This is the story of Sarala (and her husband Sajith), who had two VBACS in Cambridge, the first one in the Rosie Delivery Unit in 2013, the second one in the Rosie Birth Centre in 2015. Sarala has given permission for her doula Sophie Messager to share her birth story.
“For the birth of her second baby, Sarala hired several doulas to support her through her birth, myself, Maddie and Katie as part of a shared care team. Her second birth was attended by Sophie and Katie, and her third by Maddie and Sophie.
For the birth of her second child, Sarala and Sajith had originally hired us to look after their toddler and were planning to go to hospital on their own.
Sarala’s first baby had been breech and she’d had an elective caesarean. She was very disappointed to have to have a caesarean, as she had been preparing extensively for a natural birth. Because of this, Sarala didn’t want to write a birth plan for her next birth because she didn’t want to be disappointed again.
Sarala went into labour at 39 weeks on a Saturday evening. Contractions were spaced out at first, and they soon built up in frequency and intensity. I joined her shortly after midnight.
When I got there, contractions were about 30 sec long and 7 to 8 min apart. Sarala was leaning forward on an armchair during the contractions, doing some deep breathing. Sajith was close to her, massaging her back and hugging her.
The contractions spaced out, so we all went to bed around 2am. We got up again early in the morning, Sarala was coping beautifully, doing some lovely instinctive lunges during the contractions. Her contractions were 20 to 30 sec long but not yet regular.
I went back home to rest for a while in the morning. I rejoined them early in the afternoon, the contractions were still 8-9 min apart but Sarala was feeling a lot more pain.
Sarala was at the same spot by her chair, and dad was struggling trying to support her and entertain their toddler. I helped support Sarala with some back massage (she had a lot of lower back pain). Her contractions were a bit longer, 30 to 45 sec, and 5 to 7 min apart. I felt this was still fairly early labour and that things would pick up once their toddler had gone to bed in the evening.
Sajith and I carried on supporting Sarala through the afternoon. We used a heat pack for the back pain. She liked that and also asked me to massage her with it during and between contractions.
The second doula, Katie, arrived around 4pm and did a brilliant job entertaining their toddler which meant Sajith could concentrate on Sarala and we could take turns supporting her. We were using the heat pack a lot and I kept on running to the microwave to reheat it. Contractions were lasting 45 to 1 min and 5 to 7 min apart. I could tell Sarala was finding them harder to cope with.
I provided a lot of reassurance for both of them that things were normal and progressing despite the contractions not always being that regular. I told Sarala that she was doing really well and doing amazing instinctive moves: she was standing up during contractions, and doing lots of hip lunges and stepping movements. She said she didn’t know what she was doing and I told her her body did.
Dad and Katie took their toddler to bed and he was asleep by 7.30.
Shortly after that, as expected, things started to pick up. Contractions became closer to 1 min long and 4 to 5 min apart. Whilst Sajith and Katie were taking the toddler to bed, Sarala started to complain the contractions were too painful and she wanted to go to hospital for pain relief. I explained it was best to wait until she was in more advanced labour because otherwise her contractions might stop when she arrived there (I thought she still had a long time to go at that stage). I told her that during the next contraction I would try something new to help her. I did a technique called shaking the apples (shaking her thighs) and she said it helped.
I carried on shaking the apples, soon joined by Sajith and Katie. Sarala was kneeling forward on an armchair between contractions and starting to sit back, squat, then stand up bending forward on the chair during contractions. When she stood, Sajith and I shook one thigh each. Sarala said it really helped, and soon said she felt much better.
I had a strong sense that she was making fast progress.
Sometimes around 8 in the evening, Sarala’s waters broke and she said she wanted to go to hospital. We drove to the hospital (Katie stayed with their first child at home, providing some much-needed reassurance that he would be well looked after). Whilst we walked from the car park to the delivery unit (DU) she had about 4 contractions.
Once in the DU we got taken straight to a room. I asked for the pool room (Sarala was quite keen to try a pool) but we got told with VBAC using the pool was too much of a risk :-(. [Note: this was 2013, there is now a pool room available on Delivery Unit for VBACs]
The midwife seemed nice and caring. As expected for a VBAC (as per Rosie VBAC guidelines) she wanted to use continuous monitoring so I asked for a wireless unit (this was a totally new thing at the Rosie in 2013). The midwife examined mum by abdominal palpation and setup the wireless monitor but with the wrong kind of straps as she couldn’t find the proper ones. She said baby was a bit OP which fitted with the back pain and long, stop-start labour pattern. During the contractions Sarala got off the bed and stood leaning over it, and Sajith and I resumed shaking her legs. The problem is, this dislodged the monitor (the crappy straps didn’t help) and the machine kept losing the trace.
The midwife asked if we could stop shaking her and massage her instead for a while whilst she got the 20min trace, so I suggested we help Sarala onto the bed, kneeling and resting against the back of the bed with pillows. Even then the monitor sometimes got dislodged and Sarala found it so much harder to cope without the shaking.
Soon Sarala said she wanted pain relief. The midwife discussed gas and air and pethidine, but said she didn’t want to give her gas and air if she wasn’t 5cm dilated yet. As the contractions were 5 min apart, I could tell the midwife thought that mum was still in early labour. But having seen her labour develop, I suspected she may be much further advanced.
The midwife wanted to do a vaginal examination (VE) before agreeing to pain relief and mum agreed. When she took her knickers off there was a little bit of meconium on the pad and both Sarala and Sajith panicked a bit at that point, despite the midwife reassuring them that the baby’s heart rate was fine and that it might be old meconium.
The midwife did the VE and seemed very surprised that mum was “quite dilated” then announced 6 to 7cm. She also said she wasn’t sure if she could feel a head or a bottom.
So she got a doctor to do a scan. Sarala and Sajith and I had a bit of a wobble then thinking we were headed for another caesarean but the scan showed baby was head down. Phew.
Sarala was then given gas and air but soon said that it wasn’t helping and she wanted an epidural. The midwife said it was too late for pethidine.
I had a feeling at that point that Sarala was in transition (nearing full dilation). When her pad got changed there was fresh meconium and mum really panicked and shouted “get the baby out, get him out!”, I knew she was close to birthing her baby, because it is quite common for women to have big emotional responses during that stage of their labour.
The anaesthetist came and started setting up the epidural. I still had strong feelings mum was in transition. She was begging for the relief.
I told the midwife about my feeling and she took it on board and started to ask mum if she felt like pushing or felt pressure in her bottom.
Once the epidural tube was in place but no drugs had been put through the tube yet, the midwife did another VE and found mum fully dilated! She’d gone from 6 to 7 cm to 10cm in just a couple of hours.
At this stage I hoped she could just be left to push and the midwife suggested that it might be best to not give the drugs as the baby’s heart rate was dipping during contractions and the epidural could cause a drop a blood pressure and make things worse. She said she would need authorisation from the doctor to give the drugs. I was really hopeful by that point. Sadly, a more senior midwife came in to say it was ok to give the drugs and so they did.
Immediately after they started to coach her to push, telling her to hold her breath and push. Sarala was sitting on the bed at that stage.
The midwives weren’t happy with progress and there were dips in the baby’s heart rate so they put Sarala’s legs in stirrups and carried on coaching her to push. She had only pushed for 30 min or so when there were talks about her being a VBAC and not being allowed to push for long (Rosie VBAC guidelines suggests pushing for no more than an hour). They said they needed to help the baby out with an instrument and I asked did they mean forceps and they said probably a ventouse. I was still hopeful. A doctor came in and did a VE, and said “I’m going to do forceps”. He explained the risks and the episiotomy. I asked Sarala and Sajith if they were ok with that and they said yes.
The doctor applied the forceps, did a couple of pulls, and the baby’s head was out, he came face up.
I told Sarala and Sajith that the head was out. The doctor then took out the forceps and without waiting for next contraction, pulled the baby’s body out.
The doctor clamped the cord straight away and didn’t give Sajith the opportunity to cut it.
The baby was placed straight onto mum’s chest. It was just after midnight.
They gave Sarala a syntometrine injection without getting consent, and the doctor pulled the placenta out.
They then took baby to the resuscitaire to check him, he was ok and was soon returned to mum’s chest for skin to skin.
The doctor became concerned about Sarala’s tear and her blood loss and called another senior doctor in. They said she had a third degree tear, which needed stitching in theatre.
Sarala got prepped and wheeled into the theatre. Sajith was extremely worried for her (he wasn’t allowed in theatre, and neither was I) so I asked the doctor to reassure him that she was ok. Sajiith said I looked worried (I was very upset about how the birth had been handled) so I lied saying I was worried the stitches would make her sore.
We were left in the room, me feeling very upset and angry, and Sajith feeling shocked and upset too.
The midwife was concerned about baby’s grunting and got the paediatrician back in who did a heel prick sample. Baby perked up and the paediatrician wasn’t worried. But Sajith was really worried for both his wife and son at this point.
I told myself to put on a brave face for his sake and asked him if he wanted to hold his son and he said yes. The baby was alert and gorgeous, and rooting/sticking his tongue out. Holding him helped Sajith feel more calm I think.
After what felt like an eternity, probably around 2am, we got taken to recovery to meet mum. They said the repair had gone very well but she had lost 2 litres of blood and they needed to do some tests to see if she needed a blood transfusion.
Later, I went to give some of the cake I had made to the midwifes. I was angry at them for what had happened to Sarala but I thought anger isn’t going to help anybody here. So I went and gave them the cake anyway and it felt good to do that.
I helped Sarala put her son to the breast and I thought: at least this part is going to work. And it did. Baby latched on straight away and suckled like a champ. It felt good that something at least had worked well.
I drove Sajith home at 4.30am on Monday morning. He thanked me for my help. He also said he felt really upset. I told him I would be happy for him to talk about it at some point, and that it would be better to get it out than keep it in.
I got home at 5am.
I spent a lot of the next day crying for Sarala and what might have been instead.
Sarala ended up having to stay in hospital for 3 days due to blood transfusions.
After the birth I spoke to the Sarala and despite the outcome she was pleased she hadn’t had a repeat caesarean because she was much more mobile at this stage than the last time with a caesarean and that’s what she wanted, especially with a toddler to look after. She said she was glad I was there because if hadn’t been there they would have gone to hospital much earlier and would have probably had another caesarean.
Two years later, Sarala was pregnant with her third child.
She had reflected on what she felt had helped and hindered her last birth experience, and was very keen to avoid a repeat scenario, and therefore planned to give birth in the Rosie Birth Centre.
Sarala started having contractions at 41 weeks, around 6am on a Friday morning. We joined her about an hour later.
When Maddie and I got there, her contractions were already 45 to 50 secs and 3 min apart, so about 30 min later we went to the Rosie Birth Centre.
We arrived between around 8am and immediately got shown to a room close to the elevator to the DU (room 10-which is the room the Rosie tends to assign to VBAC mothers as it’s the closest to the DU in case transfer is needed). Sarala soon settled in, contractions were coming thick and fast and Maddie and I took turn in squeezing and rocking her hips with our hands or with a rebozo. I felt instinctively I didn’t want to shake her legs “apple style” because it might remind her of her previous birth. We starting filling the pool straight away.
Soon after the usual midwife checks Sarala got in the water (without asking anyone she just got in by herself really quickly), it was obvious she was in very strong labour and the water (and gas and air) helped a lot.
Me, Maddie and Sajith sat around the pool, me holding the gas and air to her mouth when she needed it, Maddie stroking her and offering her water, Sajith touching her shoulder. Things progressed very fast, she had a wobble (I can’t do this) around 9 or so, and then soon started to make pushy noises. She started putting her entire face under water during the contractions, blowing bubbles, I worried she was going to inhale water but she was completely fine.
Sajith was quite anxious, asking if things were ok, and we reassured him that things were fine and progressing as they should.
She pushed for about 20 min, being very vocal and loud and sobbing quite a lot, and around 9h45, the baby’s head was out already! There was meconium around his nostrils so the midwife pressed the emergency buzzer and asked for a resuscitaire. At this point I was worried because Sarala had said repeatedly she didn’t want any drama, and I thought oh dear here comes the drama! But no, the midwife passed the baby between Sarala’s legs and let her recline back in the pool (she had been pushing on all fours), and let her hold him for a minute or so whilst she clamped the cord (Sajith got to cut it this time), so she could take the baby (who had started to cry before the clamping) to the resuscitaire. Thankfully baby was fine and was returned to Sarala pretty soon.
Sajith hugged me and I sobbed. I couldn’t help myself-it was such a relief!
Sarala got out of the pool and to expel the placenta (Sajith handed me the baby to hold at this point which was very sweet).
Then Sarala sat in bed with baby skin to skin and had some proper cuddles. They stayed there for a while, the midwife checked Sarala and she had a tear that needed stitching but nothing serious. The midwife did the stitching in the room.
We had tea and cake and a lovely time talking about how much nicer it had been this time.
I felt such joy for them that they got to experience a positive, empowering birth. It was a very healing experience for them, and for me.
The next fews days we got texts from Sarala:
Hi Maddie and Sophie, thank you so much for everything. We decided to stay over at it was so relaxing. We will be going home soon, after baby check is done. such a different experience, I still can’t believe it! Many thanks again, lots of love, Sarala
Hi Sophie and Maddie, I just wanted to say thanks again for your help. you guys really helped us a lot and exactly what we wanted. Thanks again for making that experience magical! Sajith”
Since Sarala’s births in 2013 and 2015 there is more choices at the Rosie Hospital for VBAC women, for example, there is now a newly furbished pool room available in the Delivery Unit, as seen in Chloe’s birth video.
If you want a midwife-led VBAC at home or in the Rosie Birth Centre, talk to your community midwife at the earliest opportunity and she will refer you to the Consultant Midwife clinic for an individualised care plan.
Support is also available in our online peer support group.
There’s FREE monthly face-to-face support at Cambridge Birth Choices free drop-in group, held on the first Friday of the month at Hinchingbrooke Hospital Huntingdon, the second Friday of the month at Cambridge Women’s Resource Centre and the last Friday of the month at Satyam Yoga Centre.