Wednesday, 26 February 2014

A photo post :-)

Some photos from my vbac:

Christmas day - 40 weeks pregnant exactly

In the birthing pool

My darling husband holding me up


Meeting our baby girl for the first time...

... and then suddenly realising what I had just done. Such a blurry photo, but I love the pure emotion captured here!

My beautiful vbac baby, 9 days old!

Happy family

To midwife or not to midwife... and the truth about interventions

So the default childbirth 'attendant' in South Africa, even for a low-risk pregnancy and birth is a gynae (technically an obstetrician, since they are there in an obstetric role, but we all call them gynaes anyway). Why would we need a doctor when we are pregnant? We treat pregnancy as some kind of disease, as a medical problem to be fixed, and yet we are often healthier pregnant than at any other time in our lives, barring those with true medical conditions.

In a low-risk normal delivery, a gynae is called by the hospital midwives when you arrive to give birth, and is then periodically updated until they decide a C-section is 'required' or you are ready to begin pushing and they arrive to catch the baby. A hospital midwife is usually allocated to you while you are in labour, but will leave when her shift ends and another midwife comes on duty. Before you go into labour, you see your gynae every so often for 10 - 15 minutes at a time for a quick scan, and to get your urine and blood pressure tested.

In contrast, you see your midwife for an hour at a time before giving birth, she meets you at the hospital when you arrive (assuming you're having a hospital delivery - but at least you have the option of giving birth at home with a midwife), spends as long as necessary with you and you will only see her during your labour. By then you know her and trust her, as you have spent so much time with her, and she is able to encourage you in a way that is meaningful to YOU!

The contrast between the amount of time spent and the amount of money you pay for each boggles my mind! My entire hospital vbac birth (hospital stay, midwife, paediatrician and lab tests to check if C had jaundice) cost almost as much as the gynae bill alone of a friend who gave birth a couple of months before me.

But what if something goes wrong?

Firstly, something is a lot less likely to go wrong if you leave your body to birth naturally. No induction, no augmentation (to strengthen contractions or speed up labour), no pain medication. Yes an epidural is a wonderful invention - but its also likely to slow your labour down at best and can possibly stall it altogether, especially if you get it too early. Gynaes generally have much less experience in natural, normal birth than a midwife, and so tend to not trust the birth process quite as much. They get nervous when a birth isn't happening quite fast enough, or when fetal heartrate decelerates (totally normal during a contraction).

Unfortunately, one intervention tends to lead to another. You get induced because at 39-odd weeks you think you've been pregnant long enough (because, of course, pregnancy only lasts 40 weeks at most. If you are pregnant longer than your due date there must be something wrong with your body). The Pitocin you are given comes continuously, unlike the bursts of oxytocin that your body naturally produces, which causes extra-strong and extra-long contractions and your baby may struggle to recover in between contractions (usually a C-section will be recommended). Pitocin may cause placental abruption, uterine rupture, laceration of the cervix and hemorrage after giving birth, and also causes more painful contractions, so you ask for an epidural.

The epidural inhibits the production of a number of key labour hormones, increases the length of your labour (by up to 7.8 hours), increases your risk of a C-section by 2.5 times and increases the risk of pelvic floor problems (urinary, anal and sexual) after birth. Women who have been given an epidural are often confined to bed, instead of allowed to labour in the position most comfortable to them. Since they are lying on their back, their baby is 4 times more likely to turn posterior, decreasing the chance of a natural birth. Epidurals also cause immune suppression and decreased  heart rate, blood and oxygen flow in babies, and can be present for up to 36 hours after birth (similar results are seen after a C-section, often leading to sleepy babies and breastfeeding problems). Babies who are exposed to anaesthesia may also be less alert and active for up to a month after birth.

All of this is much more likely if you are giving birth with a gynae.

Midwives have seen natural births so often - they know that you can do it! And because they know what a normal birth is supposed to look like, they also know what its not supposed to look like, and will be able to identify a (true) problem quicker and more accurately than a gynae. Gynaes spend much more time practicing their operating techniques than observing natural births, and are so adept at 'picking up problems' that they often anticipate them before they even occur, leading to the interventions that so often cause more problems than they solve.

And if something does go wrong, your midwife would call your back-up doctor (or the on-call doctor if its in the middle of the night). Just like the hospital midwives would call your gynae if something goes wrong during your gynae-assisted birth. My back-up doctor knew when I was in labour, and phoned my midwife every so often just to check on how things were going - if I had a problem, she would have been there just as fast as if I had been her own patient.

I understand that in higher-risk pregnancies, more specialised medical observation is required, but a normal run-of-the-mill pregnancy is best handled by the people who specialise in normal, natural births - a midwife! She's cheaper, spends more time with you and is more experienced - its a win-win situation all around!

Thursday, 30 January 2014

It's hard not to compare...


Its been a month today and its so hard to not compare...

Last time at a month in, I was still recovering. My scar twinged when I stood up, and hurt when Sophie kicked me. Obviously! My back was killing me. I had a colicky, miserable baby with a bad dairy allergy that hadn't yet been diagnosed. Because of that, she hardly slept, and only ever on me - so I was getting 2 or 3 hours of broken sleep a night. I was still hurting at the fact that my birth plan had gone so horribly wrong and struggling with the baby blues. I adored my baby, but didn't yet feel like she was MINE. I didn't know how I was ever going to go through that again, although I have always known that I wanted at least 2, preferably 3 children. I didn't want to see people and I was hiding out in my house for a while to come still. When I did see people, I felt disconnected from them and battled to make conversation.

This time, I have no pain (my tear took a couple of weeks to feel 100% again, but nothing compared to a C-section incision). I can cuddle my baby and toddler without any fear of being kicked anywhere. Charlotte is a peaceful, content baby with no allergies and wakes once or twice a night - I cannot say that is definitely from her birth, but babies born naturally are less likely to have allergies. Even with 2 kids under 2, I am still getting far more sleep this time around. I have had the odd day when I felt a bit down, but on the whole I am still on an absolute high from my amazing birth experience. Charlotte has felt like MINE since the moment she was born, and it has been such a joy to bond instantly with her. I was ready to go through pregnancy and labour again from when she  was only a couple of days old (As my doula says, a good birth experience is addictive). And I've been out and about since the day after I had her, just a few hours after arriving home from hospital. I've really enjoyed spending time with friends.

I can't help but feel that her peaceful birth - in water with very dim lighting while I was surrounded by people that I knew and trusted, feeling emotionally and physically safe - has contributed to her peaceful nature. I don't know, but I can't help but compare.

Friday, 10 January 2014

Charlotte's birth story ... my very long vbac story


Charlotte (or Bean, as we had been calling her for the past 8 months since I found out I was pregnant) was due on Christmas day, but I wasn’t expecting to have her anytime early or too close to my due date since my body so clearly wasn’t ready to give birth when I was induced at 39+1 with Sophie. I had a healthy pregnancy and had really enjoyed being pregnant this time, and was in no hurry to have her out – plus I was hoping for a January baby (just so that she’d be one of the oldest children in her class once she starts school, rather than the youngest, and also so that her birthday was further away from the hype of Christmas) but like any pregnant woman, by the time my due date arrived I was just so excited to meet her and I went to bed each night wondering if tomorrow would be the day I woke up in labour.

A couple of days past Christmas I found out that the people we had arranged to look after Sophie when I was in labour were now going camping in the Berg for 5 days (without so much as an apology or explanation), which left me bitterly disappointed and stressed about what we were going to do with her, since I really wanted my mom at the hospital with me. My positive, calm state of mind was totally broken and I spent a couple of days worried and in tears. Thankfully a long phone call to my sister helped me to put things in perspective, and I realised that there was no point in worrying about what could not be fixed or planned for. I planned to speak to a couple of people the next day about being a back-up plan for us depending on when and what time I went into labour.

The next morning, Sophie woke up wanting a bottle at 3:40am. I could feel from as soon as I woke up that something was different - I was feeling contractions! They definitely weren't braxton hicks as I felt some pain, but they were still quite manageable. I rested for a while after that but Soph woke up again half an hour later, and then as soon as she settled the alarm went off, so no more sleep! I didn’t want to make a big fuss over them as I was terrified that they were going to fizzle out, so I just stayed as quiet as I could for a while and tried to see if they were regular but without timing them.

I started timing them soon after 5 and they were about 10 min apart, so I messaged Leigh (my doula) to let her know soon after 6. They were getting a bit closer together and more intense but I was still quite comfortable, so we went to church (where they spaced out a bit) and I just told Noel that there was no way we were staying for tea afterwards as I didn’t want to talk to anyone! I was trying to keep my day as normal as possible, and keep my expectations low, although I was SO excited that *just maybe* my baby was on her way. We went shopping after church and had a quick brunch together. After I mentioned to Noel how afraid I was that they might space out further and stop, he asked if we could invite friends over that evening for a visit… He got in a bit of trouble for even thinking about it! 

Once we got home, they started becoming slowly more intense and closer together again, but still quite manageable. I finished sewing some letters for her room (realising that I might never do them if I didn’t finish them then!) and checked that our bags were all packed. At some point I let my midwife, Arlen, know that things had started  and through it all, I kept messaging Leigh. During the morning, she sent me a very encouraging message about how I had fought so hard for so long to be allowed a trial of labour, but now I didn’t need to fight any more – I had my team around me, and they were there to support me. Much later I decided to go down to see Arlen and get checked so that I knew how I was going - I still hadn't asked Leigh to come because I was coping fine although I had started having some that were almost a minute long and I had to vocalise (like breathing really loudly) through them.

When I saw Arlen at about 4:30/5pm, she confirmed that baby was lying nicely (not pushing on my scar at all) and her heart rate and my blood pressure were fine, and then she checked me - only 1cm, but fully effaced. I was a bit disappointed because the contractions were fairly intense and it had already been quite a long day so I was hoping I would be further.

She told me to go home and start power walking, and go to the hospital when my contractions were 5 minutes apart and 1 minute long for at least an hour. So I messaged Leigh on our way back, and she came and joined us at home. We walked around the neighbourhood until it got dark. That made the contractions quite a bit more intense, and Leigh was worth 10 times more than what we paid her in rubbing my back, helping me breathe more effectively and suggesting different positions to cope with the pain and to help baby drop a bit more.

My mom had cooked supper (her and my dad had been there all day and they were staying the night so that they could watch Soph when we went to hospital), so we all ate and then started timing contractions again around 8:30. By the time we'd done half an hour of timing it was very clear that they were closer to 3 min apart on average, and some even as long as 90 seconds, and getting really painful. I relied on Leigh a huge amount to get through each of them. So we packed the bags in the car, phoned Arlen and headed off to the hospital.

The contractions were coming every 2 minutes during the drive - that was horrible! They were much easier when I could move a bit to ease them. So I was very relieved when we arrived at the hospital, and after having 2 contractions outside before we even made it into the building (with 2 teenage girls watching – I’m sure I scared them from ever having children!), we made it inside. It was about 10:30 by the time we made it into the delivery room and Arlen hooked me up to the monitor to check on Bean’s heartrate and to do an internal. I was 2cm.

It was tough. I was exhausted after such a long day, the contractions were very intense and I didn't know how I would cope if they kept getting worse - and if I had to do this through the night as well! Logically, I had at least 8 – 10 hours left. Leigh kept me focussed though, and we had a bit to do like monitoring the baby through some contractions to check she was responding ok (not too good when I was on my back, but when I lay on my side or sat up she was fine), then Arlen gave me an enema (such a relief, because I kept feeling like I needed to go but there wasn't too much time between the contractions and I didn't really feel like pushing).

I then decided that we needed to do something, and it felt like maybe she was in a bad position and that's why things were taking so long. So I did some research on spinning babies to hurry up a slow labour and found what they call the roll-over
. The roll-over is 8 different positions which you have to hold for 3 contractions each, which gradually rolls you over – and in the process allows baby to move around – out of a bad position if need be, or simply to explore different positions that may make descending easier.

At 12:30 Arlen spoke to my back-up doctor (who had been busy in theatre at another hospital) and she wanted to know how dilated I was. So Arlen checked again, and I was now at 3cm. Making progress, but still so far from where I needed to get to.

Leigh and I then started doing the roll-over. We had done 1 position on the floor using the birthing ball, and 2 on the bed on my side when I started to fall asleep between contractions and the contractions really slowed down. In my memory, it feels like they had spaced out to about 15 minutes apart, although Leigh later said she thought it was more like 5 minutes apart. I vaguely remember Leigh asking me if I wanted to go on to the next position and I said no (because I wanted to rest a bit more). The whole time, she was helping me through each contraction by pushing on a spot in my lower back, or by rubbing down my back - you cannot believe the difference it made!

At some point I remember her taking her hand off my back and I think she turned to speak to Arlen, and as she released her pressure I felt a contraction hit like I was in a head-on collision. That woke me up pretty quickly! I shouted and she whipped her hand back pretty quickly, but that was the most intense contraction yet. Then as it was tapering off, I suddenly felt like I HAD to go to the toilet, and I needed to push right then, lying on the bed. I assumed the enema was having a delayed effect and I hadn't yet got rid of everything
J


Arlen and Leigh looked at each other, and I could see they were a bit confused. I know that you get an urge to push at the end, but I really thought my body was totally messed up and was trying to get me to push when I was only 3cm (maybe 4 at best). Arlen checked me again, and as she was checking she said, 'if you're a good 6cm, then you can get in the tub'.

I didn't watch her, because every other time she had checked it had been bad news, but Leigh said you could see her reach in, and feel a bit, and then she stopped. And then she tried feeling all around. Eventually she pulled out and she looked at me. 'Well', she said, 'I think we need to phone the doctor’. My heart sank.

... and then she carried on, 'because I think we need to tell her to come watch a water birth'

I looked at her, very confused!

'You're 10cm', she said. 'You need to get in the tub'

As she said that, another contraction hit, and I pushed on the bed some more. It totally took over my body, so that I don't think I could possibly NOT have pushed!

As soon as that contraction stopped, I got off the bed as fast as I could (with help from Arlen and Leigh), stripped off (I had bought a costume top to wear, but at that stage I was quite happy to not put it on - thankfully between Noel, Arlen and Leigh they found it and put it on me) and managed to get into the pool with only 1 more time of pushing (standing on the floor in the middle of the delivery room - I half expected my baby to just pop out!)

My first photo in the pool was at 1:30, so it was less than an hour from 3 to 10cm.

Through most of the time we’d been at the hospital, Noel had been staying out of the way, sitting on the floor and talking every now and again but not too involved. He was exhausted though, so at about 12:30 someone suggested to him that he go have a nap in my hospital room (there was no one else in there at the time). He spent the next (almost) hour taking bags backwards and forwards, to try sort out my things, and was just about to go to rest when I started wanting to push and we discovered I was 10cm. Thankfully he was still there, I don't know how I would have been ok without Leigh for long enough for her to go call him

Once in the pool, I struggled to find a comfortable position for a while. The water took away all of the pain of a contraction, but the pressure felt overwhelming. I have seen photographs of women kneeling upright, but that just felt all wrong to me, so eventually I realised that I was most comfortable almost lying down, floating in the water. I couldn't stand if my sacrum touched the bottom of the pool though, so Leigh called Noel in to hold my arms and support me. He was an absolute rock through this time, kneeling on the floor next to the pool and holding me up the entire time. I could hear him panting with the exertion every so often, but he never complained and kept telling me how well I was doing (and ended up with a bruised chest the next day, for his efforts).

The contractions came very close together at this point, and in each one I would have the urge to push about 3 times. I wasn't sure how to push though, so I'd push a short while and then stop as soon as the urge stopped. Leigh then stepped out of the way, and took my camera from Noel (we discovered that I had left the SD card at home though, so we could only get a maximum of about 20 photos – ironically I had 2 sets of spare batteries packed!), and Arlen came and knelt in front of me.

After a while of me trying to push, I realised I wasn't getting too far on my own (I think I also expected her to come out much quicker, without realising that she still had to be pushed all the way down the birth canal – for someone who had done so much research before the birth, I really wasn’t thinking while it was all happening), so I asked Arlen to talk me through how to push more effectively. That was a lot harder, but it wasn't too long and I could feel her crowning. Ouch!! Each push, I could feel her pushing out and the skin stretching, and then she would go back in again. Again, I felt like I wasn't doing something right, as if she should somehow just pop out - actually, doing that part slower can be a very good thing, because it gives the skin time to stretch and makes it less likely to tear.

The pushing was the most incredible work though, and it really took every second in between to try recover and build up strength for the next one. Serious puffing and panting to get some oxygen back in my system! Soon after 2am, I was doubting whether I was ever going to get her out - I asked Leigh how long it was going to take, and I checked with Arlen that it was now definitely too late for a caesar - I want to laugh when I think about it now!

I remember her head coming out about 3 or 4cm, and then slowly going back in between pushes. Then I asked Arlen how many contractions it would probably still be, and she thought 2. Well the very next one, I could feel her head coming, and Arlen just kept telling me to push, and eventually I just felt this whole warm soft squishy head pop out - at that stage there was absolutely no pain, it was just a pleasant, warm, gentle feeling. The next pushing urge came soon after, and Arlen again was telling me to just keep pushing, and suddenly her shoulders were out and then Arlen handed her to me and I had a baby. Charlotte Elizabeth Noelle was born at 2:10am, exactly 22 and a half hours after labour began.

It took a couple of seconds to register, and then I started laughing/crying - it was just the most incredible feeling to meet her after such a long, difficult day and all the effort that it had taken…

And then I realised - I did it!!! I fought so hard for my vbac, and I really did it! That triumph was mind-blowing!

We lay in the pool for about 45 min (Arlen had another birth in the room next door), Noel cuddled her but no one took her away from me. I just stared at her and soaked in the moment. From the very first moment, she felt like mine – that bond that I had expected when Sophie was born came instantly this time around.

When Arlen came back she realised I was bleeding quite badly, so we clamped the cord (which had stopped pulsing by then), and then I got out so she could see how bad my tear was and stitch it up. I latched Charlotte then, while she was doing that.

The stitches were horrible, because it felt like I'd done all the hard work already and it was unfair to add more pain in after what I'd just been through, but I was still able to walk straight away after giving birth – after having a shower I took a walk to the nursery to see Charlotte. And I drove the next day, soon after we got home from hospital. So even though it was sore, it was nothing like the pain of a caesar.

Thankfully, through the entire day, I felt no scar pain (I sort of expected to feel something, since I had felt pain at times during my pregnancy – which is apparently quite normal due to the scar tissue stretching), and I honestly didn’t even think or worry about my scar once. I had read that mom’s intuition is often the most obvious indicator of a uterine rupture and I had been convinced that I would be concerned about a UR during labour, but it didn’t cross my mind at all.

The whole experience was a journey – physically, emotionally and spiritually. It was so much bigger than me, and it took over my entire being. What a privilege to go from a cold, emotionless, matter-of-fact, ‘first you are pregnant, then you have a baby’ first time around, to a whole-body experience this time.

Without a doubt, Charlotte’s birth has been the most difficult thing I’ve ever done. And yet also the most rewarding, healing, empowering, amazing experience of my life. I cannot adequately describe either the intensity of labour or the incredible euphoria of birthing her, and I am just so grateful for the confidence and support of Noel, Arlen, Leigh, my family and a couple of close friends. God has blessed me with so much, but right now this feels like the biggest blessing of all – to bring Charlotte into this world in the way He intended, the way her and I were born to.

Between then and now

Just a quick catch-up...

The good news - the hospital allowed me to have a doula attend my birth, providing she attend an orientation meeting there, which she was quite happy to.

The bad news - when I eventually spoke to my gynae about wanting a midwife at my birth, she instantly said no. She said that a midwife's only goal was a natural birth, whereas her aim was a healthy mom and a healthy baby, and suggested that if I chose to use a midwife I would end up with a brain-damaged baby. At best, she was prepared to allow my midwife to be a doula for me, but not to take charge of the birth. The more we 'discussed' it, the more I realised that she was actually quite nervous of natural births in general, not just vbacs - and that she saw me as a high-risk patient simply because of my scar.

I may be scarred, but I'm not broken.

And we all aim for a healthy mom and a healthy baby, we just all have different opinions on how to achieve that aim.

I phoned my midwife in tears the following day, and she suggested a couple of other doctors that may be prepared to be a back-up. Every one of them ultimately said no. One even phoned me, and told me he thought I was being silly.

I began to think that she wouldn't be able to attend my birth, and stopped worrying about it - more because I didn't know how to solve it than because I had accepted it. It was only later that I realised I had to do something, when my gynae said that she was going on leave from the day before my due date. To make matters worse, her covering doctor is notoriously pro-surgery, and I think even if I arrived at the hospital ready to push, he would have carted me off to theatre to cut my baby out of me.

I then made an appointment with a local GP, who I had heard was very pro-natural birth, and she suggested another gynae I could try. Alternatively, she suggested I look a bit further to a hospital in the next-closest city and find a doctor there who would allow me to use a midwife in that hospital.

I emailed her suggested gynae, and after almost 2 weeks of waiting (just as I was ready to start making phone calls to enquire about supportive doctors in the other city), she replied that she was quite happy to be my back-up providing I come in for a consultation to discuss concerns prior to my vbac attempt. I was 34 weeks pregnant and I finally had a back-up doctor!

She was very thorough, and had phoned around to check on how responsible my midwife was before agreeing to be back-up for her. She also did a scan, and checked fluid level, as well as baby position (occiput posterior that day - but thankfully she moved soon after), cord flow, placenta function and even my cervix. She didn't want me to go further than 40 weeks, but was prepared to accept my very first scan (at about 5 weeks) which gave a due date of 3 January.

After that, I contacted my midwife and doula in relief to tell them that we were back on track.

Thursday, 2 January 2014

5 reasons why I've fought so hard for my vbac

**Disclaimer
(I started writing this post at about 38 weeks, when if I was having an RCS, I would have been going in really soon. It has taken a while to get all my thoughts typed out, so I am finishing it off 3 days after the birth of my little girl. Please excuse any continuity discrepancies as a result of this!)

The more I think about my decision to attempt a vbac, the more I am convinced that I am doing the right thing - the only thing - that makes sense for my family and I. I have had people tell me they think I am crazy, and others terribly concerned that I am doing something very dangerous. I respect these concerns, but my research has shown over and over that it is not nearly as dangerous as we are lead to believe (particularly in South Africa, with our scalpel-happy birth culture), and that far from being a crazy option, unmedicated natural birth is the best and safest option for mom and baby.

I realise that some women will take offense at what I have to say. Please understand that I make no judgement on anyone else's decision. I do however have serious issues with doctors who don't ever explain that there is another option - and that justify unnecessary caesareans (whether they may be a woman's first or a repeat) by scaring a woman with the terrible  consequences that would have resulted if she had not had it ... and the label 'emergency caesar' that gets thrown at the c-sections that are done only too readily.

It is true that some c-sections are genuine emergencies. But the World Health Organisation recommends a maximum of 10 - 15% of births be done by c-section (to maximise mother and baby health), so you have to wonder why South Africa is so different that 70 - 95% of births in private hospital 'have' to be by caesar. The very label 'emergency' makes most women believe that their caesar was totally necessary, when in fact so many are merely as a result of an obstetrician's impatience, desire for his own convenience (rather than what is best for mom and baby), and his arrogance in assuming that his surgical skills are a better method of birthing than the way we were designed.

So many women just assume that their gynae (technically they are obstetricians when talking about pregnancy and birthing, but in South Africa we tend to refer to them as gynaes, and so I will stick with this practice out of habit) knows best, is up to date with research and only makes recommendations based on the best interest of her and her baby. Gynaes are only human! The greatest lesson I have learned in my vbac journey is that gynaes are not infallible. Sometimes those considered the 'best' in a city/hospital are actually those that are the most human, and make recommendations based more on their convenience (and human opinion) than on evidence-based medicine (and medical opinion).  I long for the day when women make their OWN decisions about what is best for their child's birth, rather than simply accepting a gynae's opinions as fact.

Reason 1: My baby will come when she's ready *
All scheduled C-sections are too early. Simple as that. Some babies will have complications because of it, some won't. But the fact remains that if you haven't gone into labour, your baby was not yet ready to be born.

Some of the more common problems that babies have are respiratory distress and jaundice. Although babies are technically term from 37 weeks, they are only classified full-term from 39 weeks. Many countries will only schedule repeat c-sections from 39 weeks at the earliest (most from 39+3 or even 40 weeks) unless there are valid medical reasons for an earlier delivery, South African doctors are only too happy to schedule them from 38 weeks. By 36 or 37 weeks we generally feel huge and exhausted, and are only too ready to be un-pregnant again. Our doctors are only too happy to pander to this by suggesting we have our babies early to avoid the 'danger' of going into labour.  No doctor ever tells us that it would be better for our babies to come on time rather than early, that there are still risks after 38 weeks (and in fact, no doctor would even admit that 38 weeks is actually early - despite the fact that only 50% of women go into labour by 40 weeks including premature babies, and the average first-time labouring mom will only go into labour at 41+3 weeks), and that our comfort is often at the expense of our baby's health.

Babies born between 38 and 38+6 weeks are twice as likely to have breathing problems than babies born after 39 weeks. (Babies born from 37 weeks are 4 times as likely to have breathing problems).

Plus, due dates are at best an estimate. Even going by your last menstrual period (or LMP) can be out a few days, because we all ovulate at different times - and every day counts!

Certain antibodies are only transferred in the last weeks in the womb, so babies that are evicted before their time is up lose out on these antibodies and the protection they provide.

The church I go to starts at 9am on a Sunday morning. Some people are there by 8:50 or even 8:45 to park and get a good seat (or just because they like being on time). Most people arrive at or just before 9:00. My husband and I are usually late, and so we can arrive there anytime between 9:05 and 9:10 (and even later some days - the day I was in labour, we arrived at 9:20!). Taking babies out at a pre-specified time because they 'should' be ready by then, is like saying that everyone who attends that service should be there at 8:50. If we were somehow transported to church at 8:50am on a Sunday morning, we would probably still be in our pyjamas, eating breakfast. One time just doesn't work for everyone, even though we all aim for 9:00. Same thing for babies.

Reason 2: Labour hormones are GOOD for my baby *
Hormones released in labour help protect baby's brain, prepare her lungs and build her immune system, as well as helping baby to imprint on mom and assist with attachment and bonding.

Oxytocin is a feel-good, bonding hormone that is released during and after birth for an hour or more. It helps mom and baby learn to trust each other as well as feel calm and happy. It also acts in mom's brain to initiate affectionate maternal behaviours.

Pitocin is an artificial version of oxytocin and is used in inductions. However, it doesn't cross the blood-brain barrier. If no anaesthesia (eg by epidural - or in a C-section) is used then mom's body will still respond by releasing oxytocin during the birthing process - and so labouring before a C-section has some significant benefits, especially for baby. No oxytocin leads to an increased risk of postnatal depression as well as more difficulty in bonding. Oxytocin will still be secreted after a C-section while breastfeeding, but it remains low for at least 2 days after birth, which tends to increase mom's anxiety and decrease breastfeeding success.

Reason 3: C-section risks for baby
A lot of these risks are interlinked, and so some information will overlap between paragraphs.

Earlier I mentioned the increased risk of respiratory distress in babies born before 39 weeks. One of the hormonal and physical consequences of labour is that fluid from baby's lungs is absorbed. In babies born via C-section without the benefit of labour beforehand, there is a 4 times higher risk of breathing problems (assuming both babies are the same gestational age). This may be a contributing factor as to why C-section babies are twice as likely to suffer from allergies as vaginally-born babies.*

I also mentioned earlier that a number of antibodies are transferred from mom to baby in the last weeks of gestation - even more antibodies are transferred during labour, helping to protect baby by providing some initial immunity and a healthy gut system (a good reason to give your baby probiotics if you ever need a C-section). This may contribute to the fact that babies born via low-risk elective C-section (including RCS) have a tripled death rate in the first month of life compared with vaginal births.*

The risk of a c-section baby dying of SIDS is also significantly higher than that of a vaginally-born baby, which is probably connected to the increased risk of breathing problems as well as decreased immunity. A study carried out on rats showed that compression (i.e. from labour contractions) had a huge effect on breathing - rats were delivered via c-section and then either subjected to compressions (similar to those experienced during labour) or not. Those who underwent compressions were all still alive after an hour, whereas a number of those who were not compressed died fairly within the first hour. *

C-section babies are also at risk of being cut by the obstetrician's scalpel as s/he cuts open the uterus, although none of us like to think about it. 0.1 - 3.1% of babies born via c-section will suffer from lacerations due to surgery.

Anecdotally, I took my daughter to both a chiropractor and a kinaesiologist to help with her wind, colic and allergies. Both of them said that they see virtually only c-section babies. In particular, the chiro said that c-section babies are pulled instead of pushed out, and this regularly causes some spinal misalignment, which can result in general pain or cause gas bubbles to become trapped (because they cannot travel through the baby's system quite as easily) which can be very painful for a little baby. So next time your newborn is gassy or just plain miserable, it may be worth taking them to see a chiro - they can make a world of difference.

Reason 4: C-section risks for mom
First up, I am 3 - 11 times less likely to die from a natural birth than a c-section, depending in which study I use. That's a lot, no matter which way you look at it.

I'm also less likely to suffer a heart attack, need a hysterectomy, stay in hospital for longer (or be readmitted to hospital later as a result of a C-section), get a hematoma, struggle to recover (with the exception of haemorrhoids, which are more common after a vaginal delivery) or have long-lasting pelvic pain.

Plus, I'm also less likely to have painful sex after a natural delivery. Yes, that sounds like it makes no sense! But 40% of women who have had a caesarean delivery suffer from dyspareunia (pain during sex) after birth (which may last up to 6 or even 12 months after the birth), compared to only 26% of women who have given birth naturally.

Reason 5: I don't want major surgery unless really necessary!
This seems like a bit of a no-brainer to me! Just because C-sections have become routine here don't make them a simple procedure! They are still major surgery and so carry all of the general risks of any major surgical procedure, namely anaesthesia complications, bleeding problems, blood clots, risk of death, delayed healing, difficulty breathing and risk of infection.

I accept that giving birth involves pain of some sort. However, I'd rather deal with that pain before my baby arrives, rather than afterwards. I don't want to have to be in pain with a newborn and a toddler to take care of, unable to pick up my toddler because she's too heavy, unable to drive for 6 weeks, hobbling around, sore and yet still drowsy from the pain medication.


The honest aftermath - my feelings after my vbac
3 days ago, I got my vbac. It was hard work, far more intense than I had imagined. It took all day, from 3:40am until 2:10am the next day. That's a long time! It was seriously painful at times. I doubted whether I could do it a number of times. I got a second-degree tear and 9 stitches. That was really sore afterwards, and is still quite tender now. That's the bad side of it.


But the exhaustion gave way to elation and euphoria as soon as I gave birth. And that euphoria was also far more intense than I could have imagined. I went home the following day - I've been home for 2 nights already, whereas if I had a c-section, I would only have gone home today. I got up and showered as soon as I handed my baby over to be measured. I drove the day after I gave birth - without feeling like a rebel ;-) I pick up my toddler and cuddle her as much as I (or she) wants. And that tear hurts, but nothing like a c-section incision. I'm not drugged up on pain medication.

I felt and watched my baby come out from me - she felt like MINE from the instant I saw her. Then she was put on my chest and we just hung out together and gazed into eachother's eyes (and started breastfeeding as soon as she started rooting) for a couple of hours. No rush to bundle her up and take her off to be weighed and assessed. It was peaceful, at her pace (and mine), intimate (darkened lights, warm water) and most of all, it was just so real. My baby is alert, feeding well and is peaceful - can I say that all of this is from her birth? Of course not. But its hard to not compare this to my first, who was so sleepy from the anaesthetic that she struggled to stay awake long enough to feed for the first few days.

It was probably the hardest thing I have ever done, physically and emotionally, after fighting so hard for it and having so much invested in succeeding. But it was also the most rewarding, healing, triumphant, amazing experience. I could keep trying, but there are no words to describe what I felt then and still feel now at the memory of it. It goes so far beyond meeting your baby for the first time.
 

Monday, 19 August 2013

A long overdue update!

So it's been a loooong time since I last posted!

I'm now 21 weeks, and all is looking good. Baby is 3 or 4 days ahead on all measurements and - so far - gaining with every ultrasound (which is so wonderful after Sophie, who was always 2 - 3 weeks behind!). I have an anterior placenta, which means that my placenta is in the front of my uterus, something that happens in about 30% of pregnancies. Sadly, this has buffered most of my precious Bean's kicks, so I only feel him/her move when lying breech because the kicks are then aimed lower than my placenta. I have noticed more and more movement over the last couple of days, and I think *just maybe* I'm starting to feel movement through the placenta. It will be a while before I can feel him/her regularly though. Also, we still don't know what gender baby Bean is - the angle wasn't great at my last scan (19 +1) so although the doctor guessed one gender, she admitted she honestly wasn't certain. My anatomy scan is next week Friday at 23 +2, so hopefully we'll be able to see nice and clearly then!

I have also sent off a motivational letter to the hospital ... all local private hospitals have a strictly no doula rule, and I really feel like a doula will be able to help me - especially since my midwife will not allow me an epidural since this is a vbac attempt (which I'm secretly grateful for, since epidurals seem to be associated with decreased vbac success, as well as increased uterine rupture risk).

This is the letter that I sent:

Dear XXX (Client service manager)

I had my first child at XXX Hospital on 10 February 2012, a failed induction turned caesarean section which I found bitterly disappointing. Since then I have been researching and hoping for a vbac. I am now 21 weeks pregnant with my second child, and hope to give birth at XXX Hospital again in December. I am seeing Sr XXX (midwife) and she has advised me that XXX Hospital does not usually allow doulas to be present during births.

I feel very strongly that a doula would help in my case specifically and would like to request that you allow me to have one assist at my birth.

Being a vbac mom, I have a number of added fears and anxieties to deal with, and I really believe that a doula would help make my birthing experience a more positive one than what I experienced last time (due to my failed induction and – I believe – rather unnecessary caesarean, not as a criticism of XXX Hospital).

Research suggests that having a doula present can shorten labour and decrease the likelihood of needing a caesarean section. I will not be using any pain medication (Midwife's preference with vbacs), and doulas can help with managing and alleviating pain in other ways. Also, I am concerned that my husband may need more support during labour than I will be capable of giving him and I would really appreciate the support that a doula can offer to him as well, so that he might feel more comfortable with my labour process and have a better idea of how to support me (rather than the other way around!).

I have spoken with XXX (Doula), a WOMBS-certified doula and she is happy to come in and meet with your staff to discuss how she can help me without hindering their duties, as well as to go through any orientation process necessary.

I appreciate your consideration of my request and look forward to your response.
 
Kind regards, etc
 
I copied the Maternity Unit manager in on the email, and have had a response from the Client Service manager so far, saying that the Maternity Unit manager will get back to me soon. I feel quite positive about my request though - if they refuse me I will appeal higher up, probably with the Hospital manager and even higher up in the XXX Hospital group. The group has an article on their website talking about different methods of pain relief/management, where they even mention a doula as an expert in alternative pain management techniques - plus one of their hospitals elsewhere is used as a doula-training facility.
 
I've also been doing a lot of research into vbacs and caesarean sections, including the various risks of both - hoping to link some on here in the next few days.