Labour in the Delivery Unit at Addenbrookes: My Story

You join me roughly halfway through my labour, after my planned water birth was thrown out of the window and replaced with the bright lights of the delivery unit, and approximately 20 hours in. You can read Part 1 here.

I have been rushed upstairs in a hurry, but a quick heart rate check puts everyone at ease that despite his slow progress, my son is still blissed out inside and in no immediate danger. And so the waiting continues…

To epidural or not to epidural?

You’ve probably guessed by now that the birth plan wasn’t keen on an epidural! I’d become very hung up on avoiding a potential of cascade of interventions and I was adamant I did not want to be stuck on my back in a bed.

But at around 4am, the midwife turns to me and asks if I’ve thought about having an epidural.

Despite the sleep-deprivation and exhaustion, something in my brain (probably my misplaced pride demanding I be tough) has a bit of a hissy fit – I insist I neither want nor need one.

She gives me a look.

At the rate I’m going, it will be another 16 hours before I even get to 10cm, she says, and since I have not kept any food or water down in over 24 hours, nor slept more than a couple of hours in the last 48, she is concerned I will not have the energy left to push my baby out when the time finally arrives. I feel a little bit like a naughty schoolgirl being told off.

What is an epidural?An epidural is a form of pain relief that works by delivering anaesthetic directly into the fluid around your spinal cord (in an area known as the epidural space) – this prevents pain signals from travelling to the brain. As a result, you cannot feel anything below your waist.The procedure itself is not very painful – the anaesthetist numbs the area before inserting the epidural needle – and once the epidural catheter is in place, you may even be given a small control which will allow you to determine how much pain relief to use. You will also need to have a pair of belts wrapped around your belly to monitor the baby’s heartbeat and your contractions.Epidurals get quite a bad press in some circles – as with any medical procedure, there is a small risk involved (for example, if the needle delivering the anaesthetic hits a nerve instead) and they also mean you need to remain on your back for the duration of your epidural as you cannot stand or move around. This has its own implications as it is not an optimal position for your baby to descend. They can also extend the length of your labour, as you may not be able to feel your contractions to push effectively. That’s why epidurals are part of the infamous “cascade of interventions” which make instrumental deliveries and c-sections more likely.However, they do have a useful role to play in a situation where a woman has been in extended labour and needs to be able to rest to have any chance of a vaginal birth.

It is my decision, the midwife says, and she cannot advise me to have an epidural, nor offer it to me unless I ask for it, but I should consider the situation.

I look at this woman who has worked on the delivery unit for decades, seen hundreds, thousands of babies arrive in the world, a woman who has experience of this situation which I could only dream of, and I ask her: “what would you do?”

“I would have the epidural, get some rest, and be ready to give it your everything when it’s time to meet your son.”

I have the epidural.

A waiting game

As the anaesthesia enters my system, it’s a really odd sensation. The numbness hits my back first, and then spreads around my body to my tummy, but in the time between I am able to feel my actual contractions for the first time.

For the preceding 24 hours, my back labour has been so severe that I have had no perception of the tightening and release at the front at all, then for those brief moments I know what it is like to feel conventional labour contractions. And then the anaesthesia continues it’s journey through my body and I can feel nothing at all. I look around the delivery suite and for the first time am able to appreciate the surrealness of the situation.

At this point, I also lose the TENS machine – it’s hardly needed any more now there’s no pain to distract me from.

It’s replaced instead with a pair of rather fashionable belts that monitor the strength of my contractions, and check my boy’s heartbeat to make sure he’s all a-ok.

I also gain a little device to top up my epidural at will, although apparently it has some sort of cap so that it will only dish out so many hits in any given period of time. Initially I’m worried that this is like the scenes in the movies where patients are crying out for more pain relief, but it’s apparent fairly quickly that the anaesthetist has done a stellar job and I probably woudn’t feel a thing if I were hit by a double-decker bus.

I spend the next 8 hours or so tapping this little button, knowing each tap brings my son that little bit closer to me. The midwife had suggested I might get a little sleep, but nature has other ideas, so instead I respond to messages from friends asking me if there’s any sign of the little man yet, unaware that in fact we’re right in the middle of his arrival.

They seem surprised that I can text during labour, but of course the intensity has dialled back now that I can’t feel what is going on! It seems a bit odd to say so, but here I am in the middle of labour and I’m actually a bit bored!

Tell me those magic words: 10cm dilated!

A new day brings with it a third midwife and a new supporting cast of assistants too. One of them checks the print-out from my contraction monitoring and suggests that my hormone drip might need turning down. Cue confusion as the midwife checks the charts and assorted wires that surround the bed.

“She’s not on a hormone drip, that’s just her natural contractions.” Always good to hear your contractions are so strong that if they had been artifically induced they’d be turning them down! Although, definitely preferable to hear that once you can’t feel them!

Just after lunchtime…except I’m not allowed any lunch – by this point I’m pretty ravenous, but since my waters were popped and I had to be whizzed up to the delivery unit, I’ve apparently become high risk. That means the clock is ticking and they don’t want me to eat “just in case” I need surgery. So Phil eats and I stare at him in ravenous jealousy.

So yes, just after’s Phil’s lunchtime, the midwife does another check and says those magic words: “10 centimetres!”

I can’t believe it – it’s finally time to push!

Except it’s not.

I am advised that since I’ve had an epidural, it’s actually best to give the baby an hour or so to descend naturally, without exhausting me too much, before I try to give him a bit of a helping hand. And so we wait again. Hey, it’s been nine months, what’s another hour?

Action stations

The clock ticks around another 60 minutes, and finally we’re ready. Phil is by my side, the midwife stands alert, and I am psyching myself up for what I assume will be one of the hardest experiences of my life. There are even a few bonus medical professionals hovering just outside (my room on the delivery unit isn’t the biggest!) just in case they’re needed. Push hard and smoothly for 10 seconds, then rest, the midwife advises.

I push.

It’s an incredibly weird sensation, pushing with all your might, yet unable to feel a thing. Expelling all that effort, but no sensation if it’s making any difference whatsoever.

I push again, and the midwife smiles: “I can feel his head!” At last, my boy is within touching distance, quite literally! After all the setbacks of the last day and a bit, something is finally going right.

Then her brow furrows.

She tells us that she doesn’t mean to worry us, but she would like to get a second opinion – it doesn’t feel like our baby has his head in the right position. In comes the consultant and he and the midwife take turns at checking the baby’s head.

Not the most dignified moment of my life.

A minor complication

The upshot is, our son has not tucked his head to his chest as in a typical birth and instead has his neck slightly extended. It’s known as “brow presentation”. Essentially, instead of descending with the top of his head, it’s more like his forehead that is emerging first. And that means that instead of presenting the nice, small circular surface area of the top of his head which should fit smoothly through the pelvis, he is instead offering a much larger oval surface area which is a much tighter squeeze. Yikes.

It’s a very rare complication, affecting around 1 in 1,400 births.

It also causes inconsistent pressure on the cervix, which explains why I was having contractions consistent with the late stages of labour, while not even registering 4cm in dilation. Essentially each contraction was pushing him forwards, but then the positioning meant that he was just reversing straight back where he’d come from as soon as the pressure of the contraction eased. No wonder it has taken this long to get him even halfway descended.

The consultant says that as the baby isn’t distressed, he’s happy for me to continue pushing for an hour or so to see if I can make some progress, before heading off to the next room on the delivery unit to check in on another labouring mother. So there I am, once again in the capable hands of the midwife, with another clock ticking.

Join me next time to find out how that goes, and for the grand finale!