Your pelvis size is not the problem in birth

Akemi and Riana moments after birth

I met Akemi only a week before she gave birth but her birth was one of the most transformative births I have attended as a doula. Here’s her story from my perspective as her doula.

In the wee hours of New Year’s Day, I got the call that Akemi was in labour. So, at 3am I jumped out of bed and drove down to the Gold Coast.

When I arrived Akemi was having regular, mild contractions about 10 minutes apart. So I suggested she get some rest.

Later in the morning we went for a long walk on the beach which helped to bring on stronger rushes. It was also a great opportunity to talk and connect, as I hadn’t had the usual few months to get to know Akemi.

The space between each rush seemed to be getting closer together, so we headed back to the apartment.

After another lie down and massage, we hit the stairs. Stairs are great when you’re on the cusp of active labour. The movement in your hips jiggles the baby and brings on stronger contractions that open up the cervix.

We used a sarong as a rebozo because of the heat that day

Around lunchtime, the intensity picked up and Akemi was needing to concentrate and breathe through the rushes. I did some rebozo work with her as I had a feeling the baby was a little posterior (she was getting a lot of back pain and her belly button was suppressed). The movement helped ease the intensity too.

Within a couple of hours, the rushes were about 3-4 minutes apart, so we talked about when they might like to go in to the hospital and we all agreed that things were moving along a great pace and that it would be okay to go in.

The birth unit was by the ocean with pictures of dolphins and coral reefs on sea green walls.

With the music Akemi had brought with her it was a calm and tranquil setting for her labour.

My hunch about the baby’s position was confirmed by the midwife so we continued to keep Akemi active throughout the labor using the rebozo, dancing, shimmying and various different positions to encourage baby to turn into the optimal position. Akemi’s labor never halted though and she continued to make good progress.

At about 10pm it seemed that Akemi was hitting that transitional stage but she didn’t yet sound pushy. It stayed like that for a while and I wondered if maybe there was a bit of a cervical lip in the way. A bit later, at the midwife’s suggestion, she agreed to a pelvic exam and the midwife said that there was, in fact, a bit of cervix still to get out of the way of the baby’s head. So we laid her on her side to ease the pressure on her cervix (so it could fully dilate without becoming swollen).

About midnight, Akemi was getting a strong urge to push so we moved her around and got her dancing and lunging and using every position under the sun to open up her pelvis to maximum capacity.

The descent of a baby’s head can take time. In Akemi’s case, it was slow going but with each urge to push, her baby’s head moved just that little bit further down. She did have a small issue with her bladder. The baby’s head was in the way so with a little help, that pressure was relieved and we could see more and more of the baby’s head.

Now I need to tell you what was happening in the room at this point. Akemi was on the bed with her legs up around her ears. I know, doesn’t sound like a very appealing position for birth but, in this case, it was what she needed. Her baby was still posterior and on rare occasions with a posterior presentation this beetle position works really well. She was definitely making better progress this way than she was in other positions.

Meanwhile, the obstetric registrar had waltzed in and demanded that something had to be done to get the baby out because Akemi had been pushing for a long time (2 hours by that time). The registrar, a woman, said she would have to do an episiotomy (didn’t ask, just stated it as fact) saying to Akemi “You’re definitely going to tear.” Then she kept going on and on about how Akemi’s last doctor has done a caesarean section because Akemi was too small to give birth and that she may need to push the baby back up the birth canal and do a caesarean section.

Now, Akemi is Japanese and by this stage in labour her brain had completely shut down to English, so, fortunately for her, she didn’t understand much of what the registrar was saying. I loved it when her husband, Craig, would talk to her in Japanese in between the registrar’s rantings. I had no idea what he was saying. He could well have been saying: “this stupid woman wants to cut you again. I’ll just tell her where to go,” or he could have been saying “You’re doing great honey. I’ll get you a cup of tea when this is all over.” In any case, after each translation, he turned to the registrar, smiled and said “no thank you, not now.”

At one point, Akemi, who had not complained once during her entire labour, looked at me and said, “Can you still see my baby’s head?” I smiled and said, “Yes, of course, She’s right there. She’s not going back in. I still believe you can do this Akemi.” The change on her face showed steely resolve. It was like she’d gotten the second (third, fourth, fifth) wind she needed to birth her baby.

The registrar, thinking that either an assisted birth or caesarean section was going to happen, had called in her obstetric consultant (her boss) and was still talking over Akemi like she was a foolish child when the consultant walked in. The consultant, a lovely, warm woman with a beautiful Indian lilt to her voice, took one look and saw what we all saw, the baby’s head crowning. She said “Oh, you’re gonna push that baby out” and within two pushes, at about 2am January 2^nd, little Riana joined her mother earthside.

The registrar was mercifully speechless.

A tired but happy crew after the birth of Riana! In this photo: Akemi's daughter Mia, Akemi, Riana and me!

Akemi’s experience was transformative for her but also for me as a doula. I never doubted she could give birth normally but what struck me was that, during her long labor and long second stage, she never doubted it either. Most women who come to me for support with a vaginal birth after caesarean section (VBAC) spend a lot of time and energy doubting themselves and overcoming the negativity that is thrown their way during pregnancy and birth. Most of these women need a massive dose of confidence. Once women believe in themselves, they birth easily, even if the birth is not straightforward, even if they are the size of my 12 year old with a 6ft tall partner. Akemi is testament to that.

Recent research by the Queensland Centre for Mother’s and Babies shows that most women have a caesarean section because they’ve been advised to by their doctor. The research also shows that only around half of the women having planned caesarean sections are fully informed before agreeing to the procedure. In Akemi’s case this was certainly true. She had her first caesarean because her doctor had told her she had to (because she was very small and her husband very tall). After that, she’d had trouble with breastfeeding and starting researching and reading about birth. That lead her to question the reason for her initial caesarean section and she choose to have a VBAC for her second baby.

I’d like to thank Akemi and Craig for allowing me to share their story from my perspective. I visited them last week and all are doing well.

ps: Catch the radio interview I did on this issue last week on ABC AM (Radio National) here: http://www.abc.net.au/news/2012-01-19/queensland-mums-uninformed-about-caesareans/3781916