Rachel's VBAC

"Rachel tells of her intervention-free straightforward VBAC in hospital following an elective caesarean for her first baby due to an unstable lie."

My first child was born by elective c-section because she had an unstable lie (mainly transverse). The consultant terrified me with talk of prolapsed cords and made me stay in hospital when this was discovered at 36 weeks. I found this so stressful that I asked for a c-section. This went smoothly physically, but I was completely unprepared for the psychological impact - feeling that I hadn't 'given birth' but that my baby had been taken from me, that I wasn't capable of looking after her as I hadn't been capable of giving birth to her, and just that I had missed out on the empowering experience of labouring and birthing a child.

It took me a good couple of years to fully realise how I felt and to come to terms with it. I think I might not have felt so bad about it if I'd been convinced that a caesarean was unavoidable - if I'd had the chance to labour and it hadn't worked out or if she had still been transverse when I went into labour. With hindsight I felt that I should have waited to go into labour naturally at which point she might have got into position, and if I'd had more support and encouragement rather than all the scaremongering, this might have been an option.

So when I was expecting my second (and probably last) child I was obsessed with having a VBAC. I really wanted it to be MY birth experience and not some horrible medical procedure, so I considered an HBAC (Home Birth after Caesarean) but I wasn't really comfortable about this unless I had a midwife who was comfortable with it - and the CMs (Communitiy Midwives) weren't! As an independant midwife was quite an expense I decided to try for a hopsital VBAC, with HBAC as my fall back position if I didn't get a positive response from the hospital. I decided it would be better to tell the hospital what I planned to have, and fight my battles beforehand, rather than wait until I went into labour and have the stress of having to convince them that yes, I did know the risks, and no, there was no way I was going to have any intervention without a very good reason.

I saw a consultant's registrar at around 20 weeks. They were happy for me to try a VBAC, and weren't too bothered about some things such as length of labour, but were most unhappy about my refusal to contemplate CEFM (Continuous Electronic Fetal Monitoring) and talked a lot about the risk of uterine rupture (no mention of the risks of a c-section). They wanted me to come back again at 36 weeks for a sizing scan (like they're so accurate!) and another chat, which I took to mean they hoped I would have changed my mind by then!

I had lots of lengthy chats with my CM about what I wanted (apologies to anyone who ever had an appointment after me) and after some initial doubts she obviously decided that I really meant it and was very supportive. She arranged for me to see the consultant midwife, who was absolutely fantastic; her attitude was that we should expect things to go well and I could have/not have anything I wanted. She wrote a letter explaining this so that I wouldn't get any hassle when the time came. She only asked that I have regular checks with a hand held sonicaid and an internal exam every 3 hours once I was having strong contractions to make sure things were progressing, and I was happy with that. My CM also switched me to a different consultant, whose only concern was to have me in for regular checks if I got to 42 weeks. It just goes to show how different they can be!

The only snag at this stage (about 34 weeks) was that the baby was, yes, transverse! The consultant midwife gave me some tips on getting it to turn, which meant that I spent a week in the height of summer with a sarong strapped tightly around my tummy. The baby must have found this as uncomfortable as I did, because a week later he was head down and he stayed put.

The great day came when, just before midnight 2 days before my due date, my waters broke. We duly trotted off to hospital and they confirmed that the waters had indeed gone, but the baby wasn't engaged and I wasn't dilated at all yet. On account of the lack of engagement and the previous caesarean, they were keen for us to stay in hospital, but as I was only having mild contractions every 10 mins and we felt that nothing would happen for ages we declined and went home. They didn't give us any hassle about this, which I felt was down to the fact that I'd obviously done my homework and knew what I wanted.

We arrived home at 2.30am and I sent Eliot to bed to get some rest. This proved to be a bad idea because my contractions instantly speeded up to 5 mins apart and, on my own, I struggled to cope. An hour later, at 3.30am, I woke him up and suggested that we return to hospital. They did an internal examination at 4.30am and I was devastated to learn that I was only 1cm dilated, as I was finding it really hard to cope. Ironically, now that I wanted to stay, they were keen for us to go back home, or at least down to the ward to walk about! Fortunately they didn't press the point and instead offered me gas and air and a warm bath. So much for my resolve to have no pain relief - I didn't know anything could hurt so much! They took on board my birth plan and never mentioned any other sort of intervention.

The next few hours were a bit of a blur. Since I wasn't, in their view, in established labour, I didn't get the 15 minute checks (I think they stopped by a couple of times). I was left in Eliot rather overwhelmed hands - no offence, but if I could go back in time I'd have got a doula as I think a bit more support would have made all the difference. Eventually I felt that I couldn't cope any more and sent Eliot off to find a midwife and demand pethidine. The logical part of my brain knew that actually this probably wouldn't help at all, since the contractions were more or less continuous, but I was pretty desperate by now. I was even having fond thoughts of the caesarean!

A midwife finally showed up and talked me through some contractions. She gave the opinion that I was probably 3-4cm dilated, which left me feeling that I really couldn't cope with another 5 hours of this. She asked me to get out of the bath so she could check what was going on and we could make a new plan; this took some time as I was waiting for a gap in the contractions before I moved, but there never was a gap - just a variation from very painful to excruciatingly painful.

I finally made it onto a bed at 8am and was heartened to find that actually I was 8cm dilated. At this point Eliot went off to go to the toilet, the midwife wandered off to find some one else and I found that I couldn't breath. It dawned on me that actually I was pushing, so I told the midwife when she reappeared and she had another look, at which point it was all systems go - the baby was coming very soon! Eliot asked what did that mean - in the next 10 minutes or so? No - it meant in the next minute! He was really excited and it was very touching to see. Another contraction, and out popped Isaac at 8.14am weighing 7lb 15 oz. So the notes read: Stage 1 - 3 ½ hours (actually time from 1cm to 8cm), Stage 2 - 14 minutes (actually 8cm to delivery). The fly in the ointment was that the speed of the second stage meant that I tore really badly, and had to go into theatre to be stitched up under a spinal block. There was a bit of déjà vu - same place my daughter was delivered, drips, etc, but frankly I didn't care at this stage. I was just glad it was over and I'd done it!

Despite the stitches and spinal block, I was up and about, feeling fine, within a few hours. It was fantastic to be able to sit up, to pick up my baby when he cried and fetch my own breakfast, none of which I could do after my caesarean. But the best bit was the fulfilment of giving birth to my child by myself - something I would never have appreciated if I hadn't had the caesarean.

So there we are - a hospital VBAC with absolutely no intervention (until after delivery) and no hassle from the medical establishment. It wasn't perfect, but it was good enough and I'm still really thrilled that I did it, amazed that my body did such an efficient job, but also sad that I didn't trust my body enough to do so first time around. A big part of me would love to have another child just so I can try and do it even better with an HBAC. Maybe I was just lucky to find a few supportive people, and also that the labour was so quick! But I do believe that doing my homework and getting buy-in for my birth plan beforehand helped because it meant that people respected my decisions and didn't question them, and I was able to relax about it. Mentioning that if they didn't agree to what I wanted then I would darn well stay at home also helped!

© Rachel 2005

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