VBAC WITH A DOULA’S SUPPORT

My birth story second time round makes more sense in the context of my experience with my first one.

The first time was very disheartening and disappointing; I ended up having nearly no say about anything during labour and I laboured in a very unproductive environment which resulted to an otherwise unnecessary C-section. The culprit was the fact I had Strep B. I was told that if my labour starts with my waters gone, which was exactly what happened, I had to go to the hospital straight away for antibiotics. So I arrived at the hospital 6am with no contractions. I was given antibiotics, dressed in a hospital gown, and attached to the IV stand. That meant that I had to stay in the antenatal ward where there was no space around the bed for me to move and I had to push the IV stand to be able to go to the toilet which was very impractical. Two hours later contractions started fast and thick but I was left on my own devices in the busy, noisy, bright, non-spacious antenatal ward. I laboured there for nearly 12 hours reaching 6cm dilation. I was kind of forgotten. I was begging my partner to go and find someone so I can get a private room. For a while he couldn't get hold of anyone. When he eventually ran into the midwife in shift he had to ask "what does she need to prove to get a private room?". I was desperate for darkness, quiet, and privacy to get into my zone. There was neither free room nor available midwife... (I was at St Thomas' in London for context, as busy as the traffic outside of the hospital). Around 7pm I was told "we know you prefer a room at the birth centre but there's an available room at the delivery ward". Desperate as I was, I agreed, naively believing that it wouldn't be any different. As soon as I entered the delivery ward room I was strapped to the machine and told to lie on my back on the bed to be monitored! I got confused, what happened all of sudden and I need to be closely monitored? I'm guessing that was the protocol of the room without exceptions... I had to argue to get out of bed as I literally couldn't breathe. With a bit of nagging they found me wireless straps so I could move around the room but the beeping of the machine is still in my ears. It undermined my concentration. I remember labouring with my fingers squashing my earplugs further into my ears. Between 8pm-11pm we changed three midwives; every time I was derailed from my concentration to greet and make introductions. I made a progress to 8cm but after midnight the contractions slowed down. By 2am I was exhausted and nearly lied down to sleep. Nonetheless, I was told that I wasn't progressing and for this I needed the artificial oxytocin and I was "advised" I'd better have an epidural as well because I wouldn't be able to handle it. This is what happened. From that moment onward, I gave up physically and mentally, sat in a chair waiting for the "science" to work. Bright lights came back on. 7am the next day I was 9 and something cm dilated. It was pointed out that 24hours passed by, kind of my time was up, and we'd better do a C-section... I was furious and utterly depressed... I was treated as a set of numbers that failed to deliver. If I only had asked what the alternatives to strep B antibiotics would be. If only I had stayed home to establish labour...  That became the goal second time around along with a very big scepticism about how effective the interventions for the sake of speed are. 

So second time around the ideal plan for me was to establish labour at home and go to the birth center of the hospital which is next to the delivery ward. This way, if any complications had arisen, I could be transferred to the delivery ward. An appointment with a consultant at about 20 weeks of pregnancy nearly crashed my dream. That consultant nearly bullied me. Although she listened carefully to my first birth story, basically me telling her that I was tripped over due to all the interventions, she didn't take it into account in her recommendations. She told me repeatedly that she had to protect the midwives and the other labouring women of the birth center from me because my scar might open! Surely I wasn't a bomb threatening other people's lives! She insisted that according to the guidelines I had to go to the delivery ward to be monitored by the machines. However she missed to tell me that the CTG is a very unreliable indicator of the scar opening. Furthermore, because I was in the 40+ years old category,  she was categorical that I needed to be induced at 40+3 days of pregnancy if labour hadn't started so that I avoid the chance of stillbirth. She missed to tell me that the probability was at most 1 out of 200. She also missed to tell me that an induction would lower my probability of a vaginal birth. However, she made sure to point out that other hospitals induce at 38 weeks. Apparently the limit of 40+3 came from the fact that my first child was born at 40+3. All this for 1 out of 200 probability of stillbirth which is defined as death probability at any point from 26 weeks onward and not death rate at 40+ week! If it was a lottery ticket, I would be certain that I wouldn't win the prize! All this put-down made me feel furious and depressed once more. I remember, right after the phone call, I went to find my partner and I started shouting in tears. It took him a while to understand what happened. Instead of being encouraged, I was scaremongered. I nearly gave up my ideal birth scenario and defeated I tried to come to terms with another C-section as I was sure that this would be the outcome of any intervention.  

In the meantime, I had decided to hire a doula anyway. Partly for practical reasons, to drive me to the hospital and be with me while my partner looked after our daughter. Partly, because first time around I missed the warmth of a friendly female presence during labour. My midwives were busy looking at numbers. A compassionate one came too late. My poor partner was also lost in that unfriendly environment worrying about me. Subconsciously I sensed that he would also benefit by a friendly experienced woman reassuring him that things would be alright.

Emily, my doula, very quickly sensed that I was defeated and had nearly given up my dream scenario. She listened to my first birth story, what the consultant had said, how I felt, and what I wished. Without me realising, she gently started coaching to make informed decisions about my second birth. Looking back that was exactly what I completely missed first time around. 

I found myself eager to understand my options, the pros and cons of each scenario. I'm thankful to Emily that she pointed out the full versions of NHS guidelines and other similarly reputable sources of information. I did my own research as well, reading reports by Harvard and Stanford Medical schools, Canadian and Australian midwives associations, etc. Thanks God I am a statistician and used to be a post-doc researcher, so I felt confident to interpret all the stats and their reliability (results based on experimental designs can be interpreted in the sense of x causes y but results based on observational data and cases studies should be carefully interpreted and can be biased in statistical terms).

I took notes and wrote down my questions ready for a true dialogue rather than being lectured at the second appointment with the consultant at 38 weeks. Thankfully I had a different consultant. He appreciated my homework, listened to me carefully, and calmly explained all the angles of each scenario to make sure that I was aware of all pros and cons. At the end he supported my decisions to head to the birth center and wait until my due date based on my period (which was 40+5 based on the due date calculated using the scan) before making any decisions about induction. What a difference! I felt listened to, empowered, and supported by the health system, truly being looked after as an individual rather than as a point of a statistical distribution.

My due date based on the scan passed by but I remained calm. From 39 weeks, the Braxton-Hicks became more frequent throughout the day, the tummy tightening lasted longer and during the night they felt even tighter and lasted even longer. They didn't go away when I was moving or changing position. I sensed that my body was getting ready. I could sense a change emotionally too. I became more easily teary and upset. So I thought, labour shouldn't be far. I kept the gentle walks, ate well, and had lots of sleep. I loved Emily's advice to not skip a meal and eat as if it was the last meal before labour!

40+2 morning came, which was when my water broke with my first one but no signs of labour this time. I thought that it was definitely time for a good long walk to nudge nature a bit! After a full day's outing with my partner and daughter in one of Cornwall's beautiful gardens, we went back home in the evening. I obviously felt very tired. I was tempted to skip supper and rush to bed but Emily's words echoed in my ears! We had supper and then I went straight to bed with my daughter for a bedtime story. I couldn't resist falling asleep next to her which meant asleep by 8pm! Whilst falling asleep, I felt very intense Braxton-Hicks, slightly different than before, but I ignored them to not get disappointed. Around 10:30pm I woke up and heard my partner heading to our bed. I came out of my daughter's room to tell him that I wouldn't join him until he turned off the light. Partly I didn't want to fully wake up and partly I felt strongly to stay in the dark. I snoozed and around 11:30pm whilst I was getting up out of my daughter's bed, I felt some tiny trickle. I immediately thought "this is very unlike me, it could be my waters". I went to the toilet, didn't feel anything more and went to bed with my partner who was about to fall asleep as well. 10 minutes later, I needed the toilet again and this time whilst getting up I clearly felt my waters leaking. After going to the toilet, I went back to bed with the intention to sleep to wait for the contractions. First time around there was about 4 hours gap between waters breaking and contractions. However, this time, after 5 minutes, the first contraction came rather strong that I needed to breathe through and couldn't reply to my partner's question "are you alright?". Still I was determined to sleep through the first contractions to save some energy. They were very strong though and lying in bed felt very uncomfortable. Kneeling over the bed felt better. In between contractions I was gathering my last minute stuff to be ready to go to the hospital when it would feel appropriate. I called Emily to let her know with the idea that probably things would build up by the morning. After about an hour, the contractions came thick and fast.

The bathtub didn't feel comfortable. The warm shower felt nice but the steam in the air made me feel uncomfortable to breathe. All I wanted was to walk fast up and down the corridor as if I was trying to escape the contractions. At the time I thought I was wasting my energy but went with it because walking fast felt kind of like pain relief. How bizarre! Looking back though, this walking might have helped the baby to "slot" even further down. Quite quickly I started doubting myself if I could make it. I thought "this is very intense, I don't remember it being that intense at my first labour, how can I go through half a day like this?". I had expected at least half a day of labour and hadn't believed that second time could be faster to avoid disappointment. My partner sensed that I was very unlike me and gently suggested to call Emily. I agreed for him to call her. I was trying to find the gaps between the contractions to breathe and rest but they felt lasting only a couple of seconds. I was struggling to cope thinking "why did I want a second child? I won't do this again", and for a nanosecond I wished I had opted for a C-section. Funnily enough, I immediately told myself off reminding myself that I prefer a day's discomfort to a C-section! Looking back, probably I was transitioning to the second stage of labour but it didn't occur to me at the time as I was mentally prepared for a lengthy labour. 

Thankfully Emily arrived super quickly. Later my partner said that it felt like she had been waiting outside of our door! At a moment of doubt and anguish, Emily reminded me to think of my safe place and that worked wonders. It distracted my mind from the sensations, and I could cope. After observing me for a while, she asked me if I thought we should go to the hospital. Probably it was obvious to her, but me still being fixated with the time / length, I thought "surely I am not in an established labour within a couple of hours and I don't want to go to the hospital to be told how to be". So I answered that I didn't know. Thankfully, Emily was proactive and told me that she would go downstairs to find my notes to have them handy and call the hospital as it would be no harm to let them know that we would be on our way at some point in the next hours. I agreed. 

Once she went downstairs, I felt the first very strong involuntary push! Unbelievably intense! I panicked as I sensed 4 or 5 more of those and the baby would be out in the bedroom! I shouted "she's pushing, we don't have time!" but Emily thankfully maintained a calm atmosphere. For a second I thought to give birth at home. I'm glad that Emily explained to me that it was very unlikely that there would be midwives available to attend a home birth. I'm glad that I gathered myself to make it to the hospital because in the end I needed medical support. Whilst the involuntary pushes continue, I struggled to get downstairs and then into the car. 

In the car, I didn't know what to do, to let my body do its magic or to hold back. Quite quickly, I decided to hold back until we were safe in a room with midwives. I didn't want the baby to be accidentally injured by delivering whilst we were driving or get cold by stopping at a layby 2am in the morning. Indeed holding back just enough worked and the pushes stopped. As soon as we arrived at the hospital, I half relaxed and intense contractions resumed at the entrance. Emily informed that she was told that because of staffing (and not because of my previous C-section) we had to head to the delivery ward rather than birth center. I wasn't disheartened, I was half expecting to defend the way I wanted to give birth (ie no straps attached to beeping monitoring machines, left in my zone) because the second consultant didn't put down in my notes that we had a thorough discussion, I understood the pros and cons, and for this he supported my choice of birth center.

I gathered all my energy to get to the elevator and walk down the corridor of the delivery ward to the room given to us as the contractions came back intense. Emily tried to advocate for my choice of birth center but the midwife was categorical that I needed to talk with the consultant in shift so that they made sure that I understood the risks. I wasn't fazed. Although I had imagined myself giving birth squatting or on all fours and dreaming of a birth pool, on the moment I felt that I wanted to be not just standing but also stretching my body upwards on my tiptoes. So I thought it didn't matter whether this happened, at the delivery ward or birth center. Plus I couldn't gather more energy to walk down the corridor again. I concentrated to get back to where I was in my bedroom with the involuntary powerful pushing. Thankfully it was resuming. It was very intense and I was probably moaning very loudly! Despite all, the midwife wanted me to lie down so she could do observations! There was no way I could physically change position! So I asked her to do what she needed to do with me standing. A minute later, it became clear to her as well that there was no time for observations. Something said which I don't remember but I remember myself saying "no straps please" and heard Emily explaining something but the words didn't make it to my brain. A few minutes later another midwife put the handheld machine on my tummy to hear baby's heart. I loved that moment, so heartwarming, I heard my baby's heartbeat, same sound as during the antenatal appointments. I found those moments tangibly connecting with my baby. There she was again on her way out! A few minutes later I saw with the corner of my eye a midwife on the floor waiting for the baby and heard her saying "can I have a second pillow please in case baby comes out fast?". I thought to myself "great! There is someone to catch the baby, I will completely relax now" and carried on stretching upwards on my tiptoes. After a few minutes, I felt the stinging sensation, so called ring of fire, but to be honest I didn't feel it in that dramatic way. It was just another sensation no more intense than pushing. I said out aloud "it's stinging" to let everyone know where I was and in a way to ring fence my "zone" and to be left in peace to deliver. After that, 2-3 more pushes and the head was out. I felt so relieved and happy but kept focused. By the way I was expecting that bit to hurt but it didn't at all. Next involuntary push and my baby was out!

How amazing nature is! I didn't push actively at all, I just didn't hold back. I let my body to take over! I couldn't be happier! I made it! Baby was born at 3.40am! 4 hours after waters broke! If I didn't have the car ride, it might have been even shorter! And as things turned out, no pain relief was used.

The placenta delivery was a bit complicated but after the birth high I wasn't affected emotionally! I lost about 2 litres of blood during the push stage (I glanced at the floor and it was indeed a pool of blood). The midwives wanted the placenta out quickly before my blood pressure got completely deregulated. I got two injections but nothing happened. Apparently the cord also snapped whilst a midwife pulled it. I didn't become aware of this as I was holding my baby girl admiring her. I had to go to the theatre for a manual delivery of the placenta. I was under full anesthesia for an hour. I also had stitches for a second grade tear which I didn't realise happening either. 

When I came around, I was told that I had fibroids in front of the placenta blocking it. I wasn't surprised about the fibroids as I was told so in the past. I was feeling very wobbly when standing or walking but alright to breastfeed my baby whilst in bed. My only regret was that I hadn't express colostrum before my due date for the odd occasion like the one happened to me. Not that the baby went hungry and it didn't have any impact on the breastfeeding thanks to my confidence (as I exclusively breastfed my first one in her first year) and the help of the midwives. It's just my baby didn't make the most of it during her first hour when she was fully awake and curious. 

I had to stay at the hospital for two nights to monitor my iron levels. Thanks to pregnancy vitamins I was getting from week 5 of pregnancy (which include iron) my prelabour iron levels were very high. So the blood loss led to a level where only  iron infusion (intravenous) was required rather than blood transfusion. Within a day after the iron infusion I felt steady on my feet and within a week I felt back to normal! 

I had the best experience at the postnatal ward. All the staff was professional and very helpful plus checking if I'd like some tea and biscuits in between meals even through the night! On the second night, they were very considerate to have one mum and baby in each ward (there weren't many of us it was Good Saturday) so that we all could get as much rest and sleep as possible. On Easter Sunday I had a very tasty roast dinner for lunch (honestly!) and then discharged. I was the happiest mamma on earth - car was full with two girls in the back!