05 Dec

Book Review: Vaginal Birth After Caesarean

Vaginal Birth After Caesarean: The VBAC Handbook, by Helen Churchill and Wendy Savage, is a neat little book absolutely packed with useful information for mothers considering a VBAC, and those supporting them.

It is worth reading just for its forthright introduction explaining exactly why the authors choose not to adopt the tentative and controlling jargon often used by health professionals. The careful use of language in the book is in itself empowering.

Reading this book, I learned that 70-80% of VBACs are successful; that the risk of VBAC is lower than the risk of a planned Caesarean; and that the reasons commonly given not to “try” to have a VBAC do not appear to be evidenced across the board. Even the section dealing with higher risk groups shows that in most cases a VBAC can be possible.

The second part of the book includes several VBAC stories, not all of which were successful; however the stories demonstrate and affirm the wide range of experience even within this segment of birth and labour.

This is a useful and succinct guide, and I highly recommend it.

To order aginal Birth After Caesarean with a 25% discount, just follow the link and use the discount code KH25 at the checkout.

19 May

Paul’s birth story

Paul is a web designer and a dad.

Crowborough Birthing Centre is a relaxed, midwife-run ward which is ideal for natural deliveries without medical intervention, and it’s also where we’d decided that Relly would give birth. We planned a relatively easy labour, using hypnobirthing to control the pain caused by the contractions. Or the “discomfort” caused by the “surges”, as hypnobirthing would have it.

Relly knew the baby was on its way when it shifted to an uncomfortable position and the surges started for real (there had been a few days of ‘practice’ surges beforehand). We headed to the birthing centre at about midnight on June 25th, over 24 hours before Toby was born. By the time we got there Relly was suffering with severe back pain caused by Toby’s unusual angle, so the plan became to try various things to get him to move to a more normal position. Unfortunately, hypnobirthing only takes care of the usual pain associated with labour, and not the type caused by this kind of complication, so this was agonising for Relly.

We put some relaxing music on and ran a huge warm bath, and the mother-to-be spent the next few hours manouvering into various positions to try to get Toby to take his weight off her spine. By the morning there was little progress, and we both tried to get some rest before trying a walk around the car park and nearby streets as this can also help Toby align himself properly. I dare say the “getting some rest” was easier for me than for Relly.

The hours were ticking by and there was still no sign of Toby having corrected himself. Early afternoon came, and Relly was still in a lot of pain from her back. None of the midwives could offer any further help. It was looking more and more like some kind of intervention would be needed, such as breaking the waters that protect the baby to speed up the labour and hopefully move him into the right position for birth. The downside to this is with no comfortable internal water-bed to ease the baby’s movements it could get even more painful for the mother.

Whatever we chose to do at this stage, Crowborough was no longer the best place for us as there was a good chance we’d need facilities they don’t offer. At 4pm Relly transferred to Eastbourne DGH in an ambulance with its lights flashing, which she describes as both exciting and incredibly uncomfortable for somebody in labour!

The transfer also meant a change of caring staff, and after an hour at Eastbourne the new midwife transferred us to our delivery room and examined Relly. Shortly before 7pm Relly’s waters broke (its a common misconception that this is always the first sign of labour, though if you’re “lucky” enough to have it happen in M&S you’ll apparently be treated to £250 of vouchers for your trouble!), and there was a considerable increase in pain as Toby virtually landed on Relly’s spine.

Relly was doing so well with no pain relief, and the hypnobirthing was working better that we’d expected on easing the labour pains, but the complications had become so painful that Relly opted to have an epidural – anaesthetic injected into the spine which causes complete numbness.

In preperation, the midwife rigged up a drip and inserted a canula into Relly’s wrist, unfortunately missing the vein and pumping fluid into the flesh of her arm! I was first to notice this and, not being great with needles, first to need a seat to avoid passing out. The midwife hastily removed the drip and moved it to her other wrist, where the same thing happened again!! Having run out of wrists to try, she just gave it another go in the same one. Relly’s poor wrists were bruised for days.

By 8pm, the anaesthetist had been and gone, pleased that Relly had waited until after the football finished before requesting an epidural. He had to apply the anaesthetic after a contraction, but like all the medical staff was amazed that Relly was showing no signs of contractions thanks to the Hypnobirthing, and he needed her to tell him when to inject it.

At 9pm the night team came on shift – Hooray! More examinations for Relly! But the epidural had kicked in and things seemed to be getting easier. The hours still ticked by, and after 10pm a by-now-exhausted Relly was given syntocin to speed up the contractions and force Toby into a birthing position.

An hour later, 11.15pm, and Toby was in position but lifting his head to avoid coming out! Unfortunately, all this time the only way the midwives could tell Toby’s position was to do their James Herriot impression, and by now everybody had wanted a go. Between them they couldn’t decide what else to do so they called in a consultant who arrived at 12.15am.

The consultant had a go too, and with all the bedside manner of a doctor with a phobia of bodily fluids, suggested a cesarian section. Relly had been awake and in labour of some form or other for the past 40 hours, and was too exhausted to be giving birth. But without the luxury of a choice, we agreed to the c-section.

As I followed Relly’s bed being wheeled into theatre at 1.30am, it dawned on me that the complications were resulting in a serious and unplanned emergency operation, and that if things continued to go wrong from here it could be tragic. The morbid thought hit me that I could be going home alone.

At 1.45am Relly’s drip failed because the drugs were making her shake uncontrollably, and theatre assistants rushed around to attach a new one.

Ten minutes later, what they term “knife to skin”. I hadn’t realised how violent this would be. I was sitting next to Relly’s head as she was strapped to a bed, and behind a curtain the surgeons were slicing her tummy open with less care than you’d use to carve the turkey at Christmas. There was lots of yanking and pulling, and although Relly could feel no pain she described the sensation as if somebody had put their hands in to do the washing up.

At 2.10am, Toby was born. He was cleaned up internally and externally (he had swallowed some fluid) and passed to me to show Relly, who was still semi-conscious and strapped to the bed. She managed a smile and a “Hello Toby” with a tear in her eye, and then I was whisked off to a ward while they took an hour stitching Relly up.

So there I was, on my own for the first time with my son. My Son. What do I do now? This was a completely unfamiliar situation. I was tired, but I’d been through nothing compared to him and his mum, who still hadn’t really seen him properly. I sat with him on my bare chest for a while, hoping to see Relly soon. The midwife came and weighed him and took some measurements.

Newborn Toby meets mummy and daddy When Relly was finally wheeled round on her bed, she was so exhausted that she just wanted to be asleep. I knew how important it was for both her and the baby to have immediate contact, so I put him in her arms for a few minutes and she took a bit more time to say hello. There would be plenty of time in the coming days and weeks to get to know this little stranger who had come into our lives, but at that time both mummy and baby needed to sleep, and we were all relieved that the ordeal was over.

And from that moment on we’d always an “all” rather than a “both”.

Originally posted at @niceopaul

15 May

Helen’s Birth Story

Helen has really benefited from all the support from Karen and would like to share her story with readers to prove that difficult starts don’t mean difficult babies

Every story has a background so here is ours. Lynn and I met in 2001 and had a shotgun wedding in December 2011 when I was 30 weeks pregnant. Marriage had always been in the plan but on finding out just how important it was to the future of our unborn child that we were married, we quickly planned a small wedding with immediate family and very close friends, which meant that Lynn would be named as a parent on the birth certificate rather than having to adopt the baby. Lynn hates it when I say we got married for the legal reasons, of course we didn’t, we are very much in love but other things had always been a priority, however, once we were made aware of this important factor marriage somewhat became the priority.

So you have probably realised that our baby was not conceived in a traditional man + woman + good times = baby, kind of way! Our baby too has been born out of love but with the additional help of an amazing selfless anonymous donor. We chose home insemination, and you can imagine the happiness, excitement and shock when it worked in the second month of trying when we had been told it was so much harder to conceive a child in this way.

So the baby was growing, and the due date was set, 24th February 2012.
Except our baby had no intention of making it to the due date!

On the 30th January 2012, I was just finishing getting ready for bed, pregnancy had been uncomfortable now for a couple of weeks and although I loved every moment of being pregnant, bed and night times weren’t my favourite times of the day, no longer able to turn over in my sleep, throughout every night I also endured the discomfort of having to wake to a fully conscious state to turn over and regular bouts of night cramps in my legs which were excruciating (these were however the only pregnancy symptoms I suffered so I am not really in a position to complain). So in reality I had not slept well at night for a couple of weeks and was getting used to napping in the day to catch up on those missed z’s. However this Monday, I had spent with my parents and had not had the regular nap that I was used to so I was exhausted.

I finished brushing my teeth and in my nightie stood by the bed ready to take on the challenge of removing my socks, I leant over and I heard a pop, my mind suddenly flashed back to our 34 week appointment with the midwife who had said ‘sometimes you hear a pop and then you have a few seconds to get to somewhere that you are comfortable with you waters breaking’! I rushed to the bathroom, made it on to the loo and then they went! My mind then flashed back to an NCT class, ‘most women’s waters don’t gush, many just trickle or seep and some don’t go at all’ Well mine certainly went, with a whoosh, I was blown away by the amount of water I was losing, in fact a little concerned, I checked the toilet for blood, but it was clear. Relieved, I called to a sleepy Lynn, ‘babe, my waters have definitely broken, you better call the hospital and your parents’.

Oh, I forgot to mention, I did have one other complication in pregnancy, gestational diabetes, we had been warned that this would have some consequences on labour, I couldn’t use the birthing pool and would be constantly monitored throughout labour as my blood sugars would be unpredictable so we were going to write our birth plan around this. I also had been informed I was likely to have a large baby possibly over 10lbs and that they would recommend an induction on the due date if the baby hadn’t come due to the risk of being oversized.

Yes, you read correctly, we hadn’t written a birth plan, we had an appointment to do this with the specialist midwife on the 1st February 2012.
So here I was, pretty unprepared, sat on the toilet, wondering what was going to happen over the next few hours and when I would get to hold the baby we had both longed for so many years. We had chosen at our 20 week scan to not find out the sex, so that too was on my mind, would we be meeting our son or daughter? I was excited, terrified, happy, sad, concerned, anxious, and overwhelmed all at the same time, thank goodness I had Lynn there to support me through the next 30 hours!

Lynn’s parents arrived to look after the dog and I was bundled in to the car sat on several towels as I was still leaking lots of waters and we had been told that the smell of the waters is hard to get rid of. A ten minute ride that I barely remember got us to the hospital and I was taken into an assessment room.

Still leaking waters I stood ashamed in the middle of this baron room while my waters dripped all over the floor, however this was met by some very friendly faces, who clearly were used to this kind of behaviour on a daily basis and reassured me it was ok and sat me on the bed.

I was strapped to a machine which quickly gauged the babies heart beat, had my blood pressure, pulse, and temperature taken and was told they thought I had some kind of infection which meant that although I wasn’t in established labour they wanted to keep me in. Then I was scanned which they struggled to get a decent picture from as I had lost so much of the fluids from the baby. I was experiencing very mild period like pains, which the Doctor informed me were moderate contractions so I felt confident that I would be able to cope with labour with little pain relief.

Lynn and I had discussed the labour on many occasions, I was adamant that I did not want an epidural, diamorphine or pethadine, I was going to do this naturally with gas and air and maybe a Tens machine. I had downloaded and had been practising hypo-birthing for a few days and was confident that this would get me through the worst, whilst Lynn supported me emotionally. We had learnt massage and breathing techniques at our NCT classes as well as some tips on good birthing positions and I was an astute birthing ball user. This was all going to help me, and the baby would be out in no time I reassured myself.

Sat there excitedly waiting for the Doctor to come back and give me an examination, I imagined being told I was three or four centimetres and that things were progressing nicely, however I couldn’t have been more wrong. After the most painful horrendous experience of my life so far the Doctor looked at me and said, ‘your cervix is still high, hard and not open at all’ to say I was disappointed was an understatement, I had assumed that as the baby had broken the waters my body would have naturally responded to this by getting ready to have this baby.

By 4am I turned to a shattered Lynn and told her to go home and get some sleep, things weren’t moving quickly and she looked exhausted, the midwife agreed that it would be best for Lynn to go get some sleep so she trundled off into the cold night.

Although I tried hard to also get some sleep this was very difficult, not least because the nurses were in and out every hour checking me and the baby because of the infection. I was also far too excited to sleep, we were finally going to meet the little person that had been growing inside me for 36 weeks, who I had felt wiggle and squirm, experienced every single hiccup with them and already loved them more than anything else in the world. Although I was worried that they were coming early the midwives were not and reassured me that at 36 weeks everything would be developed and that the baby would be fine.

At 8am a familiar face appeared back at the door, I had missed Lynn so much over the last 4 hours, not being able to share every thought I was having was hard, but she was back, and she wouldn’t now leave me again until the evening after the babies birth (38 hours away!)

Nothing much happened over the next 5 hours, I had a wash, sat on my bed, bounced on my ball, Lynn and I talked excitedly of all the dreams we had for our baby. By 1pm the midwives and consultants decided to induce the labour as it was not progressing in the way that it needed to considering the infection and lack of waters. A pessary containing inducing hormones was inserted and I was told to sit tight for 24 hours as that is how long it is likely to take.

Well 30 minutes later I was experiencing ‘proper’ contractions, to say they are painful is an understatement but they are a special kind of pain, knowing that each one is bringing your baby closer to being born makes them somehow more tolerable.

Over the next 8 hours I had many many examinations, Dr’s came and went with and without teams of students, I cant tell you how many different professionals had a look, a squeeze and a feel of me inside and out! By my 3rd examination I was an experienced user of gas and air which made them slightly more comfortable.

At 4pm the pain had become unbearable and I found myself taking the advice of the midwife and having a shot of diamorphine the first thing on my list of ‘nevers!’
Diamorphine actually turned out to be a very good decision, they gave it with anti sickness medication so I didn’t feel sick at all, it gave me a chance to relax and even have a few minutes sleep, the only negative side effect to me was that it made my skin super sensitive and I couldn’t bear being touched by anyone which was upsetting for Lynn and my sister Lauren who had by this point turned up with some lifesaving pants and nighties for me.

Lauren stayed for the duration of my labour, offering the emotional support to Lynn that I couldn’t give and allowing Lynn to take time away from me just to grab food and drinks etc. Although Lynn and I had decided that the birth was going to be something that we would experience alone, Lauren was fantastic and like many pre-birth decisions that change when you are actually in the middle of labour we are both eternally grateful for her support throughout the birth of the baby.

The monitoring of the baby was pretty much constant throughout the labour, and twice during my labour I was prepped for surgery to have a c-section as the babies heartbeat was dropping throughout my contractions, however just as I was about to be wheeled down, an ‘emergency ‘ took priority over me the first time and the baby suddenly showed signs of recovery the second time making the consultant change his mind.

Finally at 1am on Wednesday 1st February 2012 I was 10cm dilated, to say I was elated was an understatement, I was exhausted by now but so excited knowing that the baby was very nearly here. Oh did I mention that I also had an epidural at 5cm dilation, another one of my ‘nevers!’

Epidural actually was no where near as bad as I thought it was going to be and actually when you are experiencing such a drawn out labour it was a god send, I wouldn’t recommend it if things are moving along swiftly but as pain relief goes I went from agonising contractions to total calmness through a mild tightening. I had always assumed that epidurals numb you from your neck down but the one they gave me only numbed me around the tummy and I could still walk about with it in. The biggest downside was the catheter that I had to have put in due to the epidural.

At 2am I started pushing, I had received a top up on the epidural so it was hard for me to feel the contractions and I was relying on the midwife telling me when to push as she was feeling my tummy. After 2 hours and many more visits from consultants the baby had decided that they actually didn’t want to come out after all and yet again I was prepped for theatre, they were going to try forceps but if these didn’t work after 3 attempts then they would give me a c-section to get the baby out.

Leaving Lauren in the delivery suite Lynn got all dressed up for theatre (again) and I was wheeled a short distance down the corridor, I was transferred onto a theatre bed which was agony as the epidural had worn off and I was mid contraction as they moved me. They then topped up the epidural and this time numbed me from the boobs down in case they had to perform a c-section.

Before I knew it my legs had been strapped behind my ears and I was surrounded by a huge team of medics. I looked down to see the Doctor who had completed my first examination back on shift and about to deliver our baby.
I remember being told to push as the midwife was feeling a contraction and then our baby was born, so quickly and with only minimal force from the forceps, the baby was lifted over and a member of the team said to Lynn ‘tell her what it is then’ all Lynn at this time could reply was ‘it’s a baby!’ she was so overcome by emotion it hadn’t registered that it was a little boy. ‘It’s a boy’ she exclaimed several moments later, tears flowing down her face.

A side effect of full epidural is full body shakes and it was as a result of these that I didn’t feel comfortable holding our son straight away, this was probably my biggest regret as what happened next will haunt me for ever.
Lynn was cuddling our son, we named him Sebastian later on, but he was nameless at this point. I was delivering the placenta and being sewn up as I had to be cut due to the forceps. The paediatrician came over and said she needed to check him over as he was ‘grunting’. Not thinking anything of it I agreed to be wheeled to recovery while Lynn waited with Sebastian.

I was lying in recovery when suddenly this little bundle came my way, he was placed on my chest and I took in the biggest breath and smelt him for the first time, he smelt amazing, the NCT class leader had said that your baby would smell amazing but until you experience it you will never understand. As soon as I had taken this first breath and placed a gentle kiss on his forehead the Dr whipped him away saying he needed to receive some oxygen in special care, and just like that he was gone!

Lynn and Lauren went up to special care and took some photos for me but nothing was filling the hole in my heart that needed to hold my baby boy, I was sobbing uncontrollably that I just wanted my baby but no-one would bring him back to me.

I was transferred to the ward and immediately requested that I was wheeled up to the special care unit. Lynn grabbed a wheel chair and we wet up to Buscot ward. I had been told that Sebastian just needed some oxygen so imagine how I felt when we got up there to find him covered in tubes and monitors with tubes going in his mouth and nose.

I burst into tears and a Dr came over who told us that Sebastian was actually quite poorly, he had respiratory distress syndrome and they were giving him antibiotics because of the infection that I had. He was struggling to maintain his blood sugars and wasn’t able at this point to maintain his own body temperature due to everything else going on for him. They thought that they may have to ventilate him later on as he was struggling to breathe so much, but they were monitoring this.

We couldn’t cuddle our son at this point, just place our hands in his incubator which was upsetting as he flinched every time we touched him. We were taught to do a ‘containment cuddle’ where you cup his head and bottom in each of your hands and gently push in, this mimics the womb and he didn’t flinch away from this kind of touch.

After around an hour we went back up to the ward, feelings of concern, despair, worry and fear filled what should be the best time of our lives. We were on a ward with another lady who had a baby in special care which was nice for me as it was hard to see other ladies with their babies when ours was in special care, it also gave us someone to talk to who was going through exactly the same thing and feelings.

We went back up a couple of hours later dreading the worst, but we were delighted to find that he had not been ventilated and infact they had reduced the levels of oxygen he was receiving as he was doing so well, although we were still unable to have a proper cuddle we left that visit feeling much happier.

The midwives in the special care unit had suggested that I hand express my colostrum for him as he would really benefit from this as he was only on a glucose drip in the incubator.
Hand expressing is an interesting task, and with all the will in the world I just couldn’t do it, even allowing a midwife to ‘milk me’ at one stage in an attempt to get some nourishing goodness for our son. Lynn pooped home and brought back our electric pump which worked a treat. It was still hard work and the stuff is so sticky its hard to actually collect but I did well and was regularly expressing about 0.4ml which I eagerly ran up to Sebastian and left it on his incubator for them to feed through his nose later.
This continued for a couple of days and my milk came in on day 3.

Sebastian was getting better and better each day, day two came our first cuddles which were amazing and my first few attempts at breast feeding. Something I knew I wasn’t going to give up on (and did succeed with a little help from a special breast feeding counsellor a few days later, a different story!)

And by day 4, I was lying on my bed, expressing milk preparing to go and see Sebastian when he was delivered down to me. The best moment of my life so far! Although again overwhelmed as I just stared at him for about an hour in total silence wondering how on earth I was going to look after something so little (he weighed around 5lb 9oz) I knew that the baby shaped gap in my heart had just been filled and it was time to be a proper mummy.

Sebastian is now a healthy 9lb, 12 week old baby who is thriving in everything he does, he brings joy to everyone that meets him and has a smile that could melt an ice cap.