With three very different labours and births under my belt, I had zero expectations for the birth of my fourth baby…apart from to expect the unexpected.
My first baby had been an uneventful hospital birth. My second baby was a home birth with shoulder dystocia. My third baby was a planned home birth turned immediate hospital induction at 37 weeks upon being diagnosed with Obstetric Cholestasis.
With baby number four, I was fully expecting to have another OC / ICP pregnancy and early induction, as the repeat rate for Obstetric Cholestasis is very high (between 50-90% chance you will get Obstetric Cholestasis again if you had it in a previous pregnancy).
The familiar itch began earlier than last time – mid way through my first trimester. And by the third trimester I was having twice weekly bloods and trace monitoring. All signs pointed to induction by 37 weeks being likely, and ever since learning I was pregnant we’d been mentally prepping for a mid-June rather than the early July due date.
So, imagine my surprise when my bile acid levels remained borderline, but never high enough for a diagnosis of Obstetric Cholestasis, and within the safe levels that no one saw need to push for an early induction.
I started to get my hopes up that maybe I was headed for another spontaneous labour after all, like with my first two babies. Perhaps I would get to be at home, or at the birth centre that I’d previously longingly walked past on my way to the labour ward for induction.
Going to all of my MAU check ups armed with the latest ICP research to show induction would not be necessary with my borderline bile acid results. Had this research been out when I was pregnant with Otto, I possibly would have swerved the 37 week induction with him.
This baby clearly had other plans in mind for us, though. I’ve never gone more than 3 days overdue before (although I suspect I might actually have done with my first baby, and that the scan dates were actually out of whack – we never knew when he was conceived, really).
But for whatever reason, baby number four (who had a very reliable ovulation date) was making no moves to leave his womb home, and by 42 weeks, I was very much STILL PREGNANT with no signs of imminent labour.
It’s a good thing I’ve learnt over the course of having my four children not to get my hopes up for any particular type of birth, otherwise I would have been crying at the injustice of swerving an OC induction only to need one just for being overdue!
Induction at 42 weeks pregnant
41+5 is the gestation at which my hospital trust likes to get you booked in for an induction.
I was in two minds as to whether to push this deadline by a few days just to give my body some valuable extra time to see if labour would kick into gear naturally, or whether to stick with the 41+5 date and, as a first step, go for the only type of induction where I would be allowed to use the birth centre – the 24 hour propess pessary.
I had been really keen to use the birth centre, knowing that the overall experience of a labour ward induction would feel a lot more medical, and there would be a lot less encouragement for me to stay active and move around (in my experience they LOVE strapping you to a monitor on labour ward when you’ve been induced – after my experiences, I have a lot to say on continuous monitoring… more on that later).
My birth centre deadline was looming, because once you hit 42 weeks, you are no longer allowed to labour there. I was also wary of being admitted to the induction ward at 41+5, knowing it can be days before a successful induction, having previously been stuck there 6 days attempting and failing to induce labour, and then waiting days for a room to be available on labour ward for an ARM with my third baby.
During one of many check ups in my third trimester
I discussed options with my midwife and she mentioned something called outpatient induction, which would mean I could have the propess pessary induction and then go home for 24 hrs to see if it worked.
In the event it didn’t work, I had decided 41+6 was the day I was comfortable being admitted to the ward for induction anyway, the day it would have been too late to use the birth centre (unless I miraculously went into spontaneous labour that day), so trying the outpatient pessary induction the day before at 41+5 seemed like a no brainer.
If it worked overnight and I went into spontaneous labour, I wouldn’t need to come in for an induction the next day.
BUT, as I have learnt many times throughout my experiences of complex pregnancy / consultant led care, and induction; you might be told one thing by one person, only to be told something different by another person.
So, I was entirely unsurprised when I rocked up for my outpatient induction booking only for the midwife to tell me that outpatient induction is not allowed for people who have had more than 2 births already. They wanted to admit me onto the ward there and then at 41+5, but I knew I wanted one more day at home before I gave up on the slim chance that I’d be in labour before the 42 week deadline to use the birth centre.
I wanted to give myself the best chance of a spontaneous labour that I knew would be paced much better than the intense labour I suspected I would experience with induction.
So off I went home in an ever increasing state of anxiety. I knew a more direct form of induction was looming, and I was struggling to dissociate from the traumatic experiences of my last induced labour.
Unfortunately, labour did not miraculously start overnight. So, the next day I found myself resigned to the antenatal ward for however long it would take to get this baby out.
Once I realised induction was inevitable, a lot of the trauma I’d experienced with my third labour and birth came swimming back up to the surface. I hadn’t quite realised how much it had affected me until I was faced with the prospect of repeating a similar experience again.
Covid 19 and the last weeks of pregnancy
Our older children had already left to go and stay with my mum the day before my non-starter outpatient induction, because at 42 weeks we knew this was last chance saloon and that I would definitely be admitted to the ward this weekend.
This was July 2020, in the midst of the Covid pandemic, and my children hadn’t set foot in anyone else’s house or touched any member of our extended family for months. When the government allowed schools to go back for the last two weeks of July, our children didn’t go back to school like many of their classmates – because I was full term and we were all shielding at home so as not to bring Covid into the hospital or be without a birth partner when I went into labour.
After I arrived home from the failed attempt for an outpatient induction, Sam and I were at a loose end without the kids around. So we went to our local Aldi to pick up a few labour snacks and try and distract my mind. This was the first time I had set foot in a shop or supermarket since March 2020 when the government had advised people in their third trimester to isolate. I had pretty much just been at home or the local park all those months. Sam had been doing any necessary supermarket runs, and mostly we’d been buying online.
Finally being back in a supermarket added an extra level of surrealness to those hours or days just before everything happens when you are waiting to go into hospital to meet your new baby.
Waiting for induction
I had hardly slept the couple of nights before being admitted to the ward. My hands were shaky and I was feeling constantly sick with anxiety.
The morning of my induction booking, just before Sam was about to drop me off at the hospital (due to Covid there was a no visitor policy on the antenatal ward so he wouldn’t be able to come in with me like last time) I was sat on the sofa with a sick bowl in front of me, hands shaking like a leaf, unable to eat or move without feeling overwhelmingly sick with anxiety.
It was a purely physical adrenaline reaction, I felt like a scared, trapped animal.
At the time I gave birth to Bay in July 2020, these were the hospital Covid rules. One nominated person was allowed to visit you on the postnatal ward during the four hours above. No one was allowed into postnatal outside of those hours.
My experience of waiting to be induced is that a whole lot of nothing happens until everything happens.
So I didn’t go in on the first day expecting much at all to happen that day, and I was right. I went in mid morning, and a plan wasn’t put into the place until 8pm that evening – when a midwife examined me and decided I was dilated enough that my waters could be broken, rather than needing to start with pessaries or gels. Or this new thing called Dilapan, which I hadn’t heard of before, but is now what my hospital trust prefer to start with for induction, as it’s non-hormonal and therefore a more natural way to encourage labour without overstimulating the cervix.
With my previous induction, I’d had the maximum dose of gels and pessaries allowed over a period of 5 days, and it was my waters being broken on day 6 that was the thing that finally got my labour going with my third baby, so I was on board with this plan for an ARM, with one big proviso: This time round, I wanted to have an epidural in place BEFORE the breaking of my waters.
Things had happened so quickly and scarily as soon as my waters broke with my third baby, that I wasn’t willing to contemplate experiencing that again. My body was wracked with nerves at the thought of it, and I just didn’t feel that fear would serve me well in labour this time round. I just knew that labour this way would be hard and fast, as it had been with Otto, and that they would want to have me strapped up to a continuous trace monitor staying as still as I could, and that is something I can’t do without comprehensive pain relief.
The midwives on antenatal ward seemed confident that an epidural before breaking my waters would be fine, so I tentatively started to get less nervous about it, even though I knew that once on labour ward, the midwives and doctors there could decide that was not an option after all.
There’s a lot of back and forth between doctors and midwives when you are being induced, and you don’t always get to speak to a doctor directly. So I’ve learnt not to trust anything anyone tells me about anything until I speak to the person who has the final say on my plan for induction.
So now, it was a matter of waiting for availability to move to labour ward for my ARM.
There is no clear timeline for this, as it depends how busy labour ward is, and that changes all the time as emergencies occur, and as women who have progressed to active labour on the antenatal ward get moved to labour ward, and as women who have gone into spontaneous labour at home come in.
Even though you are on an induction path because you’ve been deemed urgent, you still end up being back of the queue compared to labours that are progressing and simply can’t wait, so it’s a frustrating and stressful limbo type of situation.
Last time, I was waiting 6 days for a room on labour ward to become available. So I was fully prepared for another long wait.
Staying on the antenatal ward can be psychologically hard. There are women labouring all around you, struggling with pain, often in active labour for a long time before they are moved to labour ward or birth centre. It is difficult to listen to, imagining yourself in that same situation, which is inevitably going to happen sooner or later. And even worse during the pandemic when you can’t have your partner with you – my heart really went out to those women. Not easy times.
I was sharing a 6 bed bay with 3 other women when I arrived. Two of the women were in labour, quietly concentrating on their contractions. One moved over to labour ward at 4cms, then shortly afterwards the other women was hurriedly wheeled to labour ward on her bed because the fetal heart rate was dropping.
Listening to the heart rate slow from my own bed set my anxiety sky high again, not only for that poor woman who was still without a birth partner at this point, but because it also brought back a visceral memory of Otto’s birth – the sudden rush of staff, the emergency alarm pinging, and how it felt to be told that his heart was seriously struggling.
After those ladies left for labour ward, I knew for sure that it wouldn’t be tonight that I’d be called to labour ward. I tried to relax, used my nice bath products in the gross shower room, put on my noise cancelling headphones and just tried to clear my head. I was still unable to eat much and my hands and arms were still shaking all the way up to my shoulders with anxiety.
Itchy legs – although my bile acids stayed within the safe range, my ALTs were high and I had severe itchiness throughout the third trimester.
8pm shift change rolled around and the night shift midwife introduced herself.
She confirmed that there had been a few emergency situations on labour ward so it was unlikely I’d be called that evening. She could see that I was shaking and we had a little chat about mindfulness.
The bay was much quieter now that it was just me and one other lady waiting to see if her pessary would work, so I decided to try and sleep whilst it was quiet, knowing that it would likely get noisy again soon, as more women in labour came in from triage.
I had it in my head not to expect to be called to labour ward any time soon, and that whichever day it would happen, I would be called in in the morning when the 8am consultants and midwives arrived on shift, as that had been my experience with Otto.
Ear plugs in (an absolute MUST for the antenatal ward), I attempted sleep but none came.
My mind was racing with too many thoughts and memories. I took a trip to the toilet at 11.30pm and was flagged down by the midwife, who told me that she’d just spoken to labour ward and I was next on the priority list, once they’d finished up with the emergency they were dealing with, and provided no one else arrived at the hospital in labour in the meantime.
So I went back to bed thinking it COULD be overnight, or failing that, there was a good chance I’d be going to labour ward at some point the following day.
I was NOT expecting to be woken an hour later at 12.30am and told to pack up my stuff and call Sam because I was going to labour ward right now.
Read Part 2 of Bay’s birth story – An epidural and the syntoncin drip