"It won't happen to me"

As much as I might like to, I haven't been able to cruise through my pregnancies thinking that bad things won't happen to me. Too many bad things have happened to friends (or friends of friends) - either to themselves or their babies - for me to be under any illusions that those two little pink lines on a stick mean that you'll definitely be holding a healthy baby 9 months later.


I realise that my view of this is statistically skewed, considering that I know far more women who have lost babies at the end of their pregnancies than at the beginning when it is far more likely for a woman to miscarry. Generally, we are conditioned to expect that with good perinatal care, women and babies will survive just about anything that is thrown at them, provided they can get the right treatment in time. But what is bothering me more and more is that we have not left even the smallest opening in our minds to accept what is the harsh reality for the remaining few mothers and babies: that no matter what they do, or how cautious they might be... loss of life is still part and parcel of childbirth (and parenting) and few of us are prepared to really consider that as part of the journey.


Having just read this article in The Age, I am once again irritated by this "new" style of reporting that seems to be happening ALL THE TIME at the moment. I say it's "new" because I have never noticed it before, but maybe it's always been like this and I've just never noticed. Basically, it goes something like:


"Hey, a really horrible thing happened today. Just thought you should know because something equally bad might happen to you too! ... But I won't give you any of the details about how or why it happened, or how it could have been prevented... I'll just leave you with a whole bunch of ideas to piece together however you see fit. Okay? Cool. Thanks for reading".
Signed, Name of reporter (if you're lucky)


Awesome work!! Thanks so much for the brilliant display of investigative journalism. As a concerned 'consumer' about to give birth in hospital, but also being cared for by an independent midwife, I felt compelled somehow by this lack of sufficient information to find out more.... And presto! In about 30 seconds flat, I can jump online and find out what this 'journalist' has been too uninterested to discover (despite the lives and heartbreak of those involved). So what did I want to know? Well, if we know that this woman died of cardiac arrest - and we also know that she was at home when it happened - then it would also be good to also enquire as to whether the outcome would have been different if the woman had been in hospital... wouldn't it?

Through doing my own search, I was able to discover that cardiac arrest affects around 1 in 30,000 women and, disturbingly, they are usually young and healthy. According to the Society for Obstetric Anesthesia and Perinatology (SOAP) report I found:


"Cardiac arrest in the parturient has numerous causes. The most feared and deadly is amniotic fluid embolism (AFE). AFE can present with cardiac arrest, hypotension, bronchospasm, coagulopathy, fetal distress or cyanosis (2). Even with optimal treatment, AFE is associated with a high rate of morbidity and mortality. It has been reported that only 15% of patients who survive AFE are neurologically intact" – and this review, being conducted for hospital-based anaesthesiologists, presumes the woman is receiving hospital-based care and even goes on to list further potential risk-factors associated with being in the hospital environment!


Obviously, in this case, we don't understand the cause of the womans cardiac arrest (and it may not have been AFE), but I still think it's interesting to understand the rarity and seriousness of potential hazards to birthing mothers and their babies, such as cardiac arrest, or catastrophic uterine rupture (which is the adverse event that's been pinned up on the noticeboard for my own impending VBAC attempt).


Once again, another link has been drawn between home birthing and a tragic event, leaving the reader to deduce that it must be more dangerous to birth at home... when in fact, birthing AT ALL is just downright dangerous to the few mothers and babies who are affected by these kinds of adverse medical events. Just because we live in a society where excellent medical care is available to most people (leaving aside the fact that this is true for some more than others), I have only found out the limitations of what is "known" and is "safe" about giving birth through taking an actively inquisitive approach to both my pregnancies.... and ONLY because I was planning a home birth the first time around did I realise the responsibility I had to take for my OWN level of risk with regard to the entire pregnancy and birth. There was never going to be anyone else who was prepared to look me in the eye and promise me "it won't happen to you". I can't believe there are people out there who actually think that this is what home birth is all about, or what independent midwives out there are practicing. In fact, it was one of my independent midwives who pointed out that risk can be measured as a 1 in 100/1000/10, 000 chance..... but if it happens to you, your own risk is actually 100%. Now there's a statistical interpretation worth considering that many people just don't.


It saddens me that the partner and young children of the poor woman who lost her life - will have their grief overshadowed (and even disrespected) by some "debate" about whether she was "doing the right thing". In fact, it's kind of disgusting, now that I write it down in those terms!


Was she doing the right thing... planning to have a healthy baby and NOT have a cardiac arrest during labour? Isn't that what we're all planning to do when we plan to have our babies? - I know I am. Absolutely, I'm planning not to die and planning to have a healthy baby. But at least I'm not ignorant about the risks. At least I've spoken to my family about the risks and said to them, 'Well, so far, so good... but I've kind of just had to accept that there's about a 1 in 1000 risk of something pretty bad happening to me or to the baby. There's not a lot we can do about it, except be well informed and choose the best care providers we possibly can and hope for the best.


Our attempt, as human beings, to hope for the best - is what takes on the form, shape, colour and life to become our experiences. If, through hoping for the best, we wish to birth at home... we wish for a beautiful, peaceful water birth (or for a completely painless caesarean birth) ... and a wardrobe full of freshly washed baby clothes and a list containing those one or two (or 22!) perfect baby names... These are all ways that we are expressing our desire and attempting to 'actualise' this positive hope we all share. It is not recklessness or stupidity to plan for these things... but maybe it's idealistic to plan for them with the expectation that everything will definitely be okay.


It is so, so sad that for this family everything was not okay, and that there will be people judging them for it who wouldn't have judged them if they'd been in a hospital. I have packed my hospital bag, but am by no means confident that something like this won't happen to me or my baby; but we must carry out our plans knowing there is actually nothing I can do to "be safe" except wish it to be so.


It is the individual's family that lives with the outcomes of events like these, and it's nobody else's job to reconcile themselves to the circumstances surrounding a tragedy. We do not judge (in the same way) those who choose to live rurally or further away from a emergency facilities as being "irresponsible", yet this would sometimes mean the difference between life and death for many people in life-threatening circumstances – and is essentially the same issue that home birth presents: the actual distance between the potential for a medical emergency and the type of care that may be needed.


Anyway, enough from me about that. It's back to the sorting baby clothes and agonising over the baby name list... pacing expectantly and rubbing my belly and imagining that, soon, she will be here and that we can all be a family together. This is what the colour and the shape of my "hope" looks like.


Sure.... some people call it OCD, but I call it hope... and I think all women are equally entitled to it!

My sisters

I've grown up with one sibling: a brother. I suppose I have to say I don't know what it's like to have a sister (one that I've grown up with), but I've been thinking recently bout how much this idea of "not knowing what it's like to have a sister" has changed for me.

Basically, at this stage in the pregnancy, I find it's really easy for me to feel like I've worn out my welcome. I know that all I am thinking about is the baby and my body - and the relationship between the two. I'm pretty sure that's all I'm talking to anybody about as well!! So I'm feeling like pretty poor company, in the social sense.

But you know, at the same time, I can't help it. It's what I need. ... Sometimes if feels like it's the only thing I need!!

I have had one 'sister in friendship' since high school; and since getting married 8 years' ago, I've acquired 3 more 'sisters' (real ones!): My husband's sister; his brother's partner; and  my brother's new wife. Such amazing women! All different and very strong. All welcoming of me, yet I have often felt that I don't know what I should do with these relationships. Like I don't know who I'm supposed to "be" to be someone that's interesting and important to them.

Yet, as time goes on, our lives become more inextricably entwined. The shared life experiences of our growing families naturally cause us to bind to one-another and our stories start to integrate all the more. While I am listening to them... I realise I am also listening to myself listening to them. I am learning more about who I am and what it means to be a woman, just through the presence of more and more great women in my life. Whether or not I am fulfilling the same role for anyone else: this is what has become true for me.

Of course, it's not just these four fab women in particular who are my 'sisters'. Now that I'm attuned to the concept, I can recognise them everywhere! Since having my son, I am now part of a sisterhood that is limitless. Becoming a mother has opened me up to the fullest extent. While I feel at my most vulnerable, I am also at my strongest - because I know, now, how much I share with so many other women who inspire me on a daily basis.

So I want to say thank you to all of my sisters, who have been humouring me and listening to me... sharing with me my very smallest and very greatest of concerns over these past months of pregnancy. I am acutely aware of how much I have asked of you and of how little I've been able to offer in return. But I could not have done it without you! I couldn't be so well prepared for the kind of birth I want to attempt without the many, many conversations about my hopes, fears and frustrations... and without quizzing you all on your own experiences and frantically scribbling down as many mental notes as I possibly could; shamelessly guzzling every ounce of care, insight and support on offer. If it has seemed too much, I only want you to know it's meant the world to me and that I haven't taken it lightly. I think I have grown giddy on this new 'girls only' drug that I've discovered, and I hope you'll take me back once I come back to earth.

...

Soon there will be another among us... But I will defer any extended ruminations I have about becoming a mother to a little girl. Of course, it's all going to relate back to what I've said above - and completely relate to my own experiences of being a woman. But for now, I'll stay true to this path and fully indulge in the richness of the last, heady couple of weeks of such utter and complete immersion in my thoughts and this experience of pregnancy - of the "before". Who knows, it may be the last time I'm here ... and I must make the most of it, no matter how crazy and indulgent it may seem to others.

There is no other world like this one; and the potential is so great to learn more about myself as my image is reflected back at me from the surface that's winking back daylight from above my head. In this state is where I can feel my sisters gathered around me... waiting with me. Even those who didn't choose to support me, I can feel the power and wholeness of your presence, whether or not that presence represents a level of frustration, or even alienation from me and my experience; what's amazing is that it doesn't seem to matter! Whether or not you offered, or whether or not I asked, you are all there.

Now is not the time to swim up and take air. My baby and I are busy gestating together... I will take my first breath when she takes hers; I will become real again when she becomes real. Now is not the time for thinking of things that will lessen the power of what is occurring and is about to occur. All that matters is that right now, I am lucky enough to find tangible comfort in these thoughts. I don't need promises or guarantees to get me through the things to come. Having the amazing support of all the women in my life is a million times more important than knowing what will happen next.

... and whatever happens next, I feel I couldn't be better prepared.

The day you went away

This is the song that's playing through my head as I look down at my ankles.

http://www.youtube.com/watch?v=Zfqusp7s5o0

I'm sort of pleased that the fluid retention is as hideous as I remember it, as I really struggled toward the end of my first pregnancy – and there was absolutely NOTHING ELSE wrong with me except for having swollen feet and ankles. If you'd asked me a few days ago, I'd have said I was feeling super-fantastic and even better than I did the first time around!

Yeah, that was before this happened.

I guess I was expecting it – and the hot weather is largely to blame – as well as just the general strain. My body is now suddenly heaving with the weight of this extra person (and attaché of calories). Even my wonderful acupuncturist didn't stand a chance against the primordial power wielded by the Element of Water. (Hmm... maybe Ondine is the most appropriate name after all - I think it means "water sprite")

I devoted this weekend to doing not much apart from be disgusted... and even allowed myself to put my feet up, getting myself all in a tizz about what position the baby might get herself into in the process! So I went to the pool to swim laps this morning in my quest to  'do something about it', which was pleasant, if nothing else.

All of this commitment to doing nothing resulted in Cole having his first major-ish accident where he fell of the couch backwards and gashed his head on the coffee table on the way down. There was quite the show of blood at the time which actually stopped almost as promptly as his crying. But as I was having a look and cleaning it up, I noticed it was a fairly gaping sort of gash so we decided we'd better take him to The Childrens' Hospital to get it closed up somehow. Wow!! What an amazing redevelopment: he barely even had a chance to get mesmerised by the giant aquarium before we were seen (< 2 minutes after arrival) and they proceeded to superglue the cut back together in another 5 minute period before we could be on our way. Of course, we didn't go without letting him check out the fish ... eyes eagerly searching for the "BIG one!!! BIG one!! - there he is AGAIN - he's COMING!!"

Then (after a much-needed rest) I spent the afternoon thinking about what I might really, actually NEED for the moment I go into labour... which included getting a bigger bag for hospital and shopping for those glamorous items such as maternity pads and Panadol Extra. Staring at the wall of Panadol boxes in the supermarket, you'd think I'd have some luck trying to find the one I wanted – but no. I had to go into the chemist, where I walked up to the counter and asked for what I wanted. The sales assistant asked,

"Is it for you?" and I said,

"Yeah, for the labour."

There was a woman also standing by the Prescriptions Counter nearby who looked over and said to me, in her very finest, nasally Footscray drawl...

"That's not gonna help, love!"


I think this last bit of pregnancy is supposed to be a lesson in all the things that aren't going to help, or change anything. No matter what you do, your body is going to cope however it's going to cope (or otherwise) and no matter what you do... or what else you try and distract or occupy yourself with... nothing else is going to loom as large or demand more of your attention. Every single little thing you do is heavy and lumbering with 'baby, baby, baby' and, 'birth, birth, birth'.

All I can do is visualise this little water sprite with her head down, moving lower and lower as the space in there becomes more unavailable. They are decidedly unromantic visualisations... My "mantra", if you like – this time around – goes something like: "It's really not that far! I mean.. C'mon. Seriously." The last few inches of the impasse are slowly softening away inside my grumbling and protesting body, preparing to allow for the event of birth. I have confidence that this is the case, even though I have never done 'that bit' before. My bag is now packed full of UNDOUBTABLY "unhelpful" items that are irrelevant to such an enormous physical undertaking... Including the Panadol Extra, which I did end up purchasing after all.

Forgot the icy-poles – will have to get those next time.

Also, maybe some superglue –???

The Birth Plan

Planning a birth is like planning a wedding. Except that you don't know what day the wedding is going to be on; and you don't really know if you can have the venue you want... or anything else for that matter! You just have to rock up on the day and find out.

Maybe the sun will be shining, all your guests available and it might all take place when the you've had enough time to lose that last 3kg before your last dress fitting.... and then the music starts and everything's romantic and lovely and it doesn't drag on too long and the guests are happy...

Or it might all happen really fast, when you're miles from your goal weight; and when the people you wanted present aren't available; and the venue changes suddenly and nothing is as you imagined it. Disaster could even strike at any time and you'd have no way of knowing if and when such a thing might happen!

So... Would you still PLAN it?  ... Would you still circle a day on your calendar, patiently considering the probabilities (from a positive viewpoint, of course) and happily chat away to every family member and total stranger who wants input, as though you really had any idea when/where/how it was all going to happen?

Maybe this is a crap analogy full of truly shallow comparisons, but I guess this comes some way to describing how I now feel about planning this birth. I already "planned" a birth once, almost exactly 2 years ago, and that was fun/interesting. I certainly learned a lot!!

But with 3 weeks (?) to go until our new baby is born, I have had to come to some sort of resting place with my ideas about the birth - not least of all because it involves other people who are going to help me try and achieve what might very well be the impossible dream: The intervention-free, physiologically natural, vaginal birth of my daughter.

Things are different this time. In terms of our plans, we are not "planning" a water birth at home with independent midwives. We are "planning" for the baby to arrive, probably in a hospital setting; hoping desperately that things progress in a manner that would ultimately be compatible with a home birth; but with the setting now seeming somehow irrelevant, we've decided that if things are going well, then the hospital staff (at our particular hospital) seem to be happy to let nature take its course... and if things don't progress in the way we would like, then we're probably going to be in the right place.

What about all the lovely things that might make this birth absolutely perfect? (Relaxed location, truly private surroundings, comfortable birth pool, beautiful music...) I am still thinking about these things. Was the birth of our son less than perfect? Well, yeah! It's been a hard thing for us to fully process. But the things that made it okay in the end were not on that list. The things that made it okay were the fact that he's healthy; that we got breast feeding established; and that we had amazing support from very knowledgable and generous people that allowed us to see past many elements of what went wrong and focus on what could still be achieved despite that most of it wasn't going to plan. Really, this was incredibly positive, given the terrifying nature of the emergency surgery and the complete loss of my own sense of agency and control over my body.

Some people will undoubtedly read this and think it's sad... or that I sound jaded and not at all positive. But writing that last line about having "control over my body" makes me realise that I wasn't completely ready to surrender to the birth of my son, no matter how it was going to take place. I've told many people since that it was still so utterly surreal - even after 5 days of labour - when they handed him to me for the first time. I simply couldn't believe that there was really a real baby in there that whole time!

Discovering his 'realness' has been the source of much joy in our lives over the past 2 years. I am quite genuine when I say that this pregnancy - this baby - is so much more real to me (before birth) than my son ever was. I am looking forward to this birth in a way that I doubt is even possible to experience first time around. Then again, there'll be other mums who've birthed vaginally who will be laughing behind their hands at my eagerness! My sage and extremely pro-VBAC independent midwife was the first one to tell me that I shouldn't look forward to a discomfort-free experience.... but that it was more likely that instead of my recovery being 6 weeks, it might be more like 3 after a vaginal birth.

... Should I "plan" for that?

That reminds me, I'd better get some more icy poles for the freezer!