Friday 20 Dec 2013, 9.00am
The last day of school term. Dad and the three kids have left for school. I am in the kitchen loitering by the boiling kettle when I feel a gush of warm liquid. It's followed swiftly by another gush. Waddling to the loo, upon inspection, I see clear liquid. It's not a show, nor is it bloody, it doesn't stink of pee, so it must be amniotic fluid. I am 37 weeks plus 5. It's a boy! I think. Anyone who knows me knows the boys come circa week 37, my daughter kept me waiting until week 42. It's got to be a boy and labour must be imminent.
I return to the kitchen, excited, thinking through my day and about what needs covering and or canceling; there is school pick up, the curtain man's due in one hour and a friend's visiting later tonight. Even as I mentally rearrange my day I can feel the recognizable cramps that signal the onset of early labour. Hands on the counter, I close my eyes and welcome each contraction into my body. I feel calm and confident. Half an hour passes like this, with me hip-circling and breathing intently. Then, suddenly, my privacy is disturbed by an onslaught of people; first Ren, our trusty Battersea Yoga assistant, pokes her head round the door; then Angus in exuberant and boisterous mood; and almost simultaneously the curtain man dings the doorbell.
Even as I open the door to let him in, I can feel my labour slipping away.
Home birthing's not easy when your home is Piccadilly Circus.
Friday 20 Dec 10pm
It's 13 hours since my waters have ruptured. Midwife Jessie has been and gone. She confirmed the liquid was amniotic fluid, took all my vitals and promised to be on call later if it kicks off. Now the house is empty and quiet, with the kids sleeping-over at my sisters. I am hopeful I will go into labour tonight. After a take-away dinner, we draw our beautiful new curtains, and go to bed fully expecting to be woken by contractions in the early hours.
Saturday 21 Dec, 9.00am
No labour. It's been 24 hours now since my waters went. I know what the NHS policy is on Premature Rupture of Membranes (PROM). But I do not wish to be induced. I feel happy to push for an extension. On the phone to the midwife I agree to go in to St Thomas's to be monitored and have my vitals taken. The midwives are happy to support my decision.
At the hospital, on the antenatal ward, I sit on the monitor and have temperature and blood pressure taken. A woman is in labour behind the drawn curtain in the bed next to me. She is struggling, clearly distressed. She shouldn't be here. But there are no beds on the labour ward. I am reminded why I chose home-birth and am resolved to get this labour started one way or another.
Midwife Megan checks the position and says the baby is 3/5 engaged and LOP. (Left Occiput Posterior). That is not good news and may explain the lack of contractions. She wants to take blood and test for infection to feel super-satisfied that all is well. I feel confident all is well and decide to use the blood tests as a negotiating tool to buy me more time, if necessary, tomorrow. I agree to give blood at 48 hrs if labour has not yet started.
"Hopefully, you won't have to, says Megan "as eighty per cent of babies have come by 48 hrs after PROM." Off the monitor, I put on my headphones and march back through the wind and rain, determined to walk this baby out.
Sunday 22 Dec, 9.30am
No labour. 48 hours. Am feeling bothered. The house is a mess. The children are rampaging. The bathroom needs cleaning. I feel concerned that this baby is not coming. I am also cross with myself. Practically, I am not ready. Having only stopped working five days earlier, I have no baby stuff and the cot is not yet up. All this must be resolved.
After a morning of frenetic nesting - including floor cleaning on all fours, vigorous scrubbing and ardent hoovering, we decamp en masse to PJs on a last-minute xmas spree and baby shop. In the maternity department (where else?) I have a waters gushing incident. Damp but encouraged, (perhaps the baby has dropped), I engage the assistance of a staff member, buy a clean pair of leggings, fresh underwear, baby gear then join my family in the restaurant. A vexed pensioner barges past me on my way out of the lift. The shop is heaving. Suddenly the ongoing dampness and the heat get the better of me. I am starting to feel very tired. This is no place for a woman keen to get into labour.
At the hospital, Midwife Camilla confirms the baby is still LOP though dropped slightly. I give my blood for testing and once again march the 3 mile stretch home. I spend an hour upside-down shaking, rolling and inverting my body in the hope of tipping the baby out of the pelvis so that he or she will re-engage and labour can progress as normal.
The house is quiet; the crib is up and the bathroom, gleaming. I go to bed full of hope.
Sunday 23 Dec, 9.30am
No labour. My 72 hours are up. I am depressed, confused and still leaking clear fluid. It does not smell offensive. I ignore the phone for an hour or two and hide under the duvet. Eventually I resolve to answer it. It's midwife Jessie. "Am I ready to come in?" With a heavy heart I agree to attend St Thomas' for an induction at 4pm that afternoon. Jess the midwife, tries to lift my dismay with the news that it may still be possible to labour in the Home from Home unit - if the induction goes well.
St Thomas'. Consultant Kate talks me through my options which are two: either the Syntocinon drip, administered in the labour ward with constant monitoring, (because of the risk to the VBAC scar), or Prostin gel, labour ward and constant monitoring.
I feel stuck between a rock and a hard place. I cannot believe I am about to agree to all the interventions I have spent three pregnancies avoiding by choosing the home-birth experience. "What if I say no?," I ask.
Suddenly another option is on the table. No action.
A very interesting conversation follows about the NICE guidelines which previously gave 3-5 days grace after PROM before the NHS brought it forward to 24 hours to minimise risk further. Given I'm a VBAC, its possibly the option with the lowest risk.
My mind is made up. As long as I give blood and am monitored daily, my wait time is extended a further 48 hours.
"Go home and get yourself into labour," smiles the consultant concluding the conversation. I have the biggest smile on my face as we leave.
Back home, I order the hottest curry on the menu (three chilli marks) and google the castor oil induction remedy - an old midwifery trick - which I plan to employ the following day if no action follows tonight.
I am tidying away toys from the sitting room when I feel my first contraction. I pretend to ignore it and move to the kitchen waiting to see if things continue. They do. With cautious excitement I text the Homebirth team: "Get bellydancing," midwife Jessie texts back: "Get them nice and strong." With pleasure.
Pulling up the playlist from my birth-dance blessing ten days earlier, I spend the next two hours gyrating, squatting, and hip-swiveling my way around my bedroom floor. It feels great to be dancing my way through early labour. It feels great to be finally labouring.
My revelry is disturbed by the phone. It's Ailsa, lead midwife on duty. Excitedly, I tell her the good news. She congratulates me but her voice is flat. Then she hits me with the latest news: This evening's blood-test results have come back from the lab. My infection markers are up on yesterday's score. Given the amount of time passed since the waters went, I must transfer in and have intravenous antibiotics. I cannot have a home-birth.
I cannot believe what I am hearing! I feel so cross!. Nor can I hide my feelings. This is the LAST thing I need. I tell Ailsa: "I feel well. My temperature is fine. I have a cold. That must be the reason."
"It's too high for that," she tells me. "We are concerned it may be a uterine infection. You need to come in."
In the darkness I sit there. Contractions have stalled. The baby was coming. I felt it. Now what? The baby could be here in a matter of hours. Am I really going to give up after getting this far just because my CRP has risen, when I feel well? It is 11.30pm. I decide to call an independent midwife friend to ask her advice.
I have spent the last ten years teaching the importance of personal responsibility for women during pregnancy and birth. I It is something I believe very strongly in. To feel empowered as a woman moving through the system, I must make and accept fully the consequences of my decisions as mother of the babies I seek to birth and protect. I weigh up the risk to my baby of continuing to labour at home tonight versus all the intervention i will now face if I transfer in and the inevitable complications that will ensue. If I had a temperature, felt unwell or my waters smelt, I would be the first to transfer in. But my instinct continues to tell me I am safer at home.
My body acknowledges my decision by upping the ante. I go to the loo and, as I sit there inviting the contractions in, they suddenly intensify to the degree that I know and recognise as established labour.
"Call the midwife back Angus!" I shout. "Tell her I can't transfer in. They have to come out to me. The baby is coming."
Four hours have passed since we made that call. Both midwifes turned up almost instantly. Like Angus and I they expected a swift arrival. Now we are all gathered together in the dim light of my bedroom. We all know something is amiss. My contractions are irregular; strong and powerful when I stand up and move around; slowing right down if I stop moving or kneel. I am getting tired and wanting to rest but feel the need to keep the contractions going. Despite not wanting to examine me, and increase the risk of infection, Ailsa now thinks it is important to see where we are.
I lie back on the bed and close my eyes as her fingers rummage around my cervix.
"Well," says Ailsa after a good root about, "you are 6 cms dilated, your cervix is lovely and soft, but unfortunately the baby's head is tilted to one side."
My heart sinks. I know from experience, this kind of mal-positioning is hard to shift. I recall a birth I attended where the mother got stuck at 8 cms for 8 hours before transferring in for an epidural, syntocinon drip and eventually a C-section. Is this how my last birth will end?
Ailsa suggests that I do some lunges to make space on one side. I elephant walk around the room, lifting and opening up each hip in turn as high as I can. I put my foot up on the bed and lunge into each hip. The contractions continue to deepen.
Between contractions I sit on the loo and practice the pelvic clock exercise to soften the tissue in the pelvis. When the contractions come on the loo, I make sure I offer no resistance to them.
I have no idea what time it is. I feel like I have been labouring all night. There is still no sign of an urge to push. We are stuck. We all know we are.
I am struggling with a rising negative mental state. I also have constant and deep sacral pain which is bothering me. I must remember to be present. To stay in the moment. With each contraction I remind my body to accept it. "Let it move through you," I repeat as they pass through me one after the other. But I can feel the mental resistance is there. I can see the lack of progress. My body wants to stop and sleep. What if my baby needs help? What if my baby is really stuck?
When a woman reaches transition she often thinks she cannot continue. 'It's too much. Too hard.' The contractions are coming every minute, lasting a minute. But they have been for hours. 'Am I there,' I wonder? I am certainly thinking: I can't take much more of this. "Yes," I call out, with each one to positivise the experience and to remind my flagging body not to resist.
Angus is wilting too, having just flown back from Australia - and been up for 36 hours. I remind him to stay present with me contraction by contraction. At this point I need moment-to-moment encouragement. I feel so tired. I am losing faith. Without it I forget to let go. I forget to breathe out. The midwives are silent, endlessly note-taking. Occasionally they remind me to relax my shoulders, to keep my voice low in my body when the pitch rises. I start Om-ing to focus my mind and direct the sound.
I don't know how much more time passes when Ailsa quietly calls my name.
"We need to discuss alternative options,' she says. "I think this baby might need some help in getting out."
6am Christmas Eve
What or whom do you call on when you run out of strength? In the sanctity of the bathroom, overwhelmed by this labour, I call on the strength of my late mother, to guide me. With wave after wave sweeping through me, I hold on to her face, radiant, in my mind's eye. If she can do it, I can do it. 'If you can do it,' I repeat, 'I can do it.'
I hold onto the taps in the bathroom and surrender my body to the force moving through me. 'Let it move through you', is my other mantra.
Back on the loo (It deepens the contractions), another one cuts through me. I concentrate on opening up my body. I lean forwards over the bath and spread my legs pulling back through my tailbone. I can feel something shifting. The baby moves. Suddenly there is the unmistakable low grunt of the pushy contractions that signal the onset of the 2nd stage.
We've done it. Not quite believing the sudden progress I shuffle back to the bedroom.
I kneel over the bed, grasp fistfuls of duvet and pull back roaring. The midwives listen with bated breath to the sounds I am making. We all recognise it. Instantly the energy in the room shifts.
"Ok!" says Ailsa. Maybe not a transfer after all. 'This baby is coming!"
This baby is coming. But it's taking its time. Despite a five minute second stage for birth three. It is still to be another half hour before I meet my fourth child. There is not enough power behind the contractions and it takes all my mental and physical strength to bring it to the perineum. I chant OPEN as the contractions slowly move it through my body. Two steps forward, one step back. I know I am nearly there.
Suddenly we are back at Piccadilly Circus. My sister has arrived. The kids have woken up and there are now 7 people (including me) in the room. I ask them to leave. I need privacy. Calling on my mother again, I take a deep breath in and with the next contraction bring the baby to crown. It burns hot and bright. But I must be patient because it still takes another four contractions to stretch the perineum around the head. I muster all my energy and with the next contraction the head is born. A few minutes later it slithers out and Ailsa quickly passes it through my legs. It is a boy. And thank God, he is born.