Louise - a home birth after two caesareans

by Bernadette Tilley

Bernadette's third daughter, Louise, was born at home on 31st March 2000 weighing 7lb 10 1/2 oz, with her elbow by her head and her hand on her cheek! Bernadette's first two daughers, Rose-Marie and Charlotte, were both born by caesarean section.

"I am 35 years old and it has taken me this long to realise that I have a right to say what happens to my body and my baby. I'm sure that if I had read more widely on the subject of childbirth six years ago, then I wouldn't have had to endure two caesareans in what I consider a very hostile and oppressive conditions."

When I found out that I was pregnant with Louise I was really happy. The pregnancy was planned and both Paul and myself were very excited and surprised that I'd got pregnant so quickly. I'm not really sure why this should have surprised us, because this is what had happened with my other two pregnancies. I went to the doctor's to start the ball rolling with antenatal appointments and at 12 weeks was booked in with the midwife. We discussed my two previous caesareans. The midwife asked me whether I had any negative feelings about these, because it was likely that I would be required to have another caesarean. I remember telling her that although I would have preferred the outcome of both these births to have been different that I was okay with the experiences. Who was I kidding? As soon as I'd said all this to her I realised that the main person that I was deceiving was myself. This is when the panic set. My God! I was pregnant and it looked as though I was going to have another caesarean. I couldn't bear the thought.

I didn't know who to talk to about this. Was I normal to feel this way? Why did it matter how our babies are born as long as they are healthy? I had two healthy children didn't I? Pull yourself together I told myself. Having a strong word with myself about how silly I was being didn't help this time. I couldn't shake off the feeling of absolute terror of the thought of having another caesarean. I rang my friend Francesca who had had a caesarean and was expecting her second child. She was going for a VBAC (Vaginal Birth after Caesarean ). Francesca seemed confident that it would happen for her this time. She had a non-repeating reason for her caesarean (like both of my caesareans!) and no medical reasons for requiring a caesarean eg. Placenta praevia, bad pre-eclampsia. But what about the scar rupturing? I asked her. The risk of this happening is quite small even in cases where there is more than one scar she replied. She had done a lot of research into the subject.

I felt encouraged by this conversation and started to search for information that could help me. I also asked to see a consultant at the hospital, so that I could discuss my options with them. I didn't want another caesarean! Most of the information that I found via the internet advocated the safety of a VBAC. I read medical journal after medical journal. The evidence was mounting in my favour. I was buoyed up and confident that I wouldn't need a caesarean if I didn't want one.

Whilst whizzing around cyber-space I made contact with a couple of people who really helped me. One person ran a VBAC Support Group from her home in Bognor Regis, and the other was Dorothy, an independent midwife who I'd contacted via the Association of Radical Midwives. I hadn't really considered a home birth before I spoke to Caroline from the VBAC Support Group. She never advised me to do anything she just opened my mind to different possibilities. She sent me a book to read called Open Season by Nancy Wainer Cohen , a book about VBAC and Caesarean Prevention. I read this and then got another book called Silent Knife by the same author and her co-author Lois J Estner. They confirmed what I already knew deep inside. My body was meant to give birth. There was nothing 'wrong' with me just because I'd had a caesarean. These two books worked very much on the emotional side of giving birth as well as pointing out that VBAC was a safe option in most circumstances

"I went to see the consultant and my world fell apart"

Then I went to see the consultant and my world fell apart. The consultant was arrogant and patronising. He treated me like I was a silly little girl without a right to a point of view. I tried to talk to him about the medical literature that I'd read. He didn't want to discuss that with me. He told that there was a very strong possibility of my scar rupturing during labour and that my baby would die. He told me that the only baby that he'd pulled out of a ruptured uterus was a dead one. I asked him how often this had happened to him. He told me that it was none of my business. He also told me that he was not interested in women having positive birth experiences. I was disgusted.

His main reason for not allowing me to labour was that I'd had an infection with my second caesarean and this would have obviously weakened the scar. I asked him how many women who'd had two caesareans without an infection had laboured and been successful at this hospital. He told me that this didn't happen, because they didn't allow those women to labour. The infection after the second caesarean was just more ammunition. The advice would have been the same. He wrote down on my notes that in his opinion I should have an elective caesarean at 38 weeks. He then asked me what date they should book me in for my caesarean. I shook his hand, thanked him for his advice, and told him that I hadn't made my mind up about what I was going to do. Paul and I asked for the hospital notes from my previous two labours, so that I would have a record of what had gone on before. I felt that I could use these in order to make a decision about what I wanted to do.

After the appointment at the hospital, I went home and cried and cried and cried. I couldn't stop crying. I couldn't go to work, because all I could do was cry. I didn't know what to do. Every time I thought about having this caesarean I cried some more. I felt as though somebody had died. My grief consumed me and the seeming inevitability of having a third caesarean filled my every conscious thought. A couple of days after this appointment Francesca rang after successfully having a VBAC with her second son. I was thrilled for her, but told her about what had happened at the hospital. She was very supportive, but she admitted that she did not know what she would do in my position.

I kept remembering the words of my internet midwife, Dorothy, that if things didn't work out for me that I should prepare to have a 'joyful caesarean'. I couldn't imagine doing that, but I searched the internet for organisations supporting caesarean birth, and birth stories of those joyful caesareans. To be honest, I didn't find many people who were totally happy with their experiences. Some women had no choice, because of various problems that they had experienced, but for many others although they saw their caesareans as necessary, they still had a longing that they could have been different. I would look at the birth plan in my hospital notes and cry, because they were all geared up for vaginal births ie. First Stage, Second Stage, Third Stage etc. I wept, because at this time I didn't really believe that I was going to reach my dream.

The yearning for a 'normal' birth

Yet the yearning for a vaginal birth built up and grew stronger and stronger. I can only describe it as the longing that infertile couples must have when they want a baby, or the overwhelming instinct for animals to protect their young. This feeling inside me was so powerful, it was almost frightening. I was at a loss with myself, because I didn't know how to deal with such deep-seated emotions. I could feel myself sinking into a deep depression, a black abyss. I know that Paul was very worried about me. I know that if I'd realised how awful I would be feeling at this point, then I would never have got pregnant, but I was pregnant and somehow I had to get through this black cloud.

At this point, I remembered some more words from Dorothy. She told me not to waste my tears on crying, but to use my energy to fight for what I wanted, and that I'd look back on this time and realise that I was a much more assertive, confident woman.

I asked to see another consultant at the hospital for a second opinion. She had a much kinder manner and was far more concerned for me as a person, but her advice was the same as her colleague. She did, however, stress very strongly that nobody could force me to have a caesarean. She wrote that in my notes. I went away from this meeting feeling just as sad as before.

I was virtually resigned to having another major operation. I rang Caroline at the VBAC Support Group and contacted my internet midwife. Why did I want a vaginal birth so much? Where was all this grief coming from? I'd never pictured myself as an earth mother, so why all this now? I was happy with my two little girls and I knew that their births had never influenced my relationship with them. I couldn't imagine loving another baby more. Caroline gave me lots of encouragement. She sent me birth stories of people that she had supported. They gave birth vaginally after two caesareans - one of them was a breech delivery as well. She gave me telephone numbers of people to contact who had had two caesareans and delivered vaginally. I rang them and listened to their stories. Also, in the books that had read there were lots of women who felt the same way as I did. I was normal to want this!

Not all doctors feel the same way...

My internet midwife Dorothy gave me the telephone number of an obstetrician in London with whom she had worked. He talked to me for an hour on the telephone. He was incredibly lovely. He didn't criticise me for wanting what was after all the natural way to give birth. He couldn't see any reason why I couldn't labour if I wanted to. He tried all sorts of ways to think how I could come up to London to have my baby with him as my obstetrician, but we knew that it was too impractical. He was in North London, so it was all a bit far, but it made me realise that what the obstetricians recommended was in fact medical opinion, not medical fact, and that not all doctors felt the same about my situation.

My research into childbirth opened up a whole new world for me. I began to realise that if my previous labours had been treated differently then they too would have resulted in a vaginal birth and not a caesarean. I had been very frightened during both my previous labours and had not been given the support that I'd needed in order to labour successfully. Maybe it's time for me to explain what happened first and second time round in order for you to understand what I mean.

Rose-Marie's Birth by Caesarean

For my first baby I'd laboured at home from about 10am until 10pm the day before Rose-Marie was born. The contractions were very regular and quite close together. I wanted to go to the hospital to have myself checked over just to give myself the assurance that everything was going well. I fully expected to be sent home. Each time that I rang the staff just didn't want me to go in. I found out later on why. Eventually, I was so upset by this that we just arrived. Then the nightmare began….

On my initial assessment on reaching the labour ward the midwife couldn't find my baby's heartbeat. She asked me when was the last time that I'd felt my baby move. I couldn't remember. I was absolutely terrified. She buzzed for help and it seemed like there were a thousand people in the room with me. One person was looking for the baby's heartbeat, another was taking my pulse to make sure that it was different to the baby's. Somebody was taking blood out of my arm for matching. Somebody was breaking my waters. The panic was thick in the air. I was breathing in fear and so was my baby.

After what seemed like forever, Rose-Marie's heartbeat returned to the normal range. For the staff at the hospital, the immediate emergency was over and my husband and I were left to ourselves. I was shaking in fear. One of the doctors thought that I was cold! (There's the ability to empathise for you!) It was the hottest July night you could imagine. He shut the window for me. I couldn't believe it. I wanted to scream. I'M TERRIFIED, YOU STUPID MAN! But you don't do that sort of thing, do you?

I had been fitted with a Foetal Scalp Monitor that was broken and couldn't be removed so every time that I had a vaginal examination my baby's heart went crazy. Wouldn't yours? The Labour Ward was a bit like the Marie Celeste. There was nobody around for the whole of the night, because of a flu epidemic at that time. I think the telephone got more attention than we did. We were told to look at the CTG machine and if the heart rate went below 100, to buzz for help.

I was absolutely terrified and was expected to dilate. I now know that this was unlikely, because of the fight-or-flight response that my body was experiencing at the time. My body was actually resisting the labour until I could find a safer moment to birth my baby, but unfortunately I didn't realise that at the time. It was only during my third pregnancy that I found out all of this.

Anyway, to cut a long story short, after a long night of neglect, then acceleration with synotocinon, epidural, taking blood off my baby's head etc etc, the doctor decided that he was going to 'deliver' my baby. Unfortunately, I didn't realise that this meant a caesarean until they pushed the consent forms under my nose. I'm obviously a bit on the stupid side. By this time, I was so convinced that my baby was going to die I would have agreed to anything. There was a huge panic to get me to the operating theatre. I had my baby under a general anaesthetic, and didn't see her until she was an hour old. Nevertheless, I was thrilled with my little girl and put everything behind in the belief that this was a one-off and I couldn't possibly have to go through another caesarean.

Charlotte's birth - a second caesarean

Throughout my second pregnancy, I was very positive that I would have a vaginal delivery this time. I went into spontaneous labour. I was told to go to the hospital as soon as I was in labour, because there was a possibility that my scar would rupture. Unfortunately for me, they laboured this point a bit too much and I was again terrified of what was about to come. Every contraction convinced me that my old scar was about to burst.

I asked for a mobile epidural. This was something that everyone had agreed that I could have, but when the anaesthetist came to do it, he flatly refused. He said that as I'd had a caesarean already that there was a strong possibility that I'd need another one. I buckled under his superior knowledge. The full epidural was sited. It didn't take. I was using gas and air, but couldn't move around to help myself through the contractions. The anaesthetist came back. He asked me whether it was possible that I might be imagining the pain. His arrogance has never ceased to amaze me. He prescribed more anaesthetic, but this didn't work either. After many hours he finally re-sited it. It was better, but not fully effective. My husband and I didn't feel comforted when he told us that he hadn't slept for 36 hours!

By this time, I was so wound up by the epidural not working. I couldn't move around and I felt very hot. I wasn't allowed to eat or drink anything, because I might need a caesarean, because I'd already had one. I was hungry and thirsty. I now had a fever. Once you have a fever then the chances of you having a caesarean go through the roof. I now know that fevers are a side effect of epidurals. It disappeared after the epidural wore off. Again, to cut another long story short, after 12 hours at the hospital they decided that a caesarean was the best option, because I wasn't dilating fast enough for them, my scar might rupture any second(!), I had a fever, my pulse was racing (I was so stressed)…and I'd already had a caesarean anyway, so they might as well get on with.

I trusted their judgement, because they were medical people and I am not, and agreed to the second section. My epidural was topped up and I was wheeled in for my caesarean. Everything was fine, until my baby was pulled out and then the agony started. I could feel awful pain down my right side. It felt as though somebody was stabbing me with a knife. I asked the anaesthetist to do something about the pain. He said he couldn't give me any more morphine, because I'd been given enough to knock out an army. He couldn't top up my epidural any more, because then I might stop breathing. I asked him to knock me out, but he refused saying that it wasn't worth it for the time that I had left. It wasn't until they'd stitched me up forty minutes later that the awful stabbing feeling stopped.

I had another lovely baby girl, but I couldn't concentrate on enjoying her, because I was in so much pain. If I'd just given birth to baby giraffe then I couldn't have cared less. Afterwards, I got a really bad infection in my wound that took ages to heal. It was months before I was back on my feet. I resolved not to have any more children.

The journey to home birth

Anyway, back to my home birth. I knew that I needed to work on the logic side of my nature to convince myself that having a vaginal birth was safe for me and my baby. I bought another book by Henci Goer called Obstetric Myths versus Research Realities. This book pulls together much of the research done into childbirth over the last 40 years. It exposes many modern obstetric practises as being detrimental to a woman in childbirth eg. Constant fetal monitoring, epidurals, elective caesareans for breech presentation. It also has an excellent chapter on VBAC.

I was discovering many ways to maximise my chances of avoiding a caesarean birth. I needed to convince myself that what I wanted was safe. I didn't find any evidence in any of the medical literature that an infection weakened the scar for future pregnancies. Henci Goer's book confirmed this for me. I was also using the Home Birth Reference website by Angela Horn (www.homebirth.org.uk) and another very useful site by Ken Turkowski whose little baby girl had actually died through a botched VBAC attempt (www.worldserver.com/turk/birthing/).

I did, however, wobble between going for what the doctors had advised and having an elective caesarean rather than following my dream of a vaginal birth. I'm not used to going against medical advice. The biggest psychological barrier that I had to get over involved empowering myself to take control of my own body and birth, rather than leaving it up to somebody else to make the decisions. I rang Caroline many times. She kept asking me where I really wanted to have my baby. I used to joke with her and say that the side of the road looked attractive or under a tree. In my heart I knew that I wanted to have my baby at home; I just wasn't ready to face up to that yet.

I went along with the GP and hospital midwives until the day that I realised that it was possible that none of the midwives that I'd met at my antenatal appointments would be on duty when I went into labour. I'd even had an appointment with one midwife who'd said that she hoped that my breech baby wouldn't turn so that I'd have to have a caesarean. Afterwards, I was in tears and distraught. My breech baby did turn.

Some of the midwives were very positive and supportive, some of them were not quite on my side. Who would I get when I went to the hospital? A supportive midwife, or a scared, ignorant one? I'd have to start explaining all over again what I wanted. I felt that I might be under a lot of pressure when I arrived at the hospital to give in to having another caesarean. I wouldn't get the support that I needed to achieve what I was setting out to do. I hadn't achieved a vaginal birth with their 'supposed' support. How could I manage it without it? I decided to ring some independent midwives to see whether this was the route that I wanted to go down.

I interviewed a couple of independent midwives and eventually decided on the Thames Valley Independent Midwives. After much agonising and a lot more research and thinking about the subject I decided to have my baby at home with independent midwives. This is my birth story.

Louise's Home Birth

My waters broke at 4.00 am on 31st March 2000. I didn't have any kind of premonition that this was going to happen. My other two children had come a week late. This little one had decided to come a week early. Paul jumped out of bed getting me towels to mop up and I hopped to the bathroom in a vain attempt to get most of the mess down the loo. Paul then rang Melanie to tell her that my waters had gone. I talked to her on the phone and she told me to go back to bed and get some rest. You've got to be joking! We went back to bed and chatted like two children. We were so excited. I did have a bad headache and was feeling sick, so I took a paracetamol and that got rid of my headache for me. The sickness passed, so I polished off honey on toast and a nice cup of tea.

 My mother was staying with us at the time, but was due to go to France that very day to stay with one of my sisters to look after her children for a week. My sister was having a few problems with childcare arrangements. After much discussion it was decided that she should go, because she would lose the money she'd paid for the train, and she couldn't let my sister down. We packed my mother off for the train. Rose-Marie and Charlotte were sorted out by Heidi our nanny and went off to school and nursery school.

Melanie came at about 10.30am to have a chat. I'd already fitted my TENS machine, because I was getting some contractions, but they were about 10 minutes apart and weren't really very painful yet. She asked me whether I wanted the baby that day. Of course I did! In that case she said you'd better start walking up and down the stairs and really moving about. She left to go and do some visits with other clients with instructions that when the contractions were getting stronger and closer together then I was to ring her. Her words were 'When you think you need me then ring me and I'll come back'. So I wandered about all morning wondering when that would be.

Paul popped out to the doctor's to get a prescription for oral vitamin K. He'd been gone what seemed an age. When he got back he said that none of the chemists stocked it. I suggested that he go to the hospital pharmacy, because they were bound to have it there, so off he went to get that. Melanie rang again at about 12.15pm, she was just about to go shopping. I still felt okay, so again I agreed to ring her when I needed her. Anyway, Paul came back from the hospital pharmacy furious, because they hadn't wanted to give him the prescription, because they didn't know which department to charge it to, because we were having a home birth. Paul had insisted that they give him the medication suggesting that they charge it to the department that I would have been in if I'd been going to the hospital.

I now felt that I needed Melanie as the contractions were getting stronger and closer together! Ah! That's what she meant! I remember saying to myself. When we rang her she was in Sainsbury's doing her shopping. She jumped into her car with her shopping and came straight over to the house. She arrived at about 1.30pm. We packed all of her shopping into the fridge. Paul and Melanie massaged my back during the contractions which was lovely for a while, but I suddenly didn't like it any more, so they had to stop.

At 2.00pm Melanie suggested that I get into the bath. I wasn't too keen, as that meant that I'd have to take off my TENS machine which was working quite well for me. I got into the bath which I have to say was better than I thought it would be. I lay down on my left side and had people pour warm water over my stomach. I also had a few biscuits which helped keep my strength up. As the contractions got stronger and stronger, I was sinking lower and lower into the bath. It was at the point that I thought I might drown that I decided to get out. I was also cold and had started to shiver. So at 3.30pm I got out of the bath and we put my TENS machine back on.

This was when I remember seeing Elaine who had been called. We put her shopping into the fridge, because she'd been in the supermarket as well. Sometime during the day my two other children had been packed off to stay with Heidi. I don't know when that happened. Melanie and Elaine decided that clary sage oil would help with the contractions, so they put some on a hankie for me to smell. I also had lots of arnica that is supposed to be good for bruising. I was starting to feel some pain in my bottom, and was feeling a bit like pushing, but I didn't having that overwhelming desire to push that I'd read about. At 6.00pm I felt like pushing and was sitting on the loo doing just that, but didn't feel that I was getting anywhere, and wasn't quite sure what I was supposed to be doing anyway.

At 6.15pm, Melanie did a vaginal examination with me standing up. I had an anterior lip on the cervix that was probably slowing down my progress. At 6.45pm I had another vaginal examination whilst lying down on the bed. It was at this point that I was put into bed lying on my side with gas and air with the instructions that I should resist the urge to push. I was trying to get rid of the anterior lip on my cervix that hadn't gone away. I have to say that I quite enjoyed this part of the labour. It gave me the chance to relax and rest before the pushing stage ahead. I do like gas and air! I remember saying to Elaine that she wasn't getting it back and there had better be enough to last for the rest of the labour. I had little pieces of banana fed to me at this point.

As time went on I was finding that I couldn't resist the urge to push. Melanie and Elaine encouraged me to take a kneeling position, but I actually found standing up more comfortable. Elaine looked at me a couple of times and said that I wasn't making best use of the gas and air. I'm breathing it in! Honestly! I told her. She checked that it was working and discovered that the mouthpiece wasn't connected to the cylinder. I decided at that point not to bother using it, although I didn't want to leave go of the mouthpiece, just in case I needed it. I also had a little suck or two in between contractions just for fun! At about 8.00pm I started pushing again, but that anterior lip decided to come back, so at about 8.30pm Melanie pushed it back behind the baby's head during a couple of contractions which did the trick. Hurray! I could just get on with it now! I continued pushing whilst standing up and holding onto the bed post and Paul who was sitting on the bed.

I was making a lot of noise. Melanie kept telling me that I'd have a sore throat after all of this if I didn't try and make the noise from my chest rather than my throat, but I thought that it was all a bit late to change my technique now. If I got a sore throat then I'd deal with that when it happened! I could now feel the baby's head coming down. I didn't quite believe that it was all happening. I remember dreading the part when the baby's head comes through the pelvic floor and the skin stretches over the head. I was surprised that this actually didn't feel that painful. It was just incredibly uncomfortable. It reminded me of a dream that I'd had before Louise was born. I was standing in a dark cave with very low lights. Lots of women were standing around me. I gave birth to a baby and it didn't hurt, it was just incredibly peaceful. The similarities with my own birthing experiences were amazing, because I did give birth standing up, with low lights and people standing around me, and again it was just incredibly peaceful. There was no noise (apart from the noise I made myself), there were no bright lights and there was an extreme feeling of love.

Louise was handed to me through my legs. The cord was still pulsating and we said hello to our new baby girl. I was still very shocked that things had gone so well. Paul cut the cord and he carried her about talking to her whilst I delivered the placenta which I might add was a lot more painful than I'd realised it would be. A useful time for the gas and air at this point! I had a bath with Louise. We counted her fingers and toes to make sure that they were all there. She was weighed and came in at 7lb 10 ½ ounces. I did tear a little bit, because Louise came down with her elbow by her head and her hand on her cheek. I needed one stitch which wasn't too bad, and probably would have torn at all if she hadn't been such a tinker with her arm. Those perineal exercises were good for something after all! I went to bed and tea and toast miraculously appeared.

 The birth was an incredibly positive experience for both Paul and myself. If I ever had another baby (which I'm not planning to do) then I'd never consider a hospital birth unless there were good medical reasons for doing it. I feel that it's not right that I had to find an independent midwife in order to get what I wanted out of childbirth experience, but it was worth every penny.

Bernadette Tilley

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