A healthy daughter and labor without an epidural!

I met Mirjam and her husband Yuri at an information evening at the Maasstad Hospital in Rotterdam, they were immediately really enthusiastic about a birth photoshoot. Shortly afterwards, they came by for an introductory chat. Their pregnancy had not been without worry. At the first scan the baby’s bowls appeared whitish and the femur bone (the upper leg bone) shorter than it should have been. They received a long list of possible problems that their child could suffer from, from which Downs syndrome was the ‘least serious’ and cystic fibrosis (which is eventually fatal) the worst. Soon after the scan Mirjam and Yuri went on holiday. It soon became a chance for them to think long and hard about what they would want.  Termination of the pregnancy was also an option. They soon came to a decision, if it was cystic fibrosis then they didn’t want to burden their child with that. Because it’s inherited, this can be ruled out with a test. It turned out that neither parent was a carrier of the gene.  They decided not to end the pregnancy. Their child would be welcome whatever should happen.  At the second scan, the bowls looked fine and although the femur was a little short it wasn’t strikingly so. It could turn out to be a completely healthy child after all. For Mirjam and Yuri it was welcome news. Nonetheless, they kept in mind that something might be well wrong. During the introductory chat, I got the feeling that if this should be the case, then this baby couldn’t have asked for better parents.

Mirjam and Yuri had made a birth plan because there were a few things that they found important. It’s always good for me to be aware of the birth plan. Not only so that I know what’s coming but also because of my own experiences (my training as a midwife and all the births that I have been able to photograph). As well as being a photographer I am also, if it’s necessary a doula (www. doula.nl). Mirjam explains that she really wants to try it without an epidural and that my support would be welcome if I deem it to be necessary. If I know this in advance then I’m more than happy to coach!

On top of all this, it was going to be interesting for another reason. The due date was the 31st of October and I was going to be away between the 1st and the 5th of November. We’d agreed that the fates would decide if I would be there or not  J I said at the time: “if you really want me to be there then you’ll see that your baby will figure out a way to make sure I can be”.

Last week I received an email from the Maasstad Hospital about a new campaign they were beginning and in the attachment was a photo. By pure co-incidence Mirjam was in the picture! When I received the mail, I sent it straight on to Mirjam, I could also wish her luck with the final preparations. It was the 17th of October, she had just entered week 38 of the pregnancy. I got a reply the same day: “the final preparations indeed. Everything is going well for us and the little one. I don’t think it will arrive before the 31st, so we’ll cross our fingers that the baby will stay put until you get back. 😉 We’ll keep you posted if anything changes.

That very night, just after 4 the phone rings. It makes me jump because I’m  totally not expecting it. It’s Mirjam! Her waters have broken, she has no contractions yet and she’s on the way to the hospital. If anything changes then she’ll ring me back. When I hang up I start to wonder if I even have all my gear ready. I’m so used to first babies being overdue that I totally hadn’t seen this coming, certainly not after her email…I fall back to sleep (sometimes it can take hours before the contractions start) and I’m woken up again by my phone. It’s 5.15am. This time it’s Yuri: “Mirjam is 3cms dilated and we’re going to the birthing suit”. At this stage anything could happen, but I decide to get up. I do take things easy though, I don’t think I need to rush. I take a shower, eat something at my own pace and, before I get going, I fill the tank up with petrol. At 6.30 I get on the motorway. Yuri texts that everything is going well and that I needn’t rush. That’s fortunate because it’s really busy on the roads. I arrive just after 8am at the hospital. The last time they had checked, Mirjam was 4cms dilated.

She’s lying in bed, on her back. Now it is scientifically proven that lying on your back in bed is the least effective position to have contractions and get the dilation going. The more you move, the more room you create in your pelvis, the baby can engage better and the dilation will progress faster.  I try to encourage Mirjam to get out of bed or at least to lie on her side. Your coccyx is moveable and can just make that last bit of room possible, but this doesn’t work well on your back. Mirjam tries lying on her side but finds the contractions much more painful (as is often the way). I decide to wait and see if the dilation is progressing (which might well be the case) before I try to move her from what for her is a comfortable position.

Yuri is wearing a fantastic t-shirt for the occasion! On top of that, he’s made himself as comfortable as possible on a camping stool next to the bed. This was a tip from a friend of his who sat for 16 hours next to the bed before he became a dad. A great plan. The chair must be comfortable as every now and again Yuri nods off J Later, I get him some Red Bull and get coaching Mirjam, and that keeps him awake! If this doesn’t work then he can always use his plant mister on himself. They’ve brought a plant mister with them, a good idea; If Mirjam gets hot, Yuri can refresh her with a few squirts J

At 9,30 the dilation is checked again. Still only 4cms L The doctor suggests to put in a drip, stimulate the contractions and discuss pain relief with Mirjam. I know she really doesn’t want it, but it is very hard to make a decision at the moment in the midst of the pain and the dilation not progressing.  Nonetheless, I’m convinced that she can do it, but I don’t dare speak up in my position as photographer, certainly not with the doctors in the room….Once they’ve gone I put on my naughty hat and utter the motto, ‘there’s no harm in trying’. I ask the midwife if we can delay the drip and first try to get the dilation going by getting Mirjam out of bed and coaching her. If we do that, I’m convinced it will help and that maybe nothing else will be necessary. Luckily she takes it on board, which I’m very grateful for. She goes to discuss it with the doctor and comes back ready to coach Mirjam. She has a few good tips to help Mirjam relax. In any case, she is out of the bed. Yuri makes his contribution to aiding relaxation and puts on some soothing music. He has brought little speakers with him, another great idea.

The doctor comes back and says that they will check again after half an hour, but if there’s no change then they’ll start with the drip. I’m pleased. I hope that the dilation will advance. Mirjam is doing really well in the meantime! She gets through the contractions well, keeps calm and listens really well to what Yuri, the midwife and I are saying to her. Half an hour later, the doctor is back, for me it’s the moment of truth. I really believe that “anything is possible” when it comes to your own body, as long as you get good advice. I hope, even though it’s only been half an hour that it’s made a difference. And yes indeed it has; 5 cms! Inwardly, I make three double backward somersaults! Brilliant, Mirjam.

Despite the progress in the dilation they still want to start the drip because the contractions aren’t coming regularly enough. They’re going to slowly give something to stimulate the contractions. Mirjam has gained some energy from the fact that there’s been some change, so I hope that this will be enough. Pain relief is mentioned again twice, but Mirjam doesn’t ask for it and with our help its going well, which is great to see.

Actually the centimetres “crawl” onwards. It’s not going quickly but it’s progressing. Mirjam is finding it tough, but she can handle it. She sits on a chair next to the bed, stands next to the bed, lies on her side…She tries everything and it works. At 1pm she’s 7cm dilated and by 2.30 she’s reached 8cms. Normally, they come to check the dilation every 2 hours, but from 7cms Mirjam already feels the need to push. You see it even looking at her stomach. If everything in her body is asking to push, but that’s not possible yet. If you do push without sufficient dilation then you will damage your womb. So, she has to ‘pant away’ her desire to push. If you’ve ever had to do this then you’ll know that it’s the very, very, very hardest thing to do.  It goes against what you feel and what your body is asking to do. As time goes on it only gets worse and worse. We all try to talk her through it, to keep her spirits up and keep her going. At 14.50pm she really can’t take much more, but the test shows that she’s only 9cms dilated.  This is torture! Their baby is beginning to react more to the contractions and doesn’t seem to be enjoying it so much. Therefore, at the last minute, it’s decided to also do a blood test on the baby. Everything is prepared and I just hope the Mirjam can find the strength not to push and to go through this test. Just as everything is ready and the gynaecologist is ready to begin, the little head appears right by the ‘way out’! The test is not necessary! She can push!

“Thank God” is the only the only thing Mirjam can utter. At 15.40 she can push. Fin –al – ly! It seems that she can make good use of her frustrations from not being allowed to push before because 10 minutes later their little girl is born.  Yuri is allowed to take hold of his daughter and pass her to Mirjam, a beautiful moment.  There is laughter and tears and wonder and at first glance she looks totally healthy. She is lovely and she is given the name Inéz.

The umbilical cord is cut, it turns out that Inéz had a full on knot in her cord! Yuri lays Inéz down with her Mummy. She quickly starts to look for the breast and Mummy and Inéz have a practice at breastfeeding. After the first ‘cuddle hour’, skin to skin the paediatrician comes to check her over. While he is examining her, Mirjam says to Yuri: “maybe she does have a bit of a Downs Syndrome look to her face”.  I haven’t said it out loud, but it did cross my mind when she was just born. I don’t know if you’re more likely to think that if you know that the chance is there.  The doctor says gently that he thought it too when he first saw her.  It’s a tense moment, although I notice that nothing can take away Mirjam and Yuri’s happiness. He checks her very thoroughly and, with exception of a small indicator, a larger gap between the big toe and the second toe, he can’t see any characteristics which would suggest Downs syndrome. He says he 95% certain, but he’ll come back tomorrow to check once she’s “de-wrinkled” a bit.

Inéz is dressed with the upmost care by her Daddy (it’s great when Dads do that) and then can lie next to him. The family is called and there’s talk of this little miracle and how the birth went. Mirjam feels great and is really pleased that it went just as she wanted, without an epidural. I’m thanked several times, but she really did do it herself, right!

Shortly after that her parents and sister arrive and Yuri’s family come to gaze on Inéz. Now I’m no longer the only one with a huge camera. Inéz is without doubt the centre of attention. We take a group photo and at about 7pm I leave. It was once again a beautiful birth and I’m very happy that everything went so well and that Inéz is healthy.

Dear Mirjam and Yuri: I wish you every happiness with your little girl.

PS. The doctor came back the next day and confirmed that there was no indication of Downs Syndrome. Everything is going well with Mirjam, Yuri and Inéz.