PATRICK’S STORY OF ANESU-GRACE’S BIRTH
Netsayi gave birth to our beautiful daughter, Anesu-Grace, a couple of weeks ago. I want to write down the story of her birth now for three reasons in particular. 1. For my own benefit - so I can be sure to remember the twists and turns we negotiated in the years to come. 2. As a testimony for Andy and Marijn: our brilliant, remarkable midwives, who ensured Netsayi had the kind of birth she wanted. 3. To reassure anybody currently facing challenges similar to ours – a 37 year-old first time mum, trying to give birth to a breech baby in the Orwellian dystopia that the NHS turns out to be … Are you sitting comfortably? Good. But before I begin I want to point out one thing: I am not, by nature, a hugely sceptical person and I was predisposed to trust the NHS and take the (numerous) doctors at their word. Fortunately, Netsayi is of a more critical bent.
THE HORROR STORIES
A few months ago, when Netsayi first told people that she was pregnant, it soon became apparent that all the mothers we knew had ‘war stories’ of their births and they were determined to share them. There were numerous tales of epic labours, emergency caesareans, agonising inductions, botched epidurals and so on. It wasn’t long, therefore, before Netsayi decided she’d heard enough. When did giving birth become quite such an intolerable and inevitable drama? After all, didn’t everyone come into the world this way? Or perhaps we missed the memo. Netsayi wanted to give birth naturally, without a lot of drugs and intervention. She was by no means zealous about this intention. Nonetheless, whenever she declared her plans to the mums we knew, she was typically greeted with the amused raised-eyebrow of the battle-hardened vet and some version of, ‘Natural birth? Minimum pain relief? Well, that’s what I wanted too. You’ll see …’ It was in reaction to such attitudes that Netsayi investigated hypnobirthing, after she was told about it by another friend; about the only one who had anything positive to say about childbirth. Netsayi began to read around the subject and realised that there was, in fact, a whole movement against the medicalisation of childbirth in public health care. Birth, the argument goes, has been turned into something scary and unnatural to pander to medical schedules and medical arrogance. Perhaps, therefore, many mothers had not been saved from worse by the wonderful doctors (as they thought), but had actually suffered the consequences of bad medical decisions. Put simply, perhaps many women had birth horror stories because they had been scared into them. When about 30 weeks pregnant, Netsayi read a hypnobirthing book and, thereafter, we took some hynpobirthing classes as a couple. More to the point, Netsayi was fastidious in her practise – listening to the hypnobirthing meditation and visualisation CD a couple of times a day. If the NHS seemed to suggest that childbirth was some kind of medical trauma that could only be negotiated with a crack team of doctors primed with the latest equipment, the hypnobirthing movement seemed to claim the complete opposite: that, with the right practise, childbirth could be a pain-free exercise in deep breathing. Could either of these opposed positions really be true?
Meanwhile, throughout her pregnancy, Netsayi became increasingly vexed by her care in the NHS. She just couldn’t get a straight answer to a straight question; not least because she never saw the same person twice. This had all sorts of implications, but one example will suffice. Netsayi was told that her iron level was low and that she should take a supplement. Then she was told that she should double the supplement. Then she was told that she shouldn’t be taking iron and her original level was fine anyway. Three different conversations, three contradictory pieces of advice, each of which impacted on her physical wellbeing. Bluntly, the iron led to constipation, the constipation to a urinary tract infection, the urinary tract infection to successive courses of antibiotics, the antibiotics to thrush, the thrush to bleeding and a run to the hospital … not great. At one of the antenatal classes we attended, one of the other women told Netsayi that, if you had a home birth, the NHS would provide you with the same midwife throughout your pre and post-natal care (even if you ultimately decided to have your baby in the hospital). So that’s what Netsayi decided to do: choose a homebirth, at least to ensure some consistency of care. Enter Netsayi’s Aunty Jo stage left. Aunty Jo is a former midwife and she came to visit us when Netsayi was about 32 weeks pregnant. She palpated Netsayi and told her that she reckoned the baby was in breech. To be honest, we didn’t think much of it; partly because we didn’t really understand what impact that might have and partly because Netsayi was subsequently examined by several doctors and midwives who had all said the baby was head down. At about 34 weeks, Netsayi had to go into the hospital to have her notes written up after we lost the original set. She took the opportunity to say that she’d decided on a home birth. She was told that it was now much too late in her pregnancy to ask for a home birth and it just wouldn’t be possible. Netsayi was upset by this. After all, we’d been specifically told that we didn’t have to make our birth choices until week 36. It was at the next hospital visit, however, that the meconium really hit the rotational air conditioning. Netsayi needed a new scan to replace the missing original. ‘Oh dear,’ she was told by the scan technician. ‘The baby’s in breech.’ She was immediately bustled in to see an obstetrician who gave her the following choice, more or less: ‘You can have an elective caesarean. We’re really good at those. Or you can have a vaginal breech delivery. We’re not very good at those.’ Not really much of a choice at all.
RETURN UNTO CAESAR
When Netsayi got home, I tried to reassure her that a caesarean wasn’t the end of the world. After all, I was still in the mindset of taking the doctors at their word and, besides, lots of women we knew had undergone caesareans and, despite the horror stories, lived to tell the tale. We resolved, therefore, that Netsayi would have an ECV the following week – an attempt by the obstetrician to turn the baby manually from the outside. In the meantime, we would try to encourage the baby to turn on its own through acupuncture (moxibustion) and chiropractic treatment (the Webster’s technique). If all else failed, however, Netsayi would have an elective caesarean – this was, we were told, the safest option for a breech birth for both mother and baby alike. We went in for the ECV in week 37. When the obstetrician performed a further scan, she discovered that the baby was not only still in breech, but that the umbilical cord was ‘loosely around its neck’. We asked the doctor if she was happy to go ahead with the ECV. She said she was since, if the baby became distressed, they would perform an emergency C-Section right then and there. We weren’t much reassured by this and, after conversations with Aunty Jo (and one of the NHS midwives), we decided not to go ahead. Instead, we resigned ourselves to a caesarean for the 39th week. The designated day was the Tuesday after a bank holiday weekend. Consequently, we had to attend the hospital on the preceding Friday for Netsayi to have her blood tests done and so forth. We had a further scan and the baby hadn’t turned – no joy for the moxibustion and Webster’s. The designated day was also, we discovered, not in Netsayi’s 39th week at all, but her 38th (to fit in with hospital schedules). We were both uncomfortable with this since we’d read about the potential breathing complications for babies delivered too early. More to the point for me, however, was the fact that Netsayi didn’t look ready to give birth. It’s a strange and, perhaps, ridiculous thing for a first time father to say, but I intuitively felt that it wasn’t the right time. We went in to the hospital on the Friday as scheduled. We saw a doctor who seemed interested in nothing beyond getting Netsayi to sign her consent for surgery. When we asked for better explanations, she became defensive and fetched her boss. The consultant was the same doctor who’d been due to perform the ECV. She talked to Netsayi for some time and tried to reassure her. She agreed that we could put off the C-Section for a few more days, to the following Friday (which was, at least, in Netsayi’s 39th week). So that was the plan. Over the weekend, Netsayi became increasingly miserable. She had spent so much time and energy doing her hypnobirthing preparation in anticipation of a natural birth and now she felt she had no choice but surgery. She was worried about our baby being born before she was ready, worried about her own short-term recovery from the C-Section (not least because we live in a top floor flat) and worried about the possible implications for her long-term health. I sympathised – of course I did – but I was pretty much convinced a C-Section was the right thing to do. After all, I kept coming back to the simple mantra: ‘We’re not doctors. The doctors say you need a Caesarean. You need a Caesarean. By the beginning of the following week, Netsayi’s anxiety was at its peak. She was trawling the web for info about the possibilities of vaginal breech delivery and the dangers of a C-Section. Of course she wouldn’t do anything to endanger our daughter, but she at least wanted to try going into labour – for both her benefit and the baby’s. She started to look on the Independent Midwives website (independentmidwives.org.uk) for someone with experience in vaginal breech delivery. Frankly, at this stage I wasn’t that keen on going against the doctors’ advice. But I figured Netsayi had to do what she thought right so, as long as I didn’t believe she was taking any risks, I should support her decision. Then, however, Netsayi pointed me to the material she’d been reading (in particular the articles on the Association for Improvements in the Maternity Services website – aims.org.uk) and my position soon shifted. Put simply, I read 1. That the research indicating a C-Section as the best method of delivering a breech baby had long since been disproved. 2. Of the risks and related dangers of a C-Section … It was no longer just that I felt I should support Netsayi, I was now also convinced that attempting natural birth was the right thing for her to do. Netsayi spoke to an independent midwife on the Tuesday and she and her colleague came round the following day. Enter Andy and Marijn stage right.
ANDY AND MARIJN
From the outset, Andy and Marijn inspired confidence in me. Andy explained the physiology of a vaginal breech birth and said that the most important thing was not to intervene – the baby would get herself into the right position on her own and any attempt to ‘help her’ would only cause complications. For this reason, she strongly advised that we have the baby at home, since hospitals tend to panic at the sight of a baby in breech and would have Netsayi in theatre before you could say ‘epidural’. Andy was the first person we’d spoken to who didn’t seem to regard the baby’s breech position as a major problem. I realised that everyone else had stood around Netsayi like cowboy builders, shaking their heads and puffing their cheeks – ‘See that, there? That’s a breech baby, that is. Nothing else for it but the knife, love, trust me. Cuppa tea? That’d be lovely …’ Really. That’s what it was like. But, for me, the very best thing about Andy and Marijn was their realism. This is a hard thing to explain, but I’ll give it a go. Before Netsayi reached her third trimester, I didn’t realise giving birth was a war. But it is. There are two loose armies facing one another – the medicalised birth camp and the natural birth camp. The ‘medicalised’ think that birth is a trauma to be overcome through medicine. Of course, this isn’t what their propaganda says, but, trust me, it’s what they really believe. The ‘natural’, on the other hand, believe that birth is a normal process. They are a more benign force, certainly, though they too have a dark side – their propaganda of birth as some kind of zen love-in can be every bit as unhelpful. An expectant mother, therefore, walks in the nomansland between these two armies. If she veers towards the ‘natural’, the ‘medicalised’ will try to scare her with all the stories of what might go wrong. If she veers towards the ‘medicalised’, the ‘natural’ will regard her with unconcealed pity and make her feel like a failure. What was so great about Andy and Marijn was that they aligned with neither camp. Andy said that they were very confident about delivering a breech baby naturally, at home. But she also said that there were a few medical concerns and, should anything go wrong or slow down, they’d recommend a transfer to the hospital straight away. At last! At last, we had found two people to support Netsayi who had no agenda of their own and would act as advocates for what she wanted. We felt like a weight had been lifted from our shoulders. We decided to put off the elected caeserean. We were at least going to try to do it at home. Andy’s advocacy skills were soon tested. After she learned of our decision, the hospital’s head midwife rang Netsayi. She wanted to persuade her to come in to see the obstetrician. She said something like, ‘We just want to make sure you understand the implications of your decision.’ Perhaps it sounds silly now, but we had reached the stage when any communication from the hospital sounded like a threat, including this. I asked Andy if she would liaise with the hospital on our behalf and tell them not to contact Netsayi directly again. So that’s what Andy did. Our advocate was advocating. Calm. The next couple of weeks were peculiar, really. Every day or two Andy or Marijn came round to check up on things, but mostly we just sat and waited. I bought everything on Andy and Marijn’s shopping list, Netsayi tried out the TENS machine, we practised inflating the birthing pool … As we approached the middle of week 41, Netsayi began to get a little fidgety. Although she was eager to avoid a Caeserean, she had also resolved that she was not going to let the pregnancy go beyond 42 weeks. Again, Andy and Marijn were calmness personified. They said they could make sure she had a C-Section booked for the end of her 42nd week, but they also said they didn’t think it would get that far. And so it proved.
Ever since she fell pregnant, Netsayi had wanted her Aunty Jo to attend the birth. Unfortunately (though fortunately!), Aunty Jo’s two sons were both due to have babies in Sweden in the week preceding ours, so it looked like Netsayi would be disappointed. As it turned out, Keith and Eva’s baby turned up pretty much bang on time, while Thomas and Anna’s had decided to dawdle. But, on Sunday night in the middle of week 41, we got a phone call from Aunty Jo saying she wasn’t going to wait any longer and she was flying back to England. What’s more, she was coming straight to London (instead of back to Manchester) on account of the volcanic ash cloud – serendipitous, as it transpired. I picked up Aunty Jo from Heathrow. She said that while Eva had wanted her to be there for the birth, Anna had not, so it was better for her to leave. That way, Anna would give birth soon and she could be there for Netsayi who’d been waiting for her arrival. We got back to the flat at about 11pm. Anna gave birth in Sweden that night. The wisdom of aunties …
THE LABOUR PARTY
The next morning, Aunty Jo took Netsayi for a walk while I finished off some work. About half an hour later, I decided to go to the gym and caught them up about 200 metres from our front door. Netsayi was having occasional contractions and walking was tricky. I asked if it was still OK for me to go to the gym. Netsayi said, ‘Of course.’ ‘But don’t be too long …’ Aunty Jo added ominously. About an hour later, my mobile saved me from the treadmill. Netsayi said she was now having more contractions and she’d called Andy. I asked what she wanted me to do. I imagined boiling water, chanting mantras, that kind of thing. She asked me to go to Tesco’s on my way home and buy some mince. I got home mid-afternoon. Andy arrived soon after. She agreed that Netsayi was having contractions but said there was a long way to go yet. She left us to it. Netsayi seemed calm and happy. She reminded me of what the midwives had told her sister when she’d turned up at the hospital in the earliest stages of labour: ‘Come back when you’re not smiling!’ Aunty Jo cooked supper. We all went to bed. Netsayi went to sleep quickly and woke up quickly. She wasn’t smiling. Around midnight, the contractions were stronger and she was struggling to stay in any one position. She threw up. I woke up Aunty Jo who suggested I call Andy. She arrived at about 2am. She performed an examination. Netsayi was 3cm dilated. Andy said she could feel the baby’s bottom and maybe a foot. To be honest, the rest of the night is a bit of a blur. The contractions intensified and subsided. Netsayi couldn’t really sleep or get comfortable. I remember making hot drinks of various kinds. I remember inflating things (the birthing ball, the pool). I remember a lot of fiddling with the TENS machine. I ate a lot of chocolate biscuits. At one point we sat listening to Ray LaMontagne and I shed a quiet tear. I think I was feeling sorry for myself. God knows why. Marijn arrived about 4am to relieve Andy. She talked to Netsayi quietly and administered TLC. I suspect I will now always find a Dutch accent soothing. Morning arrived and Andy went home to get some rest. I had a chat with Marijn who told me that Netsayi wasn’t, in fact, in active labour. She said she would hang around, however, as our baby wasn’t flush to the cervix so there was always a slight worry about cord prolapse. Netsayi rested, had a bath, experienced the odd contraction. She was more than a little dispirited by idea that she wasn’t actually in labour and she said she couldn’t imagine letting this situation (these sporadic, strong contractions) go on for that much longer. Basically, she was knackered. Marijn suggested Netsayi might take codeine for pain relief and to help her relax. I was happy to be despatched to Boots. Outside, I was surprised to discover that the world was still turning. Marijn had told me that the pharmacist might question the use of codeine in labour and that I should say I ‘had a cough or something like that’. In Boots, I asked for codeine. The pharmacist asked what it was for. ‘I have a cough,’ I said. ‘A cough?’ ‘Something like that.’ She gave me some codeine based cough syrup. I didn’t know what to do. I asked for capsules too. She gave them to me. I tried to return the syrup. The pharmacist said, ‘It really is the best thing for a cough.’ I ended up buying both.
Back at home, Netsayi’s contractions appeared to have increased in frequency again. I emptied the birthing pool of last night’s cold water. I remembered that Andy had put me in charge of ‘temperature regulation and inflationary services’. I was taking my job seriously. A man likes to have a job, I find. Netsayi’s contractions continued and intensified throughout the early evening. I was convinced she was in full on labour. Marijn was less keen to put a label on it. I looked at her notes. She’d started referring to me as ‘Roger’. We were all a bit tired. At about 9 o’clock I went for a short walk and, by the time I got back to the flat, everything had changed. Netsayi’s contractions were becoming less frequent and more mild. This wasn’t a good sign. It looked like the whole process was about to stop again. Netsayi was starting to talk about going to the hospital – maybe our daughter was in breech for a reason, maybe our daughter didn’t want a natural birth. Marijn agreed it was possible that the labour had ceased to progress and that we should just take that as a hint. She called Andy for a second opinion and some relief (she had, after all, been working about 18 hours non-stop!). Andy was on her way. For my part, I understood Netsayi’s exhaustion and frustration and I absolutely supported her desire to go to hospital, but I was a little disappointed too. Having previously not cared about anything but a healthy mum and baby, I realised that I’d actually begun to look forward to the birth at home and had really come to believe that’s what we would do. While we waited for Andy, Aunty Jo took Netsayi down to the kitchen to make a cup of tea. Suddenly the contractions came stronger and faster again. Suddenly we were all systems go. Andy arrived. Marijn brought her up to speed. Aunty Jo was with Netsayi. The man in charge of ‘temperature regulation and inflationary services’ was doing an exemplary job – the pool was ready to go. Almost as soon as Netsayi got in, her waters broke. A whole lot of meconium came with them. Andy said this was nothing to worry about since our baby was breech. The baby’s heart rate was still consistent and normal. Andy rang the hospital and the ambulance service to let them know what was going on in case we needed an urgent transfer. Again, she said this was nothing to worry about; just normal procedure. It was now about 11.30 pm and once more everything dissolves into something of a blur. Netsayi was in the pool. We dimmed the lights and put on her hypnobirthing CD. I’m sure she can explain it better than me, but she didn’t look as if she were in pain so much as profound discomfort. She also seemed very focused on the job in hand and, for the most part, calm. We were all calm, speaking in whispers. Netsayi held Andy’s hand, then mine. At one point she said she didn’t think she could cope with the contractions and asked for gas and air, but Andy told her that wouldn’t help at this stage and she soon settled back into a state of complete focus. At about half past midnight Andy suggested Netsayi got out of the pool. Because our baby was breech, Netsayi couldn’t give birth in the water. We carefully manoeuvred her out of the pool. She knelt on the floor with her head in my lap. The next hour was probably the most remarkable of my life. I won’t go into detail. With gentle encouragement from Andy and Marijn, Netsayi gave birth to our daughter. There was no drama, she took no pain relief and there was no interference. This isn’t to say that it wasn’t dramatic and painful, nor that Andy and Marijn weren’t regularly checking the progress of the birth. However, the whole atmosphere was one of quiet purpose. I was awe-struck by Netsayi’s will and composure. Anesu-Grace was born at 1.30am.
A couple of years ago, Netsayi and I were both intrigued by an article in the paper describing ‘false rhinoceros syndrome’. The article told the story of the Indian sultan in the 16th century who gave the king of Portugal a rhino as a gift. Working from inaccurate court sketches, a German artist made a woodcut of the animal including apparent armour plating and an extra horn at the neck. A print of this woodcut can still be seen in the British museum. So successful and ubiquitous was this woodcut that for the next 300 years it was faithfully and consistently reproduced as fact despite all the anatomical evidence to the contrary. ‘False rhinoceros syndrome’, therefore, describes the extraordinary human capacity to believe things that are simply not true.
In preparing for the arrival of our daughter, Netsayi and I discovered that typical attitudes to childbirth in this country contain several false rhinos. Pregnancy is not an illness that requires treatment, Caesarean Section is not the safest and simplest way of delivering a baby, and breech presentation is not abnormal … I could go on. Fortunately, thanks to a combination of Netsayi’s intuition of the right thing to do and the brilliant support of Andy and Marijn, we eventually managed to pick our way through the half truths of statistics, idleness and convenience to a calm, beautiful and natural birth. We feel blessed that Anesu-Grace was born in this way and we believe that, whatever the future brings, she has had the right start.