From one extreme ... to the other!!

Gina tells of her planned home VBAC in 1992.

My first baby arrived in this world after a long, slow, inefficient labour culminating in an emergency caesarean section under epidural. She was a breech presentation, and although I was allowed to labour and did so to the bitter end, the caesarean really was a foregone conclusion.

The arrival of my second baby could not have been more different.

Having always wanted to have my babies at home for some deep and unknown reason, among the many millions of tears I shed following the section, were some because I thought I wouldn't be able to have my second baby at home. Then I started to wonder why not? Some two years later I came to the conclusion that there were no valid medical or physical reasons why I couldn't give birth at home perfectly safely. In fact, when I weighed up the pros and cons it was very clear to me that, in my case at least, it was in all probability SAFER for me to have my second baby at home.

My next problem was a growing realisation that the medical establishment was most definately NOT going to agree with my conclusions. Along with this realisation came the worry that I would never find a midwife who would be prepared to go along with my wishes.

My second pregnancy took a year longer to begin than I'd originally planned. A Foresight clinician soon spotted the problem - hypoglycaemia (low blood sugar). That didn't take long to sort out and soon I was fitter and healthier than I'd felt in years, and pregnant again.

Wishing to avoid beginning any battles in early pregnancy, and not being convinced that early antenatal care was of much benefit, I left it fairly late before sending the standard 'I'm pregnant and I want a homebirth' letter copied word for word from Beverley Beech's book "Who's Having Your Baby". The Director of Midwifery Services at our local hospital passed it on to the Supervisor of Community Midwives, who telephoned to arrange an appointment.

The meeting took place at my home. I was 20 weeks pregnant, over morning sickness' and feeling fully charged for an out- and-out battle. None came. She was wonderful. No arguments, no lectures on the 'risks', no attempts at emotional blackmail. She explained that regrettably I could not be offered continuity of care due to staffing levels (a big disappointment and worrying because I felt I needed to be able to trust the midwives during labour) but she assured me that none of her midwives would 'try to get me in', and I believe she spoke the truth and was not 'wool pulling'. She also wanted to ensure I was happy to have my antenatal care from the local community midwives, which I was. Had I not been happy she would have allocated someone else.

I was amazed. Was it really going to be that easy!

With my homebirth all booked and agreed I then decided I ought to inform my GP out of courtesy. So I went to see him. His reaction threw me completely. I'd expected him to either treat me as a silly girl or to be threatening in some way. The poor man simply fell apart in front of me. The full weight of the sheer responsibilty he felt for me and my baby in what he perceived as a potentially fatal situation was almost too much for him. Most humans put in that position would have fought back but he was desperately hunting for a way to say yes he would deliver me and be able to live with it! I'm sure I totally ruined his Monday morning and still wonder if he managed to pull himself together sufficiently to deal with the next patient! In the end he too, turned up trumps. I wrote to him explaining that I wanted to be delivered by female midwives and wished to avoid male, medical involvement and hoping he would understand. He wrote back to me agreeing to provide emergency cover which was perfect as far as I was concerned. Most GPs would have been tempted to read me the riot act and strike me off!

My GP did advise that I see a consultant at the local hospital, but I really didn't see the point of entering into avoidable arguments whilst pregnant, so I simply ignored this advice. Just as well because I was reliably informed postnatally that this particular consultant is a 'Once a caesarean, always a ceasarean' man. Just the sort of person VBAC advocats need to steer well clear of whilst pregnant!

My pregnancy continued to be totally normal - the midwife pronounced me "disgustingly healthy". Since I'd been regularly attending keep fit classes for the previous two years I continued, but gave up at 36 weeks as the exercises I still felt able to do became uncomfortable. I was as fit and healthy as I could be for labour.

Well over a week before labour I started to get a vaginal discharge, which on discussion with the midwife turned out to be the 'show'. There was quite a lot over several days which I found surprising. Last time I'd only had one blob at the start of labour. This marked difference was a taste of things to come.

On 18th February, some ten days to two weeks before my due date of 1st March, I woke up with a sharp pain in my pubic bone area. It only lasted a moment and was accompanied by a little trickle of water. I leapt out of bed (well almost) as I'd been unable to find a waterproof sheet for a kingsize bed. I went downstairs intending to make a cup of tea and to use the toilet in the downstairs bathroom. It was about 5.l5am.

While I was on the loo the contractions came thick and fast. A quick self administered internal left me completely puzzled - I couldn't feel anything that felt like a cervix as I'd expected, it just felt smooth, round and hard. Gordon came downstairs to see what was going on, realised I was in labour and asked "what do we do now?". "Oh nothing yet" I said, thinking it would be hours. I was wrong.

Shortly afterwards (I don't know how long as my watch was still upstairs beside the bed) I had two contractions that I found very difficult to cope with. The 'water buffalo' noises I was making brought Gordon back downstairs again quick. I remembered reading in Grantly Dick-Reid's book 'Childbirth Without Fear' that you never have more than ten like that before you're in second stage and pushing. I was incredulous - surely it couldn't be going THAT fast!!

Suddenly I wanted the reassurance of a midwife and started shouting instructions at Gordon. Phone the hospital, the number is by the phone, the labour ward number, tell them it's definately labour, tell them it's going fast, tell them I think I can feel the head. The realisation dawned that the smooth, round hard thing I'd felt earlier must have been the head. I really wanted that midwife and I wanted to convince the hospital that this really was IT and that they didn't have time to mess around!

Then poor Gordon had to run around preparing upstairs. We'd had two bedrooms, the upstairs bathroom and the hall plastered the previous week so there were things stacked in the bedroom that needed to be moved. Then a stream of further instructions as to where to put the dustbin bags down (I hadn't acquired a polythene sheet) and where to find the old sheet to put on top, etc., etc., etc. It was different for Gordon this time too - no time to get bored, no long hours spent trying to doze in an uncomfortable hospital chair!

As soon as he'd finished I removed upstairs, taking a low stool and a thick jumper that I'd been knelt down leaning on with me. As soon as I was there the next contraction ended in a definate push. There was nothing I could do, my body was pushing and that was that. Where's that midwife!

The poor girl arrived in a panic. The first on-call midwife lived an hour's drive away and as she was much nearer she'd got the call and been told we could SEE the head. Then she'd been unable to find the house. Gordon had spotted her running to the phone box outside and had gone to get her. She ran up the stairs and must have been able to see I was pushing as she came through the door. She was trying to introduce herself as we'd never met, get the lid off the box of midwifery tricks that had been delivered a few weeks earlier, and work out where she was going to get back-up from, all at the same time.

Everything was going against this poor midwife. The other on-call midwife obviously wouldn't be able to get here on time, she couldn't figure out how to get the lid off the box and I was being most uncooperative! We had a somewhat fraught meeting:

Me: "No I can't lie, on the bed while you give me an internal, you'll have to manage it as I am, please please don't make me lie on the bed. No you can't call my GP. He's a man. I know you need backup but if he comes he'll have to stay downstairs I'll go mad if he enters the room."

Midwife: "Now Gina, home deliveries are all very nice but I'm on my own delivering this baby and I need to examine you. What if something goes wrong?"

Second stage or not I was extremely lucid. "You're not delivering this baby, I'm giving birth to it, and NOTHING IS GOING TO GO WRONG". I'd never been more sure of anything in my life!

Well she managed to give me an internal - the only one of the entire labour and delivery, and painful it was too!. She discovered I was indeed fully dilated and satisfied herself the baby was head down and not breech. I suggested that one of the community midwives who'd given me antenatal care might be prepared to come out as her back-up and off she ran downstairs to phone. It was now just after 7.OOam, about two hours since I'd woken up. The time had flown by.

From then on it all went more or less like clockwork. The local midwife arrived in minutes, the atmosphere in the room calmed down. With each other for support the two midwives were wonderful although I was so busy I really didn't pay them much heed. Pushing was painful, it brought tears to my eyes, it felt just as though someone was trying to break my coccyx off. I was offered gas and air and knew there was pethedine in the fridge, but I didn't want pain relief. It's not that I'm a martyr or anything, but I was too busy concentrating to be bothered with the distraction. Yes it was very painful, but somehow the pain was incidental. I have damaged my coccyx in the past and wonder if perhaps it wasn't as flexible as it should have been. I certainly haven't read or heard of that description of pain anywhere else.

I was on my knees with my perineum on the floor, leaning forward over a very low stool - not the most wonderful position for giving birth! The midwives were trying to coax me into a more advantageous position, but for one thing I was stuck, and for another I didn't know them well enough to have sufficient trust in them to even try to move. Also, my position meant they couldn't see how the head was descending and I think perhaps second stage was taking longer than they'd expected. On top of this I was getting very tired. Their urges to push got stronger and then I got the bit between my teeth and decided I'd had enough and this baby was coming OUT.

I pushed through the pain. Too late I recognised the change of sensation of the head on the perineum, too late the midwife shouted "Pant". His head was out. Moments later, during the same contraction his body slithered out. It was 7.54am - less than three hours since I'd woken up!

I collapsed with exhaustion. I had absolutely no energy left. There were cries of "Mummy it's a baby, Mummy it's a boy" and I vaguely remember turning my head to see the midwife bending over a baby on the floor. From the point of delivery my memory is rather hazy as I was somewhat dazed. It had been rather like a furious roller-coaster ride. I'd had to hang on with every muscle fibre in my body. I hadn't been in control but at least I hadn't lost it, and I'd known where I was every inch of the way, but the speed had left me awestruck.

The midwife asked if she could cut the cord - Gordon declined the offer. Since she assured me it had finished pulsating I agreed. I was cold and shivering and just wanted to be warm in bed with my baby. I did offer the breast to the baby knowing it would help the placenta out if he fed, but he wasn't interested, so I asked for the syntocinon injection although I'm sure I didn't need it. That part over, the midwife stitched my tear - a short but deep second degree tear which apart from being a bit tight sex-wise, has given me no trouble at all. A very quick bath and finally into bed to get warm.

It was lunchtime before my mind really cleared again, and lunchtime before we found a name for the baby - Jaimie. I was amazed that such a short straightforward labour could be so totally PHYSICALLY draining. In contrast, 24 hours labour followed by a caesarean, although it was EMOTIONALLY traumatic, I now realise hadn't really tired me physically. My arms were the worst, they ached in places I didn't know I had muscles and hurt every tine I moved them. I slept most of the morning too, whereas despite missing an entire night's sleep with the section I has been wide awake. Recovery was different too. I bounced right back this time, whereas it was downhill from the section for months. Within a week I was completely back to full strength and health and haven't seen the doctor once.

My GP visited the first day to carry out the paediatric check and put me in mind of a dog with two tails. "You proved them all wrong didn't you!" he greeted me. "I told you I would" I replied. Of that I'd never been in any doubt, even though I could see close friends thinking I might be over-confident - when it comes to having babies a woman can't be over-confident.

My daughter, who was a month away from her fourth birthday chose to be present. I'm not sure how she reacted really. I don't think she was frightened. It was just a normal part of life. She wasn't bothered by my sickness in early pregnancy and tended to get in the way! So I suppose she viewed the birth with a similar matter-of-fact frame of mind. She was with her Dad who was happy to sit back and let the midwives do their stuff. She wouldn't leave Jaimie's side for two weeks afterwards and there has never been a sign of any jealousy. Joey saw more of Jaimie in his first hour of life than I did, staying with him while he was washed and dressed, and while I was stitched and bathed.

During pregnancy Joey was adamant that she wanted a sister and I think I might have had problems if I'd come home from hospital with a boy! As it was she saw him arrive and therefore there has never been any doubt in her mind that he is the same baby as the one in Mummy's tummy. I'm glad she chose to be there, as she has seen birth as a normal life event, and didn't have to be separated from her Mum which she would have found difficult to cope with.

And what did my poor, long-suffering husband think of all this? He is not 'into' childbirth. I never did find out how he felt about the impending homebirth. His attitude was that since his opinion wouldn't make any difference there was no point in him having one! I was having the baby, I was having it at home, and that was that. He was rather worried the baby might arrive before the midwives and relieved that it didn't. He found it all a bit gory and says he'll be happy if he never has to see another baby born. "So, if we have another baby, you'd choose not to be there would you?" I asked. "Oh no, it wasn't that bad" he replied.

And me. How do I feel about it? At peace. No emotional high - I was too knackered! No feelings of elation as expressed by so many women. No high celebration. I was pregnant, I gave birth and now I have a baby and life goes on. What is so wonderful is the calm inner confidence, and the complete absence of anything negative.

It wasn't a perfect birth, and there were things I'd do differently next time, and things I regret. But none of these things bring tears or upset me. The caesarean section tore at the very core of my being and that is now mended.

October 1992

See Gina's Caesarean birth report.

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