The Two Week Wait
10 Questions To Ask Your Care Provider
Pregnancy After Miscarriage: How Long to Wait Before Trying Again
Bleeding In Pregnancy
Birthing Your Placenta : Active Management versus Physiological Management
5 Common Postpartum Experiences
In this week’s episode, I chat to Lou about her three births. She discovered at 34weeks that her first baby was breech. After a failed ECV she sought a hospital that supported vaginal breech births and subsequently changed caregivers at 39 weeks to achieve the birth she wanted. Her second birth, under the care of midwives, was smooth and straightforward but afterwards, with two babies under 18months, Lou struggled with undiagnosed postnatal depression. She booked into a midwifery program at her local regional hospital with her third baby and after a very quick water birth and low apgar scores, baby Astrid fed and settled well. However, the midwives and obstetricians were concerned about low blood sugar levels so they did blood tests every two hours before transferring to a larger hospital. In honour of Birth Trauma Awareness Week, Lou shares the trauma of the first few days of Astrid’s life and the challenge she faced as a mother up against a particularly condescending doctor.
A mum to three young girls, Lou Nicholson is currently campaigning as an independent for the Finniss electorate in SA. She first fell pregnant while living in NZ and connected with a beautiful midwife there before moving back to Adelaide at 20 weeks. By that stage it was too late to get one on one midwifery care so she joined the midwifery team at her local hospital.
“At 34 weeks the midwife noticed that Lily was head up; she didn’t think it was a problem but she did mention that if she was still breech at 36 weeks they would do an external cephalic version (ECV) to try and turn her.
“I was working fulltime and I really kept my head in the sand because I was really quite nervous about birth. Everything I’d seen on tv of women screaming and the waters breaking in the supermarket. Foolishly, I wasn’t looking into what I might face, different experiences and how to advocate for myself. I was very much just going with the flow and not informing myself. I was booked in for an ECV at 39 weeks and they said if that didn’t work I’d be booked in for a caesarean. That really rattled me so I went home and my husband and I did all the research and I lay upside down and did curb walking and tried everything to turn her. But just because I had my head in the sand about it I never thought it would be out of my control. I never thought I would be booked in for a caesarean.
“I’m a twin and I’m the second one and I was born breech in PNG in the 1980s. And I remember thinking, if mum can do that in PNG in the 80s, surely current medicine can support me to do that now in a major Australian hospital. That’s when it hit me how big a deal it was for me…to give birth vaginally and I wasn’t going to let someone take that away from me with the stroke of the pen.
“The ECV is quite invasive, it was quite intense. They give you an injection to relax you and with their hands on my belly, they tried to manually turn the baby and they got her halfway twice but she wouldn’t budge. Afterwards the obstetrician handed me a form and told me he’d book me in for a caesarean. I declined but he told me he was the only one who would be able to attend a vaginal breech birth and perhaps he wouldn’t be on that day. So I signed the form and was just devastated.
“I was posting on a natural birth facebook page and someone recommended I go to the Womens and Childrens Hospital so I called them and met with the OB and he said he would support me to have a vaginal breech birth. There were conditions; I needed to go into labour spontaneously and I did that a few days later. It was on and off for about 20 hours before I went to the hospital. I had Sam and my Mum there and on the shift change, at about 9pm, the new OB came in and we had a good chat about it and he was happy to go ahead with a breech vaginal birth. I had an epidural and they continued monitoring me and by 2am I was fully dilated. There were quite a few student doctors in the room; my birth was an opportunity for them to witness and learn about breech birth which I was really happy about.
“I pushed for about twenty minutes and I was given an episiotomy and her bum came out first and then her legs and he was talking through the process with all the students who were there. When she was born she was taken to the resuscitation table because she wasn’t breathing very well but I got a quick cuddle with her before they took her to the NICU. She was only there for a few hours before she came back to me.
“I fell pregnant with Harriet 9 months after Lily was born and I got in early with the midwifery clinic, all my appointments were at home and I felt really good being with this midwife. It was a very straightforward pregnancy, she was head down and I went into labour at 39+5 again. I birthed her on the bed and it was all good. She fed really easily and I stayed for one night, just for a bit of a rest, and I went home the next morning.
“Birthing her was really intense compared to birthing Lily, it really does feel like you’re birthing the baby out of your bum. I was really proud of my body but I do remember afterwards thinking: I’m not doing that again…especially going through transition which I didn’t experience with Lily because I had the epidural. But a few weeks afterwards it just faded and I remember thinking that I couldn’t wait to do it again.”
Lou and Sam decided to make the move from Adelaide to the Fleurieu Peninsula. However, Sam was still commuting to the city each day and Lou was thrust into the intensity of parenting two babies under 18months old. It was a challenging, exhausting and relentlessly intense time that took her to the edge.
“It was so hard, looking after two babies. I was literally drowning but of course I told everyone that I was good and everything was fine. I desperately needed help but I felt like such a burden so I just kept going. I was very low and really tired and I remember thinking: this isn’t postnatal depression, this is a reasonable response to these circumstances. When I told Sam and my sisters that I wasn’t feeling good, I found that just telling them was quite cathartic. I felt like I was on the cusp of depression, of going into that black hole. A midwife in my third pregnancy told me that I did have PND and I was actually on the cusp of psychosis. It’s hard to look back and recognise how hard I was doing it.”
Lou was delighted when she fell pregnant for the third time with baby Astrid but she admits that overwhelm accompanied her joy; she was already doing so much, giving 100% every day, could she add another baby to the mix?
“I brought up my concerns with my midwife because I was a bit worried about how I would cope after birth. With the third you kind of forget you’re pregnant a lot of the time. Although it’s still hard, you’re better equipped to handle it. It was a really straightforward pregnancy and I chose a regional hospital that had a really good reputation for midwifery-led care.
“I went into spontaneous labour at about 41 weeks and twenty minutes after we arrived at hospital, I birthed her in the water. There were two massive contractions and she was out; she shot out and it was so intense. She looked at me and it was beautiful and then she just slumped. She had a low apgar and they gave her oxygen and they were rubbing her. It’s quite a blur; I was on cloud nine and I was on th
e bed, my midwifery student was helping me deliver the placenta. The obstetrician came in and they called the emergency crew from the major hospital to come and have a look at her.
“They brought her over to me and she was on my skin, she snuggled and was initially very pale but within 15 minutes she got her colour back and was feeding. She had a strong latch and fed for ages. The obstetrician was happy for her to stay as long as her blood sugars were monitored. It was the middle of the night so Sam went home to be with the girls and I stayed in hospital; she seemed like she was doing really well but they were checking her blood levels every two hours, pricking her heel, it was so traumatic. Her heels were black and blue. She wasn’t maintaining her blood sugars so they told me they were going to give her a bottle of formula and they gave her a glucose injection. Unfortunately, her blood sugars were still low.
“The whole time I just kept thinking that she seemed and looked so well and perhaps the only reason she had low blood sugar was because they kept unwrapping her and pricking her heel. She was feeding well and sleeping, she was alert and crying. There didn’t seem to be anything wrong with her. I just didn’t know what to do but a beautiful midwife encouraged me to go to the main hospital and she reminded me that I’m my baby’s best advocate and she encouraged me to hold my ground.
“I couldn’t go in the ambulance with her and it was awful, it was 40minutes to the next hospital and I was just horrified. My mum and I drove down and when we got there, she was having all these tests done, she was under bright lights and screaming and I was just desperate to hold her, I just kept asking to hold her. I just kept pushing and I got her and fed her and she settled.
“ Then the doctor assessed her in the cot and asked me, very confrontationally, why I birthed her in the water. He had a preconceived idea of who I am and what I’m about. In my opinion he thought I was a difficult patient. I’ll never forget him talking to me in a very condescending way and he was putting his little finger in Astrid’s mouth so she could suck it and settle. It took everything that I had, I was just so upset, all I wanted was to have my baby. He suggested a possible brain injury, he went to the worst case scenario and then when her bloods came back for inflammatory markers she’d need antibiotics. They took her to NICU for a brain scan and they told me I couldn’t hold her or breastfeed her.
“We stayed for a few days so they could finish the course of antibiotics and it turns out that there was nothing wrong with her at all. It came back negative for bacterial infection and her blood sugars came good on their own. We’re so lucky to have the service of NICU when we need them but I found it really challenging to be there because I just knew there was nothing wrong with her. I was trying to pull myself together when the consultant did his rounds; I was trying to collect myself to prove that we’re all good and that we could go home. I honestly feel like she just got a fright from being born so quickly and that her blood sugar levels couldn’t recover because she was stressed from being unwrapped and pricked every two hours.”
Breech birth, Birth trauma, Water Birth, Three vaginal births, PND, Vaginal birth, Epidural
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