Vaginal Birth following Caesarean Section

AIMS Journal, 1990, Vol 2, No 2

After a caesarean for her first baby Yvonne Williams was appalled to discover that a natural vaginal birth after caesarean (VBAC) was unheard of locally.

The Caesarean Support Network decided to investigate the situation nationally by conducting a simple survey Of the VBAC policies at individual hospitals.

After having planned to give birth naturally with my first child and ending up with the most gruesome labour culminating in an emergency caesarean section I vowed to do it differently when and if there was ever to be a next time. After writing down my birth experience I was convinced that what happened to me was iatrogenic, (doctor caused), albeit probably not deliberately. They had taken all the usual precautions. Artificial rupture of the membranes, regular injections of pethidine. When labour had progressed a further seventeen hours a drip was inserted and continuous electronic fetal monitoring was started. I was not allowed to go to the loo in private, instead my husband had to empty my bedpan. I have always valued my privacy but at that time I was being a good girl and doing as I was told, now looking back I don't know why because none of their routine interventions was in any way benefitting me or my baby. Instead I believe due to the lack of privacy in the labour ward I could not relax, and as a result my cervix did not dilate properly which I believe necessitated my emergency section. Or there again, being under a locum consultant did not help matters, a strange man that I had never met before who was extremely rough examining me and spoke very broken English.

On returning home during the convalescing period it was quite obvious that people thought I should be back to normal with varying different lines of thought from various people. Some treated me as if I had just had my appendix out and others thought that a caesarean section is the easiest way in the world to have a baby. You go to sleep one day pregnant and wake up the next, baby delivered, quick, easy and painless. It was thoughtless remarks like these and, "well so what if you did have a rough time you have a healthy baby you?" which sent be into a deep depression. In reality I did not know that I had a healthy baby because I never knew for certain that the baby I was looking after belonged to me.

On reading childbirth books if there was anything relating to caesarean sections it was limited to about two or three pages of fiction not fact. "If you need a caesarean section it will be explained fully to you" … "choice of anaesthesia" … "you may need to stay in hospital little longer than if you had a normal birth and you will feel slightly tender around the site of the operation for a day or so". Quite obviously written by people that have never had and are never likely to need one.

What about the future? I could find no information about this. In a Pregnancy Dictionary it mentioned that after a caesarean section any future labours would be a trial of scar. "Trial of scar", what is this? I started to ask as many people as possible who I thought would know. My Health Visitor and my Doctor at the Family Planning Clinic, did not know for certain what a trial of scar would consist of and the only way for certain that I would find out was to contact the maternity unit and ask them. Incidentally, after a caesarean section, how many women are told before they leave hospital that their next labour will be a trial?

My appointment with the midwife came one Saturday afternoon. I walked into that place with all the uncertainty that I had felt the first time. All the horrible painful memories came flooding back to me, I immediately knew that if I was at home I would react differently in the same way the midwife would react differently. In my home I would be at ease and she would be my guest, whereas in Hospital I was very uneasy where she was very much at ease. I tried to explain my inner feelings to her but it did not matter, for as far as she was concerned everybody was much better off in Hospital, for if anything disastrous happened, then all the necessary life-saving equipment was on tap for all the numerous eventualities that occur during childbirth.

I asked if they had a policy on labour following a caesarean section, and indeed they had. On admission to the labour ward they attach an intravenous drip of sugar and water. I asked why this was. "To prevent dehydration and because we starve you", she said. I asked why and she said "well if you need a general anaesthetic there is a risk that you could inhale your stomach contents". She also mentioned that the fetus would be monitored

continuously. I objected to this saying that restriction of movement would pervert the normal course of labour and machines have a tendency to go wrong. She disagreed with this theory saying that the information received from the monitors was' reliable enough.

Then followed a Short lecture on scar rupture, which just about topped it all. I left the maternity unit so depressed and angry with their system which I knew was wrong. It goes against everything that stands for natural birth. They are obviously in charge and this procedure is for the benefit of all - or is it? I almost immediately contacted our Network leader and told her of their procedure for VBAC - thinking that I must live out in some sort of backwater. She thought it might be an idea to write to various units around the country and ask for their policies on trial of scar.