All births are special but some are ground breaking and the women that strive for a different type of care deserve recognition for the work they have done to change the status quo in our maternity system.
T is one of these women. When I first me her through a mutual friend 5 years ago she was 6 months pregnant with her first child. T is clever, passionate and strong. I was dismayed to hear she had a long hard birth ending in a emergency c/s and upset to hear she had been let down by her doula and hadn't received the care she needed. Fast forward 4 years and T and her partner D approached me to talk about having my support as a birth doula for their upcoming VBAC.
Over the past 5 years I have supported other women to plan their births after a c/s. Some women opted for a planned gentle c/s, others went for home birth. All of these women felt dismayed with their lack of choice for a place to birth. There were two options available in our area, consultant led care (for vaginal or c/s) on the Consultant led unit(CLU) with no access to active birth equipment or water pool OR home birth.
Many of these women exclaimed their frustration that because of their high risk status they were denied access to the sparking new MLU (Midwife led unit), which opened in 2016, it boasts birth pools, mood lighting, active birth pads and beanbags and a 10 minute transfer to the CLU. It became a running joke in the Carmarthen positive birth group that only women with 'a golden vagina' got to birth in the MLU. As well as women planning VBAC's, women with high BMI, advanced age and existing medical conditions were also denied access.
The mothers that chose to home birth were frustrated that the narrow choice led them to birth in very rural area with potential transfer times of 40- 90 minutes. Many times I had conversations with Midwifes and Supervisors of Midwives expressing these concerns. In the summer of 2017 with a change of management which brought along positivity about normal birth for ALL women it felt as if the tide was turning.
After several discussions with T about having a home water birth she kept coming back to her real desire which was to birth in the MLU. This was partly to do with the transfer time being around 45 minutes and that there home was down a long woodland track and small so didn't have space for a birth pool. In September at 38 weeks we arranged a meeting with L (the Clinical led Midwife) S (Clinical risk Midwife) and P (T's consultant). We had a lengthy discussion about the risks of VBAC in the MLU including the non avalibility of Continual fetal monitoring, the transfer time and also that T's labour would be expected to progress at 1cm per 2 hours. At Plan was written and it was agreed the T and D were to have their VBAC in the MLU, THE FIRST TIME EVER
It felt momentous to me and I heard a collective sigh of relief from the potential women this would effect in the future. I'd like to recognise T's bravery in this meeting she wasn't put off or wobbled by the detailed explanations of possible risks and there consequences. She remained steadfast in her believe that her body could birth her baby.
I received the call from T on a clear starry October eve. T was 41 plus 2, surges were strong and every 2 minutes. I traveled to their home full of hope knowing this birth had the possibility to be both healing and transformative. T was on her hands and knees in their lounge, I worked with her quietly, massaging her lower back, and holding a hot water bottle on her back. The surges took her full concentration, there was a lovely purple line indicating that dilation had started!
We phoned the MLU and started the process of getting the truck ready, we made a dark quiet nest in the back where T could stay in labour land and I could maintain contact with her. The first part of the journey was a bumpy 15 minute ride through forestry tracks, hanging on for dear life this was extreme doulaing! T walked from the truck to the antenatal ward, they took one look at T and suggested we go straight to the CLU as the MLU wasn't staffed and the Midwives believed birth was imminent. T's noises hadn't changed to the expelling noises but we went to the CLU to be assessed. This was a disappointment as we hadn't expected this. On assessment T was 3 cm ( I really believe that the journey and being taken to the CLU had closed some of the opening that had happened).
T and D reconciled themselves to being in this room for a while, we were told that T had 4 hours to get to 4cm so we could go the MLU. That seemed really achieveable we made a nest on the floor with with blankets sheets and pillows, pushed the bed to the side and focused on oxytocin promoting activities. At 7 am we had a visit from the E the manager of the MLU who had just come on shift, the pool was filling the MLU was ready when we were- PURE JOY!!
T again astounded me as she walked the 5 minute journey to the MLU through crowded corridors and downstairs. Roaring with each surge she was primal! We got to the MLU and E had set up a lovely space, there was no pressure for vaginal examinations and the babies heartbeat was monitored very discreetly. At 12 co clock after 6 hours of wonderful, powerful, painful total focus taking surges T asked for a VE. Me and D waited for the results quietly (as T didn't want to know straight awy) E held up 9 fingers 9cm ,9cm!!!!!!! T you are fucking amazing!!!!The joy and elation filled the room, we all cried. I felt T an D's doubts dissipate 'Her body works… she CAN birth this baby'
The next few hours T was racked by the strength of her body fully opening and getting ready to meet her baby. The involuntary urges that over take birthing mothers became clearer and clears. T came out of the pool and walked and squatted following her body at first then following instructions from E. Unfortunately T's baby had two non reasurring heartbeat readings and alongside this and the length of the second stage E suggested we transfer to CLU. We were gutted, but it all happened very quickly and T and D were soon prepared for theratre, c/s and assisted delivery were discussed a whirlwind of medical people we could see her babies head, he was so close.
The next part I wasn't there for as our hospital only allows one person in theatre but T said after emotionally she had given up, she was knackered. The Midwife told we afterwards T's baby had been OP (back to back) and has his head tilted to one side, the doctors has used forceps and with T pushing aswell her baby had been born vaginally. Not the gentle MLU VBAC T and D had planned but a MLU labour and a chance at a normal birth.
As with all births that didn't go to plan T has some regrets, that she didn't dig deeper and find the strength to push her baby out herself. My belief is it was more to do with time limits placed on her and I remind her that by working with the Doctor she did birth her baby and just as importantly her choices for MLU birth were important and will be life changing for 1000's of other women.
If you would like to plan a VBAC in Glangwilli MLU (or anyother MLU!) heres some steps you can take to achieve it
Read the RCOG VBAC paper https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg45/
Join the VBAC UK fb group for support https://www.facebook.com/groups/149800885093152/
Attend a local Positive birth meetings http://www.positivebirthmovement.org/
Arange a meeting with the clinical lead/ risk mw (some areas have specialist VBAC clinics) as your MW about how to do this
Write a birth plan ask for what you want and plan for all eventualities
Attend a birth prep class or hynobirthing
Hire a doula, evidence shows doulas have a massive effect on reducing the likelihood of you needing a c/s www.doula.org.uk.
Here's what T had to say about her experience
We wanted to birth in the MLU as it offers more facilities than our home such as running water, inside toilet, birthing pools and 10 min transfer time. When i was initially assessed it was assumed i would have consultant led care in the CLU, I smiled sweetly and said thats my decision and I'm planning a home birth with possible transfer. We had already met with Staci about this birth which helped by arming us with knowledge of procedure and medical language. I cooperated fully with the consultant but resolutely insisted we didn't want to birth in the CLU unless it was an emergency.
Staci's support was amazing, she is totally non judgmental and very knowledgable but i think she was more surprised than me that they agreed to let me in the MLU! Once we got in the MLU our birth experience totally chilled, the pool, the dim lights, the midwife all eased me immensely. Staci's presence was very gentle, she really empowered us and also made us laugh which is really important. Each time i have dealt with the doctors at my births i have felt disempowered and not listened to. My transfer to the CLU made me feel as though I couldn't do it, they insisted i lie on my back, feet up, they even had the radio on, so insensitive. Staci was a brilliant buffer between me and them.
My husband was dubious about having Staci as our doula as she is my friend and we were let down by a doula friend at our first birth. She supported us all as a family and he really appreciated her efforts and being included in all decisions, she totally won him over! Staci laid out our options clearly and enabled us to take control of our own birth, her input was vital but subtle, and very thoughtful. I can't recommend Staci's doula services enough.
It makes me sad that I had interventions at the end and my recovery was impeded by that but my memories of the labour will always be of being in the pool in the MLU and eating homemade chocolate! To deal with the other stuff, such as surges in the lift and random members of the public staring at me, I just apply a sense of humour!