Sasha Daisy’s Homebirth Journey ...

8.22am, Tuesday 29th August 2006

by Nikki Koop

 

Thoughts of a homebirth had crossed my mind for the birth of our first daughter, Eleni Clover. Ultimately we made the decision to birth with the Midwifery Group Practice in the Women’s and Children’s Hospital Birth Centre. Being our first pregnancy and not knowing how I would cope with labour pains and any potential complications, we decided we would feel more comfortable with hospital backup close at hand if it was required, and being more relaxed we would be better able to achieve our aim of a vaginal birth without drugs and any interventions. With the guidance of a marvellous midwife, Emily Daw, we achieved everything we had hoped for.

Eleni Clover was born in the water after an 8 hour labour, with no drugs, no interventions and no tearing. My husband Alex caught our darling baby, brought her to the water’s surface, we discovered her gender for ourselves after a few minutes of awed baby gazing, and he cut the cord after it had finished pulsing. It was the perfect birth for our firstborn, and we still would not change a thing. For our second child, I wanted to do things a bit differently. I now had trust and confidence in my body and knew how it was very capable of birthing easily. I wanted to use that confidence and experience to enhance this child’s journey into the world. We researched homebirthing from early on in the pregnancy, but the financial side of it was our stumbling block. It wasn’t until I was about 25 weeks pregnant that we had explored all our options and bit the bullet in withdrawing from the MGP and hiring an independent midwife. We chose Lisa Barrett to help us in our baby’s homebirth journey. After meeting with her, we liked her professional approach to birthing. Her work was guided by factual and evidence-based information, and she had a wealth of experience behind her. We felt comfortable that we would be given unbiased information for each choice we would need to make, that our decisions would be respected and that she would be a strong advocate for us if or when required. I also felt it was important to have a student midwife with us, and we chose 1st year student Megan Castell to join us.

My pregnancy was much easier this time. A small amount of spotting at 8 weeks was worrying but resolved without any problems. I still had morning sickness, but it eased by the beginning of the 2nd trimester, and the early tiredness wasn’t as bad. It may have felt easier due to my caring for Eleni, as opposed to being totally focused on my pregnancy and every little sensation the first time, or it may simply have just been a case of different pregnancy & therefore different symptoms. However, I became convinced the differences meant I was carrying a boy, but Alex was convinced it would be another darling daughter. Our 19 week morphology ultrasound showed our lovely baby growing well, but also the presence of choroid plexus cysts on its brain. The absence of other abnormalities meant it was not a concern for our carers, but it remained a niggle in the back of my mind throughout the remainder of my pregnancy. Once the morning sickness disappeared I felt fit, healthy and strong, and this feeling dominated until the end. At 28 weeks I chose to have the Glucose Tolerance Test, and my results came back within ‘acceptable’ limits. My iron levels were slightly below the recommended level for pregnancy, but supplementing with liquid Floradix remedied that. Each appointment with Lisa and Megan was quite uneventful as I felt so good and there were no pregnancy complications. As the pregnancy went on, our baby decided it really was quite comfortable being breech, and showed no signs of wanting to turn cephalic.

Around 34 weeks we decided to try changing his/her mind, and I began the nightly ritual of lying upside down on an ironing board tilted at a 45 degree angle. This was a challenging position to get in and out of, some days I could stay there for the full recommended 15 minutes, other days I could only last 5 minutes before the blood rushed to my head and the weight of the baby and my stomach contents got too much. Just before 36 weeks, Alex set up the board a bit differently, and as I got on, our cheapie chipboard ironing board snapped. At our appointment with Lisa the next day, we discovered the baby had turned cephalic, so thankfully the days of being upside down on the ironing board were over and the broken board didn’t matter. Or so we thought…

On a Saturday morning at 37+3 weeks I woke up and realised I had not felt the baby move since early the night before. Much poking, prodding, walking around, and drinking cold orange juice couldn’t produce even a ripple of movement, so we rushed off to the W&CH in tears and panic. I was hooked up to a CTG machine, which showed a good heartbeat, but not much movement, so I stayed connected for a further 20 minutes to ensure baby was ok, and its movement picked up to a more reassuring amount in this time. The attending midwife however was not convinced the baby was still cephalic, so we had a quick ultrasound to confirm the position. Sure enough, our baby had once again decided that being breech was better, that it needed to be close to my heartbeat again. I had researched my options for breech births when baby was breech the first time, and had decided that I would still attempt a vaginal birth at home, especially as Lisa had the necessary experience to facilitate it safely. When the baby turned cephalic, I put breech thoughts out of my head, and now I needed to confront them again. After much thinking, I decided that this baby was trying to teach me something, and I believe it was to trust in my baby and body, to stop trying to control a process that I really can’t control, and to accept whatever happens even if it isn’t what I had planned. I also believe that my baby stopped moving deliberately so that I would find out it was breech and learn my lessons in time. With those lessons in mind, I decided I would give myself and my baby the best chance of having a cephalic birth, and once again go on the ironing board, try acupressure and moxibustion, and attempt an External Cephalic Version before 38 weeks. If those attempts did not work, I would accept that this baby needed to be breech for some reason, and birth it at home provided its bum engaged. If its bum had not engaged by the time labour had started, I would bypass any pharmaceutical ways of forcing that and would accept a caesarean section. Once I had decided that, I felt very peaceful and open to whatever my baby had planned for us.

I had the ECV booked for 37+6 days, and with my support team of Alex, my mother and Eleni, plus Lisa and Megan, I admitted myself to the W&CH labour ward. The CTG showed a good heartbeat and movement rate, I had blood taken ready to receive anti-D afterwards, and was ready to receive salbutamol via IV to relax my uterus to make the turning easier, all that was left was to wait for Dr Chris Wilkinson to arrive. He did, and on palpation he was certain my baby was still breech. He still needed to check the exact position by ultrasound though, and much to everyone’s surprise found our baby had turned cephalic. In hindsight, that must have happened a couple of nights beforehand, the baby kept me awake for several hours with very vigorous movements which must have been it turning again. Even though the baby was once again 3/5 engaged, I prepared myself for both a cephalic and a breech birth, knowing that it still had lots of fluid and room to turn again, and quite possibly we would not know for certain which way the baby was until it was actually being born, and I was ok with this.

With the baby most likely being cephalic, being 3/5 engaged, the strength and frequency of Braxton Hicks contractions, the fact that Eleni had been born one day early, and that I was still breastfeeding, it all led us to believe that this baby would be born before the due date. I now stepped up the pace in finishing off projects in case this did happen, and had everyone on standby from 38 weeks onwards. Again, my baby had a lesson for me - patience. My due date came and went, with no real signs of labour being close. I now started to think about my options in going ‘overdue’, and decided that anything up to 40+7 would be very gentle and non-invasive. I wanted this baby to choose its own birth day, however, I was not comfortable with going past 40+14. With Lisa, I planned that at 40+9 weeks I would have acupuncture to try induce labour, and if that didn’t work, I would have a stretch and sweep at 40+12 weeks. If that too failed, at 14 days overdue I would reassess everything with Lisa. In the meantime, I burned clary sage oil, had sex every day (Alex was happy with that!!), and started taking 2000mg Evening Primrose Oil tablets daily.

Each night I would go to sleep wondering if the next day would be the day, and each morning I would wake up and somehow know it wouldn’t happen that day. After thinking I would go early, making it to 40 weeks and beyond frustrated me. I still felt extremely good, was sleeping well, and was still enjoying being pregnant, but I was very much looking forward to experiencing labour again, having our much longed-for homebirth and meeting our new little family member. I was extremely excited about birthing at home. I wanted Eleni to be at the birth, even if she slept through the labour, and had asked my mother to be her support person in case she got bored, distressed or was too distracting for me. My midwife had taken photos during Eleni’s birth, and I very much wanted this birth to be filmed, so I asked my brother Nigel to be the videographer. I envisioned the birth pool set up in the corner of our lounge room, near a window for natural light, but with walls on two sides of the pool I could face in case I needed to block everything and everyone out. I wanted our screen of our wedding photos and a little table of meaningful nick-knacks in the corner behind the pool to give me something to focus on, the oil burner on and my lava lamp going for softer light, and a range of music from Paul Kelly to Mental As Anything as a distraction. We had stocked up on snacks and drinks to have on our kitchen table, celebratory champagne in the fridge, and had DVDs to keep our support team occupied during any boring parts. Alex would decide at the time if he wanted to jump in the pool with me or to stay on the outside of it, but he would catch our baby and place him or her in my arms. We would discover and announce the baby’s gender ourselves, wait for the cord to stop pulsing before he cut it, and would have a physiological third stage regardless of how long it took. I had it all organised and ready to go, we were just waiting for our baby to choose its birth day.

I turned over in bed at 4.30am on Tuesday 29 August, six days overdue, and feeling a gushing sensation thought I had wet myself slightly. I hobbled down to the toilet to discover lots of clear mucous, not urine or amniotic fluid. It was exactly like the fertile mucous I was watching for when we conceived our baby, and I had the thought my body was trying to make a new baby before it had evicted the current tenant! I had assumed the mucous plug would be the same as it was in my first pregnancy, but even though it was quite different I knew it was part (or all) of the plug. I put on a pad, and went back to bed but couldn’t sleep. The baby had become very active, wriggling around quite vigorously, and I lay there wondering if it was turning breech yet again. (In hindsight, it was the baby moving into the anterior birth position from its almost posterior lie facing my left side.) I could feel more mucous coming away, and around 5am some irregular, strong but painless Braxton Hicks contractions started up. I didn’t take much notice as I’d felt them since 16 weeks, but by 6.15am I had an inkling that today would be the day.

I SMSed Lisa and Megan to give them a heads up so they could organise their day, and my mother and brother so they could also get organised. I told my mum she’d still be able to keep her dentist appointment at 9.30am, but should pick up my brother from the other side of town beforehand just in case. By 6.30am I was bored of lying in bed – the baby had stopped moving by then but the BH were getting more intense, even though they were still not proper contractions – so I decided to have a shower. As soon as I got out they changed in sensation, becoming regular and much more intense and painful but still well within my comfort levels. I knew then that my labour had just started, so woke Alex to help me time them. They were coming roughly every 2 minutes, lasting 30-45 seconds. Because they weren’t lasting long I thought I had plenty of time and we dawdled around. Lisa called at about 7am to check how I was doing, I told her I was ok, but wasn’t sure at what point to ask her to come out, knowing she had a 45-60 minute drive depending on traffic, and I didn’t want to ask her out too early and waste her time. We decided that she would drop her son off at kindy and she’d head out here after that, as I still thought I had plenty of time. I called Megan at 7.10 and told her Lisa was heading out soon and we thought it would be a good idea if she headed here soon too. At 7.15am the contractions stepped up another notch, and I needed to be silent through them and concentrate on my breathing and pelvic rocking. Lisa called back shortly after to suggest we start filling the birth pool as it takes 2-3 hours to fill, and I had a contraction while I was on the phone with her. She heard something in my voice and breathing that suggested that she didn’t have time after all to drop her son at kindy and said she was on her way and she’d be here by 8.15, 8.30 at the latest. I felt relief at that thought, as my contractions were so close together and I hadn’t expected that to happen so soon. As I continued to have contractions every 1.5-2 minutes, Alex spurred into action, moving furniture and setting up the frame of the pool.

Between contractions I helped get the canvas lining in place, and Alex was trying to connect the hose to the laundry taps as my mother and brother arrived at 7.25am. As Eleni was still asleep, they both got stuck straight into helping Alex to start filling the pool with cold water, and Nigel also started filming me and asking questions about how it had started earlier. The pool filled quite quickly to 1/3 full of cold water, and we could now start adding hot water. (We needed to add the hot water later to help keep the pool temperature as hot as possible.) Unfortunately we only have a small hot water heater and the hot water ran out quickly, so Alex, mum and Nigel set to work boiling water in kettles and in saucepans on the stovetop. In the meantime I set up the oil burner with lavender, clary sage and orange oils, but didn’t really get a chance to do anything else between contractions. The pool was set up where I wanted it, the photo screen of our wedding photos was in the corner, the oil burner and the lava lamp were on, but that was about as far as I got with what I had envisioned the set up to be.

One of my few concerns was that in my first labour I had no strong physical urge to push, it was more of a mental urge, and for a while I was pushing unknowingly against a stubborn cervical lip. I wasn’t sure if I would know when to push this time either, or if I’d get a cervical lip again, plus I knew if it did turn out the baby was breech it was advised I resist the urge to push for an hour to ensure my cervix was fully dilated. As it turned out, just before 8am, I first felt the urgent need to push. It was immensely strong, like a freight train rushing through my body, and there was no mistaking it. I was concerned that Lisa was still at least 20 minutes away, and did not want to push without her there in case the baby was breech or I had a cervical lip. While Alex, mum and Nigel were starting to sense the need to rush and were frantically trying to fill the pool to a high enough level and warm enough temperature, I knew the pool would be nowhere near ready as I was ready to give birth there and then, and needed to have an alternative place to birth. I set up a drop sheet and towel in front of a lounge chair, and fell to my knees leaning over the seat of the chair in yet another contraction. The frequency and strength of the contractions were so unexpected, I was having trouble focusing and gathering my thoughts and concentration between them. I felt almost like I was drowning in them, though they were never unbearable. I felt hot, and stripped off my jeans and top, leaving only my bra and knickers. With each contraction, by now every minute, the urge to push was so strong, and I was roaring with it and resisting it at the same time. On the video, it is striking that even at this point, I was able to hold a conversation with someone, but glazed over and roared through a contraction before picking up the sentence exactly where I left off. I now feel the need to go to the toilet, and Alex helps me. Once there, I can feel a huge soft bulge coming out of my vagina, and ask Alex what he can see. He says it looks like a big whitish balloon, and with a resisted push I feel a pop and a small gush, which is my waters partly breaking. The urge to poo eases, so I just take my knickers off and make my way back to my chair. Eleni has woken up while I was in the toilet, and my mum and Nigel have entertained her and gotten her dressed.

Megan arrives shortly after, around 8.10am. More resisted urges to push come and go. I say to Alex that I’m not sure if I need to do a crap or have a baby, he laughs and says probably both. On the video you can see part of the membranes hanging out of me. I can feel what I think is the head (not a bum!) descending, and I wish Lisa would hurry up or she’s going to miss it all! Lisa finally arrives around 8.20am while I am in the middle of a contraction, I am aware she has walked in the door but I am unable to acknowledge her until the contraction has passed. By this point I am not really paying much attention to what she and Megan are doing, I am trying to focus to avoid the drowning feeling. Alex has sat down on my lounge chair, and I am leaning into him and continuing with the pelvic rocking and deep breathing. On the video Lisa gets straight into it, leaning down to see what is happening (what a view she must get!), and must realise how close I am to giving birth as she and Megan immediately get the oxygen and other equipment ready in a hurry. The oxygen tank blasts out a noisy shot of oxygen quite close to my head, and I barely jump. I come out of a contraction enough to yell at my mother and brother to stop filling the pool! it’s too late! the baby’s about to come! and Lisa also says to stop, and tells my brother to get into position as the head is about to crown. Nigel barely has enough time to do that when another huge urge to push hits me, but I feel safe to go with it now that Lisa is here. I instinctively start panting, and with barely any effort on my part, the head appears.

The video shows the head coming out quite quickly and easily, and as the head is fully born you can see the membranes are still over the baby’s face, trapping amniotic fluid under it. You can see the baby’s eyes are open, looking upwards at the faces looking back in awe. Lisa announces what is happening, and that she is pulling the membranes free of the face, releasing the fluid, but I am not aware of what she has said. You see the fluid running off the baby’s face, it is squinting, and twice spits out a fountain of amniotic fluid from its mouth with a little squelching sound. I come out of that contraction, and ask Alex if he still wants to catch our baby. He rushes around behind me, not realising just how quickly it is all happening, and gets into position. Another wave hits, and I am vaguely aware of Lisa telling me to push slowly and gently. I hear her saying something else, but I don’t know what. The video shows she is telling Alex how to bring the baby out and up, and giving me additional guidance. With the next contraction, the baby doesn’t turn easily by itself, so Lisa guides its body to turn. With a pop the shoulders and arms are born followed by the rest of its body. I feel the stretching more intensely than my previous labour in the water, but it is not unbearable. I am focused on breathing and half pushing the baby out, and the different sensations as the different body parts are born. The video shows Lisa quickly and calmly pulling the cord over the baby’s head where it was wrapped around its neck, and neither Alex nor myself are aware of this until a few days later when we watch it.

It is relief when the baby is out but I am not with it yet, and don’t quite click that our baby is now here earthside with us. The time is 8.26am. The remaining amniotic fluid gushes out warmly onto the towel I am kneeling on. I do hear someone say “it’s a girl!”, on the video it is Alex saying that, and he passes our daughter to me through my legs. I feel stunned and dazed and in awe of this lovely creature I am now holding. I blow gently on her face to encourage her to start breathing, and she lets out a healthy cry. I see her colour go from purple to pink, and note she has quite a bit of vernix on her head and face, and wrinkly hands and feet. I am given a towel to wrap around the parts of her body that aren’t in contact with mine, to help keep her warm, and I can’t take my eyes off her face. She is beautiful, and I think she looks very much like Eleni did except I think she is smaller. Alex and I look at each other, and silently agree that yes, of all our chosen names, she looks like a Sasha Daisy, and we introduce her to everyone.

Eleni is curious, but a bit hesitant. She doesn’t like the look of the blood on and around me, but approaches to give me a big hug and a kiss, before retreating to the background where she is content to sit with her Nana and Uncle Nigel. I feel like I sit there for hours staring at Sasha before I feel another contraction to birth the placenta, but in reality it’s only about 10 minutes. The first post-baby contraction dies away, but the placenta comes out easily with the next contraction. Alex cuts the cord, and Eleni whimpers when she sees the scissors. We have taught her that scissors are sharp, and she is scared we are hurting Sasha. We give her another hug and reassure her. I now move up off the floor and onto the lounge where our baby and I am wrapped in more towels and blankets to keep us both warm. I put her to my breast, and she starts to feed straight away. She is a natural. Her feeding brings on some afterpains, and maybe because I am sitting still, they oddly feel more uncomfortable than my labour contractions. Even though I am holding our daughter, and have fallen in love with her immediately, I feel so dazed by the speed of it all, and have trouble absorbing the fact that I have given birth in such a short space of time.

My labour was 1 hour and 50 minutes, and if I had gone with the urge to push when I first felt it, it would have been closer to 1 hour 15 minutes. I think to ask Lisa if I tore, as I didn’t get the skin softening benefits of the water, she and Alex agree that I didn’t. Later examination confirms that I had no tears, but 2 grazes so superficial that they are barely there. After sitting on the lounge for a while, I start to get cold. The birth pool is too cold for me to get into, so we get our normal bath filled with some pool water topped up with boiling water from the stove. Before I get into the bath, Lisa checks Sasha over. Her head circumference is 34.5cm and her length is 52cm. To weigh Sasha, Lisa places her in one of our green shopping bags and hangs the bag from a fish scale. She weighs in at 3.74kg, or 8lb 4oz, to my surprise she is heavier than Eleni though I still think she looks much smaller. We then dress Sasha, and Nana has her first hold. Alex helps me to the bath, though I feel surprisingly strong. The warm water feels good, but I am quick, I want to get back to my newest daughter. Back in the lounge again, everyone is euphoric at the ease of the birth and surprised by the quickness of it all. I also feel a bit lost.

I am lucky that I really enjoy being in labour and birthing, if I could do it over and over again I would. I love the anticipation of it, being in the thick of it and feeling all the sensations of labour and birth, and the joy of meeting a new human being of Alex and my creation. I had waited excitedly for so long for our homebirth. We anticipated maybe a 4-6 hour labour, and I thought that was the perfect length of time - long enough for me to enjoy the process, short enough not to get overwhelming. When it all happened so quickly, my mind couldn’t quite keep up with my body and I was left feeling like I had missed something. Later someone said to me that I would probably prefer a quick labour like Sasha’s to Eleni’s 8 hour labour or even longer. I don’t actually have a preference; both were equally good, just different. Eleni’s was longer, but I had time to gather my thoughts between contractions and always felt in control. Sasha’s was short and sweet but with the contractions coming so close together I felt somewhat overwhelmed.

We spent the rest of that day getting to know our daughter, and introducing her to a steady stream of our immediate family visiting. In the days following her birth, she has slipped easily into our lives and hearts. She is a natural feeder, and is very calm and happy. She is almost the spitting image of Eleni at the same age, except she has a bit more hair that is slightly darker. I am already in love with her. I love her funny little crossed eyed gaze as she tries to work out who I am. I love the gurgles and snorts she makes in her sleep. I love the little kink in her hair at the nape of her neck, her facial expressions as she fills her nappy, her baby smell, how she looks and feels as I hold her over my shoulder to burp her, and how she’s so keen for a feed that she tries to ‘help’ stuff my nipple in her mouth and ends up with both her hands in her mouth instead.

I am ecstatic we achieved our dream of a homebirth. Alex is a bit disappointed that he let his tiny reservations stop him from getting as excited as I did in the lead up, as once it was over he realised how much he really enjoyed it all. He now cannot imagine anything other than a homebirth with Lisa again for any future additions to our family. Lisa jokes that next time she is camping out at our house from a week before my due date, otherwise she has no hope of making it in time and I’ll end up free-birthing! I have recovered so quickly, and my postnatal visits with Lisa and Megan are probably very boring for them as there’s nothing to do! After the initial hesitation on Sasha’s birth day, Eleni has taken to her extremely well and is very protective and loving towards her. She loves to hold and kiss Sasha, and her face lights up when Sasha looks at her. I am not sure how much Eleni enjoyed the birth, but I think it was more the sight of my blood that unsettled her, not the birth itself or the sudden appearance of a new baby, and it definitely hasn’t had a lasting effect on their relationship.

I am also extremely happy I had the birth filmed. So much detail was captured, a lot of which I wasn’t aware of at the time, and the birth scenes themselves are so fabulous I wish I could show it to everyone, but I can’t because of its private nature. I highly recommend to anyone considering filming their birth to do it, even if you don’t have it at the ‘business’ end. Even just capturing your reactions and those of your support people is worth seeing, and there is so much you don’t notice when you are the one in labour. In the days and weeks following Sasha’s birth, I have found myself watching the video over and over, or thinking about how it all happened a lot, and I always have a smile on my face. It was such a relaxed, intimate, empowering, and exhilarating birth, and to me is exactly how a birth and the memories it creates should be.

Thanks to midwife Lisa Barrett, student midwife Megan Castell, my mum Maxine Koop, my videographer brother Nigel Koop, and especially to my husband and daughters, Alex, Eleni and Sasha Cook for making it all happen with me.