Mothering By Heart: John Emmanuel Ng's Birth

John's Birth

written by Pat Chong

1 August 2005

1743pm

Mother: Pamela Vanessa Lim

Father: Adin Ng

Doctor: Dr Paul Tseng

Labour Support: Pat Chong

Attending midwives: Nurse Manager Ng Geok Pin and SN Lim Hwee Ling

Hospital: Mt Alvernia Hospital, Room 1

EDD: 28 July 2005

Pamela’s first birth had been an oxytocin induction at 41 weeks. She had an epidural administered when she was about 7 to 8cm dilated. The labour had ended in a caesarian section birth. She finally birthed a son weighing 4.07kg then.

With this birth, she had wanted as natural a birth process as possible. With this end in mind, she changed her doctor to one known for expectant management, read up and worked with a labour supporter. Despite her preparations, Pam still had several concerns - chiefly the size of the baby. Although she wanted a vbac very much, she was not sure if this might be possible. She had had dreams about labour stalling and not progressing as well and was worried if this might be a portent.

As her due date grew nearer, well-meaning friends and acquaintances had told her that her baby was still ‘high’ and looked ‘big’. All these comments did not help reassure her of her ability to birth her baby.

27 July 2005
Pam was concerned about the size of the baby, estimated to be 4kg just a week before term. During a routine doctor’s visit, she discussed her concerns with the doctor who did a vaginal examination and found her cervix to be ‘stretchy’ and dilated to 4cm. Pam decided to be admitted into labour ward to have her waters broken the next day.

Upon further discussion of her fears and reading up of the risks and benefits of an amniotomy, she finally decided against it. Meanwhile, her labour supporter had given her other options for natural induction eg sexual intercourse, walking, eating pineapples and Tabasco sauce!

Over the following days, Pam faithfully tried all the different methods, finally resorting to the famous spicy fish head curry at Dempsey Road on Sunday. While she didn’t go into labour, she did report feelings of crampiness and a ‘pulling’ feeling in her lower pelvis. As a side effect, Adin had the runs after generous helpings of Tabasco sauce and the fish head curry! She kept in constant touch with her labour supporter through the phone and through text messages. One discussion centred upon her long menstrual cycles - which seemed to indicate that the 40weeks pegged for ‘normal’ gestation might not be relevant. It seemed all the more likely that she would go past 40 weeks.

By Sunday, she seemed to finally relax and ‘gave up’ persuading baby to come, informing her labour supporter that “baby is just not ready lah!”

1 August 2005

Pam called Pat at 8.30am in the morning from her bathroom. Her waters had broken. She had one or two contractions which came close together but did not last long. She still seemed calm and able to cope well, so it was decided that she would remain at home for a while more and have her breakfast and see how the contractions progress.

At 9.00am, the contractions seemed to be coming at 1 in 3 minutes but not lasting very long, only about 20 - 30sec. Pam said that while each contraction does not last long, she has had to pause in whatever she is doing in order to cope.

By 9.30am, Pam decided that she would be more comfortable in the hospital since the contractions were coming so quickly. She would meet Pat at the hospital.

At 10.15am, Pat met Pam and Adin at the hospital. Pam looked happy, and excited. She was coping well, walking to the labour ward and stopping every time a contraction came. They were greeted at labour ward by Nurse Manager Ng Geok Pin and placed in Room 1.

NM Ng went through the birth plan with Pam and Pat. A mattress and sheet with a birth ball was placed on the floor as requested and a CD player plugged in. Pam changed into the hospital gown and was monitored for 15 to 20min on the CTG. Baby’s heart tones looked good and the contractions were coming 1 in 3min, though still lasting for only half a minute or so. Pam also requested for a vaginal examination to be done. NM Ng examined her and said that she was dilated to 3.5cm. Pam was surprised because Paul had earlier told her she was dilated to 4cm and felt that this was a ‘setback’. NM Ng reassured her by telling her that it was between 3.5 to 4cm and sometimes, if the person checking stretched the cervix a little, it could go up to 4cm. So it was not that the dilation process was halted and regressed.

As Adin went to complete the admission processes, Pat stayed with Pam. Pam was still coping well at this point, preferring to sit on the edge of the bed and leaning forward every time a contraction came. She also tried standing up and leaning against a shelf to cope with the pain.

As time wore on, the contractions came faster and faster, though still of short duration, although each contraction clearly was more intense and more painful. Pam said her back hurt and there was pressure on her lower abdomen, near the pubic bone. A cold compress on the lower abdomen and massages on the lower back seemed to help.

Pam seemed to cope reasonably well but seemed less in touch with what was happening around her. When Adin returned, Pat suggested that Pam try other positions such as standing and hip swaying to take the pressure off the tailbone and lower back where the pain was. Adin held her as she leaned into his arms and swayed.

Pat suggested that it might help the baby descend if the pelvic canal could be further ‘opened’ through ‘lunging’. A stool was placed near her left leg. Pam was asked to place her foot on the stool, at a 90deg angle and lean into it. She tried this for two contractions but reported more pain. She tried this with the other foot but also reported more pain. So this position was abandoned in favour of a side-lying position, as Pam also reported feeling very tired.

Pat showed Pam how to lie down on her left, with a pillow in between her legs, her lower leg straight and upper leg bent. A few more contractions went by with Pam lying down, eyes closed, vocalising softly as the pain came. Pat also massaged her back.

Around 12.30pm, Pat asked if Pam wanted to pee and helped her to the bathroom. Pam had two contractions there. Meanwhile, Paul had arrived so after one contraction, Pam returned to the room. Paul did a vaginal examination and found that she was about 5 to 6cm dilated but the baby’s head was still high at +2 station. He told her cheerfully to “hang in there” and asked the nurses to call him when things changed.

Adin went to buy some sandwiches and drinks for Pam. She ate a part of the sandwich and drank some water in between contractions. The lights were turned off and Pam sat upright in bed, supported by pillows as she tried to cope with the contractions. In between contractions, Pam asked if sitting down was effective in helping her progress. She was willing to try other positions if this was not, despite being tired. Pat suggested that she kneel on the bed, leaning against pillows raised up against the back of the bed - again, the objective was to take the pressure off the back and still stay vertical while leaning against the pillows to get some rest. This position was alternated with sitting up vertically and with lying down whenever she felt too tired.

By around 2pm, Pam indicated she would like to try going on all fours on the floor, leaning against the birth ball. NM Ng came in and checked her and said she was about 8 to 9cm dilated but baby’s head was still high. She encouraged Pam to push to try to bring the baby’s head down as this might be less painful for her. At this point, Pam still had not expressed that she had any strong urges to push. Despite this however, she decided to push with every contraction and found that it brought some measure of relief.

After a while, Paul came in. He watched as Pam pushed hard. There was a slight anal flare, indicating that baby had indeed moved down a bit. He watched her progress for about half an hour. Pam worked really hard at this and Pat reminded her often to keep her jaw loose and to make low grunting sounds as she pushed. Finally, he examined her vaginally and asked her to bear down during a contraction. He told her that the baby was lower than it was when he examined her earlier - about -2 station - and that it did seem to come down further when she pushed hard. He asked if she had a strong urge to push and Pam said, “sometimes.“

He advised her to push only when she had the strong urge to and if not, to just let the uterus do the work for her and try not to push, in order to get some rest otherwise she would be very tired before too long and any pushing would be inefficient.

Paul then left and asked the nurses to call him later. Pam seemed tired and Pat suggested going into a supported squat position with Adin supporting her from the back to take the weight and pressure off her arms and her knees. She tried this position for a couple of contractions but reported that she felt more efficient pushing on all-fours. So she went back to the all-fours position.

After a while, it was clear that she was becoming really tired. Adin was also concerned about her tiredness and suggested that she not push for a couple of contractions. Although she tried this, she reported it was more painful not to push. So Pam went back to the bed and tried not to push, with Pat encouraging her to pant or blow gently against the urges to push. Pam tried sitting upright in bed, holding on to the grab bars which NM Ng brought up but reported this was uncomfortable and painful. Pat then suggested lying down again in the exaggerated Sim’s position. It seemed more comfortable for her and she went through a few contractions like this as she breathed through each contraction and fought the urge to push.

After a while, NM Ng came back in and checked Pam again. She said that baby was a little lower but still a bit on the ‘high side’. She asked if Pam wanted Paul to come and assist in the birth, as in a vacuum or forceps delivery. She felt that this was a big baby and that Pam might need some assistance. On hearing this, Pam nodded. She felt very tired already and the contractions were obviously overwhelming her. It was also difficult for her get any rest against these contractions.

With that, NM Ng went to call Paul and the nurses readied the equipment and the bed for an assisted delivery.

Paul came just after five and gowned and suited up. Pam’s legs were placed in the stirrups. He placed his hand in the vagina and asked Pam to push hard. With that hard push, he said he could feel the baby descend further. After the next push, he asked her if she wanted to do this herself or if she needed him to help her. Pam shook her head and asked that he help her with this. Paul then said he was going to use the vacuum and use minimum traction but most of the work was still going to be done by Pam’s pushing efforts.

The vacuum cap was attached to the suction hose and the cap was lubricated generously. He placed the cap into the vagina and attached it to the baby’s head. The machine started and he instructed Pam to push hard whenever she had the urge. Pat and Adin supported her from the back and held back her legs as well as she pushed. Pam pushed hard, so hard that she went red and purple in the face. Pat was concerned about this and reminded her to breathe through the push. Paul also encouraged her to “change breaths and then push again”.

As the baby’s head emerged, Paul exclaimed, “No wonder! The baby is OP!” and NM Ng excitedly pointed out, “See, the baby was trying to turn already!”

The baby’s head was elongated due to the suction of the vacuum and once the head was out, the rest of him emerged rather quickly. Unlike the natural process of rotation, where one shoulder and then one arm would emerge at a time, the baby came out with his arms at his sides in a whoosh of blood and water.

He started to cry almost immediately and NM Ng said, “He is gurgling. There is a lot of mucus so I am going to suction.” The baby was suctioned and then placed onto his mother.

There were cries of relief, congratulations and thank-yous all round as everyone tried to guess how heavy the baby was. Pat took pictures and Paul invited Adin to cut the cord.

There was a short wait for the placenta and Paul did a gentle cord traction. He asked Pam to push a bit and then the placenta was out. He then gave Pam a shot of syntometrine, saying that after a prolonged labour, the uterus may not contract as efficiently and the syntometrine would help it contract. Pam agreed to this and the nurse administered the injection.

As everyone oohed and ahhed over the baby, Paul stitched Pam’s perineum. He had not given an episiotomy and Pam had torn neatly down the midline. When this was done, he completed the paperwork, congratulated them once again and left.