“So you’ll be having another c-section then?”
I’ve lost track of the number of times people asked me that during my pregnancy. And I get it, for a long time I believed that once you’d had a caesarean that was it, you’d never be able to have a vaginal birth. And whilst I had had an incredibly positive c-section birth with R I knew that a second c-section would never be my first choice.
But even after I was introduced to the idea of a VBAC (vaginal birth after caesarean) I still had some massive misconceptions about what it might involve. The way people talked about VBACs made it sound inherently risky; something best attempted in the medical setting of a labour ward.
(Not) thinking about birth options
Of course R being a breech baby meant that I was also aware that the choice could be taken out of my hands if this baby was head up as well. Add in a hefty dose of anxiety that comes with pregnancy after loss and it’s safe to say birthing options was something I wanted to bury my head in the sand over and simply refused to think about for most of my pregnancy.
But having had a c-section means that burying your head in the sand isn’t really an option. At 16 weeks I had a call scheduled with the Birth After Caesarean (BAC) midwife. Up until this phone call I’d been pretty sure a hospital birth was the only option (I’d also assumed I’d be under consultant-led care but it turns out that I didn’t need to see a consultant at all during this pregnancy). But during the call the BAC midwife mentioned the possibility of using the birth centre.
Except she was ambiguous about whether it was an option for me. My c-section notes confirmed I’d lost more blood than was normal. I’d been close to having a blood transfusion (which explains why I passed out several times after birth). What wasn’t clear was whether this was due to a nick in a blood vessel during the surgery or my uterus failing to contract quickly enough. After my D&C there had also been a concern about blood loss. Perhaps I was at risk of bleeding. It seemed to be a concern that no one could give a firm answer to.
As the birth centre is co-located at the hospital I couldn’t see the benefit of using it if inevitably I would have to transfer up to the labour ward. I just wanted to be able to get into the zone and not have my labour interrupted by a transfer, even if it was between floors in the hospital. Starting on the labour ward seemed like the sensible choice and the one that my healthcare team wanted me to take.
Coming up with a birth plan
As my pregnancy progressed I had a further call with the BAC midwife at 35 weeks. Again we discussed a hospital birth. It was clear that the team would want to monitor me during labour. The BAC midwife also suggested that I should have a cannula put in on arrival given my previous blood loss. Speaking on the phone it seemed totally sensible. We discussed what would happen if I went overdue and another appointment was scheduled for 39 weeks but I joked with the midwife it was unlikely I’d get to 39 weeks. With R I’d gone into labour at 38+5. She advised me to pack my hospital bag just in case.
In fact the baby coming early was something I was certain about. Whenever anyone asked my due date I felt reluctant to say it was in July. I’d caveat my response to say that the baby would likely come early. I knew deep down this baby wouldn’t stay in through June. I went on mat leave at 35 weeks, which seemed really early but meant that I would get a few weeks leave even if baby came early.
Somewhere between that conversation with the BAC midwife and my next midwife appointment I pulled my head out of the sand. I read the Positive Birth Book and started to believe that maybe, maybe I would have the vaginal delivery I’d missed out on last time around. And when I did get my head out of the sand, I realised that perhaps a hospital birth wasn’t ideal. After all, the risk of intervention is lower for birth centre births (even if you have to transfer to hospital). I started to consider the possibility that I could have a much more natural birth, potentially in water. I decided that I would discuss with my community midwife whether this was a possibility at my upcoming appointment. In preparation I started to put together a visual birth plan using the Positive Birth Movement symbols.
Breech baby or head down?
Of course hanging over me was the possibility that this baby would be breech too. If they were then a ECV may not be an option due to my previous c-section (I was told it would depend on baby’s position and the view of the consultant) – not that the ECV worked last time around.
My community midwife was confident that baby was head down. But my midwife last time had said R was head down right up until it was confirmed on a scan she was breech. So it wasn’t a surprise that I wasn’t fully confident about baby’s position. My midwife had suggested at an earlier appointment that I discuss with the BAC midwife whether there would be any benefit to having a scan (bearing in mind that baby could still move after the scan). The BAC midwife agreed that a scan would be helpful and booked me in for the following week at 36+6.
As it got closer to my scan I became more confident that baby was in the right position. Whereas with R I could feel her head under my ribs, this time my bump was soft at the top. I couldn’t be sure of course but I started to believe that vaginal birth would happen.
The morning of my scan N dropped me off at the hospital and I headed to the Maternity Assessment Centre (MAC). Within a couple minutes the specialist midwife had scanned me and confirmed baby was head down. Suddenly all of the worries about having another breech baby were gone. I headed home, excited to have my appointment with the midwife that afternoon to discuss my birth plan.
No signs of labour
Before I left for midwife appointment I went to the loo (and totally forget to do a urine sample). When I wiped there was a clear jelly-like blob, possibly my mucus plug. I was running late so I put on a pad and headed to my appointment without giving it too much thought.
At the appointment I mentioned to the midwife that I’d started to lose my mucus plug. She didn’t seem concerned, particularly as I was 36+6 so almost at full term. I wasn’t showing any other signs of labour and baby just at the top of my pelvis so wasn’t really engaged yet.
We discussed my birth plan and my midwife was supportive of me wanting to use the birth centre but she stressed that they prefer women to have continuous monitoring for VBAC births. This wouldn’t be possible if I was using a pool in the birth centre. I’d done a bit of reading around continuous monitoring and I felt confident that it wasn’t necessary (NICE no longer recommends continuous monitoring for VBAC and there is no evidence that it allows for identification of potential scar rupture). But we agreed that I would be open to using the pool on labour ward (which would also allow me to be monitored) if available. My midwife suggested what would likely happen is I would be asked to be monitored before a final decision was made about where I would give birth. In part this would also depend if the birth centre was open as staff shortages meant that sometimes it is closed anyway.
That evening I discussed my birth plan with N so that he knew what I wanted. As I sat on the sofa watching TV I was starting to feel a bit crampy and uncomfortable. The baby was moving a lot and I noticed that I was getting quite heavy discharge with a pink tinge to it. I phoned MAC before I went to bed for reassurance and they just told me as long as there was no bright red blood or green tinge there was nothing to worry about. I popped a towel on the bed in case my waters broke during the night and put together a birth playlist before finally falling asleep.
The start of something
At 2am I woke up feeling really wet – I thought perhaps my waters had broken but actually it was just a lot of discharge and a bit of leaking wee (pregnancy is so glamourous isn’t it). I still felt crampy but no contractions. So I laid awake planning what I would do that day just in case this was the start of labour and listened to a meditation to try to get to back to sleep. But sleep was pretty impossible and I spent the next two hours taking trips to the loo and generally feeling uncomfortable. I also made a plan for R as I was supposed to be looking after her but felt like I would struggle – even if I wasn’t in labour yet I would probably need to catch up on sleep and prepare as it seemed like labour wasn’t far off.
Then at 4am I felt my first proper contraction. Unlike the general cramps I’d had until that point this felt like something I needed to breath through using hypnobirthing breaths. Ten minutes later I had another. At this point I woke N to tell him I was going into labour and that I was going to get up. My friend had sent me a tens machine which luckily had arrived in the post the afternoon before so I put the pads on my back and sat on my birth ball and gently rocked while breathing through contractions that were coming every 10 minutes. I also phoned MAC again and they advised me to head in to get checked.
It was still very early, with dawn just breaking outside but we needed a plan for R. N tried phoning his dad and stepmum but unsurprisingly they didn’t pick up. After several attempts N managed to get through to his stepmum on her mobile. We agreed that they would meet us at the hospital and pick up R. N would just have to stay in the car with R while I was monitored in the MAC.
By this point every time I stood up from the birth ball I would get strong contractions coming close together. I kept using the boost function on the tens machine each time I got a contraction and 4/8 breathing but while the contractions felt manageable when I was sat in the birth ball, dealing with them while standing was much harder. Each time a contraction came when I was standing I would have to bend over and wiggle my bum whilst making a variety of noises. Up until this point I’d been wearing a vest top and my underwear but going into hospital would mean I needed to be fully dressed. I went upstairs to try to find something to put on but all of my maternity leggings were in the wash. I tried to put on a skirt but it felt too tight and uncomfortable. In the end I grabbed N’s pyjama bottoms and put them on.
I managed to eat a bowl of cereal while N got R up and dressed. Of course R wanted mummy to help her get ready so somehow I managed to sit her on my lap to out her shoes on while I sat on the ball. Getting into the car was a bit of a battle though. R wanted me to strap her into her car seat but by this point the contractions were coming quickly and standing was a struggle and there was no way I could get her in her seat. So with a crying toddler upset that daddy had strapped her in we set off.
The car journey was intense. While I’d been sat on the ball I hadn’t felt a lot of movement (causing much panicking) but as soon as I was in the car the baby was making some big movements again which felt really intense when combined with the contractions. Plus the position of the car seat was uncomfortable and I had awful thoughts that we might have to pull over and deliver the baby because it felt like I was almost ready to start pushing.
Monitoring in MAC
We made it to the hospital at 6am. I left N and R in the car and started to walk to across the car park to the hospital entrance. But almost as soon as I started I had to stop as another strong contraction hit me. I leaned against the nearest car and breathed through it. A second contraction came almost immediately after. Luckily the MAC staff had spotted me struggling to get across the car park and sent down a midwife with a wheelchair who whisked me up to the MAC.
I was taken to a cubicle and asked to sit in the bed while the monitor was put on. I asked for a birth ball and the midwife explained that as soon as the monitor was on I’d be able to sit on a ball. Whilst I was happy to be monitored by that point even sitting on the bed felt like it would be a massive challenge given how quickly my contractions were coming. Somehow I managed to get on the bed and the monitor was put on. As soon as I sat on the birth ball it was an immense relief.
As I sat alone in the cubicle all I could think was how much I just wanted to get into a room and set up a safe space ready to deliver the baby. I didn’t really care if that was in the birth centre or on the labour ward by that point. I felt a bit scared, mainly because I was by myself and I could tell it wouldn’t be long before the baby arrived. I was fairly certain I was reaching transition and the environment I was in was less than ideal. I can’t remember if I used the call button or if the midwife just came in to check on me but as soon as she did I asked if I could be moved to a room.
The midwife told me that she would need to do an internal exam to check my dilation before she could move me to a room. “You’re in labour but you could be like this for days yet.” With hindsight I can understand why she said this. My waters hadn’t broken and I’d been having contractions for just over two hours so it was possible that I could be like this for days. She reassured me that I was the only person in the MAC so it was private.
I was unsurprisingly less than impressed. I could feel that the baby was coming and if the only way I could convince her was by having an internal exam then so be it. Although it felt like an immense struggle to get onto the bed again I somehow managed it. Most of this feels like a blur now but the next thing the midwife said was “you’re sitting on baby’s head right now” and suddenly I was being wheeled to a delivery room (and I was told there wouldn’t be time to fill a pool for a water birth).
In the delivery room I was moved onto another bed but I shifted myself around so I was upright. I was facing into the bed which was facing the wall but I could sense there was activity going on behind me with lots of people in the room. A midwife asked where my birth partner was and I explained that he was still waiting outside with our daughter. I asked whether R would be allowed in with him. They explained that R couldn’t be in the room but asked whether it would be OK for a midwife to watch her outside. I said that would be fine and dialled N before handing my phone to the nearest person.
N was expecting me to call him to say whether I was going to the birth centre or labour ward so he was a bit surprised when the call was from a midwife asking him to come up to labour ward straight away. When I looked at my phone afterwards the call was made at 6.45am. R was left with a midwife outside and within a few minutes spotted Nana from the window.
Vomiting backwards
I wasn’t really aware of what was going on around me but the monitor was having trouble with the position I was in so I was asked to turn around and lay on the bed. I kept saying that I didn’t want to be on my back and that I didn’t want to be monitored – I just wanted to be on all fours and push this baby out! By this point there was around five midwives in the room (I think at least one was a student). The midwife who was in charge later told us she was only on labour ward to cover a break.
The midwives were discussing whether they could switch to auscultation and then asked me if I would be happy with them using a clip (foetal scalp electrode) to monitor baby and allow me to move freely. I’d read about the clip, which is really more of a tiny screw in baby’s scalp. It wasn’t something I really wanted but I also desperately wanted to move as I could feel the urge to push and was really struggling with laying on the bed. Although I hadn’t wanted continuous monitoring it felt like using a clip was a comprise that would allow me movement and so I agreed to it.
I was also asked about having an injection to deliver the placenta. I had wanted a physiological delivery but I knew that they were looking at the notes from my c-section and had a concern about blood loss (I don’t think anyone actually looked at my birth plan). Again I agreed as I just wanted to get on with it. What I hadn’t understood was that they also wanted me to have a syntometrine drip to help my uterus contract which meant having a cannula inserted.
I asked for the cannula to go in my wrist but they were struggling to insert it. It took two attempts to get it into my hand but I wasn’t really paying attention. As soon as they told me the clip was on I turned over so I could kneel and lean into the bed (all while a poor midwife battled to get the cannula in). As soon as I moved my waters came out (my waters would have been broken in order for the clip to be inserted but baby was plugging the gap).
I leaned into the bed and could feel my body pushing to expel the baby. I’d read about the foetal ejection reflect but the feeling was completely odd to experience, like wanting to vomit backwards. The midwives were telling me to push but I tried to just ignore them and go with what felt right for my body at that moment, breathing down and doing a lot of screaming!
After about three contractions I could feel that baby was crowning but just not quite out. The contractions weren’t painful but the feeling of baby crowning was. I’d heard this referred to as the “ring of fire” and that was all I could think about in the moment. I tried to visualise the baby coming out as I pushed but it felt like baby wasn’t getting any further. With each contraction I was screaming, not in pain but perhaps in frustration. Mainly I felt like I just needed to make a noise as I focused on pushing. But I also worried this was wasting energy so I tried to “breathe the baby down”.
I heard a midwife say the baby was getting tired and that I needed to give a big push. As the next contraction came I put everything into it and felt baby’s head break free and the whole body followed after in a huge whoosh. I had expected head to come and then another contraction to push out the body rather than it all to happen at once but luckily two midwives were behind me to catch the baby. While N told me we’d had a boy they handed him around to me for skin to skin. I pulled off my top, completely unbothered about being totally naked, and held him to my chest, my head resting on the bed as I panted. I felt like I’d just run a sprint race. It was 7.11am and I’d been in labour for just over 3 hours.
The aftermath
I was helped to turn back over and cut the cord after a few minutes. The next bit is a bit of a blur but while we enjoyed skin to skin they pulled out the placenta and stitched me up as I had a second degree tear. At this point I was offered gas and air for the pain of being stitched up but after labouring with nothing but the tens machine (which had been forgotten about as soon as I got to the delivery room) and hypnobirthing breathing I didn’t feel like I needed anything.
During all this I’d been sat on the rather messy bed (honestly it looked like something out of a horror movie) and so I was helped to move position to allow the sheets under me to be changes. I immediately vomited as soon as I moved. Apparently its’s really common for the drip to cause sickness. The midwife told me that either you throw up during labour or afterwards. I had tea and toast but felt too sick to really eat it. A midwife weighed the baby and cleaned him up. N put his first nappy on (a gorgeous newborn puffin pop-in). He weighed 7lb 5oz, not a bad weight considering he was three weeks early!
After a couple hours we were moved to the recovery ward and I was able to get the cannula out and have a shower. N wasn’t allowed on the recovery ward until visiting hours so he headed home to sort out R to stay the night with Nana and Grandad and pick up the car seat. I was given a side room so we had it all to ourselves. Once I was off the drip the nausea was gone and I was able to enjoy some dark chocolate that I had packed in my hospital bag. But the room was hot – it was the hottest day of the year so far and hospitals tend to be hot anyway.
By mid afternoon we’d had all of the checks and were discharged. Certainly very different to the three nights I spent in hospital after R was born.
Reflections on a VBAC
At first I was frustrated that T’s birth wasn’t how I would have wanted. In particular I felt like I had to agree to having the clip and the injection / drip, which were not things that I wanted. I was annoyed that no one seemed to even look at my birth plan. But in hindsight I can understand that it was a very quickly developing situation and the healthcare team were trying to keep me and baby safe for a VBAC delivery by following their best practice guidance.
When I spoke to my community midwife afterwards (and she was worried as she could see from my notes that things hadn’t turned out as we had discussed) she said that a fast labour could increase risk of bleeding which was probably why they wanted me to have the drip.
