Sarah’s inspiring home birth story

I can't believe that it's been over a week since our birth unfolded and I'm so excited to share our story! Before I start though, I know a lot of you know me as a midwife and whilst I'm proud of what I do, I would like to emphasise that I'm sharing our experience NOT as an NHS midwife, but a MOTHER. I would also like to highlight that the clinical care I received from both NHS and independent sources was exemplary and I cannot fault the midwives, sonographers, consultants and support staff who I've seen - you are all a credit to your respective professions.

I'd always wanted to have a homebirth and planned for it with each of my previous pregnancies but for one reason or another I birthed both of my sons in hospital. This time around, I promised myself that I wouldn't give up, and, all being well, I'd get my homebirth this time. With the provisions for homebirth in the region being what they were at the time, I was told that the NHS might be able to provide my intrapartum care but that there was no guarantee (being cared for by a small team or an individual this is always a risk due to sickness and other birthing clients). I'd known of a few instances where NHS care had fallen through before and so began enquiries with the powers that be, just in case. Sure enough, at 36 weeks I received the email that confirmed that the NHS services in my area would be unable to provide homebirth care. Devastated doesn't even begin to cover it. I'll admit that I fell into a pit of despair for a while and attempted to reach out for support. Eventually I pulled myself together enough to contact the ICB and after some to-ing and fro-ing between the ICB and the NHS, I was transferred over to the care of my angels Debbie and Jess at 38 weeks ❤️

THE BUILD UP

Having gone past my due date twice before, and after a stressful period of uncertainty surrounding my care, it didn't surprise me when my due date came and went. I opted for membrane sweeps after 40 weeks, 50% because I am nosy by nature, 50% to see if I could encourage labour whilst my mum was staying with us. 2 days of prodromal labour later, at 40+4 my mum sadly had to journey home. I was disappointed that she wouldn't be present for the birth of my final baby but Debbie and Jess reassured me that baby would come when he knew that the time was right. I dropped my mum off at the station at lunch time, still having on and off contractions, so to cheer me up my husband Ed took me and the boys for a lovely walk along the riverside at Rothbury. We hopped across the stepping stones and paddled barefoot in the shallows under the bridge which was blissful in the muggy heat. We headed home for a relaxed evening and by the time the boys were in bed the contractions were becoming more regular. At about 8pm I scoffed some pizza and then hopped in the bath, letting Jess and Debbie know that things MAY be picking up. Being the 3rd night in a row that this had happened I wasn't wholly convinced but knew that it would be just typical of me and my babies to birth within 24 hours of my mum leaving! The bath didn't particularly help as I'm a bit of a fidgeter during contractions so I dried off and tried the birth ball instead. By 10pm things were ramping up rather than slowing down as they had previously and I was starting to get some pelvic discomfort. I remembered the feeling from the end of my labour with Bertie so gave Debbie a ring and thanks to her tingling midwife senses she was ready and raring to go!

LABOUR LAND

Whilst Debbie was flying up the A1, Ed and I prepped the living room ready for baby's arrival. Shower curtain down, essential oils out and fairy lights on: the birthing room of my dreams. Debbie arrived around 11pm and Jess joined us not long after. We discussed the possibility of a VE (again, mainly because I'm nosy!) but we all knew I was in active labour regardless of the findings. Our lovely cat Hades decided to join us and stayed close through the contractions. I never thought I would have a feline as a member of my birth team but he was keen to be involved and I highly recommend having a furry creature with you! He had always been the first to know when I was pregnant, labouring or miscarrying so it felt fitting that he was present. Around midnight (I think?!) I decided that I wanted to know what was happening internally. Debbie found that I was 6cm with a bulging bag of membranes. Baby's head wasn't super low so we knew we likely had a little bit of time before he made his entrance and so we focused on finding a comfortable position. Jess and Debbie helped me out with some counter pressure and hip squeezes which was better than any drug! We gave the rebozo a go but I was exhausted so Debbie suggested that I tried to rest and created a nest for me on the sofa with the entonox. I drifted in and out for a little while and talked a bit of nonsense. 

2ND STAGING IT

By around 3am the pelvic pain was becoming unbearable. The contractions themselves were manageable but my symphysis pubis felt as if it was being pushed out of joint. The only position that came close to being comfortable was on all fours, leaning across the foot rest. I knew I was entering transition stage at this point because I stopped being able to communicate properly. For me and my autism, this is fairly normal and Debbie and Jess were amazing at figuring out what on earth was going in my head. Transition, for me, felt like the separation of body and soul. I remember being told by a mentor during my first year of training that physiological birth is more than a physical experience; it is a spiritual journey. It takes us outside of our own bodies. And it really does feel like that. I was aware of the physical feelings but there was also another level of awareness. I knew that my baby was ready to come but in true transitional fashion, I wobbled. I didn't WANT to push, I didn't WANT labour to be over. Baby was ready, but I wasn't. I was frustrated that, though I could feel my body pushing, I couldn't feel any internal movement. Debbie encouraged me to follow my urges and reassured me that she could see external signs that baby was on his way. Again, the contractions themselves were not difficult but the pelvic pain was getting worse. At the peak of contractions I honestly thought my bones would break, though I knew deep down that they wouldn't. After about 30 minutes of pushing I asked for another VE. Debbie found me to be fully dilated with the bulging membranes still present. I asked for my waters to be broken to see if this was what was holding him back and for a short time the pelvic pain was a little bit less. Another 20 minutes passed, the pelvic pain increased again and I couldn't get comfortable at all. 

A DRAMATIC BIRTH

I told Debbie I was ready to transfer in to hospital: something felt off. All of a sudden, baby's heart rate, which had been steady throughout labour, dropped to the 90s and Jess made the call to the ambulance service around 4am. Debbie got me down onto my left-hand side and tried to help me breathe through contractions to give both me and my baby a break, but the pelvic pain had now been replaced by rectal pressure. Within 5-10 minutes, the rapid response paramedic had arrived. I felt heartbroken that I had come so far only to end up transferring in. "I've failed again", I said to Debbie. She looked back at me and very sternly said "No, you haven't". I get the feeling that she knew baby was minutes away from arriving and sure enough, at few contractions later as the ambulance paramedics arrived, I instinctively reached down and felt the folds on the top of my baby's head crowning. "Can you feel him? You've got this", Debbie said, and seconds later the rest of his head was born. With the next contraction at 04.23, my beautiful boy was born into Debbie's hands and placed straight on my chest. He had straight, dark hair! Both of my older boys had curly, fair hair, but this one was dark-haired! I couldn't believe that I had done it. I was elated. I looked up at Debbie, who looked to Jess and said "Was he just born face to pubes?!" and Jess said "Yep!" Suddenly my labour made sense! A little star-gazer. 

A COUPLE OF 3RDS

We kept the cord connected to deliver the placenta as I couldn't decide what I wanted to do with it, and Debbie checked my perineum. Unfortunately because of baby's position and the speed of his birth I had a significant tear. Debbie advised that I head in to hospital for assessment. Although I was disappointed to not be snuggling up in bed with my little one, I trusted Debbie's judgement and knew how important perineal repair is for future health. Happily, the paramedics had stuck around and so we plodded slowly out to the ambulance and headed down to NSECH. I was assessed by the registrar who said I had a very small 3a tear but that theatres were busy. While we waited, Debbie checked baby over and I tied his cord tie. Having had a good long feed in the ambulance, little one happily settled with Debbie and I managed to get some much needed sleep. When the time came for me to go to theatre she stayed with baby until I was back and settled - talk about going above and beyond! All went smoothly and by the evening, I was back at home, tucked up on the sofa with my husband and our 3 beautiful boys, exactly how I had dreamed. 

THE EXPERIENCE

Having a homebirth was the best decision I ever made and I am so glad that I didn’t give up when things got tough. Although, in many ways, it wasn't the birth that I had pictured, I know that it all happened in exactly the way it was supposed to. This birth felt redemptive and taught me the true power of my body. If you had told me a few weeks ago that I was about to push out a direct OP baby in my own living room with no intervention, supported by 2 incredible women, I may well have rolled my eyes at you! It was a difficult labour but it wasn't abnormal. Since my son's birth, I've been asked a lot of questions about my experience. These are the 3 that feel most important to highlight:

1. Were there any signs that baby was back to back? Looking back, none of the typical clues were there: there was no back pain, his heart rate was easy to auscultate and my bump was exactly the same shape that it always had been. The only suggestion was the severe pelvic pain, but that was still not the normal presentation of malpositioning. Short of an ultrasound or wildly invasive VE, there was no way to confirm his position.

2. Do I wish that I had known that he was back to back? Absolutely not! I know how my mind works and if I'd know I probably would have started to doubt my own abilities. Don't get me wrong, I'm sure a lot of people would have used the knowledge to their advantage but I'm very happy that I had no idea.

3. Do I think that I would have avoided a 3rd degree tear if I was in hospital? Obviously there's no way to know for sure, but I honestly believe a deep tear would have been the best case scenario. More likely, I would have ended up with a rotational forceps or caesarean. Having undisturbed "extra time" in the 2nd stage meant that I was able to birth my baby without intervention or assistance: something that I may have struggled with in an obstetric setting.

I am eternally grateful for everyone who was involved in my care. My community midwife Vickie, who listened to my hopes for birth and did her best to get me the care that I needed. Jess, who supported me through an emotional, traumatic 3rd trimester and used all the tricks in the book to make my labour more comfortable. And Debbie, who stepped in when I had lost hope, both in my pregnancy and labour, and handed my power back to me. I am forever in your debt. You all gave me the strength to continue through a difficult few months and to achieve the healing birth I had hope for. What a joy it is to be held close by such inspiring women.