An impossible dream?

ISSN 0256-5004 (Print)

AIMS Journal, 2008, Vol 20 No 3

Melanie Hughes describes her journey to a home birth after four caesarean sections

After five children, four of whom were born via caesarean section, was it really possible for me to plan a VBAC (vaginal birth after caesarean section)? I researched the world wide web and read as much information regarding VBAC as possible. I must admit, I was slightly confused as the statistics I had been quoted by the consultant were very different from the ones I was now reading. The fact I had given birth vaginally with my first was an added bonus in my favour surely, but a VBA4C? I knew I was up against it from the start and would need to plan carefully to ensure I would at least have a fighting chance.

I looked at all my previous pregnancies, my first pregnancy was induced at 41 weeks. I was deemed ‘post dates’ (this was in 1994) and due around Christmas and New Year. I’m sure this swayed the decision to bring me in for induction of Labour (IOL). I was admitted to the hospital to begin the induction process. It took 3 doses of prostaglandin gel to get my cervix soft enough, but I didn't start dilating till 16 hrs later. My waters broke spontaneously and I went on to progress quickly, however I was aware I was being clock watched. If I hadn’t had such a strong determined midwife who continually stopped the doctor from coming in and trying to speed things up, I’m positive I would have had an instrumental delivery of some sort or probably a caesarean section. After only half an hour of pushing my son was born and although sore I went home the next day (Christmas Day) with my new baby, all 7lb 11oz of him.

My husband and I decided to try for another in 1996 and were delighted to find our baby would be due in February. Unfortunately at 12 weeks pregnant I had a bleed and after a scan I was told I had separation of membranes and would lose the baby. This diagnosis later changed to 'vanishing twin syndrome' as there were two amniotic sacs but only one baby. I was told there was still a chance I could lose this baby too. All went well though, until I reached 38 weeks when I had small bleed again. It was decided by the consultant, who did no other tests, to presume it was coming from the placenta. I was advised to have this pregnancy induced at 38 weeks. Needless to say induction failed, cervix hard and not at all ripe, waters were forcibly broken, baby went straight into distress, emergency caesarean section (recorded as due to failure to progress) baby born with APGARs 9 and 10 and weighing 7lb 10oz. Who said caesarean sections were an easier option? I felt like I had been in a car crash. It took me three months to feel 'normal' again.

The original bleed turned out to be nothing more than cervical erosion…..

Baby number three was a complete surprise in the year 2000, but news of VBAC being a viable option made me smile, there was no way I wanted a repeat performance of last time. I was told I had to VBAC in hospital and would have to follow certain rules and be given a set amount of time to deliver due to the extremely high risk of uterine rupture following a previous caesarean. I got to 41 weeks and once again post dates was mentioned. I was yet again told I needed to be induced, but as a VBAC I would only be allowed one dose of prostaglandin gel (I now know VBAC should not be induced due to the higher risk of rupture from the gel.) I had one lot of gel and was told to lie flat on the bed, within a few hours I started having contractions. A monitor was strapped to my stomach and I was left alone. I saw a series of midwives come in, sit down, look at the monitor and disappear again. Once they were able to break my waters they did it to speed things up. I was hooked up to oxytocin to hurry things along. I was not allowed up off the bed but surprisingly got to 8cms dilated. I was told the baby’s head was still high, not surprising as they wouldn't even let me sit up. An hour later I was told I had been given long enough, I was allowed no more time. The medical staff told me everyone was waiting for me in theatre and they could not wait any longer. I had no choice, I had to have another caesarean section. At 8cms dilated I had been so close and yet so far, son number three, 7lbs 4oz, born via caesarean section. Reason given 'failure to progress.'

2002, pregnant again, maybe another boy we both laughed. The pregnancy progressed well, however, we were told VBAC was not an option and a scheduled caesarean was the only safe option. We were informed of the risks of VBAC but we were not told of the risks linked to multiple caesareans. Apparently you read this when you sign the consent form. The caesarean was planned for 40 weeks, to avoid me going into labour naturally as it was ‘too dangerous.’ I was nervous the morning I went in, but decided to have an epidural. I wanted to be awake and was assured all would go well. However once my fourth son was removed I started to haemorrhage. My uterus began to contract back down and as it did it began sticking to my bowel and bladder, the next thing I knew they were sending me off to sleep.

I woke up to my husband holding our newborn son and telling me how he had been ushered out of the theatre and left alone in the corridor while they tried to control the situation. I knew I had lost a lot of blood (borderline for a transfusion) as I kept falling asleep for days later. The consultant who performed the operation did return to tell me under no circumstances was I to have any more children and that I should be sterilised. Baby number four was a boy, 6lb 9oz, classed as small for dates.

2006 and a complete shock, I was pregnant. I didn't know what to do. Mark, my husband, was worried. I had been reading up again, every pregnancy was different and although I had problems during the caesarean section, it had been four years ago and I had been fine since, no problems with my periods or pain after. I mentioned VBAC but hubby thought it wouldn't be possible, so I spent weeks researching everything I could find on VBAC and VBAC after more than one caesarean. I begged him to read the data and finally, when he did, he came to the same conclusion, VBAC was a safe option and I had more chance of being attended by a bogus doctor or having a cord prolapse than I did of a uterine rupture. However, a hospital clock watching VBAC was not for me. I had been there and tried that. I decided the only option would be for me to book a home birth. I went to book for a home birth with my midwife at the doctor’s clinic, unfortunately she would hear none of it and seemed more intent on telling me off for getting pregnant in the first place.

To qualify for a home birth she said I had to fit the criteria. From the list she asked me to fill in I would be surprised if anyone ever did fit it.

First baby: no
Had more than 3 children: no
Over the age of 35: no
Overweight: no
Diabetic: no
VBAC: no
the list went on and on.

I attended the hospital to see a consultant obstetrician, again I was told, ‘No’ to the home birth. However, I was now being told that I could have six caesareans if I wanted to, and that the consultant himself had done a 6th caesarean on a lady earlier that week. I thought to myself how things change, years ago I had heard you were only allowed three sections and then had to be sterilised, now they were saying there was no limit to the number of caesareans I could have. I asked why I couldn't try for a VBAC3C and was told the risk was too high. When I asked for the statistics the consultant admitted he had none as he ‘didn't allow’ women to VBAC after more than one caesarean.

I continued with my plans for a home birth and asked for midwifery care only. I met with the SOM and she explained to me the risks of VBAC and also the risks of caesarean and I made my own informed choice to continue with my plans for home birth within the NHS.

At 41 weeks and still no baby yet again, the pressure began. My midwife, who was supporting me, was getting pressure for me to see a consultant as I was regarded yet again as post dates. The consultant I was told to see was apparently VBAC friendly, so there was no need for me to worry. After 15 minutes in his office, both hubby and I walked out, tears streaming down my face, after being shouted at by the consultant for being selfish and putting my own silly ideas before the life of my child. I wanted to be left to go into labour naturally but the scan had dated me due four days earlier than I actually was. I agreed to additional monitoring and on my first visit to be monitored, the machine concluded I had a pathological trace and the midwives told me that if I went home they could not guarantee a 'live' baby. Faced with this information and not knowing or understanding what exactly was being said, the only thing I could do was make a decision on the information I was given at the time. I accepted the caesarean, much to the doctor’s surprise, without a fight. I think he had formed the opinion that I was a woman who would risk all for the sake of a natural birth, even my baby’s life. He soon realised that I wasn't this 'earth' mother determined to VBAC at all costs. The caesarean section went ahead.

Baby boy number five was born, 7lb 5oz, dated by them to be at 42 weeks but by my dates just over 41, APGAR scores 9 and 10. The doctor who performed the surgery was really nice to me throughout. He came and saw me on the ward later that night and the next day. I told him I planned to have more children and he smiled at me and said he had all fingers crossed that I would VBAC.

I gave him all the information I had got through the internet and through books and studies done worldwide and I hoped that even though it hadn't made a VBAC for me possible this time, that he would read it and make it possible for someone else in the future. At least if one women benefited it would have been worthwhile.

My VBA4C home birth

In 2007 we decided to try again. This time it was more difficult for me to conceive due to the fact that I was still breast feeding. I used online fertility charting to chart my cycle and for the first time ever I began to see a pattern which was every 32 days and not every 28 days. I always knew my menstrual cycle was longer than most, but to see this pattern via a chart and know I ovulated between day 18 and day 20 made me realise that perhaps I cooked my babies longer than most. I had a reason why I did not go into labour before 41 weeks. Armed with this additional info and the knowledge that to go into labour naturally was the best option for a successful VBAC at a time my baby would be ready meant no inductions.

I again booked a home birth via the Head of Midwifery (HOM) at my local hospital. In the short time since my last pregnancy I had already noticed a real improvement in the opinion of VBAC. The government was encouraging more home bir ths, the HOM was very pro VBAC and her midwives were desperately trying to cut down the increasing caesarean rate. Their aim was to reduce the number of instrumental births and to try and stop the first caesarean being done. Normal pregnancy was now being defined as 37 - 42 weeks and because of this the number of inductions was going down and the caesarean rate was getting lower.

My pregnancy progressed well and as my due date approached I felt confident and had many positive dreams of birthing my baby. Some of these dreams were so surreal. In one of them I had just given bir th vaginally and everyone was congratulating me and saying ‘well done’. However, in this dream I kept seeing me going to the mirror and checking my scar to see if I had really just given birth.

41 weeks approached fast and this was now my nemesis. I had never been allowed to go past 41 weeks in previous pregnancies. What if I didn't go into labour naturally? What if my body didn't know how to do it? I really struggled during this time, but luckily at the beginning of this pregnancy I had become friends with Mandy, a fellow VBAC herself, and asked her if she would support me as my doula, she agreed. I phoned and emailed her during this difficult time, she came to visit me and helped me relax, advised me to listen to my VBAC hypno-birthing CD’s and to remember the reasons why I was taking this particular route. I was never afraid of the giving birth but I needed people around me who were positive. I needed to enjoy this extra time.

During weeks 38 to 41 I niggled on and off, sometimes waking with pain and wondering if this was it, only for it to stop and fizzle out. At 41 weeks plus 6 my blood pressure became raised and my ankles swelled. I contacted my community midwife who advised I should be checked at hospital. I discussed this with Mandy and agreed to be checked. Mandy came over to support me for this trip to hospital. Bloods were taken and my baby was monitored. All was well, bloods were fine and baby was active. My midwife agreed to me having a sweep to see if it would encourage anything, but in all honesty I wasn't expecting it to. I had had sweeps before and nothing happened but I was only 41 weeks when I had them before. Maybe being a few days over this would prove to be more successful this time.

42 weeks plus 1, I was standing talking to a friend on my doorstep. I said goodbye and as I shut the door I got a sudden strong tightening. It stopped me in my tracks. I got up the stairs and sat on the toilet, another came, really strong, so strong I couldn't get up for at least 5 minutes due to the shock. I ran a bath, convinced it was nothing and that if it was anything a bath would not stop it. The bath stopped it ... so I went to bed disheartened again.

4.00am, dog barking, or did the pain wake me up? I got up and made it to the toilet before another came along ...wow this hurt. Still not convinced, I struggled downstairs and informed hubby it was nothing to worry about, I was going down to play mahjong on the computer. I had lied, I intended to use contraction master (an online contraction timing device) to time these pains to see if they were the real thing or not. I really was confused, I thought labour started with contractions spaced out, but mine appeared to be every two minutes lasting 45 seconds, sometimes a minute. These pains took my breath away and it took me till 7.30am to finally be convinced enough to wake hubby up. By this time I was really having to focus. Still convinced this wasn't normal, I scanned the internet for info on contractions and when to call the midwife. I phoned Mandy and I think she must have realised it was the real thing as I listened to her telling hubby she was on her way.

Mandy arrived and helped me get through these contractions, while Mark phoned for the midwife. Ted, my midwife, arrived just after 9.00am, completely relaxed. I asked her to check me, which she did, 2 - 3 cms dilated 70% effaced. ‘Is that all?’ I replied, deflated. I began to think maybe I had called too soon and the clock watching would begin. Ted assured me she didn't clock watch and as long as baby was happy then she had all the time in the world. I couldn't believe the contractions were coming so fast and fierce, I was only this far forward but baby was fine and happy and coping with the contractions.

Mark, my hubby, helped me focus and for a few hours I relied on him and my tens machine to cope with contractions but as I increased the tens machine I found it was having a less and less effect. Ted and Mandy advised me to get in the bath, something I didn't really want to do. I was worried that if I got in the bath the contractions would stop. They assured me they wouldn't and Ted added a few drops of lavender to the water to relax and me and clary sage to keep me ticking over, just after 12.30pm I got in the bath.

I was in the bath for two and half hours and the time flew by. Every time I got a contraction Mandy or Ted would pour the hot water over my belly, this helped loads and dissipated the pain. I had seen this done before on a home birth programme on television and thought I would find it annoying, in fact it was completely the opposite.

At 3.00pm I got out the bath and asked Ted to check how I was progressing. She never put any pressure on me to be checked but I wanted to know myself how things were going. On examination I was found to be 5-6cms, waters bulging. During this check my waters went as Ted withdrew and immediately I twanged to 8cms.

I then needed additional pain relief and welcomed the gas and air. Shortly after however I noticed an overwhelming feeling of wanting to bear-down when the contraction ended. I continued to make these pushy noises and Ted checked to see if all was OK. I had a small anterior lip which was preventing the baby coming down and once I had another contraction Ted was able easily to push it back and the baby’s head came down. Now my pushing was becoming more effective. By this time a second midwife had arrived to assist Ted and had brought more gas and air.

After only fifteen minutes of pushing I felt my baby's head crown and within seconds he was born. Wow. I couldn't believe it. I had finally done it. I looked down at him in amazement, I was crying, hubby was crying, two of my children slept through it, the other three were totally amazed and happy at seeing their new brother born. Mandy and Ted were congratulating us both, I picked him up and cuddled him, he seemed so big and everyone was surprised when he weighed in at 9lb. I even got to have an uneventful physiological third stage and in the words of my midwife a 'perfect textbook birth'.

We all went to bed early that night and it was the perfect end to a perfect day. As I walked past my bedroom mirror, I stopped and raised my T-shirt and looked at my scar. There it was, just a faint silvery line that appeared to smile at me, for the first time ever I smiled back. Instead of negative feelings when I looked at it, I now had positive ones for it now it reminded me that I had given birth vaginally, naturally and finally!

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