All through my pregnancy I wasn’t especially concerned whether I had a natural delivery or a c section – I could see the pluses and minuses of each. I had assumed I would probably have a natural delivery, but it was nice to know a c section was there as an option in case it was needed. I planned to use a TENS machine (very common in the UK where I’m from) and cleared this with my OB. I had to buy my own, whereas in the UK you can just rent one. I also planned to wait as long as possible before having an epidural, and then only if I felt I really needed it. I also booked a doula so my husband could relax more during the birth, and I would have more support.
I chatted with my doula a number of times in the lead up to the birth. She warned me that if the baby was big (over 9lbs) they would push for a c section, but this didn’t really sink in at first. At my OB check up at about 39 weeks I had a scan to see the size of the baby. It was estimated at 9lbs6oz. Straight away my OB was talking about how I should have a c section and if I didn’t the baby could suffer shoulder dystocia, and how this could be very serious and might result in the baby not surviving. I was told to choose which day the following week I would have the c section and they’d book it that day. I felt very pressured to do this and that my OB didn’t want to discuss the matter with me or answer my questions – he just wanted me out of the office. I was surprised at this as he had been very nice and good at answering questions before, as had the others in the practice (it was policy to see all of them which I was fine with).
So the c section was booked for the following Wednesday and I was almost in tears on the way home. Fortunately I’m a pretty logical person and I come from a medical family so by the time we were home I had a plan. I would research big babies and shoulder dystocia on the web to see what the general consensus was on the matter. Also, we looked at all the measurements and weight estimates from my previous scans (I’d had quite a few as the baby had a minor issue they were tracking). The weight estimate had certainly taken a jump from the previous one and one of the measurements used to calculate it was off the scale (i.e. outside 95 percentile). My parents had flown in the night before and seeing as my Dad is a Consultant Radiologist he was able to say that this measurement was very easy to over-estimate as it was the abdominal circumference. If the sonographer doesn’t place the points in just the right place then the measurement will be oblique (oval around the body) instead of circular. This made us doubt the accuracy of the latest weight estimate, and besides they are always + or – 1 to 1.5 lbs at that stage as it is a calculation, not a set of scales.
I did many searches on the web and found lots of useful articles on when a baby is considered big (some say over 9lbs, some say over 10lbs), whether or not this increases the chance of shoulder dystocia (it doesn’t, as it’s based on the relationship of the baby to the mother’s pelvis, not just the size of the baby) and whether or not a predicted big baby should be used as a reason for an elective c section (it shouldn’t). In fact, many places said that the use of ultrasound to size up babies in the later stages of pregnancy should not be done at all as it is no better than a guess.
Obviously, going with a natural delivery still presented a small risk of shoulder dystocia, just as there would be for anyone, so I also read more about the potential risks of c sections (to decide if I felt they were more acceptable or not), as well as the risks of various negative outcomes from shoulder dystocia and the methods that can be used to facilitate delivery when it does occur. I found that there are many procedures that can be used if the baby does ‘get stuck’ and that in almost all cases delivery can still be made, though sometimes with temporary and / or minor injury to the baby. I also found that a c section is no walk in the park and that there can be serious implications for future fertility / pregnancies.
Based on this information I decided that I was going to cancel the c section, and ask about waiting to see if labor started naturally, or whether I could consider an induction instead. My Dad supported this decision as he had read the information I’d found as well, and eventually my husband also felt comfortable that I wasn’t taking any unnecessary risks. At my OB appointment on the following Monday I was prepared with questions, some prints of the information and a strong mind to not be pushed into something I didn’t want.
I was seeing a different member of the practice, in fact the one deemed the most laid back about letting women decide what to do, so that was helpful. I think she was prepared that I was going to need some extra time to talk about things. I said I was canceling the c section, and asked about induction. I was told that was not an option as they would lose their malpractice insurance if they were seen to induce someone known to be carrying a big baby. I then asked how overdue I could go before they would want me to have the c section anyway and she said I could go the full 2 weeks. We also discussed the fact the baby’s measurement seemed to have jumped and how this could have been influenced by a different sonographer on a different machine. We agreed to schedule another scan with the same sonographer I’d used most of the way through, on the same machine she always uses. This was booked for Friday morning and then I’d see her again straight afterwards. I left feeling much happier and back in control of the situation.
On Wednesday I felt that baby was much lower than before and thought something might happen in the next day or so. I was right because at 5:30am on Thursday my waters broke. I went to the bathroom and found the trickle had stopped. I put in a maxi pad and went back to bed. I lay there wondering if I could have been wrong and that nothing had happened. In the end I decided that if my waters hadn’t broken then I should just go back to sleep, and if they had then I would be having a busy day so really should get some sleep. Either way, sleep was the best option! At 8am I woke either just before or just after the baby moved. I felt a big pop and then I knew my waters really had broken. Off I went for breakfast and to tell everyone today was the day. My contractions started straight away, and were about 5 mins apart from the beginning, but weren’t too painful. By 9am they were getting worse and I headed up for a shower. I didn’t make it in straight away as I found I needed to lean forward on the bed or all fours during the contractions to deal with the pain. My husband found me like this a little while later and said that if I wanted that shower I should really get in there now.
After the shower I had my husband fit the TENS machine electrodes and I started using the machine. He said I should call the OB and I said, no he should! He did and was told we should head straight to the hospital. He called my doula with the news and said we’d meet her there. Getting to the car was more of a challenge than we’d expected. It took a few threats of calling 911 to get me to start moving, and each contraction I had to get back down on the floor. Eventually we made it and off we went. I was using the TENS machine all this time, and gradually increasing the strength and using the boost button during contractions. It makes you feel all tingly in your back where the electrodes are, though as you increase the strength it goes from tingly to down right uncomfortable, though at least takes your mind off the contractions. The idea is that it stimulates the body to release endorphins (natural painkillers). To get the most from it you need to build it up over time, hence putting it on near the start of labor.
During our drive to the hospital my husband made the most of a police car that pulled out ahead of us, deciding that if he was behind it then it couldn’t stop him for speeding. My parents were telling him to slow down, but that had no effect. Nor did my shouting not to accelerate during contractions, but only between them. He said afterwards that he was worried I might have the baby in the car. By the time we got to the hospital and up to the birthing center it was about 11am. It was pretty obvious I was in labor so I bypassed triage and went straight into a delivery suite. I was asked to change into a gown, and remember heading to the bathroom alone and then calling out that I could do with some help. Once changed I was checked and was already 5cm dilated. I’d been expecting a long first stage of labor so had prepared plenty of videos to watch, but there’d be no need for those.
My doula was a great help keeping me focused and bringing damp towels, etc. An hour later I was checked again and was told I was 6cm. This was rather disappointing given the fast progress earlier on, and the level of pain I was in. I felt I was getting no break between contractions and that I just couldn’t take this so I started asking for an epidural. The anesthetist was busy so I was told I’d have to wait a while. By nearly 1pm he was available and I was asked if I still wanted the epidural. I said yes, but my doula said that I should try changing positions as I’d not done this at all. I’d been on the bed leaning forwards onto a birthing ball, and rocking back and forth as this position seemed to make the pain the most bearable. I was persuaded to try standing up which I did for only a few seconds before the next contraction came and I headed straight for all fours on the floor. I was also grunting and getting a strong urge to push and my doula realized and told me not to. I was helped back onto the bed and went back to the old position. My Mum tried to suggest that I was so close that I might get through ok without the epidural, but I was having nothing of it. Everyone except my doula was sent away for lunch so the anesthetist could do his job.
At the time I didn’t realize it, but looking back I can now see that I was in transition, i.e. the worst part of labor where you don’t get a break between contractions. I think that if I’d realized it was going to change then I might have been able to get through without the epidural. As it was my doula suggested that I was checked again before the epidural – I think she thought I was pretty close too and that if I’d known how close I might have changed my mind. No one listened and so I wasn’t checked until about 1:30pm, after the epidural was in. I was 9cm so was probably 8 or 9 when they started doing it so was quite lucky to have got it I think. I was a changed person after the epidural - was sitting up in bed, chatting away. I could feel when I had a contraction from the increased pressure, but don’t remember any pain. I was also able to move my legs a lot and could turn from one side to another. I don’t know if this was because I had less meds than sometimes or because they had to place it slightly higher than usual due to a small amount of scoliosis in my spine. Obviously the TENS machine had come off before the epidural and the anesthetist had been quite interested in whether I thought it had helped or not.
By 2:30pm I was 10cm and was told by the OB (who was actually one of the ones covering for my practice, though he was in touch with mine by phone) that I could start pushing if I wanted. This took me by surprise as I didn’t think I’d get the choice to push or not! My doula and nurse said I could wait and let the contractions do more work for a while, but I thought I’d have a go at pushing. They let me start, but I know now that they weren’t getting me to do proper pushes for about an hour. At some point I was offered a mirror which I said yes to. The OB kept coming in to see how I was doing and I think he was reassured that I was making progress. My husband joked with him about not sharpening the scalpel just yet. It looked to me in the mirror that I was miles off getting this baby out, but the OB at one point said he’d be out by 5pm. Around that time they started preparing for the birth and at 5:20pm Jack Hayden Matthews was born. Once the head was out he turned on his own and out came the shoulders too! No way were they getting stuck. The OB had to hold the baby’s head on his stomach while he suctioned the mouth and unwrapped the cord from the neck (even with this his heart rate hadn’t dropped during any contractions) and then when he was done, out he slithered without another push. He weighed in at 8lbs 13oz, big, but not THAT big.
I’d been given an episiotomy, but had torn pretty badly as well so the OB spent quite a long time stitching me up. I kept the mirror the whole time so I could see what was going on and was asking him which layer he was stitching. He didn’t seem to want to go into too much detail though, but he did give me extra numbing injections when I said I could feel what he was doing. Soon I was reunited with Jack and was in my postpartum room. Jack was perfect and I was glad I’d not had the c section as my room mate had and seemed to be having a hard time. A friend who’d badly torn had suffered with an infected wound so I was extra careful to use the spray bottle every time I used the bathroom for weeks after the delivery. I took painkillers for a few days, and was able to move around and sit comfortably from the start. In fact when I didn’t take painkillers on about day 3 I noticed more pain in my arms and shoulders than anywhere else. Eventually I worked out that was from tensing up holding my legs while pushing. In all the excitement of having the baby we forgot that we’d booked a scan for the next morning. I remembered after my husband had left for the night, but had no way of contacting him. We called later the next day to apologise and they said not to worry, they’d guessed we’d probably had the baby.
With hindsight I’m pretty certain the epidural slowed down the delivery as I’m sure I’d have pushed more effectively without it. My doula and nurse did say I was pushing well, but I really think the strong urge I felt when standing, and the addition of being able to push not lying on my back / side would have made a difference. However, even though I was technically pushing for 3 hours, I was only really properly pushing for 2 and apart from getting tired it wasn’t a big hardship. Jack made it out fine and I didn’t have a c section so all ended well in the big scheme of things. I’d definitely consider an epidural again, though given the fast labor this time, I may not have time to get one next time. That is a bit of fear for me and I’d prefer more backup options. In the UK nitrous oxide (laughing gas) is used in 60% of births and is great because it is self administered, leaves the body quickly after you stop breathing it and can be started at any time. I’d love to have this option here as I have a friend who used it for her second baby when it ended up being too late for an epidural. I would also love the option of laboring and possibly delivering in a tub, though I’d have to change OBs and hospital to get that.
