Katie’s Positive Episiotomy Birth

This positive birth story is with first time mum Katie who used EBRAN to decide an episiotomy was the best option to birth her baby boy, Kit. Later reflecting on her birth, Katie said the felt like she “bossed it” and we couldn’t agree more! 

Signs of Early Labour

From Thursday evening I felt quite uncomfortable, unsure if I was going into labour, or had an upset tummy. I was quite constipated that day and the next, so I thought “it can’t be labour, labour gives you diarrhoea”. I had pressure pains in my bottom. By Friday morning I was having irregular contractions. By lunchtime I called mum to join me as she was allowed as a second birthing partner at RBH.

Contraction Timing

Mum arrived at about 3:30pm and my contractions were mostly 5mins apart and 30-60 seconds long. I used the pregnancy+ app. You have to pay for the premium version to get the contraction timer but it was great.

From about 4:30pm my contractions were 3 minutes apart and lasting about 60 seconds. They carried on like this for a long time. Some had longer intervals, and these were paired with stronger contractions. Similarly some followed more quickly but were less intense. I used my tens machine (not sure it helped), and tried to have a bath, but we had no hot water!! So I laboured mostly on all fours in various rooms of our house. I was sick once. I tried my hardest to breathe. It was a conscious effort to exchange “owwww”s for deeper breaths in and out.

Despite the lack of change in timings, mum could tell I was progressing. My show arrived at about 7:00pm and was quite bloody. Just before this I could feel a pressure and something trying to pop with each contraction so I took off my bottoms and stayed in the bathroom. We decided to go to hospital.

Heading to Hospital

My contractions continued quite consistently on the journey (about 20 mins). We arrived at the hospital and I had to squat in the doorway for a contraction. We went into triage where I had some obs taken and an assessment. I was 5cm dilated. My waters had already broken (I had no idea when). They said I was losing blood and they were a bit concerned. After a second opinion they said they would rather I went to the delivery suite where consultants were on hand, rather than the midwife led unit. They wanted to continuously monitor the baby, so that meant no birth pool. Using EBRAN, I agreed the babies safety was the most important. I was transported down whilst squatting on a big wheelchair, having strong contractions on the way. I could hear my noises had changed, and I felt a bit of pushing happening. One of the midwives mentioned that she thought I was pushing.

Labouring at the Hospital

We arrived in the room I was to give birth in. It was a hospital environment but I didn’t care by this point. My midwife, Laura, was lovely. I just wanted to be on all fours and I wanted some pain relief.  Before being examined again I was given gas and air. The examination showed I had progressed from 5cm to 9cm in less than an hour. I laboured a bit more on all fours.

A cannula was put in ready for emergency medications, it was a struggle getting one in. The monitor kept slipping on my tummy. I was still losing a quite lot of blood and was pushing quite hard. Focussing on using the gas and air was helpful even though I wasn’t really sure it was working but it was distracting me.

I also got through three bottles of Lucozade sport. I felt he was getting stuck but Laura reassured me I was making amazing progress. My moans were quite loud, and went very primal especially at the end of each contraction when the push urge was it’s strongest. Still losing blood, a consultant came to examine me. She confirmed I could still have a vaginal birth. Laura put a clip on baby’s head to monitor him better. I said I didn’t want to give birth on my back, and Laura said I should go on my side. Laura said she looked at my birth plan and did I want a warm compress. I said yes please, so she did that.

At some point I remember asking “is this where people say they can’t do it?!”

Laura said “yes you’re nearly there!”. I was proud and thought ‘blimey this has been quite manageable really!’

Choosing an Episiotomy

I felt my perineum in the way and I wasn’t confident it was going to budge. Baby was getting distressed and Laura suggested an episiotomy. I used EBRAN again, again prioritising the baby over myself and using the knowledge that I could feel he wasn’t going to break through himself. So I said” if you REALLY think you need to do an episiotomy, then OK, but are you going to numb me?”. They said “yes of course”. So Laura injected the anaesthetic and made the episiotomy cut, but the anaesthetic hadn’t worked. This was one of my worst nightmares, I heard myself scream REALLY loudly and high pitched, but it was over in a split second and with a very concerted extra effort on the next contraction baby’s head was out, with a small graze from his hand on the way. I gave one or two more pushes and he was born at 10:26pm. He was put straight into skin to skin. He was slippery!!

Delivery of the Placenta

I had wanted to try and birth the placenta naturally, but due to the blood loss they advised the injection. This was a no brainer really, there was no reason not to have the injection so I said yes. The placenta was born quite quickly, and it felt like a big relief, finally there was nothing putting pressure on me. Laura asked if I wanted to see it and I said yes. So she showed us how it turned inside out when it was born, and showed us the sac around it. It was huge, and pretty cool but gross. Like a big red jellyfish. My husband cut the cord once it had turned white.

Postnatal Care

Baby’s breast crawl wasn’t going so well but it didn’t matter. We were both a pretty disgusting mess of blood and poo. Laura said it was good for his immune system! Still bleeding; I had lost over a litre. The consultant came to examine me and see if he could find a source of the bleeding. I don’t think he could. I needed tranexamic acid but the cannula I had in wasn’t suitable, so I had to have another one which was also tricky to get in. Laura did my episiotomy stitches. I said I was scared of being stitched up, so Laura made a real effort to check she had numbed each and every place she would stitch. She managed to put them in without pain. Baby was weighed, assessed and had some heel prick checks. All came back okay. I consented to him being given the Vitamin K injection. He was cold though, so he was placed on a hot cot.

The midwife asked me to go for a wee as my continuing contractions were causing pain. Having no idea how to release my pelvic floor, I nearly fainted so we gave up. At this point I was desperate for a shower, but I couldn’t stand safely, so mum cleaned me up a bit with some wet wipes I had brought. I have a history of bladder problems and chronic infections, so Laura offered to catheterise me. I decided to have one left in so I didn’t need to worry about it for a while (I later regretted this decision, as I was so swollen they didn’t want to take it out, and I felt it held me in hospital for longer than needed).

Staying in Hospital

I was transferred to the ward at around 5am on Saturday morning. Ben and mum had to go home at that point. Ben could come back at 8am but I told him to go and get a good rest. He came back at lunchtime.

I stayed in hospital for two nights and left around 5pm on Monday. We were kept in for a variety of reasons. Baby had gone cold twice so he needed 24 hours of obs. I was anaemic, and also needed monitoring. They needed me to demonstrate I could wee. I also had horrendous pain with breastfeeding. We perfected his latch and it improved quickly, but he also has a ridiculously strong suck, so it’s still quite sore. Finally, I was getting very breathless and had pressure pains in my chest when I moved about. This was likely due to the anaemia, and is slowly improving.

Reflecting on things

Overall, I know that straight afterward I remarked on my birth as being much easier than I expected. Despite a few hiccups, it went smoothly and quickly. I laboured at home for the perfect amount of time, and my pain though strong, felt very manageable. Despite the episiotomy I don’t feel at all traumatised, and it’s healing without much pain. I am proud of myself and I think I bossed it, in my own way. I was loud, but I’m not ashamed of that.

Welcome to the world my darling boy. We can’t wait to watch you grow.”