Birthrites: Healing After Caesarean.

The Birth Story of Isaac Alan - my third child.
Bridget Blackwell.

I feel an urgency to write this down before it gets lost in the mists of fatigue and the busyness of life with three children under five. My mother-in-law is still with us for another three days and Graham, my husband, is off work so I will take the time out to retreat to the computer and type away.

Isaac is now eleven days old and I feel a sense of relief and peace that he is finally with us. The pregnancy was a long one - really long and although it didn't start off as such it turned into a quest to achieve a vaginal birth - just a normal delivery like women have been doing for thousands of years. Despite two caesareans I just couldn't understand or accept why my body was not able to birth a baby the natural way. I was just average height, weight and I had had no complicating features to my pregnancy.

I'll start with the easy bit - the labour which from start to finish was only 8 hours and 10 minutes - unlike the pregnancy which was approximately 6264 hours (but who's counting?). The baby was already six days overdue and my spirits were low as with every passing day I felt my chances of a successful VBAC were diminishing. I knew the baby would be getting bigger and my options for induction were limited. Sally, our midwife, came to visit on the Wednesday- I always felt better after a visit, she gave us hope and reinforced us with positive thoughts. We talked about options for getting labour started - homoeopathic, a massage, an internal examination, a jasmine bath bomb and booked the final option - an appointment at KEMH the following Wednesday which would lead to waters being broken to get labour started. Sally had asked how long I could keep going and I said two weeks overdue which gave us until Good Friday. I felt I could not personally go on longer and I would stress about the health of the baby a lot after the two week time limit. Already I had a fear (one of the many), that the baby would die in utero in this overdue time and I would forever berate myself for not following obstetrician protocol and having a 38 week caesarean as is the standard.

After Sally left that morning, Graham and I talked about options and decided to try one induction technique per day and not use all the tricks at once. Sally had left two lots of homeopathics and I was going to try them that day and the following weekend, and I booked a massage (as an early Mothers Day gift) for the Friday. I took the tablets around midday, in amongst picking up Alice from mums place and Louis coming home from preschool, then we all had afternoon naps. I felt a lot of uterine movement in the afternoon but this all settled down in the evening and I went to bed disappointed and planning to buy a jasmine bath bomb the next day.

I felt the first contraction at midnight and wondered if it was for real. The second one was half an hour later - I thought I would just write down the timing of these just in case this was real labour. After a false start 12 days prior I was still hesitant to get excited. I have the piece of paper in front of me - 12.00, 12.32, 12.39, 12.54, 1.09... at this point I thought this really might be it so sat down to eat two weetbix. The contractions continued 1.15, 1.20, 1.25, 1.30, 1.36 and during this time I finished packing my hospital bag and wrote a list of people to ring when the baby was born. I had candles burning in the bedroom and felt in control - breathing through the contractions and thinking the positive affirmations that we had thought about in the Birth classes with Nikki - "My body is strong, Breathe, Relax, Let go, I can birth this baby safely" 1.41, 1.50, 1.55, 2.01 these contractions were starting to really hurt and I felt lonely so I woke up Graham - "I think the baby is going to be born today". He was pretty excited and started getting organised. 2.07, 2.12, 2.20, 2.24, 2.28, 2.35 - these contractions were starting to really really hurt and the length and the increasing frequency made us realise that we couldn't politely wait for a reasonable hour of the morning to ring Sally. Sally asked us how long the contractions were - we hadn't timed them - 2.40, 2.45, 2.50, 2.55 , 2.59 - 60 sec, 55 sec, 30 sec, 55 sec, my waters broke. 3.17am we rang Sally back and she asked us if we wanted her to come - somehow I still felt hesitant to ask someone out at this hour of the morning but fortunately Graham said yes, come while I was in the middle of a long painful contraction. I remember saying to Graham that we should enjoy this part of the labour - in the quiet of our bedroom with the candles giving off a gentle light, because we did not know what the future hours held.

Sally must have arrived about 4am and her hand on my back during a contraction, felt warm and soothing. I know it sounds dumb but I was really taken back with just how much the contractions hurt. I was scared that if they hurt this much now how was I going to get through the rest of labour. Sally suggested I had a shower to ease the pain but during this I switched from being in control to losing it and vocalising with each contraction. Sally then said it would be best to get to the hospital and I agreed - I already was wondering how I would manage the car journey. Graham woke his mum, who had been staying with us to help out, and phoned my mother to let her know we were going into hospital. I hadn't wanted mum to know earlier and worry unnecessarily but I was aware we might need her quiet prayer support from this time on. I thought somehow that getting to the hospital would stop the pain - just like I thought somehow that when Sally arrived she would stop the pain. I felt every bump in the car on the way there and was yelling at Graham to slow down (he told me the next day that he was only driving at 50km/hr).

We arrived at KEMH and although I initially declined the use of a wheelchair to get to the labour ward - I soon realised that we'd never actually get there if I tried to walk it. I was actually glad it was not ten in the morning , with lots of people around, as my cries echoed down the corridor.

My memories of the labour ward are kind of hazy as I had my eyes closed for most of the time until the baby was born - its as if I could only cope with hearing and feeling. The obstetrician came in and started with the old two caesarean/ scar rupture lecture and I just called out "No, no" then heard Graham and Sally take over and say we had already heard this. I'm not sure if they left the room at this point to finish the discussion or whether I just tuned out. I think I asked the obstetrician if there was anything wrong with me and then when he said no, I said "Then go away". Sally suggested I have the IV bung in - much to my reluctance as with Louis' birth they took a few attempts to get it in and it was the most painful part of the whole birth (ha! little did I know about pain). I was aware though that this was more of a political move than medical one and grumpily thrust my arm out and told the guy, who had been patiently waiting, to hurry up.

On my arrival, they did an internal I was told I was 5cm dilated - I was disappointed - after all this pain, how on earth was I going to get to ten. "I can't do this" I wailed to Sally - a phrase she would hear on a regular basis over the next few hours. Despite all this effort to get to a VBAC, I never knew if I would achieve it or whether my mind or body would let me down.

I can't even remember what position I was in but I'm sure I was on the bed until Sally helped me down to go to the toilet. She asked if I wanted an epidural - the idea of the pain ending was ,at this point, quite appealing and I was sure I was still at 5cm dilated and had hours to go. When we got back in the room, I do remember mentioning an epidural but then I think they must have done an internal and before I knew it, I was told I was fully dilated and allowed to push. I had actually dilated from 5 to 10cm in 1 _ hours. I remember vaguely thinking "What you really mean I'm going to have to do this...". I was still sucking on the gas - actually chewing on the end bit more like it. At one point the midwives told me to let go of the gas as I'd get a sore throat - (like who cares about a sore throat !) and the baby didn't like it (I immediately stopped). It was a relief to be allowed to push as I had been anyway - I couldn't help it. I could actually feel the baby coming down the birth canal. It was only when I got to the final pushing stage that I actually realised that there was only one way out - forward. The midwife explained that I was to give a small push then pant then another small push and pant and proceed like that. I remember thinking that that explains all those pushing and panting exercises in the old fashioned antenatal classes and what you see on television. I also thought that she had to be kidding to think I would voluntarily go into the pain. But I realised there was only one way to ultimately stop the pain and that was to push into it - there was no way out now except to deliver vaginally.

Graham had been there for me to lean on and at this point I had his hand in a firm grasp, and as much as he wanted to see the baby's head and watch the delivery, he didn't want to let go of me. He did briefly and had a quick look. They told me the baby's head was out and I put my hand down to feel a sticky warm hard mass coming out of me. I remember thinking that that was meant to be the hard bit over with but I was still dubious. With the next contraction, the rest of the baby just slid out and I heard a cry - that's the baby crying someone said. I opened my eyes and looked down to see a baby on the pillow - the light seemed very bright and I almost didn't believe that the baby had come out of me.

The midwives lowered me down to a beanbag and I noticed the baby was a boy - who could miss those big strawberry red testicles. We had been convinced it was a girl - not that we minded it being a boy, we were just surprised. The room seemed to take on an almost surreal clarity and I noticed what one of the midwives looked like - I had heard her voice but not seen her this whole time. I think I was in a bit of a state of shock - a combination of having actually delivered vaginally, the baby being a boy and my body was very tired and very relieved that the pain had finally finished. I thought I would feel extremely emotional at this time but I just felt (and looked) stunned.

I had ended up giving birth standing up - despite the varicose veins - the last two hours of labour were in one position - standing leaning over the beanbags which were on the bed. I couldn't have moved if I'd wanted - if I'd been asked to get on the bed you would have had as much chance of getting me to climb Mt Everest. In the end, the old ballet and cycling muscles in my legs had held me strongly. Although I had not consciously in labour thought about it - the three bits of advice from one of the books "Stay on your feet, stay on your feet, stay on your feet" must have been in my subconscious.

It had been a long pregnancy and journey to find the right care for us. We were blessed with a straight forward short labour. There were so many factors that had contributed to this, it would be hard to pinpoint one.

The decision to have a third child was a big one - I had been quite sick in my previous two pregnancies and staying at home being a housewife isn't exactly my forte. We had both come from three child families and felt that an extra sibling was one of the greater gifts we could give our two children ahead of things like a private school education etc. We both agreed that sooner rather than later was a better long term option although three under five would be a challenge. I had some extra work and so we decided that towards the end of that we would start trying for a baby. As fate would have it, we conceived on the first month - to be truthful if it had taken much longer I probably would have backed out of the idea. I felt nauseous two days before my period was even due and delayed doing a pregnancy test because I knew I was anyway. I work in the laboratory at an infertility clinic and so I had two bloods taken at work four days apart so I could look at the doubling rate of the hCG. A colleague at work ran them for me and sure enough they showed a healthy developing embryo. At seven weeks I had an ultrasound scan at work with the part time Saturday person - swearing them to secrecy. I was very pragmatic about it - if this pregnancy wasn't a goer, I wanted to know about it early. But there was a little jelly bean with a heartbeat, the right size for dates and in the uterus - giving as much information as you can get at 7 weeks.

The morning (all day) sickness came in about six weeks and with it came the tears and the doubts and the depression. I was so tired I was in bed by about 7pm and going straight to sleep. Graham took over all evening duties and we actually had Graham's mum, Pauline, staying with us and asked her stay on longer to help out. She stayed at extra 3 weeks from weeks 6 to 9. At week 8 I went to see my GP - when I told her I was pregnant I looked so terrible she thought I didn't want the pregnancy. It was hard explaining to people that this pregnancy was actually planned - sometimes you can not enjoy a journey but you have to do it to get to a destination. Although admittedly, on almost a daily basis, I wondered whether we had done the right thing and in retrospect we would have been better to have left it another six months.

The morning sickness continued and being winter, I (and the rest of the family) also came down with the flu, colds, gastro and conjunctivitis. I felt cold for months on end - morning sickness has this side effect. I took maxallon on a daily basis to keep my dinner down - I knew from the previous pregnancy that if I could manage not to be sick I felt better the next day. I also took homoeopathic and naturopathic remedies and ginger and other morning sickness friendly foods - anything to feel better. People asked if they helped - I don't know, maybe I would have been worse. I only was working one day a week but during that time worked only three days in eleven weeks (luckily I had some sick leave saved), fortunately work was very understanding and they had already seen me go through two pregnancies.

The hard part was the depression - that dark foreboding feeling as you wake up each morning knowing there was not much to look forward to and this would go on for weeks more. It was very difficult each day - feeling ill and looking after two small children. Graham could judge whether it had been a good day or not as to whether dinner was cooked or not - planning and preparing dinner seemed to take on mammoth proportions. I withdrew from a lot of activities - I couldn't really cope with other people and did not want to inflict myself upon them. I didn't tell the mums at playgroup until I was 14 weeks. There were a few people there with infertility issues and it seemed unfair that I conceived so quickly - the least I could be was happy about it.

We thought about the birth, I had read Naomi Wolfs "The Mask of Motherhood" and knew we wanted things differently from last time. We chose a different doctor and a different hospital - South Perth Community Hospital. I rang the hospital and spoke to a midwife asking which doctor was the least interventionist and encouraged natural birth. She said she wasn't allowed to tell me but would send me a list of their referring doctors and put a mark next to one. When the information arrived we rang Dr G and booked in for a 13 week appointment after we had had the ultrasound scan. Even at that time, I knew if the scan was not normal I could not go through another pregnancy again and we would be a family of four. The scan was normal and with the adjusted figures, I was given a 1: 2178 chance of a trisomy baby which we were told was low and didn't require further investigation.

The appointment with Dr G went okay - we just went through all the blood and scan results. We discussed my previous pregnancies and deliveries. He basically said he could understand the first labour leading to a caesarean but the second being due to bad varicose veins was unnecessary. I felt quite betrayed - and angry, that my desire for a VBAC in my second pregnancy had been dismissed so easily. I asked if I could try a VBAC after having had the two caesareans and he said yes. His condition was that he would only allow it at KEMH, if we wanted to go to South Perth we would have to be an elective caesarean as they did not have adequate emergency facilities. I didn't think this was unreasonable, as I knew South Perth had a small maternity unit and that staff at hospitals which have lots of emergencies, deal with them better. He informed us of the risks of VBAC which is basically a 1:200 chance of scar rupture and a 1:10 chance of this resulting in fetal death, fetal disability or hysterectomy. I calculated this to be a 1:2000 chance of a serious undesirable outcome - about the same risk of having a trisomy baby. He explained that that was why he delivered at KEMH (who had anaesthetists on call 24 hours), because if scar rupture did occur then as long as you got the baby out within 17 minutes then everything was usually fine. I said we would think about things - being so early in pregnancy there was no rush to decide on details.

As the sickness continued through to 15 weeks, it was getting harder to handle - in tears I called for help and managed to get to see someone at the Women's Health Centre in Fremantle. It was someone who deals with postnatal depression and I explained that I don't get post natal but antenatal depression because of the sickness. I saw her twice - I don't know if it helped but it didn't harm. I decided that the only way to stop getting sick was to raise my immune system I so decided to join a health club to get some fitness back. My friend was going to good one which had a free creche and had aqua aerobics classes - I already had the start of varicose veins which I knew would only get worse later in pregnancy and make it difficult to walk. Immediately after joining I got sick again, then we went away for a week so the start of getting back on top of things was delayed.

Graham decided to take a week off and we booked into a holiday house in Dunsborough - looking for a break for all of us and a bit of sunshine as it was October by then. It was good to get away but the weather was not kind - we only had t-shirts on for one afternoon and it was fleeces for the rest of the time. We took our bikes with us and did a bit of riding - I was over the morning sickness! Louis made the major achievement of learning to ride his bike without trainer wheels. We even went to Lakes Cave which is quite a descent down (and up) by stairs and I felt strong enough to do it.

We got back to Perth - I was 18 weeks, relieved that the sickness was over and looking forward to a few months of my good time in pregnancy. I started at the gym and they developed a pregnancy friendly work-out. I went regularly two to three times a week, varying the workout with an aqua aerobics class and I could feel myself getting stronger. Even the quote from Helen Keller on the wall at the gym seemed appropriate "Why consent to crawl, when you are inspired to soar." We had the 19 week scan - everything was fine except the placenta was a bit low and we should recheck it at 32 weeks. I wasn't worried, I knew they were often low and usually moved up with the growing uterus. We had a 20 week appointment with Dr G and nothing much was discussed, blood pressure, urine and uterus size were fine.

Then in December, at last, I made it to a Birthrites meeting. I had made contact early in my pregnancy but with being sick and going away - this was the first time I actually made it. Alice was sick, I took her along feeling guilty that I was taking a sick child. She was feeling so miserable though that she clung to me the whole time and there was little chance she infected anyone else. I chatted to a few people and heard a few stories. I realised that it was okay to not tell people your plans especially if they weren't supportive and would tell you about all the negative experiences. After this, I limited telling our plans to a few close friends, my sister and my parents. I was given the next Birthrites magazine and I asked to be recommended some books to read. I was already 23 weeks pregnant and aware that I was leaving this a little late. The books I took home were "Open Season" by Nancy Wainer Cohen and "Natural Childbirth after Caesarean - A Practical Guide" by K. Crawfored and J. Walters.

And so I started to read and cry and read and cry and question and cry and get angry and cry.

I realised I had never cried over the previous two caesareans - when we had been told with the first we were having a caesarean - 21 hours after waters breaking, an epidural put in for high blood pressure, failing to dilate beyond 7cm and a posterior lie for the baby, I had only let a single tear out - after all it was best for the baby and they could have left me all night (like we asked) but it wouldn't have made any difference anyway - would it? At 35 weeks with the second pregnancy I had asked if my varicose veins would cause a problem in delivery, after an examination I was told it would be best to have a caesarean as they could be made worse in delivery and have long term problems. I reluctantly agreed, I managed to negotiate the date a week later to move it away from my own birthday but I still feel she ought to be a March birthday. As the date for the elective Caesarean moved closer, I desperately wanted to go into spontaneous labour and felt all wrong about the decision. I found out about Birthrites at 38 weeks with this second pregnancy but did not have the strength or support to change things at this late stage.

I must have had some doubts about my care provider for this pregnancy as I remember the women at Birthrites recommending the Community Midwives Programme. I rang them before Christmas only to find they were (not surprisingly) full until the end of May and I was due early April - they suggested I try an independent midwife. I also phoned our health fund and discovered that we were covered for an independent midwife and the out of pocket expenses would be comparable to that of the obstetrician. It was around this time that I decided I needed a lot more information about everything and I would try contacting anyone who could give me a piece of the jigsaw.

I spoke to a midwife, Nikki, for an hour and she listened to my previous birth stories. Nikki reassured me about trying for a VBAC after two caesareans and that the obstetrician I was with was known for being VBAC friendly. She suggested as an alternative a certain Dr P at Woodside although I wasn't overly keen as I had worked with this doctor and felt that knowing the doctor through work had been an issue in my last two pregnancies. I booked into her birth classes which would start in February, as I felt I needed to go back to the beginning and relearn everything about child birth to ‘get it right'.

It was December 23rd, 5pm the end of another hot, humid 38 degree day - we had five in a row around that time. We were at the end of yet another bout of sickness in the family spreading over six weeks - a mix of gastro and flu. I was just finishing two weeks of flu for myself, the kids were basically better but Graham was yet to come down over Christmas. I remember sitting in Dr G's office and resenting him and my husband who both had on long shirts and long trousers - having been in air-conditioning all day. I had on my coolest summer frock and was sweating. It had been 30+ degrees inside all day, I had been looking after two grumpy children and I was hot, hormonal and asking questions. I had done my reading and now I was ready to ask questions about treatment, limitations during labour and why things were the way they were. I admit I wasn't in the best of moods.

I asked why it cost $850 for a VBAC and only $150 for an elective caesarean? Wasn't there a lot more involved in caesarean surgery than a VBAC that was a straightforward six hour labour? Why was only KEMH suitable - surely SJOG Murdoch having so many deliveries should be able to cope? Continual fetal monitoring - was that absolute or could it be intermittent? Dr G had previously suggested an epidural - was this really necessary as I felt it had interfered with my first labour? How was I sure he would give me a really good go at labour?

I came away from the appointment feeling like total crap - to put it bluntly. I knew I couldn't go back to him - how could I? If he couldn't handle me emotionally during a consultation - how could I trust him to look after me in labour when I would feel most vulnerable?

The issues of pregnancy then got swept aside with the festive season. It was Christmas then we went away for a week to Busselton for the most relaxing holiday we've had with children - with a group of people from the Family Bushwalking Club. Holidaying in primitive but adequate dongas next to a quiet beach at a church campsite - enjoying a bit of cycling, walking and swimming.

We came back from this holiday to a letter which made my cry for two days and made me angry and shook my confidence. It was from Dr G. In summary, for a third of a page it stated all the risks associated with a trial of scar, he defended himself of being knife happy when in fact he was one of the more VBAC friendly doctors and concluded that if I didn't like the way he did things he could refer me elsewhere. I felt angry that he didn't acknowledge my professional background and made out that I wasn't taking the risks seriously. It was like he thought I would try a VBAC at any cost and having worked in the field of infertility for 11 years, I knew of many miscarriages, premature births and deaths. I had finished work at 26 weeks for this pregnancy so I could escape the fear that my work had created in me - it was hard to focus on the normal when you were surrounded by special cases. He must have been taking things very personally that day as I had made a general comment about obstetricians and how it was their job to ‘cut and paste' so that is what they tended to do.

So now there really was no going back to Dr G.

I went to the Fremantle Resource Centre and spoke to a midwife there and borrowed a few more books. I attended the next Birthrites meeting - not in good spirits. I borrowed another two books - ‘Birthing the Easy Way - Learning the Hard Way' and ‘Silent Knife' by Nancy Wainer. So I continued to read and learn. I systematically phoned my way down the list of independent midwives listed in the Birthrites magazine and asked questions and cried and listened and learned. I wasn't sure what I was looking for - everyone said to trust my feelings and go with what felt right. I couldn't figure out what felt right but I did recognise what felt wrong so I just continued by default. I went to see a counsellor, L, who came highly recommended by the Community Midwives and I cried some more. She said I had postviral depression (I had been sick a total of three months out of the previous five)- which seemed appropriate and would explain why I felt like I did during pregnancy - everyone is so ready to label you postnatally depressed once they see you with a baby but it just didn't seem to fit with me as I always felt better when the baby was out. She suggested antidepressants which I didn't like the idea of during pregnancy and I felt I was already over the worst. She said to just find someone and trust them and focus in on the pregnancy. I said I was trying and I was getting confused and if this was a wedding or some other major life event I would delay it by six months because I was running out of energy and I didn't have the heart to continue this journey. But I was pregnant and I had ten weeks go and time would not stop for us.

During this time, we went to Fremantle and met with some of the midwives. The first thing Sally said to us is to not consider her because she would be away for Easter, I said the baby would be out before Easter. We sat and talked and asked questions. What we really had problems reconciling was the huge difference of attitudes between the obstetricians and midwives. Each midwife I had spoken to had asked me if I wanted a homebirth - that was the last thing on our minds - surely with all these risks of uterine rupture, haemorrhaging and fetal death - a homebirth would be out of the question. But as we explored our options in Perth - phoning hospitals, obstetricians and midwives, we began to understand why people in our situation would choose a home birth - why home would ironically be the ‘safest' place to birth.

I had not seen anyone for five weeks with my pregnancy and although I could feel the baby moving regularly, I felt vulnerable and began to worry if everything was ok. I made an appointment with my GP but because it was holiday time the appointment was three weeks away. So I booked an ultrasound at work - they had suggested I recheck the position of the placenta anyway. Everything looked fine and I quietly measured myself on the scales and asked one of the nurses to take my blood pressure. I found myself cornered by three colleagues asking when my caesarean was booked, and of course I'll be another Caesarean and it was so much more convenient anyway with a caesar to organise childcare etc. I just mumbled something about not quite having things organised yet and quickly escaped.

Graham and I decided that we needed someone who knew what ‘normal' looked like - a normal pregnancy, a normal labour and a normal delivery. Only someone who had a lot of experience with the normal would be able to recognise abnormal and guide us to a caesarean if it was really necessary. I also decided that I did not want to be cared for by a male - if they did not even know what period pain was like, how would they get me through the pain of labour? We needed someone strong enough to speak on our behalf if the system got too much for us - like it had before. Looking at our finances we decided we could afford an independent midwife if we used the public hospital system.

So we rang Sally (who at the end of the previous meeting had said she would be available) - I was reluctant as I do respect peoples holiday needs and I imagine as a midwife the overlap for home and work is strong. She was new to WA so did not seem worn down by the system and was open to the idea of going to KEMH not Woodside which seemed preferable to us. All the Community Midwives seemed more keen on Woodside and Dr P then trying KEMH. So to keep an open mind we went on a tour of Woodside and made an appointment to see Dr P.

We were impressed with the 83% midwife delivery rate of Woodside but somehow it did not feel right going there - maybe it was the peeling paint on the shower ceiling. I knew if I ended up a caesar, which we had a reasonable chance of being, I would rather be in KEMH. We met Dr P who immediately recognised me and asked me where I had worked (questions I wanted to avoid). He was ok with the idea of being backup to Sally as long as I came into hospital straight away and didn't attempt a homebirth. He also let us know that Dr T who delivered my first two children did over 700 deliveries a year which averages out to two a day so he would need at least half to be caseareans. Dr P gave me the most encouraging words I got from any doctor during my pregnancy that I had a ‘reasonable chance of a vaginal delivery'. But I didn't want to go back - I preferred the anonymity that KEMH offered.

The birth classes with Nikki started and there were four other couples - all first timers, all not just home births but water births. I felt I was letting the side down a bit - I was just going for a vaginal birth - it could be in hospital, with an epidural or forceps - whatever - I wasn't aiming too high. I was a bit envious of their high expectations of first time birth until I remembered I had been the same five years ago. I had booked into the Family Birth Centre with the full expectation of having a natural delivery and had ignored them when they talked about their transfer rates and Caesarean rates - after all, I was fit, I had done my reading and believed in my body and natural birth. From week to week I looked forward to the class and really listened to what labour was about. Emotionally it was good to connect to these positive people and renew my faith it what I was doing each week. It was good to hear about alternative child care methods and I thought I was doing really well having got two children through on cloth nappies until I was reminded about the harm of Napisan.

Having decided on KEMH, we decided it would be responsible to have at least one appointment there to book in and to discuss any issues being a VBAC after two caesareans prior to arriving in labour. I went back to my GP who obligingly wrote out my third referral for that pregnancy and didn't question my attempt for a VBAC. The appointment was booked for 35 weeks and I had been warned by the women at Birthrites that it could be a grilling experience. Prior to the appointment, Sally had accessed the website of the KEMH Clinical Guidelines and we were heartened to read the opening line under VBAC management that "For the majority of women with a previous Caesarean birth a trial of labour should be encouraged." Further along as a relative contraindication to VBAC it stated "More than two previous caesarean sections." We should be laughing - I'd only had two not more than two caesareans, so I thought we'd be fine and be totally supported at KEMH. Ha!

The appointment started with the midwife, went to the doctor who had a student doctor with her and then progressed to the Senior Consultant. I explained to the doctor that I was having care with an independent midwife but we were coming to KEMH for the delivery. She said she'd never heard of that and didn't know whether it was possible. I said I understood that Sally could only act as a support person and not in the legal role of midwife, that was why we were having this appointment to get things sorted out and all my test results on record. She assumed through the whole examination that I was a repeat caesarean and only at the end when she made some comment I said no, I was attempting a VBAC. Then (I'm sure her nostrils flared) she said that was not possible and she would have to get the senior consultant to talk to me. I said fine that was why I was here to get things sorted out before coming in in labour. I felt like a school girl waiting for the headmaster as we waited for the senior consultant. So we got the lecture. There was nothing new in the information we were receiving - I'd read it, I'd heard it from Dr G and Dr P and so we sat and listened with our armour on. He told us in graphic detail about the two scar rupture cases he had dealt with - I mumbled that I don't suppose he wanted to tell us about the 398 normal cases. He said that was I aware that I had less than a 70% chance of achieving a vaginal delivery - I said I only had a 30% chance of a caesarean whatever Perth hospital I walked into and a 50% chance if it was SJOG. He was about to refute me when he realised I was right. I thought I handled myself alright in the appointment - it was only as I got outside that I broke down. Graham said the appointment was no more or less than he expected. The Senior Consultant had achieved his goal - I got home wondering if we were doing the right thing. I felt the only words I had heard were fetal death, scar rupture, haemorrhaging, permanent disability - was I right to risk all this to satisfy my curiosity and desire to experience birth? I felt devastated.

During our next birth classes, we talked about our fears which, for me, had just been fuelled. While everyone else came up with one or two, I found myself once again reduced to tears and the list of fears so long that I couldn't count them. Nikki suggested we go home and talk about them and cast some ‘magic' to try and dispel them. I was willing to try anything - so that night I made a list of my fears starting with the major ones of maternal and fetal death to minor ones of varicose veins bleeding in labour and not being able to cope with other people emotionally at the time of birth. Graham suggested we burn them to get rid of them - I thought this would be messy and set off the fire alarms in the house. So we engraved them all onto a candle and burnt this down over a period of a week. It did seem to soften the intensity of the fears or maybe it was the rescue remedy I had started taking. It was about this time that I read the memoirs of Henny Ligtermoet - a Dutch woman who had migrated to Perth and through her own search to have a homebirth, established the basis to what would become the Community Midwifery Programme. Despite giving birth to two children at home in Holland, Henny had came across great resistance by doctors to home birth in WA in the 1950's - "Do you want your baby to die?" Henny had been a friend of my fathers and as he was moving house he had cleared out some books and came across her memoirs that she had given him. I think it helped my dad to reassure him I was in good hands, that Henny had been involved in this homebirth movement. I have learned a lot about fear and the role it plays in birth - the way it now dominates mainstream childbirth practices and creates the poor birth experiences of today. The words from "Strictly Ballroom" that "a life lived in fear is a life half lived ..."echo around. But there were three main facts in my life that contributed to my fears and I couldn't change. One fact was I had had two caesareans, second was that I had worked in infertility for a long time and known of many tragic cases and thirdly my father's mother and the child had died in childbirth. These three things could not be changed and, so much as I had romantically entertained the idea of a homebirth, I felt I needed the safety backup of a hospital with good emergency facilities.

Towards the end of my pregnancy I was on an emotional rollercoaster - Sally would never know if she would find me in the pit of despair or positive and ready to take on the challenge of labour. The important part of her visits for me was the reassurance she gave and her willingness to listen about all my latest thoughts, theories, doubts and fears. I was glad it was my body giving birth as I felt it was stronger than my mind - my mind I was sure would stuff it up. My pregnancy remained normal in terms of blood pressure, urine, fetal position, uterine measurements etc.

I was sure I'd go early but that was not to be. I had gone into spontaneous labour at 39 weeks with my first and had the elective Caesar at 39 weeks with my second so I was fully expecting to go early with this pregnancy. Strangely enough I did have some contractions at 39 weeks. I had felt strong Branxton hicks contractions early in the day and they were massive when I went to pick up my boy from school. When I got home the contractions took my breath away as I was trying to change the two year old's nappy. This was not the day to go into labour - I had only four hours sleep the night before (insomnia had featured strongly in all my pregnancies) and I knew Sally had her own birthday party on that night. I called Graham home from work and went to bed - lying down seemed to stop the contractions as each time I got up they happened. By the time I went to sleep I hadn't felt anything for three hours but I was confident I could get them going again by being busy the next day. The next day I went to an aqua aerobics class and then for a walk at lunch to the river with the kids. Nothing. I rang Sally and she said labour can stop and start and real labour could still be three weeks off! So I quelled my disappointment and got back on with life.

I continued with the aqua aerobics classes, although by the end I was just walking laps for most of the lesson - I think somewhere I had the thought that they couldn't caesar a moving target. I suspended my gym membership when I was four days overdue more because I couldn't cope with people's comments about when the baby was due than my physical inabilities.

A friend of mine had her pre-booked caesar a day before I was due - I felt resentful. It was not fair I knew I was pregnant even before she had ovulated. My baby should have been first - yet I knew I had made this choice which made it even harder. Why couldn't I just except a third Caesar like everyone else? Why did I have to stubbornly stick to wanting a VBAC? The due date came and I didn't have the heart to go to Birthrites that morning - my baby should be coming. Each day overdue felt like a week and a new list of fears developed - fear of being induced, fear of baby dying while waiting for spontaneous labour, fear of failure, fear of the pain of labour. And what of the baby? I had been so focused on the pregnancy what about coping with three children, the sleep deprived nights, what if was a boy not a girl like I was expecting?

I was told I would not stay pregnant forever but those overdue days were very hard. I did not stay pregnant forever, although it had been a very long pregnancy, and so we lead around to the beginning of this story. There were so many factors that helped us achieve our desire and I never knew until the very end whether we'd get there. Isaac is now five weeks old and Graham has long since gone back to work. There is a mound of washing waiting and a baby crying for attention so now this story ends and a new one begins.

Bridget Blackwell May 2003