In writing the Journal one of my main aims is to encourage the woman to reflect with me on her own lived experience, and to attempt to put something down in writing. This is not easy. A new mother, whether she has other children or not, has plenty of other things to do. Making herself focus on her thoughts and memories of the birth, and all that is happening, can be a confrontation that the woman prefers to avoid. Or she can put it off, waiting for enough time to think clearly and carefully before committing thoughts to paper.

When I give the woman a copy of my journal entry I ask her to please give me a copy of what she writes. I also ask her to try to write something before she reads mine, so that it is truly her memories. Some women never give me their stories. I understand that they may not be ready to share at this level. However I treasure the responses that are sent to me.

The story which I called "WHY" (#5), written about the experience of an emergency caesarean for cord prolapse, records my emotions and frustrations at the time. The pages in my journal are accompanied by pictures taken during the operation, and picture after picture of a beautiful baby boy - a celebration of life. The woman, mother of five little ones, found time to respond.

The woman's response (used with permission)

"The head coming down - when we talked about this, you suggested that perhaps there might have been an emotional reason. The moment you said this I thought of how I felt when I knew I was pregnant again. I was pleased to be having another baby, but part of me was saying "I'm so tired of being tired, and now there's going to be another baby." I don't think this pregnancy was any different in terms of physical tiredness, but emotionally I've felt a lot more tired and discouraged than with my previous pregnancies. A few days before I went into labour Andy had to work late ('til midnight) and start early (7.30) the next day . I remember thinking that night that I'm too tired to cope with labour - I'll just have an epidural at the start.

I'm not sure how emotional factors could affect the head coming down or not, but if it was an emotional cause, the tiredness and discouragement I felt for most of my pregnancy would be my explanation.

Today: our baby is 16 days old, and I'm feeling tired, (things ARE easier physically as I'm no longer pregnant) but I wouldn't be without him for the world."

This acknowledgment of her feelings about the pregnancy and the baby are quite thrilling to me - perhaps even more important than an "uncomplicated birth".

I actually think the most likely explanation for the failure to progress; the inability of the woman to move into that state of being fully engaged with the labour, was that a large, elastic loop of healthy umbilical cord, full of protective jelly, was coming between the baby's head and the birth canal - not a full cord presentation, but just waiting in the wings. Each time the womb contracted the head was met by this springy obstacle, which bounced it back rather than allowing progress. When the waters broke that loop of cord came down quickly.

I think this birth could have been very different in the home setting. I would not have artificially ruptured the membranes with a high presenting part. But I think the woman needed to lie down in a fetal position and have some rest. She tried every other position, but when I suggested lying down she refused. She seemed to want to stay away from the hospital bed. I have seen women in this sort of "stale mate" labour completely turn off into a sort of hypnotic state, then wake up in about 30 minutes, ready to give birth. That *might* have given the baby's head a different pathway for engagement. Or perhaps a long walk would have helped. I don't know.

The other point to note in this case is that by the time the woman had been transferred to the operating theatre (5 minutes), in a knee-chest position, she felt the strong urge to push, just before the anaesthetic took effect. The doctor made a clinical decision to take the baby abdominally rather than vaginally. We will never know what would have happened *if*.

Every woman, every situation is so complex. I am happy to be able to reflect, search, and learn each time.