Gillian's first baby, Elena, was born in hospital after an epidural and forceps. Because of her forceps delivery, Gillian was initially told that she could not have her next baby at home. Here is a copy of our correspondence during Gillian's pregnancy, before Emily's birth story:
Email from Gillian - January 2002
With my first birth (Elena, 18/05/00) I had been planning a domino birth so as to have the option to stay at home without having to fight for the right - seemed the easier option when booking. However, I ended up going into labour slightly early (while I was still at work!) and bleeding a little and having meconium in the waters so ended up in hospital. This was OK but the sad part is that I agreed to an epidural because of the threat of caesarian ("it will save valuable minutes") and also because they said it would be at least another 8 hours before I got to the pushing stage (when I first went in with the bleeding they said I was in established labour and 3cm dilated and this was still the case at 8pm).
I asked if they would check my cervix before the epidural (it was about 10:30pm by then and I was starting to feel the contractions at last!) but they said that my contractions were ineffective and it would just be disappointing for me to hear that I hadn't dilated further. So in went the epidural. They checked immediately afterwards and sure enough I was fully dilated. With a fresh epidural I was unable to push well and didn't have gravity to help. Ended up with a forceps delivery in front of millions of people waiting to resuscitate Elena, who cried immediately and had an Agpar score of 9/10.
Based on this experience, I thought the safest place to be would be at home with the next one. An epidural-free zone and only my own germs on the toilet seat.
When I went to my GP and she asked me if I'd be happy going back to Wythenshawe hospital for No 2, I said that I was considering homebirth this time. She told me that I wouldn't be able to do it from that surgery and would have to reregister somewhere else. The midwife would explain all that.
Saw the midwife who said that she couldn't book me for a home birth as I had an instrumental delivery last time. Wouldn't accept that the epidural increased the chances of a forceps birth. I know that no-one can prove that I wouldn't have ended up with a forceps birth even without an epidural, but Elena wasn't huge (only 7lbs 14oz) and it wasn't a very long labour so I wasn't particularly tired. (Pain started about 10pm and she was born 3:30am. Supposedly I was in labour from before 4pm but I was just sitting around in the hospital not exerting any energy at all.)
The line she gave me was that she would book me for a hospital birth and then I would have a consultation with at consultant and we would discuss it further then.
Feel a bit fobbed off and would like it sorted out before then.
Wish I had read your website before I went and gone directly to the Midwife Supervisor. Now worried that if I do that I'll get the community midwife all annoyed at me and get myself labelled as a problem patient.
Do you have any advice in the meantime?
Reply from Angela
I'm sorry to hear that Elena's birth went pear-shaped. Surprised that your midwife thought a forceps delivery was a contraindication to future home birth, as lots of women have home births after forceps. You will find plenty of birth stories on the website where this has happened.
There is plenty of evidence that epidurals lead to an increase in assisted deliveries, especially with first-time mothers; this is often more pronounced when the epidural is given near to second stage because a) mother cannot feel to push properly, and b) epidurals are known to affect pelvic floor tone which can make it hard for the baby to rotate, which it needs to do to descend through the pelvis. Have a look at the Association of Radical Midwives' website for some references - the epidurals page is at www.radmid.demon.co.uk/epidural.htm
Actually I would have thought that you were a very good candidate for home birth in some ways - you managed to dilate quickly in hospital, under considerable stress, where many women's labours would have stalled and they would have ended up with a c-section for failure to progress. Clearly your body is well-designed to give birth even in adverse circumstances - who knows what you could do without all the hassle to hold you back?
Wish I had ... gone directly to the Midwife Supervisor. Now worried that if I do that I'll get the community midwife all annoyed at me and get myself labelled as a problem patient.
And you think that disagreeing with a consultant is not going to get you labelled as a problem 'patient'?!!!
But seriously - what the supervisor of midwives thinks of you is not the issue. The issue is that you want to book a home birth and have been dissuaded by the midwife who you hoped would support you. If you want to discuss this with a consultant, that's fine, but if you do not wish to, there is no need to. Whether you want to take up the offer of an appointment with the consultant or not, one way of dealing with your booking would be to write direct to the supervisor of midwives just saying that you are due on x date, have been booked under team y, or whatever, and that you have decided that you will plan a home birth, and would she please make the necessary arrangements. No need to be confrontational - just state calmly and clearly what you intend to do.
Personally I would say that going for a home birth is worth fighting for, if it is what you want. You will only have this baby once. I'm sure the midwives will have far more awkward clients than you to worry about, so please don't let yourself be pushed into a birth which is not right for you because you are worried about making waves. And it would be extremely unprofessional of the supervisor of midwives if she did get annoyed at you - her job is to make sure that midwives are doing their job properly, not to bully women into lining up on a conveyor belt!
You might find the Homebirth UK email group helpful. It is an informal chat group for anyone interested in home birth in the UK - parents, midwives, etc. You will certainly find other people there who have had home births after a forceps delivery, and many who have been told they 'have' to see a consultant to discuss home birth, and then found that actually they do not 'have' to do any such thing.
3 March 02
The good news is that the consultant said there is no reason why I shouldn't be put down for a home birth at this stage so all is well except that the hospital administration can't cope with this and keep sending me letters telling me they have a bed booked for me and that I must have my 20 week scan on a certain day because I am under the care of a particular consultant!
Email received 28 August 02
Gillian, Motoi and Elena are happy to announce the birth, at home at 15:35 on Tuesday 27th August 2002, of Emily, weighing in at 8 pounds and 5 ounces. All concerned still in shock at early arrival 2 weeks before due date!!!
I woke up that morning feeling a bit liquidy and found I had a bit of browny streaked mucus coming out of me. Not like a classic show or anything, though.
Eating my breakfast at 7:30 I could feel vague twinges (even twinge seems like too strong a word for them - if I had been busy with something else I'm sure I wouldn't have noticed them). After spending a considerable amount of time in denial I decided that it just might possibly be labour and it would be a good idea to tidy up the back bedroom (intended place of birth). Motoi went out to get enough food to see us through to the weekend. By about midday I was having to stop what I was doing with each contraction. I bounced on my birthing ball (this was the best £9.99 I ever spent!) through each contraction and got up and pottered in between. They were coming about every 3-4 minutes by then.
I phoned the midwife and the really starchy one, who I was hoping to avoid, turned up. She proclaimed me to be 3-4 cm dilated and said she would stay. I said I would be fine and persuaded her to go off and do a clinic. She left but left me her mobile phone number. I couldn't face her hanging around.
My friend came a bit later to deal with Elena. I was getting to the point where I couldn't cope with her being around and hanging on to me through each contraction. "Ooh, Mammy having 'traction. Bounce bounce bounce!"
The midwife reappeared at about 2:30 and my friend took Elena out for a walk a little later. My TENS machine was up to max by then so we ran a bath to see if that would help instead. Midwife settled down for the duration on the settee.
Bath helped each contraction feel shorter. They were intense but not really painful as such. I was still having converations between them and uttering odd words during them.
Then at about 3:10 there was a really intense bit where there seemed to be no gap between contractions and it all went on until at 3:20 when I felt my waters pop. Felt a bit desperate as last time I only really started to feel it after they broke so was really thinking it was all just about to start and that I wouldn't be able to cope. Also knew they would make me get out of the bath in case of infection.
Note from Angela: It is certainly not standard practise everywhere to ask mothers to get out of the bath in case of infection, once the waters have broken. I am not aware of any evidence that staying in a bath or birth pool beyond this point increases infection rates, and of course the waters have broken beforehand in nearly all cases where babies are born in birth pools. It is simply not an issue for many midwives.
Motoi went down to get the midwife. The contractions stopped and I could then feel the head about to burst out.
Midwife still didn't beleive anything was happening and said things like "Can you get out of the bath?" and "Would you like me to get the Gas and Air from downstairs?" I was unable to answer as I could feel an explusive contraction coming. Soooo different to my first birth where I was pushing from my head as I could feel nothing with the epidural. This time my head wasn't in it at all. My body totally took over. There were about another 4 comtractions and they came at wide enough intervals to give me a rest in between and at 3:35 she was born. Motoi missed the head coming out as the midwife had sent him downstairs to get her mobile phone to call the secnd midwife. She arrived shortly after the birth.
After that there was the fun of witing for the placenta. I didn't want the syntometrine and they gave me a time limit of an hour to get it out. There was real pressure there and they had the injection ready in the syringe after about 20 minutes and were hassling me. They kept speaking to each other in low voices. Don't think they had ever seen a physiological 3rd stage before!
When the hour struck I remembered about the homeopathic birth kit I had borrowed. Hadn't used anything as it had all been so straightforward. Looked up retained placenta and took two of the likely ones. Then it just shot out. What a relief!
I had a 3cm tear but the midwife respected my decision not to be stitched. Doesn't feel too bad. Nipples are worse!
Emily is a really settled and predictable baby and this makes it all much easier. Drug-free is definitely the way to go! And doing it at home too. If I'd been in hospital for that 3:10 - 3:20 part I would have acceped any drugs available and fallen into the same trap as last time. They wouldn't have examined me as I wasn't "due" an examination until 4:30. Emily was an hour old by then!
Hoping mine is a classic case of the patient being right and all the professionals not knowing what they were talking about. Hopefully it will give other women the will to fight the powers that be!
Gillian had another baby, Lewis, in 2005.
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