Michelle's first birth of her miracle baby Lara
As my pregnancy progressed and I immersed myself deeper into Hypnobirthing theory, it became clear to me that the gynae who had helped us get pregnant, Dr. Raman, was not in favour of my aiming for a natural delivery.
I sought guidance from Nadine, our Hypnobirthing teacher, on what would be the right way to either seek support from Dr. Raman to consent to a water birth, or to obtain his blessing to switch to another doctor who would be more amenable to this delivery method.
I knew as a patient it was my right to choose the doctor I felt most comfortable with to deliver our baby. My dilemma lay in my gut feel that under Dr. Raman's care, my delivery would definitely be skewed towards medical intervention, even if it was not entirely warranted for my birthing situation.
On the flip side, I was also very grateful that Dr. Raman - via the same medical intervention I was ironically trying to avoid now, helped us to get pregnant in the first place, and projecting into the future, I did not want to burn any bridges with him in case we needed his help again for baby number 2 (yes, some would say, "You haven't even finished eating breakfast yet, and already you are thinking about dinner", but that's how far back my intention-ing for Kiaen Aaryan went...)
Nadine's advice seemed fair and sound.
She pointed out that since Dr. Raman had been frank in his stance with me, I owed it to him and myself to also be frank with him, and if that meant changing doctors at this late stage, then a professional doctor would be unfazed and encourage me to choose someone whom I could be fully confident would align with my choices.
Ultimately my aspirations for a water birth had to take a backseat to more immediate considerations.
The baby's due date was 6th January 2016, but in the last few weeks of my pregnancy, Dr. Raman recommended induction on the 30th December 2015, because the baby's weight had plateaued for 16 days starting from week 37 and there were concerns placental function were possibly compromised.
Being well aware of Dr. Raman's proclivity for risk aversion by that point (when he had found out I was on my way to my baby shower after one of my prenatal appointments, he point blank told me, "I don't believe in such things - you know I had a patient who after her baby shower, her baby died” (!!!)), I sought a 2nd opinion.
I researched names of doctors who were known to be more encouraging of minimal intervention births, and had experience supervising water births, and Dr. Paul Ng in Pantai Hospital emerged as a recommendation.
I recall attempting to make an appointment at his clinic when I was 38 weeks pregnant, being told his schedule was fully booked for the next few weeks and my almost frantically begging his receptionist to please, PLEASE, squeeze me in for an appointment.
Somehow in my mind, starting induction was a sure and steady path for me to getting a C-section, especially when during a tour of Pantai Hospital's labour and maternity ward facilities, I had heard nurses talking about certain doctors for whom if the lady had not delivered her baby by 5pm of the day she was brought in, they would order a C-section by default, with the unspoken implication being, 'even if it was not medically necessary'.
Luckily the nurse/receptionist, detecting my desperation, took pity on me, and I was able to have a consultation with Dr. Paul, to get a second opinion on the need for induction.
Although he did not veto the proposal to induce, stating there was "no harm in inducing" (which to me, is still very different from "it is absolutely necessary that you be induced"), I was encouraged when he outlined what sounded like a comprehensive 5-step journey of steps to facilitate natural delivery, which we could exhaust all of, before opting for, and only if absolutely necessary, a C-section.
I would later find out that apparently Dr. Raman was a 'sifu' (teacher/mentor) of Dr. Paul's and so it would have been unlikely that Dr. Paul would have 'lawan tauke' in overruling Dr. Raman's recommendation to induce me, but it was still encouraging to me that Dr. Paul was willing to try a few approaches before a C-section, thereby giving me and my body every benefit of doubt I needed to give natural delivery my best shot.
Looking back on it now, more than a few friends have commented on the 'audacity' of my switching doctors, pretty much at the 11th hour of my pregnancy...and I can say without going into specific details that this was also a cause of friction between my husband and me.
Understandably, Kishore's perspective was that if Dr. Raman stated "X" as a fact, then who was I as a non-medical professional to challenge that view?
And I can only say in my defence that it wasn't that I thought I was smarter than any doctor.
It was that through my own reading and research, and particularly through exposure to the Hypnobirthing principles, I had been equipped to ask more questions than someone less 'intense' may have thought to ask, and thus had a wider range of options to consider than someone who perhaps only had 1 option presented to her, and accepted it at face value, not knowing other options existed.
I reasoned with Kishore that a C-section was also surgery with its own risks and ramifications, not just at point of birth and postpartum in recovery, but also possibly beyond, and that it was my body that would ultimately be undergoing all the processes...
Finally I gave him my assurance that at the end of the day, I wanted our baby delivered safely just as much as he did, and that I would not allow my ego i.e. 'wanting to be right' to jeopardise the wellbeing of the child we had fought so long and hard to bring about, and that if indeed I would need a medically required C-section, I would do it.
Thankfully he responded with the trust, respect and ultimately love for me that has been a cornerstone of our marriage, supporting my decision to switch doctors and aim for a natural delivery, even though it probably cost him a great deal of his own peace of mind.
I spoke with Dr. Raman candidly about my wishes to switch to Dr. Paul, and he was gracious and professional in giving his 'blessing'.
So on the 30th December 2015, incidentally Kishore's birthday, we celebrated his special day with a lunch with close family, including my sister's family and my mother who had flown in from Sabah to be at my side for the birthing and to handle my confinement, before checking in to Pantai Hospital, expecting to welcome the baby before the new year.
Lara Anoushka would only make her appearance FIVE DAYS LATER.
Dr. Paul, true to his word, was very good in really allowing me sufficient time to try to birth as naturally as possible, with water birthing as an option if I got to the required 5cm cervical dilation, and all other indications were satisfactory.
I was given 3 dosages of prostaglandin induction hormones spaced out over 3 days, and managed the resultant surges without any painkillers ('surges' being Hypnobirthing - speak for 'contractions', designed to frame them with the more positive connotations needed to counteract common language in which childbirth is presented as something that is unequivocally painful and traumatic, instead of the miraculous, powerful and natural phenomenon it actually is).
In those first 3 days, I managed the initially dull, gnawing sensations by meditating using the Birthing Affirmations recordings I had practised the Hypnobirthing breathing exercises with, and these really helped to calm me down and keep me focused on the breathing techniques.
Apart from the labour sensations, throughout the 3 days, I also had to mentally deal with my slight, but steadily increasing frustration at hearing other labouring women around me deliver their babies without delay, the babies' first cries punctuating the silence of the labour ward every couple of hours or so, while there I lay, progressing at what seemed like a snail's pace.
New Year's Eve came and went, and instead of celebrating the dawn of a new year with our new baby, Kishore, my mother and I, hunkered down, unsure when exactly Little Missy (for we had predetermined that we were expecting a baby girl) would make her appearance.
Family members being kept abreast of developments over Kishore's 'live feed' WhatsApp updates began to place bets on when the baby would arrive.
Labouring though I was, I think any stress I may have experienced probably could not compare with that of my mother and husband... who stayed by my side, taking fitful naps on decidedly uncomfortable benches and chairs, throughout my stay.
Though tired, I myself was decidedly calm, content to wait out the process as I had wished from the beginning, while they, in addition to dealing with the discomfort of the cold, clinical environment, would have had to deal with concern over my and the baby's wellbeing, as well as uncertainty as to when what was surely an ordeal as much for them as it was for me, would end.
The prostaglandins only got me to 3-4cm cervical dilation even after the 3rd dose, so I wasn't able to try delivery via water birthing as intended because of the minimum requirement for 5cm dilation before I would be allowed into the water birthing tub.
By Day 3, Dr. Paul was asking me to consider progressing efforts by using Artificial Rupture of Membranes (AROM) to puncture the membranes containing my amniotic fluid. Removing this fluid buffer between the baby and uterus stimulates uterine contractions, which are also promoted by the rush of prostaglandins from the amniotic fluid.
On the one hand, this would hopefully speed things along, on the other, by introducing that rupture, we would also introduce an increased risk of infection if there was a prolonged time between rupture and birth.
As Dr. Paul outlined the pros and cons of this procedure to all of us, I saw him give a subtle look of appeal to my mother, whom he was aware was a retired nurse who had also practised midwifery.
It was as if he was silently beseeching her to 'please talk some sense into your stubborn daughter', and certainly I found out later the length of my stay in the hospital was becoming something of a comedy in the ward, with one of the gynaes familiar with me, Dr. Kamaljit, asking, "Has Michelle delivered yet?" on her daily rounds, as I continued towards what looked to be a record breaking labour duration.
But my mother was not willing to be co-opted into diverting me from the course I had set for myself.
I had prepped her for my birth plan in advance by asking her to read the materials I had gathered on the distinctions between the Hypnobirthing approach and the Active Management of Labour practices she had been trained in as a nurse.
Correctly interpreting Dr. Paul's silent appeal, she spoke up, but not in the way he might have wished.
"Don't look at me," she said, in her gentle yet firm manner, "My daughter has done her research and will make her own choices about what she wants to do with her body. I will respect her decision."
So Dr. Paul gave me overnight of Day 3 to think about the AROM option... but entering into Day 4 in hospital, I started having 'bloody show' mucus, indicating that my labour was progressing on its own, and giving us all hope that things were going to kickstart themselves thereon in.
Again Dr. Paul gave me the benefit of the doubt and we rode it out waiting, but when by the end of Day 4 there was still no baby, he brought up the issue of potential infection and that although the baby's heartbeat was stable (hence his OK thus far to just allow my body time to do its thing) he was conscious of me being over exhausted and not being able to do the final pushing when it came time.
He recommended the much stronger induction drug of Pitocin, which, according to him, would be better taken with an epidural as the resultant surges would be more intense.
While he commended my efforts with non-drug assisted pain management so far, he could see how much energy I expended in these efforts, and advised that some of that energy needed to be reserved for the final stretch.
While I had not been 'in pain' throughout the labour so far, the surges only instigated each time I had 1 dosage of prostaglandin but then tapering off until I had the next of the overall 3 dosages, I could not fault his logic in Day 4 of my labour.
It was this long, drawn out process of induced labour that reaffirmed common recommendations and definitely my own belief that if I should be lucky enough to choose to do so the next time around, I would wait it out at home until the baby and my body fully decided 'it was time', before heading into the hospital.
Common observations are that subsequent labours are usually faster and 'easier', but I really credit my second labour with Kiaen being a 'speedy' 1.5 hours, to the fact that he was 'fully cooked' at 40 weeks and 5 days, and I waited until he was well and ready to make his appearance himself, rather than be tempted to induce once we passed 40 weeks (but before the 'end limit' of 42 weeks).
My mother by that time also had concerns about maternal distress (even though I wasn't necessarily displaying any outward signs of such) so at midnight of Day 4 heading into Day 5, I agreed to an epidural and being hooked on to the Pitocin drip.
By noon of Day 5, I was 9.5cm dilated and was finally in a position to start 'pushing'.
By Day 5, one might think I would have just submitted to whatever procedures needed to take place, but on the contrary, I somewhat took over the final stage of labour because when the midwife was prompting me to push, I felt it was going against what my body was telling me.
The best way I can think of to describe what I felt, was that it seemed like the surges were like my climbing a hill, or a surfing a tall wave (even though I have only ever IRL 'surfed' small waves cresting close to shore) and the midwife was asking me to push when I was halfway up the hill/wave, and I would tire out before I reached the peak...
Intuitively it felt to me that what I SHOULD be doing was to only push when I reached the peak of the surge, and fully leverage on the ‘momentum of gravity’ from the top of the peak by pushing at THAT point....if that makes any sense at all...
Whatever the case, after a few attempts at following the "Push!" prompts by the midwife and not feeling the progression, I politely asked if I could please be allowed to push only when I felt like it.
Now it was the midwife’s turn to look to Kishore in confusion and in silent appeal.
Kishore shrugged his shoulders in response, as if to say, "If that's what my wife wants... she's been having her own way so far... why change things now..."
To her credit, Angie the midwife was very good, telling me, "OK, you go ahead, do what you are comfortable with..." and as she saw I henceforth made MUCH more progress timing the pushes myself, she seemed very impressed and pleased, telling Kishore, "Oh your wife knows what she is doing! She must have had a very good Hypnobirthing coach!"
This is in stark contrast to an anecdote I heard the other day about a lady attempting natural delivery who was told to push and realised she had "no idea what that meant", with only “1 in 10” of her attempts seeming to hit the mark with her midwife, ultimately necessitating a C-section to birth her thankfully healthy baby. I cannot imagine the fear and helplessness this lady would have experienced, not understanding what the midwife, and her own body, was telling her to do.
In my case, I was so AWARE of what was happening with my body, at one point I was even dictating the dosage of the Pitocin drip ... because at one stage I felt the surges were losing momentum and weren't strong enough to help me 'ride the wave' in birthing the baby so I asked the nurses if it was possible to "dial the dosage up a notch"... which they did.. and then when the resultant surges became too strong, I asked them to dial the dosage back to an 'acceptable level'...
As much as it appears that I was in control of the situation, after what seemed like hours of pushing I did reach a point of ALMOST giving up, and clearly remember thinking, "I'm so tired, I've tried so hard, I've really given my very best... if they need to cut me to get this baby out, let them just cut me, I'm SOOO TIRED...."
Almost as soon as the thought entered my head, I remembered one of the Hypnobirthing lessons saying that it was a common labouring phenomenon, that at the point that you are about to give up, that is exactly when your baby is coming.
Sure enough, as I finished thinking maybe I should tell them to, ‘just cut me’ (as if it was that easy), I heard the midwife tell me, "OK Michelle, you've done really well, we can see the baby's head now, so you just need to stop pushing and wait for the doctor to come. Don't worry, he is already in the building, he just needs to come to the ward."
For the uninitiated, the gynae is not generally with you throughout your labour, with midwives taking you through what I would (unscientifically) say is 90% of the way and then only bringing the doctor in for the final 10% of the riskiest part of the process.
Whatever the case, after 5 days of labour, my response to being told to 'stop pushing' and effectively 'hold it in', was (though unvoiced),
ARE.YOU.EFFING.KIDDING.ME. This baby is coming out NOW, doctor or no doctor."
Having had a taste of my determined streak, the midwife looked at my unimpressed, exhausted face and said the smartest thing she could have said at that point, to bend me to her desired outcome,
"Michelle, we are aiming for MINIMAL TEARING" (referring to my birth plan specifications for no episiotomy).
Hearing those words, I mustered every ounce of willpower I had to stop pushing and almost Suck.The.Baby.Back.In.
Thankfully, I did not have to ‘suck it in’ for too long, soon hearing Dr. Paul's cheery greeting of "Hello, hello, how are we doing?" as he entered the labour room, making me want to simultaneously strangle him in consternation while also hug him in relief...
Ultimately, I was able to deliver with only a very minor outer nick to the perineum...and birthed Lara Anoushka, at 3.07kg and 49cm, at 2.25pm, 3rd January 2016.
Later, when as a courtesy I messaged Dr. Raman on the baby's safe delivery, he reverted that he already knew, having silently co-monitored my progress together with Dr. Paul throughout my labour, including the 2.5 hours that I was pushing. Almost like a guardian angel - a class act that I was quite moved by, and reassuring me that I had not burned any bridges as I feared I might.
Even though the overall birth was not as 'natural' as I had planned for, given the involvement of many drugs and interventions, I was still very happy that it was a vaginal delivery and that I did not need an episiotomy.
Hypnobirthing really helped educate Kishore and me about our birthing options, to respectfully ask the right questions and ultimately for me to understand how to work with my body, instead of against it, and how the techniques and knowledge learned can be used in any type of birth.
My mother was very open and supportive, and in observing the actual process in action, was so impressed at how I was able to use the concepts to calm myself down and actively participate in the birthing, that she has been advocating other childbearing age relatives who are interested in starting a family to explore the Hypnobirthing concept.
It seems so fitting then, that because by God’s grace we were granted not only the baby we desired but the birthing experience that brought her to us slowly, but safely, we would name her Lara Anoushka, Anoushka in various languages meaning ‘grace’, 'fulfilment of desire' and ‘gift of love’.
Even knowing everything that I would have to go through to bring her into the world, were I asked to do it again, I would do so in a heartbeat, to have her be part of our life.
I give thanks for God’s gift of love that you are to all of us Lara Anoushka, and look forward to being amazed by the intricate beauty of the life you will pattern for yourself.
Mama, Papa, and now Kiaen Aaryan, will love you always .