem to come off and fall asleep after a short 10min feed. Then put them back on and don't stop till they come off of their own accord again. Even if it feels like they're on there for ages. Aiming for about 20mins feeding minus burping or nappy time. Sleep as long as they like in between.

After milk comes in, don't let them sleep more than 3 hours ish, then wake to feed if they haven't already. Feed from one side until baby comes off of own accord, burp nappy etc, then put back on same side and drain boob. If baby still looks hungry then offer other boob. Start from the second side the next time. So if left then a bit of right on feed 1, start with right on feed 2. Keep going till the baby stops.

If things are difficult, every midwife or support worker in hospital will end up giving you different advice, if you find something works, stick with it, and tell every midwife the thing that worked. Don't expect them to have put what worked for you in the notes or told the rest of the team mid shift.