3 under 3

Archive for the ‘Pregnancy’ Category

Continued from here.

I slept as well as I could the night before Neave’s birth. I had the usual nervous, excited, anxious thoughts doing loops in my head all night, so it was hard. But, at least I was at home in my own bed, instead of sharing a room with another about-to-give-birth mother, and being woken and poked and prodded by nurses all night long. There were also no crying babies, blaring lights or beeping machines to keep me up. Just my unborn baby kicking merrily at my ribs. This was a new experience for me – I was in hospital days before each of my other births, so being home was nice for a change. When my alarm went off (just as I was drifting into the deepest sleep I had managed all night), I hopped out of bed, woke Tom, and set about getting breakfast. Tom, Tiernan, Molly and I ate together as a family of four for the last time. We told the kids that they would have a new brother or sister by the end of the day. They were excited. Tiernan wanted a brother. Molly wanted a puppy. We said we’d see what we could do.

We called the hospital at 7am, as instructed, to find out when we should head down. They were experiencing a bit of a rush and so asked us to call back in an hour. With some extra time to kill, I had a shower and made sure I had absolutely everything I needed in both mine and the baby’s bags. The baby’s bag was chock-full of white, yellow and green clothing. Having washed baby clothes to pack was also a new experience – we were completely unprepared for both Tiernan and Molly, so both had to wear hospital clothes for their first few days.

I don’t remember what time we ended up arriving at the hospital, but I think it was around 8:30am. We walked into delivery suite, were shown to a room, and met our midwife, Rachel, and her student (whose name I have forgotten). We showed Rachel our birth plan, which was quite specific. This being my third induction, I knew exactly what I was in for, but I also now knew, thanks to some research, that there were certain things I could have a say in. My assumption for my first two induced births had been that I had no control over the situation whatsoever, and no-one, at any point, gave me any indication that this was not the case. However, after extensive reading about what induced births look like in the UK, I suddenly realised that I should be the one calling the shots. It was my baby and my body, and the midwives and doctors were there to give me their advice, but not to order me around. So, after double-checking with my obstetrician that this was actually the case (he conceded, somewhat reluctantly), I wrote my birth plan.

In my plan, I stipulated that I wanted to be given the minimum dose of Syntocinon, the artificial hormone used to induce labour. I also stated that I wanted the dose to only be increased very, very slowly. The reason I was so specific about this is because of what happened in both of my previous births. The usual procedure for induction is to break the membranes so that the baby’s head puts pressure on the cervix and helps it to slowly open. Then the Syntocinon drip is started, with a low dose at first, and is increased every half hour until labour is established, which is defined as three strong contractions in every ten minute period. However, I read a paper on the OC Support UK website, which suggested that women with OC may sometimes overreact to Syntocinon, with far stronger contractions that what would normally be expected. Now, I don’t have any ‘non-OC’ contraction experiences to compare to, but I do believe that my body did overreact to the Syntocinon I was given to start both Tiernan and Molly’s births. Both times, everything went well – I started to have light cramps that gradually got stronger and stronger and became harder to cope with, as is to be expected. The reason they slowly turn the drip up is to try to simulate the progression of a natural birth, from light contractions in the beginning to strong, pushing contractions at the end. However, in both Tiernan and Molly’s births, there came a point when suddenly the contractions were completely, overwhelmingly strong, when I felt like I was being ripped in two and that the pain was going to kill me. It was unbearable. The first time, I responded by demanding an epidural, the second time my baby was so tiny that she was expelled from my body after only 4 minutes of pushing. The third time around, I wanted to avoid these crippling contractions altogether, if possible. I wanted to give my body the chance to do its job with only a little kick-start. My obstetrician agreed that this was fair enough, given that I had responded well to induction in both my previous births. For some women, induction doesn’t work at all. Since I had a good track record with it, he agreed that I could ask for the smallest dose possible, with the drip only being turned up every hour.

My birth plan also stated that I wanted to be able to try different positions throughout the birth, rather than being stuck on the bed or in a chair, as I had been with Tiernan and Molly. I knew this would be difficult, as I had to be attached to foetal monitors to make sure the induction wasn’t upsetting the baby and that she was safe. However, I knew from my reading, that it was possible – monitors can be repositioned periodically if they need to be, and turned off for short intervals for labouring women to go to the toilet or change positions. Despite this, Rachel seemed dubious on this point. She said she was happy to go along with my first request for as long as the labour was progressing satisfactorily. But as far as trying different birthing positions went, she really just wanted me to stay on the bed or in the chair. I was a little disappointed but had to concede the point. So, we got on with things.

We went through the usual procedure. I had a cannula inserted into my hand, through which I was given antibiotics for GBS. I then had my waters broken by an obstetrician, and the Syntocinon drip was started, on a low dose. Then the waiting began. As with both Tiernan and Molly’s births, I experienced period-like cramps to begin with. These showed up on the monitor, but barely registered. But they were there, and at least they proved that something was happening. This was enough to convince Rachel that we could indeed leave the drip at the lowest level for an hour before turning it up a notch. When going into a birth for the third time, most people would expect to be in and out of the delivery suite faster than ever before. However, since we were taking a new approach this time, I felt sure that this birth would actually take longer than Molly’s (about an hour and a half after labour was ‘established’), and possibly even longer than Tiernan’s (six and a half hours). I really thought Molly’s size was the biggest factor contributing to her fast birth, so I was quite dismissive of having this third baby quicker. The labour certainly took a lot longer to establish, which was to be expected, but  that didn’t concern me at all. I was happy to take my time. It was pretty boring though! At around lunch time, the delivery suite shift changed, and we were assigned a new midwife, Beth. I remembered seeing Beth around the hospital after both Tiernan and Molly’s births, so I felt very comfortable with her. It also helped that she was so lovely. I didn’t bother mentioning my birth plan to her, having already resigned myself to the task ahead, in my chair. However, Beth took the time to read it from my folder, and she came in to let me know that if I wanted to move around and try different things, she was all for it. I was so happy. By this stage, things were getting a little bit uncomfortable. The drip was still being turned up very gradually, and Beth was happy that we were making enough progress to continue taking it slow. After being unhooked to visit the toilet, I decided I wanted to stand up for a while, just because I could(!), so Beth set the monitors up with me standing. She also raised the bed right up so I could lean on it during contractions. I still wasn’t quite in established labour, but we were getting close.

This position worked for about an hour or so (I’m a bit hazy on the details), but I eventually got tired of standing / leaning up, so asked to try something different. We lowered the bed and I knelt on the floor with my arms on it, resting my head on my arms in between contractions. I’m not sure at which point I crossed over into ‘proper’ labour, but I think things started to feel a bit more serious at this stage, so maybe it was then. However, after a while on the floor, my knees started to hurt and I wanted to move again. I apologised to Beth for the inconvenience, but she laughed and said that this was exactly what she was here for, to make me comfortable. I felt really lucky to have her as my midwife this time around. We did more tricks with the bed, this time lowering the end so I could kneel on it, and raising the head to give me something to lean on. I found it hard to get comfortable there, probably because I had a baby coming out of me (slowly), so nothing was really going to be ‘comfy’. Beth brought me a ball to lean on instead of the bed head, but I just couldn’t relax between contractions in that way, so I asked to go back to the floor. Sorry Beth! Once back in my original leaning position, Beth brought a mat to put under my knees (covered in a sheet), and some extra pillows to make it easier for me to kneel. I decided I was much happier there. Beth also started getting various ‘baby’ things ready, which let me know that we weren’t too far away. She asked if there was anything else she could do for me at that point, but I said I was fine. It was getting to the point where I was finding communication a little tough. Tom was great throughout all of this, too. He was patient. He held my hand, rubbed my back, passed me water. Waited. There wasn’t really anything else for him to do.

As I’m writing this, I’m surprised at how ‘fuzzy’ Neave’s birth is in my memory. It is the most recent, but the hardest to recall. I think this is because it was the ‘nicest’ – I won’t say easiest because it wasn’t easy, but it was the one where everything went right and where I felt the most respected and in control. Tiernan and Molly’s births were both so jarring and, indeed, traumatic, that they have imprinted themselves so much more clearly in my mind.

So, some vague amount of time after returning to the floor, the contractions were stronger. I was getting through the pain by breathing slowly in through my nose, and out harder through my mouth. I found that when I concentrated on doing this, it was enough to distract me from the pain and it didn’t seem as acute. It was still there, and it hurt a lot, but I was coping. As the pain got worse, I think I moaned a little when I was breathing out. It seemed like the thing to do, and it helped a little. Maybe I was just trying to let Tom and Beth know that it was really hurting! Eventually, I started to consider pushing. I asked Beth whether I should and she said I should go with whatever my body wanted to do. So, next contraction I did push. I pushed out a poo. I can’t believe I’m actually including this detail, because it’s so embarrassing, but my aim in sharing my birth story is to tell the truth, and truthfully, this is what happened. Apparently it happens often. So there you go. After that I decided not to push any more for a while, and this worked fine. Until my body decided that it really was time to push and have this baby now. As with my previous births, when it was time to go, it was really time to go. Only, these pushing contractions were nowhere near as powerful or scary as the last two times. I attribute this to the Syntocinon drip being kept at the lowest dose necessary.

When I started really pushing, Beth knew because I also started yelling. A lot. She asked me to kneel on just one knee so that the baby would actually have room to come out. I somehow managed to do this, despite my legs feeling incredibly tired and weak – there is a down side to standing and kneeling during labour, you have to use muscles to support yourself! Through the next few contractions, Beth encouraged me by telling me my baby would be in my arms very soon. I concentrated on her words while I breathed and cried. I also squeezed the crap out of Tom’s hand. When my baby’s head was out, Beth told me to reach down and hold it so that I could be the one to catch her when she came out. This was another point on my birth plan, only, by this stage I had completely forgotten about it. But Beth remembered, and she made sure I did it. I will forever be grateful to her for that. With one last contraction, Neave’s body left mine, and I pulled her into my arms. She was slippery and warm, and quite heavy, I thought. Nice and pudgy, but just a little bit blue! And after a quick check, I also noticed she was a girl! She didn’t cry right away, which had me a little concerned, but Beth gave her a quick suction to unclog her nose, and she let out a quiet little wail.

Beth and another midwife (who joined us at some point in the proceedings without me really noticing), then helped me onto the bed so that I could hold my baby on my chest. They put a blanket over us, and got me ready to deliver the placenta. I was so distracted by my gorgeous, red-haired girl that I barely registered this going on. I held my baby in my arms, and drank her in. She had a cute little, round face, and dark blue eyes. I knew they were dark blue because they were wide open and staring back at me. After a little while, we had our first try at breastfeeding. To my amazement, Neave actually attached pretty well, and stayed attached for at least half an hour. It was slightly painful, so I did try taking her off and re-attaching her a couple of times, but this didn’t really seem to help much. In the end I decided that I wasn’t too bothered by the small amount of pain – it was worth it just to have her straight on the breast like a proper baby, instead of it taking months of hard work. Sitting there with my baby in my arms for such a long time after her birth, was like a dream come true to me. It was another ‘tick’ for the birth plan – I got to deliver Neave and was the only one who held her for the first hour of her life. Again, this was thanks to Beth, who did the usual measurements (length, head circumference) while Neave was feeding, and she waited until she was finished before weighing her (3065g, or about 6 pounds, 12 ounces).

It’s amazing how quickly after birth everything returns to normal. One minute, I’m in the ‘zone’, with almost no verbal skills beyond crying and yelling, unable to concentrate on anything other than giving birth. The minute the baby is out, all pain is forgotten, the fog lifts, and I’m able to carry out a conversation as if nothing happened. Only, something huge did happen – I gave birth to a baby! This is when the little details, that were totally ignored before, start to register. “What time was she born?” 4:58pm. “So that means the labour was how long?” 1 hour and 25 minutes. “What?” 1 hour and 25 minutes. “Are you kidding me?” No. You pushed for three minutes. “What?” And then, “Oh my God, did I really do a poo?” (For comparison, Molly’s birth was 1 hour and 15 minutes long, with a pushing stage of 4 minutes… so Neave’s birth was surprisingly quick, once we got going!)

Tom did eventually get to give Neave a cuddle, while I had a shower. Then we called his Mum and Dad, who had Tiernan and Molly, to come and see her. We had prepared some presents to give Tiernan and Molly, from the baby. They went down a treat. They were more interested in their new toys than they were in their new sibling, although Neave did get plenty of love, too. Tiernan didn’t seem to mind too much that he had another sister and not a brother. Nanny and Poppy were also quite chuffed with their second granddaughter. So everyone was happy.

The kids didn’t stay happy for very long, however, so Nanny and Poppy took them home after a quick visit. By this stage, it was time for the baby and I to move upstairs to the maternity ward. We were visited there by my sister, Kate and her partner, Mitch. Neave was sound asleep, and I really wanted to be, too. But I was happy to give Aunty Kate her first cuddle with her newest niece before turning in. As luck would have it, Neave and I were given a single room, yay us! After Kate, Mitch, and Tom all left, I eventually climbed into bed, exhausted, and tried to think of suitable names for our darling girl.

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Okay, so here comes the next installment of my childbirth novel! For other installments, see here. I’ve also written a much more brief account of my pregnancy with Neave here.

You would think that after two rocky pregnancies and two premature births, I would have been done with the whole baby thing. Certainly, I was very put off ever having another baby in the first few days, weeks and months after Molly was born. It was all so scary and traumatic. I never wanted to go through it again. After two experiences with Obstetric Cholestasis (a condition caused by pregnancy hormones interfering with the liver’s ability to process bile acids, which can cause stillbirth, particular after 37 weeks gestation), I was sure there would be no avoiding it in future pregnancies. I was also very worried by the fact that I seemed to have a much more severe case of it the second time around, but with no warning symptoms until it was too late. If I were to do it again, surely it would be even worse?

Added to this, I also had a hard time getting over the guilt and grief that surrounded Molly’s birth. I felt I had let her down. Even after she came home, and I became super busy looking after a toddler and a premmie baby, I still had these nagging feelings of failure. So I started to do some research online, and I found this wonderful site, OC Support UK. The site includes a wealth of information, including forums, birth stories, and opportunities to become involved in research. I started to learn more about the disease, and I slowly began to come to terms with what had happened to me. More importantly, I also learnt that any future pregnancies were not necessarily doomed: some women with OC have gone on to have healthy pregnancies in future; and most of the women who have developed OC again have had healthy, almost-full-term-babies, through the help of their doctors and an appropriate management plan. I was stunned at how much more aware of this disease people seemed to be in the UK. Here in Australia, even my obstetricians had seemed fairly clueless about what I should be doing in my second pregnancy, when I told them of my history with OC. They definitely should not have told me to wait for the first sign of an itch before acting.

Anyway, armed with this new information, I started to consider the possibility of having another baby in the future. I had always wanted three children. For a while after Molly’s birth, I tried to reconcile myself with stopping at two. As I was told many, many times by others, I had my perfect, pigeon pair, who were both happy and healthy. What more could I want? However, maternal desire is a funny thing. I just didn’t feel done. Perhaps I could have felt complete with my perfect pair had I been the one controlling the decision not to have more. But as it was, it felt like my experience with OC was robbing me, not only of the last two, precious months of Molly’s pregnancy, but also of any future pregnancies. It sucked. Eventually, I resolved that, while I loved my two babies dearly, deep down I really wanted another one. But I was going to be smart about it.

So I immediately got pregnant again. Not smart. We weren’t ready. While we had recovered somewhat (but not completely) from Molly’s high-drama entrance to the world, we still had many, many things on our plate. Tom was studying at TAFE; life with two under two was tough enough – now we were expecting three under three; and not to mention the bills, bills bills! I’m sorry to say that the first few weeks of Neave’s existence were not exactly joyous. I think both of us felt trapped, scared, and pretty stupid for allowing ourselves to be in this situation. However, after a few weeks passed, and we had a little more time to get used to the idea, we both started to come around. It’s not that we didn’t want another baby, we just hadn’t planned on it being so soon. But, sometimes you just have to deal with what you’re given. So we sucked it up, and tried to stop feeling sorry for ourselves. We started to share our news with family and friends. Of course, we got a lot of What the????  responses, but mostly people were supportive and understanding.

I didn’t waste any time making an appointment with my GP: I had to get her onside to agree to let me have tests. Lots and lots of tests. This was the most important lesson I learnt from Jennifer and OC Support UK: I needed to get baseline Bile Acids Test (BAT) and Liver Function Tests (LFT) done at 12 weeks so that we would know what was ‘normal’ for me. Then I would need to get them done every four weeks, until I reached 26 weeks of pregnancy, when it would become fortnightly. If I made it to 36 weeks, I’d then be having the tests weekly. This was the ‘management plan’ that I should have followed when I was pregnant with Molly, but didn’t because I was told there was no need. How different things might have been. The horrible thing about the BAT is that it is a fasting test. So, on testing days, I would have to get the kids their breakfast and then take them with me to the pathologist. I’m not a good faster. I get all weak and wobbly and headachey, even when I’m not pregnant. So you can imagine how much fun it was to sit and wait for ages with two toddlers in the boring, boring pathology clinic while I was hungry and cranky. I had so many tests done that, by the time Neave was born, I had visible scars in the crease of each arm. They’ve faded now, though.

Two days after each blood sample was taken, I would ring my GP for the results. My poor GP must have been thoroughly sick of me by the end of it all. But she was very patient and obliging. She printed me multiple copies of the blood test referral she wrote so that I didn’t have to visit her every time I needed to get a test done. She also read out every number on the results so that I could write it down and then plot it on the table I was keeping. Yes, I was that anal. To me, those numbers were of vital importance. As long as they all stayed within normal range, I was happy. My baby had time. I was completely terrified that the bile acid levels in my blood would suddenly jump without me being any the wiser, as happened in my pregnancy with Molly. I was also convinced that this would happen earlier than last time, at around the 28 week mark, because it made sense to me that it would happen earlier each time (with Tiernan I had symptoms from about 33 weeks, and with Molly it was 31). I desperately wanted to avoid having another baby spend time in the NICU.

You can see how all of this would have made me feel like a bit of a nervous wreck throughout most of the pregnancy. I decided not to do any teaching from the beginning of 2010, when I was about four months pregnant, because I wanted to be as stress-free as possible. In between blood tests, I tried not to think too much about what my next results would be. I tried to think positive thoughts, and visualise a big, healthy baby at the end of it all. But it was hard.

In between my multiple blood donations, I started visiting the high-risk clinic at Nepean hospital every three weeks from about 18 weeks on. At each visit I would insist on seeing my actual obstetrician (and not the registrars), because I wanted to make a plan with him about what we would do if any of my blood test results started to climb. He didn’t take too kindly to my extensive research and lists of questions. He just wanted me to play dumb and let him make all of the decisions. To him, I was just another meddling, pregnant woman. How dare I try to have a say in what happened to my body, and what actions should be taken to try to prevent another premature baby? Sometimes I felt like I was talking to a robot. A baby-delivering robot who had no empathy or basic human feeling. He didn’t care how or when my baby was born, just as long as it was alive. Then we could be scratched off his list, and we would become someone else’s problem: either the NICU or the maternity ward midwives. Being in the public system, I really didn’t have much choice but to try to work with this guy. So I plied him with questions and tried to cobble together a basic ‘plan’, which went along the lines of: I could continue getting blood tests and collecting results and bringing them to him; if things started to change he would review the situation at my next appointment; I wasn’t to call the hospital with results but if I was worried I could go to delivery suite; as soon as my levels went above the normal range, I would be admitted to hospital and started on medication to try to reduce it; if I stabilised I would be sent home, on medication, and induction would be booked for 36 or 37 weeks; if I didn’t stabilise, my baby would be born by induction or caesarean. At the end of each appointment he would try to reassure me by smiling and saying, “You know, you may not get cholestasis this time around.” And I would think to myself, Don’t worry, I will.

28 weeks

And I did. At about 30 weeks, one of the enzymes tested by the BAT came back slightly (very slightly) high. The other important enzyme had also climbed, but was just within normal range. I booked an emergency appointment with my obstetrician, arranged childcare for the kids, packed a hospital bag, and went to the appointment, expecting to be admitted and started on medication post-haste. However, my obstetrician was decidedly underwhelmed. He asked me to get a repeat test and come back in two weeks. No way. In two weeks, the thing could have sky-rocketed and I could have been itching like a dog with fleas. In two weeks it would be too late. So I told him I wasn’t happy with that suggestion. I wanted medication. He said he couldn’t give me medication because he couldn’t give me a diagnosis based on one only slightly high enzyme and no symptoms. I explained to him (again) that I had no symptoms last time until it was too late. Couldn’t he give me medication prophylactically? He still wouldn’t budge. I was turning out to be a major thorn in his side. He deliberated for a few more minutes, and then suggested I see a gastroenterologist for a second opinion. I agreed. Driving home that afternoon, I felt so many different emotions. I was pretty upset and angry that I still wasn’t being taken seriously, although the appointment with the gastro gave me some hope; I was relieved to be going home to my family instead of being stuck in the hospital; but mostly, I felt drained. The anxiety and nervous tension of the last few months were starting to get to me. I just wanted it to be all over. I cried as I drove home.

So, a few days later I saw the gastro. I paid him $200, and I got my own way. He agreed with me that I would probably end up with OC again. He agreed with me that I would probably end up on medication for it at some point. He agreed with my obstetrician that there was no evidence that taking medication prophylactically would help at all. But he agreed to let me just go ahead and take the damn medication, anyway. At last.

Ursodeoxycholic Acid is not cheap. I think I paid about $100 for only a month’s worth of tablets. But the price was worth the peace of mind it gave me, let alone anything it may or may not have been doing for my stressed-out liver. Starting the medication marked a turning point in the pregnancy, I believe. Finally, something productive was being done, other than my ‘torture by needles’. Finally, someone had listened to me and acknowledged my feelings and my input into the decisions that were made about my body. I felt warm, fuzzy feelings towards my gastro guy for quite a while. I started to relax a little and enjoy being pregnant for the first time in the entire pregnancy. The whole thing had been one emotional rollercoaster ride up until that point. But now I knew that I was doing everything possible, and that I would just have to wait and see what happened. It was very freeing. Tom and I started to get a bit more serious about the ‘name game’. We had a few boy’s names to choose from that we both liked, but we were struggling with girl’s. I figured that meant the baby was probably a boy. It had worked that way with both Tiernan and Molly.

Things continued to go well until 34 weeks, when I was surprised to discover another sharp climb in my blood results. This time, my obstetrician wanted to admit me and monitor the situation for a few days. I knew this meant that I would probably be having my baby within days. I had already packed a bag for myself and a bag for the baby. Optimistically, I left the baby bag at home. I figured Tom could bring it to me when the time came anyway. Once in hospital, my obstetrician and gastro decided to increase my medication to the maximum dose, and take daily blood tests to monitor my bile acids. I also had twice-daily foetal monitoring, where I was strapped up to the trace machine and told to press the button whenever I felt my baby move. Each session lasted about half an hour, and it was pretty uncomfortable. However, it was nice being able to just sit and listen to my baby’s strong heartbeat and know that, despite everything I was going through, so far everything was great with her (I didn’t know it was a her, but it’s easier to just say ‘her’). It was bonding time. All around me, in the antenatal ward, woman were wandering around in various stages of pregnancy, and even labour. I felt almost certain that I would be one of them very soon. I resigned myself to having a 34-weeker. Not full term, but much, much better than a 31-weeker. I felt no guilt this time – I knew I had fought and fought the hardest I could, and now I just had to let things be. At least a 34-weeker should, theoretically, have a much shorter stay in the NICU, and have a much easier time of feeding. So, all going well, with no complications or infections, perhaps we could have our little one home in two weeks? Not great, but not as bad as last time. I was nervous, but at peace with the situation.

So imagine my delight when, after two days in hospital, both my doctors came to tell me that while my bile acids were high, they were fairly stable, and that I could go home tomorrow after one more test. I couldn’t believe it. This had never happened before – I had never left hospital still pregnant. I am going to throw caution to the wind and attribute this marvelous fact to the medication I had already been taking for some weeks. Of course, in the science world, this can’t be proven because 999 other pregnant women with OC didn’t also take part in a trial with placebos vs medication vs no intervention at all. But, when you compare my three experiences with OC, the best outcome I got was when I started taking ursodeoxycholic acid before I was officially diagnosed, with the dose increased once my diagnosis was confirmed. There is no doubt in my mind. I will forever be grateful to my gastroenterologist for taking this chance with me. And I’m thankful to my obstetrician for at least referring me to my gastro when he didn’t know what else to do with me. I feel a little sorry for him, even though his attitude sucked. I wasa pain in the arse. But I was right. At this point I should mention that I would never have had the courage to do all of this wheeling and dealing with so many doctors and midwives if it weren’t for the support of Tom, my Mum, Jennifer from OC Support UK, and also the benefit of my previous pregnancy and birth experiences. This time around I knew what I wanted, I knew what I was entitled to, and I knew how to get it.

I went home the next day, with a tentative induction booking for one week later, at 35 weeks. In the meantime, I was to start weekly bile acid tests, and return to the hospital for foetal monitoring every two- to three-days. This was a serious inconvenience – poor Tiernan and Molly, who had been dragged from one waiting room to another for months now, were starting to get pretty fed up with it. Me too. But, it was necessary, and so much better than having to drag them to the NICU every day. So we did it, with lots of help from family and friends. Sometimes one or both of them would be minded, sometimes I would be met at the hospital and they would be taken for a walk while I was busy. And sometimes I had to do it alone. Despite being so happy to be still pregnant, this phase of the pregnancy was very, very exhausting. I was getting big and cumbersome, and I was spending lots of time running around after toddlers, wrestling toddlers into the car, entertaining toddlers in waiting rooms, as well as the usual tasks of feeding, cleaning, dressing and, you know, nurturing them. A hospital bed and a few days respite was starting to look rather inviting!

Things still looked good at 35 weeks, so my induction was postponed for another week. By now, I was starting to get a bit excited. 36 weeks was still a little too early for my liking, but it was a huge improvement on 31 weeks. It was exciting, but stressful too; every week, I would mentally prepare myself for having a baby on Friday, but then, after my Thursday appointment, I would have to mentally prepare myself for another week of being pregnant instead. It was pretty exhausting.

During the next week, three days before my induction was booked, I started to itch a little at night. Very, very mildly, but enough to make me a little concerned. I also felt a bit ‘icky’. A bit light-headed, vaguely nauseous. Nothing I could put my finger on, but just generally ‘off’. I decided to go down to the delivery suite to have my baby monitored again, and another blood test, for peace of mind. I waited until Tom was home from work, and then went down. Once there, the midwives were very kind and reassuring, and they hooked me up to the monitor, took my blood, and called an obstetrician for me. My baby was still there, as happy as ever, kicking away. It took a while for the on-call obstetrician to arrive, but eventually she did review me and my situation. She said everything seemed fine with the baby, but we wouldn’t really know more until we got the blood test results back the next day. She gave me a choice of being admitted, just in case, or I could go home if I wanted to. I felt reassured that my baby was okay for now, so I went home. That night I slept well, and there was no sign of any itching. The next day, I went to my usual Thursday appointment. My obstetrician was away for the Easter long weekend, so I was reviewed by a registrar. She told me that my results were actually slightly lower than they had been the week before. I was pretty surprised, but pleased. I tentatively asked whether that meant my induction could be put off for another week? She thought about it for a minute and then said she would have to check with another obstetrician since my one wasn’t available. I waited for about half an hour. When she returned, she said the doctor she had consulted had seen no reason not to wait another week. Wow! Once again, my baby was going to get another week. 37 weeks. I had never been that pregnant before. Technically, that’s full term.

This was fantastic news, but I felt quite ambivalent about it. One of the little ‘hang ups’ I had over both Tiernan and Molly’s births was that neither of them were spontaneous or even the slightest bit natural. During this pregnancy, even through all of the complications, I think I still held a vague hope that I would somehow, miraculously get to experience this. However, driving home from the hospital again, still pregnant again, I finally was honest enough with myself to admit that I was so damn sick of being pregnant that I really didn’t mind being induced early. Not just physically, but mentally too. I was really, really ready to have this baby now. So I couldn’t help being a little disappointed that it wasn’t going to be over tomorrow. That I would have to wait another week. It may seem odd that I felt this way, since I was the one who asked to wait another week. But I did it for my baby, not for me. I knew that one more week would make a huge difference to her. Once again, we called everyone and told them no baby for another week. Once again, I played the role of exhausted-pregnant-Mum. But at least it was Easter, so there were more people around to help.

At my next antenatal appointment, my obstetrician asked my why on earth I was still here? So I told him. He didn’t seem too happy. He told me that this was it – Friday 16th April was the day. No more delays. In all of the papers I had read about OC, there was some debate about whether 37 or 38 weeks should be considered the maximum ‘safe’ gestation before induction. As mentioned above, OC is associated with a higher risk of stillbirth after 37 weeks, and no amount of foetal monitoring or ultrasounds can predict which babies will live, and which won’t. That is why doctors prefer to induce early. Despite the evidence that the risk doesn’t seem to increase until after 37 weeks, my obstetrician was of the opinion that inducing at 36 weeks was better. I can see that he wanted to be safe rather than sorry, but I was worried about the risk of inducing a little bit too early. While Tiernan, who was born at 36 weeks, was fine in the end, it was pretty obvious that he really wasn’t ready to be born. For this reason, a 37-week induction sat much better with me. So I guess we were lucky that my obstetrician went away for Easter, because I’m sure he would have insisted on 36 weeks had he been there.

Anyway, a slight rise in my bile acids that week only cemented the deal. I knew not to argue for more time. I didn’t want to anyway, I was done. It was time to have this baby!

This is Molly’s birth story, continued on from here.

I didn’t sleep much on the night before Molly’s birth. I was feeling too miserable. I made up my mind not to go through with things in the morning until I had spoken to an obstetrician and confirmed that this was definitely the right thing to do. It sure didn’t feel like the right thing to do. It felt like I was about to allow my perfectly healthy baby to be taken from my body way before she was ready. I could have justified it more easily had I felt that I was so unwell I couldn’t continue the pregnancy. But I didn’t feel unwell at all. Looking back, I think this has been the hardest thing to accept: that my body was failing Molly, and she was the one who was going to suffer most for it, not me.

In the morning, a nurse came to take us down to the delivery suite. She looked at my belly and asked, very concerned, how far along I was. When my reply was 31 weeks she said, “Oh, that’s okay then, I thought your notes said 37 weeks.” When we looked doubtfully at her for calling this a good thing, she explained that my baby, being perfectly healthy and a good size for her gestation, was in a much better position than would a 37-weeker of the same size, because a 37-weeker that small would probably have something seriously wrong with it. Hopefully, our baby would only need to grow and learn to feed. This gave us a bit of perspective, but it wasn’t enough to make us feel better.

When we met our midwife, I immediately told her that I wanted to talk to the doctors again before going ahead. She replied that we had to wait anyway, as there were still some blood test results pending, which would confirm our course of action. She set about getting the preparation underway, all the same. I was cannulated, given IV antibiotics (for GBS), and hooked up to foetal monitors. When the doctor finally came, my last hopes were dashed. She came to confirm that my platelet count was normal, and we could continue with the induction instead of a caesarian. What??? Nobody had bothered to mention that I was under consideration for a caesar. I had assumed they were checking to see whether the medication I was on was working, which I hoped might mean we could delay the induction and wait and see how things went for at least a few more days. However, they were doing nothing of the sort – the blood test they were referring to was to rule out a much more serious problem, called HELLP syndrome, which is potentially life-threatening. The reason they were checking for this was that my liver enzymes were much higher than what would normally be seen with OC. Sadly, even though HELLP syndrome was ruled out, there was still no going back for me or my poor bub, it just meant that we could try for a vaginal birth rather than a caesarian.

 Once underway, Molly’s induction was much the same as Tiernan’s, only much, much quicker. The midwife attempted to break my waters, but couldn’t. She tried for at least ten minutes before having to find an obstetrician to come and have a go. It’s really not the most pleasant procedure at the best of times, and it was terrible to have it dragged out this way. Molly really, really wasn’t ready to come out!

Finally, the membranes burst and the Syntocinon drip was started at about 9:30am. We waited, terrified, for the contractions to start. We weren’t terrified of the labour, as we had a fairly good idea of how that would go, but we had no idea what our baby was going to look like at the end of it, or whether she would be okay (we didn’t actually know the sex but it’s easier to just say ‘she’!) Natalie, our midwife, made us feel a little better by saying that she had delivered a 31-weeker only a few days earlier, and this baby was doing well. It had even come out crying, which was a great sign.I tried to relax, but I just felt sick to my stomach about what we were doing. Forcing my baby out like this was all wrong.

Meanwhile, the Syntocinon was doing its job and I was starting to feel period-like cramps. These became stronger and more regular as the labour progressed. I started to think about pain relief (not because I needed it yet, but because I thought I’d better at least have a plan in my head!), and realised I was very much against having an epidural this time. I knew that our baby would be taken away from us to be stabilised in the NICU (Neonatal Intensive Care Unit) as soon as she was born, and I wanted to be able to follow as quickly as possible, without having to wait to be able to use my legs again.

As with Tiernan’s birth, the Syntocinon drip was turned up every half-hour, until the labour was established (three strong contractions in every ten minutes). And, as with Tiernan’s birth, I was coping fine, until I suddenly wasn’t! Natalie had told me to let her know when I felt the urge to push, as this would be her cue to call in the paediatric team, who would take care of the baby once she was born. Having not felt the urge to push with Tiernan (I was under an epidural before I got that far), I wasn’t sure, but tentatively announced that I thought I would need to push soon. Ish. By the next contraction I was quite sure. Natalie did an internal (flat on my back again – agony!) and said that I was only 6cm dilated, so it wasn’t time yet, but she thought it wouldn’t be long. She suggested I try the gas and air to get me through the next few contractions. After setting me up with the gas, Natalie turned to fill out some paperwork, but before she had gone two steps I was screaming and writhing in pain. The baby was coming, right now! The pain was so sudden and so intense that I started to panic, hyperventilating and bellowing the house down. I think I scared Natalie, too. She called the paeds, and then had to work hard to try and calm me down, repeating my name, over and over, until I listened to her and started to breath properly with the gas. It didn’t do much for the pain, but it did give me something to focus on. Once again, due to the Syntocinon, the contractions I experienced were so intense that I had no control over my body. Rather than pushing Molly out, I felt that she was forcibly expelled by the drug. I later found out that the whole birth lasted an hour and twenty minutes, with a ‘pushing stage’ of only four minutes!

Our beautiful, tiny, baby was born at 12:50pm, weighing only 1700g (or a little over three pounds). Natalie held her up to me, very briefly, so I could give her a kiss and see that she was, in fact, a girl. I had only a moment to take in her tiny form. I remember thinking that she actually looked quite good – like a ‘real’ baby, but much smaller. She had good colour (well, a bit blue, but her skin was pinkish and not translucent as I had been half expecting). And, she was crying! My brave little girl was crying as loud as she could (which wasn’t very loud at all), letting us know that she was okay, but rather cranky at being out here so soon. I breathed a huge sigh of relief.

All too soon, Molly was whisked away, and I had to get down to the business of birthing the placenta. Without a baby in my arms to distract me, this seemed to take much longer than it had the first time around. I didn’t need any stitches this time. I was so pleased to be able to jump (well, maybe not jump, but hobble), into the shower straight away to get cleaned up. We were then taken to my room on the maternity ward, where we nervously waited to be allowed to see our little girl in the NICU…

I have decided to write about each of my children’s births while I still remember all of the gory details! Don’t read this if it isn’t your thing. Personally, I love birth stories.

I have written about my pregnancy with Molly before, but skipped a lot of the detail. This is a more thorough version.

Okay, so you would think that after Tiernan’s shaky start I would have been at least a little bit nervous about having another baby. I wasn’t. In fact, I was so not-nervous that I became pregnant again when Tiernan was only eight months old. Then, suddenly, I was nervous! But not about the actual pregnancy part, really. After talking to the doctors when Tiernan was born, I came away believing that of the two conditions I ended up being diagnosed with, pre-eclampsia was the more serious, which was also the one I was least-likely to get again. I now believe that this isn’t quite true, although we never really got to the bottom of what happened with Tiernan’s pregnancy. Perhaps the undiagnosed obstetric cholestasis meant that I was more prone to pre-eclampsia, but who really knows? In any case, I was lead to believe that I shouldn’t have any issues with further pregnancies – if I developed OC again, it would be caught earlier (because I would know what to look out for), and managed effectively.

I was more nervous about how I was going to finish uni whilst also pregnant and trying to look after a one-year-old. My final subject of uni, which involved eight weeks of teaching and a million assignments, was my biggest hurdle (or so I thought). We upped Tiernan’s daycare to three days per week (he had been going once a week while I was working casually), and he spent the remaining two days with either his grandparents or with Tom.

It was extremely stressful. I was, in essence, working full-time, with the added bonus of then having to work from home of an evening, too. Because prac sucks – there is all that teaching, planning, preparing, evaluating, researching, reading, assignments, etc. etc. etc. I was also largely responsible for making sure Tiernan had food to eat and clothes to wear at daycare each day. I missed my baby boy terribly. I felt incredibly guilty that I had so little time for him all of a sudden. He coped pretty well, though. He loved his carer, Jillian (who is amazing!), and it also meant that he got some bonding time with Tom. I consoled myself with the knowledge that it was good for him to strengthen his relationships with some of the other, wonderful people in his life. Plus, the situation was also temporary. Prac would be over in a couple of months, and then, once my assignments were done, I would be able to have some quality time with him before the baby came. Or so I thought.

Throughout the pregnancy, I had been visiting the clinic at Nepean public hospital. Shared care was no longer an option for me, because of Tiernan’s complicated birth, so I was visiting the obstetric registrars (and if I was lucky, an actual obstetrician) each time. I asked, several times, whether I should be having any blood tests along the way to check that my liver was behaving, but was told that nothing needed to be done until I started to itch (the first, and often only, symptom of OC). So I waited to itch. I had a pretty good idea that I was going to eventually, but assumed that the worse thing that would happen would be another induction and another slightly early baby.

Everything went well until about week 30. I started to feel a bit run-down. I put this down to stress and exhaustion. My prac was nearly over, but I was starting to wonder how on earth I was going to get through the sheer workload. I didn’t want to do it any more. I must have known something was up, on a sub-conscious level. I started making noises to my prac supervisor about whether it would be possible to finish my prac a week early, due to being too tired and pregnant to continue. This lecturer had been extremely supportive throughout the semester, as had my prac teacher and the school principal, but she wasn’t sure whether there was anything she could do to ‘let me off.’

And then, at 31 weeks, the itching started. I woke up with itchy palms and feet. It wasn’t too bad and I was able to go back to sleep. So I let it go for one more night. When it came back again, I knew I would have to go to the hospital and get checked out. I was a bit disappointed, because I had hoped maybe I would get away without any OC this time. I had a brief moment of panic that if I went to the hospital they wouldn’t let me out again, like last time (with Tiernan), but I dismissed it: I imagined I would have a blood test, be diagnosed, and then be sent home on medication, an order to take it easy, and to come in for monitoring more frequently. I was fairly sure that I would be allowed to finish prac early, now that there was a medical reason, so I could use my ‘resting’ time to complete my assignments, and then spend time with Tiernan and prepare for the baby. Maybe it wasn’t going to be so bad, after all.

Well, of course, that wasn’t how it went at all. I did go to the hospital, on my way home from school that day. I did have a blood test. I waited hours for the results. And then I got bad news. My blood results were through the roof: two enzymes that are normally at levels of less than 40, were now above 600! I wasn’t going anywhere.

Once again, I found myself calling everyone from the hospital to tell them that I wasn’t allowed to leave. Tom came with clothes and moral support. Before being sent upstairs to the antenatal ward, I was given a shot of steroids that would help mature the baby’s lungs in case she had to be born early. Even though I was assured this was just a precaution, it totally freaked me out.

That was a horrible night. I was terrified about what might be about to happen, and I really missed Tiernan. I hadn’t been able to see him because he was already in bed when Tom came with my clothes. While I lay in my bed, not sleeping, I managed to convince myself that all this talk of the baby being born soon was just ridiculous (why induce a baby at 31 weeks? Pretty drastic, thought I). They were more likely to try to keep me in the hospital until the baby could be induced more safely, at 35 or 36 weeks. Well, I decided that I wasn’t going to be kept away from Tiernan for that long, so I would try and negotiate to be let out until then, even if it meant daily visits. With this plan firmly settled in my mind, I eventually drifted off to sleep. (Yes, I slept – the medication they gave me, ursodeoxycholic acid, stopped the itch completely this time around).

My blood levels were monitored over the next couple of days. I had been admitted on Friday with levels of 600+. On Sunday, my actual obstetrican came and told me that my levels were now over 1200, which was getting dangerous, for me. At this point, I don’t think they were too worried about the baby. I don’t know what exactly I was in danger of (liver failure?), not having the presence of mind to ask at the time. I was in shock. You know that funny ringing sound you get in your ears when you’ve been at a concert and then go somewhere quiet? I was listening to the obstetrician rattle off the options: caesar now, or induction tonight or tomorrow, through that ringing sound. In the end, she decided it was safer to try an induction, as this was my second baby (so labour would be quicker), the head was well down, and my cervix was 1cm dilated already. Also, she told me, a ‘natural’ birth can be better for premmie babies (as well as full-term ones), because it helps squeeze some of the gunk from their lungs. She then left to make arrangements.

Tom and I were left reeling from this devastating news. If I was worried about having Tiernan ‘prematurely’ at 36 weeks, imagine how I felt now that I would be having a 31-weeker. A timely visit from some paediatricians answered some of our questions: they told us that babies born at 31 weeks have a 98-99% chance of survival; some babies born this early have learning difficulties, and/or hearing and vision impairments, but not many; that the biggest risk after the birth is infection; that our baby may or may not be able to breathe independently; and that the baby would need to stay in the Neonatal Intensive Care Unit until some time around the due-date. It made us feel a little better, but it was a lot to take in.

Then we got another visit from the obstetrician, who told us that, as the NICU at our hospital was currently full, I would have to be transferred to Westmead that night, where my case would be reviewed by whichever doctor took me on. I hoped against hope that they would decide not to go ahead.

Then ensued the ridiculousness that is being transferred! I had to pack up my things, and then be wheeled out to an ambulance on a stretcher. It was so humiliating. The worst part was that I didn’t even feel the slightest bit unwell! I could have driven myself to Westmead with no problems, and here I was, being treated like an invalid. Actually, that was the part that stung the most about my baby being born so early – I couldn’t get over how well I felt. Run-down, yes. Stressed, yes. Tired, yes. But seriously ill? No way. I just wanted to go home, rest up, and have this baby in a few more weeks.

We finally got to Westmead at around 9pm (Tom drove and met me there). We were seen by my new doctor. She decided to do more bloods, but also booked me in for induction first thing in the morning. I held on to a glimmer of hope that the medication I was on may have kicked in by now, and they would call the whole thing off in the morning.

I was taken to the antenatal ward. Tom stayed with me for a while. We didn’t bother writing a birth plan, this time. We knew how it would go. There were no words to say. Eventually, he went home to get a few hours sleep before returning in the morning, and I went to bed feeling like a big failure.

Continued from here.

The morning of Tiernan’s ‘birthday’. Don’t I look positively refreshed, from my great night’s sleep?

After months of speculating about what going into labour might be like, I found myself in a situation quite removed from my dreams of a straightforward, ‘natural’ birth.

At about 8am we headed down to the birthing suite. We met our midwife, had the basic induction procedure explained to us, and then sat around for about three hours while every available staff member attended to some sort of emergency. This did nothing for my nerves.

When our midwife re-appeared, we showed her our hastily written birth plan. It said lots of lovely things like ‘warm bath or shower’, ‘going for a walk’, ‘different positions’, ‘heat packs’ and ‘don’t offer me drugs’. The midwife read the plan before crushing all of my hopes by pointing out that, since I was being induced, I would be hooked up to a drip and a foetal monitor the entire time, which would restrict my movement. In fact, I had a choice between sitting on the bed or sitting on a chair, and that was it.

Oh.

She then went about preparing me for the induction, which included inserting a cannula into my hand, hooking me up to a drip, giving me antibiotics (for GBS), taking a blood sample (I can’t remember why), and then giving me fluids via the drip when I nearly fainted (great start to a labour!) When everything was finally prepared, a doctor came in and broke my waters (quite painful when it’s done manually), at about 11am. The Syntocinon drip was then started. The normal procedure is to start with a low dose of Syntocinon, and gradually increase the dose every half-hour until labour is established, when it will be kept at a constant flow until the baby is born.

Labour was very, very dull for a while! Tom and I sat around watching boring day-time TV. I was pretty uncomfortable straight away – not from any labour pains, yet, but mostly from the pain of having had my waters broken. Plus, I now had a giant baby head resting right up against my cervix without any cushioning around it, so sitting was rather difficult already. It wasn’t long before I started to get period-like cramps, which is what we were hoping for (induction doesn’t work for everyone), and these gradually became quite regular and persistent. I was told, by the midwife, that the ‘magic’ crossover point from pre-labour into labour would be when I was having three, sustained, contractions within a ten-minute period (which they would determine by reading the printout from the foetal monitor, and not by asking me. Surprise, surprise). It seemed to take a bloody long time, and quite a lot of pain, before I was even in proper ‘labour’, which wasn’t until about 1pm.

My original plan was to manage the pain on my own for as long as possible. Heat packs on my back helped for a little while (well, they took the edge off), but soon became quite useless and mostly annoying. Actually, I was quite surprised by how well I was coping – I found myself getting into a rhythm of just ‘breathing’ through the contraction. I would have loved to have rocked and walked around – I think this would have helped a great deal. Or, better yet, had a shower. But, I was stuck in the stupid chair, with tight straps constricting my distended belly. My only relief was when I was allowed up for toilet breaks, which were frequent.

At some point we got a new midwife (when the shift changed), and I remember her name was Elizabeth. I don’t remember how soon it was after her arrival that things got bad. Really bad. All of a sudden, I found myself hunching over and making this guttural, heaving noise and pushing with each contraction, and I had absolutely no control over it. I remember several people telling me I would have to stop doing it (there seemed to be extra people in the room now), but I was helpless. At the same time, the ‘people’ were expressing dissatisfaction with the trace of my baby’s heart rate – there wasn’t enough variation between contractions, which could indicate that he was becoming distressed. Solution? They made me lie on my back and stay perfectly still so they could make sure it really was his heart rate acting up and not my stupid, labouring self knocking the probe out of place while having a hideously powerful (bend-me-in-half) contraction.

Well, on my back, I quickly became quite convinced that this pain was going to kill me (he was posterior, but it would have hurt more on my back, anyway – this is absolutely the worst way to try to give birth!) There was no staying still. I was still being bent double, and now I was desperately repeating Epidural! Epidural! Before calling for the anaesthsetist, they did a quick internal exam and found that I was now 5cm dilated (from a starting point of 3cm). It was progress, but I still had another five to go, and there was no way I was going to survive this torture, on my back, for that long. EPIDURAL!

The anaesthetist soon arrived, explained the procedure and the inherent risks (ie. you could get an infection and die, or I could sever your spinal cord and you may never walk again, or the thing might have no affect whatsoever). Tom and I were given a few minutes to discuss, but as far as I could see, there was no choice to make – a small chance of death or permanent disability versus certain death from the intensity of this pain. So, epidural it was. While the anaesthetist was setting up his equipment, he explained to me again that I would have to stay perfectly still while he inserted the needle. Meanwhile, I still felt as though I was being ripped in half from the inside, was still bellowing and still finding it impossible not to writhe with pain – how on earth is this going to work? I wondered. He won’t be able to do it and then I’ll just die. Miraculously, just as the anaesthetist finally was ready to give me the epidural, I experienced about a five-minute lull between contractions (transition period? I’m convinced it was), and I felt better almost instantly.

The pain-induced fog was lifted. I could think straight again. I wasn’t going to die, after all. Amazing! But, what do you know, another progress report revealed that I was now 10cm, and it was time to push!

It turns out that one of the new ‘people’ who had bustled into the room during all this was the attending obstetric registrar, (let’s call her Dr X). I didn’t like her at all – she was pushy, arrogant, and didn’t even have the decency to talk to me directly, instead preferring to issue her orders to Elizabeth. When it was declared ‘time to push’, she told Elizabeth that I had one hour to push the baby out, or she would come in and pull him out with the Ventouse vaccuum. I feel this was unnecessary: the baby’s heart rate seemed to return to a more ‘normal’ pattern after the epidural, because I stopped moving around and interfering with the equipment. How I wish I hadn’t been so scared that I simply went along with Dr X’s orders. Really, there was no reason for there to be such a rush. I think it was simply her wish that my baby be born as quickly as possible, for whatever reason (because she wanted to go home? because she didn’t know how to ‘let things be?’ because she was bored?) However, nobody tells pregnant women that they actually have a choice in these matters, and that they don’t have to relinquish control of their bodies to the ‘experts’. It has taken me three births to learn this.

After Dr X left the room, I started the tricky business of trying to ‘push’ a baby out while under a full epidural. I was almost flat on my back again, and, although I could tell when it was time to push, I had no idea how hard I was pushing. Not very hard, I think! I was actually really worried about pushing so hard that I would tear, get a haemorrhoid, or push a poo out instead. Because, that’s the downside to having an epidural – these things mattered again when I was fully present in the moment, whereas minutes earlier, the fact that I was naked in front of fifteen million strangers had barely registered on my radar.

So, anyway, one hour was quite obviously not enough time to push the baby out (not without muscles or even gravity to help me). In swept Dr X again, along with two more midwives and a team of paediatricians, and finally ‘extracted’ Tiernan from my body, at 7:31pm. I was given a quick look before the paeds took him and checked him over. He was declared ‘all good’, and handed back to me fairly quickly, though. And what a sweetheart! Apparently the maternal rush of love doesn’t happen for everyone immediately, but it happened for me. I instantly fell in love with him and knew that I would do anything  to protect this tiny, precious being.

Tiernan. 2900g (6 lb 6 oz) and 51cm.

He had a perfect little face, with a tiny nose, wrinkled up ears and that long, newborn head, with copper-coloured, wavy hair! He didn’t cry much, just looked around and took it all in. I remember the way he kept sticking his little tongue out, as though wondering what this strange, dry air was and where had his lovely, warm bath gone?

My preoccupation with my new baby boy didn’t quite distract me enough from what was going on ‘down there’, though. My friend Dr X, having congratulated herself on a job well done with the vacuum (“Did you see how well I did that? Got it first go!), was now busy giving me stitches for a grade 1 tear (basically a graze, usually better left alone). Her reasoning was that I wouldn’t feel the stitches go in (epidural), so why not? About a week’s worth of pain is why not – I have since learnt that stitches hurt way more than a tiny tear. Thanks, Dr X, I’m glad I could be of service to you, while you practiced your vacuuming and stitching. Now maybe you should go and learn some people skills.

In the weeks and months after Tiernan’s birth, I was so busy, so exhausted and so in love with him that I really didn’t give much thought to my birth experience. But eventually the realisation caught up with me that I was pretty disappointed with the whole thing. I was a bit annoyed with myself for succumbing to the epidural (but seriously, the pain!), because I guess that is what lead to me not being able to ‘push’ Tiernan out myself. With the obstetrician’s complete self-absorption added to this, I ended up feeling that I hadn’t really had much of a role to play in my son’s birth at all. However, I also realised that there were elements involved that were simply out of my control, and I was eventually able to let the grief go. I learnt some valuable lessons from my experience, and I took them with me to my subsequent births.

The best, and most important, part is that I got to meet my beautiful boy and take him home with me, and that is all any mother really wants.

After reading some birth stories lately, I realised that I have never taken the time to write about my own birth experiences properly. Mostly I want to record my experiences for my own personal benefit, but I don’t mind sharing them here, for anyone who is interested. I love reading birth stories, but I get that they’re not everyone’s cup of tea. So feel free to skip this post (and subsequent ones!)

Also, I should probably point out that my pregnancies were very complicated, so a high level of intervention was needed for my births. I was completely unprepared for this, especially the first time around, when my late pregnancy suddenly went from ‘normal’ to ‘not good’, and so I ended up feeling quite disappointed with the way events transpired. This left me grieving for my ‘lost’ last month of pregnancy, and the labour experienced I had hoped for. However, once I recognised this grief for what it was, I was able to come to terms with it and move on. I did, after all, have a healthy, happy baby at the end of it all. So, mine is a happy pregnancy/birth story, but one that is complicated (and quite long, sorry), and I haven’t spared too many details (or it wouldn’t be my birth story), so if you plan to give birth one day in the future, maybe you don’t want to read on…

See here for a much more brief account of my pregnancy with Tiernan.

After the initial shock of discovering I was pregnant, I was quite excited about the prospect of becoming a mother, and I spent much of my early pregnancy reading books, searching the internet and watching birth videos, trying to get as much information as I possibly could about the changes that would be happening to my body, and the whole birthing process. In other words, I attacked the problem in my usual style, by getting informed, and making up my mind from there.

Ah, the innocence! I remember being so absorbed by myself and my baby. I had a one-track mind: what will the baby look like? what will birth actually be like? how will I look when I’m all fat and pregnant? I already love this baby. Baby, baby, baby. I also had a few more pressing concerns, like where will we live? how will I finish uni??? But, in general, I was fairly confident that things would work out.

Whilst being distracted with baby thoughts, I was also studying my fourth year of a Bachelor of Education, and working part-time in retail. And, later on, I was also teaching full-time, (on prac). By this stage I was into my third trimester, and was getting pretty big and cumbersome, and not really enjoying it much. I remember liking the look of my body naked, but hating it in the big, frumpy clothes I had to wear. I was totally sick of feeling fat and uncomfortable. I was also getting pretty bad heartburn, and some very annoying groin pain when I walked (or, more accurately, limped).

Apart from these, fairly typical, pregnancy complaints, everything had been progressing well up to this point, and we had no reason to believe that things wouldn’t continue this way. We started to narrow down our list of possible baby names, went to antenatal classes, and purchased some of the many, many, many items that transform one’s home into one-that-looks-like-there’s-a-baby-in-it. Oh, and we also moved house!

I was still on prac, and about 33 weeks pregnant, when the itching started. At first it was only on the palms of my hands, and the soles of my feet. I usually only noticed it at night, or if I got too hot during the day (it was late autumn/winter, so not often). However, after about a week of this, the itching started to spread, and intensified, until it was keeping me awake for significant periods at night. The only, brief, comfort I could find was by putting wet cloths on the affected areas and trying to ignore the burning sensation.

I spoke to my GP about it during my next visit – I had opted for shared-care, with most of my visits being at the GP and only some with the midwifery team at my local hospital. She wasn’t sure what the itching was about, but thought it may just be because my pregnant body was so fat that my skin was stretching and causing the itch. Actually, I experienced very little swelling of my hands and feet, so this theory didn’t make much sense. In any case, she recommended a menthol cream to help soothe the itch, which helped take the edge off, but didn’t really help me sleep any better. So, while the problem was definitely getting me down (my prac was close to finishing, but I still had several assignments to complete, and I was still working), it didn’t seem to be anything vital, so I tried not to worry about it.

However, when I mentioned it to my Mum, over the phone (she was living in Maclean, about a 10-hour drive north), she told me about someone she knew who also had this kind of itching in pregnancy and ended up being really sick. She recommended I try to find out more about itching in pregnancy. And hence my relationship with google began! (Whenever anything happens, I always google it first, to see whether I should be worried – rashes? google. Pain? google. Strange bruising? google. Vomiting? google. Baby eating poo? google).

The problem with google is that it tends to make you freak out, which is what I did when I found all of these sites that told me I might have something called Obstetric Cholestasis (a liver problem that can occur in pregnancy, which, if unmanaged, increases the risk of stillbirth after 37 weeks gestation). I went to the GP the next day, but couldn’t get into my usual one at short notice, so had to settle for another. This doctor basically made me feel like an idiot for even thinking twice about anything I’d found on the internet. He dismissively told me that I couldn’t have OC, as I would have jaundiced eyes if I did (actually, the only reliable symptom of OC is the itch), but he did, grudgingly, agree to write me a referral for a liver function test, just to shut me up. Looking back, this was my first experience of being shut down as a mother (or expectant mother). I was already just a mother. What could I possibly know about anything?

I continued to itch like mad for the next week while anxiously awaiting the test results. I was becoming quite deranged. I had scraped my way through my prac, by the skin of my teeth, but was now ready to collapse with exhaustion. I finished up work (I had to quit, as I was only casually employed), and tried to concentrate on my assignments, but kept falling asleep instead. When I returned to the GP (my usual GP this time), at 35 weeks, she checked the results of the liver function test, and agreed that my liver was definitely not happy with something. To help her interpret the results, she conferred with someone from pathology, over the phone. The pathologist she spoke to agreed that things were out of whack, but assured my GP that this was to be expected in pregnancy, so there was nothing to worry about (I now know quite a bit about liver function tests, and what the pathologist said is true of some of the levels that are measured by a liver function test, but not all). So, I came home again, quite relieved to have escaped the dreaded OC, but still desperately itchy.

The shit finally hit the fan at my 36-week check. My blood pressure was through the roof (something like 130 over 100). My GP checked it three times, just to make sure, before sending me to the hospital for what she called ‘monitoring.’ Poor, naive me went home to collect my laptop and assignment notes first, imagining I would be there for a few hours (being ‘monitored’) before coming home. I didn’t even know, as I left home, that I would have my baby in my arms when I returned.

In the end, the laptop was fairly useless. My ‘monitoring’ took place in the birthing suite (the ‘monitoring’ department was full), and so I got to listen to the shockingly non-hypothetical bellows of a real, live woman in labour. Luckily, my sister had decided to come for moral support. We both sat there, completely stunned, thinking Gosh that’s me/her in a few more weeks! We were there for hours without learning anything about what I was doing there or when I could go home (I have since learnt that you have to ask, and keep on asking), before, in typical hospital fashion, a midwife burst in and abruptly dropped the bombshell that I was being admitted with Pre-eclampsia and Obstetric Cholestasis. The Ha! I was right! was not so satisfying.

I was shipped upstairs to the antenatal ward. I called all and sundry and let them know of my predicament. My husband came with clothes (for me – we still had no idea that we were going to be parents within days). He kept me company for a couple of hours before being kicked out at 8pm. I felt so frightened and alone after he left. I was completely overwhelmed. Suddenly, everything was so very, very real. I was plied with medications that would hopefully bring my blood pressure down. Interestingly, nobody bothered to start me on any medication for OC until a lovely (male) nurse noticed how much agony I was in, with my constant itching during the night, and brought it to the doctor’s attention first thing in the morning. I was subjected to two-hourly blood pressure checks, around the clock. Two-hourly! The minute I finally drifted off to sleep I was being woken again for yet another check. I was told to collect every drop of pee that issued from my body and tip it into a big plastic bottle with my name on it. When I had to move beds two days later, I also suffered the indignity of having to carry my bottle of piss to my new room, only to be told, Oh, we don’t need that anymore.

It is truly amazing how little information you are told about yourself when you are a patient in a hospital. How little you are to be trusted. How little you are consulted about decisions that directly concern you, and your body.

It is also truly amazing to think of myself as I was back then. It was less than four years ago, but I am looking back at that scared, naive 23-year-old in an almost maternal way. I want to comfort her and tell her that everything will be okay, and that she will grow from this experience in so many, immeasurable ways.

After two days in the antenatal ward, it was decided that the best option was for me to have this baby very soon. Tomorrow, in fact. Oh my God! I was excited (to meet my baby, and end this ordeal) and terrified at the same time. An internal examination declared my cervix to be an already very favourable 3cm dilated (yay me?), so I was booked in for induction first thing in the morning, and told to get a good night’s sleep. Yeah, right. There are many things you take for granted when pregnant, and one of them is that nine months is plenty of time to get your shit together for a baby. We had bought all the stuff but hadn’t built/assembled/installed/washed any of it yet! We hadn’t even got all of the junk out of what was supposed to be the baby’s room. That’s what we had planned to do with our ninth month. I think I really missed out on an important step in preparing for the baby, the ‘nesting’ stage. Instead, Tom, his brother and (future) sister-in-law, and my mum did my nesting for me, while I was still in hospital after the baby was born.

So, on the night before officially becoming a ‘mother’, there I was, worrying about what kind of omen it is when a baby doesn’t even have somewhere to sleep, or clothes to wear. I also remember worrying about the fact that my baby was going to be born prematurely (at 36 weeks and 3 days), and what that would mean for his health. Would he be able to breathe? Feed? Would he have to be in an incubator? Despite the obstetrician’s assurances that my baby would most likely be completely fine, I was still extremely nervous, and was dreading the possibility that he may not be able to stay with me after the birth.

I can’t really explain pregnancy number 3… I knew I wanted one more child, but after 2 pregnancies affected by cholestasis, I was certain that I would get it again, and was terrified of having another baby at 31 weeks, or possibly even earlier. I am sure that having the two pregnancies so close together, and also the amount of stress I was under during the second pregnancy (due to uni work), were contributing factors to the severity of my problems with Molly, even though there is no conclusive evidence to suggest either theory. At the same time, I think I sort of liked the idea of another pregnancy, as a chance to get things ‘right’ – I was still grieving for those last precious weeks that I missed of having Molly growing inside me: feeling her movements, bonding with her, getting excited about, and preparing for her birth. So I put off thinking too much about contraception, and… well, obviously Tom and I are too fertile for our own good!

If people thought I was crazy for having 2 under 2, I don’t know what they thought when I grudgingly admitted I was having 3 under 3! Tom was absolutely not impressed. The poor guy was just getting used to having two, and wasn’t even convinced about having a third one ever. But to his credit, he eventually got over the shock and even managed to get a bit excited by the whole thing, towards the end of the pregnancy. He is a fantastic father and he works very hard to support us, and we are lucky to have him!

So, pregnancy number 3 was completely terrifying – I was convinced I was going to have this baby at 28 weeks, and was determined to do everything in my power to prevent it. I decided to try to be as stress-free as possible, and so didn’t work after the first few months. Life with two toddlers was stressful enough already, so casual teaching in Mt Druitt a couple of days a week was not hard to give up! (I also decided that during this ‘time off’ I should take up some further study to increase my chances of securing permanent part-time work when I returned to teaching – needless to say, it didn’t work out!)  

I committed myself to monthly blood tests, which became weekly later on, regular obstetrician visits, and two very expensive, but worthwhile, trips to a gastroenterologist, who put me on medication prophylactically when the obstetrician would not. Things went relatively well until 34 weeks when I spent a few days in hospital with elevated blood results, but, thanks to the medication I was already on, this settled and I was allowed to go home, with induction booked at 35 weeks. I felt incredibly relieved to have got so far, but I also knew that every extra week, or even day, was precious, and could mean the difference between spending time in the NICU and not. At this point I was visiting the hospital every few days for monitoring, and after continued good blood test results, the induction was postponed for two more weeks. I began to entertain thoughts of actually going to full-term and possibly even experiencing a spontaneous labour (both Molly and Tiernan were induced). However, I was also at the same time beginning to feel completely over being pregnant – especially when it came to running around after the other two, picking them up and bending down to change their nappies, etc. With a lack of sleep also thrown in, I was completely exhausted!

As it turns out, I didn’t have to wait much longer – after a slight rise in some blood test results, my obstetrician called game over. To be honest, I was relieved – I had got to 37 weeks (considered ‘full term’) and no longer cared about waiting for spontaneous labour – overrated if you ask me! Precious Neave was born on 16th April, 2010, and she was absolutely perfect.

We went home 24 hours after her birth, and got settled in at home quite quickly. My pregnancy with Neave was a valuable lesson in self-advocacy, as I believe that if it hadn’t been for my persistence in asking for the treatment I needed, then Neave could easily have been born at 34 weeks, if not earlier.