I'm thrilled to be able to share this story from Jo, one of my clients. Being empowered by knowing the guidelines and the research, and having confidence her approach was more than reasonable, helped her to plan for a water birth at the local midwife led unit, even though her first baby had been born by caesarean. It is possible.
My first pregnancy was straightforward and I was planning a natural (pool) delivery with no intervention on the midwife unit at my local hospital. I wanted to birth my baby the way nature intended (albeit in a hospital) but without epidurals, drugs etc etc. All was looking good and there was no reason I could see this wouldn't happen. Other than the pool was busy. HA!
I went into strong labour following a dramatic 'movie style' rupture of membranes but there was some query about the baby's position so I went into hospital to be checked. It was quickly discovered that the baby was breech and I was told theatre was my only option. I was devastated, and I can still remember at the time thinking I would never have a baby naturally now I was having to have a caesarean. My labour continued fast and furiously and in the couple of hours it took to prep theatre I fully dilated. I felt then, and still do, that I didn't give birth to my baby but that he was removed from my body
Fast forward 15 months and I was pregnant. I attended my first consultant appointment and met a registrar who said I was a good candidate for a VBAC. I had presumed that my only option would be en elective caesarean so was keen to hear about this VBAC idea. The Dr described what would be a very medicalised birth on delivery suite with CFM (continual fetal monitoring), a cannula etc, medics on standby because my uterus could explode at any minute!!! I thought this was an excellent idea and agreed wholeheartedly - the Drs were going to save my uterus from blowing up. Brill.
So I went away and started what was to become a time consuming 'hobby' on VBAC research. I educated myself as best I could - I could recite RCOG guidelines, quote articles etc about VBAC. I built an idea in my mind of the birth I wanted and there was nothing that would stand in my way. I was more determined to achieve this over anything else I have ever done in my life. And I did - in fact it was better than I could have even hoped.
I did lots of things to educate myself and mentally prepare myself in order to help achieve my dream I studied. RCOG guidelines on Birth after Caesarian, research papers about VBAC, FOI request from the hospital about their VBAC stats.
I gathered information from the VBAC UK facebook support group. Highly recommend this - the group is full of highly knowledgeable women who can advise how to approach planning a VBAC when caregivers may not be aligned with your wishes and pit up barriers (Side note -be warned the 'Evidence Based VBAC group' is an American group full of trolls who bully and say terrible things to each other - avoid)
I did hypnobirthing to mentally prepare for labour and cope with labour - highly recommend.
Attended a vbac workshop and met Cathy! Say no more, she's brill. I toyed with the idea of a doula to help facilitate a VBAC but decided we would go it alone
Acupressure, acupuncture after 37 weeks for cervical ripening (what a phrase!) and baby positioning
Birth affirmations, relaxation practice.
Met the midwife in charge of MLU for a birth options meeting to discuss what I wanted
Daily 'lessons' for my husband so he knew what my wishes were and could recite the guidelines as well as I could. He was to be my advocate so he needed to know what I wanted and that I was relying on him to speak up for me (felt a bit nervous about that-no pressure!)
I was happier with a hospital birth as I felt I lived a little too far away from hospital than I was comfortable with if there was a problem plus I feel at ease in a hospital as I have worked in hospitals all my life. Probably felt more comfortable than home for that reason.
I learnt as much as I could about VBAC because the natural birth I wanted didn't really align with how the hospital usually wanted me to deliver. I anticipated a fight over certain things.
Essentially I wanted a pool delivery on MLU with no medical intervention, no cannula, no epidural, no VEs and intermittent monitoring. I wanted to be left to go into labour and planned to decline any form of induction including sweeps. From my research, this was the best way to increase my chances of achieving a natural labour.
They weren't happy about quite a few items on my wish list but what with all my research and with working in healthcare I was well aware of my rights to politely decline anything I didn't want. Although it did take some balls to say thanks but no thanks when a consultant is seriously trying to persuade you into having a sweep.
My birth plan stated all my wishes clearly.
The main sticking point was the monitoring. They really wanted CFM with telemetry if I was to get in the pool. On the day, luck was on my side and I did get in the pool but the machine couldn't pick up a trace so they had to accept intermittent monitoring anyway! (There was NO way I was being strapped to a bed on a monitor so it was intermittent or nothing)
Monitoring - From my research CFM offered little benefit at identifying a uterine rupture whilst increased the likelihood of a caesarean. Outcomes were just as good with intermittent monitoring so that was my preference.
VEs - I have a lot of strong opinions about how invasive and totally irrelevant and unnecessary they are so that was non negotiable not having ANY. Also lots of reasons why VEs can sabotage a VBAC attempt
Cannula - wasn't going to theatre so didn't need one! Having a needle stuck in my arm was over medicalising things for me and represented a lack of belief that I would be having a VBAC. They can put one in as and when they need to in my opinion.
Pool - I wanted to be treated like any labouring woman. Yes I'd had a caesarean, and the percentage chance my uterus would be absolutely fine was way in my favour. So I dint see a reason to get all twitchy about being in the pool.
On the day luck was on my side - I was only three days over so didn't have to fend off the requests to induce me etc etc, my labour progressed well, pool was free (!), midwives agreeable (sort of) and I got everything I wanted on my birth plan and more. I think it was in part my sheer bloody mindedness that there would be no other outcome I simply wasn't willing to entertain the idea that this was not going to work out, and things just fell into place for me. Maybe it was all the affirmations? Or I was just very lucky?
If you are planning a vbac and would like to have a water birth, or give birth at home or in the midwife led unit these are steps you can take:
Ask to speak to the consultant midwife. Request individualised care.
Write to the head of midwifery, with the expectation of support.
Point out that other units support this.
Highlight that it is your human right to choose which interventions/monitoring you will accept, where you give birth and to have the pain relief of water. To deny you access to birth pool for pain relief they could be in contravention of your human rights.
Seek support from online groups.
Seek support from local groups/people such as Positive Birth Movement groups, or a local doula/antenatal teacher.
Seek support from the PALS (Patient advocacy and liaison service) at your hospital.
Write to the chief executive of the hospital, cc to AIMS.
If you would like to know more about your options I have a page of links to research and articles, a free online recorded webinar about home birth after caesarean (lots that is relevant to vbac in other settings), and vbac workshops.
I am a doula and antenatal teacher in Bedfordshire.