Emergency Caesarean
after spontaneous rupture of membranes (SROM) and 40 hour labour ordeal
by Clare Perriss –
Weymouth & Dorchester NCT
My birth story begins with being diagnosed with gestational
diabetes at 34 weeks. I was referred to an Obstetrician specialising in
gestational diabetes, and she was really great. I voiced my concerns and my
preference for a natural birth and she was able to tell me what she honestly
thought the risks were in our personal situation, and from there we made a
plan.
Instead of the stock standard, "We'll induce you at 38
weeks," she compromised and said that she would like me booked in for
induction at 39 weeks. I spoke to her about wanting to do what was possible to
get my body prepared prior to induction so that I was given every chance that
my baby would come without needing induction. A series of stretch and sweeps
were scheduled leading up to the induction date. I also made arrangements to
have some reflexology and moxibustion done around these dates.
I had my first session of reflexology/moxibustion just
before 38 weeks, and it was wonderful - very relaxing, and I was given a moxa
stick that I used at home also. I had my first stretch and sweep a couple of
days later, at 38 weeks 1 day. The midwife came out with a show, and said she
thought the cervix was quite soft, I was 1cm dilated and the baby was starting
to engage. I was so excited! I thought that this could mean that my body and my
baby were really getting ready to go and we would be able to avoid induction.
That night, I started having more painful tightenings when I went to bed, and a
few woke me up at night. However, they had stopped by morning.
My next stretch and sweep was at 38 weeks 4 days. The
midwife informed me that I was 1-2cm dilated, and that things were looking very
good. She came away with a good show, which continued during the day but
stopped by the evening. I was very excited, and I said to my husband Stephen
that I thought something might happen overnight. The next morning, 16th
December, I woke up at about 7.15am to a very strong tightening, and feeling
warmth on the sheets. I immediately knew what had happened - my waters had
broken! I jolted out of bed as fast as was possible at 38+ weeks pregnant to
avoid staining the bed too badly, and waddled over to the loo with my legs
closed tight, leaving a dripping trail behind me!
I called the midwives at the hospital who said to come in
and be monitored. Stephen helped me get ready, and off we went, a 45 minute
drive to the hospital. I was a little nervous, but there was a calm about me as
I knew this was it. Our baby was finally going to be here with us before too
long. Stephen was calm, but I could tell he was nervous also.
I brought a number of towels and sat on these in the car,
although it seemed that sitting down was the one thing that stopped the flow!
By the time we arrived at the hospital, I had completely soaked through my
tracksuit pants, and walking to the maternity ward only made matters worse. I
arrived in maternity very clearly showing that my waters had broken, with dark
patches almost down to my ankles! I was put on the montitor, and baby was doing
very well.
I changed my tracksuit pants, and as the morning went on I
continued to have irregular tightenings, some quite painful, others barely at
all. Each time I had a tightening, a heap more fluid would leak, so I ended up
going through another 3 pairs of underwear, a packet of maternity pads, and
another pair of tracksuit pants! Stephen went into town to buy me some more, as
I think he felt like he needed to do something. He came back with pyjamas,
tracksuit pants, and even a new pair of lovely slippers!!
I spent a lot of that day walking briskly around the
maternity ward and leaning on all fours over a chair, trying to help things
along. I was excited and frustrated by equal measure, as I really thought
things would have kicked off by that point. By afternoon, nothing was happening
aside from the irregular tightenings, so a consultant came to talk to me.
I made sure they were aware that I wanted to give my body
and baby a chance to start things naturally, and the consultant was pleased and
happy for me to continue as I was, up to 72 hours after my membranes ruptured
to avoid the risk of infection. We made a decision to stay in hospital at that
point, as it was a long drive home and back again - I felt quite calm and safe
in the hospital, having spent a bit of time there for tests and scans
associated with the diabetes.
I asked to have the monitor put on that evening just so I could
hear baby's heartrate for some reassurance before bed, and at about 8.30pm I
was hooked up, and I settled down to listen to our baby for a while. After
about 10-15 minutes where I had a couple of moderate tightening, as I’d had on
and off all day, I suddenly got the most painful, prolonged contraction that
lasted almost two minutes from start to end. It had me really groaning, and the
midwife heard me from the next bed and came to check on me.
As she did, the monitor started beeping, and our baby's heartrate
couldn't be picked up. She tried to find it, and eventually did on the other
side of my stomach and it was very low. Panic stations. She pressed the buzzer
and about six people came running in. I was a bit shellshocked and wondered
what was happening. My baby's heartrate recovered, and everything settled down,
but I was moved very quickly to a labour room and set up on the monitor in the
new room.
Stephen had gone home for the night at about 7.00pm as
nothing seemed imminent, but he was called back in as there were thoughts about
whether our baby would need to be born quickly. He arrived around 10.30pm. Our
baby had done a complete twist during that full-on contraction and we realised
by the next morning she had moved posterior, with her back completely on the
opposite side of my body to where it had been.
I was kept on the monitor for quite a while. Everything with
baby went back to normal with her heartrate and eventually I was taken off the
monitor. From that first initial very strong contraction at 8.30pm, every
contraction I experienced after that was strong and I would need to breathe
heavily through many of them. They were not coming anymore regularly than 6-7
minutes apart, so Stephen was advised to go get some rest, as was I.
Stephen went to his parents’ house at about 12.30am for some
sleep as it was much closer than going home again. I had a very restless night
as I was having hard contractions every 5-6 minutes that I often needed to get
on all fours for, or lean over the bed - sitting in the chair or lying down was
very uncomfortable. I could not sleep for more than a few minutes between
contractions here and there. It was also proving very difficult to monitor the
baby on and off overnight as it had moved into this posterior position and it
was hard to keep track of its heartbeat consistently.
At about 5.30am it was suggested that an internal
examination be done to see how things were going and to place a scalp monitor
on. The internal showed I was 3cm dilated and only 70% effaced, so there was a
long way to go, and the scalp monitor was placed but unfortunately wasn't
giving any reading.
Stephen arrived at about 9.30am and I was still in early
labour, still only having about 2 contractions in every 10 minutes or so. They
were painful, and I was tired, but felt encouraged by the internal I had early
in the morning. As the day went on, my contractions did not get any more
frequent, but remained very painful. In fact, at times they would stop all
together, particularly when I was moving about and not resting. Another
internal showed that I was still 3cm dilated and not fully effaced. I was trying
to relax, but was finding it more and more difficult.
By late morning the midwife who was looking after me started
mentioning augmentation via a drip, as a different consultant who had seen me
that morning was concerned about infection becoming a possibility as time went
on. It had been more than 24 hours since my waters broke and active labour
showed no signs of starting. I had a lengthy discussion about the pros and cons
of going on the drip with the midwife and decided that if I hadn't made any more
progress in a couple of hours that I would think about it properly. I had been
sitting on a birth ball for hours, and at about midday an anaesthetist came in
to insert a drip into my arm to give me some antibiotics and have everything
prepared in case of induction.
In the meantime I had requested a TENS machine earlier in
the morning as my contractions were getting progressively more and more
painful. I was groaning through all of them, often rocking on the birth ball.
If I moved around or got up and walked the contractions would stop until I was
sitting back down again, except when I went to toilet and as soon as I sat down
on the loo, I would have an awfully strong one!
I had not been allowed to eat breakfast, so I had not had
any food since dinner the night before, and I asked to have some food and a
shower to try and perk me up a little. The drip was taken off, TENS was
unhooked, as well as the monitor and I had a shower after having a bite to eat.
I thought it would help with the pain, but as soon as I was moving again the
contractions stopped. The shower was lovely though - I felt refreshed.
I was hooked up again and I had another internal at 2pm, and
this time I felt really disillusioned. I was still at exactly the same place as
I had been at 5.30am. A new midwife shift had started and a wonderful,
professional but sensitive and soft-spoken midwife was assigned to me. I voiced
my concerns about augmentation again, and my fears about how painful it was
going to get as I was already finding the contractions in non-established
labour so painful. I wanted to do everything I could to avoid pain relief.
The midwife explained that the syntocinon would not make
things more painful than they would get naturally in a progressed labour, it
would just ramp up the intensity of how quickly they would get more painful.
This made sense to me, even though I was really frightened of how much pain I
could bare. At this point though, with her guidance and knowing that this
midwife would look after me I agreed to go on the drip and everything was set
up.
It took about an hour or so, but the contractions started to
come on more frequently as the dose was slowly increased. I could not sit on
the bed anymore, and moved back to the birthing ball, swinging around or leaning
up against the bed with my elbows and head on my arms, bouncing away. I
requested gas and air as the intensity increased. It took a few goes, but I got
the hang of the gas and air quite quickly.
Eventually, I could not sit any longer through contractions
and I started standing through them, swaying my hips and getting quite vocal!
The gas and air like made me feel extremely ‘drunk’ which took me away from the
pain and gave me some hallucinations at first. My awareness of time was going
as I started to lose myself in the pain, being detached from it when the
affects of the gas wore off. Stephen and the midwife were helping me to breathe
deeply. I don't have much recollection of this at all.
The next thing I was aware of, I was on the bed having an
internal with the midwife was trying to get me to focus on her and telling me
"Clare, you're still only 3cm dilated". I was absolutely devastated.
Even though I have very little memory of the time leading up to the internal, I
do remember how much I was focusing and continuing to think this whole time,
"Each contraction is dilating me and helping my baby to come. I can go
through this as I am getting closer each time". And to find out that all
the time on the drip had been for nothing and that I was going nowhere was the
worst thing possible. I felt completely beaten. I think I was pretty desperate
at this point, as I know I was convinced it was going to end with a caesarean,
and I was asking for an epidural. Stephen tells me I was yelling a fair bit!
After my epidural was administered the midwife turned the
syntocinon down as I was having contraction after contraction without pause,
and it was too full on. As the contractions dropped in frequency I started to
regain my awareness as I was having breaks in between using the gas and air. A
consultant came to talk to me and said that we would give it another two hours
to see what was going to happen, and then we would need to talk about the next
option.
I started to feel less pain as the epidural took effect, but
realised that it was only working on one side quite quickly. Still, it was much
better than it had been - the pain was much more tolerable as it was taken away
by half! I was tilted over to try and see if the drug would balance on the
other side, but it did nothing. I had gone back to having about four
contractions in 10 minutes, which seemed much more manageable than before.
The time until the consultant came back went by quickly,
with a new midwife seeing to me, and when the consultant did an internal at
9.30pm she said I was 3-4cm dilated and she tried to attach another scalp
monitor for the fourth time. I was exhausted and not taking things on board so
well now. I was extremely emotional, I was still no further. We talked about
caesarean and the consultant was very kind – I remember her taking my hand and
saying to me, "Clare, you have done everything you possibly could to bring
your baby into the world, now we need to give you a hand to finish it off. You
should be so proud of how much you have done to this point." It helped me
regain my composure, and we prepared for a caesarean and it was like a load was
lifted from my shoulders.
The epidural was switched off, as well as the syntocinon and
I shakily signed a consent form and we were off. Stephen held my hand until he
had to get dressed up, and I was wheeled into theatre. The anaesthetist was so
very kind and gentle, he said that he was going to replace the epidural with a
spinal block and he was sorry that it had not worked correctly to begin with. I
was crouched over for the second time, trying to stay still during my
contractions (my own natural contractions were now very full on even with the
syntocinon and epidural gone). Once the spinal block was in, it was like the
sweetest relief I have ever felt. I felt no more contractions, after 26 hours
of pain amounting to nothing and 40 hours since my waters first broke.
Stephen was seated at my head, never letting my hand go and
the fear of what it would feel like to be cut open was quickly abated when it
was all happening and I realised I could feel nothing. Before long - such a
short time! – our baby was hoisted above the curtain at 10.46pm on Wednesday
17th December and Stephen and I saw her for the first time, all squishy-faced
and red! It was a miracle!
Our baby was taken by the midwives and cleaned a little and
wrapped before quickly being placed in Stephen's arms. He found out her sex for
himself as we asked no one to tell us, and she made her first sounds in his
arms – the sweetest most incredible sounds ever. We named her Emily Acacia
there and then. The world narrowed down to myself, Stephen and our baby, and it
was the most special, intimate and amazing experience of my life, all in front
of a dozen busy people. I turned to my anaesthetist and said, "Thank you
for looking after me" and he smiled so kindly. Everything was perfect.
The time for me to be stitched up went so fast. Before long
I had my baby on my chest as I was being wheeled back to my room, and I made
the biggest effort with a midwife pushing on my feet upwards to try and lever
myself upright whilst still under the effect of the spinal block so I could let
Emily attach to my breast. I was so determined, and we did it. The three of us
were then left in private and our daughter and I had skin to skin contact for
about 4 or 5 hours as I would not let her go. Stephen took lots of photos
before he left to sleep at his parents’ again, at about 2.30am.
It turns out that Emily's neck was flexed - probably when
she maneuvered in distress at the initial prolonged contraction I had the
evening before her birth. This was why I did not progress - as her head was not
in a position to help dilate my cervix properly, despite being on the drip. She
was not an overly big baby as predicted (there was also talk of shoulder
distocia during my labour ordeal – where babies shoulders are too big to fit
through the pelvis) but she was our perfect girl who had a bit of a bumpy ride
into this world.
As much of the evening of my augmented labour I have no
memory of, I will never forget what holding my daughter was like for that first
night. I did not sleep for the second night running as the adrenaline and joy
of having her in our arms kept me going and I couldn't have been lighter or
more on top of the world. Our daughter was here with us, after a big journey
full of ups and downs to be here. All was well.
