My home birth project

After so many years struggling with fertility issues, it was a huge surprise to learn that I was pregnant again.

This time the pregnancy came alongside many questions and decisions to be made. I had just started to speak with VTEX about a job as their Chief Technology Officer and I had a lot of conflicting thoughts about wanting to be pregnant again and wanting to have another child. We were just having that feeling that "we've survived!".

After loads of conversations Mark and I decided we indeed wanted to be a family of four even though we have no idea what exactly it means until this day. Our daughter Livia is now 8 days old, and filled up our world once again with love. A friend (hello Anne!) once told me that the love just expands and you get more of it. That's exactly how I feel now that Livia is here, despite feeling a bit nervous about it up to the day of her birth.

When we learned I was pregnant we were living in Zurich but we were already questioning whether we wanted to stay there long term. Mark always wanted to give the UK a proper attempt for us to settle in and I was not sure the lifestyle we had and would continue to have in Zurich was the one I wanted for myself -- I loved the city, biking around, the amazing public transport system but I also wanted a house with a garden. In addition, with Lucia reaching an age when socialization becomes important, being in a German speaking place was limiting as we would not be able to fully participate not only in social activities but also in her education further down the line. For Mark, he felt he wouldn't be able to integrate very well locally, no matter how much he tried. German isn't an easy language to learn, and Zurich speaks Swiss German, not the German they teach you in classes.

Being pregnant though accelerated the decision making and then process of relocation. I was nervous about it because I had such a fabulous experience during my pregnancy and birth of Lucia. Birth is such a huge experience I didn't want to have anything less than what I had for my previous birth project.

This time my fears and concerns were different than the first time. I already knew what to expect in terms of actually birthing a child, so that was good, but we decided to move countries and with that came a good level of uncertainty in particular because our move was at 27 weeks of pregnancy. Mapping my concerns for this project was important to make choices about the birth of Livia.

• I feared not finding good support for my pregnancy and birth in the UK.
• I feared not having the options to do things as I wanted as a public health system usually allows for less customization.
• I also feared being in the UK could result in us not having my family around, again. 

Basically those concerns boiled down to two issues: having options that would allow me to feel in charge of my experience, and having my family around to participate in the birth of Livia.

Section 1: Having options and being in charge

As far as birthing a child goes, you can plan and prepare but in the end your baby will be the ultimate decision maker. So being in charge doesn't mean being in control and is perhaps the biggest lesson I've learn when it comes to motherhood.

In order to feel in charge, I wanted to make sure I was physically ready for another childbirth and I also wanted to ensure I had some level of autonomy to decide on the birth experience I wanted to have.

For physical preparation, I continued with my personal training sessions over Zoom with Jamie. We have been training together since I joined Facebook in 2012, and we resumed working out together after Lucia's birth. I did want to continue with those workouts because if there is an event that you want to be physically prepared for, childbirth would be that in my list.

In addition to that, I started to practice prenatal yoga with Gisela once again, twice per week while I was in Zurich. I researched for local options in Winchester, and found Rosanna and we have been training together, twice per week, since January when I moved here. Practicing yoga with her was great because she is slow paced and those two hours per week were the time I had to connect with what was happening in my body and with my baby and get some movement to the parts of my body that I wasn't really moving throughout my day.

This pregnancy was more challenging in terms of body load: I spent most of my first trimester with strong nausea and I had sciatica pain throughout most of the third trimester. Practicing yoga and having someone with loads of history on my overall physical condition was a great way to keep the pain under control, and keep myself active even though I barely went outside the house in the last trimester to avoid COVID and also the sciatica pain I had when I tried to do even things like walking for more than 5 minutes.

On the medical support side, I kept all my prenatal appointments in Zurich until December through my doctor Sarah Fuerling and even before I moved I found a midwife that I could work with for my prenatal, birth and postnatal care in the UK for continuity of care. After much research I figured some things out: first, there was no option to have birth in a private hospital, as no private hospitals near or in Winchester offer maternity services. So I had a few choices here:

a) I could just go through the regular NHS pregnancy support via their community midwives team. Then once I was in labor, I would just go to the nearest hospital for the birth and my birth would be led by whoever is on shift.

b) I could hire a private midwife and have prenatal and postnatal care. The main issue here is that for the birth, unless I had a home birth, I would still go to the hospital and birth with whoever was on shift there. My midwife could join me as a labor partner, but she would not be the person in charge of my birth. In the end I learned that there are very few midwives that work privately and are also NHS workers and in this case they can go with you to the hospital too as medical professionals.

c) I could have a home birth, and in this case I would have the same team working with me for prenatal, birth and postnatal care.

The first option didn't appeal to me at all because basically my experience would be defined by what is on offer on the NHS. From my research that was a mix of seeing different people at each prenatal appointment, not knowing who would be at your birth and in addition, being pressured into procedures to fit the guidelines. So that was out of question as just like the first time, having continuity of care throughout the whole experience was very important to me.

The second option was my favorite if I could find a midwife that would work privately and for the NHS. Fortunately I did find someone. Kathryn Weymouth was the person I found. She's an American who came to the UK to become a midwife in the 90s and has been working here since, so she has loads of experience. We spoke on the phone with her prior to our move, and left everything organized so once we arrived in the UK, Kathryn would take over my prenatal care. Since she also works at the NHS she knows the procedures and steps I had to take to be "in the system". Migrating to an unknown healthcare system was definitely a source of anxiety for me, but Kathryn's demeanor kept me at ease. Kathryn was joined by Lucinda Rae to my birth team, another midwife with whom I clicked very much the first time we met. Meeting Lucinda felt like a gift from Kathryn to me. She made me feel very safe.

The third option was interesting. I still had my concerns about a home birth, but having gone through a birth already, why not consider that?

After I moved, I was scheduled for a booking appointment with the community midwife at our GP's practice. That's when the NHS onboard you as a case. I had a very detailed 2.5 hours appointment with a NHS midwife (Sally is her name, a very experienced lady who was very caring and kind), who then referred me to the hospital to have a scan at 32 weeks because of a myoma I have in my uterus since my IVF treatments, which could be a concern. Sally mentioned that given all I had told her, I should consider a home birth.

When I went to the hospital for this 32 weeks scan I had a pretty significant disappointment. The sonographer told me my placenta was anterior (attached to the frontal wall of the uterus) and that it was located 18mm from my cervix (too close!). She told me that I had to be seen by a consultant because being less than 20mm from my cervix, the recommendation would be that I had my baby via c-section. I wasn't thrilled with the news, as you can imagine.

I got booked for a 36 weeks scan, and until then I had no idea what my birth plan would be because I had no idea whether I would have a recommendation for a c-section. Furthermore, I started to have the feeling that once I was "in the system" my choices would be very limited, and my voice perhaps not heard. By 36 weeks I had read all the available medical literature on low lying placenta and outcomes to gauge how bad the outcomes were for people like me, at 2mm of the threshold to be clear for a vaginal birth. 

The risk of a low lying placenta is that you might bleed before, during or after birth. I never had any bleeding so that was clear, but all the horror stories I had in my mind about birth always ended in someone (me, in this case) bleeding to death, so that was that.

I went in for my scan, and this time it was a scan performed by a doctor specialized in fetal medicine. He checked the baby and assured me my placenta was not too close to the cervix and therefore there was no reason to recommend a c-section. Yay! That was such a huge relief, I felt like crying on my way out of the hospital.

The whole experience though made me feel like I was pushed through a sausage machine. The care I received didn't feel individualized. I felt like a data point on a plotted graph, and unfortunately I was (at least temporarily) in the wrong side of a line. Well, too bad for me. 

Another thing happened during the 4 weeks in between the 32 weeks scan and the 36 weeks scan to check on this placenta positioning: I started getting less sure about having a hospital birth, and started to entertain the option of a home birth.

After that clearance from the consultant at the hospital, Mark and I spoke and we both agreed to plan for a home birth. Both of our midwives were thrilled as they are both home birth advocates. The only point for me was that a home birth meant committing to a natural birth, meaning a birth without the big guns of pain relief (no epidurals or opioids available). Come on, I can have gas and air though!

I mentioned to Kathryn that I liked reading birth stories as a way to prepare for my birth, and she lent me a book which I read cover to cover in two days: Birth in Focus, by Becky Reed. Its a collection of photos and birth stories told by the midwife, Becky, the birthing women and others who participate in their home birth experience. There are plenty of photos of vaginas, babies and babies in vaginas in the book. Just be aware in case you are squeamish.

Section 2: Having my family around to participate in the birth of Livia

My parents did not managed to meet Lucia until she was 13 months old because of the pandemic. They got stranded in Brazil, and that sucked. Anyway, for me this time it was very important that at least my mom would be around when Livia was born. There's something about mom and daughter in a birth situation. Birthing is a very special experience that my mom and I shared going through it, and being able to have her around to that was very important to me.

I wasn't super thrilled when Russia decided to attack Ukraine. Come on, the first baby in a pandemic, the second in a war? That didn't seem fair from the universe!

In order to mitigate that risk, my mom came to our house to stay on March 13th. She had been here for 3 weeks by the time Livia was born. Two of her sisters also came, Elaine and Isabel. Plenty of family around this time!

Section 3: What if something went wrong? 

At this point I was more relaxed about the experience than last time because I had done it once and knew what to expect. In addition, I read a lot about home birth and outcomes and we lived less than 10 minutes away from the hospital. I decided I was going to trust the universe and statistics that were telling me it was just as safe (if not safer) to have baby at home as it was at the hospital.

My home birth story

The last days of the 40 weeks of pregnancy are full of unavoidable anticipation. Each time you feel something in your body -- and let me tell you, you WILL feel many things in your body by that point -- you ask yourself whether it is happening: is that the start of it? Is my baby coming today? This time was no different than the time Lucia was born. 

My due date according to my tracking app was 3/4, and according to my 12 weeks scan was 4/4. The silly part of myself was happy for baby to be born whenever, but had a strong preference not to be an April Fool's baby. 

I was already feeling pretty clear "pre-labor" contractions for a week or so, mostly in the evenings. April 1st came and went, and in the evening I had my pre-labor contractions as usual. When we went to bed to sleep, shortly after midnight I started to feel mild but very obvious contractions, every 3 to 4 minutes. It was easy to breathe through them, so after timing them for one hour, I decided to sleep. We slept until 5AM in the morning.

It is pretty amazing how I was able to sleep through these. The peak of pain is pretty substantial, but somehow you manage to go into a very deep meditation/sleep state that is restful in between contractions.

At 5AM the discomfort of the huge belly plus the ongoing contractions woke me up again. I agreed with Mark that if they were regular in intensity and frequency, I would call the midwives shortly after 6AM. I didn't want to be that person that wakes people up at 5AM in the morning on a Saturday :-P

The contractions continued and they seemed to pick up some intensity and were about six minutes apart. Something shift in my brain and I felt the urge to be alone and quiet. I knew this mind state too well. Birth was coming! I called Kathryn and Lucinda just after 6AM.

I went upstairs to bed and kept breathing through the contractions. Lucia woke up at 7:30AM and as usual we brought her into our bed, had cuddles with her for a while and then she went downstairs to have her bottle and play with my mom and my two aunts, just like any other day of her life. Keeping a sense of normality for her was important to me.

Last cuddles as a family of three

Babies are in charge of birth a lot more than the woman. For some reason I was certain that Livia's birth would happen in the middle of the night. I did not consider I would have a morning baby, so our plan was to inflate the birthing pool in the living room and by the time Lucia woke up in the morning, baby would be born and that is it! The birthing pool is basically an inflatable pool that is larger than your bath tub so you have space to work through your contractions in warm soothing water. It helps with pain management, which is great. There's also plenty of space to invite your friends and family into the water. Not my thing though. 

Anyway, birthing pool in the living room was out of question with Lucia, our 22 months old, being around the living room playing with her toys. I don't think birth would be scary for her, but I do think my ability to concentrate in the task at hand would be limited if I was worried about her being worried about me or wanting to jump in the pool with me.

The midwives arrived shortly after Lucia went downstairs, they checked on me and then Kathryn and Mark went to find a plan B for the birthing pool. Lucinda stayed with me and I told her that at home point I wanted her to check how I was doing in terms of dilation.

The contractions were strong but not as strong as I remembered. The optimistic in me wanted to believe what a friend (hello Anne, again!) once told me: that the second birth contractions felt milder than the first birth. That was definitely the case up to that point. My strong contractions in Lucia's birth felt like my body was about to be torn in half with me alive. These contractions did not feel like that at all and felt much more manageable.

A bit before 8:30AM Lucinda checked my cervix and she said it was nice and thin, and I was 3cm dilated. I was disappointed thinking this birth would last forever. I was so sure it would be a quick one!

Immediately after this cervical check, my contractions picked up. I asked about the pool and I asked about my best friend for the morning: gas and air.

The pool was ready. They had managed to inflate it and fill it up in Livia's room. So the baby would be born in their own home, in their own bedroom, in warm water. What a nice way to enter this world!

I went into the pool around 9AM. Once I was settled in there, I asked Mark to call my mom to come see me. I knew she had concerns about a home birth and I wanted her to know I was ok and I also wanted to share this moment with her somehow.

Me and my mom,  my superhero

My mom came upstairs and in the room and stayed for what I think was two contractions, and then she left.

Gas and air arrived at about 9:30AM, and Mark started to assist me with that to handle the contractions, which were very very intense at this point.

Time is also a concept that takes a strange meaning during childbirth. I don't know exactly how long I was in active labor with dilation contractions, but at some point I had an extremely strong contraction which was a clear transition into push contractions: by the time it ended I felt my amniotic sac was already partially outside, intact, and I could feel the head of the baby (I checked with Lucinda and this happened at 9:36AM). 

I had some easier contractions after that first one. Lucinda told me after the fact that my contractions had slowed down for a bit. Thanks universe, I needed the rest! Then things picked up and at 10:00AM the baby head was out, still in the amniotic sac. Having a baby being born inside an intact amniotic sac is quite a rare event. Only about 1 in 80'000 births, so I could see a glance of excitement on our midwives' faces. Then I had a contraction which wasn't super strong, and in the next one, Livia came out, spreading her arms in the water at 10:03AM. The membranes broke as she came out. 

First mom and Livia photo

One significant difference between this birth and Lucia's was that I did not need to push for Livia to be born. If you hear about people breathing their babies out, that's exactly how it happened. My body just did what it had to do instinctively, I just took long deep breaths to ensure baby wasn't coming out too fast -- that same "pooping a pineapple with skin" feeling as before. It is a bit scary thought to entertain, but at some point you just give in to the process and once it happens you feel so powerful! 

Livia was placed on my chest, where I admired that baby and was in awe of what had just happened, once again. I know this doesn't happen instantaneously to every mom, but I immediately loved her and felt as if she has always been part of my life.

We brought Lucia to meet her little sister, and also my mom to meet her granddaughter. My aunts came to meet Livia too. It was such a special family moment. As we waited for the cord to stop pulsing, we had that moment of sharing, intimacy and peace. 

Lucia meets her little sister, Livia

I knew Mark wouldn't want to cut the cord. Neither did my mom. So Kathryn cut the cord and I had the last part of my job to do: birth the placenta.

I left the pool at 10:30AM after trying a few positions to help the placenta to pass: kneeling, standing. I just felt I had no strength to push the placenta. My pelvic floor really needs a vacation after these last two years of service. I went to the bathroom, Lucinda placed a bag between the toilet seat and the toilet bowl to catch the placenta, and a few minutes later the placenta was out. That was almost 11AM. This was also very different than Lucia's birth because it took me literally two pushes to birth the placenta in minutes. This time it took almost one hour!

Lucinda went to check the placenta. She asked whether I wanted to see it, I declined. Mark wanted to see the examination. It's important that the whole thing is expelled otherwise you can have an infection. All clear! It's incredible how my body, besides making a human, also creates this organ from scratch for the specific purpose of growing a baby and then discards it. No, we don't make pills or cook or eat placentas in this family. 

Anyway, baby out, placenta out, job done! I went into my bed for one last thing: to check my perineum for tears. That was extremely painful, a lot more than I remembered. I had some more has and air at this point. The whole area felt very sore. Lucinda found a 2cm grade 2 tear (this means the skin and some muscle tissue were affected). The position of the tear was such though that she gave me the option to get a few stitches or not. I asked about healing, and decided that no stitches would be my choice.

I made myself comfortable and laid in bed feeding Livia. It felt extremely good to be just there, with her in my bed, in my home, Mark by my side. I felt very content and in a state of bliss.

We are now four!

By 2PM, Mark had the house back to normal: birthing pool was emptied and back in its bag. House was just as normal as any other day, plus little Livia.

A home birth is something that Fernanda would never *ever* have considered 10 or 15 years ago. I said once to Mark that if we ever had kids, I wanted to strongest drugs available: "put me under and wake me up when its over!". He then introduced me to a term I didn't know: "too posh to push" 😂. Two natural births later, I couldn't be happier with the choices I've made for me, and for our babies. I couldn't ask for a better partner in crime either. Mark's support has been fantastic not only during birth, but also taking care of our daughters thus far.

The births of Lucia and Livia were extremely empowering experiences to me, so similar and yet so different. I deeply wish all women to be properly informed about their choices and empowered in their bodies to do what is right for them, trusting science and their ability to birth their babies.

Throughout these experiences I only grew in admiration for the women that choose midwifery as a profession. The midwives that supported me in the births of Lucia and Livia will forever stay with me as women who lend their experience witnessing and supporting births so women like me can stand on their shoulders and feel like superheroes.