Wednesday, 12 March 2014

Not just "the VBAC lady in room 5". Planning the birth of baby number 3.

When your're expecting your first baby you probably fit into one of three categories when it comes to planning the birth; "Natural as possible", "Go with the flow", or "Just give me everything"!! But after the first baby everything changes and the experiences from previous labours impact on planning for the next. If you started from the "Go with the flow" perspective and had a straight forward birth I suppose its a simple case of doing the same again. Perhaps you planned for every pain killer under the sun, had a complicated delivery and you feel a planned c-section is best for your second labour. For me, I started with the "Natural as possible" perspective but have gone on to have two reasonably complicated labours, leaving me with a variety of risks factors. However my thoughts on birth still lean towards as natural as possible and now I'm trying to find a way to balance my risks and obstetric history against my ideal birth. Mostly I'm hoping for a positive birth experience and a positive post natal recovery.

My first baby was born by c-section. I was 42 weeks pregnant when I went into labour, at least according to my 12 week scan. I'd declined induction and went into labour spontaneously. As I'd planned a home birth my midwife asked me to still go in for the monitoring scan arranged the day before as part of my post term care, so in early labour I spent 2 hours on the maternity day unit waiting for a scan that showed "everything was fine". I was allowed home to labour, but I'm sure the upset slowed down my labour considerably, my plans for early labour where bath's, mobilisation, bouncing on the ball and aromatherapy... not the waiting room of the maternity unit! During the afternoon the midwives arrived at our house and within a couple of hours it was established my baby had a high heart rate and I was rushed into hospital. Once in hospital I had an epidural, waters artificially broken and a hormone drip all designed to speed up my labour and get baby out sooner as her heart beat was so high. Ultimately they didn't work. Her heart rate got higher and they decided a c-section was the only way she was getting out in enough time to not end up really poorly.

How I spent my first labour

Knowing my second baby would be a VBAC (vaginal birth after caesarean section) I did plenty of research and planning before hand. I swapped hospitals and arranged a birth plan to give me more freedom of movement that would normally be "allowed" during a VBAC. But the baby was back to back. I went into labour only an hour after going to bed, but ended up with a long latent labour where it took many hours to be properly in labour, a lot of which I spent lying on my side in the hospital bed trying to rest. I'd agreed to 30 minutes on the CTG monitor when in established labour. Established labour didn't happen until 12 hours or more after I began contracting. So once on the bed with the CTG running and gas and air, having only had 1 hour sleep in the past 30 hours I stayed there. And baby stayed back to back. When I started pushing the midwife told my mum and husband that it would take a while and offered to make them a cup of tea!! When the baby started have drops in his heart rate and they got the doctor I'd already given up and told them to "just do an instrumental". He was born by forceps, facing upwards having never turned in labour. Following his delivery I had a PPH (Post Partum Haemorrhage) and lost a lot of blood. I went on the have some retained products which gave me an infection a couple of weeks after delivery and eventually required an operation.

Moments after the delivery of my second baby. 

I'm definitely not "low risk" any more. When you've had a c-section there is a scar on your womb which can rupture. One of the most common signs (though not the only sign) of this is changes in the fetal heart rate which is why they like to monitor you during labour. There's also a risk of the same things that happened in my second labour happening again, another back to back baby and the need for forceps and another PPH. To prevent baby from staying back to back and from that impacting on the labour I believe I need to be upright and mobile and not on the bed. But this is in conflict with the need to be monitored on the CTG. Yeah, you can move around near the bed space with the CTG machine on, but you have nowhere near the freedom you would without it.

So this is my conflict. The circumstances of my first labour mean constant monitoring is recommended. The circumstances of my second labour mean the best way of preventing history from repeating itself is to be upright and mobile. If I am not monitored I increase the risk a rupture isn't picked up straight away. If am not mobile I increase the risk of slowing my labour and ending up with forceps again. I need to find a birth plan and a birthing location that allows me to balance these risk factors.

My risk factors mean that I am recommended to deliver in a hospital consultant unit. There often appears to be a certain high risk attitude on a consultant unit. Women are there with risk factors and abnormal is the norm. I become extremely compliant in labour and adapt to the environment. So if they are expecting to put me on a bed with an epidural and a CTG I don't tend to fight it once in labour, however I felt about it before hand. There is also a higher chance of interventions in labour when on a consultant unit and I want to avoid as many interventions as possible, especially another instrumental delivery.

Although I'd still very much like a home birth I am worried about having a PPH at home. When I was in hospital all I did was lie in bed hugging my newborn while the hospital staff stopped the bleeding and set up drips and such. I don't remember it being that traumatic as it was all dealt with for me. Where-as if it happened at home and there was a need to transfer in I can imagine it being all the more traumatic. Also, I don't have a special bed at home, with a special blood catching bucket underneath!! Another factor against home birth for me is that I am loud during labour and the children would be at home, albeit in another room. I thing it could be distressing for them.

But a Birth Centre attached to a consultant unit, now that appeals. Delivering in a home from home environment, but just a quick ride to the consultant unit if I need it. The biggest problem is that generally Birth Centres don't accept you when you are not low risk. Where I used to live, when planning my second birth I was told "no". I could deliver at home against medical advice, or I could deliver in the consultant unit with certain restrictions (such as I wouldn't even be allowed in the shower during labour). It felt as this amazing natural supportive birthing environment of the Birth Centre was reserved for these specially privileged women who were "low risk". The rest of us had to go and do as we were told in the consultant unit. I don't know if it was the case but I felt as if all the natural birth resources and attitude was reserved for birth centre and that it wasn't allowed on the consultant unit. How could I ever get a natural birth when the resources and naturally minded midwives were reserved for women in the birth centre? My response was to refer myself to another hospital which just had the one unit and didn't segregate the services and had an all in one unit. Yeah, they had all the resources in one place, but the room had a normal labour bed and a CTG machine and somehow I just ended up towing the line.

I want to have my baby in a place where I feel safe. I want to be able to make a birth plan before and for that plan to be considered important. I want the staff and the environment to be able to make that birth plan a reality if the labour progresses normally, and to preserve what they can if things go wrong. I don't want to fight during labour. I don't want the institution and the environment itself to be against my plans and lead me down a route I didn't plan. If the labour changes my plans then so be it, the safety of me and baby is what's most important, but the expectations of how a woman "should" behave in labour and how a certain type of birth should be, should not impact on my plans. I'm not just "the VBAC lady in room 5".

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