Birthing Journeys: Positive birth after trauma

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AIMS Journal, 2019, Vol 30, No 4

By Hannah Palamara

My journey to achieving my positive birth, a vaginal birth after two caesareans (VBA2C) was just as important as the birth itself. It was not an easy road but I am so glad that I believed in myself, and my ability to give birth.

It began seven years ago when I gave birth to my first daughter. I was 22 and had no idea that birth could be complicated…complicated by medical professionals. I just thought that I would go into labour, go to the hospital and give birth. I knew that I wanted a natural, drug free birth and that I wanted to use the pool. At 39+6, a Sunday, I woke up with strong period type pains and my contractions started a few hours later. They were every 15 minutes and pretty strong. I tried to carry on as normal, taking walks, having lunch with my family as it was mother’s day, and getting reflexology to help things along. I went into hospital the next day as I had been up all night contracting and was exhausted. I was found to be 2cm and fully effaced but still in early labour so they sent me home with something to help me sleep. That night I slept and my contractions died off. The next morning they came back with a vengeance and by the afternoon they were very strong and getting closer together so I went back to hospital. I was very pleased to be 4cm and fully effaced and my labour progressed quite quickly from this point.

After about 4 hours I was 8cm and the midwife suggested breaking my waters. I had been using the pool and gas and air and everything was progressing very normally. I agreed, as I didn’t realize I had a choice. I thought that was what was meant to happen if they were advising it. Looking back there was no reason to break my waters. Not long after they were broken I went into transition and then the baby’s heart went down but then recovered. Then it went down again and stayed down. I was literally thrown on a bed and run to theatre screaming my head off. I was given a GA and a crash section. My baby was fine and she breastfed well straight after delivery. I was traumatised by the birth and I suffered with PTSD and depression in the months afterwards. No one offered me counseling or talked through the birth with me. I was offered anti-depressants, which I declined. The doctor at the hospital muttered something about CPD (cephalopelvic disproportion – where the baby can’t fit through the woman’s pelvis) and baby not fitting so I started believing that my baby had got stuck and I could not fit her through my pelvis and that she had nearly died so thank goodness I had a caesarean. She was 7lbs and had never descended into my pelvis so a brash diagnosis of CPD was just an excuse and a label. Unfortunately I believed this and carried it with me. In the years to follow I would always look back on the birth and feel traumatized and frightened by the experience. I had flash backs and the trauma stayed with me for a very long time, affecting me in my new role as a mother. I was disappointed and felt that my body was a failure and somehow flawed. I felt that I would never give birth naturally and I so longed for that experience. I felt a strong primal need to birth a baby as though I wouldn’t feel like a whole woman if I didn’t experience it.

When I became pregnant with my second daughter 3 years later, I was determined to try again. I didn’t even care if it was dangerous for me, as my parents told me it would be, I wanted a vaginal birth. At the hospital I was referred to the clinic for women wanting a vaginal birth after a caesarean (VBAC) and was very happy to be told that I could try for a VBAC. I was told I would need constant monitoring, regular vaginal exams, etc and I agreed, as I knew nothing about VBAC or about interventions during labour. Again I blindly handed myself over to the medical professionals thinking that they would take care of me.

During my pregnancy I followed a holistic birthing program to prepare my body and mind for a natural birth. I ate healthily, I exercised, I did yoga and listened to a hypno birthing CD. I also read positive birth stories. I didn’t research VBAC or natural birth in much detail and just assumed that whatever they told me at the hospital was what was best for me.

Most importantly I did not deal with the fear and trauma I still carried from my first birth. When they offered me sweeps from 39 weeks I agreed excitedly thinking it would bring my baby sooner but not knowing anything about the risks of sweeps, especially when having a VBAC. At 40 weeks the midwife told me my vaginal arch was very narrow and she could barely reach my cervix. She also said she didn’t think I had much chance of a successful vaginal birth.

This was a midwife working on the VBAC clinic in the hospital. I wasn’t fully aware of it but the fear set in at that point. What if she was right and the baby couldn’t fit through? I felt like a failure again like there was some abnormality with my body. That night my husband and I had a huge screaming row. I was so terrified that instead of voicing my fears to him I lashed out instead.

As the days passed by I grew more miserable and more fearful I had never expected to go ‘overdue’ as my first had been on time. I had a total of about 4 sweeps from 39-41 weeks. At the final sweep at 41+1 she was able to do a proper sweep as my cervix had opened and come forward a little. The next day I had some strong period pains just like with my first baby and got very excited that things were happening but no contractions followed so I felt disappointed. I ate a huge lunch and decided to take a nap. As I went to the bathroom afterwards my waters went with a pop. I excitedly ran and told my husband. The contractions started about 5 minutes later and were extremely strong. They were coming every 5 minutes so I called the hospital and they advised me to come straight in as I was a VBAC so we rushed to get ready. By the time we left they were every 2 minutes and I was so frightened as I thought the baby was coming right then.

At the hospital I felt completely out of control and out of my body. I was terrified that the same thing would happen as my last birth and could not settle myself into the contractions. I was examined and was 2cm, which really disappointed me. I had no idea that I could go from 2-10cm in a short time and thought I would be two days again with these much stronger contractions. Before my mother and my doula arrived I asked for an epidural, which of course they gladly gave me.

Fast-forward 18 hours and I had got to 9cm again with no help or drugs to speed up the process. The baby was not in a great position for birth. As I had an epidural I couldn’t move or stand to help the baby to move down and I stayed at 9cm for four hours at which point the doctors started talking about a section. They told me it was the best thing for the baby and me as we were both tired. My baby was fine, there were no signs of distress and I am pretty sure that had I turned off my epidural or just waited a little longer I would have birthed that baby vaginally. I consented and had a better experience with the caesarean than my first. I was awake and it was calm. My baby crawled up to my breast as I was wheeled in to recovery and started feeding all by herself.

Afterwards the doctor came and spoke to me and told me I should not try again for a vaginal birth as my pelvis was just too small and she didn’t advise it. Again I was happy to have a healthy baby and a safe birth but I felt like a failure and told myself I just couldn’t birth a baby naturally.

Almost 3 years later we were surprised to discover that we were pregnant again. I was still recovering from having meningitis one year previously, which had left me with some health problems, and I had just started an Open University course and was pursuing a career in photography. After the initial shock started to wear off I was excited but afraid to have a third baby. I was still struggling at times with my two girls due to my health; I had chronic fatigue and some days it was hard to get out of bed. I was referred to a consultant due to my health conditions and two previous caesareans. I didn’t realize I could decline consultant led care at the time, which is what I would have done.

At first I thought I had to have a repeat caesarean due to my history and I told my husband that is what I would probably do but a voice in my head kept nagging me and I knew I wanted to try again. I was afraid that I wouldn’t be ‘allowed’. At an early 8 week scan with a private consultant my husband voiced my desire for a VBAC and this consultant who I had never met before, who had not seen any of my notes and didn’t know my history told me and my husband there was a good chance that the baby and I would die if I attempted a VBAC due to the risk of rupture. He also lied to us about the percentage of uterine ruptures. Driving home I was absolutely furious and my husband was obviously terrified and thus began my battle to get my VBA2C.

This time things were different. I started trawling the Internet for information on VBAC especially after 2 or more caesareans. I joined groups. I asked questions, I read books and I did research every day. I educated myself and tried to educate my husband. I sent him lots of links and tried to get him to read positive birth stories. It took him a long time to come around to the idea of me even attempting to VBAC as he thought it was safer to have a repeat caesarean. I gently tried to explain that for me, the risks of a third caesarean outweighed the risks of a VBAC and the very tiny percentage of a possible rupture.

There were many fights and many tears on my part. I so desperately wanted things to be different this time but he was afraid and traumatized by my previous birth. The more I researched the more I became positive I could do this, or at least try. I read that having an independent midwife, even if I was birthing in hospital, would really give me extra support so I found one that my husband and I were both comfortable with. This was a turning point for me. As soon as I met Laura I immediately felt like I could trust her. She had a very gentle nature but also really knew her stuff and she totally believed in me from day one. My appointments always lasted a minimum of two hours. Laura was never in a hurry to leave and we spent hours talking about any concerns I had and going over my previous births. The more we spoke, the more I realized that I could do this! When I met my second midwife, Kemi, we spent the afternoon discussing birth and laughing together, the three of us, and I remember looking around the room just knowing that these were the right women to help me have my birth. I felt excited for the first time. I had found my tribe.

By this time I was 32 weeks and had not seen my consultant yet at the hospital. I had seen a registrar at 20 weeks who at first had been open to me having a VBA2C but after a brief 5 minute chat with the consultant had told me they didn’t advise I try to VBAC and would recommend a repeat caesarean section. I was disappointed but not ready to give up.

At my next appointment I insisted on seeing the consultant and I was prepared. She met me with her supervisor of midwifery and she was not friendly. She told me she knew that I was hoping to have a VBA2C but that she didn’t recommend it as they didn’t have research to support whether VBAC after 2 or more caesareans was safe.

I told her that I had researched and read many stories of women having a successful vaginal birth after 2, 3, 4 and even 5 caesareans she laughed and said what did I expect my chances were for a vaginal birth? I said 75%. She laughed again and said that it was much lower than that. I told her I would be having a VBAC either at home or at the hospital. We went back and forth. She told me I would need continuous fetal monitoring, I told her I would decline it. She told me I would need regular vaginal examinations, I told her I wouldn’t consent to them unless there was an indicator that it was necessary for the baby’s well-being. She told me if I was in hospital she couldn’t guarantee which doctor would be on duty and whether they would support me to have a VBAC. So if I came to hospital in labour, the doctor on duty might hassle me and try to force me into another caesarean.

It was so frustrating but I was strong. No one would bully me with fear tactics this time, as I knew the truth. We agreed a letter would be drawn up to be handed out to the midwives on labour ward and to go in my notes, stating that I was aware of the hospital’s policy on VBAC after two or more caesareans and that I would not consent to continuous foetal monitoring, regular vaginal examinations, a time limit on labour, a cannula, etc, should I decide to give birth in hospital.

I left that appointment feeling like crying and filled with doubt. I was so tired. Was I making a mistake? I was trying to be so strong but people kept knocking me down and telling me I ‘couldn’t’ do it. Was this doctor right? After a few days I continued my research, reading positive birth stories and I started to feel confident again, although I was very worried about being in hospital and having to fight for my VBAC whilst in labour. I therefore decided the best place for me to be was at home where I could labour in peace and not feel threatened by unsupportive doctors. It is sad that I had to choose my home because I didn’t feel safe in hospital, but this was how I had been made to feel by the system around me.

At first I told my husband and my parents that I would start my labour at home and then transfer to give birth. My parents, both medical professionals, had been projecting their fear onto me for months and I didn’t need their reaction to me having a homebirth so I kept it quiet. My husband took a while and eventually, as I started preparing for my homebirth, he realised I was planning to do it at home and he basically surrendered. He told me that he realised it didn’t matter where I did it as God had already decided the outcome. As soon as my husband was on board I felt a huge weight was lifted. It didn’t matter to me what anybody else thought but it did matter to me how he felt. Finally he was supportive and excited for this birth. The day he told me he believed I could push this baby out of my vagina I cried with happiness.

My due date came and went, which I had expected, as my last baby had been born at 41+3 but then the exterior abuse began. On a daily basis I had texts, phone calls and comments on the school run about why I hadn’t had that baby yet. I knew that until I was past 42 weeks I wasn’t really ‘overdue’ but no one else seemed to understand that.

At 42 weeks I was finding it really hard and every day was a battle; I had been in prodromal (‘stop-start’) labour for a month and every day the contractions got more painful. I had been losing my mucus plug for the last week, which was exciting, so I clung on to the positive thought of having my VBA2C soon!

My husband started to worry that things could go wrong, after seeking advice from a doctor about going past 42 weeks and he voiced his concerns to me. I had already discussed everything with my midwife and researched the outcomes and felt safe that I was making an informed decision to wait for my baby to come when he was ready. My husband went along with my decision but I know he was worried because he had only been told of the things that could go wrong and was not informed that it is quite common to go past 42 weeks.

That day I sat in my car and cried. I was so close and still people did not believe in me. I went and had a scan to keep my husband and everyone else happy. I knew my baby was fine.

The next day I went into labour and had a beautiful hands off homebirth where I roared my baby into this world in my own home surrounded by people I love.

This journey taught me so much about myself and about other people and their perception of birth. Many people see birth as a scary, risky process that needs to be ‘managed’ by doctors and not felt by women. They look at the ‘pain’ of childbirth as a negative instead of a positive feeling, when in truth the ‘pain’ enables our bodies and minds to produce the exact cocktail of hormones that help us to birth our babies ourselves. Most women, especially with their first babies, expect to be given care from their health professionals that will help them to achieve a natural birth. Unfortunately, I hear time and time again of women having a traumatic birth experience because they were led to believe by doctors or midwives that interventions such as induction, epidurals, pethidine, artificial rupture of membranes, continuous monitoring and time limits on the process of labour, are routinely necessary. It is usually not until women have their second or third babies that they realize they have a choice in how things happen and start researching and choosing how they want to give birth. Of course there are times when medical intervention is necessary and saves lives and thank goodness we have the doctors and the hospitals for these rare instances. Unfortunately far too often doctors are ‘saving’ babies after a cascade of interventions actually causes foetal distress or some other complication. The system needs to change. Instead of women relying on doctors to safely “deliver” their babies, doctors need to believe in and empower women to birth their babies themselves and only step in when needed.

I believe birth is a normal process, a bodily function as normal as breathing, that when left alone and allowed to happen undisturbed, can be beautiful and uncomplicated.

A birth against the odds

Frankie Jack born Sunday October 20th 2013 1.02am

Home water birth, Unmedicated Home Water Birth After 2 Caesareans (HWBA2C)

Saturday October 19th I woke up feeling tired. I was 42 weeks and 2 days pregnant and every day I wondered when this little boy was going to be born. I had been having pre-labour for over a month, every day the contractions getting stronger. My midwife came and checked on me that morning and we decided to do a gentle sweep. I had not wanted to have one prior to this as I was afraid that she might accidentally break my waters but I was getting so impatient and feeling under immense pressure from the outside world to have this baby now that I had exceeded 42 weeks. I knew that everything was fine with my baby and that he was coming very soon, but the negative comments were starting to wear me down.

I carried on having mild contractions throughout the day, the same as the ones I had been having for weeks. I had been losing my mucus plug for the last week and some more of it came away making me excited that labour would soon begin. My husband, Frankie, and I went into town and had lunch together and did some food shopping. Even though I was exhausted and uncomfortable, it was really nice to have some time alone together without our other 2 children. That evening we had dinner and afterwards decided to make love (even though I really didn’t feel like it!) I was still having mild contractions but we knew that it might just start things off.

It worked! Fifteen minutes afterwards I had my first strong contraction. I walked downstairs and had another it was around 9pm. I said to my husband “I think this is it!” and he smiled excitedly at me. He started bustling around and getting things ready for our homebirth. My contractions were about every 2 minutes lasting about 30 seconds. I texted my midwife, Laura, to tell her that things were happening. I then realised how strong the contractions were getting and called her to tell her. She advised me to call her when things progressed. I took a hot shower and went downstairs to the living room. Frankie was setting up candles and drinks ready.

I had to go to the bathroom and emptied my bowels a lot which was extremely hard whilst having such strong contractions. I then asked my husband to call Aini, our nanny and friend who lives with us. I was a bit afraid of the strength of my contractions and wanted a strong woman there with me. I knelt on the floor in the living room over the mattress we had prepared and Aini massaged my back for me. I called Laura again and all I remember saying was “Come”. I knew things were moving quite quickly and really wanted her there. I was so in the moment I didn’t even think about my sleeping children upstairs or the fear of rupture or anything going wrong I just went into myself automatically.

I was not comfortable on the floor so I stood up and held onto the back of the sofa and every time I got a contraction I swayed my hips in a circle and bent my knees almost like a dance. Aini was rubbing my back and I don’t know how long we were stood there but I suddenly said “I can’t do this” and my husband said “Yes you can” I realize now that this was transition but it appeared so quickly I wasn’t even aware of it. Aini then said to me “Are you pushing?” and I snapped “No” but actually I was! My body had just started pushing all by itself! I think Laura arrived at this point and I asked for a bucket to be placed under me so I could pass urine. I don’t know if I did but with the next contraction and push there was a gush of fluid into the bucket and my waters went. I remember saying to Laura “What do I do? I don’t know what to do?” and she just said, “Follow your body Hannah you are doing it!” Frankie and Laura were quickly trying to fill the pool, which was taking ages and I remember just longing for the relief of getting into the pool as I stood there. I started to roar through the contractions as I pushed and it felt very satisfying to grunt and roar as I pushed. I stripped off down to my bra as I was just so hot!

Finally I was able to get into the pool and I think I must have run and hopped into the pool as fast as my big belly would allow me. The relief of the hot water was instant and felt so good! From here I really went into labour land. I was completely inside myself and I kept my eyes closed almost the entire time. If I wanted a drink I just said “water” and my husband poured it into my mouth and he kept putting cold compresses on my face and neck, which felt amazing. I held onto the two handles of the pool every time I had a contraction and I pushed with everything I had! During this time the second midwife, Kemi, arrived. I didn’t see her but I just heard her quietly in the corner, which made me feel more at ease. I roared like a lioness with every contraction and Laura told me to keep the sounds low, which really helped. Sometimes I would say “I can’t” as a contraction started and I would then change it to “I Can!” and I would repeat this to myself and everyone around me said “Yes you can, Hannah” which really helped me to get through each one.

At one point I was pushing so hard and I shouted out “I am a warrior woman!” it was funny but also it was exactly how I felt. I felt like an amazing warrior woman pushing out this baby with all my strength I felt like I could do anything. The adrenalin was really pumping and my whole body was shaking with the strength of the contractions. With my consent, Laura monitored the baby’s heartbeat frequently and every time it was great which made me feel relieved every time. Frankie stayed in front of me the whole time and he kept saying “I love you so much, I am so proud of you” and I then took hold of his hands and with every contraction I pulled with all my might and he held on. I took my strength from him at this point and I felt his love and strength flow into me through his hands. I started to feel the baby’s head moving down and stretching me out. I pushed so hard and the head started to come out a little then go back inside. I said “It keeps going back in” but Laura reassured me this was supposed to happen so that the head would stretch me open gradually, stopping me from tearing.

I carried on like this for some time and then Laura told me we had been pushing for 2 hours but everything was progressing normally so she was not worried. She said we would review again in half an hour. To be honest this scared me a little and I started pushing with a renewed vigor and seemed to get the hang of pushing and holding the baby’s head in place to stop it going back up again. I changed my position to squatting as I was on my knees and this with the harder pushing really started to bring my baby’s head out. At one point I said “Is the head coming?” and Laura said “Yes feel!” and I did and I felt the head right there! It was amazing and I felt a spark of excitement and I said “I am going to see my baby soon!’ and everyone around me said “Yes you are!” I felt a pop and my water went again, Laura told me there was meconium but it was only grade 2, which was not very thick, and baby seemed fine. She had told me before I went into labour that she would expect some meconium at this stage as most babies open their bowels in utero from 40 weeks. As I pushed out my baby’s head it hurt but I knew if I kept going he would soon be here and I pushed through that pain barrier. Laura recommended me to stop pushing and breathe which was really hard and I squealed a bit with the pain and said I couldn’t. However, Laura and Kemi strongly recommended I did as they could see the strength of my pushing and were afraid I would tear badly so I breathed the head out and I felt it slowly coming out. As his head emerged I went into myself so much that it was as though I could see inside myself and see the head coming out from the inside. I pushed hard and the head came out and I carried on with a scream and as the contraction was still there I pushed again and my baby’s shoulders and body followed in the same contraction! At this moment I seemed to wake up from my labour trance and I heard the midwives saying “reach down and get your baby Hannah” I looked down and all I could see were his little feet and curled up legs and I reached down and picked up my baby and held him against my chest. All I kept saying was “I did it, I did it” and my midwives smiled and said, “Yes you did it!”

I had lost quite a lot of blood so I got out of the pool and lay on a mattress and as soon as I lay down the placenta came on its own without any drugs less than 15 minutes after the birth. I carried on losing blood but it did stop and my uterus started contracting again. I lay and looked at my beautiful son and nursed him for the first time. I was so tired I couldn’t move for the next 4 hours and lay having drinks and snacks. My husband took Frankie and had skin to skin with him giving me a chance to rest. I got up to try to pass urine before my midwife left and as I sat on the toilet I realized that I was bleeding heavily and I started to feel like I was going to pass out. My midwife got to work putting me on oxygen and giving me a shot of syntocinon and we called an ambulance. This was a scary time. I was trying not to pass out and could hear my girls outside the door and was hoping they couldn’t see me. I was stabilized before I left in the ambulance and stayed overnight in hospital due to the volume of blood I lost. I had a few tears stitched up in theatre but my perineum was intact which was amazing. This was a hard part of the experience and my recovery was slower because of my bleed, but I still would not change a thing. I felt so much better than after both my c-sections. Frankie Jack was 8lb12.5oz, a big boy, and his head was tipped to the side, the same as his older sister, which meant I pushed a much wider diameter out – so much for being told my pelvis was “too small” and my vaginal arch “too narrow” to vaginally birth a baby. Labour was 4 hours from start to finish! I am immensely proud of myself.

I will never forget this birth for as long as I live. This was what I have been dreaming about for 7 years. 7 years ago I had my first emergency c-section. This birth has healed me in so many ways and empowered me as a woman and a mother. I know that this has changed me and I will see these changes in many areas of my life as time goes by. It has healed the trauma of 2 emergency c-sections and being told I could ‘never’ birth a baby naturally. It has healed the trauma of being sexually abused throughout my childhood and teenage years. I have taken my innocence back and am a strong, beautiful warrior woman.