June 16, 2016
Waiting For Baby Jacob
By Rachel O’Neill
My baby arrived 23 days past my ‘due date.’ Although you don’t hear about these ‘prolonged pregnancies’ that often, let me tell you there’s a whole community of 10- month mamas out there!
This is our story…
My due date was 23rd April 2015. I knew this was fairly accurate because I knew exactly when we had conceived and like most first time parents we focused on this date as being ‘D Day’ and were naturally a bit disappointed when the 23rd came and went without so much as a tingle. I’d had a really healthy and straightforward pregnancy, I’d felt really good in myself and was enjoying the experience of growing this little baby and all that comes with that. My partner Giles, and I had done A LOT of preparation for all that was to come, or so we thought! We had decided early on in my pregnancy that we wanted to have as natural and as sensitive a birth as possible. We opted for a home, water birth and made plans to make it a really special experience. We took a Hypnobirthing course, which we both really embraced; I would listen to my meditation and affirmation CD religiously as I drifted off to sleep each night and we would practise some of the relaxation exercises together in the evenings, which was more amusing then we think it was meant to be! We had written out a clear birth plan so the midwife who would attend our birth would know exactly what we wanted to achieve, which in essence, was a quiet, relaxed, natural birth, supported by people who recognised and respected the sensitivity of this little being and the importance of this moment for our family. It’s hard to describe now, but we really felt a sense of total trust in my body, our baby and us as a couple to birth this baby successfully, whenever that may be, avoiding any unnecessary medical intervention.
Now, I never really expected my baby to arrive on my due date. I had heard that only about 5% of babies arrive bang on time so I knew the chances were pretty slim. But nevertheless we never imagined that our baby would take so very long to come, and it certainly wasn’t something we had really prepared ourselves for. I remember my midwife at my 38 week appointment saying I could have a cervical sweep if I wanted, I confidently declined, as I felt sure that my baby would come when he was ready. At my 40 week check up I was offered a sweep again, again I declined and my midwife started saying she would book an induction for 10 days’ time. I immediately felt a sense of panic and powerlessness as her manner implied that this was the process and I was expected to go along with it. Giles and I had already agreed that we did not want to be induced unless there was a medical need for it and so far there was no indication that there was anything wrong with my baby or me, so we declined to get an induction booked – which did throw the midwife a little.
“At no point did the medical staff that we encountered present the induction as a choice… and this really unsettled us.”
We saw her a week later, and she referred us to the Day Unit at the hospital as now I was considered a ‘high risk’ case even though nothing had actually changed other than the fact I hadn’t given birth yet (at this point I was just 7 days beyond my due date). It’s worth noting here that full term in the UK is considered 40 weeks, but in some European countries it is 41 weeks, so had I been elsewhere in Europe I’d just be hitting my due date. Both NICE Antenatal Care Guideline (NCCWCH, 2008) and the Induction of Labour Guideline (NICE, 2008) recommend that women in the UK with uncomplicated pregnancies should be offered an induction of labour (IOL) between 41+ and 42+ weeks to avoid the risk of prolonged pregnancy (anything past 42 weeks’ gestation). Now the wording here is important: women should be ‘offered’, and at no point did the medical staff that we encountered present the induction as a choice, but more of a case of “this is what is going to happen” and this really unsettled us. If we had a pound for every time someone said to us – ‘oh they won’t let you go much further’ or something of that nature we’d be very rich. It really frustrated us that medical staff and people in general seemed to be under the impression that my body was not my own and that it was in the hands of the hospital. People seem to genuinely believe that you are obliged to accept major medical interventions and that you have no say in the matter – which is both scary and not true.
“Whilst a number of maternal and neonatal risks are thought to be associated with post-term deliveries, there is little evidence to substantiate these.”
As a ‘high risk’ case we were now under consultant-led care, so we went in on 5th May for CTG monitoring, which showed that the baby was alive and well. A consultant spoke to us about the risks of declining an induction in a very threatening kind of way. I can’t recall the words she used exactly now, but she pretty much asked us if we wanted our baby to die! Which of course was not in any way our goal. We asked her for the evidence base for her recommendation that we should agree to an induction and she told us she could not give us the exact figures, as she couldn’t remember everything!!! Needless to say we were pretty astounded at this point by the consultant’s approach to us. At no point during her discussions with us did she share information about the risks associated with induction of labour. The Royal College of Obstetricians and Gynaecologists (RCOG) says that whilst a number of maternal and neonatal risks are thought to be associated with post-term deliveries, there is little evidence to substantiate these and women should be given information to ensure they fully understand the choices they are making regarding accepting/declining IOL. We happily agreed to regular CTG monitoring (every other day) and a scan was arranged for two days later to check the baby’s growth, blood flow and placental functioning. It was important to have all the information we could get to make an informed choice, and knowing how our baby was doing would obviously help us to make the best decision.
“We knew that for as many risks of not being induced there were an equal number of risks associated with being induced.”
During this time, Giles and I armed ourselves with lots of research and facts in order to inform our decision making. We weren’t declining induction to be difficult; we were declining because we truly believed that it was not the right thing for our baby and us, based on the fact that we were all fit and well. We knew that for as many risks of not being induced there were an equal number of risks associated with being induced. From our own research we understood that stillbirth is the primary reason for IOL, but that at 41 weeks gestation the evidence supporting a policy of IOL is unclear. The National Institute of Clinical Excellence Guidelines (NICE, 2008) acknowledge that an arbitrary time limit has been suggested because it is unknown when it is better to induce than to leave the foetus in the womb. Exactly who is at risk is also unknown, therefore NICE recommend a blanket policy of IOL for all women. We also understood that the risk of stillbirth does increase for post term pregnancies but the ‘the absolute risk of perinatal death is small’ (Gülmezoglu et al., 2012 p.2).
We also carefully balanced that small risk against the known risks of induction:
- IOL (Induction of Labour) has an impact on the birth experience of women
- IOL is usually more painful than spontaneous labour
- IOL may be less efficient
- Epidural analgesia and assisted delivery are more likely to be required • IOL (dependent on method) may cause uterine hyper-stimulation, uterine rupture, foetal distress or cord prolapsed
- When labour was induced using pharmacological methods (whether or not surgical induction was also attempted) less than two thirds of women gave birth without further intervention, with about 15% having instrumental births and 22% having emergency Caesarean sections
- In the event of failed IOL Caesarean will be discussed (NICE, 2008)
An induced labour normally means that continuous foetal monitoring is required which itself increases the risk of a Caesarean and assisted births. IOL risks forcing the body into something it is not ready to do, due to the complex hormonal interaction that primes the mother’s body and cervix. IOL may cause additional problems, including prematurity and lack of full uterine maturity. The NICE Guidelines (2008) acknowledge the risks of IOL as listed above and state that women should be informed of those risks, but not one of the consultants that recommended induction went through these risks with us. May 7th came and the monitoring and scan showed that all was well, and there was no sign of deterioration of my placenta. It also showed that our baby boy had a lot of hair! We spoke to another consultant who was much more balanced in his views, although he recommended that we now have a hospital birth as we were ‘high risk’ even though still nothing had changed. We advised we were still intending on a home birth – midwives have a duty to be present at a birth wherever the mother chooses to birth her baby so we knew that they could not refuse our home birth while this was our wish. He was satisfied that we were making an informed choice and that at that time the baby was well so there was no medical need for an induction.
“We definitely felt the heavy weight of taking these decisions into our own hands, and it would have been so much easier for us to have blindly accepted the induction… but we are so glad that we trusted ourselves.”
We continued with regular monitoring and during the days that passed I did everything known to man to help induce labour naturally. I ate all sorts of curries. about 94 pineapples, went for bumpy drives, and even did the thing that got us into this situation in the first place! I had several sessions of acupuncture, reflexology, I meditated like I’ve never meditated before and walked miles upon miles with still no success. I did begin to wonder if my baby would ever come out. Certainly as the days went on doubt began to creep in, and I worried if I was endangering my baby’s life, but Giles and I spoke so much about it and deep down we both truly believed our baby would come when he was ready and that forcing him out before that time was more detrimental to him. It’s fair to say that we definitely felt the heavy weight of taking these decisions into our own hands, and it would have been so much easier for us to have blindly accepted the induction that nearly got booked at that 40-week appointment, but we are so glad that we trusted ourselves.
I did finally accept a membrane sweep on 11th May (18 days overdue) as that felt the least invasive of all the options that were available to us at that point. It wasn’t very successful so I had a second one two days later. By this point Giles and I had put a time limit on the situation ourselves and had booked an induction for 16th May. We booked at Brighton and if our baby didn’t make an appearance before then, then we would reluctantly go in to be induced, something I so desperately wanted to avoid.
“I did feel terribly upset that things seemed to be going so wrong and began to wonder if all this time… had been a waste.”
Thankfully (or so I thought) my waters broke at midnight on Wednesday 13th May. I went back in on the next day to be monitored and have another scan; both reported that all was still well with our baby. I was having very inconsistent contractions, there was no regular pattern and by Friday afternoon they had stopped altogether. By this point because my waters had broken and the risk of infection was now present we had agreed to abandon our plan for a home birth and said that we would go into hospital for the birth whatever was to happen. I felt really sad about this, but knew that it was the safest option for our baby. Once the contractions had stopped I had accepted that induction was inevitable and we were due to arrive at Brighton for 9 am. I did feel terribly upset that things seemed to be going so wrong and began to wonder if all this time (23 days by now) had been a waste, but Giles was amazing and he helped me work it through so that I was able to accept and embrace the way things where unfolding. I can’t remember exactly what Giles said now, but I knew that he was with me 100% however it would play out and that felt so amazing that I was able to immediately relax and then surprise, surprise my contractions kicked in. Again they were still quite irregular. I couldn’t get comfy in bed as I was in a bit of pain so decided to have a bath in the middle of the night, Giles said he would use that time to get some sleep. To be fair, neither of us had slept properly since my waters broke as contractions had been on and off for the past two days. My contractions were so irregular I had even given up on timing them. Being in the bath really helped with the pain, and my contractions began to quicken when suddenly I started to push. Giles shot downstairs as he heard me, as he calls it, ‘mooing’. He couldn’t believe it when I said I needed to push. He called the maternity unit who advised him to ring an ambulance and they said they’d send a midwife.
The ambulance men were amazing and it was reassuring to know one had delivered a few babies including his own. The midwife turned up and did an examination and to our shock reported that I was fully dilated (hypnobirthing really works!), but she was concerned as she could not tell which way the baby was facing. I think she thought he was breech but I knew he wasn’t as we’d had the scan the day before. So she thought then he must be face presentation – I didn’t even know that was a possibility let alone a problem. Apparently depending on which way they are facing you may need a Caesarean. So we were transferred by ambulance for a consultant to check our baby’s positioning.
“It is important to us that more research is done into the risks vs benefits of prolonged pregnancies.”
We ended up in Hastings, and within a few minutes the consultant did her checks and confirmed he was face presentation but back to back which meant that it was safe to deliver him naturally. By this point I’d had enough and all my natural birth wishes went out the window and I was like ‘just pull him out’, but the staff were amazing and told me I could do it myself, and I did with the support of Giles and a LOT of gas and air. Jacob Valentine James was born safe and well at 3:59 am on Saturday 16th May 2015, weighing 7lb 7oz (the last scan I had predicted that he weighed over 9lbs), 23 days past his due date! He was utterly perfect, although admittedly he looked like he’d done ten rounds with Mike Tyson as due to the face presentation he had lots of swelling and bruising, but this rapidly disappeared. Staff thought that the delay of my labour could have been due to the fact that he was face presentation but they don’t know that for sure. Jacob was monitored for 24 hours in hospital for signs of infection, but was totally fine so he didn’t need any antibiotics in the end (there was no time for me to have them during labour).
The consultant was so amazed that he was born healthy despite being so overdue that she asked our permission to write a journal article about our case, which we readily agreed to, as it is important to us that more research is done into the risks vs benefits of prolonged pregnancies. Although the birth we had was not at all how we planned, in a funny kind of way the essence of the experience is exactly how we planned – the bottom line for Giles and me was that we felt in control, informed and part of the decision making. While we had to assert our rights at different points in the journey, by the 3rd time we’d been in for monitoring staff were able to see that we were making informed decisions that we felt best for our situation.
As I’ve already said it wasn’t that doubt didn’t come into it, but somewhere deep inside I knew that my body was built to do this and that my baby instinctively knew how to be born, and that those two things with the unwavering love and support from Giles would allow things to unfold in the way they were always meant to.
Gülmezoglu, A.M., Crowther, C.A., Middleton, P, and Heatley, E. 2014. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev. ; 6: CD004945. doi:10.1002/14651858.CD004945.pub3.
By Rachel O’Neill My baby arrived 23 days past my ‘due date.’ Although you don’t hear about these ‘prolonged pregnancies’ that often, let me tell you there’s a whole community of 10- month mamas out there! This is our story… My due date was 23rd April 2015. I knew this was fairly accurate because I […]