Josey | Midwife, Home Birth, Third-Degree Tear, Positive Birth Experience

Josey and Fergus, together since high school for twelve years, had always discussed wanting children. After experiencing an unplanned pregnancy at 21  that resulted in a termination, they spent years preparing for the right time to start their family. “I was one of those 18-year-olds who knew I wanted to be a mum one day,” Josey reflects on her early maternal instincts.

When they finally decided to try in September 2024, Josey counselled realistic expectations: “I said, this could be a 6 or 12-month thing and that’s not something to worry about.” However, they conceived immediately. Josie discovered her pregnancy during a night shift at the hospital when her heightened sense of smell led her to detect a colleague’s salted caramel beard oil from across the room. 

Pregnancy Challenges and Mindset
Josey pregnancy was marked by significant challenges, including severe nausea lasting until 31-32 weeks and a kidney stone at 28 weeks. “I didn’t particularly like being pregnant. I felt like I often describe it as my body is the host to this parasite and it’s a beautiful parasite and I love this little parasite, but my goodness, I have no energy.”

Choosing Home Birth Care
As a midwife at Gosford Hospital, Josey was well-positioned to access their newly established publicly funded home birth model. “I knew that this model was there. More importantly, the midwife that I had always wanted to care for me was part of that model.” She chose her midwife specifically for her direct communication style: “she reminded me of my mum and she was very strict and she had a really direct way of talking. And I knew, I just knew that I was going to be the kind of woman in labour who just needed someone to tell me to just lock in and get on with it.”

Understanding Home Birth Criteria
Josey provides valuable insight into the strict eligibility criteria for publicly funded home birth: “gestational diabetes would be an exclusion criteria… a previous PPH excludes you. Twins would exclude you, and gestational hypertension would exclude you. Anything where you would need to see a doctor would exclude you.” She emphasises that these criteria apply specifically to the publicly funded model, noting that private midwifery care remains an option for those who risk out.

Birth Preparation and Education
Despite her professional knowledge, Josey and Fergus attended birth classes.. For Fergus, whose paramedic training focused on emergency obstetric situations, this provided essential education about normal birth processes. “A lot of paramedics they do… maternity and paediatrics… they had to focus on PPH management, cord prolapse, shoulder dystocia, the really scary things.”

Labour Onset and Early Signs
At 40+4 weeks, labour began subtly. Josey initially dismissed her symptoms: “I’d been contracting all day to the point that on our morning… bush walk I had to keep stopping and breathing through, I called them cramps, I never called them contractions.” Her denial continued even as she made sticky date pudding and cleaned the house, despite passing pinkish fluid that was likely her hindwaters breaking.

Active Labour and Pain Management
Josey’s pain relief strategy was simple but effective: ” had my TENS machine, I had the bath and I had the birth pool and that was it.” The TENS machine became her primary tool: “all I could say the only thing I could vocalize at that point was as a contraction was coming… I’d just yell out press press press like someone press that boost button.”

Calling the Midwife
At 4:55 AM, after labouring through the night, Josey finally called her midwife: “I said, hey Steph, I think I’m having a baby, which she in hindsight thought was hilarious way of me telling her that it was time to come.” Her midwife arrived at 6:30 AM, recognising immediately that Josie was in transition.

Birth and Complications
Murphy was born just after 9 AM in the birth pool. “I reached down and I picked him up out of the water like I’ve done for so many babies… The first thing I said was, my God, it’s huge. And then the next thing I said, I just felt these balls in my hand and I said, my God, it’s a boy.”

However, complications quickly became apparent. Josey experienced a 1.5-litre postpartum haemorrhage due to multiple factors: “My uterus was floppy… some of the membranes were a bit ragged… I’d also had what we discovered quite quickly was a third-degree tear.” The tear was caused by Murphy’s compound posterior arm presentation: “he was born with a compound posterior arm so his arm was up over his shoulder like this and it was that little elbow in my bumhole.”

Hospital Transfer and Continued Care
The transfer to hospital exemplified excellent continuity of care. “Within a few minutes we’d called the paramedics… by the time the paramedics had arrived, the blood loss had been controlled.” Josey positive experience continued in hospital: “turning up to work and I’m getting wheeled down the corridor of births where I’m waving to all of my colleagues saying, look at my baby.”

Recovery and Reflection
Josey’s recovery from the third-degree tear has been challenging: “I spent the first fortnight, I couldn’t sit cross-legged, I couldn’t sit at all… I’m seven months postpartum now… it still hurt. I could still feel some knots of suture material under the skin.” Despite this, she maintains a positive outlook and realistic expectations for future births.

Breastfeeding Journey
Breastfeeding presented its own challenges with Josey’s fast letdown: “I was drowning this poor boy and being a midwife… anytime he’s awake, I’m putting a boob in his mouth and he was vomiting so much.” Seven months on, they continue breastfeeding successfully despite Murphy’s increasing distractibility during feeds.

Future Birth Plans
Due to her postpartum haemorrhage and third-degree tear, Josie is no longer eligible for the publicly funded home birth model. However, she remains open to her options: “I really want the same midwife and so that would dictate me wanting to give birth in the hospital… knowing that second babies quite typically come fast… I suspect that when I’m in labour with the second baby it’ll be a case of as soon as we’ve got Murphy sorted out for care… and we get to hospital and it happens.”

Key Takeaways for Birth Workers
Josey’s story offers several crucial insights:

• The importance of realistic expectations and flexibility in birth planning
• How continuity of care can maintain positive experiences during transfers
• The value of clear communication during complications
• Understanding that positive birth experiences aren’t defined by adherence to original plans
• The significance of trust between birthing women and their care providers

This episode is essential listening for midwives, doulas, and expectant parents, particularly those considering home birth or working within publicly funded models. Josie’s professional perspective combined with her personal experience provides unique insights into navigating unexpected complications whilst maintaining agency and positivity throughout the birth journey.

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