“Who homebirths? I do, a 30 year old woman with a postgraduate degree, living in Adelaide, having previously had a normal and uncomplicated previous vaginal birth. I made the choice to homebirth out of a desire to have more personalised care, to have greater autonomy about the decisions I made about my care, to have greater freedom and privacy during my labour and birth, and to give my baby the very best chance at having an optimal start to life in our family.”
The Birth of Sasha Joy MacKay
Like most birth stories, this one begins long before Sasha came into the world, even before her conception. My first daughter, Hannah Katherine MacKay, was born at 40 weeks, 4 days into water at the Flinders Birth Centre after a 5 hour spontaneous labour. I felt very happy with Hannah’s birth, very proud of my ability to labour and birth without any drugs, and satisfied with my choice of birth location and care providers. I didn’t enjoy my stay in the postnatal ward in the hospital after Hannah’s birth – in particular, the hospital food, the noise and disruption of being in a busy hospital, the constant visitors and interruptions and yet the feeling of being quite alone and isolated. I felt like a little cog in a big, impersonal machine, even though the staff were friendly and generally helpful. Several months after Hannah’s birth, I found myself reflecting and thinking about her birth often, and wanted to be able to talk to other women about their birth experiences. I wanted to share what had been a life-changing event for me with others and to learn more about pregnancy and childbirth. I didn’t feel traumatised or upset about the birth, I just needed an avenue to share with other women about pregnancy and birth.
Through my yoga group, and with the encouragement of a friend, I attended my first Birth Matters meeting and was instantly hooked! Here was the place where I could talk about my birth experience, hear of other women’s experiences and get to learn so much about pregnancy and birth through talking about research, media articles and hearing of the experiences and expertise of midwives. I began attending meetings regularly, wrote up Hannah’s birth story, and started to devour all the Birth Matters library had to offer. I discovered there was a whole other world of books on pregnancy and birth beyond “What to Expect When You’re Expecting” and “Up the Duff”, and that these ‘mainstream’ books often didn’t have a lot to offer in terms of evidence-based research and support for women who wished to avoid unnecessary interventions. I read some more scholarly texts, like “Guide to Effective Care in Pregnancy and Childbirth” which summed up all the latest research results, and “In Pursuit of the Birth Machine” which discussed how pregnancy and childbirth has become so medicalised without improving outcomes for women or babies and my eyes were opened up even more. I began to question the policies and practices that the hospital system imposed upon me in my pregnancy and birth, even within the ‘low intervention’ approach of the Birth Centre. I started to realise that there was often a large gap between what the research evidence demonstrated and what hospital policy was. I understood that even for an educated woman who thought she knew quite a bit about pregnancy and birth, it was very difficult to argue against hospital policy, and that I was only given the amount of information on procedures, practices and tests that the hospital staff felt I needed to know and that this was a long way from being genuine informed consent.
In all of my research, I began to hear more about homebirth and independent midwives. Up until this time, I had naively thought that homebirth was only for people who were ‘hippies’ or for those who were more interested in an experience than in the safe birth of their baby. I had never even known that homebirth was an option when I was pregnant with Hannah and the only person I knew who had homebirthed was a woman with a tattoo – confirming my exceedingly stereotyped and judgemental beliefs. A member of Birth Matters gave me a pile of research articles about homebirth (thanks, Lareen!) and I read them all and showed them to my husband, Robert. I talked to independent midwives about how they worked, talked to women who chose homebirth, and started attending Homebirth Network SA meetings regularly. I read dozens of birth stories (home and hospital births alike) on the internet. I also joined Joyous Birth, an internet homebirth community and read more and talked more about homebirth and the research evidence about it. Both my husband and I have postgraduate degrees in the social sciences, so examining scientific studies and following the research evidence is very important to us. For me, the information I gained here was what I needed to feel comfortable about choosing a new path for my next pregnancy and birth. I became, and remain, convinced that homebirth is at least as safe as hospital, and probably even safer for healthy women and healthy babies.
And so, Robert and I conceived Sasha and another wonderful pregnancy began. From the first moments of knowing I was pregnant, this was a different journey of trusting that my pregnancy and growing baby were normal unless there was evidence to the contrary. My belly popped out very quickly, and I began talking to women who had chosen independent midwives as their care provider in their births to help me choose the right midwife for me. In talking to others, I learnt that as well as getting the ‘right fit’ with your midwife with regards to your views on intervention, tests etc, you also had to get a ‘fit’ in terms of your personality. The relationship you have with your midwife is vitally important, and every woman I talked to felt that their midwife was their ‘midwife for life’, forever to be an integral part of their family history. I had met Wendy Thornton through Birth Matters and Homebirth Network SA long before I became pregnant, and had felt instinctively that she would be the midwife for me. At around 13 weeks, I ‘formally’ rang her and started asking her the questions that were important to me – about transfer rates and outcomes, interventions, tests and ‘routine’ procedures, and what would, in her view, rule out a safe homebirth. After that discussion, I felt completely satisfied that what I knew to be true from the research was how Wendy practiced.
Being cared for by an independent midwife in pregnancy highlighted for me what was lacking in my care in my first pregnancy. I got premium, one-on-one care from a midwife I had already come to know, and who knew Hannah and Robert. Wendy visited me in my home, for at least an hour each appointment, and she answered all my questions with honesty, expertise and a positive attitude. I was able to (and did!) contact her 24 hours a day, 7 days a week to ask questions as various issues, minor ailments and concerns came up through the pregnancy. She lent me books on pregnancy and childbirth, and knew the research on testing in pregnancy so I was able to make genuinely informed consent with regard to ultrasounds, iron tests, blood sugar tests, amniocentesis etc. This time around, I chose not to have any routine testing at all because the research evidence is clear that, in the absence of signs that the pregnancy is not normal, routine testing does not improve outcomes for mothers or babies. At each visit, Wendy would have a feel of my tummy to assess the baby’s growth and position, and listen to the heartbeat with the Pinard and we would talk about what she discovered. There was always complete openness about these examinations and never the feeling that Wendy knew more about my baby and my pregnancy than I did – there was no sense that I wasn’t ‘qualified’ to know what she knew (in stark contrast with how I’ve heard other women describe their relationship with their care provider). We were on this journey together, my family and my midwife.
Even though I’d been through one drug-free vaginal birth, I still had some of the usual concerns about how I’d cope with the pain of contractions again, and about how my labour would progress. As my last labour had been much quicker than most first labours, I also felt quite a bit of trepidation that this labour would be ‘too quick’ as I’d heard lots of women describe very fast labours as being quite overwhelming and frightening in their intensity. I had also noticed that I could feel ‘more’ baby on the low right of my abdomen than on my left side – just as I had with Hannah, and Wendy felt confident that this baby had a hand up next to its face, just as Hannah did. I had felt that Hannah’s nuchal hand had contributed a lot to the pain I’d experienced late in the first stage of my labour, and so I felt some anxiety about facing that pain again. To deal with my fears, I prepared my support team for the birth: Robert, Wendy, Michelle (my sister, main support for Hannah who may be present at the birth), Heather (my other sister, to take photographs), my Mum (a further, practical support for me), and a midwifery student (to allow her to observe the work of an independent midwife at my antenatal visits, birth and postnatal visits). Although this might seem a lot of people, it was the same number as had been present at Hannah’s birth, and I had felt very comfortable with my family members and others there. The midwifery student (who will remain anonymous to protect her candidacy in her university degree) I met through Birth Matters, and I agreed to her unofficially and secretly‘following through’ with me in my pregnancy, as midwifery students are prevented from officially following through women who choose to birth at home due to concerns at the universities about independent midwives being uninsured. I feel very strongly that student midwives, who are being trained to be the experts in normal birth, should be able to formally follow through women who have chosen care providers who are most likely to ensure they get normal birth.
With my birth team organised, I set about writing my birth plan. There were a few things I wanted to do differently this time, and some things I wanted to repeat. Most important of all was that I birth at home as long as it remained safe, that I birth in water again, and that I catch my baby as it is born. I also wrote up a transfer plan in the event that we had to go to hospital. I met with my support team and went through my birth plan, and had their unflinching support. I had thought long and hard about my birth plan, and while I knew that events don’t always go as you expect, I knew that I had people around me who I could trust to protect and work towards getting what I wanted.
In spite of me organising my birth support team, over the final weeks of my pregnancy, several people had to step down – my sister Heather moved to Kangaroo Island for her final university work placement and knew she’d be unlikely to get over to the mainland for the birth, and my midwifery student was unable to follow me through due to unexpected changes in her family circumstances. My Mum would also be travelling from interstate for the birth (due to arrive on my due date), so I also knew that it was possible she wouldn’t be present. As the weeks rolled on though, I didn’t feel any concern about having less people to support me. I felt that it was all meant to be, and that I didn’t need to do anything to ‘replace’ those who wouldn’t be able to be there.
At 35 weeks, I held a MotherBaby Blessing with a number of friends, asking them to bring a candle, a bead for a necklace, and a blessing for my birth. The day was blissful, with a friend painting a lotus flower in henna on my pregnant belly, and I was so touched by the creativity and effort people put into their choice of candle, bead and blessing. I made up my birth necklace and bracelet, and planned to write up all my blessings onto large cards to look at during my labour. I also had a long list of things to do in my final weeks of pregnancy pinned up on the fridge, fully expecting that my labour wouldn’t start until at least 40 weeks, or even later given that I wouldn’t be under any pressure to be induced (in contrast to my last pregnancy).
On Friday, 26th October 2007, I was at 37 weeks, 2 days gestation. I was feeling good, with lots and lots of Braxton Hicks contractions each day, just as I had experienced every day for the previous 5 months or so. I had a full day of activities planned with Hannah and got home from all of that in the late afternoon. I pegged out the last load of newborn clothes on the clothesline, watched some TV with Hannah and thought about having a nap on the couch. Robert came home from work at 4.45pm, an hour earlier than usual and we chatted in the lounge. At 4.55pm, I suddenly felt a strange sensation in my lower abdomen, a pinging/twanging sensation and I thought “That feels weird, I wonder if that’s my waters breaking?”, and then GUSH…down my legs flowed warm, clear liquid. I asked Robert for a towel, placed it between my legs and then we both said “This isn’t meant to happen yet!!” As I squelched off to the toilet, I grabbed the cordless phone and rang Wendy. “How are you?” asked Wendy. “Damp!” I replied. I sat on the toilet as I talked to Wendy. She told me that 60% of women go into labour within 12 hours, and 90% of women begin labour within 24 hours of their membranes rupturing. I wasn’t having any contractions, so Wendy said that she’d see me tomorrow if my labour hadn’t begun before then. I ended the phone call, pooed, and Robert started setting up the birth pool. I phoned Michelle, who was finishing work in the city, and told her I’d let her know when my labour began but to be ‘on alert’. I moved about the house, changed my clothes and got a few bits and pieces together for the birth. I was having strong, painless, Braxton Hicks contractions, and wondered when my labour might start.
At 5.20pm, I had to go to the toilet again to poo, and I thought that the colour of the amniotic fluid I was leaking was slightly tinged with green. I knew this wasn’t necessarily anything to worry about, but I rang Wendy again and asked her to come around to listen to baby. Wendy said she’d be there in 40 minutes. I felt my first contraction a few minutes later – strong enough to make noise through, but very manageable and fairly brief. Robert had got the birth pool set up, but we realised we didn’t have the hose attachment for our tap. I got three pots of water onto the stove to boil and Robert rang Michelle to ask her to stop at Bunnings to pick up a hose attachment as well as some batteries for our cameras. During their 3 minute conversation, I had two contractions and Michelle could hear the familiar sounds of my labour beginning.
Hannah was very excited about all the goings on, and was telling Robert she would get in the pool now, and when she wasn’t doing that, she was asking me “Mummy, whatcha doin’?” I told her the baby was coming soon, and kept on moving about the house, getting a drink, finding some nappies, putting on lip balm, pinning back my hair etc. My contractions were quite erratic, coming 6 minutes, 2 minutes, 4 minutes apart and I don’t think any lasted longer than about 40 seconds. I managed them by leaning forward and making a long “HAAAA, HAAA” sound and rocking from side to side. I took deep breaths during each contraction to make sure my baby got plenty of oxygen, something I hadn’t managed to do well in my last labour as I’d felt quite overwhelmed by the feeling of the contractions. The sensations this time were quite bearable, and I was pretty sure I was in early labour. I stripped off my clothes as I was feeling hot, leaving just a folded towel in my knickers. I was upstairs by myself at this time, and took a moment to talk to the baby and tell it that we would work together to bring it safely into the world.
As it approached 6.00pm, I decided to run the bath. I debated with myself about doing this so early, worrying that I might use up the hot water before we started filling the pool, but I rationalised that the hot water system would have enough time to refill before the pool was needed. As the bath filled, I went to the toilet again and decided that I might just have a feel inside my vagina to see what was happening. I’d never felt comfortable with that idea during my labour with Hannah and had felt that I needed an ‘expert’ to tell me what was happening in my body, but this time, I felt completely comfortable. At the full stretch of my fingers, I could feel the edge of my cervix, and the head of my baby, soft and wrinkly and about the size of an apricot. I wasn’t sure if I was fully dilated or not, but could tell that my cervix had obviously dilated a lot and my labour was much further along than I had suspected.
I didn’t feel any concerns about my labour progressing quickly, particularly as the contractions were so bearable. I got into the bath as it filled, sitting cross legged, then lying on my side for a contraction. I then turned around, kneeling in the water and resting up on my elbows on the edge of the bath. With the next contraction I suddenly felt this enormous, unstoppable urge to PUUUUUUSSSSSHHHH, and could do nothing but surrender to its intensity. I let out a shriek as I pushed hard (and pooed some more) and heard Hannah run out of the bathroom. This was the only contraction where I felt that I ‘lost it’ and felt overwhelmed by the sensations in my body. I reached into my vagina and felt that my baby’s head had moved down about halfway into my vagina, and I could now feel a kiwi fruit amount of head under my fingers.
Robert ran up the stairs on hearing the noise I was making and asked me what I needed. He went up and down the stairs in response to my requests for my water bottle, some of my candles, a bucket for the placenta etc. Wendy rang to let us know she was stuck at the railway lines and was on her way – she could hear me in the background and knew she’d have to hurry! I wasn’t feeling afraid of giving birth without Wendy there, and never felt a moment of panic or fear for my baby’s safety, but I knew that I wanted the emotional support of a woman who had birthed before. I wanted to say to someone that “this was hard” and to hear someone say truthfully “I know it is”.
Wendy arrived at 6.15pm and as she came up the stairs, Robert asked if she thought I was fully dilated; Wendy looked at me in the bath and said she could see the baby’s head! I agreed to Wendy having a feel of the baby’s head, and then she started adding more warm water into the bath to get the level higher for my baby’s birth. Wendy asked if I wanted anything, and I said I wanted my poo out of the bath. Wendy replied that babies love this environment, and I shouldn’t let it worry me. I put my head on her shoulder and swore a few times, expressing the intensity of the sensation of pressure on my perineum. I initially felt I wanted some counter pressure on my perineum from a flannel, but changed my mind within a few seconds as I wanted to keep my hand on my baby’s head as it was born. I gave small, grunty pushes as I felt I needed to, and felt more and more of my baby being born under my hand; the top of her head, her ears, her face, her shoulders, then her tummy and then all of her warm, wriggling body slipped into my hands and I lifted her up out of the water onto my chest. What a joyous moment! I was stunned, in shock, relieved, excited, overwhelmed and amazed. My baby was born, into my hands, in my home, and after only one hour of labour (6.23pm for those playing along at home!).
I gently turned my baby over and saw that I had given birth to a second beautiful daughter, Sasha Joy MacKay. Hannah and Robert had witnessed the birth, and Hannah immediately asked to get into the bath with me and her new baby sister. As she splashed about, Robert took some photographs and Wendy supplied me with homeopathic remedies. Michelle arrived 10 minutes after Sasha was born, bringing her son Seth with her (as it happened, that day was Seth’s 3rd birthday!). Michelle was very disappointed she’d missed the birth, especially as she’d put a great deal of effort and thought into how she’d support Hannah during my labour.
I cuddled and welcomed Sasha in the bath for 20 minutes, experiencing strong, aching afterpains. As the bath cooled, I got out and onto my bed which had been lined with old towels and plastic sheets. The afterpains were unpleasant, and (frustratingly) lasted longer than my labour pains, but I didn’t want to interfere with the birth of my placenta in order to ease them, especially as I wasn’t bleeding at all. I laid Sasha on my tummy and let her crawl up to my breast and self-attach. She began breastfeeding as if she’d always done it, and I rested as my family moved around the bedroom and Wendy began writing up her notes. As the afterpains continued, Wendy suggested I try squatting to birth the placenta and ease the pains, so I squatted over a bucket next to the bed and gave two big pushes to birth the placenta, 45 minutes after Sasha’s birth. I had wanted to keep Sasha attached to the placenta until her cord had stopped pulsating, and was prepared to not cut the cord at all (allowing the cord and placenta to dry up over 3-5 days; a lotus birth), but we chose to cut her cord 14 hours after her birth as I found carrying her placenta around with her was impractical and meant I couldn’t cuddle her like I wanted.
I had a warm shower to wash Sasha’s meconium poo off me (like mother, like daughter!) and then Wendy examined my perineum – I had no tears (even though Sasha did have her hand up next to her face as she was born), a minor graze, and no bleeding at all. Sasha weighed 3.68kgs, or 8lbs 2oz, was 49cms long, and had a 34.5cm head circumference. Michelle’s partner arrived soon after, and entertained Seth and Hannah with PlaySchool and balloons downstairs, and then organised dinner for us all to share. Everything felt so normal and personal and yet extraordinary and universal.
My experience of Sasha’s birth was everything I dreamed of in that I birthed safely at home, in water, and caught my daughter myself. While my labour was much earlier and quicker than I expected, it was wonderfully relaxed, bearable and safe. Sasha’s birth has given me enormous additional confidence in my body and its ability to grow and birth a baby perfectly. I am completely satisfied with my choices this pregnancy and birth and would do just the same if there’s a next time (except I’ll give up on the birth pool; the bath does just fine!).