Giving Birth in Malta: Kaia’s Birth Story
Who Knew Birth Could Be a Positive Experience?
It’s somehow been seven weeks since I welcomed Kaia into the world, and it simultaneously feels like a split second and a million years; a crazy time warp. Most of the time, her birth seems like it was just moments ago and I keep asking myself how nearly two months have already passed. Simultaneously, I think about how far I’ve come mentally and physically in that time and how much more confident I am dealing with her than I was in the new moments at the hospital.
While we were in the hospital, I documented everything zealously, not wanting to forget the timing, the moments, and the unexpected aspects of labor that took me by surprise. Like many women, I had a birth plan. Your birth plan is one of those things they tell you not to hold onto too tightly. The reality is that labor and delivery is an incredibly individual experience and it’s impossible to predict how it will progress from woman to woman and pregnancy to pregnancy. I knew that full well, but I still had a PDF in Scott’s email detailing what I hoped I’d achieve during this delivery (obviously – have you met me?). Basically, I hoped for something pretty natural with interventions only if necessary. Ultimately though, my goal was to have a positive birth experience if such a thing was possible. I mean, was it possible? All we ever really see and hear when it comes to labor is that it’s earth-shattering pain that we endure but that the final product is worth the endless hours of torment. I knew that I was willing to compromise on some of my plan if a) it was medically necessary, or b) if my intuition told me otherwise. Let’s just say it was a good thing I wasn’t married to the plan.
I had a number of ‘risk factors’ that put me at risk for an early-term birth: ‘advanced maternal age’, an IVF pregnancy, some family history, etc. I was prepped from about 35 weeks that the baby could come whenever, but each week I’d diligently go to my OB for a check-up only to find that she was still comfortably cocooned. It’s a funny reality about pregnancy. The first 30 weeks you’re frighted about having a premature baby, and the final ten weeks seem to last an eternity. Will I be pregnant forever? By 40 weeks, I really did start asking that question, but fortunately, we had a plan in place. At 39 + 2 I’d gone in for a membrane sweep to see if that would ‘naturally’ induce labor. It was a big moment for me because they’d evaluate where I was in terms of dilation… I was praying I was a couple of centimeters along already and that she was prepping for her arrival behind the scenes.
No such luck. I was 0 centimeters dilated and all of the other factors they check showed no signs of her looking to make an imminent debut. I had a medical induction scheduled for 40 + 2. I was due on New Year’s Eve but if she didn’t come by then I was scheduled to go in on New Year’s Day to begin the process of induction. That was not part of my plan but I also wasn’t expecting her to go past her due date. My parents and Scott’s parents had come in for her birth plus I was teetering the line with her size. Until about 30 weeks along, every doctor kept noting that she was a ‘big baby’ (way to scare a girl!). At 5’1″, that scared me a bit. She was on track to be around 9lb if she continued the way she was growing. Luckily she slowed down in the final weeks but a C-section was something I really didn’t want if it could be helped so I didn’t want to risk her baking too long and becoming larger than I was prepared for.
We watched the fireworks on New Year’s Eve from our balcony in Sliema and went in on January 1st for my induction. I was praying I was already somewhat dilated or showing some progress, but no. They examined me and nothing had changed since my last appointment. In this case, with my induction, the first stages were designed to help dilation get going. They explained they’d apply a gel and let it sit for around 6 hours before they’d re-examine me. They do this a max of three times; if dilation doesn’t happen and they can’t break your water at that point then it’s C-section time. I’d committed to starting the process so there was no turning back now. They applied the first dose at 1:30PM. Scott diligently sat in a chair next to me at Mater Dei hospital in a shared room while we watched Sons of Anarchy using shared airpods. At 7:30PM they came back to check on me. Nothing had changed. I was still 0cm dilated and not showing signs of progressing.
Cue depression and momentary anxiety… I was starting 2 of 3 max doses and praying that this would have some effect. At 8PM they applied the second dose before Scott was booted per hospital policy. 8PM is generally departure time for guests of patients, but they graciously let him stay with me until 9PM, until after the medication was administered and we had a few minutes together. He departed and was set to come back around 9AM the next day when they’d apply the third dose.
My water broke on its own at 2AM and I was 1 cm dilated. Praise the Lord. Scott was en route back to the hospital and I was moved to my private delivery suite where we would remain until the baby arrived.
Labor & Delivery
One of the things that stood out to me when I chose to have our baby in Malta was the approach, a totally different style from what we’ve become accustomed to in the US (more on this below with my thoughts). Malta’s hospitals and birth centers use a midwife-led approach which means midwives handle labor and delivery unless a doctor needs to intervene. My midwife, Emily, was a godsend.
I’d entered the delivery suite at just 1cm dilated and that had taken about 12 hours, 6 of which were somewhat active in terms of discomfort. I told my midwife going in that I wanted to steer clear of the word ‘pain’ when I was talking about this and just use the word ‘discomfort’ to readjust my mindset. I was dilating very slowly – I labored in a hot bath for a while and used a birthing ball. I opted for gas and air for pain relief for about an hour but I was nauseous during labor (unexpected!) so that helped with pain but didn’t help with run-to-the-bathroom nausea (by the way, running to the bathroom whilst in labor is not really a thing; it’s a waddle). We decided it was time for Pitocin to really get things moving along. She started off slowly and then doubled the dose as time passed to get things really moving. People mention that Pitocin really ignites that feeling of labor in a major way and it’s true. I made it to 3cm, which took hours, and knew that my thought on having a positive birth experience might be thwarted with Pitocin and no real pain meds. I chose to have an epidural and could not have been happier with my choice.
The anesthesiologist was incredible, talking me through it all and helping me get comfortable. Ultimately, once it kicked in, it was perfect: even (not the lop-sided numbness people talk about) and I still had movement in my legs which I thought was next to impossible! I felt only the tiniest sensations when my cramps were at their peak, but it was a complete game-changer in making labor manageable. By noon, I was almost 5cm dilated and had barely felt that transition. At 1pm, the team came in, alerted by the baby’s heartbeat being off. They explained that she could be in distress or I could be ready to push. Only an hour had passed since they’d confirmed I was at 5cm dilated so the thought of being ready to push was clearly not what was happening. Emily came in to examine.
I was 10cm dilated and ready to push. Like, HOW? It took me 22 hours to get to 5cm and then just an hour to get from 5cm to 10cm?! I didn’t know this was a thing but I was beyond thankful. Now it was time to deliver but I needed to be present for that so we shut off the epidural for the main event and allowed an hour for me to regain sensations (let’s say there was some noticeable discomfort at this point with my body recognizing the contractions again). At 2:15PM I still didn’t really feel the urge but my midwife was ready to coach me through based on my contractions. I began to feel when the time was right and she coached me accordingly with how to breathe and helped me get into different positions to try pushing and moving the baby down. Contrary to what you see on TV, apparently laying on your back is not the most ideal way to deliver a baby (hello, gravity) so I moved as much as possible with her guidance.
There was pain; I mean, of course there was, but that wasn’t really the dominant feeling in all of this, which shocked me. I felt amazed and empowered. I was doing what felt impossible: pushing a baby out and watching a life emerge. I had so much positive encouragement and help from my midwife along the way that it all felt positive. I wanted to believe that such a thing was possible but I had rarely read of people speaking of giving birth as something positive; the transcendental part far outweighed the discomfort. Kaia emerged at 3PM sharp with just 45 minutes of pushing at a fighting weight of 3.47kg (about 7 lb. 10 1/2 oz), and I made it out unscathed without a single stitch.
Kaia was in my arms and on my chest before I knew it and Scott was there to cut the umbilical cord. It was all surreal but I felt present, which I’m thankful for. The next step – the final phase of labor and delivery -was delivering the placenta. After giving birth to a baby this isn’t something we think about; it’s sort of an easy given and most women don’t really remember it. They gave me a shot to help the placenta detach and then I just needed a few little pushes to get it out.
The placenta is typically delivered in 30 minutes. 60 minutes is really the max window for placenta delivery before it’s problematic. I was in my newborn phase with Kaia which probably made it so I didn’t feel what was happening in my body. Additional midwives were called in; first one, then another, then another until there were 4 or 5 women working on getting the placenta out, pulling and pushing to no avail. Only half of it had been delivered and one of the major side effects is serious hemorrhaging which was happening unbeknownst to me. Around 4PM they made the call that it needed surgical intervention for removal. I was taken to the surgical theatre while Scott bonded with Kaia. They gave me a drip to numb the pain and a team of 8 – 10 doctors, midwives, and surgeons worked on removing the placenta. I had lost enough blood at this point that I was freezing, pale, and unable to really communicate (you know that feeling of hearing people but not being able to open your mouth to say anything?). I’m not sure how much time passed but the team was able to handle it and get me back to the delivery suite to begin taking in blood transfusions. After two transfusions I slowly returned to life and by the next morning I was feeling much more myself. My labor and delivery was actually quite perfect aside from this; something I hadn’t accounted for or anticipated in the slightest. Who even includes that in their birth plan? No one, because that’s never part of a plan; it either does what it’s supposed to or it doesn’t, and I was so thankful to have a team there to intervene when I needed it.
Giving Birth at Mater Dei in Malta — & Why Malta?
At the core, I chose Malta for family reasons. I wanted my daughter to be born in Malta and to maintain the cultural tie, knowing it might otherwise get diluted over time. My mom was born on the island and her family goes back as far as anyone knows. My dad’s family is also from here. It doesn’t hurt that Malta also has an exceptional healthcare system, which was wholly evidenced by our experiences from the moment we began interacting with doctors and midwives in this process. As I mentioned above, like a number of European countries, Malta has a midwife-led approach to birthing which means doctors aren’t present in labor and delivery if everything is ‘normal’ along the way. If it weren’t for my placenta issue at the end, I wouldn’t have been in contact with a doctor but for check-ins during induction, the epidural (obviously requires an MD to administer), and post-delivery check-ups. At 34 weeks pregnant, I had a midwife come to our house to discuss delivery with me and prep me for what to expect. Three days after I delivered Kaia a community midwife came over to check on me – and her! – in the comfort of our home (completely free, by the way).
Half the time when I mentioned my ‘midwife’ to people, it seemed novel to American friends. People would ask how I chose to go that route or think I was falling on the woo-woo camp. In the US we tend to equate ‘midwives’ with home birth, basically on the same end of the spectrum of encapsulating placenta. For many, it seems a bit of a hippie domain to use a midwife. Midwives in Malta are really the equivalent of L&D nurses more or less, with years of university education and years of day-in-day-out dealing with solely pregnancy and labor and delivery. That was reassuring for me – if there are specialists when it comes to having babies, these folks are it. And honestly, my midwife made my experience. The day after delivery I was already able to look back in awe of how incredible it all was and how amazing the experience of delivery was, which is not something everyone can say (my own mother has a completely different, rather traumatic hospital story with my delivery that would make anyone not want to give birth again).
Now, I will say, I mentioned the woo-woo factor above, and believe me, zero judgment about how anyone chooses to give birth if their medical team thinks an at-home birth is a safe approach for them (it wouldn’t have been okayed for me anyway given I was high risk). There are birthing facilities (not the hospital) available as alternatives where things like water births can be incorporated. Even if I could do that, I wouldn’t have because I wanted to have a medical team nearby just in case it was necessary for me or for the baby. As it turned out, it was necessary and I was so thankful to have the doctors nearby to handle those needs quickly. For anyone debating giving birth in Malta, suffice it to say that if we were to have another child, I can’t imagine doing it anywhere else after the experience we had. And without writing another 2500 words on the topic, it’s worth noting that Mater Dei also has a great Breastfeeding Clinic with lactation consultants that take great care in monitoring baby’s health and supporting mom’s journey, wherever that may lead. To all of the midwives and doctors who were part of our journey at Mater Dei, thank you for leaving me with the best memories from one of life’s most pivotal days.