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|Before the Birth
24th December 2004
Felt strong contractions when I was doing my very last minute Christmas shopping. I was taken aback because I never felt a contraction that strong before for the previous 3 kids. To understand this statement, you must know where I am coming from. All my 3 prior birth were all medically and actively managed:
Kieran (1997) : Waterbag leaked. Gynae burst my waterbag and put me on oxitocyn drip to speed up labour. Had epidural. Prolonged labour that ended with Kieran being forcepted out He was almost 4 kg. Had bad post partum haemorrhage (PPH) with a few bags of blood pumped into me.
Gillian (1998) : Induced at 36 weeks because the gynae said that big babies contribute to the PPH and he doesn't want her to grow too big. Still , she weighed in at a respectable 3.68 kg even at one month early. No PPH but had some thing a lot worse -- the baby had severe jaundice because of ABO Blood Incompability with me. At 5 days old, she needed blood exchange transfusion. It was more traumatic than the PPH. Her jaundice stayed for a month plus and every few days I had to bring her to the polyclinic for the bilirubin test. I effectively had no confinement period with this one and my mood would go up or down in sync with her jaundice levels. I was hovering very near Post Natal Depression with this one.
Keagan (2000) : Induced at 36+ weeks and was 3.77 kg. My easiest birth so far. No PPH, no ABO blood incompatibility. He was readmitted to hospital because of his slightly elevated jaundice levels. Nothing as bad as Gillian's, though.
For all three births, I had epidural before the first contractions hit. Chicken, right ? Yup, that's me :-). That's why I was taken aback when I felt that very strong contractions on Christmas Eve.
I did lots of reading up on natural childbirth, got myself a labour supporter (Pat Chong) and a gynae well known for his pro-natural natural stance (Paul Tseng).
I made a quick call to the Gynae hotline and Paul called me back soon after. He ordered a day of bed rest (luckily we had attended the Christmas Vigil Mass the night before). If the contractions don't stop, then I have to meet him at MAH labour ward otherwise to see him on the 27th December (Monday).
Boy, was I glad to make it over to 2005 with the baby still safely inside me! At one stage, I really thought that she was going to be born at the tail end of 2004. The New Year celebration was subdued all over the world because of the almost 150,000 lives that were claimed by the 26 December 2004 tsunami.
Her 4 kids and mine had a fun time playing together and after the labour discussion, we adjourned to Swensen's at White Sands. Should have seen how the Swensen's manager's eyes widened when he asked me how many seats I need and I told him "We have 2 couples and 7 kids among us". Guess big families are not very common in Singapore these days, but among our circle of friends, we do have lots of friends with at least 3 kids, some with 4 and 5 !
4th January 2005
Went for my gynae visit and was told now at 34+ weeks, the baby was 3.4 kg- 3.5 kg. It's about correct, I think..because both Keagan and Gillian who were induced at 36+ weeks were about 3.7 kg. I feel like a humongous elephant :-( I can vouch that pregnancies do get tougher the older you are.
Paul Tseng offered to teach me nipple stimulation to speed the labour along once I hit the 37 weeks mark. I'm really in two minds about speeding the labour along. On one hand, I know almost for sure that if I leave this one inside me for the full 40 weeks, she'll be at least 4 kg and the spectre of PPH is always at the back of my mind. On the hand, if she's taken out at 37 weeks, I assume her liver will not be as mature as it would be at 40 weeks. I do need her liver to be as mature in case she has the ABO incompatibility problem. Oh well....
I think I overdid it yesterday. Instead of the usual 2 hour afternoon rest, I was up on my feet the whole day. In the late morning, I had to get the kids ready for school and then I had to rush to the shop because the TCS production crew is coming (with Zoe Tay !) to film at the shop at 1.30 pm. It was for the Zoe mummy program on channel 8.
16th January 2005
After breakfast, Ivan dropped me off at Tampines Central to do some banking and after that I decided that I should take this last opportunity (before the baby pops) to window shop at Century Square and Tampines Mall. Boy, is Century Square revamped beyond recognition now ! I LOVE the ladies' toilet on the second floor and I even checked out their brand new nursing room. Not that I ever using nursing room in shopping centres anymore (except to change diapers). I just nurse wherever I have to. My verdict on the new nursing room ? Nice but not so functional. Looks like only one mama can use it at one time !
7 February 2004
7 February 2005
Doctor: Dr Paul Tseng
Labour Support: Pat Chong
Hospital: Mt Alvernia Hospital, Room 2
This is a story of a wonderful, empowering, natural vaginal birth - the fourth of a series of three prior medicalised births, all artificially induced, with epidural pain relief and episiotomies. The birth of her first baby resulted in a post-partum haemorrhage. The second baby was born with ABO incompatibility which was initially undetected and untreated, resulting in a transfusion.
Rita, who thought she had a low threshold of pain and who had never gone through labour pain in its entirety, was initially apprehensive about her chances of achieving a natural drug-free birth. But this being her fourth baby, she decided to give it a shot. To boost her chances, she chose a gynaecologist known to be expectant management-friendly and to have labour support at her birth. She read up widely and kept herself informed and she made a birth plan.
Her concerns prior to the birth were: a post-partum haemorrhage, ABO incompatibility for the baby and the elevated jaundice levels that come with the condition, birthing a big baby vaginally.
But as this story shows, her body is built to labour efficiently without the use of oxytocics and given time, information and support, her own courage, strength and determination, she is able to birth a big baby vaginally and have a birth experience totally different from her other previous experiences.
Chronology of birth
0230am Water bag bursts with a gush, wetting panties and shorts. Rita wakes up and packs her bags for the hospital. Rita SMSes Pat at 3.30am to say that her water bag has burst but there are no contractions. Rita asks what is the normal pattern of labour once the water bag bursts. Pat SMSes that it could take days or perhaps hours. At this point, Pat thinks it will take a while yet and SMSes Rita to get some rest.
0400am Mucus plug comes loose.
0600am Contractions have started but are irregular in nature, each a couple of seconds long and at intervals of 25min. Rita notices some fresh blood and needs to keep changing her sanitary napkin because the water keeps flowing steadily. She calls Pat to see if the blood is normal. Pat reassures her that this is normal and part of labour.
0800am Rita seems alert and happy. She is able to cope well with the contractions. Getting her work done at home and seeing to her children are occupying her time and distracting her from the intensity of the contractions, which still seem to be bearable at this point.
Ivan wonders if he should go into the office today. Rita does not think this is a good idea.
1000am Ivan and Rita decide to get the kids ready and off to school. Rita reports that the contractions are getting more regular and a bit more intense. They are coming at about 20 to 15min apart although still not lasting very long. She also reports a slight feeling of pressure in the rectum. Pat says this is normal because the baby has to turn and descend. Ivan and Rita decide to send the kids in to school and head in to the hospital. Pat says she will meet them there.
1005am Pat calls the Mt Alvernia Hospital Labour Ward to tell the nurses that Rita will be coming in. She updates them on Ritas status and requests for a CD player and a birth ball to be ready.
1100am Rita, Ivan and Kieran arrive at Mt Alvernia. Rita looks calm and seems to cope very well with the contractions. As Ivan parks the car, Kieran, Rita and Pat go to the labour ward. They are allocated Room 2. Pat gets the birth ball, the CD player and arranges for a mattress to be on the floor, extra sheets and hospital gowns for Rita.
1130am Ivan and Kieran go off for lunch and school. Pat stays with Rita. The attending midwife SN Daphne Chua comes in. She goes through Ritas medical history and birth plan. She asks if Rita would mind a vaginal examination and to be monitored for a baseline reading of the babys heart rate through CTG. Rita agrees. A vaginal exam is done and Rita is found to be 5 to 6cm dilated, the membranes and forewaters are intact and bulging. The babys head is still high. Rita is strapped to the CTG machine and monitored for about 10min. Babys heart tones are around 138bpm.
1130am to 1230pm Rita still seems alert and coping well with contractions. The contractions seem a bit irregular and last for about 30sec, coming at about 10min apart. She asks about the forewaters being intact and Pat explains that the earlier gush of fluid at 2.30am is likely to be a hindwaters leak and not the entire water bag breaking. While the dilation at 5 to 6cm suggests that Rita is in active labour, she still seems to be very lucid, very much in control and not in labour land as yet. Rita wonders how long more labour will last.
1230pm Pat suggests taking a walk, to stay as mobile as possible and let gravity and motion help the baby descend and for contractions to become more efficient. Rita agrees and they go for a walk up and down the labour ward corridor. The conversation is kept light and although Rita has a contraction once in a while, she still seems well able to cope.
Back in the room, Pat suggests acupressure. Pat explains that acupressure has been known to stimulate uterine contractions and while this should not be done before labour actually starts or before 36 weeks gestation, it is a safe and non-intrusive way of stimulating uterine contractions as a first-line measure if contractions seem to be flagging or irregular. Rita agrees. Pat presses on the acupressure point on Ritas hand. She does this for about five or six times and then stops.
Pat also suggests not talking anymore to help Rita retreat into a mental mode more conducive to birthing.
1240pm Ivan returns after sending Kieran to school. Pat goes out of the room to get a basin for cold and hot compresses, in readiness for the latent stage of active labour. When she returns, she notices that the pattern of the contractions have changed. They are lasting much longer, are extremely intense and coming at shorter intervals. Rita now has to focus on getting through each contraction. Pat suggests that Ivan support Rita by slow dancing with her and gently rocking her pelvis.
1300pm to1330pm The contractions are now highly intense. Rita moans softly through each contraction. While each contraction is strong and she is in tears, she copes very well through each wave. Ivan supports her and encourages her to keep going. They try alternative positions such as going on all-fours using the birth ball for support. This position seems to work well for her. They try a few more contractions in this way.
Rita reports the urge to pee. Pat says this is a good sign as this is the bodys way of emptying the bladder often, making for space in the pelvis as the baby descends. After peeing, the contractions are observed to pick up in strength and intensity, along with the urge to push.
SN Chua is called in. She asks if Rita would agree to a vaginal exam before she calls Paul. Rita agrees.
The vaginal examination reveals that she is now fully dilated and ready to push. There is no anterior lip. SN Chua goes out to call Paul. Rita is encouraged by the information that she is now fully dilated.
1330pm to1400pm Each contraction is now coming at 90sec apart and lasting about 90sec to 120sec. Rita complains of pain in the lower abdomen and back. Ivan supports her by giving her back massages. Pat heats up the rice sock and uses it at the lower abdomen. Rita indicates that this is useful. Pat also alternates this with a moist warm towel on the lower abdomen and the sacrum. The heat seems to help her cope with the pain.
Paul arrives. Rita tells Paul that the urge to push comes and goes. SN Chua suggests a vaginal exam by Paul. Rita is hesitant but agrees to this. The vaginal exam shows Rita to be 9cm. Paul thinks it will be a while more. Rita seems disappointed to hear this but Pat and Ivan continue to encourage her and tell her to work through each contraction as they come and not worry about the dilation. Pat tells Rita that shes only got a little bit more to go and her body is working excellently.
1400 to 1511pm This is an intense hour for Rita, Ivan and Pat as the contractions now come fast and very strong , sometimes contracting so long that Rita wonders why the pain is endless. Pat reassures her that each contraction, the stronger it is, the harder the uterus is working to bring the baby down. She reminds Rita to keep her jaw loose and not tense up, to vocalise if she needs to.
Going on all-fours on the floor with the birth ball, Ritas water bag breaks with a pop and amniotic fluid gushes out. Rita is amazed that there is still so much water.
Towards the end of the hour, Rita reports an intense urge to pass motion. Pat encourages her to go with her body and push if she really feels like doing so. Rita seems tired and does not think she can hold the all-fours position. So Pat and Ivan help her to the bed and she lies on her side.
A midwife comes in and asks if she could do a vaginal examination. Rita refuses. But a look at the perineum indicates that the baby is indeed coming. She goes out to call Paul. Pat suggests that Ivan come over to Ritas left and lift her leg. She reassures Rita that it is okay to push if she wants to. Pat sees that Rita is already involuntarily pushing, as she grunts and bears down. Pat strokes Ritas head and hair and tells her she is doing great. Rita says she cannot do this. Pat tells her that she can and that she IS doing it because the baby is coming. She reminds Rita not to scrunch her face up and push.
The midwife goes out to call Paul again and to get another midwife as Paul might not be able to make it in time.
As the baby crowns, Pat reminds Rita not to push but pant or blow to gently ease the baby out. The midwives try to support the perineum. The baby is born at 1511pm. Its a girl!
1511pm to1530pm The midwives want to suction the baby. Pat reminds them that the birth plan says no suctioning. However, the midwives explain that the baby is not breathing and needs to be suctioned. About a minute or two later, with the midwives suctioning and rubbing the babys chest, the baby cries. The baby is dried and given to Rita to hold. She cuddles the baby and tries to latch the baby on. The nurses want to cut and clamp the cord but Pat reminds them that the birth plan says that the father is to do this.
Paul comes in at around 1515pm. He clamps the cord and Ivan cuts it.
The placenta emerges intact. All marvel at the size of the placenta. Ivan says they plan to keep the placenta to plant it in their garden.
Paul notices a small perineal tear and repairs it, using some LA. He palpates the uterus and encourages her to nurse the baby and massage the uterus herself to help it contract.
After Paul leaves, the baby is cleaned up and Pat reminds the midwife not to clean off too much of the vernix. The baby is weighed and measured. She is 54cm long, with a head circumference of 35cm and a whopping 4.55kg heavy - the biggest and heaviest of all of Ritas babies!
Welcome, baby Meghan!
Written by: Pat Chong,
Childbirth Educator and Birth Supporter
|Meghan being weighed after birth|
|After the Birth|
|7 - 9 February 2004
I thought the birth went very well (more on my thoughts of the birth later). I didn't have PPH and the baby's blood type is the same as mine, erasing the possibility of ABO Blood Incompatibility. Meghan, had a problem latching on to my breasts properly. She'd pucker up her mouth or when she opens her mouth (to wail) her tongue would curl upwards making it very difficult to position my nipple in her mouth properly.
The LC at Mount Alvernia spent close to 2 hours trying to correct her latch but the little girl still haven't perfected her latching techniques yet :-( And from very early on, she's shown a very definite preference for the left breast.
By the day I was discharged, both my nipples were extremely sore due to the incorrect latch. To make matters worse, baby Meghan couldn't go home because of her elevated jaundice levels (about 15+)
15 - 17 February 2004
|How about if I flash my multiple dimples at you, auntie Doris ??|
|Meghan (10 days old) looking up at Doris Fok with a slightly doubtful expression|
|Meghan being sunned|
|What I think of the whole childbirth experience
I read up as much as I could about natural childbirth in preparation for Meghan's birth. I think I borrowed the whole natural childbirth collection of books at the Pasir Ris library TWICE! I also surfed the net looking for more natural childbirth information. I think I read far more on childbirth than I had for the first 3 births put together! I even made Ivan read the books so that he knows fully what we are getting into. For the first 3 births, I was content to let my doctor take charge of the whole proceeding.
To my amazement, I read in quite a few literature that some women had orgasmic childbirth experience. Wow!!! If I'm ever so lucky, he he !! I read up on ways to manage pain without drug and was determined to do completely without any pain relief, not even the gas. I put it clearly in my birth plan that no one was supposed to offer me ANY pain relief at all.
I knew what to expect at which stage and I went in fully prepared for the very difficult transition period that everyone talks about. When the midwife proclaimed me to be fully dilated, I was really elated. I thought..."wow, that was a piece of cake". Then Paul Tseng strode in and did a VE and when he said that I was only 9 cm dilated, I actually cried! Because I know the dreaded transition is still ahead of me.