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Happy Birthday Little One (week 38)

Bang on 38 weeks we are much closer to being sorted. Daddy and I had finally purchased a new camera and I was just about on top of the laundry. I was looking forward to a couple of weeks of relaxation. After all, first babies are always late. Right?
 
The following night at about 2 in the morning I started getting some stomach pains and some discharge. No gushing or anything like that, so I wasn’t too sure (but in retrospect I now think this was when my waters went). I went back to sleep. By sleep I actually meant I just shut my eyes and chilled out as best I could whilst switching between in the various positions the yoga teacher had shown me. Unusually Daddy managed to sleep through my excessive wriggling.
 
Early morning I decided to wake Daddy up:-

- You awake?
- Hmmph?
- Are you happy with the camera we bought? Are we keeping it?
- Yes. Why?
- We should charge the battery. I think it is Little One’s birthday.

 … and back to (ish) sleep I went smiling whilst leaving Daddy in a gentle panic. We got up again at about 9ish and called ahead to the hospital to say that we expected to be in later that day and check where to go etc. We also double checked when we were supposed to go in (Our NCT teacher said to count 3 contractions in 10 minutes and wait an hour and count contractions for 10 minutes and if it is still 3 (or more) it is time to go in.)

We were told this was correct and I was advised to take a bath and when it was time to attend to go to the Assessment Centre.
 
I had a bath whilst Daddy sorted out the hospital bag. My stuff was more or less sorted but Little Ones had just been washed and everything was still a bit disorganised.
 
Anyway, the time came and off we went. (Will someone please tell me who thought it was a good idea to put speed bumps all around a women's hospital?) We arrived at the assessment centre and were installed into a bay.

I went to the loo and had bloody discharge and panicked a little (and was told that was OK). There was a lot of waiting around and it seemed like we were in that tiny cubicle forever. It was really hard to get comfy.

I was asked if I wanted to go home and come back again. We said we didn't so we were sent off for a wander. We went to the cafe and I Daddy got me some lunch on the basis that it could be a long day. I think I managed a few spoonfuls between the contractions.

To be honest I was starting to get a bit stressed out and the time between contractions had increased. If this wasn’t labour then what on earth was it!
 
We went back to the assessment unit where a CTG trace was done. It was confirmed that I was in labour and I was sent to the midwife led unit.
 
Things took a real turn here (for the better). I was assigned a midwife to look after me on a one to one basis. She was also supervising a student midwife. The student seemed fairly competent so I felt like I got two for the price of one, which was nice.
 
The first thing she did was examine me and I think she said that I was 4 cm and that this was good. I was also introduced to gas and air (supplied from behind a picture on the wall). It was a revelation. Absolutely fantastic stuff! Daddy put the radio onto Classic fm for some background noise and we were all set.
 
The pool wasn’t available as someone else was in there but the midwife advised me to try the shower for pain relief. I thought this sounded a little crazy and was a little reluctant but it was actually brilliant. (In retrospect I think the pain relieving qualities of the shower were actually superior to the pool for me). I was even given portable gas and air to use in the wetroom. Bliss!

The midwife was really good humoured. She got soaked whilst doing my observations and was totally chilled and matter of fact about the whole thing as if it was just one of those things that happens every day (maybe it is, who knows?). In fact, throughout my time on the midwife led unit the midwives were absolutely awesome. On the one hand they made me feel like an individual but at the same time they were very confident in their advice and comments like they had seen it all before and everything was good. I was able to revert back to my original plan which was for others to take charge and for me to zone out.
 
The stress of the assessment unit was forgotten and the contractions were back in full swing and things were moving forwards.

Timings are a bit fuzzy but it wasn't long before the pool became available and we went there. The pool was nice but I think the shower was just more "me" I much prefer showers at home so why I thought I'd feel any different in labour I don’t know. Daddy later told me that although I seemed relaxed when I was in the pool the contractions slowed back down.
 
I remember that whilst I was in the pool things started to feel less comfortable "downstairs". I was still able to cope and I remember thinking that it was going to get worse towards the end (and I thought I still had a while to go) so I was reluctant to have all the available pain relief yet as I wanted to save "the good stuff" for when it really mattered. I was sucking on the gas and air as if it was going out of fashion and remember turning to Daddy and saying "I think I am going to need an epidural AND a c-section!"
 
When I was learning about labour we were told that it was normal to have a little freak out at some point. We were told that after your labour is sufficiently progressed you then need an adrenaline kick to get the baby out and that you might scare yourself to help with this. I think that was probably what was happening and It seems Daddy had also been paying attention in the ante-natal classes as he seemed fairly chilled and did not summon an anaesthetist.

Despite that little outburst I didn't actually need a c-section or an epidural in the end!

After a bit in the water I was reassessed and found to be 10 cm. Little One wasn't coming out of her own accord though in the water despite trying a few different positions so I got out of the pool and tried out the bed.

Progress felt slow and I was told to push on contractions.

Every so often the monitor was put on my belly and I could hear Little One's heart beating away. It was like she was urging me on and we were working as a team. I really wanted to help her to get out so we could meet.
 
It felt like although I was having really regular contractions they were fairly brief so I found it difficult to sustain enough push with each one to make any real progress. It felt like it was two steps forward and three steps back and we were getting no closer to Little One’s arrival.
 
I was gripping hard onto a funny shaped pillow thing and also onto something on the wall which I think I managed to pull off. Oops (the midwife, calm as ever, reacted as if everyone damages the building and that this was all fine). No doubt if the estates manager reads this blog then I’ll be sent a bill.

We were getting closer though (very slowly) and following the threat of an episiotomy the strain was released. I was told she was here. At first I thought this meant the head had delivered and there would be one more push but no, she came straight out.

My little princess.

The midwife lay her on my tummy and I was so scared I would drop her or hurt her. She was beautiful. She had dark hair and big brown eyes wide open and curious. I was so surprised at how awake she was looking around at her new world. She had the tinyest little hands and was just perfect. This was the little person we had been waiting to meet and she was so much more amazing that I ever could have imagined.

 My mind and body went to jelly. I was freaking out a little bit. I couldn't quite believe that they had let me hold this perfect little beauty. I was so scared I was going to drop her (which is silly as she was just lying on me!)

Everything I knew went out of the window. I remember the midwife asking if I wanted the drug for speeding up the delivery of the placenta and thinking "what is a placenta". Daddy cut the cord and the placenta delivered on its own.

After a little cuddle we went back to our previous room and Little One was weighed (a dainty but perfect 5 lb 15 oz) whilst I took a shower. I came out to see Daddy indulging in some skin to skin with my Little Princess. He looked so in love. Neither of us could stop looking at her.

Happy birthday Little One. Welcome to your new world.

Clinical Comment

 Simon Mehigan Consultant Midwife

At last, after all those months of waiting the big day has arrived!

Congratulations.

Not many women have their babies at 38 weeks or before, in fact most have them between 39 and 41 weeks. Your daughter obviously couldn’t wait!

The early stages of labour can be the most challenging time especially for first time parents. You’re not quite sure if this it, or a false alarm. It’s great that you tried to stay relaxed, and get sleep all be it short lived. First labours can be long (between 12 and 18 hours is the norm) and tiring. Making sure you eat and drink regularly is also important as it helps keep your energy levels.

It’s good to hear that your NCT teacher gave you the same advice as we would around when to attend the hospital: contractions every 3 minutes lasting between 45 seconds and a minute that have been coming this often for at least an hour. If you come to hospital too soon we will encourage you to go home as all the evidence suggests that hospital is not the best place for women in the early stages of labour. Having said that everyone copes with pain differently so we encourage all women to ring for advice and support when they are going into labour and if we feel it is appropriate we will invite you to the hospital even if the contractions are not coming as often as every 3 minutes.

A bloody discharge is not unusual when you’re in labour, fresh blood however can be a sign of a problem so do let us know if you notice any.

The Maternity Assessment Unit can get busy at times (we are currently altering how we staff this area to increase the number of midwives during our busiest times), it can also be a worrying environment for some women which is why, if it’s appropriate and as in your case we will send women and their partners off for a walk around the hospital, especially if they don’t feel comfortable going home.
I’m so pleased that you were suitable to go to our Midwifery Led Unit; although my remit is across the whole of the maternity unit my heart really does sit within midwifery led care (must be all those years working on the community looking after women having their babies at home!) Over the last few years we have seen the number of women utilizing this is increasing year on year with just under 2500 babies being born there last year.  Did you know it is the biggest midwifery led unit in Western Europe?

The team of midwives is so passionate about giving women a positive birth experience; they have climbed mountains, baked cakes and done a whole load of mad things to raise money to help improve the environment on the midwifery led unit.

We are a teaching hospital so at any one time we may have student nurses, midwives and doctors. We would never expect a woman to have more than one student involved in their care. Allowing them to observe possibly provide some care helps them but as you said can also feel like you’re getting two for the price of one. Our students are always closely supervised and you will always have a midwife looking after you.

We class established labour as being when a woman’s cervix is 4 or more centimeters’ dilated and she is having regular contractions. You may have met women who were in “slow labour” for 2 or 3 days, what that means is it took them a number of hours to reach the magic 4 or in technical terms they had a long latent phase which is the stage before established labour.

Gas and air and water sounds like the perfect combination for a peaceful birth (or a university pool party as I understand from my son that you can buy miniature cylinders of gas and air on the internet!). Bath, birthing pool or shower any of these will help you in labour. We don’t have any baths at the women’s so we encourage women to use their own at home in the early stages. Once you get to hospital you can use our showers or one of our 2 pools. We have one on the midwifery led unit and have recently opened one on the labour ward, which means we are able to offer waterbirths to women who previously were unable to have this as a choice. If you’re unclear whether you would be suitable to use the pool talk to your midwife.

The adrenaline rush you described is an essential part of labour and usually occurs as you approach the pushing stage. We call this time “transition” it can be very frightening for women and their partners as previously calm women can be become agitated, restless, frightened asking, like you, for an epidural or C-section. Midwives know this is a normal part of labour and so will support you and your birth partners through it, offering reassurance.

Then comes the “2nd stage” of labour or the pushing bit. This can be long and tiring especially in your first labour, midwives will encourage you to find the best position to help ease your baby out, whilst at the same time will start to monitor your babies heartbeat a bit more often as this can be a challenging time for your baby as well as for you.  There will, I’m sure, been lots of positive encouragement to get you through this stage and then………all of sudden………it’s over………and your baby has arrived, or in your case your princess.

Congratulations

Do you have a question for Anna or Simon? If so please email us at Feedback@lwh.nhs.uk or alternively use the feedback tool at the bottom of this page.

by Anna

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