Adele's Birth Story...
Adele’s Birth Story – By Kylie Booth
For most birth stories published by CARES-SA, the story begins with a recollection of the women’s first birth, a caesarean, and the journey to do things different next time. To be fair to the reader who may not know me personally, and to truly appreciate my journey, I need to go back about 15 years earlier.
In the mid 1990s I was a medical student, young, a bit naïve to the great world but very keen to learn. My obstetric term was a difficult time for me. The system as it was then, was not kind to medical students, most of us didn’t get our required 5, “natural” (vaginal but still very interventional) deliveries, and soon found ourselves very comfortable in theatre assisting with caesarean births – I did over 30! It was difficult to get a natural delivery because not all women wanted a medical student present, and when a generous woman agreed to have one of us assist her labour and delivery, we still missed out on the delivery as a midwifery student always got first priority, even if we had supported their labour for the last 10 hours. I found the qualified midwives intimidating, sometimes rude and scary, and there was never an opportunity when midwives were able to offer their knowledge to us. It was very them versus us, even to the point that medical students were not allowed to sit in the ward staff room as apparently we used “their” coffee (I didn’t even drink coffee back then). I remember the anxiety I used to feel just walking into the ward trying to avoid “them”. I still get that feeling now, just visiting friends there.
Time moves on and I knew I wasn’t tough enough to stand my ground in labour and delivery, so obstetrics was out of my career options. I worked as a paediatric registrar and once again had to argue with midwives as I tried to suction a newborn, take a healthy caesarean born baby away to an incubator to observe for 90miutes (it was policy), or try to resuscitate a very sick meconium stained infant who had been born in the birthing unit 10 minutes earlier.
By the end of my junior doctor days, my experiences had led me to a few conclusions about birth and babies;
- My baby would be born in a level 3 neonatal facility hospital (WCH or FMC), in case it needed care.
- I would never have a “trial of scar”- a previous term for a VBAC – as I was involved in the care of a baby whose mother had a catastrophic outcome after a trial of scar.
- I didn’t like midwives very much, and independent midwives were just plain scary.
- The longer a women’s birth plan is, the more likely she is of terrible complications.
- Only hippies had home births, and women who go home from hospital a few hours after giving birth are just crazy.
Please keep reading, as a lot can change in 15 years………….
In 2004, my husband, Shane and I were very excited at the prospect of becoming parents. My mother had birthed vaginally twice in a country town, so I assumed I would be able to birth naturally. I felt having a private obstetrician providing care in a private hospital was going to give us the safest and best birth experience. Retrospectively it was not a wise choice for a healthy low risk, first time mother. But wisdom can only come from experience.
Attending the antenatal class at the private hospital where all the Dads “rehearsed” a caesarean should have been a warning that my chosen birth place was not a suitable match for my desired natural birth. “1 in 3 of you will end up birthing by caesarean” we were told, I didn’t have the knowledge that the actual statistics were closer to 2 in 3. I wasn’t aware that the highest risk factor for a first time mum birthing by caesarean was having private health insurance.
I refused induction at 40 weeks, negotiating to 8 days post dates, but that night I left my home and went to hospital to dutifully be monitored and have gels inserted, I unknowingly signed myself up to the “cascade of intervention”.
2 lots of gels, artificial rupture of membranes, IV syntocinon, continuous monitoring, on the bed and a midwife who barely touched me in labour.
Somehow despite all of this, my body managed to get to full dilation, and my unborn child did not go into fetal distress. Fifty minutes of pushing a posterior baby to nowhere, and by 5pm with the anaesthetist on her way home, and theatre preparing to close, an “Emergency Caesarean “ was recommended and 30 minutes later my son Marcus, was surgically birthed. I am sure my care providers all got home in time for tea. Shane and I were so glad to have a healthy child that the actual birth quickly became forgotten entity.
My post birth hospital care was appalling with lots of negativity over my well thought out decision to bottle feed Marcus. I rarely saw staff, and no one even lifted their heads from the nurses station as I paced the corridor with my screaming infant night after night.
At my six week check up, I had a slightly longer consult than my barely 5 minute antenatal visits – I guess that is because I asked some questions – for the first time.
When I asked about future births I was told, “you will need to book a caesarean next time as your pelvis is too small to birth a baby and you have red hair”( I still don’t know why red hair is a risk factor)
I persisted as in my medical training I knew “trial of scars” were sometimes allowed (I prefer the correct term of Vaginal Birth after Caesarean - VBAC).
Her response was “you could try – but here are the rules. Must birth before 40 weeks, must progress at 1cm per hour, must have an IV in, must be continuously monitored, must be on your back and a maximum pushing time of one hour – otherwise you will need a caesarean.”
I walked out of the consulting room knowing I would never go back, but had no idea of how to or if I really could birth another baby.
In those early months whilst recovering from the caesarean I received all the usual “well, at least you got a healthy baby”, and “birth is just one day of your life” and “lucky you, you did it the easy way” responses from well meaning friends, if I ever showed any disappointment in not being able to birth vaginally. I started to blame Marcus’s head size for getting stuck, until he innocently asked at about 2 years of age why did he have such a “big head”. This saddened and shocked me into realising that the system and my ignorance let me down, not my son’s beautiful head.
About 8 months later, by chance, I saw a book at our local library – standing upright, the front cover glaring at me. The book was titled “Vaginal birth after Caesarean” by Robert Flamm. This book ignited something inside of me – a need to vaginally birth a child, and the medical knowledge that not only it is a safe option, it is what is recommended by the World Health Organisation.
My first step was to ring our local public hospital to find out if I could birth any future children in the birthing unit, as all of my reading spoke about the importance of continuity of care with a known midwife. I was told I couldn’t birth there due to my previous caesarean and I was now considered “high risk”, but the midwife gave me a phone number of a support group who gave information to women post caesarean section, and mentioned they had an information session on that weekend.
Im not really a “group” kind of person, I wasn’t into team sports, I really didn’t enjoy mothers groups, I had never attended any form of therapy, Im not selfish, but have never needed to rely on others, and I like to be the one in control, so making that phone call was probably one of the biggest things I had ever done. I spoke to both Jo and Carolyn that week (co-founders of CARES-SA) , and registered for the workshop.
Bravely, alone, I attended the Sept 2005 National Caesarean Awareness Day workshop hosted by CARES-SA (Caesarean Awareness, Recovery, Education and Support – SA).
I was a bit overwhelmed by all the naked birthing and breast feeding photos, but the speakers including midwives and an Obstetrician, were full of the information I was looking for. I came home with a new energy and lots of research to read.
After leaving a career in rural general practice 6 months into my pregnancy to be a full time parent for Marcus, I enjoyed the opportunity to read research documents again. I was hungry for knowledge.
Not long after I attended my first CARES-SA coffee morning, where I met another first timer – Michelle, which was the beginning of our now 5 year friendship.
The CARES-SA library was my treasure trove, and each month I would come home with more books, or birthing videos. The pink kit – a DVD set, and Birthing from Within, were 2 books that completely changed my birthing core. I recommend them to all pregnant women now. Birth isn’t clean and neat and tidy and controlled. Birth is primal, it is grunting and it can be loud and messy and is all about surrendering to this monumental power inside of you. I loved every birth story I read, I wept, I clapped my hands with joy, and sometimes I just sobbed, but every one of them helped me on my own journey.
2 years on, and Shane and I were ready to have another child.
Before I had even conceived, we had chosen independent midwife, Deb, to be our care provider. Living south of the city, I was ineligible to access the WCH midwife group practice, and the FMC program still considers VBACs too high risk. Deb also worked WCH, so had good contacts there. Although we were still undecided regarding birthing at home, we were very lucky to have the option of birthing in a public hospital with a private obstetrician, if we need, who completely supported our midwife.
I had met Deb, at previous CARES-SA meetings. She was gentle and quietly spoken and had an air of magic about her. Of course she was very experienced and powerful when she needed to be, but I wasn’t scared of her – I had an innate trust in her. This was so important to me, considering my past traumatic experiences with a few overpowering intimidating midwives I had worked alongside in the hospital system. Surprisingly conception took 6 months and Shane, Deb and I were very excited once it finally happened.
With Deb, I had the opportunity to discuss what had happened with Marcus’s birth, and what we could do differently this time. Her visits, at my home, were very therapeutic for me. Antenatal visits lasting 1-2 hours, with morning or afternoon tea were luxurious. Deb getting to know Shane and Marcus, allowed us to form a trusting network. When my morning sickness suddenly stopped at 12 weeks (I vomited for most of Marcus’s pregnancy), Deb came that day and using a hand held Doppler- allowed us to all hear a healthy baby’s heart beat. Deb came with me to my Obstetrician appointments at 11, 20, 36 and 41 weeks. His support of midwifery care at home unless medical intervention was required reassured Shane and I that we had chosen the right birthing team this time.
A quote by my Obstetrician, which became very important to me towards the end of this pregnancy was, “Some women take 38 weeks to grow a baby, some take 42” I knew that this time, there would be no issue going past my due date.
During my pregnancy 2 other CARES-SA members achieved VBACs after 2 previous caesareans at WCH, both had Deb as an independent midwife. This really inspired me that I could do this too. CARES-SA coffee mornings were very important dates in my diary. I felt welcome there, I felt I was listened too, yet I was learning so much about birth and hospital policies and natural birthing, none of which had been covered in my medical training. I made friendships with really amazing women. Towards the end of my pregnancy I was given a handmade beaded bracelet from one of those women, which I wore in my labour, and still wear to CARES meetings now. A handmade booklet of inspirational poems and birthing mantras was left on my doorstep at 40+ weeks by another. The “crystals” which were handed to me near my due date were placed under my pillow until labour when I held the satin blue bag in my left hand the entire labour and birth. I believed the energy of all those other birthing women, was being directed to me. The action of passing over the crystal to the next birthing women is still such an emotional and sacred act for me.
I needed to make my fitness a priority, so even through winter I attended aqua aerobics and tried to walk with Marcus as much as possible. I squatted for hours, everyday doing puzzles on the floor with Marcus. As early as 20 weeks by pelvis was very loose and my abdominal separation was so great that my baby could pop out through the gap, so physio was required for a tubigrip abdominal support and a pelvic support belt, and lots of massage around my hips and sacrum.
In spite of my medical training, I even went to a chiropractor to see if they could help, unfortunately I choose someone without much Obstetric experience, but now regularly see a great one.
As far as pregnancies go, it was a wonderful experience. I felt fit, physically and psychologically and ready for labour. As I had expected, my due date came and went, and so did 41 weeks. In that last week we had some difficult decisions to make as 42 plus weeks was past both my own and my Obstetricians comfort zone, but as I couldn’t be induced, it was either wait or elective caesarean.
We tried natural induction methods even including Evening Primrose oil capsules vaginally which are supposed to help ripen the cervix.
At 41 weeks and 5 days (a Thursday), I had a CTG tracing and an ultrasound which confirmed everything I already knew, everything was perfect. Unfortunately though, my cervix was long firm and closed, which meant a stretch and sweep or rupture of membranes was not an option.
It was at this point doubts about our birthing choice were starting from our friends and extended family. There were lots of “whys” and haven’t you had that baby yet” comments.
Sometimes a chance meeting with a stranger can have a powerful impact on you. This happened when in that final week there was suddenly no hot water. Not a good option when there is a birth pool in the dining room waiting to be put together and filled. The gas repair man came and asked how long I had to go. I replied that I was already a week overdue, and he just smiled and said, “The baby will come when it is ready. Are you having this baby in hospital or at home?” I looked at him in such surprise, then he mentioned he had recently emigrated from Holland, where all 3 of his children had been born at home. He fixed our hot water issue, but his belief that I would birth this baby were inspirational to me.
Friday and Saturday were a difficult time for all of us, Shane had already decided to have that week off work, as we knew the baby would have to come eventually. We spent the days gardening, I squatted for a lot of it. Saturday morning I realised fetal movements had slowed. I called Deb in a bit of a panic. She asked me if I had used the fetal Doppler to check the babies heart beat which she had left for me that week. I replied “I have 6 times already this morning!!” Deep down I knew it was the quiet before the storm.
Shane was keen for me to go into hospital on Monday for a final check, I pushed for Tuesday, as we knew our only option at that stage would be an elective caesarean.
Saturday night we watched an old favourite movie of mine, gorgeous Patrick Swayze in Point Break, hoping the waves would trigger some kind of waves in me. About 930pm I suddenly felt nauseous and went to the toilet and had a small vomit, I felt clammy and strange and decided to rest in bed. By 10 pm my own waves were happening, not anything too exciting but a wave like flutter in my uterus. By 11pm the gentle flutter was gone, there were contractions. I went to the toilet and was so excited to see a mucous plug on the toilet paper. “Our baby is ready to be born” , I whispered to Shane and we hugged each other knowing we had given this baby the best start to life – allowing it to choose it’s own birth date.
Midnight – I had the Tens machine on my sacrum and I was sitting on the fit ball. I could talk through a contraction and was feeling very proud of myself. I asked Shane to call Deb, to let her know. She laughed when she heard me talking and said “If she is still talking, then they aren’t real contractions!” (Damn, I thought I was doing so well!!)
1 am- I was pleading with Shane to call Deb for her to come over, my contractions were only 1 minute apart, no rest time, just one after the other. Secretly I feared this baby was going to be born quickly at home with no help. (Retrospectively – that would have been such a wonderful thing!!)
Deb arrived about 2 am , as did my Mum and Sister, who I wanted to be at the birth, but I hadn’t realised they were coming straight away. At that stage I was panicking and out of control. Deb calmed things quickly but getting me in the shower on my fit ball. I couldn’t believe that I had no issues being naked whilst labouring – It felt very primal and natural.
With lots of guttural noises and controlled breathing the hours passed. After showing Shane how to “rock” my sacrum, Deb got comfy in her beanbag, she knew I had a long way to go, but at the time was too kind to tell me.
I had read labour was a dance between mother and child, and you needed to work with your unborn child. I had written down a lot of positive thoughts and mantras, but all I could come up with at this time was the theme song to “Bob the builder” playing over and over in my head, “Can we fix it? Yes WE can!”
6 am – I felt like I wanted to push. Subconsciously I think I had given myself and 8 hour time limit to birth this baby at home. I was ready for a vaginal examination to see how I was progressing. Deb examined me while I was leaning over a beanbag. Five centimetres dilated, membranes intact, head high.
Despite all the psychological work I had done, somewhere in my head was my previous obstetrician’s rules. 1 cm per hour- 8 hours and only 5cm. I was falling behind target, I was in excruciating pain every few minutes and I was still going to end up needing a caesarean. A massive decompensation occurred, it was like an explosion of emotion and I just cried. I wailed really loudly for what seemed about 10 minutes. Shane looked so vulnerable and just held me really tightly, Deb put her hand on my shoulder.
Once it was over, and feeling very embarrassed, I sheepishly looked up at Deb. She said it was important to get all the emotional baggage out of the way, so now, I can focus on birthing my baby. I was focussed again and ready to work.
Deb was convinced that this baby was anterior, but thought I wasn’t dilating enough as the intact membranes were stopping the head descending. None of us were comfortable with rupturing membranes at home, so hospital transfer was looking likely.
8 am – My in-laws arrived to collect Marcus, who had slept thought the night. I had spent the last 2 hours holding the wooden end of our bed, and squatting through contraction s and making lots of loud noises, as there was no hot water left in the shower.
9am Sunday morning. The decision to transfer to hospital was made. The birthing pool remained packed in a box in the dining room. I still had belief that I would birth this baby vaginally.
Luckily it was Sunday morning so the drive from Aberfoyle Park to WCH, only took 35 minutes instead of the usual 50. I had 6 contractions during this time and found squatting in the footwell of the back seat leaning over the back seat was the best position for me. We proceeded through admissions and met Deb up in labour ward where I headed straight back in the shower. I had had a very severe pain just above my right front hip bone that had been troubling me for a few hours and the hot water helped it a bit.
The only disappointing part of my experience was that upon transfer to hospital, Deb lost her “midwife” title and became my birth support person. My 2 hospital midwives were nice, but I wished Deb could have been the one in control.
Deb gave me iceblocks to suck on while I was in the shower to keep my hydration up. I did have plans of eating through labour, but had only managed a ¼ of vegemite toast at 6 am.
At Midday I decided to have an epidural which provided a great relief, and my Obstetrician came in and we decided that rupturing my membranes would be a good thing as my baby’s head was still high in my pelvis. I was 6-7 cm dilated and the amniotic fluid was clear.
Essentially from 12 -5 pm I rested. I agreed to continuous monitoring and I was lying on my back. My birth plan said I didn’t want either of these things, but in that moment it seemed the right thing to do and somehow hearing the rhythm of the baby’s heart beart was reassuring to me.
I wasn’t completely passive during this time though. At one point, when my usual midwives were on a tea break and Deb had gone to have a few hours rest, a new midwife came in and took a seat by the monitor. Despite an epidural top up, the pain in my leg and sacrum started getting worse and it started to feel like Marcus’s posterior labour. I asked her if there was anything she could to do to help. She replied just wait a few minutes and went back to staring at the monitor. Something very primal occurred at that point. “Get Deb NOW!!” I almost roared at Shane. A couple of minutes later Deb appeared, rolled me on my side, rubbed my pelvis and the pain settled. I turned to the midwife and said, “This is how you be a midwife. Watch and Learn!” She left shortly after and I didn’t see her again, but I felt empowered in my bed bound state.
At 5pm I agreed to another VE. 8-9 cm. I remember feeling elated when Deb announced, “I will just go and make up some bottles of formula, your baby will be here soon.” At this point I really believed I could do this, and the momentum started to pick up again.
6.30 pm- I had the urge to push, and was encouraged to do so. Shane and Deb were supporting my legs, and my Mum and sister, Rachel, who had been emotionally supporting me the whole labour finally had a job to do- not what they were expecting though. For some reason as each contraction ended I would vomit, so they were continually changing the vomit bags! The strategy worked though, as with the force of the vomit the baby’s head would descend down a bit further.
It was no longer painful. I was more like a sporting challenge which I thrived on. The chant of “Push, Push,” then my gag was almost comical. I had wanted to birth on all fours and I knew Deb wanted me to get up, but as things were going well in a supported squat I was too scared to move. “I can see the baby’s head, and there is black hair” said Shane. The reality that I was birthing this baby suddenly hit me, and there were tears from a few of us.
Not quite over yet, I finally got to experience the “ring of fire” for myself, and yes it did feel like that, and I was so scared I was going to split in two!
On the hospital wall, by my bed was a poster I had coloured in from “Birthing From Within”. It reads “As I birth my baby, 300 000 other women worldwide are doing so too”. That poster united me with all mothers and gave me a burst of energy to continue.
I remember pleading with Deb to help me. I just kept repeating “Help Me” over and over again to Deb, She got me to focus and calmly said, “Only you can do this Kylie.”
Suddenly relief, and everyone was celebrating, my baby’s head and hand were out. ( I think the pain I had earlier in my front hip was probably the elbow!) The purple/blue coloured half born infant wasn’t a surprise for Shane as I had encouraged him to watch a few natural birth videos when I was pregnant – otherwise he would have been shocked at this point.
My hospital midwives had been great and very encouraging. I didn’t feel another urge to push for a few minutes, so we all just rested and waited. One more huge push and another vomit and I was instructed to help pull up a wet, slimy, pink, infant onto my bare chest.
In that moment life made total sense.
My baby looked up at me, turned their head from side to side as if to check out their new surrounding, then gently rested on my chest again and was covered by a warm blanket.
After a few more minutes and tears of joy around the room I realised I didn’t know the baby’s gender for sure. I had always suspected I was having another boy as at my 19 week scan the radiographer predicted a 4kg, 95 percentile infant. I lifted my child’s leg and just screamed with wonderful disbelief “It’s a girl!!” Of course everyone else in the room knew that a few minutes earlier and just assumed I had seen!
I was sobbing with both joy and complete exhaustion.
We had planned a physiological third stage (something not even mentioned in medical school!), so our baby girl, “Adele” stayed on my chest for another 45 minutes until the placenta was expelled, with such a massive vomit I had to lift her up.
My Mum cut the actual umbilical cord to separate Adele and I, then later when she was on the paediatric trolley to get checked, Shane cut her umbilical stump.
My Obstetrician came in about 9pm to say hello and we debated whether or not to suture a small tear, which in the end he did.
My support team all had a well deserved cuddle of Adele while I got cleaned up in the shower, and it was only then I realised I was starving. It had been more than 24 hours since I had last eaten – a record for me!
My Mum fed Adele her first bottle, it was a very special moment for all of us. The two of them are still very, very close.
It was now about 1130pm and as Shane, Mum and Rachel were preparing to go home, I stood up and fainted. Luckily Shane caught me, and when I came to, they had all decided no one was leaving until I was safely tucked up in bed upstairs in the post natal ward, which took another hour.
I asked the ward staff to care for Adele overnight as I had been awake for over 40 hours straight and knew I was going home in the morning.
Afterbirth pains were agony and I found myself needing to sit in the shower at 2, 4 and 6 am, so I didn’t really get much sleep.
Baby checks the following morning and I was interrogated by the paediatric registrar why I had refused vitamin K injection for Adele. 15 years ago – I would have also asked a mother to explain her decision, but not now, my answer was simple. Adele was born with a physiological third stage, no intervention, she has all her clotting factor that she needs – just like any other birthing mammal, my daughter didn’t need any extra, as we didn’t interfere with the delivery of the placenta. Deb who had come to visit me added, “There is plenty of vitamin K in formula and she is feeding fine”. He left in obvious frustration. In contrast to my previous hospital stay, all other staff were very supportive and professional.
By 1030 am I was walking out of the hospital cuddling my new baby daughter, with big brother Marcus, Shane and my Mum by my side, knowing that Deb would be visiting us at home tomorrow.
It felt like it should.
So there it is, my story. I am so glad I have evolved into who I am today. We all come from different places with different beliefs and different birthing expectations. My journey has made me re-evaluate some of my own core beliefs. Quoting Russell from our recent Empowered Birth night, “ I now love my own beautiful, birthing body”
Thankyou to the very special women involved in CARES-SA especially Carolyn, Belinda, Trudi, Kate and Michelle for guiding me through. My graditude to my WCH midwives and my Obstetrician, who believe women can birth after caesareans. Thankyou to my Mum, Dad and Rachel, who supported me without questioning me. To Deb, I say thankyou for everything. You epitomise why independent midwives must be “allowed and encouraged” to continue to practice in our community. Finally to Shane, who took this journey with me – Thankyou for your unwavering support.
