Alison’s story
published in Practising Midwife in February 2001

Having waited for it for two weeks when the telephone rang at 03:30 I knew exactly who it was. Alison told me that her contractions were coming every 5 minutes. “Never trust a multip” I heard ringing in my ears and so with a quick brush of the teeth and a call to my partner Kay, who was to act as second midwife, I was on my way. On the drive to Alison’s house I offered up a silent prayer “please let me be worthy of the trust this family has placed in me”.

Alison had booked me when she was sixteen weeks pregnant. When I visited her she was contemplating an elective caesarean section as her first birth when her son James was born, six years previously had been very traumatic. She had felt totally out of control, was not able to facilitate any of her choices regarding place to labour, pain control or position for birth and had sustained a third degree tear from an extended episiotomy. She had suffered slight incontinence, post natal depression and a fierce unnatural possessiveness over James that contributed to the almost breakdown of her marriage.

Alison obtained copies of her notes concerning James’ birth from the hospital and throughout the pregnancy we discussed in great detail all the issues surrounding the events of James’ birth. Together we tackled each topic and read the research evidence pertaining to the events and actions that may have contributed to the previous poor birth experience. This provided the foundations of planning for this birth and as Alison became more aware and educated in the normal birth process the more confident she became. I witnessed a turn around and Alison, before my own eyes, gradually changed from a worried nervous shadow into a blooming, excited, empowered woman! She decided that a home birth was what she wanted and I began to get as excited as she was.

When I arrived at her house on D day (or should we say B day?) Alison appeared to be contracting strong and regular. Andrew her husband set about making tea and toast and when Kay arrived I sent her to the next room to go to sleep and said I would call her when things heated up "hopefully when the sun comes up” I commented to Alison that I think there is nothing more beautiful than the day breaking with the sound of a newborn’s cry. Little did I know it was to be almost sunset before that happened! We had discussed vaginal examinations and Alison wanted to avoid them if necessary. I saw no reason not to respect her wishes. Baby was in a perfect position for birth everything was normal and so we awaited events...and waited.

Alison took a bath, walked about, took her homeopathic remedies and tried her best to avoid Andrew who was trying to force feed her a banana to keep up her strength! The sun rose and so did Kay but baby William did not put in an appearance. However he was healthy boy with a strong variable heart rate and so we waited some more. At 9am Alison decided that she now wanted a vaginal examination, which found her to be 8 cms dilated with bulging membranes and the baby’s head at mid cavity. I could not define the position due to the bulging membranes but on palpation baby was direct OA, deeply engaged and so an excellent finding. We now knew it would not be much longer...or so we thought.

The walking and force-feeding continued. Andrew felt that his role was principle nutritionalist for everyone except himself. The homeopathic remedies continued, which took care of a short period when the contractions slowed down. This was the first time that I had worked with homeopathy and I was impressed. Alison became very tearful at one point and yet instantly returned to her former state of absolute control following taking a remedy. By mid-day I was beginning to wonder if we would ever see this baby and this time it was I that suggested an examination. Alison was now 9cm dilated with the baby still the same distance away. The words “never trust a multip” were beginning to take on a new dimension!

Kay and I had several discussions and both were in agreement that although taking it’s time everything was ok and we were confident that we would see the baby this side of Christmas! At 3pm with an almighty ear shattering scream Alison ruptured her membranes and lots of lovely clear liquor gushed out over the floor completely missing the well prepared area and leaving an almighty patch on which Andrew could practice his floor scrubbing later on. Alison began to make familiar grunting noises a few minutes later.

As in the vast majority of cases of a woman having had a previous normal delivery we expected to see the baby’s head very soon after the membranes ruptured and Alison began to grunt. However Alison had not followed any “averages” so far so I suppose we were wrong to expect her to start now. Alison was in second stage for three hours. In the beginning the pushing was half hearted with long “rest and be thankful” episodes so we tried to encourage her to breathe through the contractions and take advantage of the breaks. This was the part of her labour that Alison had feared experiencing again for all the years since her last birth. Kay and I felt that psychologically she was not letting go due to her fear of tearing. This has recently been reinforced, in our reflection of Alison’s labour, during a conference we recently attended. (Childbirth at a Turning Point 11 November 2000 Plymouth University). Obstetrician and scientist Michel Odent explained the inhibiting effects of fear on the production of oxytocin. Alison was now using the intellectual part of her brain in dealing with her fear rather than letting the primitive part take control, which promotes the release of oxytocin. This was inhibiting the natural progress of her labour. All she needed now was love and reassurance to encourage confidence in her body.

Gradually her pushing became more effective as she tried every position known to nature to find one that she felt confident in. We felt that William was also playing his part and was determined to take all the time he needed. Throughout all this time William had remained in perfect condition with a strong variable heart rate and Alison never once got despondent. At 6:10pm William finally was born pink and lusty in perfect condition. His arm and elbow were up around his neck so may have contributed to his slow arrival. Alison did not sustain any perineal damage and to her that was like reaching the peak of Mount Everest. Alison’s birth experience confirmed to Kay and I what we already knew, that every woman is unique, that maybe then there is no such thing as a “normal” birth and the word “natural” should take its place. Furthermore there is no place for clocks on the day of a birth.

Alison had intended birthing her placenta physiologically and so completing the whole natural birth process but changed her mind and asked for Sytometrine. Her reasons were that she couldn’t be bothered to wait! Kay and I for some reason not too hard to work out could understand that!

Alison and Andrew both feel that William’s birth has gone a long way to healing the emotional trauma and strain that their love and marriage only just endured after the awful time surrounding James’ birth. Further more Alison is convinced that had she had William in Hospital she would have had interventions to speed up the process in the first stage and maybe even an assisted delivery in the second given the unusual amount of time it took.

How sad to think she may be right.