Jitters

Dot writes: 38 weeks 1 day. I’ve been feeling pretty crampy. Lots of Braxton Hicks (not painful, but tight all round the belly and lower back, coming on promptly with any sort of exercise). Yesterday I had – not exactly a bleed, but some staining that wasn’t how the books describe a ‘show’. I rang Holles St and the midwife agreed it was probably nothing to worry about, but they’ve brought my next visit forward to this morning just in case. Still two weeks to the due date and it could easily be that long or longer, but, oh, the waiting…

Sprout update

Dot writes: we now get weekly visits from the midwives, and they came this morning. Happily Hugh was in good form. He engaged the midwives (Niamh, the senior midwife, and Aoife, a trainee) in conversation as best he could while I nipped upstairs to the bathroom; which is to say that he pointed at the window and said ‘woof-woof!’ (referring to the dog next door), and then he pointed at his toy cars and said ‘car!’. In his opinion these are clearly the most important things to bring to a visitor’s attention.

It was a rapid meeting because the midwives were having a busy morning. The usual tests were clear and my blood pressure was 100/60, which it has been at every single measurement apart from the first one, the only one taken in a hospital. I thought the bump had dropped during the week and Niamh confirmed that Sprout’s head is now engaged. She asked if Aoife could have a feel too because I had ‘a perfect tummy’. I don’t think it has ever been called that before, and I’m certain it never will again (unless I REALLY hit the gym postpartum), but I feel rather chuffed!

Fizz plop / more birth plan

Dot writes: Ken and I both stayed at home today and we had a fun-packed morning of birth preparation, interspersed with reading about the Old English Exodus (me) and some sort of awe-inspiring philosophy cleverness (Ken). Ken inflated the birth pool and filled it. This took half an hour using cold water only; presumably it will take quite a lot longer when we have to allow the hot tank to reheat part way through. Ken also wanted to give the pool a clean, and he had calculated that this required 90 Milton tablets. So we had rather an enjoyable session popping 90 Milton tablets out of their little packs and plopping them in to fizz their way down to the bottom. The kitchen quickly filled with a subtle aroma, fortunately rather better than the smell of bleach though to some extent similar. Then Ken set up the pump and emptied the pool again. This involved, rather alarmingly, submerging the pump in the water while it was plugged into the mains socket, but nobody was electrocuted.

We also had a visit from one of the team of midwives. Sprout continues to be head-down, rather more directly head down than last time (when he was a bit slanted) though still not engaged at all (and boy can I tell – get your feet out of my ribs, you little varmint…). We took the opportunity to discuss the birth plan. We discussed various scenarios e.g. meconium in the waters (which is one of the reasons given for transfer, according to the consent form), and the midwife was very reassuring about the extent to which she and her colleagues would aim for a natural birth wherever possible. I decided that the latter part of item (7) was just anxious hand-waving, so I deleted the last section, after ‘upright and mobile’, and we printed the plan off, signed it and put it in my file. Doubtless we will look back on all this and laugh (‘ho-ho! little did we know he would be born in Dunne’s Stores’),* but it feels like one more piece satisfyingly in place.

*Maybe I shouldn’t even joke about this.

Birth plan

Dot writes: earlier today I typed up my birth plan, ready to discuss it with the midwife when she visits tomorrow.

1. I wish to give birth at home, attended by the Community Midwives.

2. I would like to be supported by my husband, [Ken], and also by my mother, [Katimum], if she is able to be present (my parents are visiting Monday 21st to Monday 28th September).

3. My hope is to have a natural, low-intervention birth, using the resources we have at home and the help and advice of the midwives to manage pain and keep labour going.

4. We have a birthing pool and I would like to use it for at least part of my labour.

5. When the baby is born, assuming there is no need for resuscitation, I would like to hold him and attempt to feed him immediately, leaving weighing and dressing for a little later (though we’ll want to make sure he stays warm).

6. I am happy to have an actively managed third stage if this does not interfere with holding and feeding my baby.

7. In the event of hospital transfer, depending on the reasons for transfer, I realise certain interventions may become necessary, but I would still like to have as natural a labour as possible and in particular to remain upright and mobile. I am especially keen to avoid continuous monitoring unless it is absolutely inevitable, because I am worried about my labour stalling or becoming much more painful if I cannot adopt comfortable positions. I am aware of the dangers of a cascade of intervention if this happens, with resulting risks for the baby as well as for me.

The contentious bit is (7), of course. I wonder if I should just leave it out, because it is unlikely to have much influence on the treatment I receive if we do have to transfer in. I think I’ve already given Sprout and me our best chance of a natural birth by booking the homebirth. Still, it might be good to discuss these issues with the midwife in advance and find out what hospital policy is.

Midwifery, homebirth and the Oireachtas

Dot writes: by a rather complex process I came upon this transcript of a meeting of the Joint Committee on Health and Children which included a presentation from the Midwifery Birth Alliance. It’s quite a long transcript but extremely interesting as an example of how a great tangle of factors contribute to the state of maternity services in Ireland – notably among them the lack of statistical data on various aspects of birth outcomes both inside and outside hospitals, as well as the jealously monitored issue of legal responsibility. It also illustrates how hard it is to separate issues surrounding homebirth from issues of professional power and control.

The meeting took place in February 2003. I wonder whether there has in fact been any significant change in policy or legislation since then? I know that there are a few independent midwives currently practising in Ireland and some midwife-led and community-midwife services, but I’m unaware that there is any commitment in public policy to shift towards midwife-led maternity care as the norm. However, I note that the NMH Community Midwives’ brochure says some of their midwives are ‘midwife prescribers’, which suggests that something was in fact done about the problem, highlighted by Philomena Canning at this meeting, of midwives being dependent on GPs and consultants to get medicines for their clients. Must find out more…

Planning a homebirth – the big list

Dot writes: OK, I was going to write a brief witty post about something utterly unconnected with toddlers, babies or birth, in the hope maybe somebody in the ether would want to read it and boost our stats. But then I thought – who cares? This is what’s on my mind. Maybe my mum and our other two regular readers will be interested. But I did make the title a bit google-worthy. It should really be called something like ‘all the stuff I’ve only just thought of and am writing down in a frantic attempt to feel on top of it’.

I’ve been making a list. It’s an amazingly long list. It’s a list of all the stuff we need to organise, buy or do to be ready for that joyous moment when our baby will emerge into the peaceful (ha!) atmosphere of his family home. The question pregnant mothers should ask themselves when contemplating a homebirth is not ‘will my GP be hostile?’ or ‘what about post-partum haemorrhage?’ but ‘can I rely on myself to make, in the mental fog of the ninth month, fool-proof arrangements for the preservation of my landlord’s carpet?’ And, possibly even more vitally, ‘how good is my boiler?’ Because, frankly, I have some doubts about ours. It has already had to be fixed once since we moved (though the problem was the timer rather than the boiler itself). And when one compares the size of the average boiler with the size of the average inflatable birthing pool, it does give one pause.

I contemplated posting the whole list, but as I may have mentioned it’s quite long. So here instead are some edited highlights. I am proud to say we have already dealt with some of them.

Things to do in advance
– get a gadget so the hose for the birthing pool will actually fit onto the kitchen tap. It is designed to fit onto a garden tap, presumably for the benefit of all those women who want to labour in the garden.
– try to keep on top of the cleaning, because you don’t want the midwives to come round and find porridge in the carpet. [Possibly less of a worry for first-time parents. I seem to recall there was a time in our lives when our carpet was marvellously free of porridge.]
– prepare a box of equipment for the labour (e.g. plastic sheeting to protect that wretched carpet, towels, receiving blankets for the new baby, TENS machine) and put it somewhere accessible. Spend a day repeatedly repacking it as your toddler delightedly strews the contents around the floor and decide to put it somewhere inaccessible.
– find out how to use a TENS machine.

Things to do in the event (tasks for husband)
– drop toddler at house of childminder/gullible friend while simultaneously filling birthing pool, soothing wife, fitting bed with waterproof mattress protector and making sure midwives know where to find the teabags.

Things to do in the event (tasks for self)
– become hopelessly entangled in TENS machine.

Things to buy
– present for older child that cannot be use for experimental bashing of new baby (surprisingly hard to think of one)
– snacks for midwives (because you don’t want someone shaky from low blood sugar stitching up your perineum, do you?)
– new dressing gown, because you’re worth it.