On Monday, 42 weeks shared a birth story of a VBAC mum who was able to negotiate DOMINO care with a midwife in an Irish maternity unit. Her story is a must-read and is very popular. This second story, from the same woman, explains their birth journey and how they were able to negotiate the DOMINO care option.
Our Birthing Journey
Life & Death
Fighting for respect;
My right to choose how and where I birth my baby.
Our birthing experiences remain with us for life. They can even create the type of parent we become. What makes a “good” or “bad” birth? I have come to learn that, with the right information, only I can make the best decision regards any aspects of my birth. Respect this and I’m on the good path to a physical, spiritual and emotionally empowering birth experience; Ultimately a happy mum to a happy baby. My 6th birth (June 2013), is one of great joy and healing….No one was going to stop me achieving the type of birth space and continuity of care I knew was best for a safe and healthy birth.
My journey to this birth is a long one….
My pregnancy and births, like life, has been eventful and unpredictable. Pregnancy and birth are a time for dreaming, excitement, full of emotion and great anticipation of life ahead. A wonderful new being entering the family. For some like me, the path has taken twists and turns. I travel this path with a greater understanding of life, a stronger sense of who I am and what my needs and expectations are. Meanwhile, despite it all, I keep a firm grip on the treasured elation new life can bring to My Family and I.
I have learned from all my births and what’s really important for a safe and empowering birth. I’ve discovered in terms of our current hospital based maternity care, an optimal birth experience is a serious challenge. My experiences have not reflected this.
2006 First Pregnancy (Forceps)
My first, was born vaginally with the assistance of forceps after a prolonged second phase. The birth – like most first births – was long, tiring and very emotional. Antenatal care was standard, including an anomaly scan at 20 weeks. Despite the forceful entry my little son had into the world, the care and attention during his birth was quite satisfactory. I had several midwives attend me, I had a private labour/delivery room for 12hrs (the length of time I was in labour within the hospital). It appeared quite homely, with the equipment disguised. I was supplied with a birthing ball, an endless supply of heat packs and a hot shower for hours. I do remember the midwife apologising for the labour room not being en-suite, but that was being rectified the following year. My husband, my birth partner, had a room on the maternity ward that we both could use during the birth to ‘hang out’. It had couches, dim lighting, tea/coffee/toast/biscuits. Like a little sitting room from home. It took me a few days, to build up my strength after the birth, having gone 30 hours without sleep and blood loss from the forceps. I breastfed without issues and remember having a midwife sit with me a few times in the early hours of the morning, keeping me company and supporting me while my son fed.
It was not all perfect, as one would expect, when you are part of a system that deals with many pregnant mothers. I did not, nor was offered to do the first wash or dressing. A midwife did both while we watched. My son had a broken clavicle from the forceps delivery and I had many internal stitches. I may not have needed forceps, if I’d been allowed a short sleep to rejuvenate for the pushing phase. But this is in hindsight and my knowledge of birth at the time was limited. My greatest regret, was not knowing of delayed cord clamping at the time. This birth experience was in Australia.
2007 Ireland, 2nd Pregnancy (Missed Miscarriage)
To our great joy, I became pregnant right away. All seemed well, until week 12, shortly before Christmas I had a bleed. A scan revealed I’d miscarried approximately week 8/9 and a missed miscarriage was diagnosed. I was automatically offered a D&C and accepted. The staff were very good in supporting us. The event was a shock, but we looked ahead to the future and agreed to try again. Miscarriages despite being very emotional have a purpose. They distinguish between the healthy and not.
2008 Ireland 3rd Pregnancy (Unplanned C-Section)
Little did we know what life was about to hand us. The idea of homebirth grew on me, having met a lady that had had two of her babies at home. Some research later, my husband and I decided to make arrangements to meet with the local homebirth midwife. That first encounter was a breath of fresh air. A whole hour, talking about birth, what she offered, what our experiences were, our expectations and desires…chit chatting, creating a rapport. We left that meeting very happy. Listened too, understood and at ease. We wondered why parents did not know more about this exceptional service. The months rolled on and I looked forward to my antenatal appointments. My midwife and I (and my husband) developed a greater sense of each other, vital for trust, judgement and friendship. After all, midwife means “with woman”. I took a great sense of ownership of my health, my body and the task that lay ahead; Birthing my baby. I went to weekly pregnancy yoga classes, we attended a natural birth couples course. We were ready for a birth that would be safe, joyful, empowering and guided by the safety net of our wonderful midwife.
A few days short of full term (37 weeks), in the early hours of the morning my waters broke and contractions started immediately. We called our midwife, who made her way to our home. She patiently guided me through my contractions, while asking some questions in between. The mood was kept calm and she explained to me that because I was prior to full-term and that our baby was showing breech, I’d need to transfer to the hospital and the possibility of a C-section was imminent. We left without hesitation and arrived at the hospital. My midwife accompanied me into the hospital and we bid her farewell.
I was deemed 4cms dilated and baby’s foot could be felt showing. Within an hour and a half of entering the hospital a C-section was under way. My thoughts at this point are quite blurry, I’m not sure if I had thoughts or was it just a whirl wind of events happening around us. I lay there, with my husband at my head, scared of an unplanned operation. But we’d get to meet our baby soon.
Then a silence swept over the operating theatre. I caught a very quick glimpse of my baby’s head as someone disappeared with her. Parental instinct kicked in, and my husband and I glanced at each other in a moment of fear. Afraid to say a word, but knowing something was wrong. Time has no meaning after this. My husband is asked to follow some staff members and I’m left to my own thoughts. I’m eventually informed my baby is not very healthy and it’s not looking good. I’m left in silence again, tears streaming down my face. I’m surrounded by a team doing surgery, moving me from theatre to recovery…All in silence. It took nearly 2 hours before a voice spoke to me again. I was handed my baby to die in my arms.
Mother Nature is very strong. There’s an instinct regards our own children that no one can invade. My baby was handed to me being manually ventilated in the corridor. The bed I was on could not fit into the neonatal room. The mother in me, knew without hesitation that her life was not to be. I asked for the tape and ventilator to be removed. Our few moments together needed to be sacred.
My husband had witnessed the doctors do their best to assist our baby to breathe, but due to major developmental issues, she was not compatible for life. Her strong and perfect heart kept her growing in utero.
The post care was very sincere. I even remember the midwife who took care of me. I felt she did her best to protect us, in very difficult circumstances. Weeks later she said to me, that it just seemed all wrong ‘watching us walk down the corridor on Christmas Day, going home without our baby’. It never dawned on me that it was Christmas.
Could things have been different? Three scans had left all these problems undiagnosed. Do we blame dated service, lack of modern equipment, lack of sonographers. Had we known at prior to 12 weeks that our baby was going to die, would we have gone down a different route? Abortion is not available, would our experience of homebirth care have been taken from us, could I have delivered my baby without the need of a C-section. Little did I know the consequences of this C-section was going to have over me forever.
This scar, under HSE criteria, has robbed me of maternity choice, autonomy, my human rights in childbirth.
2009 Ireland 4th pregnancy (VBAC – vaginal birth after Caesarean)
Our daughter was born at KGH via VBAC 11 months later. Due to the grief from our previous loss and the close time frame, we were not in an emotional state to fight for a homebirth. A vaginal birth was without doubt my choice and fully supported by my doctor. No concerns were every raised regarding a VBAC.
The pregnancy was a beautiful mix of emotions. We cried for the baby we only briefly met but learned so much from. Simultaneously we cherished new life within, the joys that lay ahead in bringing a new little girl into our family. I set about preparing myself for the birth and months ahead. I recommenced pregnancy yoga, read positive books about natural birth and stayed physically healthy. I created an inner trust in my body and baby, that we’d labour in our own time, when we were both emotionally and physically ready.
I had very strong expectations about how this birth was to be. The death of a child made me question many things. It became apparent that hospital maternity care operates to a system. This is not always in an up-to-date manner, or mother/baby best interest. It’s there to attend the masses and individual care is difficult.
My birth plan, was discussed with my doctor and I also met with the head of nursing/midwifery to ensure we were all on the same path. I had included no inductions as long as baby and I were healthy, natural pain relief was preferred and to be supported, hospital pain relief medication not be offered, delayed cord clamping was essential, birth in my position of choice and I’d wash, dress my baby in my own time and baby was to be handed to me immediately with all routine non emergency checks to be done at a later date. Unforeseen circumstances would be dealt with if they arose. We really wanted to cherish this birth journey and the initial moment of our first encounter with our baby.
My hospital appointments in the final few weeks of my pregnancy were very frustrating and undermined my ability to trust my body in labour.
In the approach to full-term a woman is an open book of emotions and also like a sponge to the moods of the environment and people around her.
It infuriated me that my appointments constantly referred to the count down to 10 days overdue, inductions and C-sections. I do not recall, one positive comment to encourage me and my ability to birth naturally. Despite my strong will and trust in my own ability, I left each appointment needing to go for long walks to clear my head of all the negativity and concentrate on good birth affirmations.
At the 40+2 weeks, the appointment carried it’s usual theme. The doctor checked my cervix and said it was too posterior for a sweep and there was no sign of labour approaching. Be prepared by having my bags packed for induction day. I said I’d return for a check up at +10 days, but was going home if baby and I were healthy. I would not accept an induction just because I was 10 days past 40 weeks. The doctor passed a comment that I was the first mother he’d encountered who refused an induction. It saddened me, that induction and such a defeatist attitude to labouring spontaneously has become the norm. Again I left with mixed emotions, constantly feeling like achieving natural birth was a battle.
If birth is a natural physiological process, why did I feel like I constantly needed to fight and justify it?
In the early hours (4am) of 40 weeks+6, labour started spontaneously. We were very excited and I pottered about the house, staying calm, feeling confident and looking forward to the birth. Christmas was nearing so we went to buy a tree and I decorated it with my son. All the time, pausing to let a contraction pass. When they were 6 mins apart we decided to leave for the hospital, while I felt I could still manage the car journey. Contractions and cars are a difficult combination. The confinement made dealing with contraction very difficult and my frame of mind was very distracted at this stage. In total contrast to how I felt at home.
Upon arrival at the hospital, we were taken straight to the pre-delivery ward. The monitor was attached as I sat on my ball. Contractions were getting quite strong and I was trying my best to regain my composure, go within and let my body and baby do labour. My husband sat behind me, supporting me on the ball. This was the moment we needed to restore some composure and settle into the labour. The moment was over-ridden by questions and paper work. The approach by the first midwife was very distant and totally distracting. She sat next to her machine, with her pen and paper like we were having an interview. My husband was sent for paper work. All I wanted was some quiet, confident, emotional support to allow me go back within myself.
The downfall to lack of continuity of care is paramount in my case. I really felt like I was getting close to transition, both emotionally and physically, yet I was told I was just 2 cms dilated. My body and mind were racing at this time and no one seemed to notice. The midwife jumped up from her chair and said ‘follow me we have a delivery room available’ and off she went. My husband carried the birth ball and labour bag, therefore I was left to my own devices to follow on down the hall.
As soon as I walked through the doors my contractions started to double peak and a muscle spasm in my back took hold. The two midwives chit chatted and took my labour bag. My husband was sent away for more paper work. I stood there alone, feeling in transition and being totally ignored. I was in dismay and felt alone. The midwives proceeded to unpack my bag and discuss the colour of the baby clothes. My husband arrived back to find me in complete distress. I complained of the ache in my back, which he tried to find.
Having my husband sent away in such times of emotional and physical need, played havoc with our experience and denied him his role as a birth partner. No natural pain relief were offered, heat packs or a back rub etc. My midwives did not put a hand on me til I screamed for an epidural and then they helped me onto the bed.
The epidural was administered and I was told it would be another 4 hours (7.30pm) or so before our baby would be born. My husband had to walk to the nearest petrol station to get some food, the hospital café was closed. While he was away my instinct told me that my baby was descending and I just instinctively knew when to push. Three times I told the midwife that the baby was coming, but she kept saying she’d wait til at least 4.30pm before checking. I could not believe she was not listening to me. I could feel her head with my hand. So I continued to gentle push my baby down, not overdoing it, awaiting my husband’s return. As soon as he entered the room, I told him our girl was close to being born and finally asked the midwife to check. Needless to say 3 contractions later and she was born (5.08pm).
A beautiful, baby was immediately handed to me. She pinked up quite quickly and we stared in awe at her. It was a long awaited moment. The first few moments are very special, all encompassing.
Delayed cord clamping was next. I was being badgered into cutting the cord prematurely. Initially I did not understand why. The midwife kept repeating ‘Can I cut the cord?’ Each time it had not stopped pulsating, so I said ‘No’. It was then said to us that the paediatrician will then have to leave without examining your baby. I was not informed that one would be present, nor did I notice one present as we were consumed by the baby before us. Could the paediatrician not have done a quick check without physically removing the baby from my arms? My babies blood and oxygen entering her body are far more important.
My husband was holding our baby in the delivery room, and was almost being scolded in tone for not having dressed the baby. An order was given numerous time to dress her. Does it really mattered what a baby is wrapped in? It’s healthy, warm and in loving arms.
Finally we were left alone, to enjoy our baby and be a family. I stayed over night and requested discharge in the morning. We had had enough of a system that was over run and unattached from what is such a personal and profound experience.
2011 Ireland 5th pregnancy (Miscarriage)
Our next pregnancy was brief. A once-off bleed at 6 weeks, we decided to go straight to Kerry General Hospital. Our gut instinct knew this was not going to eventuate as good news. A scan revealed another miscarriage. I waited 8 weeks for nature to expel the pregnancy, but to no avail. The waiting did prove quite emotionally draining. I feel it was still a better option than a surgical procedure. The staff that day were very busy and at full stretch. I was told they could not offer me a private room, as is the norm in the event of treatment for miscarriage. Mine took place in a full ward. I was just glad that it went quite smoothly, so I could leave immediately.
2012 Ireland 6th Pregnancy
(VBAC One to One Domino Style care with Homebirth Midwife)
It took a full year to conceive in this pregnancy. Sheer joy and relief arrived in the from of a positive pregnancy test. Immediately homebirth is all we envisaged. Due to the MOU (Memorandum of Understanding) devised by the HSE, community midwives are not insured to accept VBAC births. We decided to move or family abroad in order to seek respect and autonomy in our birth choices.
As the weeks progressed, our previous homebirth midwife’s name kept appearing. It wasn’t until week 13 into the pregnancy, that my gut instinct to stay with a midwife I knew and trusted took over. It made sense. We had started a journey together in 2008 (2nd pregnancy) that created a bond. Having continuity of care is essential to us. Therefore it became an easy decision to stay in Ireland and demand for respect in our birth choice, by having the HSE allow our midwife attend us at home.
We had several years to fully weigh up the pros/cons of our decision to opt for homebirth. We were not entering this pregnancy/birth in denial or ignorance of either. Our experiences had handed us the benefit of becoming very informed and very decisive regards our expectations of the care we received and the type of birth we strived towards.
Birth is an emotional, physiological and unique journey for every mother and father. Each one carrying its own set of requirements and expectations. Birth creates Mothers and therefore should be treated with best practice, truth, trust, dignity, respect and individuality. Our impressions and experiences in birth stay with us forever.
The stress of having a homebirth service denied to us was casting a very dark shadow over me. I’d had many sleepless nights and felt oppressed. Our personal preferences were not being taken into consideration, nor were my doctors’ or midwife’s opinion and experiences being recognised. I cannot, nor would not accept lack of individuality in my maternity care.
We are led to believe that the MOU has been created from evidence-based practice (EBP) “Evidenced-based Nursing and Midwifery Practice” states “EBP incorporates a systematic search for and critical appraisal of the most relevant evidence to answer a clinical question combined with one’s own clinical expertise and patient values preferences”*. We believe that the MOU fails to allow for clinical expertise (e.g. my doctor and my midwife) and patient preference. In fact, it is totally exclusive of the two. My doctor said his ‘hands are tied’, my midwife is professionally inhibited due to lack of insurance and my personal preferences were irrelevant. I did request the EBP upon which the MOU policy was drawn from, but the request was not addressed.
A meeting was organised with the health care professionals involved. I continued to demand for our midwife of choice and homebirth services. The homebirth co-ordinators, were compassionate, but limited by the HSE rules. I commend them for their kindness and efforts in creating an alternative DOMINO style service in conjunction with the hospital. We now had the support of the obstetrician, the director of midwifery, HSE management and the clinical indemnity scheme (CIS).
With a birth plan in place, I could now enjoy the weeks awaiting my baby.