The Birth Survey Booby Traps

Birth Stories
Liam Yemm's Birth

baby boy

As I write this Liam is exactly one week old. My first angel was born 2.5 years ago by cesarean section and this birth was going to be my vbac triumph. I felt knowledgeable first time around (little did I know) but this time I thought I’d prepared for everything! I live in Australia and I chose to have a GP with obstetrics as my doctor rather than a specialist obstetrician. He is a birthing centre doctor and his philosophy includes minimum intervention. He was the same doctor I had for my first child and I was (and still am) very happy with him. My pregnancy progressed beautifully - no signs of pre-eclampsia this time around - and no other problems, aside from some sciatic pain. At my 34 week appointment the doctor did all his routine checks and discovered my tummy to be suddenly way ahead of size for dates. (I knew I’d been extra hungry that fortnight!) I measured 37cm instead of the expected 34cm. This seemed to concern my doctor a great deal and he felt that I should have an ultrasound in my 36th week and then see a specialist OB. He also suggested that I probably shouldn’t go past 38-39 weeks as the baby would be "too big". I was somewhat surprised by his attitude - it seemed a little panicky. My family history is several generations (at least) of small women who’ve birthed large babies vaginally and I figured if they could do it, why can’t I? I’m not even all that small! The ultrasound showed the baby to be all in proportion (ie perfect), healthy placenta and good fluid levels, but measuring 4.7kg (give or take 10% they said). I visited with the OB at 39 weeks and the next ultrasound said baby was approximately 4.8kg. By this time my tummy measured 42cm. He felt there was no problem with me going to 40 weeks, and if I felt strongly about the vbac I could safely go to about 42 weeks. He was concerned however about the incredibly small chance of uterine rupture and about shoulder dystocia.

At 40 weeks I returned to the OB and the ultrasound provided no concrete details on estimated weight as the baby was too big to measure accurately (he guessed about 5.2kg by then), but the placenta and fluid levels were still fine. By choice he would have performed a scheduled cesarean that week but he said I could wait an extra week if I wanted. Neither the baby’s nor my health were determined to be at risk. He refused to consider induction. He felt that the combination of large baby, post-dates, uterine scar and the fact that the baby’s head was slightly off-centre in relation to my pelvis, were significant enough to rule out induction altogether. I asked him if he could strip the membranes to speed things along, but when he checked me he said I was not at all dilated or effaced and so this wasn’t possible. Four days later I had a 12-hour period where I felt NO movements at all. This was the most terrifying point in my pregnancy. I was sure something had gone horribly wrong and I should have had the cesarean a week ago!

The following day I went to the hospital and had a CTG done to determine that the baby was OK - everything was fine. What a relief! However the trace showed the baby to be a little sluggish and not responding well to movement at all times. So the doctor asked me to repeat the CTG the following day. The next trace was perfect. At 41 weeks I saw my GP doctor and he measured my tummy at 45cm. I’d been considering going until 43 weeks and then giving in to the cesarean but he was really concerned about this. I started feeling rather desperate. I now had 10 days to go into labour by myself or I was going to have another scheduled cesarean. My husband and I had been trying all the natural methods of induction since I was 35 weeks (I figured it might take a while to work).

Six days before the cesarean was supposed to be scheduled I resorted to the controversial castor oil treatment. An hour after I drank the slime I started having gastric pains which lasted about 4 hours and included several bouts of shocking diarrhoea. After that the pains changed and I’m quite sure they were contractions. This was at 4.00am. I had contractions 5-8 minutes apart for about 2 hours - initially about 30 seconds long but gradually decreasing in duration and intensity. By 6.00am I’d been awake all night and thought that the castor oil treatment had been an exhausting failure. The contractions continued intermittently throughout the day however and I started to lose a little of the mucous plug. By that evening they picked up quite regularly again and were stronger in intensity. For the entire night I had strong contractions about 10 minutes apart and 30 seconds in duration. They hurt a fair bit but I was very excited that things appeared to be progressing!

The next morning everything seemed to die away again, with contractions all day about an hour apart but not as intense or long. My birth helpers were eagerly awaiting the phone call to say that everything had kicked in, but I knew that nothing was progressing properly yet. The third night I asked my husband to make love to see if we could speed things along a little. We had to pause twice to wait out a strong contraction, and then about an hour later I lost the entire plug. Obviously we had stirred things up a little! That night my contractions were regular again, about 45 seconds duration (seemed like an hour) and much stronger. I was starting to feel I needed help to get through those contractions at night. The following morning it all died down a little bit again, but I was starting to feel concerned about the baby so I went to the hospital (refused to sign the admission slip) and asked them to do a CTG to check baby’s response to contractions. Sure enough the first contraction showed a prolonged drop in the foetal heart rate and the midwife wanted me to stay a bit longer. But several contractions later the baby had showed no problems coping and he was considered to be fine. The resident OB gave me an internal to see how I was progressing and said I was 3cm dilated. Wow! I’d never been dilated before in my life. Whilst doing the internal however she was "bitten" by my angel. It turns out he was a full face presentation. I had no idea what this meant.

I’d researched uterine rupture and shoulder dystocia but I knew nothing about face presentation. She asked me when I’d eaten last and I considered this to be an ominous question. Whilst the resident went in search of my OB and was ringing my GP, the midwife (who was absolutely wonderful) spoke to me at length about face presentation. She felt that a face presentation could be delivered vaginally with a small baby, or that a large baby could be delivered vaginally if there was a good presentation, but the combination meant that it would be next to impossible for me to deliver naturally.

I cannot relate how devastating this was. My OB came to see me- and he said the same thing. My GP came to see me - and he said the same thing. The resident OB came to see me - and she said the same thing. And then the head of the obstetrics department came to see me - and he told me the same thing. I asked each of them the same set of questions regarding feasibility, could he change position etc, and they all gave me the same answers. At this point my husband was frantically trying to contact my birth helper as I desperately wanted to talk to her about it. Unfortunately she was working and couldn’t be contacted immediately.

We’d arrived at the hospital at 11.30am for a CTG, and at 2.30pm I consented to a cesarean section. It was all systems go from that point. At 2.55 we were told that theatre was available at 3.30. So the midwives started stripping me off, the resident was trying to get the IV in (took 3 attempts), a midwife was shaving me, the anaesthetist arrived to insert the epidural (that took a couple of attempts as well). I was signing pieces of paper (I have no idea what they were). My husband was trying to contact people and couldn’t get hold of anyone. My bag was still at home - we had no time in the rush to get it and so couldn’t take photos of the birth. I had a chronic chest infection which they seemed a little concerned about and I was really paranoid about (what if I coughed and they slipped with the scalpel?) Through all this I kept thinking "this is not what I want", and couldn’t help but burst into tears every 5 minutes. I cried all the way to theatre on the trolley and I cried throughout almost the entire surgery. I had no idea at that point whether or not I’d made a good decision. I’d asked that the catheter be inserted after the epidural as I’d found it so uncomfortable with my first cesarean. They did this but the epidural was quite different to the first one I’d had and I could feel it all anyway! I could feel all the pushing and pulling and tugging that everyone had told me about (felt none of this the first time) and every tug on my tummy seemed to move the catheter and it HURT! I felt buckets of fluid running between my legs when they broke the sac. The anaesthetist eventually put something else into the epidural and I could feel it less after that point.

At 4.07pm Liam Tomas Yemm entered this world, weighing in at 5.11kg (11 lb 4oz), 52.5cm long and head circumference of 39cm. His apgars were both 10. He was big and fat and perfect and healthy! They quickly wrapped him and then gave him to me to hold for the rest of the surgery. Unfortunately he was so heavy I had to hand him to my husband to hold after a while. As I was wheeled to recovery Liam stayed in his dad’s arms - until a nurse put him in a humidi-crib (in case Dad dropped him!) - and once they’d checked my vitals in recovery they both came in and Liam was put to the breast. He latched on like a pro and has spent a great deal of time there ever since! I was feeding him less than half an hour after his delivery! This was heaven to me as I’d had to wait two hours after my first cesarean to see my baby.

Liam fed all the way back to the ward and then nestled quietly into the crib by my bed and slept soundly. As he was such a large baby they performed 4 glucose tests to see if he had a blood sugar problem, but he didn’t (I knew he wouldn’t). He wasn’t bathed until he was two days old, and even then I was with him. The first night I had a PCA with morphine for pain relief, which I found to be completely ineffective. I started pulling myself into a sitting position about 8 hours after the surgery as the pain in my back was so intense. I got out of bed at 9.00 the following morning to have a shower and asked them to get rid of the useless PCA. After that I had codeine for pain relief and that seemed to be more effective.

Nothing seemed to alleviate the pain in my back however. It still hurts considerably one week later. I’ve been told it could be after birth pains, muscle pain or residual pain from my epidural. I have no idea but I hope it goes soon! Liam is an absolute angel and I adored him from the moment I set eyes on him. My thanks go to ICAN for their fabulous support in the last month of my pregnancy; to BACUP (the Australian cesarean support group), and in particular Coralie. And to my wonderful, wonderful husband for helping me to make the right decisions, no matter how painful they might be. And of course thanks also to Conor, my beautiful first born son, and to Liam, my perfect angel.

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