A Calm Posterior Labour – A Hypnobirthing Australia Birth Story

 

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Sami is a women’s health physio and so approached pregnancy and birth with an amazing amount of knowledge.
But even with all of that knowledge (or perhaps because of all that knowledge), she knew she needed to prepare in order to have the natural birth that she wanted.  She opted for a private midwifery model of care, enrolled in Hypnobirthing Australia classes, and did yoga throughout her pregnancy.
And all of the effort resulted in a beautiful birth!
Her baby was in a posterior position but Sami was able to work with her body and with her caregivers to effectively manage a challenging labour.
This is a long birth story…it was a long labour…so grab a cup of tea before you start!

Here is Nash’s birth story.
Written by his amazing mama, Sami.

As I approached my due date, I was feeling calm and really looking forward to the birth of my baby.
My husband and I had chosen to have our baby at the Birth Centre at RBWH with our wonderful private midwife Karen Hollindale from My Midwives.  

As my due date came and went, my main concerns around birth were that I was never going to go into labour and that babe would be in a posterior position. I was aware that when babies are OP (occiput posterior, or facing forwards) it can often lead to a relatively long and intense labour, including ‘back labour’ – where contractions cause intense pain in the lower back.
At this point, I was pretty good at feeling my tummy for which position babe was in, and while he stayed head down, he did seem to move around a lot – sometimes facing forward, sometimes backward, he seemed to move every day!

Of course, I did eventually go into labour – at 40 weeks + 4 days and, of course, baby was facing posterior on the day! The cheeky little monkey!

I didn’t panic, because I know that many women have gone into labour with their baby in a posterior position and have still had great birth experiences, but I did mentally prepare myself for what I knew could potentially be a very long labour.

Labour finally began when I woke at 5:00am (unusually early for me) on Tuesday 13 February with an uncomfortable stomach and a sore lower back. Thinking that I must’ve eaten something that didn’t agree with me, I went to the bathroom (several times) to empty my bowels which seemed to relieve the discomfort – temporarily. Then I started to notice that the sensations, both in my tummy and lower back seemed to be coming and going in waves… which was how I expected contractions would feel! Excitedly, I started to time the waves and found that they were lasting for about 30 to 45 seconds and coming every 3 to 8 minutes, more frequent than anticipated that early on, but they weren’t too intense and I felt totally normal in between them. I had a nice relaxed breakfast with my husband, Garrett, and we even played a card game before I reassured him that he could head off to work for the day. 

I calmly called my midwife a few hours in to let her know about the contractions starting and she suggested to keep an eye on them and to be in touch as things progressed – but also to enjoy some of my Hypnobirthing Australia meditations and to rest as needed throughout the day.

My contractions stayed consistent in their timing as morning became afternoon but gradually increased in intensity – mostly in my lower back. I found I needed to move and stretch gently during them, and then started to use my hot water bottle on my lower back to help relieve the discomfort and distract from the pain. The meditations and doing my adult colouring book were also great distractions and helped me stay relaxed as the day progressed – at times 20 to 30 minutes would pass without me even realising.

My husband came home from work around lunchtime – his boss had sent him home saying, “Why are you here when your wife is in labour?!?” – and we packed the last bits and pieces for the hospital bag. By 5:00pm in the afternoon, I had been experiencing these waves and back pain for around 12 hours and was starting to get a little agitated and snappy at hubby. I needed my space and to relax a bit so I sent him out on some errands to distract him and lay down for another Hypnobirthing Australia meditation which allowed me to fall asleep for a brief period.

Evening and dinner came and went with my back becoming increasingly painful, though still with the very welcome rest period in between the waves. My husband helped out by providing some firm pressure to my lower back and compression to my pelvis during contractions, and also doing some “buffing” of my pelvis and bum with a towel which, while hilarious to watch, felt great and relieved the pain.

Eventually, I sent hubby to bed and attempted to go to sleep myself for an hour or so, but found that lying down during the contractions was MUCH less comfortable than being up and able to move and change position, breathe, and stretch.
At about midnight, I felt I needed a little more help as things were getting a bit more intense, so I pulled out my TENS machine (a small portable electrical stimulation device) and stuck the pads on my lower back. It provides a constant tingling sensation to the area which can be turned up or down as needed, and this particular one also came with a ‘boost button’ to press in order to ramp up the tingling during contractions and then turn it back down. The TENS felt great on my back and I could combine it with the heat and still move around while I was using it.

Throughout the day, I was sporadically using an app to time the contractions and waiting for the point when I hit the suggested 3:2:1 – 3 contractions in 10 minutes, consistent for 2 hours, each contraction lasting 1 minute – which usually indicates that a woman is approximately 5 centimetres dilated.

Finally at about 5:00am on Wednesday 14 February I had reached the magical 3:2:1 mark.  The contractions were pretty intense (still all in my back and now making everything tense up through my lower back muscles) and I would have to stop and breathe and sway to get through them. We gave Karen, my midwife, a call – as always she was a picture of calm but excited to hear that things were progressing and that I was managing well at home – at this stage I could still talk during contractions – and she planned to come over to our house to check in and see how I was going.

About 30 minutes later, I was opening the doors to the balcony and felt a ‘popping’ sensation, followed by a trickle of wetness down my leg – my waters had broken! I made it to the bathroom without much drama and put on a pad (had to get hubby to help me as plastic packaging is my negative skill – he had a bit of a laugh – me labouring away for 24 hours and the main thing I needed help with was opening the plastic package).

As if on cue, not long after my membranes ruptured (waters broke), the intensity of contractions and back labour really ramped up. I continued to use deep breathing, swaying, and leaning forward over the couch but now also felt the need to expend some energy elsewhere to further distract from the pain – firmly tapping one foot on the ground or dragging the ball of my foot against the floor.
I found I was no longer able to talk during the contractions and instead began vocalizing a strong aaaah sound (progressively more loudly) which felt quite instinctive and was actually very effective as pain relief. 
I’d told hubby not to call it yelling or moaning – it’s called vocalising thank you very much!
By this stage, I was very ready to go to the Birth Centre, so we called Karen and arranged to meet her there instead of at home. At 7:00am we hopped into the car with me in the back seat vocalising away loudly as we navigated through the morning traffic. 

It was great to be able to begin my labour at home in a familiar space, play some games as distractions, change positions when needed, and feel comfortable in the moment. However, with my water breaking and contractions progressing it was time to go – and so the journey to the hospital began! 

There are many things I was grateful for throughout my labour and delivery, our close proximity to the hospital included – because I can’t say it was the most comfortable car ride ever! 

As soon as I got out of the car at the hospital, another contraction hit – I leaned on the car and did my swaying and vocalizing, using the boost button of my TENS until it finally subsided and then we made our way toward the hospital entrance. I only got about halfway before another contraction arrived and so I was holding on to one of the large posts about 20 metres from the front doors, swaying and loudly vocalizing and snapping at Garrett that “No, I don’t need a wheel-chair!” I found out later that I was getting lots of curious looks from passers-by who were coming and going from the hospital or just sitting outside getting some fresh air; at the time I didn’t notice or care as I was really starting to fall into my own zone and focusing inwards, not to mention feeling a little delirious and sleep deprived from staying awake for the last 26 hours!

The next minute, an angel of a nurse who was heading home after finishing a night shift approached us with a smile and a wheelchair. She encouraged me to hop in (which of course I did gratefully) and carried our bags while Garrett pushed the chair through the front doors (over the seemingly most bumpy floor in existence), and into the elevator which stopped at every single floor from Ground to Level 5!

 We finally checked in at the Birth Centre and headed down to the room where my wonderful midwife Karen was waiting, already filling up the birthing pool. I’m pretty sure my first words between vocalizing were, “Karen, I don’t feel like a birthing goddess!” to which she replied “Oh, but you are!”

I was actually pretty sick of the TENS machine by this point – I’d had it turned up so high that it was really irritating and almost as painful as the contractions so it was a big relief to get it off and hop in the pool. The warm water was absolute bliss and really allowed me to relax and rest. 

Hypnobirthing Australia Birth Story

The next few hours of labouring are a bit of a blur for me, I was dozing between contractions in the pool, totally submerged except for my head and keeping my eyes closed most of the time. My darling husband was helping me sip water with a cup and straw and hand-feeding me grapes, so perhaps I was a bit of a goddess!

The Birth Centre room was a large homey space with a double bed, a couch, a big bathtub, a separate bathroom, and with plenty of space on the floor for mats to rest and labour on. We had the lights dimmed and while I was in my zone, hubby had hung up my birthing affirmations and mandalas on the wall, arranged LED tea light candles around the edges of the pool, and put my birth playlist on – with a mix of Hypnobirthing Australia meditations and fun jazzy-funk mixes.  Feeling safe with a few pieces of home really helped get me through the hard stages of the labour.

Time was quite a blur for me.  Every now and then, I was aware of the midwives checking on babe’s position and heart rate and my vitals too, and of course, very subtly scooping out any poop that came out during contractions (yes this happens, totally normal and nothing to worry about).  And at some stage Karen did an internal vaginal exam to check the dilation of my cervix which at that point was 8 centimetres.

The midwives were also using a mirror in the water and a torch to see what was going on. We didn’t see much progress, however, so after a little while Karen did another check and found that there was an anterior lip of the cervix – meaning a bit of it was stuck at the front, not allowing full dilation for babe to come down. This had to be manually pushed back by Karen during a contraction and holy smokes it was probably the most intense pain so far!

After another hour or so, we weren’t seeing a whole lot more progress so I got out of the pool and tried ALL of the possible positions to birth a baby!
I started out sitting on the birth stool, leaning forward onto Garrett, trying to breathe through my contractions but experiencing some involuntary bearing down. We then migrated to the mat on the floor and I leaned over the bean bag on all fours, then to sitting and reclining against my hubby again and gripping onto his shirt.
Still, we weren’t getting any effective pushing or sign of baby’s head so Karen checked my cervix again and discovered that the anterior lip had slipped and was still restricting baby’s movement. She was able to push it back again and thank GOODness this time it stayed back! Now we were really ready to start pushing!

Its hard to imagine what pushing will be like before it happens, but for me, there was definitely no ‘breathing my baby out’! I wasn’t able to generate enough of a push while exhaling and so had to hold my breath instead of vocalizing and really direct the push downwards – kind of like doing a big poo – but I could definitely feel when the push became effective beyond just bearing down.The midwives held a mirror up for me so that I could see what was going on, and gradually (so gradually), we started to get a glimpse of baby’s head!

I found it really helpful to be able to see what was going on, but it was occasionally disheartening as I’d see a bit of his head and then a little more, but then he would slip right back – leading to me crying out “don’t go baby, don’t go!”
At this point it looked like he was totally bald as we couldn’t see any hair, however as we found out later, its because his head was tilted backwards and at an angle and he was trying to come out forehead first (instead of the top and back of his head, much easier) which was why our progress was so very slow!

I changed position several more times over the next hour while pushing – back onto the birthing stool, hands and knees, standing and leaning over the edge of the pool, and squatting – but progress was still very, very slow. The midwives were constantly checking in with babe’s heart rate for any signs of distress, but thankfully his heart rate remained strong and steady throughout the whole labour.

At one stage, feeling exhausted and disheartened at the slow progress, I began doubting myself and my body’s ability. I asked Karen, “Do you actually think I can do this?” to which she responded, “Yes, but it’s going to be really hard work.”
This show of belief was exactly what I needed and restored my confidence to keep going, along with my husband’s unwavering calm and encouragement with a running dialogue of “You can do this.” and “You’re almost there!” He was lying though – he ended up saying that for at least 5 hours before baby came!

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Once baby’s head was close enough on my perineum, Karen was able to actually tilt his head forward (chin down to chest) and finally we were able to see some more movement! I pushed for while longer standing and then squatting and eventually returned back to the blissfully warm water in the pool.

Again, things were a bit hazy, I have no idea how frequent my contractions were but kept giving it my all with the pushes, and was alternating between hands and knees and squatting in the bath. I was so tired and felt like I was ready to sleep for days that I honestly couldn’t wait for babe to arrive – if only just so I could finally rest!

I was still checking on babe’s progress in the mirror and seeing more and more of his head which kept me motivated. He was still tending to slip back a little between contractions so I ended up continuing to bear down between contractions to hold him there!

I found myself talking to baby, encouraging him to keep coming on down, and telling him that I couldn’t wait to hold him and feed him. I felt that he was so close and I was SO ready to give a few more really strong pushes but just when I really wanted them, it felt like my contractions were slowing down. This was one of the clearest moments of my labour, I felt surprisingly so alert and awake and was just waiting and waiting for the next contraction. I was in a deep squat in the pool, holding on tightly with one hand on Garrett’s shoulder and the other on the rail of the tub and just WILLING the next contraction to come. I used some clary sage and did some clitoral stimulation to help bring on the next few contractions, and after another massive effortful push, his head came out!

My first words were “Karen, what do I do?! Are you going to catch him?!” She smiled and said, “No, you are.” So I took several deep breaths and just repositioned myself a little, and with the next contraction and big push, out he came – into my hands and then swiftly brought up out of the water and onto my chest!

We stayed in the water until the umbilical cord stopped pulsing (it stopped pretty quickly, seemed like just a few minutes) and then slowly and carefully got out of the bath and got wrapped in some warm towels with babe in my exhausted arms (still with the cord attached) and walked with jelly-like legs over toward the bed 2 metres away. Hubby was helping me on one side with the midwife on the other, then half-way there I felt a heaviness on my perineum and so I told them “I think I can feel something…” Before anyone could take a breath – SPLAT – my placenta fell out and hit the floor with a bloody splash all over everyone’s legs! I could only laugh, poor Garrett was a bit shocked and trying his best not to throw up or drop me, and Renee our other beautiful midwife just said: “Ah well, this is why we wear black pants!”

Finally, we made it to the bed and I gingerly sank into it with such relief, holding babe on my chest, and stayed just like that for the next few hours with hubby next to me (I think he actually fell asleep).
I had a long but superficial (first degree) perineal tear which was carefully sutured by my midwife and to be honest, I was more nervous about the anaesthetic needles and the stitches than any part of the labour or birth!
Garrett got to cut what was left of the umbilical cord (the cord actually tore halfway when the placenta fell out).
Our first breastfeed was gently guided by Karen, and I chose to do it while lying on my side because I didn’t feel strong enough to lift or hold him.
And eventually babe was checked and measured by the paediatricians and our midwives.

In the end, Baby Nash Callum Hay was born at 2:00pm on Valentine’s Day 2018, 3.126kg and 51cm long, safe and healthy.

Hypnobirthing Australia Birth Story

I’ve never felt so physically spent or weak before in my life; I couldn’t believe how many muscles felt so tired! I think I used every muscle in my body, from my neck and shoulders to my calves and feet.

We left the Birth Centre and hospital that evening, 7 hours after he was born…and then the really hard work began!
But that’s another story entirely and this one is long enough as it is!

Upon reflection there were a number of things that really helped during my labour:

– TENS Machine – super helpful during early contractions to help with pain.

– The heat and relaxation of the birth pool worked great for me!

– In hindsight, I should have asked for something to help relieve the pain in my back (sterile water injections can work really well for some women with intense back labour) so that I wasn’t bearing down so much before actually pushing. The midwives didn’t offer because I didn’t ask – it just never occurred to me to ask for any other pain relief at the time!

– Hypobirthing Australia tracks

– Birth Affirmations and reframing the pain of labour as a positive and progressive sensation (albeit super intense) as opposed to thinking of it being an indicator of harm or injury.

– The ability to move and change position was huge – because of his positioning and quirky head tilt, there is a chance that if I hadn’t been able to move so much and help babe negotiate his way through the pelvis, he might not have been able to make it out without medical assistance.

– Amazing midwifery support throughout pregnancy and labour, thank you so much Karen and Renee!

– Supportive husband lying to me the entire time about how close I was to delivering our baby!

Sami is an Australian trained and registered physiotherapist who graduated with a Bachelor of Physiotherapy from the University of Queensland in 2010. Since then she has worked primarily in private practice with a focus on pelvic health and peri-natal care, providing education to pre and post-natal women, yoga teachers (including teachers in training), doctors, and other health professionals. She spent four years in Canada with her now husband practicing as a women’s health physio before moving back to Brisbane and opening up her dream – Body and Birth Physiotherapy – a women’s health and pregnancy physio studio that feels more like a home than a clinic.