I am a midwife and now I have to give birth myself
Warning: graphic content
So I knew exactly what to expect
During my first pregnancy, my husband (Steffen) and I almost didn't prepare for the delivery. As a midwife myself, I knew exactly what to expect and didn't think it was necessary. Well I was really wrong there! The birth did not go as expected from the start. Painful but ineffective contractions, resulting in incomplete dilation and eventually complete exhaustion.
Steffen asked me at one point; "Lys, what's going on, why isn't it going?" My frustrated response: “I don't know!! I'm not a midwife now, I don't remember my training at all." In other words, a little preparation might have helped both of us... After hours of trying at home to convert contractions into effective dilation, we finally had to make the decision to go to the hospital. This eventually got to the point where I was only 2-3cm dilated! "Are you kidding me?" I thought. "Am I just pretending?"
"We have been too naive, and should have thought more carefully about other scenarios in advance"
We wanted to give birth at home
Our plan was initially to just give birth at home. We did consider the hospital option, but we were actually too naive about this, and should have thought better of other scenarios in advance. Our delivery plan consisted of a number of points, of which breastfeeding was the most important. We arrive at the hospital, report to the desk, all while I keep a straight face and politely say 'good afternoon' to the assistant. So I even tried to hide my extremely painful contractions.
Once in the delivery room, I quickly opted for an epidural (spinal tap) and contraction triggers. Unfortunately, the epidural caused a loss of sensation and movement in my legs, but the pain from the contractions remained. This caused them to administer extra pain medication in my epidural, and eventually morphine as well. This almost completely knocked me out. I was no longer able to make decisions on my own and was completely in a state of panic. Steffen wasn't sure what to do, it was very busy in the delivery rooms, so there was little time for proper guidance. The nurse came in once to tell me sternly that I should not make too much noise during a contraction, that was not effective, I have to sigh. As quickly and sternly as she came in, she was gone…
My own midwife was at home. Rightly so, because she had already worked all night and wanted to eat and recover. She assured me that if I needed her she would come back. This little bit of communication already brought a lot of peace. Knowing that in the background she was trying to give us the confidence to fight on. On the other hand, I also thought: what else can she do for me here? I am now under the guidance of the gynaecologist. Me and the midwife have often wondered how different it would have been if she had indeed come back.
The painful decision
After hours of toil, I don't know how many people at my bedside, and little dilatation, the decision was made for a caesarean section. For Steffen an extremely painful, but mostly frightening decision. He was panicked, extremely tired (because we had been at it for 24 hours already) and felt completely powerless in this whole process. With this decision he was afraid to lose me (and our unborn child). Who should put him at ease? I'm being prepared for an OR....
Shortly after the birth, our daughter was taken to a small room next to the operating room to be checked and dressed immediately. I could only hear her cry, Steffen was with her. Then I got to see her for a while while stitching. We were then taken to the recovery room, and because of the fatigue and all the medication it took a while before I had recovered enough to go to the maternity ward.
"He was completely exhausted, didn't know what to do, and had to bottle feed his newborn daughter in a storage at 4 a.m., because there was nowhere else to go"
Breastfeeding?
Breastfeeding was not suggested at all in the beginning. Due to a somewhat high birth weight, blood sugar control with supplementary feeding (with formula) was the guideline. Without consultation, our daughter was pricked for sugar and Steffen got a bottle pushed into his hands. He was completely exhausted, didn't know what to do, and had to sit in a storage room with his newborn daughter at 4 a.m. because there was nowhere else to go.
After consultation, Steffen went home to get some sleep (after a marathon of two sleepless nights). He was assured that I would be taken to the ward with our daughter shortly. In the end this took an hour and a half. I heard this afterwards and I shed so many tears about this, I felt like a terrible mother. Together with the feeling of failure and loss of control, I experienced the birth of our daughter as traumatic. Were there any serious complications? No. Were my daughter and I alive? Yes.
But it was also traumatic.
Childbirth number 2
3 years later: How did it go when our son was born? We said from the beginning; “We don't want a repeat of last time”. But how do you achieve this? My caesarean section, on indication of non-progressing dilation, was probably due to a child that was too big for my pelvis. So the chance of a repeat caesarean section was certainly present. We started talking about the first delivery with our midwife; what happened last time? What do we want to prevent?
Trauma processing
I had to process the first birth. A caseload obstetrician who was also a psychologist worked in the same practice (the practice with which I now had a very close collaboration). She focused on trauma during pregnancy and childbirth. She did an EMDR session with me, which allowed me to process the experience better.
The second thing we did was prepare mentally for the birth, we opted for a private hypnobirthing course. Hypnobirthing, isn't that very 'hippy-dippy'? Steffen was also affraid of this. Yes, there will be plenty of courses that are terribly vague, and the book “Hypnobirthing” is also tough to get through. But our sweet down-to-earth hypno-birthing coach from Groningen had given it her own twist by combining the theory with scientific research (much appreciated by Steffen) and making the exercises less esoteric. She helped us relax and regain confidence in the process and in my own body. No puffing, but just relaxing and relaxed breathing.
Our wishes
In the meantime, we discussed our wishes before and during the delivery with our midwife; what we wanted and what we didn't want. Our birth plan stated; home birth in the bath, preferably no epidural, no contractions inducers, no blood sugar checks after birth, in case of insufficient progress (where a caesarean section was a real option) we wanted a 'gentle caesarean' (except in the event of an emergency) , no supplementary feeding, child stays with me or else with Steffen. The most important thing about this plan was that we had discussed all the scenarios, including the one from the previous delivery.
"our own wishes/choices were swept off the table"
Despite a caesarean section in my history, we chose to try to give birth at home. We had carefully weighed the risks, discussed it with the midwife and made a well-considered choice. We did, however, go to a consultation with the gynaecologist, together with our obstetrician. 10 minutes later we walked out of the room defeated. The statements that were made about our planned home birth are not worth repeating. Also, if indeed another caesarean section had to be performed, the gentle-section (natural caesarean section) was dependent on how busy the hospital was. In other words, our own wishes/choices were swept off the table.
To be clear: we were not against a hospital birth, not against intervention by a gynaecologist, we understood the indications/risks of a natural birth after having already had a caesarean section. We went to this consultation to discuss our plan, thought out down to the last detail, with the gynaecologist so that he was aware of our wishes. We didn't go there to be talked out of it. He literally told us that we were playing with our own life and that of our unborn child. The harsh reality of this is that most pregnant women and partners do not dare to stand up for themselves in such a scenario out of fear.
And now what?
We let this sink in for a while and then talked to our midwife again. What were we supposed to do with this? In the end we chose to go for a consultation again, but in a different hospital. I used to work in a small regional hospital, so we wanted to go here. I had passed on my preference for a gynaecologist and the following week I was able to make an appointment. The first thing she said was: "Lys, you're choosing this for a reason, you know the risks, which are not that high, you have clear cut-offs. Go for it!"
I could cry with happiness... I had support, also from the gynaecologist. We had the feeling that we were heard and that we were welcome in case of an emergency. This was literally all we wanted. We were able to continue with full confidence.
The delivery
Finally the contractions started in the evening on December 30th, tried to sleep for a while but around 3:00 am on December 31st they became too intense to stay in bed. A little later Steffen started preparing the birthing pool, what a relief. The warm water made for so much more relaxation. The first time the midwife came, again there was little dilation. Small panic and flashbacks occurred, but thanks to the good preparation and support of a friend and the midwife we overcame this.
A few hours later at the 2nd visit, the dilation was well advanced and the contractions were getting stronger. Our dear maternity nurse was called (also chosen by myself), and in the afternoon I got a feeling of pressure and we all thought: This is going to work! There was a nice and relaxed atmosphere. Unfortunately, the internal examination revealed that the dilation had stagnated. After careful consultation, we and the midwife decided to discontinue the delivery at home, so we went to the hospital.
There I was warmly welcomed at the front door of the hospital, the doorman was ready, the elevator was stopped and on arrival at the delivery room the clinical obstetrician, nurse and gynaecologist were ready. After settling down in the delivery room, I was examined, with my consent, and I was asked what I wanted: still try with an epidural and contraction inducers or a caesarean section right away?
Gentle caesarean
In the end we decided to try an epidural, this time it worked well. But unfortunately it still did not lead to enough dilation. We still had to go for a caesarean section. In this hospital a gentle caesarean was standard practice, so I could see our son being born myself. He was immediately placed on my chest, covered with warm cloths and stayed there until we were back in the maternity ward.
The pediatrician tried to take him for an examination, but he was clearly in good condition, so the gynaecologist immediately shouted: child stays with mom, examination will come tomorrow! The nurse helped me with breastfeeding, which means that the first breast milk had already been given during suturing in the OR. At midnight we toasted to the birth of our son and the new year with 'oliebollen' and alcohol-free champagne. What an experience!
Same outcome, different route
The end result of both deliveries is exactly the same, a living mother and child, no major complications, both times a caesarean section after epidural and contractions. But, the experiences during these deliveries were a completely differt. We very positively look back on the second birth. So what was the biggest difference? Empowering ourselves and freedom of choice in healthcare. Our wishes were respected and we kept control of the situation due to clear communication.
Yes, I know that sometimes there are life-threatening situations where making choices is not an option. However, you should also realize that this is only the case for a very small percentage. In these situations, good communication is still possible and very important.
"Guidelines are necessary but they are not laws"
Pregnant women are not sick, they are able to make choices, especially after good preparation and information from their healthcare providers. Guidelines are necessary but they are not laws. Every person is different, every pregnancy is different, so personalized care is super important. Discuss what they would like with the pregnant woman and partner. Empower them to decide together with the healthcare provider what the best care path is for them. This applies to everyone: from low-risk pregnant women who would like to give birth at home, from pregnant women who like to give birth as clinically as possible, to high-risk pregnant women who need extra care. Everyone has the right to be heard, to be respected and make their own choices.
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