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Merry's two caesarean births and her VBAC

Merry tells of the traumatic caesarean birth of her first daughter; the VBAC of her second daughter (achieved in spite of very poor midwifery 'support'); and the positive caesarean birth of her third daughter (a real emergency due to cord prolapse).

Frances

This is an account, as best as I can remember of the birth of my first daughter, when I was 24 years old. I think its safe to say I was ill-informed and naive at this time but also that it was a mismanaged birth which could have gone better. Its probably worth mentioning that at the time she was born, my local Mat Unit had 10 outstanding litigation cases of mismanaged births leading to severe brain damage.

I went 8 days overdue with my first baby, after a very simple pregnancy where all seemed to be going fairly well. The only problem seemed to be that she never really engaged and then during the last week my bump grew an incredible 8cm in height. I was hugely uncomfortable, my legs were swollen and I thought my toes would burst; they looked like sausages! Although they were concerned by my sudden growth, no one linked it to any specific problem and it was assumed that it was mostly because my blood pressure had become quite high. (In actual fact, high fluid levels are a marker for the birth defect she had.)

At 8 days overdue I went in to be monitored and while I was there they performed a sweep. Immediately I started to have mild, niggly contractions but they assured me I was wrong as a sweep would not start anything for 24 hours. I went home by 5pm and the niggles continued all evening. Because the baby had not engaged they told me that if I had regular contrations at all I had to go straight in and if my waters broke I had to call an ambulance.

I was very excited, I felt like my whole life had been leading up to this moment and I just couldn't wait to get started. By midnight the contractions, such as they were, were every 3 minutes and mindful of what they had told me, we decided we had better go in. (Mistake number 1!) On arrival we had a tour of the unit by a very nice midwife who showed us a largish room and told us that if I wanted a bath, I was welcome to use that room. Then I was put into a side room. Max fell asleep on the bed and I spent a long, long time stood by the window, leaning over an old radiator and trying to cope with increasingly nasty contractions in my back. Eventually I asked for some pain relief and was given a couple of paracetamol and told to get on with it. So I decided to have a bath (mistake number 2!) and Max went off to find a midwife to check it was okay to use the room - a completely different midwife shouted at him for wanting to use a room that had a mum and new twins in it but said of course if we felt we were entitled to disturb her to go ahead (Nasty cow!) and showed us to a nasty little bathroom with a thin, dirty bath in it. This was NOT a great success and by now I was desperately needing to poo, or so I thought, but nothing seemed to be working.

Max called another midwife who came to do an internal - she seemed baffled "I don't know what I can feel," she said. "There's no head but I think you are fully dilated. Lets get you to the delivery ward." (Wow - that wasn't so bad! we thought!) So off we trundled to the Delivery Ward and a registrar came in, who was equally baffled. She also thought I was fully dialated but that what was protruding was a large bag of waters, accounting for the pain I was feeling in my back, due to it being roughly the size of a head in the birth canal. So they decided to break my waters and then keep me sat on the bed being monitored (Mistake number 3) And this is what they did - the waters were a little green but not worrying. And then came the bad news, without a head and with the waters gone, I was back to 3cm. I had to do it all again. If only at this point I had known to sit up/stand up/kneel up/kick someone, things might have turned out differently.

So it was off to another room for constant monitoring - I was terribly tired as it was now 5am and I had been up since 5am the previous day worrying about my hospital trip earlier in the day so I lay on my side while Max napped next to me. I was still managing fine with a TENS and I think if I had stayed on my side, things might have been better. But I was very brainwashed into the "be upright" thing. Still, I progressed okay and gradually started to need gas and air etc. At 8am I was 7-8cm I think and asked if the baby would be born by 12pm - the midwife looked helpless (still no head in feeling range) and I though - "uh oh..." and asked for an epidural. But of course about a million other people had just asked and there was a 2 hour queue.

During that time things got terrible - I was in awful pain but it just felt hopeless and purposeless, everyone was being negative, Max couldn't stay awake, the contractions felt completely endless and gapless. Someone had put a scalp monitor on the baby and it was buzzing in time with the TENS, which was horrid and the flex was unbearably degrading but I was unable to vocalise anything to make someone either remove it or the TENS. They examined me just before the anesthetist arrived and I was 9 1/2cm - I'd done so well, but although my body was clearly in transition nothing was kicking in to get the baby out. And instead of yanking me to my feet and making the baby descend, they went ahead with the epidural. (Mistake number 4).

It took 2 attempts to get it in - I was curled up on the side of the bed, leaning into Max and they couldn't make it work - someone helpfully said that if I moved I would probably be paralysed and so I was terrified, in pain, exhausted and starting to feel completely traumatised. I remember thinking "I just can't do this anymore" and then realising that I didn't actually have much choice. The first anesthetist dropped all the syringes on the floor and had to send for a new lot, then his shift changed and a new one must have arrived. I don't remember any of this except that a German introduced himself initially and a Chinese man appeared 2 hours later to tell me it was over. I know that Max was starting to feel like he could do a better job. And then it only worked down one side so I had dreadful pain in my right hip (and I can't explain why but pain in one place was almost worse than everywhere) and they had to roll me about to make it work. I felt so degraded and I felt a failure because I had so not wanted one but I just had to get some respite. I do know that just before they finished, they asked me if I would mind taking part in a survey on different types of plaster. I believe it was the only time I swore and that the midwife was frantically signalling to him to leave me alone. I'd be surprised if my eyes didn't glow red.

So by now it was about midday, my midwife told me I had got to push 3 pushes a minute for an hour. I had no urge to push at all, I couldn't feel anything at all and everyone seemed to have given up on me. The midwife went for lunch! And after nearly 2 hours of pushing they said that enough was enough and I had to have a section. To be honest I was relieved. Then they said that before they did that they would try a ventouse delivery in the theatre. That seemed fair enough.

Well, if you have never had one of those, I don't recommend you try it. I was completely numb ready for the section and I still screamed in pain. I could feel them pulling my pelvis apart and rummaging inside me, my legs were in stirrups and I couldn't stop farting and it felt like the world and his wife were staring at me. It's not even funny now, six years later. So they gave up, cut into me and just as they did the baby gave an enormous lurch and shoved her head down into the birth canal. First they thought I had felt the incision and walloped another load of spinal into me, then they realised and a midwife had to put her hand into me and push the baby's head back up. And when they pulled her out, the room went silent and I saw everyone just "look" at each other. The midwife grabbed her and ran from the room, calling "It's a girl" as she left. I knew something was wrong, but I was so tired I just fell asleep. And then the midwife called Max out and when he came back his face was white/green and terrifed. The midwife was holding this little bundle with its face covered up. "She's got a little problem with her face. A cleft lip and palate. Do you want to see her?" Well of course I did and I thought she was beautiful. But I was shaking so much I couldn't hold her and it took a good while to sort me out. I shook for 3 hours in the end.

Although it doesn't really count as birth story, its worth saying what happened after. We got put into a side room and left to get ourselves together. Max went home and I didn't know if he was coming back - although bless him he got home and then couldn't work out why he had left! (Something to do with food and sleep I think!) I had planned to breastfeed and had to bottle feed and try to express (which just didn't work although I kept it up manfully for 13 weeks). She was full of sticky amniotic fluid and coughed and choked for days and I was in such a mess I couldn't sit up to help her, so she had to spend a lot of time out on the nurses station while I tried to recouperate. She got jaundice because she threw up most of everything she drank (45mls in her first day was the sum total of what I got down her) and of course she screamed incessantly because she was so hungry. And I just cried and cried. And people kept coming to visit so I felt like a freak show - 14 visitors in one day was the record I think. The midwives meant well and kept taking her away so I could sleep but I think it just made it worse - I just got to the point where I wanted her to go away for ever. And of course we knew she needed surgery in a weeks time. We came home for a few days after 5 days and those were hell - burnt food, tears, Max was great but just didn't know what to say or do. I don't think either of us could really believe what had happened.

But.... as it happened.... it all turned out okay. Living with a cleft palate.

Maddy

Having had an emergency c-section for Frances, after a traumatic 24 hour labour that ended in a ventouse, a baby that suddenly tried to emerge conventionally after the incision had been made, the section and recovery itself, and a baby that had an unexpected cleft lip and palate, I got pregnant again 11 months later with trepidation, but I knew if I didn't do it quickly, I would never do it again.

I booked with my same midwife, and was keen to have her at the birth, although in retrospect this was a mistake as she was not terribly supportive of my anxiety to VBAC. I had an easy pregnancy although I was rather worried and apprehensive and much less well informed than I am now. It was a difficult time.

2 days before my due date, we sent Frances up to my parents for the weekend. I had had a false alarm 3 days before and my midwife had examined me and said she couldn't see me dialating without inducing - I was still firmly closed. In retrospect this was an odd thing to say - I had in fact dilated to a full 10cm with my first labour but Frances had not engaged well due to a lot of extra fluid that cleft babies often have. Anyway, we couldn't decide how to spend our free evening, and ended up deciding to repaint our 24ft living room!!!! We worked till 1am and of course at 5am I woke up with labour pains!!!! I also noticed that I had painted the living room matt along the bottom while my husband had used silk for the top half!!!! So, in denial, I went for a bath to stop these "false labour" pains and he repainted!!!

Anyway, things were clearly on the move, so we called the midwife, and although she was rather cross with me, she came and I was 3cm!!! My contractions were mild and irregular so we went for a walk, with my tens machine on for the odd strong one, and when that didn't speed things up, we went to DFS to sit on sofas; I thought that might encourage my waters to break! It was during the walk that I met one of my lovely slimming class members for almost the last time; I remember grinning through a contraction at him and wishing I could get going. He actually died 3 weeks later, but I saw him once more at a class, and he gave Maddy an adoring look and said "I have 10 grandchildren, and every one is gorgeous..."

However, 3 hours later, the midwife came back - I was now 4cm but my BP was up and the baby's heartbeat was too. I agreed to go to hospital. Once there, the normal treadmill of monitoring and intervention started. I was very disappointed that my midwife failed to be much of an advocate for me, even though by this time everything had returned to normal. They tried to insist on a drip, and when questioned they said I was "showing signs of toxemia." Fortunately my husband queried this, as everything now seemed fine again. They were very put out by his questioning and one midwife became really quite rude. She was hunting about in my arm for a vein, despite my protestations, and talking about my "very difficult veins" over my head as if I was a difficult school child. She looked at me, strapped to my bed and said "you have 2 hours, you are on a 2 hour countdown to a section." (This midwife was mentioned by name on my 3rd birthplan as not being allowed anywhere near me!!!). At this point I started to cry and my wonderful husband threw them all out and told them not to come back until they had a registrar with them. I think, quite frankly, it is due to this and little else, that I got my VBAC.

After a good long time, a registrar appeared. He was wonderful. He couldn't understand the fuss and said "Lets break your waters and give you a few hours, if that doesn't work we can try a drip and if that doesn't work we can look at a section some time tomorrow." I was still only 4cm and it was 8pm at this point, so all this seemed pretty reasonable. I decided, at this point, that what was most important was to keep my head and not get tired so I decided to have an epidural. Then they broke my waters. It all became very relaxed - it was a light epidural and I could feel the contractions but still cope easily. The only thing I didn't like much during this was the midwife, who sat in the corner and "looked" at me - and I felt I wanted to hide my face for every contraction. Max did the cross word and made encouraging faces when required! The pain began to get very strong (my husband says he recalls me having two syringes of epidural with the first and only half for the second) and I had gas and air. I began to make a lot of grunting noises and the midwife said "You CAN'T want to push - you were 4cm less that 2 hours ago" I suspect I may have muttered something less than polite - I was on quick examination "8cm... no...just an anterior lip - oh I can feel the head!!!!!" Minutes prior to this she had been asking for names so she could write out wristbands and was most put out we didn't have a boy name!!!

The registrar had asked to be there at the birth as the baby's head had been very high and he was called. In these few minutes as the pain and the urge to push became overwhelming, they lost the baby's heartbeat and a panic ensued. I was bumped from my small room to a large one as I had expressed a real desperation not to have my baby removed from my room for resusitation. Frances had been taken out and brought back several minutes later and the distress that caused me was hardly tolerable. I had dreadful nightmares for ages afterwards that she had been swapped for another baby (fortunately she looks enough like me for that not to be the case!!!) so they moved me to a room with a resuss table. It was very unpleasant to be moved, but I appreciated that they made the effort to follow my expressed wish.

The registrar now said " This baby has to come out now. I am putting the forceps together, if you don't want me to use them - PUSH!!!!" And I did!!!!! With 3 pushes (not bad for a first delivery!) out she came. I have an incredibly strong memory of visualising a bowling ball emerging out of the mechanism that delivers it back to the players during this time! I felt her crown, felt her nose and felt her swoosh out at great speed - NOTHING could have stopped me pushing!!! I opened my eyes just in time to see her appear on the bed, before she was grabbed, cord cut and whisked to the table. I think I knew she was fine because I didn't ask "Is everything okay?" I asked "Is it a girl or a boy?" and refused to believe Max who had seen it was indeed a girl!

Fortunately she was fine and came back to me quickly. I had a small tear (and kicked the registrar when he tried to stitch it without a local!!!) and I lost some blood, which made me faint when I tried to stand up, but after a night in hospital (she was born at 10.55pm), I was home, elated and relieved. Even afterwards, the midwife in charge was pretty rubbish really - she was shouting at a bewildrered and tired Max to get things and he had no idea WHAT she was talking about. Grrrr....

Amelie

Quick history.... Frances was born following a horrible 20 hour labour by emergency c-section - it left me very traumatised... ho hum... I'm going to have to try and remember it to write it up, but to be honest, I would rather forget it all.

Maddy was born following a normal if not desperately well managed or calm labour and I had a natural delivery, narrowily escaping forceps by pushing very very hard and getting her out in 3 pushes!!!

So... this time I wanted a homebirth.... I planned it, controlled the midwives (!) stayed out of the consultant's way... etc but here is where the best laid plans and all that....

Baby never really engaged... was breech, cephalic, oblique, transverse... anywhere really from week to week!

I went 5 days overdue and finally woke up on wednesday morning knowing it was all about to start. we faffed about trying to decide what to do with the other two... husband convinced we had hours... and suddenly I said "we are fiddling while Rome burns here - take them downstairs!!!" As he left the room my waters popped - I heard them! I knew this was likely to be a problem as although she had had her head in the right place the night before I was fairly sure it was not right at that time. So I lay in a puddle, Max packed the girls bags and I called people on my mobile to arrange childcare... my dad, bless him, was whittling that he had to go to work the next day and what would we do if I hadn't had it by then!!!!

By the time the midwife arrived I had bad feelings... she said we would be safer in hospital without a head in the pelvis but I didn't want to go. Max's aunt arrived and started going on about how her son had not been engaged and she had a section - it was not really what I needed to hear - don't people react oddly at times of stress!!! She was great and whisked the girls away thank goodness. Fran had got very upset and refused to come near me although she did say goodbye. Then my waters went green.. .at which point even I knew the homebirth had dissolved on me. I shed a few tears but got over it, probably because Max was busy with the girls so I couldn't throw a tantrum on him!

The girls left, the midwife dialled 999, having waited till the girls were gone so they didn't see me leave by ambulance... and off I went.... It didn't wait for Max, which is probably the only clue I got that things were serious. At the mat unit they put me in a nice room, respected all my wishes about keeping people out, my midwife was a veritable bulldog if anyone tried to muscle in, and even took the monitor off after 20 mins, despite it not being a particularly good trace. After that she used a handheld one. The trace was not ideal and by now I was having reasonably strong contractions, but with no head to help me dilate. The registrar was invited in and suggested that the consultant try and nudge the baby over my pelvis. she asked to do an internal first and discovered that although I was only 2cm dilated, she could already feel the cord prolapsing and the baby's heartbeat was now dropping with every contraction to a fairly significant degree.

I can honestly say that every face fell in the room - I really think they would have liked it to work out for me but it was becoming clear that we were facing an emergency. The reg said if I had been 8-9cm dilated they could have got her out safely but we really risked losing the baby if we continued... she only needed to move her head back and engage and it would have all been over. so they gently suggested we move for a section and both of us agreed. It made a fairly big difference to me that a baby had been lost on the home birth list only a few weeks before when his cord had become trapped between her pelvis and his head pre labour. I knew what COULD happen.

I don't quite know how they created a homebirth in an operating theatre but they did. The anesthetist was wonderful (and looked like Jeremy Irons!) my midwife, who had cancelled all her visits and clinics to stay with me, looked after me while the spinal was set up and negotiated to be baby catcher even though her O.R. skills were too out of date for her to be the operating midwife. We even managed a laugh about the fact that the radio was playing "Living on a Prayer" which was possibly slightly inappropriate!!!! The only bad moment was the spinal making me feel really sick which they dealt with quickly and my poor husband who was gripped with absolute terror that we were about to produce another baby with a problem (our first had a cleft lip and palate) but apart from looking green and shaking nearly as much as me, he did really well - I had no idea how frightened he was.

Amelie cried as her head was pulled out, scored 9 and the 10, pooed all over the operating theatre and apart from being a bit grunty - was absolutely fine. I was told later that my scar, despite holding up during Maddy's birth had opened up a gap of 3cm where amelies head was pressing on it so I am in no doubt that this time I really did have an emergency c-section and that without it we really might both have been in terrible danger. Oddly, it was possibly the most positive birth I have had and though I am sad that it probably knocks out any chance of a normal delivery if we do go for a 4th and final baby, I think that it all went as well as it possibly could have on this occasion.

So, Amelie , who weighed 7lb 11 at birth and 12 days later is 8lb 6 (so I must be doing something right!) was born on the 8th May and eats, sleeps and looks a dream!

I hope this is useful - I never thought I could talk positively about a section - I never envisaged having one again - but its not all bad. I will also say that there is a world of difference between a section after 20 hours of being beaten to a pulp and one done early on when you have energy, dignity and a few muscles left. I so vividly remember staggering down the corridor the morning after dd1's section clutching my tummy and in awful pain - it took me ages to recover. This time I was able to move about my bed by the afternoon and was walking upright and able first thing the next morning. A different world! I went home after just after 36 hours and although the feelings of having had major emergency surgery when I had 2 girls already left me pretty raw, I was able to overcome it.

ADDENDUM

In some ways I just chose not to be saddened by this section; I don't have time for emotional trauma anymore and I had no desire to feel as rotten as I had after Fran. Finding my homebirth kit in the bedroom at home was a very tough time and took me a little while to cope with. I did that by sitting very quietly and focusing on what might have been and how lucky we were that things had gone safely. I had one exceptionally bad weekend when my cousin had an almost repeat experience of my first section in the same hospital - I went to pieces - but by and large this was an okay experience.

2 months after my second CS I saw the consultant. To my surprise she was excellent about the whole thing - we knew we still wanted a 4th baby and she felt the circumstances had been so unusual that she would support me in having a 4th baby and having a VBAC. Well, that baby is now a "work in progress" so we shall have to see!!!!

I am just pregnant again and for the first time I am not too bothered how the baby is born. It matters more to me to make my own choice and not spoil the peace I have found than to hold on desperately for a birth that might end in pain and anger again. I think some of this peace has come from knowing I really DID nearly lose my third child (and they also found a hole in my uterus when they did the section) but much of it comes from having had a VBAC, so I know I "can."

My third child was born by a genuine emergency section with a presenting cord - the experience was so different to my first section and the people involved made it lovely for me. In some ways, that 3rd birth was the best of all because I was consulted, in control and respected throughout. I had planned an HBAC and that planning had made me regret bits of my VBAC that I wanted to have been better. But in retrospect I know I was lucky to get that VBAC experience and it was a very very healing one, not least because I and we, grew in power during it.

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