I’m back again with another birth story to share with my readers. It’s been a while since I have updated my blog and I’m delighted it is with another positive birth story.
If you have read my previous birth stories you’ll know my first labour and delivery was a positive birth experience however my second labour was extremely traumatic.
Throughout all my pregnancies I have had health professionals, family, friends, even strangers tell me that every pregnancy and birth is different. And it was certainly true as this pregnancy was unlike any of my previous ones.
I’ll need to start right at the beginning and give some context to the birth story as throughout my journey I had experienced some pregnancy complications.
At 5 weeks pregnancy I had covid and was very unwell and up until about 18 weeks I was bleeding, sometimes spotting but occasionally it was much more. As you can imagine this was extremely stressful having multiple scans at the early pregnancy unit, and the uncertainty of not knowing whether the pregnancy would continue or not. At my 20 week scan the sonographer discovered I had a low lying placenta, when the placenta attaches lower down and covers some of the cervix. I was booked in for another scan at 32 weeks to see if the placenta had moved further up away from the cervix. At this scan, I was relieved to discover the placenta had moved.
However disappointingly the scan revealed I had too much amniotic fluid which surrounds the baby and I was diagnosed with the condition, Polyhydramnios. This increases the risk of pregnancy complications, including gestational diabetes and premature birth (more on that later). The hospital referred me to a specialist fetal medical centre to have an enhanced scan to find out what was causing the extra fluid and weekly monitoring.
I had a scan at 35 weeks which unbeknown to me would be my last scan before birth. This scan revealed the baby was estimated to have weighed 7lb10. I was not surprised as my bump was much larger than I remembered from my previous pregnancies so I was aware this was a little unusual.
The doctor explained this was because of the extra fluid which can cause babies to grow much larger than normal. The doctor arranged for me to be tested for gestational diabetes as this was also another cause for large babies. I had the oral glucose tolerance test (GTT) twice, an enhanced blood test plus I was given a device to monitor my glucose levels daily (before and after each meal). On top of this, I was having weekly monitoring, blood tests to check for common infections in pregnancy and scans to check for genetic conditions like blockages in the baby’s gut. However despite all this extra monitoring and tests for gestational diabetes nothing was found. I did not have gestational diabetes nor any of the common symptoms that cause Polyhydramnios.
It was incredibly frustrating not knowing what was causing the fluid build up and each health professional I was in contact with told me that sometimes they simply don’t always know why this happens. Which wasn’t much help to me!
After my 35 week scan I had a call with my consultant to discuss a care plan for my labour. Due to Polyhydramnios I was at risk of a premature labour and as a black woman I am three times more likely to give birth prematurely than any other ethnicity. Because of this and the complications in my last labour where I experienced retained placenta and postpartum haemorrhage the consultant recommended I be induced at 38 weeks and given a series of drugs to help manage postpartum haemorrhage including an injection of a drug called oxytocin in my thigh. This helps make the womb contract so the placenta comes away from the wall of the womb lowering the risk of heavy bleeding.
I was hesitant to have another vaginal birth after my traumatic last labour. I asked about other options such as a caesarean as although I was satisfied with the plan to have the drugs to help reduce risk of heavy bleeding, I was concerned that the baby would be too large for me to deliver by the time I reach 38 weeks.
I knew the risks of inductions and that women who are induced are twice as likely to have an emergency caesarean section compared to women whose labour starts spontaneously. If I had the option to avoid a possible failed induction due to delivering a potentially very large baby and emergency c-section, then I wanted the choice to plan for an elective caesarean.
The consultant listened to my concerns and agreed that depending on my next scan at 36 weeks and estimated size of the baby we can discuss next steps and agree a plan that I would be happy with. However like all things in life, some things don’t always go to plan and I never did have that 36 week scan…
On the morning I turned 36 weeks I had planned to go to a friend’s child’s birthday party, but I woke up feeling nauseous and very tired. A few days before, I had started losing parts of my mucus plug so I expect this was my body’s way of telling me that there was a baby on the way!
I was doing the washing up and suddenly I felt a large gush of water and knew instantly that my waters had broken. I remember having my membranes ruptured during both my first and second labours but actually going into spontaneous labour was still such a surprise. I remember both my midwife and consultant advising me if I go into preterm labour there is a risk of cord prolapse when the umbilical cord slips down in front of the baby after the waters have broken and the cord can come through the open cervix (womb). So I did as advised, I got onto my knees with my elbows and hands on the floor and bend forward until the ambulance arrived. I couldn’t feel the cord, but I didn’t want to take any risks, so I waited for the paramedics to examine me. They confirmed there was no cord but still wanted to take me into hospital.
Because of coronavirus restrictions I had to travel to hospital on my own and arrived about 20 minutes later. By then the contractions were ramping up and I was petrified the cord was going to slip down and I would deliver in the ambulance. We arrived at the hospital about 15 minutes later and the paramedics transferred me to the maternity assessment unit where I waited for a doctor to see me.
Through my contractions, I gave the doctor a quick overview of my medical history and pregnancy so far. It was so hard to concentrate and explain to her my concerns and what I wanted but by God’s grace, I managed to communicate clearly enough for her to understand I was feeling anxious about having a natural delivery because of my previous experience and my wishes for a c-section.
At this point I was feeling very vulnerable, I was on my own and in and out of contractions so in a lot of pain. The doctor asked if I wanted gas and air to help manage the pain and asked my permission to examine me to determine how far dilated I was (4cm). By then my husband had arrived and the doctor explained she would need to discuss with a consultant to determine next steps of my birth plan.
Things were moving very quickly, and I didn’t have much time to make a decision on the type of birth I wanted to have. All I knew is that I needed to make a decision quickly as my contractions were getting stronger and closer together.
It is really important health professionals remember that patients do not have the insight, clinical knowledge or understanding when it comes to making the best decisions to benefit them. On reflection, the reason I was so anxious was because I felt like I was being rushed into a decision when I didn’t fully understand what was happening. Patients need to be given the correct information and the time to understand before they can make a decision. This can only be done once they are fully informed.
The doctor took the time to explain the risks of having a c section vs natural delivery which helped me make the right decision for both me and baby. In the end I chose to continue with the natural delivery for several reasons: I was already 4cm dilated and one risk choosing a c section with a premature baby would involve having to have steroid injections to help the baby’s lungs develop. The baby would also need to have steroid injections once they are born.
There was a chance that by having a vaginal delivery the baby would not need any steroids. I was satisfied to go ahead with the plan to give me medication to help manage the blood loss and retained placenta issues. I also requested the same doctor be present during the birth as I trusted her to deliver the baby. She said she would be there anyway as I had been classified as high risk.
Once I had made my decision, I was quickly moved to the labour ward whee a midwife set me up on the bed so the baby could be monitored and fitted me with a cannula so I could start to receive the drugs to help reduce the blood loss. By this point I was having full blown contractions which felt like it lasted forever but it was only about 30 minutes. I remember telling the midwife this was my third baby so it was likely I would be delivering this baby soon. Although the gas and air was helping to an extent, I could feel pressure moving further down and the pain going from zero to 100. The midwife left to go on her lunchbreak and told me she would be returning within 30 minutes. She was replaced by another midwife who was covering for her.
I asked the new midwife for an epidural as the pain was so intense so midwife went to prepare it but it was too late. By the time she returned I was already pushing! It all happened so quickly. The doctor rushed in and called another midwife for assistance. I was being monitored and lying on my back which I’ve always found the worst position for me to give birth in. I asked to go on all fours (that again!) but doctor and midwife said they needed to monitor baby and they wouldn’t be able to if I was in this position. I wanted to tell them once I move positions the baby would be born in very soon! But I was in so much pain I couldn’t even speak. I gave my husband a nudge and he helped me move into a different position despite protests from the doctor and midwives. As soon as I was on all fours, I gave two almighty pushes in time to my contractions. The doctor told me to wait and then give another push with the next contraction and baby was born!
Third stage of labour
I was a concerned as she didn’t cry and was very blue. They took her over for assessments, she had swallowed a lot of mucus. When I heard her loud cry I felt an instant sense of relief knowing she was ok. Whilst doctors examined her it was then time for the third stage of labour: to get the placenta out and stop the bleeding.
As part of my drug management I was on drips throughout the delivery and was given the additional injections, oxytocin into my thigh to stop the bleeding. At one point my placenta got stuck in the cervix and the cord was short so she had to massage my womb to encourage it to contract so the placenta would move. It was so incredibly painful but it worked. I also had a long gauze inserted and used to absorb the blood. Finally, to manage any further blood loss the doctor removed any clots or retained placenta. Last time this was done in an operating theatre under general anaesthetic however this time I was wide awake on gas and air and an injection given to numb the pain. The pain was excruciating but I knew this was the only way to effectively prevent a haemorrhage.
The procedure was a success, in the end I only lost about 350mm of blood, about the size of a can of cola, in comparison to my last traumatic birth where I lost 2 litres of blood and needed a blood transfusion.
So overall I was pleased with the outcome of my labour and delivery. This time I felt like I was in more control, I was fully informed and had a better understanding of the risks and benefits and therefore was able to make decisions I felt best for me and my baby - compared to my traumatic birth last time where everything was out of my control.
For more information about common pregnancy complications, patient information leaflets and support in pregnancy here is a list of useful organisations and websites I found helpful:
Royal Colleges Obstetricians and Gynaecologists: Patient information leaflets produced by the Royal College of Obstetricians and Gynaecologists (RCOG) that cover a range of pregnancy and birth conditions written specifically for patients so simple to understand:
Tommy’s pregnancy hub: includes information that covers information on having a safe and healthy pregnancy from conception to birth
FiveMore: committed to highlighting and changing black women and birthing people’s maternal health outcomes in the UK find out more here.
Harris Birth Right: leading clinical unit and research centre for the assessment and treatment of unborn babies in London, part of Kings College Hospital NHS Foundation Trust