“BUT I THOUGHT THEY WERE BRAXTON HICKS”

When my first baby arrived in March 1988 this was after an arduous forty hour labour culminating in an emergency caesarean section, I vowed never again.

It was nothing more than a normal caesarean section, I had “failed to progress”, I had failed to give birth in the way that nature had intended but the worst part was the aftermath, the depression, the feeling of failure, nobody could understand the way I felt, I had a healthy baby, my first child so what was I moaning about?

As for the labour itself, partly my fault, I had gone along with the usual interventions allowing myself to believe that they knew best after all they had delivered hundreds of women before me. On arrival my labour was going great, I was 5 cms dilated, I wandered about, the midwife told me that if I had my waters broken I would have a baby in my arms within half an hour. Well how could I resist it? My membranes were ruptured I had my first dose of pethidine (does this pattern sound familiar?) from then on my labour went downhill.

I had four changes of midwife shift, obviously being in labour so long, I was introduced to an Asian locum consultant, he was awful, rude and rough and treated me like nothing more than a contracting uterus and a waste of space.

He examined me at 9 a.m. I was 7 cms dilated and I was put on the electronic monitor, 2 p.m. no progress syntocinon commenced, it was mentioned at this point that the baby was a brow presentation, 4 p.m. no progress, the midwife said meconium the consultant said section and he shot off out of the door before I had a chance to say anything. Nobody asked me how I felt about a section, I did not even know that a section was on the cards and after all those hours in labour there was more than enough time to explain to me what was happening.

The months went by and my depression lifted a bit after five months when I went back to work. my new working colleague realised when I joined the Department that I was depressed and she had never met me before, she saw a big improvement when my son was about one and this was because I had become an informed person.

I decided that I did not want to have just one child and I wrote to every organisation connected with childbirth that I could find an address to. The Caesarean Support Network and the NCT initially were the only ones that I could find. I managed to get hold of the book “Silent Knife” which I found was a real confidence booster and I also learned that home birth was safer than hospital birth, surely this could not be true, but all the literature that I found on the subject pointed to the safety of home birth and the dangers of hospital birth, especially hospital filth and infection.

Good grief I was gobsmacked, hospitals were so hygienic and clean or like everybody else so I thought. For instance we are told that we must go to hospital once the waters break in case of infection, what infection, where? Not likely to pick it up in your own home.

I decided after all that I did not want just one child, I would like to give him a brother or sister, but this birth was to be totally different from the last, this time I would do it my way.

By this time I had discovered AIMS and I received a lovely, sympathetic and understanding letter from Beverley Beech, I realised that we were on the same wavelength.

I became involved with the Caesarean Support Network, I met Sheila Tunstall in Liverpool and I found her very helpful and understanding, I had become quite well read and I did some of the work for Sheila.

During the course of my studies, I could not get to grips with this expression “trial of labour”, what did it mean? I asked everybody that I thought should know, my Health Visitor, the Doctor at the Family Planning Clinic, did not know what it would entail and told me to ask a midwife at the hospital.

I made an appointment to see the midwife, one of the same midwives that looked after me in labour. She informed me that basically a trial of labour meant that I would be starved, would be continuously monitored and would have an iv drip in place and I would not be allowed to go over so many hours in labour but there did not appear to be any hard and fast rules as to how long you were actually allowed.

I rang Sheila Tunstall and she suggested that we write to several hospitals concerning their policy on “Trial of Labour” this we did. The replies that came back were appalling, most of what was being implemented at my local hospital was happening over the whole of the country. I sent copies of the letters to AIMS for them to point these hospital procedures out to members. They also were horrified.

These routine interventions of course can be refused, but what woman wants to be battling with routine and protocol during labour. This survey started very small but turned out to be quite big, a lot of organisations became very interested in it.

In November 1988 Sheila and I were asked to attend the BBC Studios in Shepherds Bush to appear on the “Kilroy” programme. This we did and it turned out to be a great day out.

The programme was mainly about anaesthetic awareness, a lady called Anne had been conscious during a caesarean section under a general anaesthetic and had felt everything during the operation and could remember conversations with the staff, apparently they were talking about the Frank Bruno fight. There were another two ladies that had been awake during the surgery and it made me realise just how unfortunate some women can be, my experience compared to theirs, well it was just incomparable.

This was the first time that I met Beverley Beech and I also became quite friendly with the consultant on the programme, John Spencer from Queen Charlottes now UCH.

Beverley agreed to be my labour companion in my next pregnancy, I was really pleased. While Trevor, Michael and I were on the Isle of Wight for a short holiday we met Mary Cronk independent midwife. She told me that she would be willing to come to the Isle of Man to be my midwife and was quite prepared to deliver me at home, I knew that she had a lot of experience with mums having home births following a caesarean section and this was a great weight off my mind to know that the backup was there if it was needed.

I became pregnant in 1993 date of last period 23rd April 1993 but I decided to tell the medics that it was 30th April 1993.

I decided unlike most to inform my GP straightaway and to let him know of my intention to give birth at home and let him have the opportunity to strike me off if he wished. My GP congratulated me and told me that I would have to make the arrangements because he did not know the procedure, but unlike the system across where the woman sees the midwife on every occasion they shared the care and I would be seeing the midwife one month and him the next month. I could hardly believe it after all I had heard about GPs, no lectures no death threats.

I wrote the usual letter to the Supervisor of Midwives asking for a home delivery and asking her to allocate a midwife to undertake my care. She sent a community midwife around to see me and she spelt out all the events that could go wrong. The lecture lasted about an hour and after she had finished I said “despite all the doom and gloom perinatal mortality had not decreased since the move from home to hospital and home delivery was much safer than hospital” this she agreed with and said she would book me for home birth.

I had the usual sickness at the beginning and then I had some problem with the nerves in my left leg in the middle months, we thought it was sciatica to start with but it turned out not to be. Apart from that my pregnancy went smoothly.

I had no hassle over my decision to have a home birth which surprised me.

Beverley arrived over on the 25th January to be my labour companion, this was about a week before the baby was due by my dates. I thought we would have a week together sightseeing and exploring the island, visiting people that she wanted to see etc. but that was not to be as I went into labour while we were out shopping on the 26th, the very next day. I didn’t realise at first that it was labour when I was cooking the dinner at around 6 p.m. I was having to breathe through the pains. I wolfed my dinner down and took myself off for a bath.

My midwife rang while I was in the bath and Trevor told her that I was having pains about every ten minutes, she said she would watch Coronation Street and then call round to see how I was doing. Trevor and Beverley meanwhile were unpacking the pool, which had arrived here a week previously and were hurriedly trying to follow the instructions to get it inflated and filled in time.

The midwife (No. 1 Chris) came and assessed me and I was 2 - 3 cms dilated and she wrote down that established labour had commenced at 9.15 p.m. which at the time was not an assessment that I would have considered accurate as I thought I was experiencing braxton hick contractions.

By 11 p.m. things were getting bad and I was becoming a bit distressed because I still thought I was 2 cms dilated. The TENS machine didn’t work and we didn’t have any entonox. The midwife examined me and I was 7 - 8 cms and ready then to get into the pool but it was too hot. The second midwife arrived (No. 2 Joyce) about midnight with the entonox and I was too far gone by this stage to be able to suck or breathe my brain just didn’t seem able to get the hang of it. Apparently when Joyce went to the maternity unit to collect the entonox the hospital midwives remarked that they would be seeing us all later before the morning was out, obviously they were expecting me to be a home birth transfer due to my obstetric history.

The pool had cooled down a little now and I was able to get into it, which was bliss, the pain initially seemed to melt away. Approximately 2.30 a.m. I got out of the pool just after I had started pushing. At 3.10 a.m. I delivered my daughter on the living room floor, she was lively and screamed instantly with an apgar score of nine and ten unlike the delivery of Michael who had to be revived and ventilated with an apgar score of four and seven because he was doped up with pethidine.

I coped with this labour so well, I was really worried about the pain because I have a very low pain threshold and I don’t mind admitting it. I did not have pain I had contractions and I was wondering if it was going to get worse or were they just braxton hicks and they were going to die off and resume a week later when they were supposed to.

When I picked up my baby girl and put her to the breast all I could say was “I don’t believe it”. Then I said “but I thought they were braxton hicks” everybody howled with laughter, I had achieved something that I thought my body was incapable of doing.

I did not want syntometrine but I was persuaded to have it, the midwives felt that it was necessary. Although at the time I was away with the fairies Joyce was worried about the amount of blood loss.

Almost immediately after the delivery I felt quite sick, although there were champagne corks going off I could not drink any of it. I got back into the pool with help to clean myself up after an injection of maxolon. Joyce helped me into bed and as I had sustained a second degree tear they had to call the consultant on duty to stitch me up, if it was just vaginal stitching the midwife could have done it but my tear had extended into the labia and upwards into the clitoris. I was very lucky that the consultant on duty was Mr. Robert Fayle, if it would have been any of the other consultants they would have had me stretchered and brought into hospital but Mr. Fayle came to my home to do the stitching which was a big relief.

By the time Saturday came (two days later) I had not moved from my bed. Every time the midwives got me up I kept feeling dizzy and sick and I actually fainted on one occasion. Passing water was like trying to wee glass, eventually I persuaded them to pass a catheter. I did think for somebody that had had a normal birth I was feeling pretty awful. The midwife took a routine blood sample and when the result came back my hb was 7.3, I was advised by my midwife and GP to go into hospital for a blood transfusion. This I did quite reluctantly, it was quite frightening, Trevor had gone playing golf and Beverley was out shopping.

I managed to get a friend to come and take Michael, she arrived fairly quickly and then the ambulance came, at the time I was out feeding the seagulls in the back garden. For some reason they would not allow me upstairs to fetch my night clothes or soap bag or anything. They literally just put me in the ambulance and raced me and the baby into hospital. I was very unsure about what sort of a reception I would get from the staff, I thought I might be treated by some as if I had egg on my face. Fortunately, those that approved of what I had done congratulated me and those that did not approve said nothing.

I have actually never dealt with anybody that needed to be transferred to hospital at a later date and so it was all very new to me. You would think that if transfer was necessary it would be straight after delivery and not two days later like this. A Chinese Doctor came in felt my tummy and said that he thought something may be left behind, that might account for the bleeding, the bleeding incidentally I was told was not excessive. He said he was going to do a speculum examination, I told him he could not because I was extremely sore down there, bearing in mind that I had sustained a second degree tear and I had a lot of stitches, he said that he would be gentle. He inserted a speculum and twisted it around, I cried out, both he and the midwife said they could see something inside the cervix. He was trying, unsuccessfully to remove it with sponge forceps, I shouted to him to discontinue this examination immediately, by this time I was quite distressed. He said a D & C would be necessary to remove retained products, I heard somebody shout in the corridor “Mrs. Williams nil by mouth” and then a notice to that effect went on the door. I started to panic then, Beverley and Trevor had still not turned up.

However, the consultant turned out not to be available, what a relief. The proposed course of management then was for two units of blood to be administered with an ultrasound scan to be carried out the next day (Sunday) by the consultant. I had the two units of blood and I was still having great difficulty passing urine.

When it became known that a D & C was on the cards I asked the midwife to write across my notes, “no general anaesthetic.” I was told by everybody without exception that there would be no problem here as they preferred to use regional anaesthesia anyway.

When I saw the consultant the next day he appeared to latch on to the fact that I did not want a general anaesthetic. He informed me that after the scan if a D & C was necessary it would be undertaken with general anaesthesia. I was stunned there did not appear to be any logical reason for this decision, it appeared to be a case of I didn’t want it and for this reason alone he was going to make me have it. This was the first time the scar was mentioned, he said at this stage he could not rule out scar rupture.

I could hardly believe it. All the women that I know that have had a vaginal birth that have had a scar rupture have all had babies very seriously brain damaged or stillborn. I was totally against having a manual examination of the uterus, I know the dangers of converting a slight dehiscence into a major rupture, I could end up losing my uterus. Manual exploration of the scar is highlighted in “Effective Care in Pregnancy and Childbirth” as a routine examination that in the light of the evidence ought to be abandoned. I maintained my silence to see what would happen next.

We went to the Scanning Department, where the bladder was shown to be distended and the uterus showed abnormal uterine content.

He recommended another two units of blood, the insertion of a catheter and a D & C that he was only prepared to undertake with the benefit of general anaesthesia. I stated quite categorically that I was prepared to have another two units of blood and a catheter (which was quite a relief as it was so painful to pass water). I was not however prepared to have a general anaesthetic, the consultant then turned to Trevor and said “if she were my wife I would make sure she had the operation.” He left us with what would have been for most couples the makings of a real good argument. I could not believe that after failing to convince me, he then tries his best to get the husband on his side. I have heard about this tactic in text books but I never thought that I would come across it in real life.

I must say that at this stage I did not believe that anything had been left behind, I thought it was a particular ploy by him just to get me into theatre, it just shows what confidence I have in the consultant and the hospital environment in general.

About an hour later I was sitting on the loo and out jumped this enormous great blood clot. I fished it out of the loo and the midwife examined it and confirmed that it did contain placental tissue, estimated amount of blood 300 mls.

I also found out that he was insisting that I have a general anaesthetic because I had expressed a preference against it and apparently this consultant does not like women expressing their views he would prefer to tell them what they are going to have. This seems to be a bit bloody minded when there is no other logical reason for it and a spinal anaesthetic could do the same job.

So the consultant turned out to be right, at least regarding the retained placental product, but I would never have believed him such was my faith in consultants and hospitals in general. I was fortunate to escape a D & C. A further two units of blood were started but discontinued when the cannula came out of the vein and I had a catheter inserted which was quite a relief because it gave my bladder time to recover.

Looking back on my labour, delivery and early postnatal period I was extremely lucky in three ways:

1. I went into labour on Wednesday evening when the rota for that day was No. 1 Chris and No. 2 Joyce - the two midwives that I wanted. Had I gone into labour on Thursday I would have got a midwife who would have been quite unsuitable for me, a very nice girl but she would have panicked.

2. The consultant on duty that night was prepared to come to my home and assess whether he could do the stitching there although he reserved the right to take me into hospital should it be necessary. He came to my home and found that he could stitch me there, which at the time was a big relief not to have to go into hospital.

3. The retained placental product came away of its own accord.

I came out of hospital on Tuesday, the complications that occurred were something that I could not have foreseen. I am happy that hospitalisation and a blood transfusion was necessary, Beverley rang Mary Cronk and she said that she would recommend a blood transfusion for a haemoglobin of less than 8.5. Nevertheless, I did feel at the time that I had let the side down a bit.

An awful lot of planning went into this pregnancy and delivery, most women that had previously had a caesarean section and then delivered at home booked independent midwives. This was not really an option available to me and in any event I did not want to follow this route as I believe the service should be available on the NHS.

A big inspiration to me here was Gina who had a home birth courtesy of the NHS and later Caroline who had a home water birth courtesy of the NHS.

I want to thank everybody that helped and gave me encouragement, the telephone had never been so red hot. All the cards and gifts that I received were wonderful.

Anybody wanting details regarding water birth should contact Jane Ingrey, 17 Wellington Terrace, Harrow on the Hill, Middlesex, HA1 3EP, telephone 0181 094 0202 or 0181 422 9308. As far as pain relief goes I can personally recommend it, I have a very low pain threshold and I had no other form of pain relief.

(Home page www.a-little-wish.org.uk)
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