I fell pregnant literally after the first attempt. To follow was a healthy and uncomplicated pregnancy, which allowed me to remain reasonably active. Our plan was to give birth in the nearby public hospital. We thought that giving birth in hospital would be a safer choice since this is our first baby.
During my pregnancy I attended my regular pregnancy appointments and passed all the routine tests, including the ultrasounds and glucose test. I was only seen by midwives and never met a doctor, as everything seemed to be quite straightforward.
Having a normal vaginal birth and pelvic floor integrity was important to me, as I am a high performance athlete. Physical recovery from a caesraean section would have taken me a lot longer.
But things changed on the night of the 13th of May. I was 36 weeks and 5 days pregnant when my waters broke. The next morning we contacted the hospital and were asked to come in to get checked. Not long after it was confirmed that my waters had broken. Because of the risk of infection the doctor recommended to induce my labour straight away and also suggested for me to have regular antibiotics during labour.
After monitoring my baby it was established that there was no evidence to be concerned about my baby’s well-being and I declined both suggested interventions. I too felt well, did not have a fever and already started to feel period like cramps.
We headed back home to wait for labour to get stronger, with the plan to return daily to the hospital to monitor my baby’s well-being or sooner if I start feeling unwell. I was checking my temperature regularly at home, kept an eye on my baby’s movements and the colour of the water.
Overnight my contractions got stronger. We decided that it was time to head off to the hospital. We had to stop a couple of times along the way. Luckily the hospital was only a 5-minute drive away. Not long after we arrived at the hospital my contractions were assessed by a midwife. According to the midwife my contractions were irregular and not strong enough. The midwife told me that this was not proper labour and advised me that she needs to do a vaginal exam to break my waters in order to make my labour stronger. Initially this was only a suggested plan that soon ended up to be forceful.
The doctor came and asked me to sign a refusal of treatment form for declining induction and antibiotics, which I did. I was trying very hard to focus on my labour. But then, despite having had already signed the refusal of treatment form the doctor returned, advising me again that I was putting my baby at great risk of infection with the potential of death! And if that was not enough, the doctor continued on asking me to write down in my own words that I am refusing suggested treatment and that I am aware of all the risks associated with this, which he asked me to list individually.
This experience was very unpleasant. I understand that it is the duty of care of the medical staff to fully inform me of the risks and benefits of declining recommended treatment for myself and my baby. At the same time I would have appreciated and valued that my informed decisions got accepted. I was shocked at the lack of respect for a competent mothers informed decision making and the culture of intimidation to force compliance. I felt uncomfortable and stressed.
I was trying to achieve for what I believed was the best possible health outcome for my unborn baby and myself. For me this included not having an induction or antibiotics during labour without a valid medical reason, such as abnormal monitoring on the baby or me getting a fever and showing signs of infection.
My reason for not wanting an unnecessary induction was my concerns about the cascade of interevention that might follow, with the potential of leading to caesarean section, in particular for first time mothers.
Easy to guess, my contractions started to get weaker and eventually stopped almost all together by Friday morning and we decided to go back home. I generally am a calm person and do not tend to panic. But I became extremely sensitive about the hospital’s approach to my case, in particular about me making informed choices about my care and declining treatment in an attempt to avoid unnecessary intervention.
The doctor’s careless behaviour about the natural birthing processes really annoyed me. It seemed that all they cared for is to get the baby out of Maria, the quickest way possible. If the natural processes are perhaps a little slower than what would be expected according to modern medicine, they ensure that maximum interventions are in place to force that process. And all of this is done despite our baby being well and showing no signs of distress. How about our wishes?
I was completely dissatisfied with the labour care that I was receiving from the obstetric staff and some of the midwifery staff at the hospital. With every day passing negotiating safe choices became more difficult for us. We felt that we needed assistance of an independent professional and as a consequence decided at the last minute to engage a private midwife that can safely support our choices, be our advocate and assist us with achieving the best possible birthing outcome in the given circumstances for us.
I was contracting on and off all day at home with our private midwife present, who checked my baby’s heart rate and temperature regularly. In the afternoon I had an appointment for monitoring in the hospital but I chose not to attend. I wanted to reduce the amount of time that I was spending in the hospital- an environment where I felt constant pressure for induction without a valid medical reason, staff not respecting my choices and attempting to force me to be compliant with what they consider to be a reasonable, sensible or advisable choice.
Our private midwife organised a visit from Karen, who is a practitioner of Chinese medicine. I received acupuncture to promote relaxation and to stimulate my contractions. Initially I was quite sceptical about acupuncture but when I experienced its action I became the biggest fan of it. My contractions felt so much less painful and my tense muscles all relaxed. It was so relieving and became my number one pain relief option.
Saturday evening my heart rate went up slightly as well as my temperature. My private midwife did the first vaginal exam to check how open my cervix was- 9cm! We decided that it was time to head back to the hospital, in particular because I was showing potential signs of an infection.
It was a classic trip in the back seat of our car. I was on all fours and not long, we had arrived. In my head I was ready for everything and just wanted to have my baby in my arms now. My private midwife came with us to the hospital.
When I arrived, the hospital midwife put the monitoring (CTG) on me. I was checked by a doctor who told me that I was 8 cms dilated. Quite desperate news after days of labour!! I had a low fever and agreed to antibiotics. I also agreed to have a small amount of the hormone drip to make my labour stronger. My contractions felt like they were not going away at all and lasted for 2-3 minutes each! I started using gas in air in the hospital for pain relief.
The advise to have a caesarean section…
After two hours had passed the consultant obstetrician examined me. The result was devastating! Still only 8 cms dilated! She told me that the position of my baby’s head was facing the wrong way (posterior) causing my labour to be obstructed. She advised me that I will need to have a caesarean section. I was at a stage of accepting everything! I was devastated, screamed and cried! I just could not go on any longer with these contractions. My private midwife reassured me, suggested to get an epidural and wait for couple of hours. My husband Serge thought the same. The baby did not show signs of distress so we declined the caesarean section and requested the epidural. The anaesthetist was called and expected to arrive in 30 minutes.
After the obstetrician checked Maria and declared no progress, obstructed labour and gave a strong recommendation to have a caesarian section I tried very hard to stay calm. After speaking to our private midwife we decided to continue with labour and have the epidural. But lucky we did not need the epidural because 30 minutes later, just as the anaesthetist had arrived, Maria felt the urge to push!
The hospital midwife quickly checked how open my cervix was. I was fully dilated and started pushing straight away!
I was on the floor squatting and initially found it hard to find a way to push effectively. But once I found my way it got a lot easier and I could really feel my baby’s head moving down through my pelvis. After pushing for one hour the doctor returned and started to talk about a slow progress again, without even looking at me or making any physical assessment of my progress, merely watching the clock on the wall. The doctor stated that she will examine me if the baby is not born in 15 minutes. Once again, I was just talked over by the doctor instead of the doctor having a conversation with me. I ignored the doctor’s presence in the room because I was busy focusing on pushing and giving birth.
My husband attempted to advocate for me and expressed in my presence to the doctor how inappropriate her actions were. The doctor raised her voice and challenged my husband, which lead to conflict in the room. Highly disrespectful, unprofessional and inappropriate in my birthing space. Even the midwife taking care of me at that time had to intervene and asked both, the doctor and my husband to step outside the birthing room to continue the conversation.
I really lost my patience. No progress? You just entered the room, did not ask anyone anything and simply declared no progress. I told the doctor to please not interfere in such an unsupportive way. The doctor got angry. The hospital midwife told us that this conversation can not happen in the birthing space and that we need to continue the dialogue outside. Maria apparently went into final stages of birth straight after that doctor left.
17/05/15- Normal Vaginal Birth of Alexander
Not long after, the head was about to be born and the paediatric doctor and another midwife entered the room. On 17/05/15 I gave birth to a healthy boy at 00.37, Alexander, 1 hour and 26 minutes after being advised to have a cesarean section. I gave birth squatting on the floor all by myself. No instrumental assistance was required.
As soon as the baby was born it was put skin to skin with me but the cord was clamped and cut within 15 seconds despite my wish for delayed cord clamping until pulsation had ceased. The paediatric registrar was standing next to the resuscitation cot, which was placed in very close proximity to my baby and asking the midwife to cut the cord. My request for delayed cord clamping was completely ignored.
Of course at that time I had just given birth to my baby and was exhausted from labour so I had no energy left to fight. He was back in my arms 2 minutes later. By then the midwife had already given me the injection to birth the placenta and my blood loss was completely fine. I just had a small tear and did not need any stitches. Alexander weight 3055gr and was 49cm long. Not bad for a ‘premature’ baby!
After staying in the hospital for 2 nights we finally all went home feeling absolutely exhausted from the experience. Alexander was healthy, did not show any signs of infection, always stayed with me in the hospital and never got admitted to the special care nursery and was and still is breastfeeding well.
My husband and I do believe that one of the main reasons for achieving the low intervention vaginal birth in the given circumstances was because of our private midwife, who safely supported our choices during labour and birth in the hospital environment. Even though myself and my husband were against any interventions without a valid medical reason, negotiating safe choices became very difficult for us, in particular when the doctors started to say that my baby might die from infection.
For our next baby, if we will be blessed enough to have another one, we will plan a homebirth with our private midwife.
Overall I got the impression that the birthing system that we experienced is very protocol based and by no means individual, personal or woman-centered. It felt that the doctors were not interested in our wishes or birth plan and it appeared that the medical approach prevailed, even for a healthy woman. Our particular doctors attitude, which also seems to be a personal dislike was completely inacceptable, as well as their unprofessional and discouraging approach. I felt that the midwives in the hospital generally were on our side to help the natural process as much as they can. But if any decisions were to be made, it was the doctor that had the final say. In my opinion, obstetricians should not be in the labour room unless anything goes wrong.