First a background note. In the Australian health care system, you have different care options during pregnancy. I opted to see an obstetrician privately, but I booked in to have the baby in the public hospital as a private patient. Basically that meant that I was under the care of one doctor and the midwives in his practice for the pregnancy, and that when I delivered I would have the regular public midwives caring for me during labour and my doctor would come and "catch". But as my local public hospital is one of the major tertiary care centres in the city (and where I work myself as a genetic counsellor), delivering there also gave me access to some of the best care both for myself and my baby, should complications arise (including one of the major children's hospitals connected by corridor).

[For those curious, this approach has ended up costing me a bit over AU$3000 out of pocket; most of that is a fee I paid the doctor which isn't covered by my health insurance, and the rest is made up of small gap fees I paid for having ultrasounds done at a private provider. But I haven't had to pay a cent to the hospital. For the Australians reading this, I passed the medicare safety net mainly because of the expense of the ultrasounds, which helped bring the out of pocket expenses down.]

I had gestational diabetes, and even though I was diet controlled and my fundal height was measuring perfectly to dates, my doctor sent me for a growth scan at 36 weeks. This showed moderate asymmetrical intrauterine growth restriction: the head was measuring on the 75th centile and the abdomen on the 8th. Overall the baby measured above 10th centile so it wasn't so small as to really cause major concerns, but the discrepancy between the measurements did raise a red flag (and a history of big heads on the paternal side can only go so far as an explanation!).... This kind of asymmetry is usually due to nutrition issues in the third trimester, possibly indicating that the placenta wasn't functioning properly any more. This worried me a lot, because my mum had a full term stillbirth due to placental insufficiency - a random event not necessarily going to repeat itself in the next generation, but it definitely coloured my reactions to these issues. So my doctor sent me for CTG monitoring (non-stress tests) and a follow up ultrasound at 38 weeks.

The CTGs were done at the public hospital (therefore at no cost) and it was quite reassuring - not only were all the tests completely fine, but each midwife who palpated my belly commented that the baby didn't seem small at all. The 38 week ultrasound also had good news from the growth point of view - the head was now only just above the 50th centile and the abdomen was on the 11th, with overall weight estimated to be 3.5kg! So the asymmetry was a lot better and the baby certainly wasn't looking like it was small for dates.

However the doppler study done as part of the assessment showed that the flow in the umbilical cord was borderline high. Not enough for my doctor to be really really worried but he said that I'd need to continue with the CTGs and we'd need to schedule an induction at 40 weeks, as he wasn't comfortable leaving the baby inside over term. I didn't fight that at all, because I was paranoid enough myself about it all, as much as I wanted to avoid an induction given the whole cascade of interventions that it might set off. So the induction was set for Friday October 25, at 39+6. Of course, we hoped that labour might start spontaneously before that day, and I certainly told the baby that it needed to follow in its daddy's footsteps by arriving early!

I saw the doctor at 39+4, having had another 3 completely normal CTGs. This was the day I had my first cervical check... I'd been warned that the only "issue" with the doctor I'd chosen was that he had big hands, and I certainly felt them during this exam!! He said that there wasn't any dilation and the cervix still needed to move more for labour, but he'd been able to stretch it and give the membranes a bit of a sweep and therefore I wouldn't need to have prostaglandin gel prior to the induction. The induction itself would be done by breaking my waters and using syntocinon. This was non-negotiable (I had hoped that maybe he'd agree to just breaking waters and letting it wait a little before moving on to synto, but he said that for a first time delivery, both would be needed to get things moving properly).

So Friday morning my husband and I dutifully arrived at the birth unit at the public hospital at 7.30am and were shown to our room. Unfortunately there'd been an accident on one of the main routes into the area and the doctor was delayed. So we sat around until 9am before he came in and broke my waters. He was pleased to inform me that I was about 2cm dilated already (which meant the very vague contractions I'd been having for a few days must have been doing something!). I was hooked up to a monitor (breaks only allowed for going to the toilet) and we could see (and I could feel) the contractions getting stronger straight away. So my husband and I got the hired TENS machine out and got it attached to my back, and we waited for the drip to be started. While the contractions were more noticeable, they weren't really painful yet. The midwife had a few issues getting the cannula in, and synto wasn't started until 10am. Again, immediately the contractions become stronger. Because I was being monitored continuously, I didn't bother tracking the contractions myself, so I can't tell you how long they were lasting or how close together. But I know that the midwife declared me to be in established labour at 11am, and I was having to be quiet and concentrate on breathing through the pain, while using the TENS machine. The midwife turned the synto up a few times, but I don't remember when...

I was not allowed to eat after the synto was started, so shortly after 12pm my husband asked if it would be ok for him to go eat some lunch (as I'd told him he couldn't bring food back to the room). I figured that nothing major would happen during the next half hour, so off he went at about 12.15/12.20. Unfortunately that coincided with my midwife needing to go supervise a junior midwife next door, so I was left on my own...right as things started getting a LOT more painful! I remember looking at the clock at about 12.30 thinking to myself "ok some gas & air would be great right now" but I wasn't able to hit a call button (none in reach, and I was pretty tethered to the bed because the drip was on the opposite side to the monitor)... I was having to moan through the contractions and give myself quite the mental pep talk. Thankfully the midwife came back in only about 5-10 minutes later and immediately got me the gas thing. When my husband came back around 12.45 he was quite surprised to find me sucking away at it and moaning through the contractions - quite a different state of affairs to when he left!

A quick note about gas & air... it definitely isn't for everyone. I wouldn't say I enjoyed using it, but I did find it effective for helping with the pain - it didn't take the pain away, but I got all fuzzy-headed (high, I guess) and it didn't bother me as much. I kept using the TENS machine but I am not completely convinced it did much, especially once I was in transition.

Anyway. It wasn't much longer after that when I thought to myself, if this is how painful these are going to be for hours, I think I WILL have to get an epidural. So I told that to my husband and said that I wanted to be checked so I knew how things were progressing before going for the epi. He hit the call button and a different midwife came in - this was soon after 1pm. She got my main midwife and at about 1.20 she checked me. I distinctly remember the surprise in her voice when she said I was already 9.5! I'd told her earlier in the morning that my mum's labours (2 of them induced) had gone reasonably quickly, and so she cheerfully told me to thank her later for the good labour genes! Obviously this meant that I wouldn't be getting the epidural - it wasn't even mentioned again by anyone. The midwife went to tell my doctor (he was around the hospital that day, rather than at his rooms) and I can't remember whether he popped in at that point or not. But either way, I started pushing at about 1.40. Because of the monitor and the drip I had basically spent all of labour half-lying/sitting on the bed (with the back of the bed raised) and that's how I started pushing. Another midwife joined us sometime around then, as the morning midwife would be leaving at 3 and she had to transfer care to the afternoon shift. One of them got me to turn around and try pushing from a kneeling position. It didn't seem to help so I came around onto my back again. They also had some concerns for the baby's heart rate during the first hour of pushing. Somewhere in there I tried to pee on a bedpan without success, so they did an in-and-out catheter and got 400ml of urine out! Pushing was definitely better after that! I also felt like I needed to poop, but nothing came out during labour. The doctor joined us after that first 45-50min of pushing. The baby's heart rate improved after they drained my bladder, so I was allowed to continue pushing. Maybe I should have tried going on to my knees again, on reflection... Pushing was really bloody hard work. I stripped off my gown at some point and my husband was using a couple of wash cloths dipped in ice water across my forehead and back of neck - it was great. He also counted out loud during contractions to help me to keep pushing for long enough. Those things really helped me.

At some point the doctor used some local anaesthetic on the perineum, and as we progressed he told me that he thought a small episiotomy would be needed. He knew I wasn't keen on one but I trusted him and agreed. I don't know exactly what grade/size any of this was in the end, but he said that the cut did tear a little further but the whole thing only needed two stitches. Apparently my perineum is very thick and just wasn't stretching enough on its own or with some massage/stretching he was doing.

The "ring of fire" during crowning is very aptly described. But finally at 3.32pm our baby girl arrived. My husband brought her up onto my belly and we both looked to see the gender - and she peed on me! She couldn't get higher on my chest until the cord was cut, as it was apparently short. After some initial skin-to-skin time, she had to be checked by a paediatrician due the mild decelerations from earlier in the pushing, but they didn't do the full newborn check right away - she came back to me for more cuddles and initial breast feeding. The placenta came out without too much fuss (apparently the doctor held it up to show my husband!) and I don't remember being subjected to painful uterine massage. Maybe because I had the synto still hooked up, so that was helping with the after birth process? Or maybe I just don't remember getting massaged!

The morning midwife had hung around after her shift just long enough to see the baby arrive, which was very sweet of her. Before she left she and my doctor agreed that I would be welcome back to do it all again next time! lol

The afternoon midwife was also lovely. She knew that baby would need a blood sugar check but that it would be best if she got a good initial feed first. The midwife actually ended up doing some hand expressing to get a few mls of colostrum out into a syringe to give the baby, so we could be sure that she'd eaten something. She ended up passing all her sugar checks with flying colours, and also never developed jaundice. She was 3465g - a perfect weight. We all agreed that the ultrasounds obviously had us all worried over nothing major! Her head circumference was 35.5cm, and now I've plotted those on the centile charts I see that she is technically a bit asymmetric, but certainly quite healthy overall. We are completely in love with her.