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By Katie Hickey
My labour with my first baby, in 2016, was long and didn’t have that slow build you get told about in your antenatal classes! As soon as my contractions started they were intense and coming every few minutes. I was vomiting a lot and this made me feel very tired as I couldn’t keep down any food or water. I had planned to have a home birth and when the midwife arrived, despite 12 hours of intense labour my cervix was about 1cm dilated. After 26 hours at home and being around 4-5cm dilated we finally agreed to be transferred to hospital as the midwife said I wasn’t making any progress.
If I’d known then what I know now I would have given myself more time and not allowed my doubts and fears to take over. This is so hard to do when you’ve not been through labour before and especially when you have a midwife you’ve never met and worse still a midwife who doesn’t seem very supportive of homebirth! The rest of my labour ensued in the predictable, all too common, cascade of intervention. My waters were broken, I was put on a continuous monitor, I had an intravenous drip of synthetic oxytocin to try and make my contractions more frequent and more “effective” and I had an epidural. After many more hours my cervix remained at 5-6cm dilated. The doctors had been mentioning caesarean section for a while but I held off as long as I could. I finally agreed to give birth abdominally in theatre, 36 hours after my labour had started. I felt ready by this point after trying everything the hospital had to offer, I just wanted my baby to be born and really there was no other way at this point.
It was soul destroying to have “failed” at something that felt so important to my identity as a woman. My recovery was long and painful, breastfeeding was difficult and I kept feeling as though I was failing at all aspects of motherhood for a long time. I wanted to blame my midwife for being so cold, for not giving me space and for filling my mind with doubt. I will never forget when the ambulance arrived to take me to hospital, I broke down in tears and said, “I couldn’t do it.” I had already given up which I am sure played a large part in me ending up with a surgical birth. A lot of time and a lot of reflection made me realise that in fact it wasn’t the “fault” of my midwife. I had to accept responsibility for part of my birth story as well. There were multiple factors that led me to an abdominal birth all contributing to that final outcome, the unsupportive midwife was just one of those factors. If only it were as simple as to blame it on one thing but that is very rarely the case.
I’d often dreamt of what my second birth would be like and how things would be different. After my first daughter was born I decided to take a break from my career as a vet and become a doula in the hope I could help other families have a more positive journey into parenthood than I’d had. I also wanted to learn about birth and the maternity system as I knew this would benefit me in my next birth. I supported several VBAC births and spent time learning about what works well and what gives women the best chance of having a successful VBAC. I witnessed first hand the bullying and intimidation tactics laid on by some medical professionals and sadly being confronted by ignorance and fear by many medical staff. I understood just how vulnerable pregnant women are and especially if their first births did not go smoothly there is extra fear and worry that the next birth will go badly or even worse.
I started becoming interested in free birth and I read a lot of birth stories and listened to podcasts discussing free birth. I could see that a lot of women were choosing this path out of fear, fear of the over medicalisation of their birthing process. This seems such a shame that no matter what path many women chose, fear is often the overriding factor in their decision making. I felt quite drawn to the idea of free birth but given my medical background and also witnessing some difficult situations as a doula I felt that choosing a free birth was not the right option for me. I wanted to have peace of mind that there would be a medical professional close at hand if there was to be something wrong especially with my baby.
It then became the most important part of my birth preparation to seek continuity of carer. I know that having continuity from my midwives and continuity from my doula would give me the best chance of having a successful vaginal birth (I know this from experience and it is also backed up by research!). If I knew the team that would be with me during the birth I knew I would not fear unnecessary intervention because we would have the opportunity to build a relationship and discuss my wishes and preferences before the day my baby was born.
My local hospital had recently put together a home birth team of 6 midwives that offered continuity of carer. I had done some research before to see who was in the team and what sort of experience they had. There were a few very experienced midwives in the team and some younger midwives that hadn’t attended a homebirth VBAC. I spoke to the team leader and made a request for my named midwives to be the 2 most experienced midwives in the team. I knew from the research I’d done that they had the most experience of homebirth and a very strong belief in birth being a natural process. They also had the confidence and experience to talk about hospital policy but always give me the final choice in making decisions even if that went against hospital policy.
When I was looking at building my birth team I had considered all my options. I looked into hiring an independent midwife with a doula or without a doula and in the end what felt right for me was sticking with my NHS midwifery team and having a doula as well. It was important that I had a doula that felt comfortable helping me and my husband with advocacy and helping to keep the morale high when things got tough. I decided that the right doula for me was Becky, a very well known retired midwife who spent her career helping women have as normal births as possible, often at home and often when they had pre-existing conditions that may have meant homebirth wasn’t “recommended” by hospital policy. Becky set up the Albany midwifery practice and their outcomes are far better than current NHS homebirth statistics. My midwifery team knew Becky well and had worked with her in the past as well. It was in fact a senior midwife from my hospital that recommended I contact Becky in the first place and how right she was!! Becky was a vital part of my team and with her midwifery background I felt at ease that she would help protect me from being railroaded by medical caregivers during the birth.
Once my team was established I felt a huge weight off my shoulders. I could relax into the pregnancy and feel relaxed going into the birth because my biggest fear was not being allowed to labour in my natural way because my natural way may not “conform” to the hospital policies of labour after a previous caesarean section. It was only with hindsight that I was able to see how crucial this had been to my successful VBAC at home. Without the team I had I know my second labour would have ended the same as my first, in a caesarean birth.
I trusted my birth team, I was able to explain what roles I wanted them to play and my tolerances for medical presence including monitoring my baby’s heart rate and how I felt about having vaginal examinations etc. I knew my team were on my side. We all wanted the same thing which was to keep everything as normal as possible unless there was clear evidence that there was something happening that needed a more medicalised approach.
My labour began on Tuesday afternoon. My doula, Becky, had popped over for a cup of tea and a chat and whist we were sipping tea I was having some very mild contractions whilst bouncing on my birth ball. I tried to shrug them off as Braxton-Hicks but Becky knew it wouldn’t be too long until she heard from me again. Sure enough they started to get more frequent overnight but still mild. I started the TENS machine overnight and tried to get as much rest as possible.
Wednesday morning came around and my contractions ramped up. I was finding it quite challenging to cope and they felt very intense but were still fairly irregular with regards to frequency. Sometimes they came every 2-3 minutes and other times there was a longer gap. We called my mother-in-law to collect our eldest daughter as I felt I just needed to focus on myself and I wasn’t able to give her any attention. I also needed my husband to be with me and do things when I needed rather than having him looking after our toddler.
I had given a lot of thought to having our daughter present at the birth and I had really wanted her there. We talked to her about it nearly every day and I had showed her birth videos and shown her some of the noises I would make when I was in labour so she could be as prepared as possible. We knew she was only 5 minutes down the road with my mother-in-law so she could be brought back quickly if we wanted her to come back. Fred inflated the pool around 10am and Becky came and joined us shortly after that.
Becky suggested that Fred fill the pool as things could go quickly given this was baby number 2. I said I didn’t want to get into the pool “too early” something you hear midwives saying all the time and it was a residual fear I’d carried from my first labour. Becky reminded me I was a very sensible woman and if my contractions slowed down after getting in the pool I could always just get out! Right she was. Getting into the pool didn’t slow down my contractions but I did feel much more comfortable.
My wonderful birth photographer Hannah joined us shortly after Becky and started documenting the birth journey. I moved a bit around the flat from my bedroom where the pool was, to my daughter’s room and the living room.
My contractions stayed intense and I’d been in contact with my midwife Mary early on in the day. She had a day off but she was going to come and see me anyway and my second midwife Sue was on duty as well. It felt like everything was falling into place. My entire birth team was there for me, that was a huge relief.
The plan I had agreed with my midwife was that I wasn’t going to call her to come to be with me until I felt I had started pushing. Again this was due to my fears that if I had midwives there too early it would somehow slow things down or “start the clock” of how long I would be “allowed” to labour. Mary was visiting the Horniman Museum on her day off and that was opposite where I lived. She offered to come and check on me but I knew I wasn’t at the pushing stage. I felt guilty that she may have to travel all the way home and then come out to me later and all this on her day off so I agreed for her to come over earlier than I had originally intended. I liked Mary very much and I trusted her so I had confidence that having her there, even though it was earlier than planned, wouldn’t derail my progress.
Once she arrived and saw how strong my contractions were she called for the second midwife, Sue, to join her. Little did I know in the living room all the birth equipment had been laid out ready on the dining table. By this point I had kept myself hidden in the bedroom as I knew privacy and space were crucial to helping my labour progress.
After several hours and contractions starting to space out somewhat Mary offered to do a vaginal exam. By this point I had 3 very experienced home birth midwives in the flat and they had all expected the baby to have been born by now. It was approximately 6pm and I’d been contracting intensely since the morning and mild contractions since the night before. I agreed that a vaginal exam would be useful. I wasn’t completely against vaginal examinations, I think in the right context they are a useful tool but often a tool that’s overused and definitely incorrectly interpreted in a large number of births! During my first labour I had a midwife that caused a lot of pain when she tried to do a vaginal exam at home and I was quite scared of going through that again.
Hannah my birth photographer held my hand as I laid on my bed and Mary carried out the vaginal examination. I trusted Mary and I tried to relax as much as possible but I was clearly stressed and also distressed about lying on my back on my bed. It was all too close to my memories of my first labour. It felt suddenly as if I was going down that same path again….failure…to…progress…
Mary said I was 3cm dilated. I felt like I had wasted their time! Everyone was in my flat waiting for this baby to be born and by the looks of things that wasn’t going to happen anytime soon!! I had tried earlier on in the day to do a VE myself and to try and assess my cervix myself but I couldn’t reach it and now that made sense. It was too far back for me to reach myself especially with my pregnant bump in the way.
In the moment I tried really hard to remain positive. I said everyone needed to go home and luckily because I was less than 4cm dilated the midwives were able to leave without breaking their protocols. In midwifery definition I wasn’t “in labour” yet!! It bloody felt like it though!!
Becky and Hannah stayed for a little longer than the midwives and Becky finally went home to bed around 9pm. The plan was for everyone to “pace themselves and get some rest.” This sounded all well and good for everyone except me! How exactly was I to pace myself and get some rest? Not very easy when you’re contracting and having a major crisis of confidence. Around 11pm I called Mary, my midwife. I said that maybe I should just cut my losses and go to hospital now. I could get some pethidine and have a sleep (like everyone else!) or maybe I needed an epidural in order to rest. I just didn’t want to repeat the story of my first birth and labour for days and then end in an emergency c-section.
Mary was very calm and she said if I wanted to go to hospital I definitely could do that but in the meantime had I tried practicing my hypnobirthing? When she asked that I could have thrown the phone against the wall. Hypnobirthing? What good was that going to do?? Honestly! As if it was a magic cure that would help me cope as much as hard drugs? I don’t think so! But you know what? She was right. I hadn’t even tried using hypnobirthing techniques. I hadn’t listened to any of my tracks I had just got stuck into a negative rut, and I’m a hypnobirthing teacher! This just goes to show it’s not always easy to practise what you preach.
I hung up, got out of the birth pool (where I had gone to try and sleep as it was the most comfortable place). I piled all my pillows onto my bed against the headboard and knelt over the pillows with my headphones in listening to my VBAC hypnobirthing tracks. I did that all night until the morning and Mary was right. It helped massively. Mary had managed very tactfully to talk me off the ledge. She knew me, she’d spent time with me throughout my pregnancy and she knew how much this VBAC meant to me. If I had called just any midwife who didn’t know me do you think I’d have been given the same advice? I very much doubt it.
It was now Thursday morning. My contractions were very spaced out. Sometimes 15-20 mins between each one. This enabled me to eat and get some sleep. Fred and I were alone, he was trying to get me to eat as much as I could stomach, which was a couple of biscuits and sweet tea, bananas or some toast here and there. It was important to try and eat and to stay hydrated. I drank a lot of water, sugary tea and sports drinks. It was a beautiful sunny day. We went for a walk in the woods behind our flat. I practised my spinning babies (https://spinningbabies.com/) exercises. Did as much of the miles circuit (http://www.milescircuit.com/) as I could bear and we had sex twice. I can’t say any of it was very enjoyable but I certainly wasn’t going to give up without having tried everything I knew of!
I was in contact with Mary throughout the day and she was checking in on the phone about my baby's movements. She offered to come and listen to baby’s heart in the afternoon but I said I could feel baby moving loads and there was no point coming back until things were really progressing. I really felt like the baby was trying to move into a different position to help birth more easily. I had tried again to asses my cervix myself and by Thursday afternoon I could feel the baby’s head quite easily so that was encouraging that my cervix had ripened enough to move forwards and everything felt a lot lower.
We called my mother in law and asked her to bring our daughter back. She’d been gone for 2 whole days now and that felt like too much. I wanted her back. As soon as she got home my contractions ramped up. I had 2-3 hours of what felt like constant contractions. I let Becky and Mary know but then the contractions became very spaced out again after that time passed!
It was now bedtime on Thursday night. Fred went to bed and I got into the birth pool (we had emptied it cleaned and refilled it by this point). I started sleeping in the birth pool and was being woken up with each contraction which suddenly felt more painful than before. I woke Fred up and told him to call Becky (my doula) to come back. I had no idea where I was at in terms of progress but I felt that I didn’t want to be doing it on my own anymore. I wanted my doula back to hold my hand. Becky came straight over and as soon as she arrived I started to feel the contractions were different and I felt some pressure in my vagina. Becky watched me for 2 more contractions and we knew then that things were really happening. Fred called the midwives and said I was pushing and to hurry.
The pushing felt great. Everyone had told me that it felt like doing an enormous poo but honestly it didn’t feel like that. It just felt like pressure in my vagina. I could feel the head and I could feel progress AT LAST. I had complete clarity. I felt strong and I felt confident. If Becky hadn’t been there with me I’m not sure I would have been so calm, she really helped me. She told me to take things very slowly, not to rush and to just breathe and blow.
The head was visible after only a couple of pushes and we called the midwives back to let them know. Sadly Mary wasn’t working that night but I knew the midwife on her way and I knew she was lovely as well. The midwives knew they weren’t going to reach me in time for the birth so we called 999. I had agreed with Fred in advance of the birth that if we were ever in a situation where the baby was going to be born before the midwives arrived we would call an ambulance. I wanted that reassurance that if either of us got into difficulty we would be able to go to hospital as soon as possible. The paramedics arrived within seconds it felt like. They were extremely respectful and waited outside my bedroom until my baby, Eden, was born. Once Eden’s head was visible Becky came round and whispered into my ear, “You aren’t going to have another caesarean” We had discussed during my pregnancy her saying that to me when the time came and she remembered. It was amazing.
Having Becky as my doula was just perfect. Given her experience as a midwife she was able to keep me calm through the pushing stage and she was also able to speak openly to the paramedics who had never seen a baby born into water. Eden slipped out easily and was born in her sac! Fred caught her and with Becky’s help he passed her between my legs and into my arms. Becky had to help get her out of the sac, she was so slippery I couldn’t grab hold of her straight away but as soon as I had her in my hands I sat back and put her onto my chest. She was so pink and so soft. She was completely calm and I was in complete ecstasy. I felt a huge rush of love and overwhelming gratitude to have been at home, in our birth pool to give birth to our second daughter. Everything in that moment felt completely perfect. It was the birth I had dreamt about.
The midwives arrived not long after Eden was born. I just held her and soaked up what had just happened. The midwife asked if I wanted to get out of the pool to deliver the placenta and I declined. I didn’t want to go anywhere. About 45 mins after birthing Eden I felt some contractions again and gave a push and the placenta slid out easily. We cut the cord about an hour after Eden was born and we got out of the water.
I couldn’t believe I had done it. I DID IT. Never in my all my birth preparation had I thought my fears and doubts would be so strong during my labour. I was ready to give up on more than one occasion. I know that without the incredible team around me I wouldn’t have had the beautiful outcome I did. Also I know if I had gone to hospital there is close to zero chance I would have given birth vaginally. I broke all the “rules”: I laboured for a long time, I didn’t have continuous monitoring and I gave birth unmedicated in a birth pool all after a previous caesarean birth.
I can never thank the Lewisham Poppie Team enough for the continuity of carer they allowed me. Thanks to that continuity my midwife, Mary, was able to connect with me and care for me in a way I didn’t have in my first pregnancy and birth. The combination of continuity from my midwives and my doula Becky undoubtedly resulted in the birth I wanted.
I hope this story gives confidence and some guidance to all women planning to birth their babies. Seek continuity, ask for it, demand it. You won’t regret it and it is likely to impact your pregnancy and birth in many ways.
Photo and video credit to Hannah Palamara (hannahpalamara.com)
AIMS supports all maternity service users to navigate the system as it exists, and campaigns for a system which truly meets the needs of all.
The AIMS Journal spearheads discussions about change and development in the maternity services. From the beginning of 2018, the journal has been published online and is freely available to anyone with an interest in pregnancy and birth issues. Membership of AIMS continues to support and fund our ability to create the online journal, as well as supporting our other work, including campaigning and our Helpline. To contact the editors, please email: firstname.lastname@example.org
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