The Importance of Birthing Ernest
A 38-year old first time mum’s positive home birth story
While women have been giving birth for millennia before hospitals, doctors, and knitted hats were invented, in the 21st century childbirth has become an increasingly medicalised procedure in the UK and many other countries. Medical intervention — used appropriately — saves lives. But the trends in today’s current childbirth practices seem more focused on controlling women and labour suite timetables than listening to women and allowing them to get on with this natural process in their own time.
Below is a detailed and intimate account of my experiences giving birth for the first time, at home, based upon my own recollection together with my partner Ben and doula Helen’s reflections (which I requested they write shortly after the birth), and the official notes from the hospital. I was under midwife-led care through West Suffolk Hospital, the names of the midwives have been changed. After about 11am I paid no attention to clocks — times given in my story come from the birth notes. I am deeply grateful to Samantha Gadsden for creating and running the Home Birth Support Group and all the incredible members in that group for sharing support, their stories and women’s wisdom. Thank you to Helen Fortes doula of natalnurturing.com for being with me every surge of the way and beyond.
Pregnancy
Ben and I signed our agreement to move ‘pregnancy’ from “No thanks” to “Yes please” on our relationship contract in October. In April, with my period over a week late and waking up to pee in the night, I was concerned that if I were pregnant I should curb my coffee intake.
Ben’s response to me being pregnant?
“We’re going to need a bigger boat.”
I was fortunate enough to not experience morning sickness and felt perfectly fine during the first trimester. A scan at 8-weeks showed so-far-so-good and since we didn’t yet need a bigger boat, we went ahead with our long-planned trip to row 280-miles across France in Tramp, a wooden rowing boat. Compared to our previous cross-country rowing expeditions, I took more frequent breaks, burst into tears more often, and did fewer nights wild camping as showers were a hygienic necessity not just a want.
I avoided googling anything about pregnancy and birth. We began our research by joining a free informal Saturday morning chat with Debbie and Helen of the Antenatal Academy who gave me plenty of reading material which I instinctively felt aligned with my values.
- Milli Hill’s The Positive Birth Book: A New Approach to Pregnancy, Birth and the Early Weeks Reading this I felt informed enough not to need to extra antenatal classes
- Samantha Gadsden doula’s Home Birth Support Group UK Facebook group: a friendly group of over 13,000 members including doulas, midwives and women who have given or are considering giving birth at home
- Dr. Sara Wickham PhD, RM, MA, PGCert, BA(Hons) is a midwife, speaker, bestselling author and researcher who works independently and is the Director of the Birth Information Project.
Why home birth felt right for me
The importance of the hormone oxytocin in giving birth is critical. Oxytocin — the cuddle hormone — flows when you are feeling comfortable, relaxed, in familiar places with familiar faces, and in low light. This sounded like the opposite of hospital, which I find impersonal, sterile, bright, noisy and devoid of my friend nature. At our first appointment, the midwife asked where I wanted to give birth, “hospital?” she said, without giving me any other options. A couple of appointments later, I asked what the options were. She said there were three: hospital — where all pain relief options are available, midwife led unit (MLU) including some pain relief and birthing pools, located next to our local hospital, and home, where only gas and air could be used.
Outcomes for women planning to give birth at home are on a par or better than for those planning to birth in hospital. The Birthplace study based on over 60,000 UK women in 2010 found that
“for low risk women…caesareans, instrumental births, episiotomies, third or fourth degree tears, the need for blood transfusions and also the very rare need for admission to intensive care, happened less frequently to women who planned a birth at home or in an MLU” — Milli Hill, Positive Birth Book
It seemed peculiar to me that healthy women going through the natural process of childbirth would go to the place where sick people go for treatment; giving birth can hurt but in many cases it is neither a sickness nor an emergency. At hospital, midwives share their time attending multiple mothers labouring simultaneously whereas home births are attended by two midwives. However, around 45% of first-time mums transfer into hospital compared to around 12% of women who have given birth before. Living less than 15-minutes drive from the hospital was reassuring. Ben was on board so home birth became plan A, MLU was plan B and the hospital plan C.
Can you afford (not) to hire a doula?
While I felt confident about giving birth, we knew that there were many unknowns. If we were thrown a curveball, we wanted someone to present information in an objective way and to support us in the decision-making process. We chose to hire the services of Helen Fortes of Natal Nurturing who we found on Doula UK and had already met at the informal antenatal chat.
Doulas support the whole family to have a positive experience of pregnancy, birth and the early weeks with a new baby. www.doula.org.uk
Before you start thinking that a doula is beyond your budget, I urge you to ruthlessly check whether all those ‘baby essentials’ on your to-buy list are really necessary or if they can be bought used or borrowed. Many doulas offer payment plans and a doula access fund exists for ‘those experiencing disadvantage and financial hardship’. Women, babies and families need less stuff and more support.
Birth preferences
Our aim is to have a natural birth, at home, with as little intervention as possible.
Though there were elements of the birth I wan’t sure what my preferences were, I knew that it was easy to move from a no to a yes (in the same way it’s easy to move from a home birth plan to an MLU or hospital) but not the other way around. If I didn’t know, it was a no.
Guess dates not due dates
Due dates are more accurate when given as a 5-week range, 37–42 weeks. Very few women give birth on their due date. Due dates are calculated based on research done in 1744 based on a sample of 100 women. In the UK and many other countries, due dates sits at 40-weeks (280-days) but in France it’s one week later. The 280-day calculation is based on a 28-day cycle with ovulation on day 14. In my pregnancy, the only question I was asked about menstruation was the first date of my last menstrual cycle. My cycle had varied between 26 and 39 days over the last three years. I was told my due date was December 11th but when I used an online check including menstrual cycle data, I calculated December 18th. Any reference to a specific date should be called a guess date at best.
I began maternity leave about three weeks before guess date and bought membership for a local pool expecting to get a maximum of a couple of weeks out of it. During those waiting weeks, I didn’t experience any Braxton-Hicks or early signs of labour other than regularly feeling like my legs were falling out of my hips. I don’t know whether vacuuming the cobwebs on the ceiling counts as nesting. I also repotted all the house plants. That I had shifted my focus from a due date to expecting a 42-week pregnancy was important as I’d seen so many stories on Samantha Gadsden’s Home Birth Support Group of women being coerced into induction — artificially trying to kick start labour — even before due dates were reached. I felt strongly against induction as being stuck in hospital for my last days of pregnancy sounded horrible for an intervention that might be unnecessary, for a labour that can be more painful, may require increased monitoring (and therefore limit mothers’ movements and choices), and may not even work. If doctors felt it was ok to wait for three days to see if an induction kick-started labour, then it must also be ok to enjoy life for three more days to see if labour started naturally. When I saw the midwife on 41+4, she said “I have to ask you, still no plans for induction?”. “No” I said, and thought “it’s not right that you ‘have’ to ask me”.
Oxytocin flows
13-days after my guess date I was both surprised and frustrated that I was still getting my money’s worth at the swimming pool. I went swimming around 3pm on 23rd December (41 weeks + 6 days) and had the pool to myself. The lights in the pool glowed and I couldn’t remember the last time I’d been in a swimming pool in the dark. I declined a dinner invitation and ate alone at home before going to bed early. Around 8:30pm, an incredible tingling sensation coursed throughout my entire body, “I feel wonderful” I said to Ben. “That’s lucky” he replied. I knew things could stop and start and take a long time so I didn’t tell him that contractions had started, I wanted us both to rest as much as possible. He knew that something was up and we each did our best to sleep. Neither of us had much success but at least we were resting. I listened to 1-hour Vipassana meditation recordings and went to the toilet at least three times. Around 5am I sent a message to Helen doula to let her know that things were starting and that I was doing fine. When Christmas Eve morning arrived, I told Ben that today was labour day. After breakfast I called my mum and sister to let them know that things were on the move.
I wanted to enjoy outside so we slowly walked about 400 metres to the village green, stopping when contractions came along. The sunshine warmed my face. Once back at home, I couldn’t sit through contractions and stood up each time I felt one coming along. Already the contractions seemed quite regular and significant which surprised Ben and made him think that perhaps labour was quite far along. I called Helen who arrived around 10am. I was concerned I’d phoned her too early but felt glad to be able to chat and get to know each other a little more as we set off on this most incredible journey together. Things seemed to be moving so fast, both Ben and I felt sure we’d be having a daylight baby. Ben prepared miso soup for lunch under my instruction — heartening, homely, comforting, easy to eat. He used konbu instead of wakame seaweed which made me giggle. I stood up with my hands on the counter or at the foot of the stairs holding the banister and Helen started applying counter-pressure to the small of my back which was an immense relief.
While labour is commonly divided into three stages, fourteen stages of labour are presented in Milli Hill’s book, which I’d adapted to my liking and written on a whiteboard in the room I planned to give birth. Every so often we looked at it to consider where we were. I was eager to get to ‘tea and toast’ but had no idea how much was between us and that stage.
Things felt like they were progressing steadily so I suggested we call the midwives. Helen phoned and mentioned ‘three contractions in ten minutes’ and ‘unable to talk through them’. Thankfully staff were available. I asked Ben to start setting up the pool and when the first midwife arrived around 3pm I was ready to get in. She set herself up in the lounge, recording information on her computer. “Don’t get in the pool too early or you might slow things down” she told me. I felt disappointed that the first engagement I’d had with her was being told what not to do. Helen came to the rescue “If you feel like getting in the pool, get in the pool” she reassured me. The water tank had been emptied and the pool wasn’t yet full enough even though we’d ordered the smaller size. Ben couldn’t believe it and resorted to boiling two kettles repeatedly to top up the water. I got in at 3:30pm. The midwife came in to tell me “If you go over 42-weeks we like to have you in the hospital for monitoring”. I was completely baffled — the monitoring she was talking about was for pregnant people not for women in labour. “I’ve got a whole ‘nother day” I groaned at her.
Cracking on
Labouring is hard work, why should it progress at a constant rate with no breaks? I was glad to hear that the shift was changing after only an hour and the new midwife Denise arrived who we’d met before when she did our home visit. “How are you doing?” she asked. “I’m doing amazing!” I replied, which I only said because everyone else said I was. Contractions weren’t consistent, some were shorter than others and some had longer or lesser breaks between them — I felt short-changed by the shorter breaks.
We were a team of three each with a different role. Gentle, professional, supportive — Helen got absolutely soaked, continually applying pressure on the small of my back to help me through surges, irrespective of my changing positions in the pool. Ben was always there — sometimes I put my arms around his neck, squeezed his shoulders, hips, hands, and at least once, bit him and left a mark. My senses were easily disturbed. I barked “Ben take off your jumper” — the wool was wet and the feel of it disgusted me. “I’m sorry to say that you stink” — he was wearing one of those T-shirts that seems to amplify body odour. At one point I contemplated asking him to brush his teeth as the smell of cheap instant coffee breath wasn’t soothing but I held that thought in until it passed or I didn’t care anymore. I asked to try gas and air. “Have you had it before?” the midwife asked. “Only recreationally” I answered so she explained what it would do and what effect it would have. I managed about two breaths before giving up. On the next few contractions, I inhaled it again but I couldn’t breathe deeply enough with it and I found the noise annoying. I resorted back to breathing deeply and making noise.
As it became dark outside, labour continued ramping up more than Ben or I had thought possible.
“All I could think was “I’m not doing this again, this is inhuman” (Ben’s birth reflection)
Denise the midwife regularly asked to monitor baby’s heart rate. Sometimes I declined and sometimes I consented, as time went on I realised she was good at doing it without me having to move. I knew there should be two midwives for a home birth and asked where the other one was. I was told that she would only be called once I was far along enough. I felt utterly deflated as I couldn’t believe I wasn’t close enough yet. I wanted to know how much longer there was to go but I knew that nobody knew. I considered asking for a vaginal exam but dilation is not a reliable guide as it can change both rapidly and slowly and I considered the risk of disappointment too high if I didn’t like the answer.
By 6pm, contractions were still three in ten minutes, strong and regular and I was actively pushing with many of them. The midwife wanted ‘fresh ears’ of a doctor at the labour suite to listen to baby’s heart rate, which I think involved the midwife holding the baby heart rate monitor next to the phone. This confirmed what I already knew — that everything was fine. I was offered a vaginal exam ‘to check if fully dilated so as not to be pushing if any cervix remains’ which I declined. I was regularly sipping water between contractions though didn’t fancy eating. By 7pm, I’d stopped actively pushing through contractions and had returned to breathing through them instead. I was exhausted and increasingly noisy. Moans, cries, moos, swearing and saying things like “Relax, down, open”, or “Relax, relax, relax — I don’t feel relaxed”. I felt a big POP down below and was told that my waters had broken — finally a sign that things were moving forward! I was delighted to be told that the second midwife had been called and I wondered if she would make it on time.
The second midwife arrived at 8:30pm, around 24-hours since my early contractions. Alice had a wonderful energy and gave practical guidance on positioning, gravity, and going to the toilet. She recorded in the notes that I was ‘breathing beautifully, standing in pool for change of position to stretch legs’. I’d remembered reading somewhere that if you feel like you’ve hit a wall, do something different. Supported by Helen and Ben, I left the water and went to the toilet where I rocked and squatted over it, but it wasn’t long before I returned to the pool.
I’d been told that labour was a marathon, it felt like it was never going to end. “I’m so tired”, “When is baby coming?”, “I can’t do this” — my cries were met with a chorus of “You are doing this!” Water was taken out of the pool to make space to top up with warm water. By 10pm I was having five contractions in ten minutes. Inspired Alice offered me a slice of apple with our favourite local honey on it — it lit me up wonderfully and gave me a magical burst of energy. Sometimes the midwives used a mirror and a torch to see what what was going on in the pool. Surely a baby’s head was visible by now? I’d read that wanting a poo was a good sign that baby would soon be here but I’d wanted to go for hours and still I hadn’t gone. Time had become completely elastic and I was in another world.
I reached down between my legs, “I CAN FEEL THE HEAD!!!!” It was such a relief to know the end was in sight and how curious feeling a wrinkly head between my legs! But oh MY! ‘Stinging! It STINGS!” “There’s a reason it’s called ring of fire” said Helen. Listen to my body, bearing down, breathing. I don’t know how many contractions or pushes it took but baby came out into the water at 23:14. I brought him to the surface to put him to my chest but I felt I’d used up all the energy in all my muscles. I needed guidance on how to reposition myself to sit on the seat in the pool. Baby was not crying yet. I knew that babies don’t necessarily come out crying and can take a few minutes. And I knew those few minutes might feel like hours. The midwives listened to his heart-rate and were wonderfully calm. “When is he going to cry?” I fretted during those minutes that felt like hours that felt like days. “Is something wrong?” “He’s so relaxed” the midwives smiled. His first noises took ten minutes to slowly warm up to cries. An Apgar score “provides an accepted and convenient method for reporting the status of the newborn infant immediately after birth” with higher scores representing a baby doing better after birth. Baby Ernest had an Apgar score of 10 after 10-minutes. Maybe happy babies don’t need to cry when they arrive?
Unfortunately labour was not over yet. Half an hour later I stood up to use gravity to birth the placenta. The midwife said the placenta would be easy, but every muscle in my body felt spent, I couldn’t sit comfortably, and the umbilical cord was stinging me down below. Everyone helped me to stand up and go to the toilet, a slow-moving train of Ben, Helen doula and Denise midwife helping me to gingerly walk the few metres to the toilet while my wobbly aching arms held baby Ernest to my chest. Through the frosted glass window I could see blue lights flashing in the dark outside, “Why is there an ambulance here?” I wondered, panicking thinking something had gone wrong and people hadn’t wanted to worry me. “Oh! It’s the Christmas lights over the road!” I realised, it was probably Christmas Day by now. While sitting on the toilet, I asked if the cord had turned white and stopped pulsing yet and was told it had so I asked for it to be cut. Returning to the birth room, I tried to find a comfortable position, sitting, then on all fours, but I didn’t feel I was making progress. I really wanted that placenta out though I wasn’t feeling any contractions nor could I face any more.
It seemed to me ridiculous to birth a placenta while holding on to a baby when you are exhausted and seemingly the cord too short to bring the baby up to your chest. I made a suggestion out of frustration that perhaps Caroline could hand Ernest to someone else while she concentrated on the task at hand. (Ben)
We asked Helen doula if she could hold Ernest while I knelt on all fours, I remember looking down between my legs and seeing this dangling mess slowly moving lower, millimetre by millimetre towards the bowl the midwife had put under me. I used all my remaining physical and mental energy to hold my position, to engage muscles which I felt no longer existed to bear down while breathing. The placenta came out 1 hour and 20 minutes after Ernest. I had done it!
The midwife asked to examine me and told me that I needed two stitches as there was a first degree tear and they needed to stop the bleeding. Thanks to all my reading on Samantha Gadsden’s home birth group, I knew that up to second degree tears could heal naturally. The idea of having a needle poking around down there after all that I’d been through was terrifying. “Can we wait to see if it stops bleeding itself?” I asked. The midwives suggested putting a sanitary towel in my underwear and reassessing later. I told them “It will stop bleeding”. I asked my body to stop bleeding.
The midwives put a pad on our sofa to protect it from mess and helped me sit down with baby Ernest and Ben. I felt my arms weren’t working and I didn’t feel confident not knowing how to hold baby. Helen helped me supporting Ernest’s latch for his first feed. We had finished our marathon and now it was time for that long-awaited tea and toast! Helen fed me tea with a straw. Ben brought a plate with Marmite and toast and toast with honey and it was the most wonderful tasting toast I’ve ever tasted! I’d completely forgotten about the tear when the midwives asked to check — it had stopped bleeding! Eventually Helen suggested I go for a shower and we asked her to take care of Ernest so Ben could help me if needed. The shower felt incredible. Ben helped dry me and I got into bed. There Helen helped me continue learning to feed Ernest, this time lying down. She reassured me that she would help Ben put Ernest to bed in the Moses basket and I was free to rest. The midwives had done an amazing job cleaning up downstairs before coming up and wishing me goodnight before leaving.
It was a relief to witness how efficient everyone was in leaving as all I wanted was to be left alone with Caroline and Ernest. (Ben)
It was around 3am on Christmas morning when baby Ernest was put safely to sleep in his basket and Helen said goodbye. Ben came to bed and I quickly fell asleep. When Ernest woke and cried once in the night, I was so grateful for Ben’s calm, he waited and settled Ernest back down to sleep and I didn’t do a thing.
Though I was too shattered at the time to realise, waking up in my own bed with my partner and a new baby was the best Christmas morning I’ve ever experienced.
There were some things I discovered about my birth story after the fact which proved to me even more-so how invaluable doulas are. Firstly, I learnt that midwives count days from midnight, so when I was confused being told that ‘continuous monitoring was recommended from 42-weeks’, I thought I still had at least another day, but in fact, 42 weeks officially started at midnight! The notes show that this recommendation to transfer into hospital is ‘due to possible placenta insufficiency and other complications’. Thankfully I didn’t hear that scare-story during labour and in the late days of pregnancy I’d also read Sara Wickham’s ‘The myth of the aging placenta’. My notes also show a discussion between the midwives and Helen about putting a hat on newborn baby ‘to help prevent hypothermia’. Putting a hat on a newborn baby’s head is the first obstacle to giving birth to the placenta naturally. Smelling the baby’s head helps the oxytocin flow which is needed to complete the final stage of labour. Helen told the midwives I would not be accepting a hat for baby (I’d forgotten to put this on my birth preferences). Neither Ben nor I were even aware of the conversation.
Planning to give birth at home isn’t for everyone and not everyone who plans to give birth at home will do so without complications. I learnt early on that it was best not to share the decision of a home birth too widely as so many people had a birth horror story to share or projected their own fears onto me. Some people feel that a home birth is brave but I feel it is the women who choose to go to hospital who are more courageous. While birth is a natural process, knowledge is power and being informed is crucial. Research has shown time and time again that continuity of care through pregnancy and birth improves outcomes for mothers and babies. Hiring a doula was our way to ensure continuity of care since we could not be sure that we would have met the NHS midwives attending our birth. Denise midwife told us that in her four years work as a midwife, she’d never seen an entirely physiological birth. Those who choose to give birth at home often have to fight against hospital policies and practices, yet it is these women who are safeguarding and growing the knowledge of physiological birth.
To anyone else considering giving birth at home, I recommend reading both positive and negative home birth stories, exploring the resources I have mentioned here or other evidence-based birth resources, and if you can, hire a doula.
