Rachel’s (planned & accidental) homebirth HBAC with midwives from West Suffolk Hospital in Bury St Edmunds

Rachel M talked about her experience of planning a homebirth after caesarean (HBAC) in a previous blog “Have you really thought this through?

Here she tells Cambridge VBAC Friends about the birth of her daughter, Lucy.

As 41 weeks arrived (41+4 by the scan), I was feeling pretty despondent. It felt like I was going to reach the hospital’s 42wk mark and have to go through yet more discussions on risk, even though my first child was born healthy at 42+2. That evening, I made my husband stop watching his film and come and cuddle up in bed, so that I didn’t just lie there fretting. Our daughter woke up shortly after we went up and asked for a big person to sleep with her, so I went in as I knew that my days of being able to do that were drawing to a close.

Stage one

I woke up at half twelve as my waters broke. Fortunately, we had waterproofed my daughter’s bed as well! I sent her off to get Daddy and a towel, and set about changing the bed. I left my husband to settle our daughter – who was wondering why Mummy had wet the bed and was now wearing a nappy (aka TENA Lady pants) – back to sleep and went downstairs. I put on the TV and got the big ball out to lean over as the contractions started. The timer on my phone showed they were about four minutes apart.

By half one, I needed the TENS machine so I woke my husband to help me put it on. Whilst he de-iced the car and made sandwiches, I called our doula, our friend who was to look after our daughter, and the MLBU. Contractions were about three minutes apart and a minute long but I could still talk through them, so I said I’d call the MLBU back in a bit.

Soon afterwards, I found myself urgently needing the loo. I spend a while labouring on the toilet, completely emptying myself. (I later found out that an OP baby tends to press on the bowels in labour.) My friend and my husband had a go at filling the pool but gave up, as it didn’t seem like it would be ready in time to be of any use. They did a great job of giving water, glucose tablets and encouragement instead.

My husband kept telling me not to push but I was starting to feel a bit “pushy” at times. (Having not really done many final stage, productive pushes last time, I wasn’t really able to recognise that whilst I felt a pushing urge, it wasn’t The pushing urge.) I was finding some of the contractions overwhelming and wailing like a steam train when I wasn’t able to keep my breathing steady. My husband phoned the MLBU again and they suggested I head in. However, I had now reached a stage where I was not confident I’d make it there in time and so I was too scared to get in the car. (It turns out it was an icy, foggy night and so our estimated 20-minute sprint there would have been much longer.) Now it was clear that the baby would be born at home, the MLBU called for an ambulance and two midwives. Although the community midwives had taken away their homebirth kit, we still had our sheets, towels etc ready from our original plan, and these came in handy.

The paramedics arrived first: two cheerful and chatty blokes. Fortunately I was done on the loo, so we went into the kitchen, where I laboured bent over the dining table in my leg warmers and a modesty blanket. I asked the guys to turn the lights back down and get the flashy, beepy machine out of my face, whilst they regaled us tales of their wives’ labours and sympathised about back to back labour… At that point, I set one of my playlists going. The best bit was that they brought the gas and air with them. Between us, my husband and I managed to ensure that I used it effectively but didn’t overuse it so I could stay lucid. (I was completely and unhelpfully boggled last time.)
At about half two, our doula arrived. The first thing she did was tie my hair back: a gesture of such female caring. She also started rubbing my sacrum firmly, which I found really helpful. I had her hand in one of mine and my husband’s in the other. I wasn’t scared at all about being at home. Everyone around me was calm and matter of fact about the baby being well on her way. The first thing I had told the paramedics was “I’m a VBAC” but they didn’t bat an eyelid and were happy to wait for the midwives to arrive.

End of stage one

The midwives had had quite far to come and so they arrived about half three. We moved to the cosier and more dimly lit lounge, where they examined me. I asked not to be told about my “progress” – last time it had been very upsetting to be told “only Xcms dilated” after I had been labouring for hours. However, the midwives found I was fully dilated, so our doula decided I would like to know that and told me (good call!). The midwives said I could push if I felt the urge to. I asked if they were absolutely sure there was no lip on my cervix. (My sister had been told she was fully dilated with a slight lip but that it was ok to push – this bad advice resulted in a hurried transfer from home to hospital and an episiotomy. An example of the history that we carry in with us.)

Transition

Unknown to me, the midwives had no gas and air with them but the paramedics kindly agreed to stay so that I could use theirs, bless them! There was, however, an issue with the tanks. The valve in the first tank froze, blocking the flow and causing that tank to leak and run out. The same thing kept happening with the second one, and I was vaguely aware of my husband trying to thaw it back out. It meant that we used the gas sparingly, trying to save some for later.

I laboured for a bit on the sofa but the idea of being on my back felt so wrong that I got up and bent over a tall chair. That was a really free position to be in, a kind of standing crouch where I could move in whatever way happened, the closest thing to the flexibility you get being in water. After about an hour, the midwives asked me to get back on the sofa so they could examine me. Although they were calm, they would have preferred to see more descent as the baby seemed to be going up and down. That was my first moment of slight worry: I was aware that baby descending and going back up is a potential sign of uterine rupture and therefore one of the factors that leads to transfer to hospital. Interestingly, at no point was I worried about my scar. There were two or three times when I remembered that I was supposed to be keeping an eye out for warning signs but I was generally a bit busy labouring! Clearly I didn’t feel any odd sensations worth mentioning.

In hindsight, I think that the hour between being found to be fully dilated and the final bit of pushing on the sofa was part transition/part labour, even though I was trying to push.

I felt I couldn’t do it and said so. I had discussed with my husband that I wanted it to be ok for me to voice this if that is how I felt, without people panicking or acting on it. We agreed that we would have a code word and that he would need to check with me three times that I really meant it before any augmentation was to take place. (In the event, we never got round to picking a code word, so it’s just as well we didn’t need it!)

There was genuinely a point during this phase when a c-section seemed like an ok option, to just get her out safely, and I might have raised it as a possibility had I been in hospital. Let’s read that again – I really did think that. Me, Miss Anti Unnecessary C-section. It just felt like I was not getting anywhere, that it wasn’t working, that the same thing was going wrong and happening again. It’s a real example of how doubt is part of this phase. I even muttered something about pethidine (me!), which fortunately they don’t carry. They said it was too late for that anyway. I was lucky enough to be surrounded by people telling me that I could do it, that I was doing it, and I shall forever be grateful for that.

I also wonder if this phase seemed “pushy” but “unproductive” was because the baby was turning, as she was not born back to back. Perhaps it was my body getting her in to a better position, i.e. working away doing exactly the right thing even if “nothing” appeared to be happening to the observer. I wonder if that’s what happened the first time round, which they counted as pushing time…

Birth

Now on my back on the sofa, the midwife held her fingers in the birth canal and asked me to push against them. Finally we saw some more consistent progress. I said again that surely being on my back was unhelpful but they pointed out that it seemed to be working, so just go with it! (A good example of how an idea about what is right might not actually serve you well in reality, however much it makes sense to your mind.) With my husband on one side and our doula on the other, I felt out baby move down and start to crown. Our doula reminded me that I wanted to feel the head (surprisingly squishy!), which I think helped me to believe this really was working. An absolutely brilliant tip our doula gave me for finding the right way to push was to make a fist, press the fleshy part below my thumb against my lips, and try and blow. Now we were getting there! The head was born and she stayed there for a few minutes, serenely getting her shoulders into place. With a big push and a gush, she shot out on to the sofa by my husband’s feet and immediately gave a cry. Lucy was here after just twenty minutes.

Straight up on to me, warm and slippery and alive and here. I couldn’t believe we finally had two children. A lot of cuddles and a little feed, before going to her daddy for skin-to-skin cuddles. Having slept through the labour, Rosie came down to finally meet her little sister.

Stage three

I was surprised as how uncomfortable this stage was. The paramedics had stayed to find out the baby’s name but then had had to go, taking the gas and air with them. After an hour of effort and discomfort, we agreed that syntometrine was a good next step. Even with that, it took some help from both midwives to deliver it. I was grateful it was done and I had avoided a transfer to hospital.

Another point where I think I was lucky was that my midwife was comfortable sewing up my second degree tear herself, whilst I was on the sofa. (I would have happily lain on the dining room table with every light on in the place had she said that position or visibility were an issue!) I actually sang through this bit, listening to some of my favourites blues tracks which are steeped in hours of blissful dancing memories. I suspect everyone else was just delighted to have something else to listen to, as due to a mistake on my part when setting the playlist going, we had listened to just one track on repeat for the whole labour…

Reflections

My sister said to me that this is something I will be proud of forever. She’s probably right. I have always wanted to birth my children under my own steam and did my best to make sure it happened this time. However, at this point in time, it is not having a VABC that stands out for me. I think that will float to the top over time. For now I am simply buzzing from having two children and not recovering from surgery. Honestly, I could skip (if it weren’t for my sorry perineum). It’s great. When I finally got off the sofa on Sunday, I went off to the loo. No loo paper. So I just walked upstairs to use the other loo, unaided. Simple pleasures.

Each to their own but for what it’s worth, here’s what I would recommend:

  • Get a doula. Just get one. I am convinced that I would not have had the c-section had I had a doula. They are there for you and your partner, and worth their weight in gold. Ours gave us information and reassurance before and during the birth, as well as attending a hospital appointment I had to bring my daughter to, so I could concentrate. She gave me feedback on my birth preference document, to make it shorter and less confrontational. An experienced and calm voice, with the energy to look after you and your husband. Get one.
  • Try that blowing into your fist thing for the final pushing if you are struggling. Worked a treat for me.
  • Most useful items: glucose tablets, bendy straws, incontinence pants, over the knee legwarmers, music you love love love.

COMING SOON! Rachel’s partner has written about the birth from his perspective and her doula has too.

If you would like to connect with other local women, like Rachel did, planning birth after caesarean, join our private online support group, you can read more about it on support page.

There’s research, blogs, birth stories and hot topics on the resources page.

And there’s FREE monthly face-to-face support at Cambridge Birth Choices free drop-in group, held on the second Friday of the month at Cambridge Women’s Resource Centre and the last Friday of the month at Satyam Yoga Centre.

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