Helen Bourne
Anna, G5 P2, had a bleed early in this pregnancy, otherwise, she had a normal pregnancy and planned to give birth at home.
05.00 Called via delivery suite. Informed Anna was contracting well every 4 -5 minutes at home.
05.30 Arrived at Anna and Simon's home. Anna relaxed and coping well with moderate contractions every 4-5 minutes which had started at 03.00. When asked if she had felt the baby move, she replied that last evening there was good movement. She had had a show then and gone to bed at midnight. She had not been conscious of particular movements more recently but focused more on contractions.
05.45 Listened in with Pinard, but unable to pick up the fetal heart. Listened in with sonicaid, still unable to pick it up. Could hear maternal pulse, but no fetal heart. Discussed vaginal examination to assess baby's position.
(Discussion with delivery suite and request for another midwife. The possible need for transfer to hospital had already been raised with Simon and Anna)
05.50 Vaginal examination: cervix fully effaced, thin and stretchy. 5 cm dilated, loosely applied to head, membranes intact, head 1 above the spines. No cord was felt. Fetal heart still not heard. When Anna out to toilet, Simon asked me if I was worried. I said I was.
Decision made to transfer via ambulance to hospital.
06.15 Ambulance and second midwife arrive at same time.
06.20 Spontaneous rupture of membranes with thick meconium. Contractions now strong and every two minutes. After discussion with all concerned I felt it was safer to stay at home as delivery appeared imminent. Ambulance and paramedics stayed on standby. Anna having urges to push.
06.35 Anna leaning against sofa, kneeling on floor. Prepared for birth. Oxygen and suction ready. Auscultation of FH attempted but unsuccessful. Anna pushed well with slow descent of presenting part.
06.55 Head now visible at vulva.
07.05 Spontaneous vertex delivery of baby boy.
Baby delivered with umbilical cord around neck, loose and apparently torn away from placenta. There was meconium and a gush of blood with his delivery.
The baby was wrapped in the soft sheet onto which he had been delivered and he was handed to his parents who asked if he was dead, and we informed them that he was. They held him close and we offered what support we could.
After some minutes Anna felt another contraction, passed the baby to Simon and adopted a more upright position to deliver the placenta. She successfully delivered the placenta by maternal effort at 07.30. Her perineum was intact.
The paramedics left.
While Anna was in the bath, I examined the placenta and the cord which I had clamped and cut. Placenta and membranes appeared healthy and complete and three vessels in the cord. However, I found a velamentous insertion of the cord. The three vessels left the placenta at three different points and ran into the membranes, unprotected by Wharton's jelly. Where the cord had `broken', I noted it was into membrane with no protection.
I explained this to both parents showing them the placenta and cord.
The baby, Hallam, stayed with them for 27 hours after which I took him to the mortuary at Torbay Hospital.
Helen Bourne, Midwife
GIVEN THE FACT that my son was born dead, my memories of that day are remarkably positive. My whole birth experience was just as I would have wanted, because although some part of me knew that Helen, my midwife, wouldn't find the baby's heartbeat, she didn't make me feel worried. Her calm support (and my husband Simon's) made it possible for me to give birth in the way I wanted to - in my own time and in my own living room.
I am grateful that Helen didn't panic and transmit that panic to me thus disturbing the flow of labour. She made the decision to let me stay and complete the birth when my waters broke; and I am very grateful that I didn't have to give birth to my stillborn baby in an ambulance or hospital corridor.
We were able to spend that most precious time we had with our son without being disturbed by hospital routines or strangers. We just needed to be with Hallam and hold him and hold each other, in our pain.
We couldn't have been better or more lovingly cared for. Helen even took Hallam to the morgue for us the next morning.
His beautiful birth
Peaceful, calm
Holding him close
Huge sadness
Perfect small body
Beautiful hands and feet
Making his prints.
His father, lovingly, gently,
washing hands and feet
Holding him close
Letting him go
Held the hearts of many
To be free.
HB
IK modified 13th June 1999