When Jonathan and I decided to start a family I wanted to do everything right-meaning preconception care and conscious conception. We did a preconception program at the Jocelyn Centre involving nutritional advice and learning to follow my menstrual cycle. After four months of preconception care I knew exactly when I was ovulating. We got pregnant on our very first official attempt, March 20, 2002.

I have always felt that pregnancy and childbirth are a time when a woman is both at her most vulnerable and her most powerful, but I knew absolutely nothing about my options for care as a pregnant woman. I started out with an obstetrician. On our first visit, which lasted all of ten minutes, he gave me a list of tests I might want to consider, explained his charges, and then said he'd be going away on holiday the day after my due date. I realized at that moment that what I really wanted was to be cared for by someone who would be my advocate and who would honor this rite of passage with her expertise and belief in my ability to give birth (not to mention who'd be at the birth). Fortunately someone recommended that I contact Akal.

I had always fantasized about having a homebirth, but decided on the birth centre as my parents would be in town from overseas and would be staying with us at the time of the birth. I feared that their potential disapproval of a homebirth would be too stressful for me. Then the fates intervened: when I went a week past my due date the birth centre would not admit me without induction, and I was sure that my overdue status would be cause for intervention in the labour ward. Thus I informed my parents that we were having the baby at home. Luckily they were supportive-at least they put on a brave face. Jonathan was completely supportive. We discussed the possible outcomes and I told him that I would much rather start at home and end up in hospital, then start in hospital and risk intervention from the start. Having made my decision I felt such a wonderful sense of relief, and wished I had had the courage to choose a homebirth from the start (next time I will forewarn my parents and have them arrive a few weeks later).

I was already 2 weeks 5 days overdue when at 10.30 p.m. December 30 I began to feel some light contractions and noticed they were about ten minutes apart. I was overjoyed. By midnight the contractions were coming every 3 minutes and lasting anywhere from 30 seconds to a minute each. I rang Akal and she came over around 1 or 2 a.m. My cervix had been fully effaced for more than a week already, but when Akal examined me it turned out that I was only 2-3 cm dilated. She told me to rest, and she went off to sleep in a spare room. I tried to sleep, but I found the contractions too painful to sleep through so I lay in bed and dozed between them. By 6 or 7 am I had to move around. Then came a period of many hours when my contractions seemed to be unchanging, though maybe the change in intensity was so gradual that I didn't notice. I am not even sure when pre-labour became actual labour. I walked around, used hot packs on my belly, and breathed through each contraction. At one point we walked around outside to help speed things along. I drank small sips of water throughout, but I had completely lost my appetite. Next time I will try harder to eat and drink to keep my energy up, but at the time I really could not even tolerate the idea of eating.

I felt like I was coping well, and in retrospect I think I did. Time seemed to go by very quickly at first. I had done some hypnotherapy for childbirth and had been listening to a personalized meditation tape for weeks, so I was feeling more or less confident about my pain-coping abilities. The remarkable thing about labour is that the contractions come and go, and in between, nothing really does happen. With me, of course, sometimes nothing was actually happening! By evening, around 5 p.m., I was in transition, though I don't think I realized it at the time. I was beginning to feel quite fatigued by then and was falling into deep sleep for the minute or even seconds between contractions. I do remember recognizing, in retrospect that the pushing urges I had at home had been quite mild in comparison to those I had later.

I have heard that fatigue is a labouring woman's worst enemy, and I can believe it. By five or six p.m. I was feeling pretty good about the fact that I was pushing-thinking, at last, this baby is coming out! If I had given birth at that point I would have felt the twelve hours or so of labour I'd already experienced were fine, that is, quite manageable. But by 7 p.m. I had been pushing for 3 or 4 hours in different positions and not much was happening. At one point Akal did an internal and said I had a cervical lip in the way, so she put her hand inside me to push it away as I pushed. Finally I was so tired that I felt like I really couldn't do it anymore. My fatigue had been setting in gradually, but the mental recognition that I really couldn't go on came quite suddenly. I had been asking, "where's the head, is it any closer?" and it wasn't. We had been using homeopathic remedies all along. Akal had been monitoring the baby's heartrate periodically throughout labour, and it was fine until then, when it began to go down-not enough for us to panic, but to indicate the baby was getting tired, too. I asked if we should go to the hospital. Akal said, honestly, nothing has happened in the past 3 hours and the baby's heartrate is slower, so yes, she would recommend going. At that point I asked if I could have an epidural. I had always felt they were overrused and presented real risks, but after 24 hours of contractions I was just so tired-I wanted the pain to stop so that I could rest. I'd experienced as much drug-free labour and pushing as most women do when giving birth naturally, only in my case it wasn't getting the baby out! Akal very calmly explained to me what the routine was at the hospital, and what my options were. I felt perfectly lucid and understood everything. When we left for the hospital (Jonathan drove us), I left feeling that though things were not going as planned, I had done the best I could. I didn't feel like there was an emergency, only that I had never been so fatigued in my life and I desperately wanted some sleep.

Upon arrival at the hospital the doctor checked my cervix-it was back to 8 centimeters! I guess my body had just decided to close shop. The choice at the hospital became clear soon enough. If after having an epidural and resting I couldn't push the baby out, they would "wheel me upstairs" (where the operating theatre was, a kinder way to say caesarian).

The contrast between labouring at home and in hospital was just incredible. There I was, on a very hard and narrow hospital bed, attached to a catheter, a drip for the syntocinon (to speed contractions) and one for the anesthesia, fetal monitors, with lights shining down onto my vagina. Jonathan said that what with all the equipment I looked like an alien with "tentacles". To top it off, the epidural gave me uncontrollable shakes-so I must have looked a fright. But, I did sleep on and off for few hours until the pushing sensation became unbearable and I was fully dilated again.

I had done my reading during pregnancy. I knew that modern institutional medicine operates on the assumption that women need lots of intervention to give birth. I knew that a woman in this setting may fall prey to the belief that she cannot give birth on her own. The attitudes and atmosphere (lots of equipment) can easily lead a woman to assume that birth is something that happens to her, that it is external to her-rather than something that comes from within her, that she participates in, that she has some power over.

I knew all that, but I was exhausted, and it was all too easy to cede my power to the fetal monitors, the drips, and the doctors-to let them all make decisions for me. After I had dilated (again) fully, the hospital midwife told me I was ready to push. It's funny, I felt the incredible urge to push, of course, but in that setting I felt I had to wait to be told what to do. In fact, my exhaustion had pretty much defeated me. The doctor and midwife had said between them so many times that they could just "wheel me upstairs" at the slightest indication that something was wrong that I was almost hoping that they'd do just that and spare me the effort.

Fortunately, Jonathan and Akal were an incredible source of support. Akal was always at my side, calmly explaining what was happening and just generally giving me encouragement. When the hospital midwife said "o.k., time to push," I looked at Akal and said, "I'm so tired. I can't." She took my hand and said firmly, "you can and you must." I believed her because I trusted her. She was so confident, and so insistent-and she had been through it all with me and knew what I was and wasn't capable of. Finally, at the end of this long road, with those words she gave me back some of the power that I had given the machines, the instruments, and the medication.

I was at the centre of things again-in control. I looked at the clock-4 am-and I said to myself, "I will have this baby out within the hour." I decided I would just have to give it my all, and I did. I've never worked so hard in my life; it seemed at times that my baby was pushing against me as hard as I was pushing him out. At one point I told Jonathan that next time we were adopting, and in those minutes I meant it, until a baby, my baby, really did come out of me. Daniel Christopher Kelt was born at 5.12 a.m. on New Years Day.

I hardly felt any stinging as he crowned and I had only the tiniest of grazes. I recommend diligently doing the perineal stretches Akal instructs from 36 weeks. We had chosen the name before we conceived and when Jonathan saw our baby was a boy, he didn't say "it's a boy," he said, "it's Daniel." It was as if we'd known him all along. The most special moment of my life so far is holding newborn Daniel in my arms after 24 hours of labour. I remember telling him he'd done a good job-I really felt at that moment that he'd been trying to be born as hard as I had been trying to birth him, and I wanted to just acknowledge his effort and reassure him that it was over and he was safe.

I did sleep a bit afterwards, but hospital beds are far from comfortable. We all left the hospital within 5 hours, feeling fine, if exhausted. Unfortunately, I had a very bad reaction to the epidural. They punctured my spinal cord (which is more common than is assumed) with the result that I had a headache so bad I couldn't sit up for two weeks. Then I had blurred vision for another 2 weeks, and panic attacks-all epidural related. Akal was invaluable during this time. She visited every day at first, and we rang her quite often. Daniel was so sleepy the first few days that he wasn't breastfeeding well and I was expressing onto a spoon and feeding it to him. I did finally recover after seeing an osteopath and had cranio-sacral manipulation with a practitioner experience in epidural reactions.

It has been a big lesson, and a great gift to accept the mysteries of birth; to accept that childbirth is the most incredible feat of the human body; that it is something we can prepare for, but it is also a power totally beyond us. It is one part preparation and two parts surrender.

Naturally I have asked myself over and over again why my birth went as it did. I have also wondered what would have happened had I started out in hospital. Interestingly, three friends had premonitions (including dreams) about me having to have a caesarian in the weeks leading up to my birth. It is possible that had my labour progressed as slowly as it did in a hospital setting, things might have ended worse. Certainly Akal's care throughout my pregnancy, labour, and afterwards have been instrumental in shaping my positive attitude to birth, helping me cope with a less-than-ideal experience, and then coming to terms with it afterwards. If only we had midwives to help us through other life experiences! I am confident about having a homebirth for our next child, and can honestly say that now, after ten months, I look forward to it. Jonathan knows I'm always up for a challenge and am the eternal optimist! Fingers crossed.

Oh yes-Daniel. Our little angel, He's a joyful, clever, gorgeous little soul and I'd happily go through it all again for his smile alone.







Akal Khalsa is a Sydney based midwife and provides midwifery services including: homebirths,
pre-conception consultations, childbirth preparation, nutritional advise and breastfeeding support.

For more information Contact Akal.