Diana's Story
Diana, a
Kiwi who gave birth to her two children in England, shares her
story:
I’m someone who thinks twice
before spending 50 cents.
So it may seem odd that I’d pay UK£2,000
for a service I could get for free from the National
Health Service in that country. But could I?
My first birth experience went
from bad to utter disaster. I’d planned a home birth. In the
end I had a caesarean. It was an outcome that I could not have
contemplated and certainly didn’t come to terms with for many
years. When I fell pregnant second time around I thought
initially I would choose to go to hospital. I lacked
confidence in my ability to labour and give birth naturally.
And I was scared that I would be the one in 200 women whose scar
tears open under pressure from contractions. This I knew had a
high chance of resulting in my or the baby’s death.
But then I started reading
anything and everything I could find about vaginal birth after
caesareans [VBACs]. In her website
www.homebirth.org.uk
Angela Horn
writes: “Around 75% of VBAC candidates do give birth vaginally,
but the remaining 25% who have repeat caesareans will do so for
many reasons - rarely for uterine rupture.” It was when I
read that home VBACs had a much higher success rate than planned
hospital VBACs that I really started thinking.
Soon after I wrote to the head
of obstetrics and gynaecology at Pembury Hospital explaining
that should I give birth there I would expect to use the
birthing pool and did not accept that continuous fetal
monitoring was appropriate for me. The latter, I had read time
and time again, was used as a poor replacement for one-to-one
midwifery care. The reply, which included a copy of
Pembury’s “guidelines” [rules] for VBAC births, convinced me
that should I walk through the swinging doors into the labour
ward I would have my heckles up - not a good situation for a
labouring woman. Among other things I would be given a vaginal
examination on arrival, followed by two-hourly vaginal
examinations. If this wasn’t enough to put me off giving birth
at Pembury, I was told that hand-held monitoring was out of the
question. That meant labouring on my back with a continuous
monitor on. As far as I could see, the hospital saw
me as a walking uterus threatening rupture.
For much of the next couple of
days I struggled with the idea, but eventually realised that I
had little choice but to plan a homebirth.
Pembury’s guidelines did, interestingly, say they would send a
midwife to home if a woman “insists on home birth”. But I
feared that on the day I would be sent a midwife who didn’t have
confidence in me or experience with VBACs and I would be
transferred to hospital forthwith. Had I ended up with another
caesarean, I would have never known if it was in my best
interests or due to a lack of experience by the midwife,
insufficient care, or obstetric anxiety.
Choosing an independent
midwife was not difficult. A friend of mine had employed
Ashford-based Virginia Howes for a hospital birth and I was very
impressed with Virginia’s skills as an advocate.
Pembury and Maidstone hospitals do not allow independent
midwives to practice - although many other hospitals do. But
they can attend as doulas [birth partners]. This was sufficient
for me. If I needed to transfer from home to hospital, I had an
experienced professional with me who had my best interests at
heart. As it transpired, I went into labour
naturally, and the birth was trouble-free, if long. Virginia
monitored me regularly and checked for signs of the uterus
rupturing, but nothing went wrong. The first stage was 18 hours
and the second, an hour and a half.
I often wonder what would have
happened if I’d gone to hospital. My labour was only minutely
bearable when I was in the pool. I couldn’t bear to be on dry
land - let alone on my back with a continuous monitor.
Pembury’s rules also said that a registrar must be called if the
active second stage continued for more than 30 minutes. Mine
took three times that. Would I have been pressured to have a
caesarean at that stage? Ultimately, all I know is
that Virginia had the experience and the confidence in me to let
a perfectly normal birth progress to a natural conclusion.
Coughing up the £2,000 for
Virginia’s services hurt. But I would still employ her if I had
my time over again. If I’d had another caesarean, my partner
Cliff would have had to take weeks of unpaid leave off work as
we don’t have close family support. It would have cost us just
as much.
The following was written two days after the birth:
I have, since I was a
teenager, always expected that any baby I had would be born at
home. So when I came down with pre-eclampsia with my daughter,
I was shocked and horrified that they wanted me in hospital and
wanted to induce me. I fought for seven days, but eventually
agreed to the induction - which failed - and eventually agreed
to a caesarean. I had at that stage all of the stuffing knocked
out of me. I didn't have the confidence to try for another home
birth.
When I became pregnant this
time I was aware that I didn't agree with the NHS' "rules" for
VBAC births. I wrote to Pembury Hospital asking specific
questions about things such as using the birthing pool and the
use of a hand-held monitor. The reply made it clear that I was
on a collision course with them. At the same time I started to
read VBAC websites and other info and realised that I really HAD
NO CHOICE but to go for a home birth. I knew from Pembury's
"guidelines" that if I put my foot down they would send out a
midwife to me at home.
The main difference in the
care I received from Independent
midwife Virginia Howes to
that of my NHS midwife last time [who always came to my home as
well] was that her overwhelming expectations were that it would
happen the way I wanted. My NHS midwife, who I liked as a
person, always talked about ifs and buts and conned me to sign
forms about going into hospital if XYZ happened.
The birth:
It was all new to me as I had
never experienced labour, let alone even had a contraction. On
Monday I had what I thought might be a show. Then around
Tuesday morning I awoke around 2am and realised that I was
having very mild contractions. These continued throughout
Tuesday until about 11pm Tuesday evening when they became
painful.
Each time I had one I had to get out of bed and walk around with
the Tens machine. They were coming every 5 minutes through the
night [although I think I slept through the occasional one].
At 7am I called Virginia and she arrived by 8am.
Cliff didn't start filling the
pool until 8.30am, so it wasn't full enough until about
10.30am. I had started yelling with contractions around 9am -
but still found walking around during contractions the best. I
was hesitant about getting in the pool because I felt that I
would need to stand up with every contraction. But I was more
comfortable in the pool. Later on around lunchtime I asked for
gas and air. It didn't seem to take the edge off the
contractions, but it really helped me to breathe in and out
deeply and stopped the screaming - which was making my throat
raw.
I stayed in the pool until
Virginia said she thought it was a good idea to do an internal.
In theory I thought I wouldn't mind internals [they were one of
my greatest bug bears about the experience of having Maia in
hospital], but I really didn't want one when it came down to
it. But I knew she was right and inside me wanted to know how
well dilated I was. Eventually I got out of the pool and had
the internal. Apparently I had fallen asleep very briefly in the
pool. Virginia said I was 7-8cm's dilated. But at this point I
was started to get a bit negative and replied: "so you mean 7".
In reality it must have been 8.
I asked her if I could have
pethidine, but she said if I had it I would have to come out of
the pool in case the baby was born floppy.
So I decided against it - knowing in my heart of hearts that it
was the wrong thing to do at that point. She encouraged me to
walk to the end of the hall and back, which took a good 10
minutes. Once I got back to the lounge I had one contraction in
which I started pushing involuntarily.
I went back into the pool
then. I remember feeling very negative and asking if I could go
to Pembury [knowing full well this was ridiculous as I couldn't
have faced the drive] and have an epidural :). Several times I
said I couldn't go on. But I knew in my heart of hearts that I
could and I had to. I really didn't believe that Virginia and
Cliff could see the head. But I began to feel it crowning after
about an hour and a bit of pushing. Once it did crown, I could
see the end was in sight. I knew in my head I should be
breathing the baby out, etc etc, but I just wanted to get it
out, tear or no tear! After three or four contractions the head
popped out. What a relief that was. It was then one more big
contraction and the body followed. I have never felt so relieved
in my entire life. He came to the surface and started breathing
immediately - so I didn't have to get out of the pool. After a
few minutes Virginia put a stool in the water for me to sit on.
Within 10 minutes there was another contraction and the placenta
shot out.
I didn't realise they could come so quickly without drugs. I had torn, but not badly. In
the immediate aftermath I was quite shocked at just how intense
giving birth is.
It's now five days after the
event and I am very glad I did give birth at home. I'm sure
going to hospital would have been the first step in a very quick
slippery path to intervention. After my caesarean I was too
ashamed to tell anyone that didn't need to know that I had had
one. In the last five days I have told everyone I know that
number 1 was by caesarean and this one was at home. I was
hoping that it might be inspirational to other women in my
situation. I've certainly spoken to two women I know who had
caesareans first time around and who had serious doubts they
would be able to give birth naturally in future.
When the doctor came around
for the home visit he commented that the practice recommended
women go to hospital as "all the evidence shows it is safer".
What a load of baloney. Virginia is writing to him to point out
that this is just plain wrong.
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