Reclaiming birth after caesarean

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AIMS Journal, 2020, Vol 32, No 1

By Debbie Chippington Derrick

In this 60^th year of AIMS it seems fitting to reflect that when the organisation was founded in 1960, caesarean section rates were about 3%¹, and for the vast majority of those women these surgical births would have been real lifesavers for mothers and babies. At the time vaginal birth with the next baby was actually quite usual in the UK, even though this was not the case in other countries such as the USA. In the US, repeat caesareans were being recommended for many women, and the medical profession were deeming a labour following a caesarean a ‘trial of labour’.

As the caesarean rates rose, reaching around 10% in the UK in the mid-1980s, more and more women were having caesareans that they felt were avoidable. Women started to share their experiences of birth after caesarean and the term VBAC (Vaginal Birth after Caesarean) came into existence, challenging the term ‘trial of labour’.

There were several critical books published during the 1980s which provided VBAC information and challenged the concept that birth after a caesarean had to be a medically managed birth. These books also put the risk of uterine rupture into perspective. The first of these to have an impact were ‘Silent Knife’ by Nancy Wainer Cohen and Lois J Estner (1983) and ‘The Vaginal Birth After Cesarean (VBAC) Experience’ by Lynn Baptisti Richard and contributors (1987). The publication of these books coincided with my own need to understand what had happened to me. I was lucky to be able to network with other women struggling with the same issues. We questioned what we were being told and discussed what this meant for us.

AIMS was key in enabling an understanding of women’s rights during birth after caesarean in the UK, enabling informed decision making for a group who were being led to believe they had no alternative but to submit to the will of doctors for the births of their subsequent babies.

In the AIMS Journal in 1990 there was a series of five stories about VBAC and Caesarean Birth², which included Gina Lowdon’s account “I have a baby, but I’ve never given birth....”. It was articles of this sort about caesarean birth and VBAC that were helping other women to question what they were being told by their doctors and midwives. Gina went on to have a home birth after caesarean birth (HBAC) with her second baby. The birth of my third son, a HBA3C featured in the AIMS Journal in 1996³, a birth which would not have happened without the support of others which gradually led me to the realisation that I could not successfully labour and birth my baby outside the privacy of my own home.

Without the support of AIMS many women would not have had the information they needed to be able to stand their ground and to reclaim control over their bodies and their births. Support at that time was found in books, articles, at conferences, local support meetings and by phone. With the advent of email and websites that information and support was able to reach much further and AIMS has continued to be important in providing critical information and support about the rights to make informed decision about VBAC and HBAC through our books, website and Journal, as well as through our helpline.

This Journal provides an update on how women who have had a previous caesarean are faring within the maternity service in 2020. It seems clear that 30 years on the struggle still continues.

References:

1. The rising caesarean section rate: A loss of obstetric skill? Journal of Obstetrics and Gynaecology, ISSN: 0144-3615 (Print) 1364-6893 (Online) Journal homepage: https://www.tandfonline.com/doi/pdf/10.1080/01443610701337916

2. AIMS Journal Vol. 2, No. 2 — Caesareans ...Something must be wrong https://www.aims.org.uk/journal/index/2/2

3. Perseverence Pays, AIMS Journal Vol. 8, No. 1 www.aims.org.uk/journal/item/perseverance-pays