Sarah and Richard had their fourth child at home, after three hospital births.

It’s hard to know quite where to begin. Within hours of Sophie’s birth, I had no doubt that it was the best money we’d ever spent. I never thought that giving birth could feel “ok” let alone perhaps dare I say it more than ok. I didn’t feel after the birth the need to go through it all again in my head – I just felt at peace about it and ready to begin concentrating on the enormous demands of looking after my new baby. Sophie Anne was born at home and immediately after the birth it struck me how calm and quiet, private and unhurried the atmosphere was compared to my previous three hospital births. I now believe that unless there are complications that hospital seems a really weird place to go to give birth.

We booked with Kay very early on in pregnancy mainly because as far as possible we wanted to be guaranteed continuity of carer and to avoid a repeat of some of the trauma I had experienced previously at hospital particularly with regard to the birth of my third child.

It almost seemed too much at the beginning to keep seeing the same midwife in our own home at a time convenient to us. Kay always allowed plenty of time for each antenatal visit – she’d often just chat a bit at the beginning and I used to wonder why – until as the weeks went by it dawned on me that by chatting she was taking the time to get to know me which I think was extremely helpful by the time it came to giving birth and also for the care that followed after the birth.

I won’t go into detail about the birth of my third child except to say that I came through the experience feeling as though I had been violated. That is the only way I can express it. I don’t doubt that all the health professionals I encountered – and there were many – were acting according to “best practice” and therefore appeared as though they had my and my baby’s interests at heart – but it didn’t feel like that. In short so much was done to me, and I believe at times without my full consent, and never at any stage do I remember being consulted about my preferences or my feelings as a person having been taken into account.

How different it was with Kay! By the time it came to labour we had already discussed my preferences at length throughout the previous months. She knew for example that I abhorred vaginal examinations above all and she seemed quite happy about the prospect of not doing any. Throughout the pregnancy she consulted me properly about any decisions, and where necessary sought documentary evidence to help me make an informed decision as possible.

Interestingly I didn’t have a single needle stuck in me the whole pregnancy. For example she told me what all the routine blood tests in pregnancy were for, and armed with that information I decided not to have any. It seems very simple but having such information, which I had never been given before, was very empowering. How different from the community midwife with my previous pregnancy who would simply say to me on an antenatal visit “I need to take your blood this week.”

Kay exceeded my expectations in the way she respected my dignity and my personal concerns. I gave birth to Sophie and I think we managed this without Kay even touching me once except to listen to baby’s heartbeat and to support me during contractions when necessary. Even then she allowed my husband to do the main job of supporting me, as when she arrived I was in strong labour and was already relying on Richard to hold me through the pain. She didn’t come in and take over just because she was the midwife.

I really appreciated this, because in spite of the rapport, which we had built up with her, I am ultimately more comfortable with his arms around me as opposed to anyone else’s. I wonder also however whether she held back a little because I had also mentioned how in the previous labour I had felt very lonely in the hospital and had felt that my husband was effectively a spare part having been pushed aside by some very determined midwives.

Sophie arrived just 3 days after my due date. Towards the end of pregnancy as usual I had been having a lot of very strong Braxton Hicks contractions, and wondered on several occasions whether the contractions I was feeling were a prelude to the “real thing.” The day of Sophie’s birth was no different. On the Wednesday I had been having the contractions on and off all day, but by about 8pm they seemed to increase in intensity. Still not sure whether this really was labour, but because I was feeling very frightened we phoned Kay that evening. She came across about 10pm. Even at that stage I realised that she was going to respect my dignity, given that as I was in my nightie, before palpating my tummy she asked whether I had my knickers on. I really appreciated that.

These contractions went on for a few hours, and were very uncomfortable and kept making me feel as though I was going to throw up. However they gradually quietened down, and at about 3 am Kay went back home. I felt that I was in early labour, and so was happy for her to go back home. Only about an hour later however after Kay had gone, the contractions started up again, but this time I felt them more as definite pain coming from my lower back. I took some panadol, and went back off to sleep for a couple of hours, but I was aware even in sleep of the pain coming and going.

Throughout the next day I still kept getting contractions – sometimes they came regularly and sometimes they were more spaced apart. Although they were painful, I felt able to cope with them. I can remember not having any contractions around lunchtime, which enabled me to have a good lunch. I think Richard ‘phoned Kay about the contractions in the morning to keep her posted, about the fact that I was still having them. Richard had started filling up the pool the previous night and periodically he would add more water to it so that it would be full enough for when I wanted to get in it.

I was sitting on the birth ball mostly when the contractions started to get stronger and leaning forward holding on to Richard to get through them. Then I got bored with the idea of waiting around for each contraction so I suggested to Richard that we play a game of backgammon. That was really good as it took my mind off things, although by the same token the game kept getting interrupted for a contraction, which made me wonder at the back of my mind whether this really was labour.

We rang Kay at about 2pm I think to say that I was still getting contractions and they were more frequent by this stage. I still wasn’t sure I wanted her over just yet, because I didn’t want to give her another false alarm. At the same time I was very worried that I might be further on than Richard and Kay might have thought, but felt unable to communicate this to them. Kay told me then to give it another 30 minutes and to see how I felt after that 30 minutes. It felt like a very long 30 minutes as I knew deep inside that they were very strong and painful and I kept debating whether I should ring her back before the 30 minutes were up to say “please get over here now.”

However I kept going for the 30 minutes, and then Richard rang Kay and said something like “I think Sarah would like you here now.” Kay told us that she would be here within the hour. During that next hour, we abandoned the second game of Backgammon – Richard was winning, but the fact that I gave up on the game indicated to him that it was quite likely that this was the real thing. I found the contractions very hard – the fact that I was waiting for Kay to arrive however did in a funny sort of way give me something else to think about, but it seemed like a very long hour without her.

As soon as she arrived I felt very relieved, and as she came in the house, the pain seemed to step up a pace! I can remember crying a bit and saying to Kay that I wasn’t coping because I was yelling quite a bit with the pain. Kay then quietly told me that some women make a lot of noise, and it is their way of coping – so I felt a bit better about it then.

I said that the pain was coming through my lower back. Kay said that she knew a very good back massage, which she could teach Richard. I think she just started to try and demonstrate it when a split second later I yelled at her to get off. I couldn’t stand anyone touching me where the pain was it seemed.

Richard had suggested getting into the pool before Kay arrive, but I didn’t want to because I was frightened of getting in too soon even though it looked quite inviting. Shortly after Kay arrived I think she suggested the pool, and I said something like “I’ve been waiting for your permission to get in!”. So I climbed into the pool and was able to sit down in it with my legs outstretched. I must confess I felt quite happy in there, it was comfortable and I just felt happy and relaxed inside.

However the contractions still kept coming, and I found by this stage that the best way of coping with them was to hang on to the side of the pool with my arms behind me in a sort of semi squat and just to yell through them. I think it wasn’t long before Kay or Richard were also helping to support me from behind with each contraction. I was aware of someone behind me and my hands in theirs. I say Kay or Richard, because sometimes I thought it was Kay supporting me, but then I would suddenly see her at the other side of the pool so it must have been Richard. Kay did suggest trying to kneel on all fours as some women find that helpful. I tried but didn’t like it – it always makes me feel very vulnerable for some reason.

I remember asking Kay how much worse the pain was going to get. She replied with something like, “well it’s pretty intense now, so it’s probably unlikely to get any more intense.” She asked if I would like to try some gas and air, and I thought that I would give it a go. She went out to the car to get it. I felt a bit worried about her leaving me, but she seemed to trust that Richard could cope with me. I can remember feeling a tremendous pressure at one stage, and then hearing Kay saying that my waters had gone, and that they were clear and that was good.

She listened in to the baby’s heartbeat at that stage, and it was still fine. I then felt the head moving down, but didn’t want to communicate this to Kay or Richard just in case it wasn’t the baby’s head. I’m not sure if this happened before or after she brought the gas and air in. I can remember seeing her struggling in with this big cylinder, and then she started to show me how to use it. I couldn’t take in what she was saying with the strength of the contractions, but I recall her very calmly laying it down on the floor because I think at that stage her saying that she thought she could see the baby’s head.

When the head came out, it felt surprisingly OK compared to my last labour. It definitely felt smaller (my last baby was ten pounds in weight), and didn’t feel too uncomfortable hanging out of me! Kay confirmed to me that the head was indeed out, when she said to me something like “the head’s out now Sarah, with the next contraction the shoulders will be born.” That was a really good thing for her to say, because I didn’t feel worried then, and I actually allowed myself to push with the next contraction and sure enough, at 5.22pm out she came. What a contrast again from the second stage in my previous labour when I recall the head hanging out, and the midwife then saying to me “Stop screaming, shut your mouth and push!!”

I was so relieved to hear Sophie crying straight away. When my last baby was born, I though he was born dead because there was no noise, no one said anything and they took him away to be resuscitated. Again therefore in contrast to my previous labour, Kay immediately passed her to me to hold. She felt very small and slippery – I think I was slightly in shock as it had gone very quickly at the end.

Richard said that Kay kept having to tell me to lift the baby’s head clear from the water – I was finding it hard to hold her – she was crying and I was beginning to have after pains. Kay cut the cord because it had stopped pulsating and passed her to Richard to hold. She kept crying. I knew I needed to hold and feed her, but didn’t feel able to do anything much at that stage. I stayed in the pool a little while, but felt a bit chilly then so decided to get out. There seemed to be very little blood loss with the birth – there was certainly no bleeding immediately after she came out, which made Kay suggest that it was possible that I hadn’t even torn.

We had decided to have a physiological 3rd stage if all went well – in spite of the fact that I haemorrhaged last time. As there seemed to be no blood loss, Kay stuck with our decision of not having the syntometrine. We therefore had to wait for the placenta. I had never experienced this having had managed 3rd stages for all the other births. I got out and sat on the edge of the settee. Then I knelt for a while against the settee - this felt quite comfortable. The after pains were a little distressing however, but Kay remained very calm and quiet.

The whole atmosphere was very peaceful, just the three of us in our own home with Sophie crying – but I felt that that was a nice noise as it showed she was very much alive. I think I tried feeding her for a while, and I think she was very hungry, but that seemed to make the after pains worse so I gave her back to Richard. I got a little concerned at one stage about the length of time it seemed to take for the placenta to come out, but Kay was still very calm and didn’t appear at all worried. In retrospect, it was good to wait for the placenta as really nothing could be done to Sophie or me until it was out, and it gave us a really calm interlude after the birth, where significantly Kay’s attention was still focussed on me and not on sorting out the baby and rushing me onto a postnatal ward for example. Kay suggested trying to sit on the loo to get the placenta out. I got up and walked to the loo and a few minutes later out it came! It had taken just over an hour.

At every stage in labour, and also with my baby afterwards Kay never did anything without asking my permission. Even with regard to dressing Sophie after the birth. Kay asked if I would like her to do that. I was more than happy for her to do that, as I didn’t feel able to myself.

Again, I think respecting my privacy, Kay reiterated that she didn’t think I had torn and I agreed with her. My perineum didn’t hurt at all, and so both she and I felt there was no need for her to inspect it, although I am sure she would have done had I wanted this. I subsequently checked myself the following morning, and it certainly looked pretty intact to me!

Kay then helped me up to bed where I lay feeding Sophie. She even got me a hot water bottle to help with the after pains, and sat quietly writing up her notes whilst Richard went off to our friend’s to collect our children. He went to get them about 7.30pm so they were back quite quickly after the birth.

She then visited us frequently in the days following the birth for the next 4 weeks. Virginia visited us once when Kay couldn’t make it and it was really nice to see her to and listen to another perspective on things. We had already met Virginia antenatally as she did one of the antenatal visits so that we could meet her, in case she was also needed in labour and I really appreciated this for when she visited after the birth. Kay’s postnatal visits were most useful in providing me someone to chat to, when lacking in sleep and feeling overwhelmed by the demands of the new baby.

Interestingly this was the first time that I had a baby and didn’t end up with cracked nipples after the birth. I think this was due to the fact that prior to the birth Kay took the time to discuss breastfeeding with me and showed me a video on it to “refresh” my memory. At the time I thought she was being a wee bit pedantic, but actually having come through the other side with less breastfeeding trauma than with the previous three children, I think her input this time was crucial. I always believed that cracked nipples were all just part of breastfeeding, but this time thanks to the video and Kay’s advice I paid more attention to positioning and had no cracked nipples whatsoever!

I look back now four weeks on, and can truly say that the birth was a joyous, peaceful occasion. Also it was probably the best pregnancy I ever had because of the continuity of carer, and the fact that for any little worries, Kay was just a ‘phone call away. I didn’t ever have to wait for surgery opening hours to be able to speak to her. Finally I think having access to Kay for up to four weeks after the birth, has helped to minimise the stress of these early days, and now I feel ready to move on.

As said at the beginning therefore, we certainly believe that although it seemed a lot of money at the start of pregnancy, it was worth every penny!