The Birth of Eoin Eldon Moriarty – Part 2

Part 1: https://www.greenbody.com.au/2018/07/09/birth-eoin-eldon-moriarty-part-1/

I had never been in an ambulance before. I had seen the green whistle on those TV emergency shows but now it was in my hand and regularly in my mouth. During the ride to hospital the drug allowed me to close my eyes and almost fall asleep between contractions. Andy tells me that despite not sleeping for over 24 hours, following behind an ambulance with your wife inside is a sure-fire way to stay awake behind the wheel! Once I arrived at the hospital I was given gas and air and I remember the midwife at the time almost berating me for not using the gas properly. I couldn’t hear her clearly, I couldn’t think, I couldn’t do anything but suck that stuff down every time my brain would let my teeth unclench. I was then offered an opioid injection under the skin or an epidural. I had the injection to begin with but somewhere in my cloudy head I had already decided that if I wanted my labour to progress I had to get my pain down to a tolerable level. I was likely to need the epidural. It was about this time, a little hazy on the gas and waiting for the morphine to kick in, that I began to cry, disappointed that I couldn’t birth my baby successfully at home. I looked at Andy and said repeatedly “I tried.” This was the first time I saw him emotional. He later told me that the last thing he wanted was for me to feel disappointed in myself. Seeing the sadness in his face helped sober me out of my self pity. I had tried to prepare for the fact that anything could happen and that whilst I had a birth plan I would need to be open-minded. But when you haven’t taken so much as a paracetamol in about four years, being in a hospital bed after so many hours of hard work knowing that soon you wouldn’t be able to feel your own legs was quite overwhelming.

I knew what an epidural involved on a number of levels. Firstly I knew the procedure itself required a needle into my spinal column – something a needle phobic human would never usually pursue! However I had previously had local anaesthetic injected into a cut in my foot, so I knew that the local was all I had to endure and then I would likely be unaware of the real procedure. I also knew that the stiller and calmer I was the more chance the procedure would go smoothly. On the other side of things, I knew that opting for one intervention would very likely lead to another intervention and therefore that my decision would come with some potentially negative consequences. Numbing the sensation below the navel certainly blocks the pain, but it can also lead to a reduction in oxytocin release and labour slowing down or simply not progressing. Labour needed to progress or I would end up in my worst case scenario – undergoing caesarean section in the operating theatre where I would likely feel completely detached from the experience of birth. So to ensure contractions continued after the epidural, I was attached to a synthetic oxytocin drip – again with potential consequences. Intravenous oxytocin does not provide the same pain relieving effect, nor the feelings of love and bonding that natural oxytocin release creates. An oxytocin drip delivers a constant feed of hormone into the bloodstream whereas natural oxytocin release comes in waves. This means that contractions can be stronger and closer together (ask any woman who has been induced just how quickly their contractions ramp up!) but also the resting muscle tone of the uterus is increased meaning that the baby has less opportunity to recover and re-oxygenate between contractions.  This can lead to the baby becoming distressed and doctors then wishing to intervene further. If I did manage to reach the point of pushing, I would be more likely to require forceps or vacuum extraction, more likely to experience a severe tear, more likely to bleed and more likely to need a cesarean section. Finally it was also likely that the drugs I had been given would be having some effects on the baby via the bloodstream including drowsiness and a reduced ability to breathe immediately after birth.

So… knowing all of this, I was able to consider the potential consequences of my decisions and weigh them up against my current situation. Despite that situation being quite distant from the one I had envisioned for the birth of my first baby, I was very glad that I had my scientific knowledge to draw on and had done my research so that I didn’t just hear my options from the midwives, I  anticipated them, and I actually understood them. Despite the possibility of slowing down progress, I truly felt that the continuity of the pain between contractions was the limiting factor in birthing my baby successfully. When the anaesthetist arrived I told him about my ‘other’ pain and that I wanted to ensure that the epidural would be able to dull that pain given its location. He was confident it would so we went ahead and then I lay back on the bed and waited to go numb. It was a very strange experience! Like waking up having been laying in a funny position for too long and all you can feel is pins and needles.

A new midwife took over in the afternoon, a very experienced midwife. Little did I know just how grateful I would be that she was on duty and assigned to me that evening. Over the next few hours she tweaked the epidural to adequately relieve the pain and increased the oxytocin drip with the aim of achieving four good contractions in ten minutes. I seemed to be having two contractions close together, and then having a break of up to three minutes before the next contraction – not ideal. Eventually a doctor came in to make an assessment. She took a look at the record of contractions on the screen and informed me that my baby was likely posterior and would be very difficult to birth vaginally. I kept quiet, knowing that my baby had been in the same lateral position now for almost two months with its head firmly engaged for the last four weeks. She then had a feel of my abdomen and told me that actually the baby was transverse but that this was almost as difficult as a posterior birth. She informed me that it had been a very long labour (mm hmm)… and asked if my waters had broken yet? Yes, over 18 hours ago! (I knew what this meant – I had declined the group B strep test during late pregnancy – a bacterial infection that can affect the baby – and this was one of the risk factors for infection. I agreed to an IV antibiotic injection.) The doctor was surprised to hear that my waters had broken, however a number of things she said in those few short minutes told me that she hadn’t discussed my case at all with the midwife caring for me. Her parting words were that we would need to consider a caesarean section (she needn’t have said it, it was written all over her face) and that she would be back to re-assess in four hours. ‘Four hours?!’ I thought!

After the doctor left I looked at Andy and he could see in my eyes that I was about to start panicking. This was the moment that I had been dreading. The point at which somebody I had never met would walk into the room, make a brief assessment and push me in a direction I didn’t want or possibly need to go. I said to the midwife that the last thing I wanted was to end up in the operating theatre. I asked if she had read my birth plan and she took it out and went over it with me right away. This gave me some hope as everything I had included seemed like it would be ok with her – no episiotomy, no forceps or ventouse extraction unless absolutely necessary, delayed cord clamping, immediate skin to skin contact, breastfeeding asap, no hep B vaccination, no bath for baby – all fine with her. After another hour she decided to turn up my oxytocin drip once more and really get things moving. Finally the contractions were getting stronger and closer together and she asked if she could re-examine my progress. Success! My cervix had opened completely and she could easily feel the baby’s head coming down. Twenty minutes and we would be ready to push!

I was beyond relieved and now really excited as I watched her move about the room and prepare for the birth. At one stage there was a knock on the door, it was the doctor back to check on me. The midwife opened the door just enough to poke her head out and inform the doctor that she wasn’t required – I was about to start pushing! She told me that we wouldn’t have long before the doctors came back in and would want to start interfering, trying to speed things up, reach for the forceps or insist on a cesarean. I felt like she was on my side 100%.

It was time. I placed one foot on the midwife’s shoulder and one foot on Andy’s shoulder. Wasn’t he in for the experience of his life! I was given the following instructions – when a contraction rises to the peak of its intensity, push down on your baby – three big pushes per contraction. When the baby is crowning the midwife would then tell me to stop pushing and instead say “ha, ha, ha, ha…” It was really weird to be pushing so hard that I was almost out of breath and really not feeling a thing! I had had a plan for this phase to reduce my chances of tearing – to concentrate my physical effort higher up to move the baby down and to relax lower down and open up like a flower! As I didn’t have any pain to deal with, it almost felt like doing sets at the gym, each set 3-4 reps! About 8 sets in the midwife looked up and said “would you like to feel your baby’s head?” Um, I guess so?! It felt, well, like a head! It did feel softer than I thought it would and there was some fine hair on it. A few sets later I had to “ha, ha, ha” and before I knew it the midwife smiled at me and cried “Kelly reach down and take your baby!” It was 5:37pm on Saturday 23rd June. I pulled this slippery little body up onto my chest, squirmy and a bit bloody and it took me a few moments to process things before I thought to check. It was a boy. A rather large boy! Nine pounds five and a half ounces to be exact. Everyone that came into the room after that remarked at just how big his head was. He was over half a metre long – almost a third of my height.

I had a small tear and needed just two stitches. The midwife encouraged Eoin’s suck reflex and helped him latch on and begin feeding. She gave his vitamin K injection without him noticing and then I had an oxytocin injection to birth my placenta which came away easily and without complication. She then left us for about an hour. In the meantime, my parents had arrived and were anxiously waiting in the reception. They came in to meet their grandson and hear about everything that had happened. We were moved to a private recovery room at around midnight and had a few hours of sleep. Our little family were back home by 9am.

I sent a bunch of flowers and a heartfelt note to that special midwife who supported me in birthing my baby, calling her a guardian angel. Things didn’t go to plan but I was over the moon to be able to regain some control at the point of delivery and actually push my baby out. Would I do it all again? Of course. Would I try for another home birth? Absolutely. Would I eat a salad sandwich before hand? … Not in a million years.