What makes a good birth?

By Jenny Gaskell

AIMS Journal, 2009, Vol 21 No 1

Jenny Gaskell shares a story of tragedy, triumph and the value of good support, a story which suggests we question what actually defines a good birth experience

In 1999 I started training as a registered nurse. As part of my training I was lucky enough to spend some time with the midwives, both in the community and in the hospital. One night I was called and asked if I wanted to attend a home birth. Of course I agreed and I got my things together and met the midwife at the home of the woman. The woman was just 19, it was her first pregnancy and baby, she was going to be a single mum and had moved into a small flat just a week before. She had had many challenges in her life but this night was not going to be the worst. She birthed her baby with ease and enjoyment, she was comfortable and at peace with her natural instincts. She was birthing the way nature intended. I was amazed by this woman’s ability to trust her own body. The birth of that baby was the first I ever witnessed and it will stay with me forever. That week, as a student, I also attended hospital births and caesareans. My love of midwifery had started. From that moment I decided that if ever I was to have children they would be born at home with the support of midwives who, like me, also believed in my body.

In 2002 I discovered I was starting my journey as a mother. There was never any question in my mind where this baby was going to be born. My partner was a little anxious but supported and trusted my judgement. The antenatal care I received wasn’t great, seeing different midwives every time and having to explain to each of them that I wanted a home birth, even though it was my first baby. Things did not turn out as planned. The last week of the pregnancy I grew enormous feet and started to resemble a cartoon character. I was so swollen I could not even get slippers on and waddled to the GP surgery, at the beginning of January, in my flip flops! I was sent straight to hospital, my blood pressure was raised a little and I was told that I had the start of pre-eclampsia.

After feeling starved for a week in hospital and completely drained by no sleep, induction was mentioned and, to me, that was my ticket out of that place! At no point was it ever explained to me what the possible outcomes of induction were. So, one thing led to another and with no emotional support, information or advice, the dreaded words were uttered … ‘failure to progress.’ It was decided my son was to be cut from me. I was so scared and unaware of my options all throughout the birth that I agreed. Bailey was six months old before I fell in love with him. I truly thought, ‘How on earth could I be a mother if I couldn’t even give birth to him.’

I vowed that day that I would never have another birth like that. I needed the support of someone who knew what was happening to me, someone who trusted in my body. Last time there had been was no one there with me; I had felt surrounded by people but on my own.

There it was, my second positive pregnancy test, given to my partner in an envelope with a small glass of whisky next to it! This time things would be different. For as long as I had the belief in my own body I was going to birth this baby myself. I went to the hospital for the 12 week scan and was told by the consultant that if I tried for a home birth I was at risk of killing myself and the baby. This didn’t upset me, it just made me more determined to find the care and support I needed. To this day I cannot remember how I found out about Independent Midwives but I am so glad I did. I got in touch with the one who was able to help me in my journey to birthing with confidence. Clare Fisher is a wonderful midwife: the care and understanding she gave
me was amazing. She talked through my issues, and I had many after the birth of Bailey. She helped me to trust that this time I was not going to lose control and that all decisions would be made by me and my partner. She trusted me and I trusted her.

I read so much about VBAC (Vaginal Birth After Caesarean) and decided that home was the place I wanted to be. Eight weeks before our baby was due my father had a heart attack. Clare even visited me when I was staying with my mum 60 miles from my home. She supported me through a very difficult time as my father had to stay in hospital to have surgery on his heart - holistic care at its very best.

A day after my due date was to be the day to end my pregnancy. My contractions started and Clare came to support me through the birth. It was a hot day and I was scared to begin with, worried that I would have the control taken away again. Clare arrived and calmed me down; my body was birthing my baby. I chatted to friends on the phone between contractions, we listened to the terrible karaoke from the pub across the road, we laughed and I was daring to feel that I was enjoying myself!

We had agreed that Clare was to check the baby’s heart rate every 10 to 15 minutes. Everything was going just how I wanted it to. Then on one check the heartbeat had dropped to 100, Clare felt as if something wasn’t right, I trusted her so we called an ambulance and we went in. Whilst in the ambulance Clare realised she had forgotten to pick up the notes. She did not want to leave me as this was my fear and we weren’t going to turn back for a few bits of paper.

Clare was with me all the way and my partner followed. When we arrived at the hospital things got worse, the staff spent some time trying to find a heartbeat of my baby. When the consultant arrived and scanned me the heart had stopped. I was taken immediately for a section because they were unsure of the last heartbeat. They were messing around with monitors for over 20 minutes and they were not sure whether they were getting my beat or hers. The consultant that evening was quick to act as he did believe there was a chance of saving her. He made it clear that there was a chance and a section would be the only way. Only at this point did Clare stop holding my hand. She now became support for my partner. Tabitha never took a breath that day, she was born an angel, my baby that will never get old.

If there had been no chance I am not sure how I would have wanted the birth. It’s easy to say now that I would have preferred a natural birth, but at the time I am not sure what I would have wanted. However, I do know that I would have wanted the choice, time to decide and the chance to talk it through with my partner and Clare.

Clare stayed with us for some time after ; she helped us dress our baby and took some photos for us. She came back to the hospital every day. Sometimes she did not even say a word she just held me. Clare came to see us a few times after we left hospital and came to the funeral. At that point we asked Clare to give us some space as we needed time to heal by ourselves. She let us know that she was at the end of the phone at any time we wanted. An investigation took place, no faults in Clare’s care were found, just that she had left the notes behind and could not hand them over the following day.

The Nursing and Midwifery Council (NMC) decided there was a case to hear and it is still not finished today! We are supporting Clare through this as she supported us. At no point did she choose to do the wrong thing by us. She was a true midwife and any woman is lucky to have her walk beside them in their birthing experience.

After much healing, almost losing everything else I hold close to my heart, we came out the other side, a little battered perhaps and a little wiser but never losing faith in my own body. I became pregnant for the third time in November 2006. A home birth was not an option for us this time; my partner’s worry was too great as we still had no answers as to why Tabitha died. I was lucky enough to find a consultant who accepted VBAC and supported us. I was still having to re-tell my story to every midwife I came across, giving my reasons for my decisions and why I trust in my own body. This took much more extra time at appointments than needed as I was just going over old painful ground again and again.

I then stumbled across Julia, a consultant midwife working for the NHS. It sounds silly but I don’t know how I found Julia, I think it was a random chance at a breastfeeding meeting at the Welsh Assembly, we were both there just because we had a whim to go. I believe Tabitha sent her!

We met and I told her everything and that what I really wanted was to try and have a natural bir th. She gave me all the information she could find on natural birth after two sections and let me read the facts. After doing this I still believed that natural birth was the best option for me. She supported my decision and helped me to plan the care I needed. I saw only her as a midwife for most of my care, she attended appointments with me to talk to consultants about decisions that had to be made, not once did I have to re-tell her the horrific journey I had been through. This enabled me to move on. She did my antenatal care in hospital, on the Midwifery Led Unit (MLU), so I could get used to the place. After visiting this place a dozen or so times my fear of it went. This was not a fear started by the death of my baby but one that had started during the birth of my first baby. I started to believe I could birth in a hospital. I walked the corridors, went in the lifts, spoke to as many of the staff as I could: they knew my face and I knew theirs.

When it came time for my baby to be born no fight or flight mechanism switched on, I was comfortable in my surroundings. With the help of hypno-birthing, a technique both my partner and I can highly recommend, the support of Julia and a little gas and air, I was enjoying the birth process again. I was monitored by Julia and one other midwife constantly, we were not left by ourselves but at no time did we feel that our privacy was intruded upon. They stepped back and watched, they used true midwifery skills to monitor me and my baby, how I was acting, the things I was saying. They trusted me and I trusted them. I was never strapped to a monitor, nor was I poked or prodded more than I wanted. The baby’s heat rate was monitored every ten minutes, and at no point was I scared. Very, very unlike the first birth I had.

I was offered the birthing pool and after it had filled, in I got. All I can say is it was amazing, the warm water surrounding my body took me into a deeper level of relaxation. Not long after I realised I was actually birthing my baby the way my body wanted to. It didn’t take long for her to pop out, and she did actually do that! I had no idea of time during the whole of the birth and at the time I did not even know what time it was whether it was morning or night. My body took as long as it wanted to and my baby was born gently into this world. Jasmine immediately screamed when she was lifted out of the water. The most perfect sound I had ever heard. I never heard Bailey scream as I was being sick at the time and I am still waiting to hear Tabitha’s scream. It truly was the most amazing moment in my life. I loved her immediately. I had done it against the advice of most people, even those close to me. I did it, I became a woman that day, I fulfilled a dream I had had for many years, and I did it without fear or pain. When I got out of the pool I decided as I had come this far I wanted a natural third stage, I did that too! I did it. I had a pain-free water birth after two sections. All because I was supported by someone who believed in my body and supported my choices. When I hear of people’s painful birthing journeys I really feel for them as I truly believe that my second and third births were enjoyable because I had built a relationship with the midwife over many meetings. One midwife, one wo man, it’s the way it should be.

I have since given bir th to my four th child, Oz. He also was a very healthy boy, born in water in the local MLU. There were some contraindications for me being in the pool, but as I had my midwife one-to-one we were able to discuss what I felt was impor tant as a good reason to get out of the water and she was able to be a true midwife and let me lead the proceedings. I wish more women could have one-to-one care as it truly makes a difference. In the long run I am sure it would reduce costs to the NHS! Maybe more women could then believe in their own bodies, midwives could be truly midwives and be with the woman, and families could be born with much less distress.

I don’t want any one thinking that a hospital birth is safer that a home birth because its not! The support and trust were the crucial things.

I was not happy to be in hospital for Jasmine’s birth. I did want to birth both Jaz and Oz at home. I had to go in many times to get used to the place. As I only had Julia as my midwife I could talk to her about the fears from my first birth, we decided that I could go into the unit as often as I needed to work on my fears. It was the very unusual one-to-one care that helped, not the fact that I was in the unit. I think, given time, Julia could have made me comfortable in a music concert or a portaloo if she’d needed to! Clare was unable to work within the MLU, but she was a back-up if Julia could not be there.

The support I had during my first pregnancy, labour and birth was appalling, it certainly was not a good way to enter into parenthood. The support I received from Clare during Tabitha’s birth was amazing, as was the support during Oz and Jasmine’s births from Julia. Tabitha’s birth was not a horrible experience whilst in the care of Clare. The outcome was painful but the support I had from her was amazing. I hate to think how I would have coped without her. She is still there today because these things don’t go away, they don’t heal, you just have to learn to live with them and knowing Clare is there for me is a true comfort. Tabitha died in hospital and if I had been birthing her there they may not have been as quick to pick up the signs that something was wrong as I was still in early stages of labour. I certainly would not have had a midwife with me all the time! I really don’t believe being in hospital would have made any difference.

I think it’s really unfair that, as it seems to me, Independent Midwives get sent to the NMC more frequently. An NHS midwife would usually be dealt with within the NHS by managers if there is an issue. As Independent Midwives don’t have NHS managers they get sent straight to the NMC.

In Clare’s case another layer of investigation was skipped as Clare’s super visor was also the Local Supervising Authority (LSA) Midwifery Officer. To me it seems inappropriate that an LSA Officer can also be a supervisor, although I think that this has now changed.

The NMC decided that Clare needed to be disciplined for not handing the notes in quickly enough and believed that a five year caution was justifiable. It seems that she has been punished just because she chose to put my care, and her concern for me first.

I asked for a meeting with the Supervisor to go through what happened but she never returned my request. This really upset me, as my notes became public and I think I should have known that before they did. Because there is only one Independent Midwife in Wales, and she can only have a select number of women, it really was not difficult to find out who I was. There may have been something in the notes that I really did not want made public, such as if I had had a previous abortion. I should have been informed that this was happening, certainly as the local news knew before I did.

I am still friends with Clare which just goes to show how important the midwifery relationship is, as it should last years. She supported me and my partner, and, almost four years on, she is still there to talk to about it when I need to. Many people think I have three children but she knows I have four.