I had to write this while it was fresh in my head because I’m still completely reeling after my experience on Thursday. I want to shout it from the rooftops that this service exists because I’m not quite sure if I can truly articulate just how much it’s impacted me since.
Birth Reflections is a service available to those attending (or who have attended) The Coombe Women And Infants University Hospital in Dublin. It is a listening service for women who have given birth or are planning to give birth there. It aims to give women the opportunity to explore their birth, how things panned out, why things went down a certain route and how things might be different for a subsequent pregnancy and birthing experience. Partners are encouraged to come along. The reality is that events around the birth of your baby can have a profound affect on a woman and her partner. Understanding how and why things happened can be a very healing experience. It is an open forum to ask questions, reflect on what happened and fill in the gaps.
I had never heard about Birth Reflections until a couple of weeks ago when a friend mentioned it to me. She availed of the service a couple of months ago during her third pregnancy and found it to be really helpful. She spoke really highly about the experience but for whatever reason I didn’t “hear” her. Funny how you can be listening to someone but not really absorbing the information. I think on some level it was all part of my “I’m fine” strategy and I didn’t want to need a service like this, if that makes sense? Now that I’ve experienced it I honestly think everyone would benefit from it – even if you are at peace with how and why things happened for your particular birthing experience.
It was mentioned to me a second time when I got in touch with Tracy Donegan to enquire about Gentle Birth. Again I listened but didn’t really hear her. I then recently got chatting to a lactation consultant (Nicola. You might remember that I attended her breastfeeding preparation workshop a couple of weeks ago) and she put me in touch with a midwife friend of hers in The Coombe. Her name is Paula Barry and she is an absolute diamond. Due to the fact that I have an Ovarian cyst I sort of automatically fell under the umbrella of doctor led care and I resented the lack of contact I was having with midwives. I missed it. No offence to the doctors because they have been wonderful but the word midwife means “with woman” and I guess I just wanted that experience again. Through Nicola’s introduction I ended up meeting Paula last week and for my last appointments I will now be midwife-led which I am beyond happy about. For now we are putting the cyst stuff to the side and looking at it after the birth. One thing at a time. This has cleared a part of my brain to just allow me to focus on the baby and the impending task of giving birth. I needed that.
Having spoken to Paula Barry she felt that the Birth Reflections service in the hospital was exactly what I needed. She referred me to Ann Fergus who is the Birth Reflections Midwife and before I knew it we were emailing back and forth to find a date and time that suited. I got such a warm impression of Ann just from emailing her which is exactly how I felt when Paula Barry first contacted me. Even that initial email contact was incredibly reassuring. I felt excited about the prospect of feeling better and making this birthing experience a different one.
My friend had recommended that I bring my husband with me and we were able to make that happen. I cannot stress how important this was for me. Knowing what I do now, it would have been such a shame for him to miss it. Being there together and absorbing that information was really important for us to do together. It’s funny how we both remembered things differently and we both had very different questions. In a weird way it’s kind of brought us closer which is pretty special when you consider that we are together ten years this October. Thanks for that Ann.
I wanted to try and keep this piece as informative as possible without making it too much about my experience. That’s the thing – this is a very unique and individual experience because everyone’s birth experience is different. In the same way everyone’s reasons for wanting to access this service will be quite different too. You might simply have questions that you would love answers too or, like in my case, you might be feeling quite traumatized around the memories of that birthing experience. For me it was about making peace with the last one so that I could truly focus on this new one. For me it was about dealing with an extraordinary amount of fear. I knew I couldn’t have a positive birth experience without teasing out my last one.
While I want to keep it general there are literally hundreds of messages and comments that have come my way via Facebook and Instagram since I mentioned this service so I do want to talk a bit about how it unfolded for me and what I learned. I tried to explain it on my Insta Stories but it uploaded in a very annoying jumbled way so this should be a clearer was to chronicle my experience.
I’ll start by saying that the actual appointment was really straight forward. We decided on a date, time and Ann told me to ask for her at reception when we arrived. The receptionist sent us down to the relevant room and Ann met us there. She had both my old chart and my new chart. Even that alone was quite interesting to me because I didn’t really know you had a separate chart for each pregnancy and birth. There is a lot of information to store and during the appointment I was so impressed by the level of detail they include. Every step of the process was recorded in detail and they even have a pocket which includes print outs of any monitoring or scanning that took place. I think this is what makes the whole experience so enriching. Every point or step in the process had the relevant report or print out that Ann could actually refer to. She would show me the times, the patterns and how and why things happened at certain stages. I found this amazing because it was a really tangible way for me to understand how and why things happened as they did. As someone who does not understand medical terms it helped me to feel empowered rather than having a vague sense of what happened.
At the beginning of the appointment Ann gave us some water and explained that she would go through the pregnancy and birth chronologically and that I could (and should) stop her as and when I had questions. She made us feel really comfortable and I knew that I would be able to do this without feeling like I was interrupting her. She has a really lovely nature about her and is extremely approachable so she’s the perfect person for the job. She started by talking about the fact that I had a very straight forward pregnancy and that the only “thing” was that at one point I had a low lying placenta but later in the pregnancy it shifted and a scan showed that all was well.
We then spoke about some of my antenatal appointments and this is where I really started to have my revelations. My last appointment before I gave birth was on the 4th of June 2014 which was four days after my due date. This made me 40+4. I found it really interesting hearing about this appointment because in my head it didn’t really impact the birthing experience and almost wasn’t even part of the story. Now I realize that it really was. Ann spoke about the fact that the doctor had given me an internal check which showed that my cervix was starting to thin out and was a certain percentage of “effaced”. This is something that needs to happen to give birth. While I wasn’t dilated it showed that my body was beginning the preparations for birth and I had never really remembered that. It was encouraging to hear it even now five years later. I remembered the doctor saying to me that he would book me in for an induction five days later (at 40+10) but that he would be “surprised” if the baby wasn’t born before then. Now I know why.
The next topic of conversation was the “sweep”. That old chestnut. I won’t lie, I absolutely hated it and wanted to avoid a sweep on this pregnancy. I just found it so unbelievably uncomfortable. It is an invasive procedure but only lasts a minute or so maybe. I had stored it away in my memory as one of the “bad things” that I wanted to avoid this time. I saw it as something unnatural and something forced and this appointment helped me think about it differently. Ann was explaining to me what the purpose of a sweep is and what it’s intended result is. For anyone who doesn’t know a sweep is where a doctor or midwife inserts a finger through the cervix (literally shuddering as I write this) and uses their finger to kind of sweep away some of the membranes between the amniotic sac/baby and the cervix. It doesn’t hurt the baby but the idea is that it might encourage your body to produce natural prostaglandins (I’m very fancy with my medical terminology now) which are hormones that help you go in to labour. It works for some people and it doesn’t for others. If it’s going to work it tends to start or help labour progress within 48 hours. Now that it’s been explained to me I no longer see it as a bad thing. I now see it as an option to actually help you labour naturally and avoid induction. Funnily enough I didn’t go in to labour for another five days so in my case it may or may not have helped. I’m less black and white about the whole idea now though and with this pregnancy I won’t rule it out. Amazing how differently you can feel about things when they are explained properly. You just don’t have the time for this during antenatal appointments and this is why Birth Reflections is so amazing. A whole hour to really thrash things out in detail.
Another thing I learned during this part of the experience was that at 40+5 I was already at the point that a lot of people would hope induction would lead to. Some of the gels etc aim to help your cervix begin to efface and mine was already starting to do this. It meant that for me induction would have been ARM. I remember reading this on the chart and having no clue what it meant. ARM stands for Artificial Rupture Of Membranes – aka having my waters broken.
The next stage explored my actual labour and the first thing Ann mentioned was that I had not received Oxytocin at any stage during the labour. The relevance of this was that in medical terms I was not induced (I’ll get to how it all happened in a minute) and my contractions happened and progressed naturally. Again there is NOTHING wrong with an Oxytocin drip and it is a very normal part of induction but for me it was very helpful to know that my labour started naturally and that my contractions and progressions were all down to my body. It gave me confidence that things could easily pan out in a similar way this time around. They may not, but they could. I mentioned that I had read on the one page birth summary (in my new chart, at which point I thought that this was the only record of the birth) Oxytocin was mentioned but Ann was able to tell me that this was a small dose given after I had given birth and it’s purpose was to birth the placenta and to control blood loss by ensuring the uterus was contracting well afterwards. You learn something new every day!
We went on to talk about how my labour had started. It was the night before I was due to be induced and I was naturally feeling very nervous. I woke up at about 5am and told Peter that I thought that I had wet myself which was really bizarre because it had never happened in the whole pregnancy. I then started to think that maybe it was actually my waters. I couldn’t control it but it was only trickling. In the end I decided to send him back to sleep (which he didn’t argue with) and I went downstairs to bounce on my birthing ball, have a slice of toast and turn on the TV. At this point I was wired and wouldn’t have been able to go back to sleep. I popped a pad on, felt nothing strange and just continued this till about 7am. At this point I text my mam. Herself and my sister came down to the house at about 8am and by now my back was starting to really hurt. I assured my mam that they were not contractions and that actually I just felt like I really needed to go to the toilet but couldn’t go (TMI, sorry). My mam has given birth five times and knew that what I was feeling were contractions. The thing is I always expected contractions to happen in my tummy. I never expected them to be in my back. As it turned out Billy was OP (back to back) and this is where I felt all of my contractions for my labour. They were never in my stomach.
Eventually at about 9am I was convinced to go to the hospital. I was due for induction at around 10am anyway. We arrived at the Coombe (only a five minute drive at the time – we’re now about half an hour away in the new house) and I had to stop a few times with the pains. I remember holding on to the railings in the carpark mortified that people would be looking at me. We went straight to the admissions room where they get your chart and send you up to the assessment room when you are in labour. This is the room where a midwife will ask you for a urine sample and you will more than likely be hooked up to a monitor to see how baby is doing. They may also check you internally to see where things are “at”. This was another huge revelation for me. It was during this very first monitor (trace) that they first saw a pattern that they didn’t like when it came to Billy’s heart. I really didn’t know this and that will tell you how out of it I felt. At this point the chart describes me as being “distressed” with pain. I remember the midwife checked me and said I was a”about 1cm dilated” and I felt heartbroken. At this stage the pain was becoming unbearable and I knew I couldn’t even imagine how it might be 9cm from now. Ann was explaining to me that at this stage a lot of people might have been sent home if they lived close or for a walk around then hospital/to get some breakfast to let things progress more. However Billy’s heart rate and activity meant that they didn’t feel happy for me to do that and they requested further monitoring for me instead. I remember the monitoring process was horrific because I had to lye down. The pain in my back was so extreme that lying down in any capacity was excruciating.
By 11am there was talk of the epidural. The monitor was showing certain periods where Billy’s heart would behave well (certain variations, accelerations/decelerations etc) but there were a couple of periods where the decelerations lasted quite long and it concerned them. A doctor was called and it wad decided that a blood sample should be taken from the baby’s head to give a clearer picture of how he was doing (in the end this didn’t actually happen). I was so distressed that the monitor kept losing contact with the baby. I remember arching my back and begging to not have to lye down because it was so painful. I turned to my side constantly and every time I did that the monitor lost contact with the baby. I can see now why it was so necessary but at the time it felt like a total nuisance and I resented every single midwife for “making” me lye there. I see it very differently now.
The epidural was ordered and by 11am I was beginning the prep for it. Fluids were administered, a catheter inserted (all standard) and the anesthetist came to the room to administer it. Again you can see from the monitor print out that there is a gap and that is when I was having the epidural administered. Here is another revelation. When I got the epidural I assumed I was about 4cm dilated because, well, that’s what you hear isn’t it? But in reality I wasn’t. They can actually give it earlier or later but they often don’t like to as it can slow labour down. There are also risks with the epidural. In my case though I was begging for it and they felt I would be more comfortable having the baby’s blood sample taken if I was numb. I think by about 11.30am the epidural was starting to take affect. I felt amazing and was absolutely loving life at this stage as the pain had all but disappeared. They did some “scalp stimulation” which basically means they stroke the baby’s scalp a little to try “wake them up” or rouse them as often the decelerations in the heart may just be a sign that they are sleeping. It worked and Billy’s pattern started to look normal again. All was calm. I said “see you later” to the doctor and she assured me that I probably wouldn’t. I remember thinking that if I saw her again it would mean something was wrong. Unfortunately I was exactly right.
About an hour later I was checked again and was found to be 9cm. I couldn’t believe it. In around 3 hours I had gone from 1cm-9cm and that is very quick for a first labour. My cervix was fully effaced and Billy’s heart was showing signs of distress again. At this point it wad decided that I should begin pushing. I think this was at about 1pm and as Ann was reading the notes I was getting goosebumps because I knew Billy was born at 1.30pm and that this is where the “emergency” situation started to happen. The doctor came back in, explained to me about Billy’s heart pattern and said that Billy needed to be born urgently. He was in some kind of distress and they didn’t know why. I gave a couple of big pushes and at this point the decelerations in his heart were lasting a very long time. In Ann’s words – we were probably minutes away from him requiring resuscitation. I now understand why so many people filled the room and why there were a team of baby doctors waiting to take Billy. My heart is racing just thinking about it. The doctor mentioned that we needed to act quickly and that I would require some “help” to which I replied “I wanted to avoid this. You mean episiotomy and forceps?” and she explained how necessary it was. Two pushes later and Billy’s head was born at 13.32 followed by the rest of his body a minute or two later. Just remembering that moment is so emotional. He was placed on my chest and the doctor began giving me the sutures (dissolvable stitches). Actually here is another thing I didn’t know. I knew I had an episiotomy (a small cut to the perineum) by the doctor but I didn’t realize I also had a natural tear to the side of the vagina. As it turns out an episiotomy doesn’t always prevent natural tearing. It helps me understand why things healed as they did and why I was in so much discomfort (I ended back in A&E and on antibiotics because my stitches came apart and this was the worst part of my recovery post-birth).
When Billy was born they took a blood sample from him and the chord and found his PH blood levels indicated that he certainly was in distress and that, in Ann’s words, he really did need to be born when he was. They still don’t know what exactly happened or why he was in distress but Ann mentioned a number of possibilities. One possibility is the speed at which I laboured. As I said going from 1cm-9cm in less than 3 hours is very quick for a first labour. The second theory is that he actually changed position at the last minute so while he was “back to back” while I laboured he was actually born OA which meant that at some point he changed position and ended up in the optimal position. The reality is we don’t know but the monitoring was correct. Billy ended up having a heart murmur and we don’t know if that is connected or not. It’s the kind of murmur that won’t cause him any problems though and his heart is healthy and functioning properly thankfully.
The rest of the appointment explored some post-natal elements of the process such as when Billy went to special care for a night (he was very lethargic, slow to feed etc) and the fact that we stayed in the hospital for 5 days.
In the end I just felt so uplifted and these are the things which Birth Reflections taught me.
- My interventions were in fact necessary
- I went in to labour naturally and, in Ann’s words, my “body labours really well”.
- The “issues” started as soon as I got to the Coombe and not just at 1pm when the room filled with people
- I did not receive Oxytocin and my contractions happened naturally
- I progressed really quickly and had a quick first labour. This would have happened either way as I was 10cm by the time Billy was born either way.
- I have every reason to feel that this next experience can be different and if it’s not, that is OK too.
- The epidural is not a black and white thing. As Ann said “all women CAN labour without the epidural” but on the day there are so many variables which might lead you to choose it. It could be exhaustion, how things are progressing etc and that it’s OK to give yourself permission to take it if you need it but that YES I can withstand and cope with the pain of labour. All women can. I now see it as an option even though I would like to do it without purely for how I’ll feel after the birth (being able to pee, shower and walk when I feel able etc).
- I was monitored the whole time which I didn’t like but it was necessary and there was a very clear reason for it (Billy’s heart)
- The doctor who I had kind of labeled in my head as a villain is now a hero in my eyes. By pure fluke we ran in to her and Ann introduced us. I thanked her for bringing Billy to use safely and I found that experience unbelievably healing too.
At the end of the appointment Ann even offered to show me the room where the pool is. I couldn’t believe it and was so excited. We went through the doors of the delivery suite and it felt so so surreal. She showed us some delivery rooms and Peter recognized the one Billy was born in the minute we entered it. Funny how I didn’t but he did. I suppose it’s such a different experience for everyone isn’t it? As it turns out the pool was in use (which is brilliant) and we just chatted, had a little tour of the delivery suite and then I couldn’t help but hug Ann to thank her for such an amazing experience. I felt amazing. As we said our goodbyes I saw the doctor who has been monitoring my cyst, the lactation consultant who visited me after I had Billy and was trying to breastfeed and the lady who liaises between the Coombe and a magazine I write for. It was like all of the pieces of the puzzle had congregated in one space within fifteen minutes and now (as an instagram follower pointed out) I see it as the universe’s way of reassuring me that all WILL be OK. I was all the different pieces of my story coming together and showing me clearly that all is well. That all will be well.
Thank you Ann, I’ll never be able to thank you enough. My memories of the birth were completely different to how they actually unfolded and now I feel at peace about the whole thing.
Bring on labour number two. I now know I can do this.
If you haven’t gathered by now, I cannot recommend the Birth Reflections service in the Coombe enough. If you want to avail of the service get in touch with Ann Fergus by either calling 0861450910 or emailing her at firstname.lastname@example.org