... Hana's story continued

On Wednesday (Jan 9^th) late morning, John and I went for a walk to a local park. Before leaving the house, I realised there is some sort of clear fluid trickling from my vagina. I wasn’t sure what is going on, but I was suspicious this may suggest amniotic water is leaking. I called Marijn to discuss this question. She agreed to drop by, to check me before a planned visit at the Queen Charlotte’s hospital antenatal clinic in the afternoon. It appeared to me, leaking had been going on since the early morning but it was rather little earlier on, so I interpreted it as being cervical discharge following a membrane sweep from the previous day.

During our walk to the park, trickling of fluid started to be more obvious. I also started to perceive mild period-like contractions. Contractions were having a different pattern than the Braxton-Hicks ones, occurring most of the previous nights; these contractions were quite short and more intense and more resembling my "normal" period pains but, at least from my perspective, of very low intensity.

After the walk, we had a lunch and almost immediately after that Marijn came to see us. We agreed that the leak is indeed most likely a spontaneous rupture of membranes; fluid trickling rather than gushing is related to the hind water leak. We also decided, there is no need to go to the hospital as I’d rather await any further development at home. I was concerned travelling around may interrupt any pre-labour process. Subsequently, I cancelled the hospital appointment.

After Marijn left, we went to shop to Morrison’s. Contractions were slowly building up and were getting stronger. From time to time, I felt sharp pain at the bottom of my womb. John and I had an evening meal and then John put together a birth pool. Contractions started to feel more as my "usual" period pains, but still not at the level of maximum intensity. Today, it is difficult for me to describe the evening development, because I forgot most of it. I remember observing prodromal signs similar to those appearing close to the start of my period pains. But, as I can’t pinpoint these prodromal signs, which are feelings of "something" is going on rather than specific symptoms, it is also difficult to describe what was happening. We went to bed at around 11PM, but I got up after less than 15 min of rest, unable to cope with contractions. As I laid in bed, contractions immediately increased in intensity and felt approximately as half as strong as my "usual" period pains. They were perfectly manageable when I got up and started to move around. I also started to feel intense dull backache in lower spine, and developed extreme chills. I walked downstairs, leaving John sleeping upstairs, and put an electric fire on and attached a TENS machine.

It was tricky to put on the TENS machine on my own, but I managed. I was rolling on a gym ball and, at the height of contractions, using the TENS machine’s high burst option. Contractions were appearing every 3-5 minutes. The TENS machine was helping to take my mind of contractions and backache. Hypnobirthing breathing techniques also helped between and during contractions. I was coping without any issue, even though aware of discomfort. Suddenly, I started to feel quite heated. I measured my temperature as 38 degrees Celsius. I called Marijn between 1:30 and 2:00AM. She agreed to drop in and assess my feverish episode. I woke up John few minutes after calling Marijn. I measured temperature several times again; it first dropped to 37.3°C, but shortly later it increased to 38.4°C. Marijn came at about 3AM. We agreed that high temperature is perhaps a result of dehydratation and overheating. We decided to observe the temperature development over a period of time and then make a decision if there is a case to worry about amniotic fluid infection. I took two paracetamol tablets, after a laughable and desperate search for some at my home, where all meds are available but not pure paracetamol without a combination with other ingredients....:) I was even searching on Internet an exact composition of some Beachem’s products as I don’t keep product inserts. (But, one week later, I actually found a package of paracetamol in our medicine cupboard….) Shortly after that my ability to perceive time significantly diminished. I can read in my notes that, at 4AM, I went to the toilet and started to vocalize contractions. This was one of the break points during my labour. Up to this point, contractions were getting more intense, with certain regularity, but were manageable using Hypnobirthing breathing techniques, TENS machine and positioning. Then, I went to the toilet to pass urine but, sitting on the toilet, I was unable to. Instead of it, I was hit by very strong contractions. I remember trying to lean back as this seemed to help coping with pain. I also recall not being able to get off the toilet seat with body convulsing arched backwards and supported by John. Finally, I managed somehow to get myself together and walk downstairs and even to refuse help with walking. From that point, contractions changed their pattern; they didn’t seem to „stop". The restive period disappeared. Contractions, usually described in books as „…the pain will usually start slowly, rise to a peak lasting about 30 seconds and then subside....", changed in to a following pattern: with each contraction pain shot up as an elevator without much warning, remained in a peak for some time and then quickly subsided, but not to a restive period as before, but to a level of constant pain in a lower tummy segment. The whole tummy felt hard constantly and due to that I wasn’t able to use Hypnobirthing breathing techniques any more. Specifically, I wasn’t able to inflate my tummy; it felt rock hard and resisting breathing techniques. The "restive period" pain felt like having an open wound, i.e. as having an incision deep inside in a lower abdominal area just above the pubic bone. Maximum pain level, at the height of contractions, seemed to be similar to my premenstrual period pains. What was challenging an requiring all my attention was the lack of any restive period. I had to fight to relax in what remained from it and it felt, I had no real time to prepare for the next contraction. From this point things go hazy for me and I remember very little until 8AM when, according to notes, I started to push.

What I recall from this part o my labour is that, downstairs, I couldn’t get comfortable on a ball any more and finished sitting on a carpet, on a sanitary pad, my back propped against a sofa. I stayed in this position until getting in a birth pool. I lost my modesty and was happy to leak on a sanitary pad. I changed breathing pattern and remember breathing instinctively, as it felt appropriate. I remember long deep breaths in and out going through my throat. As I was unable to feel relaxation in my tummy, I was using throat as a guide to keep slow deep breathing. It perhaps wasn’t ideal for relaxation, but the best I could manage. Further, I recollect breathing through my lips as a horse and occasionally panting as well. I forgot all about the TENS machine, I had to fully focus to survive through contractions. I got totally to myself, withdrawn, losing all inhibitions, but one and that was making too much fuss and cause distress to both John and Marijn. I vomited on one occasion. I felt I need to be talked through each contraction. I also have knowledge of John being behind my back and supporting me and Marijn talking to me whilst facing me. I tried to take each contraction separately and not to think about the next one. I was also swaying my neck and rotating my feet during contractions to relieve enormous tension I felt building up in my body. Further, I was using positive and negative thoughts to brace myself. Consciousness of the labour process being temporary and working towards having my baby, were the positive thoughts, I was repeating to myself. Negative stimuli included knowledge of reducing oxygen intake and thus of potential harm to my baby, if I won’t be relaxed and stop breathing deeply. I also had a fixed idea that a decision for a transfer for an epidural will mean I’d need to endure a transfer to a hospital, continuous monitoring and a wait for an anaesthesiologist, who may never come. The second option was in my opinion as good as slow death and helped me to keep firmly gripped with an option of staying home, where nothing was really missing.

After a certain period of time, I felt I can’t cope any more. Hoping for more relaxation, I asked Marijn if it is possible to use a bath or a birth pool. Later, I went to the pool hoping for some relief. I assumed a similar semi-prone position as sitting on a floor. But contractions got much worse! I felt a bit cheated. To my comment about feeling much worse, Marijn responded that water can relax, but also intensify the labour. I eventually put together myself, but I remember moaning about pain. In truth, I was indeed more relaxed during restive periods, even though contractions intensified.

Again after a certain period of time, I felt I can’t cope any more with the level of pain and started to beg for gas&air. I remember being politely refused several or rather many times. Finally, I got to use Entonox. But, I used it perhaps only once or twice, didn’t feel any relief and pushed the device away. Then, with the next contraction, I shouted: "I’m pushing". I recollect Marijn asking me at least once before if I feel like pushing. I answered "No", but actually, I sensed something going on and could have been pushing involuntarily.

Even though the approximate start of transition is recorded in my notes, I didn’t experience any real difference between the transition and stages previous to it. Contractions felt present all the time, but my ability to cope with them declined over time. The only difference between early and later dilatation stages was feeling, in the later stage, as if tearing inside. I felt sharp pain, similar to tearing of a thin tissue or material, deep inside my lower abdomen. Further, later in dilatation, I kept touching my labia. I sensed a lot of discharge coming through, but I was mainly touching because of feeling strong pressure on pubic bone. Throughout the dilatation phase, the baby was occasionally strongly moving. Her moves at the height of contractions were specially difficult to manage.

In the pushing phase, pain during contractions immediately intensified, but the pattern changed. There was a real restive period between them, when I was feeling almost "normal". "I got on with it". To my surprise, I wasn’t able to use the special pushing Hypnobirthing breathing technique at all, even though I tried to compose myself to use it. However, at the height of contractions, I was totally overtaken by my body and I pushed with all the might. Pushing was not directed by my thinking at all; I was doing what instinctively felt right to me without thinking. It occurred to me, I need to push as if I need to pass through back passage; however, the same time I felt the pressure is „somewhere else" and pushed towards perineum in general. And I pushed and pushed, but nothing was happening. I was aware of an increasing intense pressure inside my pelvis, but I didn’t feel extreme pain, I even felt sort of "anaesthetised". I had an extreme desire to get the „thing" out. It was mentally challenging. The urge was so strong, but I felt, there is little going on.

I had a perception as if a balloon got stucked internally between my hips. Again, I didn’t have a sense of time, but was more lucid than during dilatation and was aware of pushing for several hours. But, I would never say I had been pushing for 4 hours! Later on, I started to feel a pressure on coccyx. On advice of midwives, I changed my position from kneeling to semi-kneeling with one knee bend and was alternating knees. Changing the position was very hard and, at first, I refused to do it due to feeling of an extreme pressure on my pelvis. Strangely this feeling was not associated with pain, but perhaps there was some mental blockage in my head refusing to move. Between contractions I was praying to God a lot, calling God and Jesus, perhaps even quite shouting. I was experiencing enormous pressure, which wasn’t acutely painful, more numbing, but extremely alerting my brain something wrong is happening to my body. At the height of contractions I was biting a cloth and was bearing down, mostly with my eyes closed, as much as I could down. I usually managed 3-4 pushes per contraction accompanied with deep guttural sounds. I actually didn’t feel uncomfortable at all even after 4 hours of pushing; I got cramp only once in my left calf. John was helping me so much and I was aware he was in tears, because he couldn’t help me directly. I felt very touched by that. Again, in this phase, some positive and negative mental reminders were of help, for example, knowledge of the labour process to be finite at some point. Further, I was hugely motivated by being aware of surgical delivery as the only alternative to my spontaneous efforts. Additionally, I had perception that if I start to give up or be panicky, I reduce blood flow to my baby.

Finally, I managed to push baby up to where it felt like soft parts of vagina and then it took perhaps only 30 min to the baby’s birth. I was facing clock during this phase and thus having recollection of time. This part felt very easy. Crowning was causing strange sensations, but on advice of midwives and using my instinct as well, I combined pushing and quick relaxed painting. When it happened (crowning), my body took over and knew instinctively what to do. When her head came through, I felt so relieved. I expected the rest of the body to slide through easily, but it was not so easy and now it was really challenging to find strength and motivation to push shoulders. I believe, even the rest of the body required an extra push. I’m not sure what happened around delivery of shoulders, but I sensed some alert in the room.

I felt so relieved that our baby is well and here with us and was totally exhausted, elated and tearful. I also immediately „forgot all difficulties" and remember saying, I’d do it again without hesitation, but perhaps not tomorrow.

I had time to bond with the baby in the pool, then we cut the cord and there was time for the third stage. As placenta wasn’t appearing, there was a need for an intervention. I was told it was high-lying and I got catheterized to empty my bladder. It didn’t help, so an oxytocin derivate was administered to get it out with a gentle manual guidance. Pushing it out was quite uncomfortable, but knowing this is likely the last bit of discomfort helped. And this was it. I had lots of time to test breastfeeding and to get gently introduced to our daughter. John had time to bond as well. At times, I can’t believe, I’ve done it.

I feel grateful and indebted to John and Marijn and Viv. Without them, this miracle of birth wouldn’t be possible.

My take-away messages

- Expect unexpected.....Sometimes complicated plans will never get used and improvisation will take place instead.....

- Supportive environment is crucial. Patient and positive support focused on relaxation and breathing is incredibly valuable.

- Focus and determination are indispensable.

- Knowledge of what is available, e.g. medical care, and when is helpful.

- Selection of health-care providers and a partner (who won’t run away, collapse, or start to lecture) is essential.

- An option of water birth is excellent.

- Home environment is very important if you need to relax from conventional behaviour.

In summary, two things are essential: (1) partner’s support, (2) health-care provider support.