Yes, It is Possible to have a VBAC in
a Private Hospital.
if you have the Right Support Team
In 1996 my first child was born by caesarean section after ruptured
membranes and a failed induction lead to foetal distress. I was sensitive
to the drugs in the epidural and spent the entire procedure feeling
nauseous and dizzy despite lying flat on my back. When our daughter
was given to me, I feared that I couldn't hold her properly and asked
my husband to take her so that she didn't end up being dropped on
the floor. While I was being stitched up, the baby was taken away
and fed without my permission in the neonatal unit. Needless to say,
it was not the joyous beginning of a new family that one reads about
in pregnancy and birth books. However, we were grateful that our daughter
was healthy and preceded to learn how to be parents.
When I became pregnant with a second child all I knew is that I wanted
the next birth experience to be vastly different to the first. I'd
heard about VBAC and by chance stumbled across an article about it
in a parenting magazine. The article gave the address of the Birthrites
website, which set me on a path of discovery, and ultimately, healing.
I read everything on VBAC I could, started doing yoga and relaxation
exercises, questioned my obstetrician in detail about his practices
and birth philosophies, drank raspberry leaf tea, attended a Birthrites
gathering, devised suitable visualisations and affirmations to get
myself in a positive mental state, hired a brilliant midwife to support
me in labour, attended a spiritual birthing workshop and took Evening
Primrose Oil in the final weeks of pregnancy. In short, I did everything
that I could to prepare myself for a VBAC, so much so that women who
have not experienced an unwanted c-section thought I was obsessed.
However, the preparation process was vital as it emptied the olympic
swimming pool of tears that was the legacy of my first child's birth
and slowly began to replace it with positive images of natural childbirth.
However, there were a few sticking points. The first one is that
I live in a country town and services such as Perth's Community Based
Midwifery Programme do not exist. Although the local hospital has
a low c-section rate and an excellent VBAC success rate, all my family
support was in the city. Therefore, my husband and I decided to go
to Perth to have our baby, especially since this would enable us to
have the support of a midwife experienced with VBAC during pregnancy
and labour.
The second potential sticking point was the obstetrician because
these doctors are often accused of being pro c-section. I again chose
the obstetrician who had delivered my first child, but not before
I had questioned him closely to understand more of why the c-section
had taken place. I also communicated how powerless I had felt during
the event. My obstetrician and I then spent time debating the pros
and cons of VBAC and I must have made my feelings very clear. The
result was a written agreement between us as to the parameters of
the next birth. I typed up the agreement and sent the obstetrician
a copy. He wrote a two page reply in which the key sentences were
"you have expressed deep personal discomfort and loss at not being
able to achieve a vaginal delivery. As I stated the other day, I do
recognise the importance of achieving vaginal delivery to you and
therefore would do my utmost to ensure that that will occur". This
was exactly what I wanted to hear.
The third sticking point was the metropolitan hospital, which caused
me considerable anxiety late in pregnancy. Unfortunately, this private
hospital has a notoriously high c-section rate, which it justifies
as being due to the number of well to do women who request the procedure
in order to "avoid getting a sore bottom". However, to change hospitals
would have meant changing caregivers which, given my advanced pregnancy
and my obstetrician's support for VBAC, I was unwilling to do. The
hospital's attitude seems to support repeat c-section rather than
VBAC and its policies reflect this. For example, because the hospital
considers previously sectioned mothers as high risk, it prohibits
them from using the family birthing suite, which is the only labour
room that has a bath. Thus, previously c-sectioned women are effectively
discriminated against and I wrote the hospital a long and very angry
letter of protest. Writing the letter had a cathartic effect and it
was not important that I didn't receive a response until after my
baby was born. In fact it made me realise that an effective birth
team was an absolute necessity if I was going attempt a VBAC in such
a setting.
My planned birth team was my husband, a midwife support person and
the obstetrician. We hired a wonderful midwife, recommended by Birthrites,
to assist us in pregnancy and labour but because of hospital policies
she could attend the birth only as a support person. Apart from myself,
the pregnant one, I would have to say that our midwife support person
was the most important vital of the team. She got me through the pregnancy
by helping me deal with my fears and taught me to trust in the birth
process. For example, I had to trust that whatever midwife was on
duty at the hospital when we arrived would be the perfect person to
help welcome our baby (which she was). Our midwife support person's
reassurance at the end of a phone line was also invaluable and her
understanding of the feelings of VBAC women such that I could rely
on her wise counsel. She also got me through labour with encouragement
and reassurance, and guided my husband in ways to assist me most effectively
so that he became actively involved. I still find it uncanny that
she was able to provide what was needed by instinct when I couldn't
have articulated it myself ! When the labour was not going well and
intervention seemed likely, she refused to let us lose hope and become
demoralised. She shared our excitement when the situation improved
and ultimately shared our joy when our daughter was born. In fact
I can't help but feel that we owe much of the VBAC success to her.
So if anyone finds themselves faced with the challenges of VBAC in
a less than ideal environment, do not lose heart. Assemble the best
support team that you possibly can and trust in the birth process.
The wisdom of birthing women is with you.
And Oh the Joy
On Tuesday evening 31 August I had some back pain and woke about
3am on Wednesday 1 September when contractions began. I slept badly
from then on and woke again at 5am when the contractions started getting
regular. I woke my husband Paull at about 6am and rang Lesley Jennings,
our midwife, at about 8am. At this stage the contractions were 10
minutes apart and 30 seconds duration, which Lesley said was only
pre-labour. I had an appointment with Dr Y at 9.20 am that morning
but cancelled it in case he wanted me to go to hospital before I was
ready! We stayed at home all day, with me breathing and rocking through
contractions and getting excited as the mucous plug came away. Paull
was fixed to his computer (to finish a report for work !) and my sister
collected our three year old about lunchtime. Lesley came to lunch
and I had to stand up from the table and lean forward over the kitchen
bench every time a contraction came. It reminded me of an anecdote
in the inspirational book, Birthing from Within, in which an elderly
woman advises her pregnant granddaughter to "lean over the buffet"
during contractions. Now I knew exactly what she meant !
After lunch, Lesley talked to me and Paull about our birth plan and
then went home. About 2pm I took Panadol and tried to sleep but the
contractions were much worse when lying down. Upright was definitely
better. At about 6pm I managed to have dinner and again had to stand
for some of the time. By 8pm the contractions seemed closer together
so I asked Paull to time their intervals and duration. They were longer
and closer together but still not at consistent intervals. At 10pm
we rang Lesley but she said it was still not active labour. With all
the puffing it felt pretty active to me! However, Lesley said that
she would slowly make her way to us. We were glad of the reassurance.
Lesley arrived at about 11pm and did a Vaginal Examination (VE).
She said that the cervix was paper thin (good old evening primrose
oil!) and massaged the edges of it for several minutes to release
prostagladins. There was approximately 4cms dilation and the amniotic
membranes were bulging with every contraction, so much so that Lesley
thought that they could rupture at any moment. We discussed whether
she should rupture the membranes at home but Lesley was reluctant
to do this in case there was some meconium in the liquor. However,
we did decide to go to hospital before the labour got too intense
and the membranes could be ruptured there if necessary.
We arrived at the hospital about midnight and met the duty midwife,
Kath Budinska. We were lucky to have such a like- minded person on
duty and she supported all our efforts for natural childbirth and
vaginal delivery. Kath checked the baby with an electronic fetal monitor
and then did a VE. She found that there was 4-5 cms dilation but that
the baby's head was still quite high in the pelvis. Kath then phoned
Dr Y who advised 2 hourly VE's. I leaned against some tall cupboards
during contractions and Kath put my aromatherapy oils in a vaporisor.
With the fragrances wafting around the room, Paull and Lesley massaged
my back and shoulders which was heaven. By this stage, I was starting
to feel pain in my lower back as well as at the lower front and it
slowly dawned on me that the baby was in a posterior position, having
been anterior for the entire pregnancy. How had that happened ? I
hoped that the baby would rotate and leant forward as much as possible
during and between contractions to encourage this.
Kath suggested that I get into the shower and direct the water onto
my back, which I did, and she then turned the lights off. The aromatherapy
came with me. About an hour later I got out of the shower and then
realised how much back pain there really was. Kath did another VE
and found the cervix fully effaced (yaaah !) and dilation at 7cms.
She said that the very bulging membranes were probably keeping the
cervix open. The baby's head was lower but still relatively high.
Kath then suggested an enema (yucko!) or a bath to get the labour
moving along. I was keen to try the bath, especially since hospital
policy had banned me from the family birthing suite, which is where
the only bath was, because of my previous c-section. I got in the
bath, again with my aromatherapy and the lights off, and tried to
stretch out and sleep on my side between contractions. This worked
to a point, but when the contractions came they would hit hard unless
I was on my hands and knees leaning over the edge of the bath. The
back pain was also building up. Lesley ladled water over my back in
time with my exhalations during contractions and this brought considerable
relief. When the contractions got longer and stronger, Paull took
over this role and Lesley knelt at my head and talked me through each
one. I gripped her hands and arms tightly and felt desperate if she
left the room. She really was my Rock of Gibraltar during the tempest.
After I had been in the bath some two hours, the pain finally got
to me. I burst into tears and sobbed "I want to see my baby and don't
want to suffer any more". Kath and Lesley later told me that this
is an important method of ridding oneself of adrenalin. I got out
of the bath and started to shiver despite the warm towels (surely
this was transition ?). Lesley and Paull supported me on shaky legs
back to the labour room.
By now it was just after 4am and Kath did another VE. There was still
7cm dilation but the membranes were less bulging. Kath was also concerned
as she had detected some possible swelling of the cervix. This was
not the progress I had hoped for. For pain relief I tried some nitrous
oxide gas, which wasn't effective, and soon after accepted an epidural.
I was so tired. I inhaled the gas deeply during contractions while
waiting for the anaesthetist but it soon made me feel nauseous. About
5am the anaesthetist arrived and quickly and efficiently inserted
the epidural which soon brought welcome relief from pain. About 5.30am
Kath spoke to Dr Y and agreed to artificial rupture of the membranes.
Lesley and I had wanted this earlier, but Kath later explained that
her reluctance was because she didn't want to push me to the next
level of pain relief as I was handling the labour well.
Soon after the ARM, the secondary effects of the epidural hit and
it wasn't long before nausea and dizziness engulfed me. I felt terrible,
and actually made myself vomit in an effort to feel better. I also
had to be propped up in bed as I couldn't balance nor move my legs
well enough to walk. I accepted some Masalon for the nausea but this
had no effect. I started to lose track of events and just drifted
along in a cloud of nausea with the EFM bands strapped to me. My skin
also itched from the epidural drugs. There were mixed messages from
the next VE too. The cervix had gone back to 5cms without the bulging
membranes to keep it open, but the swelling of the cervix had gone.
The baby was direct OP (occipito posterior) but the head was further
down than before. I tried to visualise the baby's body in a more favourable
position for birth but after more than 24 hours in labour I was exhausted,
and propped up on pillows I drifted off into a half sleep.
About 7am Dr Y arrived and then he and Kath did a VE each. They found
no change in the cervix, still at 5cms. However, the doctor thought
the baby was ROP (right occipito posterior) whereas the midwife thought
the baby was direct OP. It was depressing news, made worse by the
continual nausea. Dr Y then had a serious talk with Paull, Lesley,
myself and Kath about our options. As he saw it, there were three.
The first was to try induction, which surprised me as he had always
said that he would not do this because of the fear of uterine rupture.
The second option was to do a caesarean and the third option was to
wait. Dr Y then left the room so that we could discuss the options
amongst ourselves. Thankfully, no one was in favour of the induction.
Paull and I were resigned to accept another caesarean. I think he
had had enough of seeing me suffer and I thought I had done the best
I could in the circumstances. The nausea and fatigue I was experiencing
were so awful that I just wanted it all to be over too. I am sure
Lesley was disappointed with us both but she was diplomatic. She asked
me "What does your heart say?" and I rather guiltily evaded the issue
by mumbling "I don't know." When Dr Y returned some half an hour later,
we told him of our de facto decision and discussed some parameters
for the c-section. That is, the baby was to be put wet and slippery
on my chest instead of being taken away and wrapped up, and the theatre
staff were to be respectful and not discuss the footy results or the
dinner party that they had attended last night ! I also told Dr Y
that I didn't want to feel totally nauseous during the procedure as
I had the last time. He then ordered a more powerful remedy for the
nausea before departing to assemble a team of staff for theatre. It
seemed that we had reached our lowest point. Lesley left the room
to have a break and freshen herself up. She later told me that she
went down to the hospital chapel and prayed. Looking back I think
God must have listened to her.
When Dr Y returned, he said that as so much time had passed since
the last VE, would we consider waiting another 20 minutes and re-checking
the situation. I was starting to feel much better from the second
anti-emetic and readily agreed. At 8.45 am Lesley's prayers were answered
as we found that the labour had reset itself. The cervix was 6cms
dilated, the baby's head was well applied to the cervix and was actually
at the level of the pelvic spines! We were overjoyed and the cloud
of c-section hanging over our heads melted away. We decided to wait
another hour. I had another short doze before Lesley woke me up and
told me to start visualising our baby moving down and turning into
the perfect position for birth. Her tone was very much 'get on with
it' so even though sleep was preferable I started visualising.
At 9.30am Dr Y did another VE. Lesley later described his face as
that of a little boy opening his Christmas presents- just surprise
and delight all at once. It was brilliant. The cervix was fully dilated,
the baby was still at the spines and had moved from a posterior into
an anterior position. Yipee ! We were elated that our baby was ready
to be born. Now we just had to wait for the epidural to wear off sufficiently
so that I could push the baby out. Paull, Lesley and I rested and
Dr Y again left the room.
At about 10.30am I got ready to push and found that I felt uncomfortable
sitting up. I turned around on my hands and knees and gripped the
head rail of the bed. Paull stood near my head and Lesley coached
from the side. She felt my tummy for contractions and ordered me to
start pushing as each contraction started, getting three or four pushes
each time. I could feel the baby move and this spurred my efforts,
and then I was able to collapse down onto a stack of pillows between
contractions. I also was fearful of not pushing the baby out myself
as Dr Y had earlier mentioned that forceps or a ventouse could be
required.
At 10.55 Dr Y returned and hurriedly put on a surgical gown. Apparently
he said that I shouldn't have been pushing in the hands and knees
position so I was soon sitting up facing forwards again. The paediatrician
appeared too and said that if it was all right that she would take
the baby to be checked over. I told her that it wasn't all right (nobody
was going to take this baby away!) so she retreated somewhat. The
move in position from hands and knees to sitting up was a timely change
as it made the baby turn the corner into the final straight. By now
I had a midwife supporting each leg and within a couple of pushes
the baby's head was in view. Lesley guided my finger down to feel
it but even then I still didn't realize how close the baby was to
being born. Within a few more pushes I felt the head crowning and
did some serious primal screaming. This is when I decided that a vaginal
delivery was a VERY BAD idea and I definitely was NOT going to go
through with it. Lesley said that Paull's face was just a mask of
horror too. Dr Y was alternatively instructing me to push and pant
and I had no breath to argue. It was too late anyway; between pushing
and panting the head had arrived and I was so busy working that I
didn't realise it had happened ! Lesley put my hand on the baby's
head as Dr Y eased the torso out and Lesley helped me lift the baby
up under the arms onto my chest. And oh the joy. I held that wet and
slippery body and Lesley lifted her up so that we could see that we
had a daughter. It just felt so right then and still does.
Later, I was also delighted at the reaction of the hospital staff,
who were agog that a successful VBAC had taken place in a setting
that is notoriously pro c-section. Staff members privately congratulated
me on such an achievement, and the hospital paediatrician, a woman
in her fifties, confided that she had also had a VBAC. We discussed
how much better it was than a c-section delivery, especially in terms
of recovery time. I felt like I was sitting on top of a mountain looking
out over a magnificent vista.
Because of this VBAC birth I feel healed and whole, and have exorcised
the pain that I hadn't realized I was carrying for almost three years.
And best of all, even on bad days, I can still see the vista from
the mountain top. I would like to thank dedicated women such as Jackie
Mawson and Lesley Jennings for helping me to see it.
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