Quick, intense, powerful, empowering – just a few words to describe my vaginal birth after caesarean (VBAC) home birth.
I was labelled ‘high risk’ as my twin girls had been born by caesarean three years before. The chance of my uterus rupturing in labour was 1 in 200, so I was advised to give birth on a labour ward with continuous foetal monitoring and close to an operating theatre. I initially planned to follow the hospital protocol and planned to birth on the labour ward where I worked as a midwife, to be cared for by my colleagues.
And then I took the KG Hypnobirthing teacher training course which changed my birth plan completely… I had the opportunity (away from busy work and my even busier life at home with my twins) to really think about the birth I wanted. I returned home to my husband and suggested we have a home birth, expecting him to be fearful of the risks. Instead, he said, “Why didn’t you think of it before?”.
I understood the small risk of uterine rupture and the potentially catastrophic consequences, but to me the risks of birthing on the labour ward felt greater. I was all too familiar with routine procedures for VBAC women on a labour ward and the likely cascade of interventions – nil by mouth, continuous monitoring, pressure to have an early epidural (just in case I had to have an emergency caesarean), potentially a hormone drip to speed up slowing contractions, foetal distress… Instead, I trusted that my body could do it if I was supported to labour in my own home in my own way – I was fit and healthy, the uterine scar was small for my little premature twins, it had most likely healed well (no infections), this pregnancy was straightforward, and we had a healthy baby on board.
At work, the more junior doctors were shocked I would “take such a risk”, but surprisingly the consultants were more supportive.
We found a very experienced team of home birth midwives to look after us and felt very supported by them. We attended their 3-hour hypnobirthing class which, although far less in-depth than the KGH course, kept me on track and ensured my husband was on board. I saw a consultant obstetrician who was dubious of our home birth plan, but she knew I was making an informed decision and did not try to change my mind.
We ordered a birthing pool and I spent quite a lot of time lying down with my eyes closed and listening to a couple of hypnobirthing CDs. I almost always fell asleep half way through and was not 100% confident that my mind was taking in the information! Nonetheless I was confident I would be relaxed in my labour and was feeling very positive and looking forward to the big day.
As my due date came and went I became more impatient and apprehensive about the prospects of a postdates induction and having to birth what felt like an increasingly large baby. I was becoming fed up with friends, family and complete strangers asking when I was due and whether I was having any signs of labour. This made me tense and I opted for a membrane sweep at 41 weeks – I considered it better to give my body a kickstart and reduce the chance of an induction.
The sweep followed by manically running up and down the stairs, bouncing on the birthing ball and vigorous hoovering appeared may have been the trigger. A few mild period pains came and went that afternoon. Then the following afternoon whilst out in a faraway country park alone apart from my daughters and with no phone reception I felt twinges and realised I had started having surges, albeit irregular and lasting only 10-15 seconds. I thought I had better drive home! I told my mum and she said she would take the girls to stay with her for the night. It felt a little unnecessary as I was convinced my labour was some way off and would probably take a long time – my body had never laboured before after all.
However, by the time my mum arrived at around 8pm, my surges were getting a little stronger and longer. My husband and mum seemed to be taking forever to get the girls ready to leave and I became pretty irritable, asking when they would go. She had thought I was in a bad mood and being rude but hurried them out of the door anyway!
I left my husband watching the World Cup and went into our bedroom with the birthing ball, closed the curtains and put one of the hypnobirthing CDs on. I just felt like being on my own. I had done some pregnancy yoga classes and tried out every birthing ball position I could remember but when any surge came I felt really uncomfortable with all of them. I knelt on the floor leaning over the bed for a while and finally curled up on my left side on the bed. I replayed the same track on the CD again and again. During the surges I could only concentrate on slowly breathing through them, but when they subsided I was able to listen to the words for a short while before falling asleep, only to be woken by the next surge. I had no idea how much time was passing but it can only have been an hour before there was a sudden gush of warmth between my legs as my waters went.
I shouted for my husband and asked him to check my waters were clear (no meconium) and to time my contractions so he could call the midwife and let him know what was happening – I did not want to be timing them myself as I wanted to be ‘in the moment’. They were happening every 5 minutes at that point. My husband was also running the bath for me as the pool was taking forever for him to inflate (it turned out he was using the deflating pump rather than the inflating one!). The midwife said all sounded positive, to get in the bath and to call him again in another 45 minutes. My husband returned to fight with the pool.
My surges quickly became more intense and one after the other. I found it difficult to get off the bed but managed with a lot of willpower. On getting to the bathroom I felt nauseous and leant over the toilet for a while although was not sick. I then sat on the toilet and felt I needed to open my bowels and did a little. The feeling of needing to poo is similar to that of the head coming down, but I thought surely not, I cannot be so close to having the baby yet. I had what felt like seconds between each contraction and each surge seemed to last a long time – perhaps 90 seconds or more. The thought crossed my mind that what if this was too much for my scarred uterus to take, but there was no pain in between contractions or other signs of uterine rupture so I pushed the thought to one side.
I got into the bath and crouched down just where I had stepped in, loving the sensation of warm water around my belly. My husband called the midwife again just 15 minutes after the last call to tell him the surges were becoming much stronger. The midwife said he was coming. My breaths were long and loud, but I did not care whether the neighbours could hear me through the open window, I felt quite proud of what I was doing. The surges were becoming so unbelievably intense and I had a little panic that I would not be able to continue if they remained this way for hours and hours. I checked myself (I am a midwife after all!) and my cervix was paper thin, around 7 cm dilated and the head was so low. My husband rubbed my head and hand – any other touch irritated me. With the next contraction the head was coming down and I could not quite believe that it could be happening already. I grabbed my husband’s hand so that he too could feel the head coming. He called the midwife again who said he was putting his foot down, advising my husband to call for an ambulance.
During the next surge I felt the head push through in one quick movement and the feel of the head between my legs. There had been no burning or sharp pain as I had expected to feel. And with that the contractions stopped dead. My husband who had been on the phone to the paramedics and trying to remember my age (he was a little tense!) checked they were on their way and put the phone on the floor. We could not quite believe the head was already out! I then sat back in the bath in what felt like the natural position to move into.
The midwife shouted through the open front door around five minutes later and came bounding up the stairs. I was so relieved to see him. He sat at the foot of the bath, said hello and just smiled the most reassuring, happy smile. I had been panicking that I had had no surges since the head had come out but he said not to worry. Almost immediately I could feel the baby’s body turn inside me which was the most surreal feeling! The midwife suggested I stand up and he gently released the shoulder of the baby by pulling the head slightly towards by rear and out slid Alexander. I sat back in the bath and there he was screaming up at me for just a second before he relaxed into the outside world, completely alert and beautiful. It was 11.22pm, around three hours since my daughters had gone and two hours since my surges had ramped up.
The paramedics appeared although in that moment it didn’t actually click who they were. I wondered whether they were journalists for some strange reason and I remember giving them a slightly confused look. One of them turned on the bathroom light which felt harsh and artificial. My husband quickly asked him to turn it off and I loved him for that. The paramedics stayed on the landing, waiting to see if they would be needed and soon left.
I opted for a physiological third stage and the three of us sat chatting for some time. The cord pulsated until the last bit of blood had transferred into Alexander. The midwife then clamped and cut it (my husband did not want to and I was not bothered at the time although actually later wished I had). I then felt a horrible period pain-like surge and I think the placenta separated at this point. I did not have any urge to push and so stood in the bath to see if it would come that way, still holding Alexander but with two sets of strong arms close by in case I felt unstable. The placenta came out.
The water was getting cold and there was no hot water left in our water tank, so they helped me out of the bath with Alexander still in my arms, we got onto the bed and were covered with dry towels.
The midwife checked my perineum and I did have quite a big second-degree tear, but he was able to suture it then and there on my bed – my husband made himself very scarce at this point making the tea. I used the gas and air throughout and was as high as a kite! I can really understand how beneficial using gas and air could have been during the labour, but it was not to be for me as it had all just happened so quickly.
We then drank tea and ate biscuits whilst Alexander had his first breastfeed. The atmosphere was so happy and relaxed. The midwives then went downstairs to write their notes and left my husband, me and Alexander to be alone. It was magical to think that in just a few hours our son had made his way into the world and it had all happened in our own homely space.
I do wonder whether Alexander’s birth experience helped him to be such a calm and contented baby and how much his sisters contributed by being such a constant source of entertainment for him!