Birth FAQ

Warning – long post about birth stuff. I use the word vagina, and talk about puking. Not for the weak of stomach, or the easily bored.

So. A million years ago, when Inigo was born, I wrote a basic summary about what happened. What you don’t really get from that summary is that a) when I took myself off to hospital, I was really worried that Inigo was already dead. That is why I didn’t tell anyone what was going on – I needed to get the information, and process it before I had to deal with anyone else’s issues. B) I was terrified. Scared out of my skull. I had my midwives with me, and that was the only thing that kept me from hysteria, but when the doctor (the only doctor that had ever mentioned a c/s to me during the pregnancy) showed up and started talking about surgery, I was a mess. C) The transition from being a healthy woman undergoing a normal life event (under the care of my wonderful midwives) to being an incubator for a very important patient, was jarring and disturbing. Yes, pregnancy and birth can be dangerous, and I am very glad for modern obstetric medicine, and I realise that this surgery almost certainly saved Inigo’s life. Yes, I am grateful to have my gorgeous healthy boy, but I think the situation could have been handled much, much better.

And then there was the surgery. Years ago, I had filmed in the morgue at Royal North Shore Hospital. There were dead bodies there. Some of the body bags were quite small. It was the sort of experience you don’t easily forget. And really truly – the operating theatres at Hornsby Hospital look just like the morgue at RNS. When you read in the news that Hornsby Hospital needs an upgrade, they aren’t kidding. Then they stuck a needle in my spine, while a twelve year old wardsman held my hands and looked into my eyes and told me it would be all right. I really appreciated that, but it would have helped a lot if he wasn’t twelve. And then Mark arrived. In a bright yellow shirt. And he tried really, really hard not to freak out.

Then I spewed. A lot. and because of the spinal block, I couldn’t lift my shoulders enough to spew into the bad they had given me. So I swallowed, and spewed, and swallowed, all over again. And while this was happening, I heard a cry, and someone said, “It’s a beautiful boy”, and I spewed, and said “I know that”, though how I knew he was beautiful I am not sure.

Then the anaesthetist gave me some Zofran, which instantly stopped the nausea, and somebody asked, “What are you going to call him?”, and I said, “Zofran is a lovely name for a boy”.

And then they brought him to me. Covered in green/brown poo, wrapped in a cotton candy hospital blanket and with a poxy acrylic yellow beanie on his head. That is an image that is burnt into my retinas, but thank goodness there are no pictures.

After a while, they stitched me up and when I was able to feel my toes I was able to see him. A bit. I couldn’t see his face, or get a good look, but I could stroke his skin, and hold his little hand. After a few hours I was taken back to the ward and he spent his first night alone. While I struggled with the pain. The following days were a roundabout, either in so much pain I could barely breathe, or so off my head that I couldn’t walk straight. And unfortunately this didn’t leave me in a good enough state to be able to be a good advocate for myself.

The weeks following were difficult, as it pretty much always is for new mums. Add to that the extraordinary pain from the caesar, and the horrors of learning to breastfeed after all the interventions we had been through, it wasn’t an ideal start for either of us. And we won’t talk about the horrible scarring and disfigurement.

Yes, what happened needed to happen. Yes, it saved Inigo’s life. Unquestionably, there was really nothing I could have done differently, and I am proud of myself for reacting when I needed to, and surviving the consequences. But would I willingly put myself in the hands of a scalpel happy doctor ever again?

No, not on your nellie. Whatever a nellie is.

So what follows is a whole pile of information about birth, what is normal, what is not, why vaginal birth is better for babies, and why I have chosen a homebirth. I’ve also thrown in a few random factoids just because inquiring minds want to know, and I am pretty much an open book about this stuff. Frankly, I wish I knew all this the first time, so I am happy to share the knowledge I have garnered over the years.

Vaginal birth better for babies – SMH

Perinatal Statistics, Australia, 2007

Robyn Dempsey, my midwife.

Homebirth Australia – the Rights and Responsibilities of the Pregnant Woman.

Babycentre.com.au article on homebirth.

Why it’s important to choose the right midwife.

What if you do end up needing another caesarian?

Well, that is a possibility – but my chance of having a normal birth are no lower than normal – about 20% for a normal first time mum (since I have never had a labour, I am considered to have the same risk as a first time pregnancy). And if I do have to transfer to hospital, I only a few minutes away from a very large hospital that has a neonatal intensive care ward, and my midwife will travel with me, and continue to be a support to me throughout the birth and afterwards. And I will insist on having skin to skin contact straight after birth, unless there is a clear medical indication that the baby needs attention.

But aren’t you “high risk” because of a previous caesarian?

Nope, see above. Also, risk profiles depend very much on your attitude to birth. Obstetricians are experts in the problems that can occur during labour, that is what they are looking out for, and equipped to deal with. Of course, this means that by choosing a private obstetrician, your chances of interventions during birth are much higher than if you are attended by midwives, even in a private hospital. So if I talked to an obstetrician, I would expect to hear that because I had a c/s in the past, it is foolhardy to insist on a vaginal birth this time around. Some Obs will “allow” a “trial” of labour, but as soon as things don’t go to a very rigid plan, you’re on the operating table again.

Aren’t you scared?

Terrified. But I won’t ever be doing this again. This is my last and only chance to experience a normal labour and birth. To feel what it is like to climb the mountain, and know what my body is capable of doing. I want my baby to be born without a hangover, I want her (we live in hope) to be on my chest as soon as she is born, and to find her own way to the breast, and to have her first breastfeed entirely under her own steam. I want to be surrounded only with people who truly have my best interests at heart, I want to be in comfortable surroundings, and in the arms of loved ones, in my home, my space, my sanctuary.

And research shows that homebirth has no added risks for mother and baby – it’s just as safe as hospital birth if you have a skilled attendant.

Why birth at home? What’s wrong with hospital?

For a start, Vaginal Birth After Caesarian (VBAC) rates for hospitals are very low. Depending on the hospital you choose, you have between 0% and 15% chance of a normal vaginal birth after a previous caesarian. Since I have had a thorough medical review from the team that were with me when Inigo was born, I have been assured that my chances of having a vaginal birth are about the same as any woman who has never been in labour before – about 80% (and that is assuming a hospital setting, where c/s rates are way higher than strictly necessary). So basically, by staying away from hospital, I am giving myself the best hope of a normal birth. And if I do need help, I am only 10 minutes away from a major hospital with a neonatal intensive care unit.

One other thing I’ll avoid by staying out of hospital – Hospital Acquired Infection (HAI).

Why are hospital VBAC rates so low if it is safe?

For a start, let’s talk due dates. A “due” date is just a random number that health professionals can use to guess at foetal maturity, readiness for birth, and “post mature survival”. Most hospitals have a policy of how far “overdue” they will “let” you get before they induce you. For Westmead, that is 10 days. But considering that a due date is just an arbitrary line in the sand, and most babies will naturally arrive up to three weeks either side of that date, it is a bit silly to have a policy around induction based on a due date, and not on the particular health circumstances of the particular mother baby pair. Obviously this policy is based on statistical analysis, and saves time and money, but it doesn’t suit my needs, and here’s why.

Most first babies are late. Three weeks “late” is not uncommon, and with good monitoring, there is no reason to hurry along a healthy pregnancy. Cervixes ripen, babies engage, mothers labour, all in their own good time. You can bet your arse, your baby hasn’t read the “policy”.

Induction is usually started with a prostaglandin gel, which artificially ripens the cervix and brings on labour in a more gradual and gentla way than the other alternative, which is Syntocin. Syntocin is like a sledgehammer, causing sudden and violent contractions that cascade and build without the slow buildup of natural labour, and makes the pain very sudden, and very hard to cope with. Very few women can tolerate the pain of this type of induction without an epidural.

Cutting open the uterus means that subsequent labours can cause the uterus to tear. Obviously, that is a nasty thing, and best avoided. Prostaglandin gel has a slightly elevated risk of uterine rupture, so as a woman wanting a VBAC, you won’t be offered the gel – it’s straight to the syntocin drip, and for most people, fast forward to the epidural.

OK, so what’s wrong with that? Well, it’s called the Cascade of Interventions. The increased pain of induction causes increased adrenalin, which, combined with the epidural, can stall labour, leading to the need for more drugs, a longer labour, an exhausted mother, and an increased likelihood of vacuum extraction, forceps, episiotomy, caesarian, and resuscitation. Failure to progress? Or failure to wait?

So as much as I realise that some interventions are necessary, some are just not necessary, and just lead to more. So if I can keep my foot off the carousel, I’m going to have much more control of the ride.

How much does it cost? Can you get a rebate from medicare or your private health fund?

My midwife charges $4400. This includes all antenatal care, birth, and post natal care up to 6 weeks. Currently there are no Medicare rebates available, though there are changes to Medicare coming in November which may cover some of the costs. I have yet to call my health fund to check if they offer rebates, apparently some do and some don’t.

But hey, we don’t really need a new plasma TV anyway, right?

Where will Inigo be when you are in labour?

That is a decision we will make much closer to the date, with Inigo’s best interests at heart. He is already excited about “his” baby, and if he really wants to be here, then I suppose that will be ok with me. I think at three though, it is much more likely that he will be better off with Nanna or Grandma, being spoilt and lavished with attention.

Will you be finding out the baby’s gender?

Absolutely. On the 9th of September I am booked in for a morphology scan (at 20 weeks). Hopefully, if she isn’t crossing her legs (like Inigo was at this point), we’ll find out. And yes, we’ll divulge. As a knitter, I always appreciate a heads up on colour palettes prior to the birth 😉

What about other ante natal testing – you are old, you know!

I will be doing the triple test (a standard test for Downs Syndrome) in a few weeks time. If the results of that put us at heightened risk, I will consider doing a CVS.

Did you plan this baby?

“Plan” is a very strong word. We decided, the week before my 40th birthday, that we would try for another baby and see what happened. Well, what happened was we got pregnant straight away, and I started to feel ill even before I missed my period. I really feel for couples who a battling infertility, and if I could share mine, I totally would.