Thursday, June 17, 2010

Writing Workshop: She

For this week's Sleep is For The Week's writing workshop, I chose the prompt She.  Or rather, it chose me.  As soon as I saw it, words started pouring out and I could barely keep up.  As a result, this post is very long!  I've tried to edit as much as possible, but I had a lot to say and I've been waiting nearly two years to say it.  There's a lot more to say, but I'll save that for another time.


She was obviously in a bad mood and didn’t care who knew it. She entered the room and didn’t bother looking at me. It’s not uncommon to be greeted this way by doctors in this country. But I was 40 weeks pregnant, hot and already stressed about what “They” were going to say to me, so it wasn’t a good start. With her head in my notes, she stood in silence for a good three minutes and then said, “So you’re here to be induced are you?”

I was so alarmed I didn’t know what to say. She threw my notes on the table with a slap and started pulling on latex gloves. I was gripped by the irrational notion that she was going to do it right here, right now. Then she looked at me. I hadn’t answered her question.

“No. I’m not even due till tomorrow.”

She stopped. “So why are you here then?”

I knew it had been a mistake.

35 weeks into my pregnancy, we were forced into an unexpected house move. We'd found a flat in an area of London we already knew, but it meant moving out of borough, where I had a community midwife I liked and who was supportive of my decision to have a homebirth. When I told her we were moving, she told me that I could still have her as my midwife, but it would mean I’d have to have my baby at North Mid. If I wanted to have a homebirth, I’d have to register with my local midwifery service based at Whipps X. I was gutted.

I was able to register with the same health centre that I'd been with the last time I lived in Walthamstow. I’d had a supportive GP there, so I was hopeful. They also had a community midwifery service, so I could be seen at the health centre or at home, without having to go to Whipps Cross for my checkups.

I met my new community midwife. She was pleasant, if a little distracted, and she knew the North Mid midwives I mentioned and spoke fondly of them.  When I told her I wanted a homebirth, she wasn’t enthusiastic, but she wasn’t negative either. In fact, she merely said ok, wrote something in my file and left it at that. I thought it was a good sign, but it wasn’t. A couple of weeks later and puzzled that, at 37 weeks, I still hadn’t received any information about my homebirth, I asked her about it more directly. She acted as if it was the first she’d heard of it. She pulled out my file and furrowed her brow and informed me that I had fibroids.

I already knew this. My 12 week scan had shown that I had three small fibroids. When I had my booking appointment at North Mid, they automatically ticked the “birth in labour ward” box on my forms without asking or telling me. When I asked my community midwife about it later, she said they probably did it because of the fibroids, because it could be seen as a risk factor, but she also said that they should have discussed it with me first. When I told her about my desire for a homebirth, she said it shouldn’t be a problem, but it did depend on the size and location of the fibroids. She referred me to her Supervisor of Midwives who looked at my scan and was not in the least bit concerned and said there was no reason why I couldn’t have a homebirth. My 20 week scan showed a slight increase in size in one of the fibroids but they were still tiny – approximately half an inch in size. My midwife team were not concerned and kept my risk status as low, so I put it out of my mind and got on with enjoying my pregnancy.

But now they were suddenly a problem. When I explained what the midwives at North Mid had said, my new midwife looked very nervous and decided to put me on the phone to her supervisor instead of talking to me herself.

I was completely unprepared for the onslaught of negativity that came next. As soon as the supervisor started talking, I felt like the decision had already been made for me. Even though she started her sentence with, “Of course we can’t tell you not to have a homebirth…”, it was exactly what they were telling me. And the way they persuaded me to change my mind was by saying that I would very likely bleed to death, and by making me feel like I was a very silly girl who had no idea what I was getting into, it being my first baby, and that in a perfect world, we’d all get what we wanted, but what was most important was my safety and the safety of my baby. By the end of the five minute conversation, I felt upset, ashamed, humiliated and terrified. It was only after I left the office after meekly telling my midwife that I’d changed my mind that I started to feel FURIOUS.

Still shaking, I got on the internet and did as much research as I could about fibroids, post-partum haemorrhage and homebirth. What I could find said pretty much what the midwives at North Mid had said – it depended on the size and location of the fibroids. Given that mine were tiny, in a position that were not causing any problems and would not block the birth canal, and given that I’d had a completely healthy and trouble free pregnancy, I started to suspect that the negativity I’d faced about having a homebirth had little to do with me and everything to do with institutional attitudes.

I talked to a local NCT homebirth contact, Paul, my friends, a friend of a friend who was a midwife and then I phoned the supervisor back and told her that I changed my mind. I told her about my research and that I wanted to proceed with a homebirth anyway. To my surprise, her attitude towards me completely changed. Instead of being hostile, she was suddenly warm. She said she was sorry if she’d seemed negative before, but just wanted to keep me informed of the risks. When I asked her if she could provide me with statistics to back up these risks, she could not.

I should have left it at that, but their talk of risk really got to me. (Medical attitude to risk is something I could write a whole other post about.) What if I really did bleed to death? The last thing I wanted was to leave my baby motherless. What if I really was being selfish to insist on a homebirth? Reading articles about post-partum haemorrhage is not what I wanted to be doing at 38 weeks. What I wanted was proper support. What I wanted was an honest discussion about the risks involved, the real risks, as they applied to me. I wanted answers. So I decided to make an appointment with a consultant. I told the supervisor of midwives about this and she advised me against it. She said that they were unlikely to be sympathetic, but if I wanted to go ahead, then I could ring her and ask for her support if I needed it. I should have listened to her.

My appointment actually went well. I got to see the consultant himself and he was lovely. He said everything looked fine and when I asked about the fibroids, he waved away my worries as if they were flies. He used his fingers to illustrate how small they were to me and said not to worry. But he also booked me a follow-up appointment at 39 weeks. I wasn’t sure why, as I’d been seeing my community midwife for all my appointments. I later twigged that it was simply because it was the way the system worked. I’d unwittingly put myself in the system when I booked the appointment and now they were keeping me there. I knew I could cancel it but I decided to keep the appointment because I hadn’t discussed the homebirth with him. I’d been so overjoyed when he waved my fibroid fears away that I completely forgot to bring it up.

When I went to the next appointment, it wasn’t the nice consultant I got to see, but a junior doctor who looked like he’d just finished college. It was unnerving, but he was at least extremely polite. When I told him about the homebirth, he didn’t know what to say. At first he was quite positive when I’d told him what the consultant had said. But he had to go and talk to his registrar first. When he came back, he was no longer positive. He gave me almost exactly the same speech that the supervisor of midwives had given me about the risks of bleeding to death. He just delivered it with less drama and tried to be helpful by suggesting that I book in to their birth centre instead. I’d already been down that route as an option and been told that my fibroids had suddenly given me a high-risk status which meant I couldn’t use the birth centre. So it was a choice between the labour ward or home.

I told him about my research and asked for statistics to back up their fears. He spoke to his registrar again. He came back and said there were no statistics but that “it happened enough” for it to be a worry. He then became all patronising and told me to go away and think about it, but that if I did want to proceed with the homebirth, I’d have to sign a disclaimer that I was doing so against their advice. They then booked me an appointment for the day before my due date. I left feeling shaken and furious.

The next week was not a happy one for me. I veered from feeling calm and confident in my own convictions to worrying that I was going to die in labour and never get to know my child. I don’t know if that disclaimer actually existed, but if it doesn’t, it’s as good a scare tactic as you can get.

Going to that final appointment terrified me.  All my instincts were telling me to cancel, but I must have some deep-rooted need to obey authority, so I went anyway and asked Paul to come with me for support. Even Paul was unprepared for what happened.

I explained to the doctor in the bad mood that I was there because I’d seen the consultant and these series of appointments had been booked for me. She examined me and that at least brought a smile to her face when she told me that Jake was in a good position and that his head was 3/5ths engaged. It was the only consolation I took from that appointment.

I plucked up the courage to tell her about the homebirth. She raised an eyebrow and sniggered. She flicked the pages of my notes and asked me how far away from the hospital we lived. We’d researched this too. It was 10 minutes without traffic. She gave me a half-hearted spiel about the risks involved. Luckily her mood meant she was in no mood to try and talk me out of it. She sat down, wrote something in my notes and it seemed to be over. Paul and I were relieved. She didn’t mention the disclaimer and we sure as hell weren’t going to.

Then, out of the blue, she said she was booking me in for an induction for 10 days after my due date. I felt like I’d just been slapped. I was so shocked, I didn’t know what to say. Even Paul was shocked. We sat there in stunned silence.

Without looking at me she gave me another spiel about why it was in the best interests of the baby to induce if it hadn’t arrived by then. I’d read all about the prevailing medical attitude to babies being overdue and how inductions were more likely to lead to interventions like caesareans and I should have been prepared to fight my corner on it, but I just felt drained. As I sat there wondering how to take it and whether saying nothing meant that I would be obliged to come in to hospital and be induced, the nurse who’d been in the room stepped in and handed me a leaflet saying, “This is just an INVITATION to induction. You don’t have to accept it, and you probably won’t need it. This will tell you more about the process involved.”  I could've hugged her.

It was just the system. I kept repeating this to myself over and over as we headed home. It was just the system and I did not have to be part of it.

In those last few days, I immersed myself in things that made me feel joyful and human. Music I loved, reading, dancing, food I loved, sleeping in the afternoon, going for walks (waddles), reading about natural birth, and drawing my naked pregnant self. I talked to Jake and told him that everything was going to be alright, that we would be in this together and that I couldn’t wait to meet him.

A friend, a mother of three, who’d listened to all my fears and worries reminded me that I was being strong and amazing because I was already fighting for what was best for my baby before he was even born. And I kept remembering something that a midwife friend of a friend had said to me, that in her experience, the most important thing a woman in labour can bring with her, is belief in herself. That’s what it came down to. Did I believe in myself?

I never imagined that this question would come to matter so much. I’d always struggled with fear and self-doubt, especially so in those last few weeks before Jake was born. But believing in myself had never been so important. The night before Jake was due, I got up, wrote copious amounts in my journal and then let go. I made peace with my decision and let go.

Jake was born at home less than 2 days later. I had a 7 hour, trouble-free labour on gas and air. I didn’t even bleed very much. My blood loss level was just below average, not even heavy by normal standards. Everything went well. It’s a testament to how smoothly my labour went that I remember more about what I went through to have my homebirth than the labour itself.

All in all, I had 5 midwives attending to me at one time or another during the birth. Thankfully my assigned midwife, the one who’d put me on to her supervisor, was not on duty. The midwives who were there were wonderful – strong, vibrant, joyful, funny, supportive, but not in our faces. Not the least bit institutional, yet utterly professional.

Writing about this two years later still makes me angry.  The hospital literature about birth says all the right things but unhelpful, disempowering attitudes are still deeply ingrained.  I remember reading their leaflets about giving birth in hospital and not one of them mention risk.  I was the only one in my NCT antenatal group to choose a homebirth.  Of the remaining five women in my group who gave birth in hospitals, three ended up having caesareans and another had an episiotomy.  But when it comes to homebirth, the hospital literature is all about risk, and therefore fear.  It's that spreading of fear that really angers me.  It's insidious and harmful and completely unnecessary.  But I don't want to end on a negative note.

After it was over and the midwives left us alone to get to know Jake, I was holding him to my breast and it hit me that while I was worrying and stressing and going through all that unnecessary fear, Jake was just getting on with it.  He'd been getting ready to come out and it was like he knew exactly what he was doing.  It was as if he'd been looking after me in there, with quiet knowing strength, just waiting to come out and meet us.


gaelikaa said...

It was a battle but it is great that you were able to get the birth of your choice despite the lack of support. I had four normal deliveries but I needed the hospital - being an older mum and having health complications. Well done to you!

Found you on the writing workshop

Anonymous said...

I was so tense reading this, hoping it would turn out with you getting the lovely homebirth you wanted. I really cannot believe the attitude of some midwives and other health professionals but so glad you got the birth you wanted in the end. xx

Beth said...

I can understand your anger and frustration perfectly. I felt like I was being frightened into things at the end of my pregnancy, and I didn't know how to stand up for myself. You did incredibly well to research and get all the facts straight for yourself, and to stand your ground.

I'm so glad you got the birth you wanted in the end, and the picture of you and Jake is just beautiful.


Sandrine said...

So sorry you had to fight so hard to get the birth you wanted. As if the last few weeks of pregnancy weren't hard enough without the people who are supposed to help you making it harder for you! I didn't really know what I wanted with my first child, and was lucky to have a great midwife and a helpful gp. My second one was born in Turkey and the Obstetrician, used to recommending c-sections was actually very happy to go along with all my preferences - such as walking peridural and upright birthing position, just because I was a foreigner!