Better Births. Anna Brown

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      Occasionally, I reminded Fiona to stay hydrated and she began sipping water after contractions. I asked when she last passed urine, and she thought it had been a few hours. She mobilised to the bathroom. I documented and phoned my second midwife to attend – I knew her drive was a bit further than mine and felt the mother was so calm and stoic we could be having a baby here soon. Shortly after coming off the phone, I heard a quiet ‘grunt’ from behind the bathroom door. I asked to enter the bathroom and found Fiona beginning to spontaneously push at the height of her contraction. With Rob speedily filling the pool, which was just about 20 cm deep, I suggested we move off the toilet and make her more comfortable. I was now auscultating baby central and low, where we had previously been listening in at the left occipito anterior (LOA) position. A steady 130–135 bpm baseline remained post contraction. This implied that the baby was progressing down through the mechanisms of labour and was ready to be born. As Fiona moved back into the bedroom, she spontaneously knelt on her bedroom floor, leaning on the bed, and I placed pillows under her knees.

      As the next contraction came, there was a forewater rupture and vertex was visible. I grabbed my ‘delivery kit’ – a small zip‐lock bag with cord clamps, sterile scissors, swabs and, if needed, syntometrine. (We carry full delivery kits, but this is an easy grab bag when baby comes quickly.) I began five‐minute fetal heart (FH) auscultation and told Rob to stop filling the pool – the baby was coming! I asked instead for a bowl of the pool warm water and used this for my warm compress to protect Fiona's perineum, with consent, as baby advanced. I reassured her that everything was progressing well and to keep listening to her body. At this moment, her son woke up and came into the room – Rob quickly reassured him, and I greeted a hello as we had met throughout her pregnancy. The child sat excitedly with his father and supported the mother – even clapping hands in excitement! As Fiona's baby's head crowned I reminded her to blow and control her breathing, as we had discussed at the 36 weeks antenatal appointment, to allow baby's head to birth slowly – she calmly blew long breaths as baby delivered – head then body within three minutes of vertex being visible. I passed Fiona's baby through her legs and she held her close to her chest maintaining skin to skin whilst I rubbed baby and covered them both in a warm towel. The second midwife arrived shortly afterwards, and Fiona went on to have a physiological birth of the placenta also.

      On reflection, I was relieved I had attended at the time I did, despite the fact that, at the time, Fiona was reporting mild to moderate tightening. Fiona's labour was not typical as she was so stoic throughout; I'm not sure she would have ever sounded like a textbook ‘actively labouring’ mother over the phone. In hindsight, knowing the mother as I did, meant I had an understanding of her nature, and knew she would likely be incredibly calm in labour. This had a huge influence on my decision making, based on my relationship with Fiona and knowing her as an individual, which I intuitively considered when attending to her and providing care as her midwife.

      Women's Stories

      Emily's Story

      On the morning of my due date, I had a few mild cramps which came and went with me hardly even noticing them. I put it down to ‘due date excitement’! I had a sweep booked in with Emily (my midwife was also called Emily!) at around midday and I was excited at the prospect of it possibly starting things off. I took my toddler to nursery and my husband and I went out for breakfast to enjoy some child‐free time before the next baby came along. Emily and a student midwife came over after lunch at around 1:30 p.m., and after a cup of tea and a lovely chat she did the sweep for me. She said I was already 3 cm dilated and my cervix was fully effaced!! What!? My body had been up to all sorts of things without me even knowing! Emily said that we would very likely have our baby today and said to call the team when things ramped up and advised that we inflate the birthing pool. Having the sweep at home was much more relaxing than at hospital (if you can call a sweep relaxing!?).

       Once Emily and the student midwife left, I couldn't quite believe that we might meet our baby today. I felt absolutely fine except for now having a few more strong cramps. My previous labour and delivery was about five hours long so I expected something similar this time around … (how wrong I was!)

      My husband and daughter blew up the birthing pool in the front room (which she found such great fun!) and lit some candles. By now I was having fairly regular, strong contractions but as it wasn't that long since Emily had left, I didn't think I needed to phone the midwives just yet.

      I phoned my mum and asked her to come and collect our daughter so that we could concentrate on the labour. I did hip circles on my birthing ball, as advised by Emily, to help dilate my cervix. After my mum left, I was struggling to talk through contractions. They were coming every two and a half to three minutes. It had only been about an hour and a half since I had my sweep, so I thought surely I'd still have ages left. I phoned Emily to let her know that things had ramped up, but I told her I felt as though I was coping well at the moment. She advised that my husband should start filling up the pool with water and I could get in to use it for pain relief if I wanted. She also informed Heather who was on call for births that day.

      Heather phoned me a few minutes after I had got off the phone to Emily to check how I was doing, and even though it was only a few minutes later, I suddenly couldn't cope with the pain anymore. I couldn't talk and was crying through contractions. She stayed on the phone to me to listen and gauge how I was labouring and said that she was going to drive over immediately. I still thought that I probably had ages to go until I delivered the baby.

      Heather arrived and by this stage I was on all fours in my lounge and I was ‘mooing’ loudly to get through the pain! I suddenly felt as though I couldn't go through with the delivery and remembered that feeling from my last labour as being incredibly close to having the baby. I still couldn't believe that it was all happening so quickly.

      Heather helped me take my underwear off and asked my husband to get our birth kit ready and put the shower curtain out on the floor as the baby was likely to be out a bit quicker than we all thought! The contractions were becoming unbearable and I felt a huge urge to push. I asked for gas and air and my husband stayed with me and kept talking to me the whole time, encouraging me to keep going. My body seemed to do most of the work as each contraction felt so strong and made me involuntarily push. The position I was in really helped and was the most ‘comfortable’ one to be – leant forwards over the arm of an armchair. By now Kirsty had also arrived who I had seen at all of my antenatal appointments. It was so nice to have two familiar faces at my delivery.

      Heather had a mirror which she put on the floor between my legs so that she could see how close the baby was to coming out. Every step of the way she was incredible and told me exactly what to do. When to push and when not to push. She was so reassuring and if I felt panicked or scared, she seemed to read my mind and told me exactly what was going on, which was hugely calming.

      Once the baby's head was out she told me to reach down and put my hand on his head. It was the most incredible and emotional feeling I have ever experienced. I burst into tears and felt so much relief that he was nearly out. To be able to feel his head there was just amazing! With the next push he was out, and Heather helped pass him to me as I sat back and brought him to my chest whilst I sobbed (with relief and happiness!).

       Just after our baby was born and as I brought him to my chest, Kirsty used my husband's phone to take a few photos of the three of us. I hadn't realised they were being taken at the time and they are the most precious photos! I'm so grateful to her for taking them for us!!

      I opted for physiological management of the placenta, so I didn't have the injection. About five minutes after delivering my baby I felt a lot of pressure down below and Heather helped me deliver the placenta, which was quick and pain‐free. Heather and Kirsty helped clean me up, covered my sofa in towels and protective sheets and helped me lie back on the sofa and enjoy skin to skin with my baby. I put him to the breast straight away. I then realised the birthing pool was still filling up! My husband hadn't had time to switch the tap off, but luckily it was only half