by Lucinda Rae, Independent Midwife
This is a story about two different paths, loosely based on real events.
The first woman is called Rose. She is pregnant with her first baby. She is fit and healthy. She has been attending routine midwife appointments at her GP surgery. She has seen a few different midwives so far. At 38 weeks a midwife she is meeting for the first time measures her bump and flags an increase in growth. The midwife offers to arrange a growth scan, with the reassurance that it is probably just due to different midwives measuring and not to worry. The midwife also recommends a test for diabetes. Rose accepts both screening tests and starts to wonder if she will be able to birth such a big baby. At the scan the baby is diagnosed as being ‘large for gestational age’. Her diabetes test results came back negative. After the scan follows a discussion with an obstetrician who mentions an increased chance of the baby getting stuck during birth and makes the offer of induction of labour at 39 weeks to mitigate that risk. Rose accepts, wanting to do whatever it takes to keep her baby safe. But this was not her plan, she originally wanted a water birth in the birth centre and she feels disappointed moving away from that. Rose’s cervix is long and closed at the start of the induction and the first part of the process takes two days, during which she gets little sleep on the hospital ward. She has multiple vaginal examinations by different midwives. By the end of the second day her cervix is open enough to break the baby’s bag of water. Rose is delighted that she is making progress but frustrated by the long wait for a room to become available on the labour ward. By day three she is in labour and contracting strongly and regularly with the help of intravenous oxytocin. She has opted for an epidural because she needs the rest. The baby is ‘back to back’ according to the midwives. Another night comes and Rose has been eight centimetres for the last six hours. The recommendation is for a caesarean, as she is not making progress. Rose thinks to herself that maybe the baby is just too big for her to birth vaginally. To further complicate matters Rose now has a temperature which is problematic for her and the baby. Rose accepts a caesarean, it’s a calm procedure and the staff are warm and competent. The baby is healthy and weighs 3.8kg/8lb6oz. The surgeon says the baby was stuck in a poor position, still back to back, and big for 39 weeks. As the weeks and months go by Rose reflects on her birth. Was her baby really that big? What would have happened if she had waited for labour? Will she be able to use the birth centre for her next birth?
The second woman is called Lily. She is pregnant with her first baby. She is fit and healthy. She has access to ‘continuity of care’ where she gets to know her midwife and all her midwifery appointments are at home. As the pregnancy goes by she decides she wants to plan a home birth. Her midwife is confident the baby is growing well, having visited her consistently over the weeks, and Lily feels the baby moving plenty. Lily is well informed and aware that growth scans provide an estimated weight within 15% of the baby’s actual weight. At 41 weeks she goes into labour. Labour is stop/start over the first 48 hours but she is able to rest and eat and drink and her midwife gives her regular reassurance and encouragement over the phone. On the second night contractions become strong and regular. Lily feels safe in her dark, warm bedroom but the surges are intense and she wonders how much more she can do. Her midwife arrives and Lily feels like she is coping again. The pool is ready for her and the water feels so good. She feels intense pressure in her bottom which subsides a little following a ‘pop’. Her waters have broken. A little while later she notices she is pushing; an uncontrollable urge. Her midwife sits quietly by, listening to the baby’s heartbeat periodically.
Lily is moving from kneeling to sidelying and at one point standing. The midwife advises Lily’s partner to bail some water out of the pool as it is threatening to slosh over the sides! Later Lily feels a burning in her vagina as the baby begins to emerge. The head is born, followed by a two minute lull. The midwife can see the baby is well grown and for a second considers getting Lily to change position to expedite the birth, but the head is rotating and Lily shouts that ‘the baby is moving’, so all is well. The baby arrives with the next contraction. The baby is healthy and weighs 4kg/8lb13oz. As the weeks and months go by Lily reflects on her birth. She has never felt so powerful as when she was pushing her baby out. Painful. Yes! But powerful.
This story was inspired by reflections on The Big Baby Trial and by Dr Kirsten Small’s suggestion that “Storytelling can build visions of a better future. Storytelling, not evidence, is what ultimately drives system change.”
Further reading