My journey towards natural childbirth

When I try to recall my first impressions of birth, and where they came from, I can think of a few things.  One is an American movie that my Dad used to like and let me watch a number of times, called "Look Who's Talking".  It's about a married couple who have a baby and all the struggles the couple go through in the process.  Oh, and, when the baby is born, it's really cute and you can hear it's thoughts.  I remember the pregnancy was shown to be a big pain.  The mother was uncomfortable, she was moody and emotional and she was really thirsty all the time.  In one scene she drank a whole carton of orange juice.  When it came time for her labour, the contractions came on suddenly and it was all panic and agony as she rushed outside to hail a taxi, sped to the hospital (yelling at the driver to speed up) and cursed her husband for putting her in this mess as she pushed the baby out.  From watching another movie more recently, it was pretty much the same thing.  Panic, pain, fear.  Who'd want to go through that?

This negative impression was sadly reinforced by my mum's accounts of giving birth to me and my sister. She went a 10 days past her due date, I think, and was told she needed to be induced.  The doctor she had been seeing was busy playing golf when she had the procedure, and so she had to be with an unfamiliar staff, as well as student doctors who frequently came in and observed her.  My mum is a rather modest woman and so I don't think this would have been relaxing for her, to say the least.  Since she was having a chemical induction with the syntocin drip, she really found the pain unbearable, she even said she felt like she was being ripped in half!  Not encouraging stuff to hear as a girl contemplating becoming a mother.

As a teenager, I saw my step-mother give birth to my two half-brothers.  The first birth, my Dad took my sister and I to the hospital just as she was pushing the baby out.  This was a fairly positive experience.  She didn't seem to be suffering.  She was lying on her back, legs in stirrups.  She had had an epidural and when the baby came out, we got to cut the cord.  I was in rapture when I saw the sweet baby, looking around at his new environment, kicking his legs like a little frog.  The second birth, though, I must say, was a bit disturbing.  My step-mother had an induction and the whole process went very fast - she gave birth within two hours!  She decided to try without an epidural this time and only used gas and air towards the end. It was hard to watch, as she didn't seem to be coping too well and became loud.  This from a woman who frequently bears the pain of severe migraines with quiet resignation.  She was in good spirits afterwards, though, and said that the pain didn't matter because it only lasted a short time.

My sister then became a mother before me, at a young age, and she too had a difficult pregnancy with nine months of nausea as well as a long labour that she found traumatic.

All of this left me quite fearful of pregnancy and birth.  When I looked at pregnant women, I thought they must feel like they were sitting on a ticking time bomb as they counted the months and weeks towards the day of agony.  It didn't comfort me to think it would only last a day, or at worst, a few days.  It didn't comfort me that you would forget the pain.  I knew what it felt like to be in pain or discomfort (like when I burnt my hand or cut myself) and even a few minutes feels like an eternity. And, getting a baby at the end is a good reward, but I wasn't convinced it was compensation enough for what people seemed to go through on TV etc.

So, as you can imagine, I was somewhat anxious about the birth of my own baby when I fell pregnant and kind of assumed I would probably have an epidural, and maybe other things too.  However, I had already heard a little about the benefits of labouring without drugs from the time when my mum was pregnant with my youngest sister and I had already heard about the downsides of elective Cesarean section.  So, I hesitatingly began researching more about what natural birth was and it's benefits. As I read more, I realized that it may actually be something I wanted to pursue.

It seemed that every form of chemical pain relief had risks for me and/or the baby.  Just look at the cons listed on this Mayo clinic page.  I also learnt that they can interfere with the birthing process, thereby leading to a more complicated delivery, complicated afterbirth, and can possibly affect the health of the newborn and its ability to breastfeed.  It was really important to me to have a straightforward birth and for my baby to get a good start on breastfeeding.

Still, it took me a while to get my head around the idea of forsaking all chemical pain relief. I never, in fact completely ruled it out, but my hope of having a natural birth increased somewhat when I discovered the concept of hypnobirthing.  It's basically a way of achieving a comfortable, and even painless, childbirth through self-hypnosis.  I had already heard of people using self-hypnosis to undergo normally painful operations if they were allergic to anesthetic, and so I believed it was possible, but I wasn't sure I could achieve that kind of mind control.  I would have liked to have been coached in person and have that person actually attend the birth, but settled for a home-study course produced by "Hypnobabies". This course explained that self-hypnosis consists of two aspects - one is reprogramming the sub-conscious mind and the other is learning relaxation techniques. I'll briefly address each of these.

For the first aspect, the course explains that we all have preconceived ideas about childbirth and that "what the mind expects, it will create".  That is, if we have been trained to believe that birth is painful, we will expect that and then our bodies will experience pain.  Between our conscious mind and our sub-conscious mind, there is a kind of filter whereby we decide what to accept into our deepest beliefs.  In order to disable this filter, we have to go into a hypnotic state (which is basically a relaxed, passive state).  Once in that state, we can listen to positive birth affirmations and learn to believe and accept those statements or "hypnotic suggestions".  This part includes learning a new vocabulary to describe terms associated with birth that are free of the normal negative associations, and which describe birth positively, like "birthing time" instead of labour, "birthing wave" instead of contraction, and never mentioning pain.  Only "birthing sensations" or maybe "discomfort" if necessary.

The second aspect is entering a relaxed, hypnotic state, whereby you don't feel pain, but only "pressure".  Various techniques are used, including visualizations of "hypnoanethesia" spreading around the body, going loose and limp and focusing on deep, slow breathing.  By the way, the breathing that they teach is similar to that taught by the Bradley method.  Both methods also encourage the mother to move freely throughout the labour, which assists the descent of the baby.

Both of these methods work, it seems, because they fit into the physiology of birth.  Firstly, the hormone that initiates contractions is oxytocin.  Adrenaline, the hormone of fear and anxiety, undermines the effectiveness of oxytocin and, according to Hynobabies, fear can cause the lower abdominal muscles to work in opposition to the upper abdominal muscles, causing pain.  However, in a relaxed state, they argue, contractions are not really painful, but just powerful sensations.  Furthermore, deep breathing can reduce pain because it oxygenates the blood and one reason for pain is the accumulation of lactic acid from muscular contractions.  Oxygen allows the lactic acid to be broken down.  Finally, there is this thing called the fear-tension-pain cycle.  When you are in pain and fearful, you tense up because you are fearful, which increases your pain levels, causing more fear and so forth. The more your fear pain, the more pain you are in. So, purposefully relaxing, even if you are fearful or in pain, can reduce your overall pain and also release natural painkillers, endorphins.  Other things, like being able to move into natural positions in response to the descent of the child, swaying the hips, being in a darkened room, surrounded by familiar, reassuring people, can reduce fear, increase relaxation, and increase the release of natural pain killers whilst allowing labour to proceed without 'stalling'.  

The reasons for all of these are well documented in lots of places around the web, so I won't go any further into it, but it's a very interesting area.  Basically, when women are not conditioned to fear birth, are with supportive care givers who can minimize fear and the woman is free to labour and birth as she instinctively wants to, her natural ability to birth shines through and medical intervention is needed far less than it is administered in hospitals.  Giving birth in this natural way, where the natural hormones are not interfered with, can be a very empowering experience, as there is a rush of joy and a sense of accomplishment at the end.

Many of these ideas came across in a number of films, articles and stories I read and these gave me confidence that I could have a positive birth experience.  But, I came to realize that my best chances for achieving this involved finding a place to birth where I could control the circumstances to some degree and fully relax.  I would also need to be somewhere where they wouldn't interrupt my concentration during hypnosis. I imagined getting to hospital and having to fill in forms (in a foreign language) and having all sorts of exams and tests... not to mention if I didn't feel comfortable with the way the staff treated me...this would definitely break my concentration and maybe set off the fear-tension-pain cycle in a major way!  And, if this article about the situation in Serbia is true and if Bosnia is anything like this, I had good reason to run away as fast as my pregnant belly would allow.

Another part of the Hynobabies course involved staying healthy during pregnancy to reduce the likelihood of complications.  And, it presented a lot of information about routine hospital practices which can increase the likelihood of complications and make it harder to have a comfortable birth.  Through this, I realized that having a natural birth was not just about avoiding pain medication, it was also about not interfering unnecessarily in the physiological processes.  I say unnecessarily, because there is certainly a place for interventions, but it seems that hospitals apply them far too broadly based on their own convenience or on population data that doesn't adequately consider the individual case of each mother and baby. Furthermore, once you have upset that balance, the body often needs further medical help because you have taken away what the body needs to do what it's meant to do. Once you get on the bandwagon of interventions, you basically can't get off.  For example, if you have had interventions and pain medications in your labour, it is safer to have a 'managed' delivery of the placenta.  However, if you have managed to stay drug free, a natural 'third stage' is quite safe. See here.

Another big example of one procedure leading to another is induction.  That is, starting labour artificially. The worst kind is with a syntoccin/pitoccin (artificial oxytocin) drip, although other methods can also be quite nasty.  Syntocin (which is also used in 'augmenting labour') really interferes with the body's ability to produce it's own oxytocin, thereby majorly disrupting the body's own management of the system.  Syntocin contractions are said to feel much more painful because the drug doesn't affect the brain in the same way as oxytocin.  Since it's more likely that the baby goes into distress with an induction (because of the intensity of the contractions), the baby's heart rate needs to be continuously monitored, which means the mother becomes basically strapped to the bed, and this itself increases the sensation of pain.  There are also risks for the mother in overstimulating the uterus and uterine rupture is possible.  Also, once you have had this kind of labour, you are more likely to want an epidural to manage the pain, which can lead to difficulties pushing, which can lead to tearing or instrumental delivery.  First time mothers who are induced are also more likely to need an emergency Caesarian section. There are many articles talking about these risks (e.g. this).

Although there are some valid and neccessary reasons for inducing, the most common is for "prolonged pregnancy".  Take a look at this article from Midwifethinking and this article from the perspective of famous midwife Ina May Gaskin for more information about inductions for being 'overdue' and how it's not always neccessary.  I was hopeful to avoid an induction, and that is one of the reasons that I felt the need to have a private midwife who would be more responsive to my individual situation and health and not feel the need to arbitrarily send me for an induction if I went too far over my due date.

There are many other hospital procedures like that, many of which can interfere with the birth process, but which can be hard to fight if the hospital insists that these are it's policies.  For example, the routine use of glucose drips that restrict movement and potentially cause hypoglycemia in the baby, prohibitions from eating during labour, continuous fetal monitoring, restrictive ideas about how long labour or pushing can safely last, not allowing waterbirth, insistence on performing episiotomies, coached "purple" pushing, restricting movement during the pushing phase and insisting on an actively managed third-stage (birth of the placenta).   Also, it is important to consider a hospital's policies for dealing with complications, such as waters breaking hours before labour, the presence of meconium, breech presentation, or having a vaginal birth after previous Cesarean section.  These situations are not necessarily emergencies, but many hospitals have extreme stances on them.  Not to mention the way the hospital treats the baby when it's born, such as early cord clamping, taking the baby away from the mother for tests and examinations immediately after birth, bathing the baby (washing away beneficial bacteria and healthy vernix coating), giving formula instead of allowing the mother to exclusively breastfeed, observing it in the nursery away from the mother, routine injections that may not always be necessary, and so on.  I know that not all hospitals have all of these policies, but most have at least a few of them, which is why I became wary of hospitals.

The more I thought about it, I also just didn't like the idea of being in a hospital.  I felt that simply being in the place for sick people would make me expect pain.  Staff looking at me, expecting me to have pain, would also make it more likely for me to play that role, and this would also increase the sensation of pain.

Isn't that a bit risky, you may ask?  Well, generally speaking, physiological birth is safer.  Even hospitals will tell you to avoid coming in too early because that way, you will be less likely to be given medical procedures, which even they acknowledge, do tend to increase risk. Only when the risks of interventions outweigh the risks of complications that have arisen are they beneficial.  Furthermore, examples from the animal world can be very enlightening. I once read a story of how a breeder of valuable racehorses knew never to intrude on the labouring mare, as interfering risked the saftey of both mother and child. The veterinarian would simply hide and secretly observe the mare and only intervene if there was some major deviation from normal.

Through much investigation, I realized that a good midwife does very much the same thing as the veterinarian I described. She is an expert in normal birth.  She is is not trained to address major complications, but does have the experience to spot them before they become critical and can refer the expectant mother to specialist care.  As I was quite healthy and having an uncomplicated pregnancy, I felt I would be safe birthing in the comfort of a home environment with an experienced midwife.

I must admit that the leap to deciding to have a homebirth (and not just at a birth centre) was a bit scary.  It was partly precipitated by not having access to a birth centre (by the time I arrived in Australia, the only one in the city was fully booked), but it was also that I felt I would have more choice in regards to how I could respond to various potential (minor) complications.  Even birth centres have policies that can be overly restrictive when it comes to things like waters breaking early or going overdue. And, when deciding to stay at home, I was reassured by being very close to a hospital in case something went wrong. Finally, I had a very supportive husband who was, at times, even more enthusiastic about homebirth than I was!

Towards the end of my pregnancy, I started to think about having an empowering birth, not just a safe and comfortable one.  I started to move a little away from the hypnobirthing philosophy.  Maybe it was due to the influence of other mums I spoke to, maybe it was because I couldn't keep up with practising hypnosis five times a day!  I still believed that it could be possible to control your mind such as to eliminate pain but I also considered that maybe, learning to accept some pain and surrender to it with courage was part of God's way of preparing the woman to become a mother, a rite of passage in a beautiful, transformative process.

In the end, I did experience discomfort, maybe you could say pain, but I found it really manageable, and it was very healing to see that the negative image of birth I had received didn't have to be true for me. I wasn't excessively anxious or fearful.  I was patiently awaiting the arrival of my baby. The hypnosis techniques, as well as breathing deeply, really helped me to stay calm. There were times when I felt like it might be getting too much, where I thought it might help to yell out in pain. I tried this, but I could feel it instantly increased my heartrate, increasing fear and making me feel out of control and in more pain.  So, I stuck to being quite, breathing through it and visualizing positive things, like being with my baby in a "special place".  When I felt huge pressure opening up my cervix, I tried to imagine a romantic encounter with my husband on the beach. I think this helped!  In addition, using comfortable positions, being in the dark, listening to soft, gentle music and immersion in warm water all helped me to stay calm and manage the sensations.

For most of my pregancy, I found it hard to get my head around the idea that I was becoming a mother. In the first trimester, I didn't even allow myself to think too much about being pregnant, as I knew the risks of miscarriage were higher.  By the third trimester, I was enjoying being pregnant and I liked the look and feel of my big belly.  I looked with hope to the birth of my baby, but also with much trepidation, wondering if I was ready for this huge responsibility.  Even around my due date, when people asked me if I was sick of being pregnant, I said "No, I like being pregnant", maybe because I still felt a little unprepared.  So, I think I needed the long, quiet, contemplative labor I got.  Even the pain served a purpose of making me feel grateful for the gift I was about to receive, and when I got through it, the sense of accomplishment made me feel really strong and happy. I certainly needed that strength in the early days to get through the rigors of early parenthood, what with post-partum soreness, sleep deprivation, the steep learning curve of settling a baby and breastfeeding through painful nipples.

All in all, I got the birth experience I wanted.  It was a beautiful, empowering journey into motherhood.  I'm truly grateful for this because I realize that many women are not entirely satisfied with their birth experiences. I have read articles which say that the pain of labor doesn't matter because you forget it afterwards and you are rewarded with a beautiful baby.  I think this is not entirely true.  There is evidence that women who suffer traumatic births are at a higher risk of post-partum depression and even post-traumatic stress disorder. This kind of trauma can result from fear that hasn't been addressed, from environments that promote fear, from unnecessary interventions that cause complications and from inhumane protocols.  For many women, their birth experience reverberates not only into their early parenting, but also into the narrative of birth they share with their children, and so the negative image of birth persists.  It can also affect their desire to have more children.  This is such a shame because birth has the potential to be a beautiful experience.  That is why I feel motivated to share what I have learnt about birth in the hope that together, we can help create a system that respects physiological birth.

Thomas's Birth Story

Here is the story of my first child's birth and a bit about the pregnancy. For more info about why I decided to have a natural birth, see this post.

My husband, Lessan, myself and our friend Mona planning for a camp for youth 

When planning to have a child, we didn’t want to unduly impact upon our volunteer work in Bosnia and had therefore assumed we would remain there for the birth.  However, after about four or five months, I began to realize that it would be incredibly challenging for us to birth in a Bosnian hospital.  We realized that it was very important for us to have a natural birth, without unnecessary medical intervention if possible, in a very calm environment. My preference became going to a birth centre or having a home birth, but unfortunately, neither of these options are available in Bosnia.  Furthermore, although one of the hospitals seemed to give some credence to natural childbirth (it didn’t even offer epidural), it had some strange practices I couldn’t abide by, including routine episiotomy for first-time mothers and limiting the involvement of fathers in the birth.

So, with much consternation and stress, my husband, Lessan, and I made the difficult decision to leave our post for three months and have the baby in Australia.  This had the advantages of allowing us more control over the birth experience as well as being able to share this special time with our families.

After some investigation into the options, we decided to hire a private midwife with experience in home births.  We found a wonderful midwife who lives in the Adelaide hills called Julie Garrat.  She was accredited with Medicare, which reduced some of the costs.  We really liked her stance towards childbirth, which included accepting it as a divinely designed process which we need to trust.  She also knew about our Faith (the Baha’I Faith) and had a good impression of it.  We were really grateful that she accepted to take me on, even though I was still overseas and would only be arriving 6 or 7 weeks before the birth - many other midwives we spoke to wanted to follow the whole pregnancy. 

We discovered that most airlines allow you to travel between the 28^th and 36^th week of pregnancy with a letter from your doctor, so we planned the travel for when I was 34 weeks. My gynocologist was happy to approve the trip.

When investigating natural childbirth, I had come across the concept of “Hynobirthing”, a way of having a comfortable labour through self-hypnosis.  I was convinced that natural childbirth was the safest for mother and child, and also very satisfying for the mother, but I had been exposed to many traumatic birth experiences, so I was unsure how I would cope without medication.  Hypnobirthing became my source of strength and hope.  I ordered a “hypnobabies” course online and did my best to follow it once it arrived, at about week 30.  I really enjoyed doing the readings with my husband, Lessan, as it helped us come to a common vision about what we wanted.  I also enjoyed the relaxing nature of the self-hynosis sessions; however, I found it challenging to keep up with the required practice (five times a day).

I also did my best to start my pregnancy at a good weight and in good health and continued to eat well and exercise as much as I could to try to stay low-risk.  For example, I did pilates to have the strength to give birth and did a lot of fetal positioning exercises from early in the pregnancy, daily from the spinning babies website to try to make sure my baby’s head had enough room to go down, and stay down (which, fortunately it did).

We arrived in Adelaide on 7 April after a long trip with an overnight stopover in Dubai.  For the next six weeks, we spent time with Lessan’s family, making arrangements for the birth.  We visited a GP who could refer us to Julie.  We were assured by her that Julie was a well-respected midwife.  And, though this wasn't the case for Julie, we heard from the Dr that some independent midwives were not well regarded by hospitals and sometimes the transfer to hospital was complicated.  The general feeling towards homebirth in Adelaide was not as open as I'd hoped it would be.  I.e. the fact that to get Medicare coverage, you had to get a referral from a Dr, but I guess we were happy to jump through those hoops, since we knew it wasn't even an option in many other countries. For more on this issue, see this article.

Julie followed the rest of my pregnancy, visiting once a week for a chat and check-up. She checked the baby's size by measuring my fundal height, it's position and engagement by feeling my belly, as well as checking my blood pressure and the baby's heart rate.  It was really a novel experience having my belly palpitated.  I enjoyed it very much, as it felt like there was more of a connection between me and the caregiver.  In Bosnia, I had been seeing an OB-GYN (seeing a midwife wasn't an option) and she had never examined me with her hands, she only checked the baby with her ultra-sound machine, and did this at every visit (weeks 6, 9, 12, 16, 20, 24, 28, 32 etc..).  I would have much preferred to have a Dr that usually examined me with their hands, rather than exclusively taking ultrasounds, but we couldn't find one! Apparently, in Australia, they only do two ultrasounds routinely, at weeks 12 and 20, and more if necessary.  Plus, my OB-GYN seemed to want to check my blood and urine quite frequently, whereas in Australia they only do it twice unless there's a problem.  That seems reasonable to me.  Nevertheless, since I'd become accustomed to the interventionist model in Bosnia, it took me a little while to get used to the lower-tech approach and still feel like the midwife was 'doing something'. I guess I'd also gotten used to seeing the baby, which is kind of reassuring, but not really necessary.

Nesting complete at the birth location

We took some time to finalize where we would have the birth.  We couldn’t have it at my in-law’s place, where we were staying, but fortunately found another family who lived in the hills who were happy to host us for a few weeks.  They had had all three of their children at home, so they were really supportive and understanding about our choice.  We moved into their place a week before my estimated due date and basically just relaxed and hoped the baby would come.  For most of that week, there hadn't been much sign of impending labour, except for a few Braxton Hicks contractions, which I'd already been having for a while.

On 19 May (the day before my due date), we went out with some family members for a visit to a nearby village. That morning, I started to get excited because I had had many more Braxton Hicks contractions and they continued almost all day. Sadly, it all stopped that evening.  However, that day a fair bit of clear/yellow fluid started flowing.  I called Julie about it and she agreed that it probably was just vaginal fluid.  But, by Wednesday 23 May, I started to wonder if it could be amniotic fluid.  Julie came over and had a look at my pad.  She couldn’t be sure, but was tempted to think it was amniotic fluid after all.  If it was, she assured us that it was from a small tear at the top of the uterus.  The only concern was that it could lead to infection, but she thought this to be incredibly unlikely.  As a precaution, she suggested I take my temperature every 4 hours.  If I wanted to test for sure whether it was amniotic fluid, I could go to the hospital, but if they found out that I did have a leak, they would fully break the waters in the hopes of starting labour.  If it didn’t start in the next 24 hours, they would proceed with stronger and stronger induction methods.  It would mean a very different journey to the one we hoped to tread.  Just contemplating this possibility was very unpleasant; however, I was ready to take that route if it was deemed the best for the baby.  In the end, though, we concluded that the risk to the baby was very small by just waiting for labour to start naturally and by being careful to avoid infection.  We went to the pharmacy and got some supplements and spent a bit of disturbed night wondering if everything would be okay.  I even called Julie at midnight to tell her that the waters were now red, but she assured me that this was fine; it just meant there were changes happening in the cervix.

By this time, our hosts had left the house to go on a trip to Vanuatu (they left on the 22nd).  I had told mum we wanted some time to ourselves, so we just spent the next couple of days cleaning and arranging down stairs. I was grateful that family wasn’t around, since they probably would have made it harder for us not to go to hospital.

By Friday night, I started having some mild contractions, very spaced apart. I called Julie and she said just to sleep and relax, because I would need my strength for the rest of the labour. Saturday was spent with a visit from family – cooking and cleaning together.  The contractions continued, but once again, they were very spaced apart and I was able to behave as normal, I just rested and leant forward during contractions. I had a nap in the afternoon as well. By 11:30pm the contractions had become stronger and closer together so we started timing them and they seemed to be between 1 and 5 minutes apart, lasting around a minute each. I was pretty sure that this meant I was fairly advanced in the process, so I called Julie expecting she would come soon. However, she said it sounded like it was still pre-labour and I should rest as much as I could through the night and we would talk about it in the morning. I was a little disappointed to hear that, but I did my best to rest though I couldn’t really sleep through the contractions any more. Lessan went downstairs and pumped up the birth pool, then we moved to sleep in the lounge downstairs, beside the fire (because it was getting cold upstairs). We dragged an armchair close to the mattress so that I could kneel on the bed and lay my head on the chair. I spent most of my time there, from then on. We put the electric heater next to the toilet as I frequented it often. I managed to get through the night by resting between contractions and trying to use my hypnosis techniques during contractions. Unfortunately the self-hypnosis didn’t seem to be eliminating pain, but it did help me to stay calm and relaxed, which made them easier to bear. Lessan suggested I listen to the Birthing Time track from the hypnosis course, but I flatly refused as I had tried listening to it earlier in the evening and it annoyed me by suggesting that my “warm and loving pressure waves” were comfortable like a big strong hug, which simply wasn’t true. I did, however, enjoy listening to the playlist that we had selected for this time, and appreciated the low light and the oil burner burning clary sage oil. 

In the morning it was apparent that I still wasn’t in active labour as my contractions were irregular. Julie sent us a link to an article about a pattern of labour whereby a woman can have a very long latent labour followed by a very short and effective active labour. The latent phase is characterized by irregular contractions (though sometimes close and intense), and can last many days.  Changes do occur to the cervix, but dilation goes up to about 3cm.  However, throughout, the body is doing necessary work to change the body and position the baby, so dilation can increase dramatically within minutes when the time is right.  So, it’s important to trust the body, be patient and think of it like an endurance test.  Sometimes, mothers are told to keep active to try to get things going, but by doing this, they end up exhausting themselves and end up in hospital as a result.  She reassured me that I wouldn’t be slowing the labour down by resting, I was doing what my body needed.  If I did want to be active, I should only do so in the day – keep day day and night night as much as possible.  This was crucial advice and I think I may just have had more problems if I hadn’t followed it.

I spent the rest of the day much as I had the previous night, mostly leaning forward over the couch but occasionally walking around a little or sitting on the birthing ball. Anything else just made contractions unbearable.  We kept the lighting low by having the curtain closed, which I found to help foster a calm environment. Lessan supported me by bringing me food and drinks and saying prayers aloud, and reading to me a little.

In the evening Julie came to visit. My contractions had gotten stronger and I couldn’t talk through them anymore. She checked the baby’s heart rate and informed us that I was still in pre-labour and needed to continue to rest.

By midnight I was finding it harder to relax through contractions. Lessan timed some of my contractions and it seemed like they were a bit more regular, around 5 minutes apart. I was also feeling pain in my cervix and near the coccyx bone so I thought I might be in active labour. I called Julie and she said it was most likely the beginning of active labour. Once again I was quite disappointed that it was only the “beginning”. She encouraged me to continue to rest and she would come to see me in the morning. She said that she would come to check my dilation at that point (she hadn’t up until that point). If it still hadn’t progressed much then I had the option of going to hospital if I wanted an epidural so I could get some sleep. These options started to become more appealing but I still hoped it wouldn’t come to that. I just worried what transition would be like, if this was just “early active labour”.  A little later I noticed that I had a strong urge to urinate but nothing would come out. Julie later told me that this meant the head was descending.

A few of hours later, Lessan had fallen asleep and I was having a lot of trouble managing, so I decided to have a quick shower, even though we were trying to conserve the limited hot water supply. By 4am I called Julie and asked if should go in the birthing pool. She said I could if I wanted to, but suggested I could also have a bath.  I reluctantly decided to have a bath – I had been longing to get into the birthing pool from the first contraction on Saturday night.  I soon started to feel a little ‘pushy’ at the end of contractions, and this got much stronger by the time I got into the bath, around 5am. In fact, my body was pushing without me doing anything at the end of each contraction. This really scared me as I was pretty sure my cervix couldn’t have been fully dilated yet, and I had heard stories of women pushing without being dilated which caused injury to the baby. So I frantically called Julie and she tried to reassure me that it was okay to push, and that she was coming. She asked me to put my finger up my vagina and I did feel something soft there, which she said was probably the head but I wasn’t so sure because it was so soft. I still didn’t believe it was okay to push, even though I couldn’t stop the pushing when I tried. I was making loud noises in my attempts not to push and counting the minutes until our midwife would arrive.  Meanwhile, Lessan went out to fill the birth pool.

When Julie arrived, she checked me and saw that I was more than fully dilated, the head was about to come out!  She helped me walk to the birth pool, which felt strange because the head was so low.  I was going as fast as I could so that I wouldn’t have a contraction on the way, but I didn’t, since they had become quite spaced apart.

Lessan got in the pool with me to support me.  We saw that it was 6:15am.  We were happy and smiling, marveling that the time to push had come so unexpectedly.  Lessan held me as I lay back, and then I decided to squat, so he sat in front of me and held my hands.  I pushed only when I felt a contraction.  As I said, they were now quite spaced apart and also their intensity seemed a lot less, more of just an opportunity to push, which was a huge relief.  Soon the head emerged and I could feel it with my hands.  It was so soft and I could also feel the hair swaying in the water.  Each time I pushed, the head came out, but then at the end of the contraction, it came back in.  This was happening for some time and I was starting to become impatient, but I still didn’t want to push too hard and risk tearing.  Julie was just sitting by and reassuring me that I was going well and that everything was as it should be.  She also busied herself boiling the kettle to keep the pool warm (unfortunately the hot water system wasn’t cooperating too well).  At some point, she checked the baby’s heartbeat and said that he was “enjoying his birthday”.  She also took a number of photos for us.  Lessan got out at some point, since I was managing without needing to lean on him and he was uncomfortable in the water.  Actually, I was too, but I liked the water for the pushing. Eventually, the head came out to a certain amount and didn’t retract again.  At the next contraction, it emerged fully as I was kneeling forward.  Then, with the next contraction, Julie told me to give a big push.  This took a lot of strength and I felt more uncomfortable stretching than ever before at that point, but it didn’t matter so much because that was the moment that the rest of Thomas’s body emerged.  Julie caught him from behind and passed him to me under the water so that I could lift him up!

I pulled him into my arms and held him for a while. He was quiet and not breathing at first, but Julie assured me he was okay, since he was still being fed by the placenta.  I blew on his face and he eventually let out a bit of a cry, which was a relief.  From then on, he was rather calm and content. I then tried to lead him to the breast, but he didn’t want to take it.  We called the family and had a chat.  After a while, I became a bit uncomfortable, as the water wasn’t warm enough and also I had a bit of discomfort down below.  I was also worried Thomas was getting cold.  Once the cord stopped pulsing, Julie clamped it and Lessan cut it.  I then handed Thomas to Lessan so that he could hold him while I pushed out the placenta.  The idea was to wait for contractions to come naturally from the nipple stimulation of the breastfeeding, but that wasn’t working, so I just pushed really hard and it came out, mostly.  I had to push and also pull it a little to get the rest out.  Big globules of blood also came out, which made it seem like the placenta was broken, but fortunately it wasn’t.  The pool went all red, like there’d been a shark attack (so I guess I hemorrhaged a bit)!  After that, I was pretty eager to get out.  Julie helped me climb out. It felt very strange because my belly was like jelly, it was as if I didn’t have any abdominal muscles at all!

She led me to the bed and I lay down and tried to breastfeed again.  It wasn’t working, so Julie intervened to help things along.  He finally latched on.  It was so strong, it felt like he was biting, but I remained calm as our midwife saw that he was latching on correctly. While he fed, I ate some food Lessan brought to me.  Julie then had a look to see if I had torn as I looked at Thomas next to me.  Unfortunately I had.  This had been something I really wanted to avoid.  But, now that it had happened, I wasn’t particularly concerned.  It hadn’t hurt me a lot and it seemed rather minor in the scheme of things.  I hadn’t torn when the head was coming out, as I had felt myself that whole time, but it must have happened when the shoulders were coming out, as he had probably twisted himself a bit.  In fact, I remember feeling him trying to wiggle his way out.  (Even when only part of his head was out, I felt him turn from side to side – a very weird experience!)  She saw that it was a shallow cut, but it went all the way to my anus, so it required stitches.  Apparently, I have an unusually short perineum.  At first, she thought it would be best to have the obstetrician to do it, so we prepared ourselves to go to the hospital.  But, after realizing this obstetrician wasn’t there, she called him at home to ask some questions and decided to do it herself. The local anaesthetic didn’t really hurt after the previous exertions, and then the stiches not at all.  Thankfully, I had a midwife who was a good suturer, who carried local anesthetic! I then got up and had a shower.  I still couldn’t wee, and it felt like I had no muscles left down there, but I weed later in the day and by the next day, I was basically back to normal in terms of elimination needs.

It felt so strange to suddenly have a baby.  It took me a little while to get my head around the idea.   I had used all my mental power to get through the labour and birth, I wasn’t quite ready for this next stage.  It also took a little while (that day I guess) to bond and really fall in love with Thomas.  I didn’t exactly feel a sudden rush of emotion for him; it grew slowly but surely over the day.  However, I was incredibly happy and excited about the birth.  I felt so relieved that it had gone so well in the end and that the baby was safe and healthy. I was so relieved that I hadn’t ended up in hospital. I had avoided being induced because of the leaking amniotic fluid and I had avoided going because of exhaustion from a long labour.  I was also incredibly surprised that I had handled the pain so well.  I had hardly even made a sound the whole time (except for the pushing, which had left me with a sore throat, not because it was painful, but due to the nature of the sensation).  I reflected that, although definitely uncomfortable, I found the labour manageable and not deserving of the fear that people create.  I felt much empowered for having gone through this experience almost entirely on my own – for many hours Lessan was asleep and our midwife wasn't there for most of the time.

Thomas asleep after his first feed

I should add, though, that it seemed like the hardest part of our midwife's job started after the birth.  She was responsible for making sure Thomas was healthy, was feeding okay and was gaining weight.  She visited me every day in the week after the birth to make sure this was the case and then a couple of times a week in the weeks before we left Adelaide.  Thomas and I had a little bit of trouble getting the hang of breastfeeding in the first few days, so it was such a relief to have that constant support and guidance.  I had many questions and concerns and Julie was always on available by phone, between visits, to help which was great.  This was a great, though brief, experience in continuity of care!

I think a lot of my good experience can be attributed to having a very experienced midwife who trusted in the natural order of things, yet knew when intervention would be needed, and encouraged me to rest and also take charge of my own experience by showing her confidence in my ability to birth this baby!  I also did benefit a lot from the hypnobirthing preparation.  It helped me learn to relax, even when I felt fearful.  Though it didn't eliminate pain, as it said it could, I don't think this is a problem.  I'm now not sure if it is realistic to do so.  It's part of the order of things, a part of transforming into a mother, but maybe that should be another post!