Next Birth After Caesarean – Navigating the System and Defending One’s Birth Rights
After the birth of my daughter, I wrote about when birth does not go according to expectations, with her delivery resulting in a caesarean section. A previous surgical birth had multiple implications for my second pregnancy and delivery, the major one being the freedom of choice and support pertaining to a repeat caesarean section or vaginal birth after caesarean (VBAC).
Whilst the decision process is different for every mother depending on her previous birth experience, expectations and wishes, I made my decision pre-pregnancy to have VBAC when my obstetrician said I would be supported to pursue one second time around. For various reasons I grieved not being able to attempt a vaginal delivery with my daughter, so the opportunity to have a VBAC was a healing experience for me, but it certainly was not an easy road.
My husband and opted to go with public maternity care this time around, so navigating that was challenging in itself at times, even though I work in a public hospital myself (new respect for patients!). I actually found feeling supported and advocating for myself at my antenatal appointments more challenging than the care and respect I received during labour and delivery. Perhaps seeing a different consultant at every outpatient appointment who all have very differing opinions and experiences when it comes to a VBAC, made it difficult to have a well-supported birth plan in place. However, I was so fortunate to have a very supportive and pro VBAC registrar on duty the night I laboured and morning I delivered.
I have decided to share my birth story as a timeline below. It is quite long so there are some no so pretty details.
How it unfolded…
Thursday 9th Nov (39+6) – I had a vaginal examination done at my 40 week outpatient appointment, I was surprisingly already 3cm dilated and baby’s head was head very low and had started to engage. Tears welled up with the sense of relief I felt when the obstetrician confirmed that things were looking favourable for a vaginal delivery. She thought labour would be imminent. A stretch and sweep was done at the time of the vaginal examination but this didn’t do anything for me (if anything made me question why things weren’t moving along thereafter). Despite things looking optimistic, I still had an induction booked for 40+10.
Saturday 11th November – after my forth acupuncture session in the morning, I started to lose my mucous plug. I noticed that the cramping and abdominal tightening I was intermittently experiencing seemed stronger and more frequent.
Monday 13th and Tuesday 14th November – I kept losing more of my mucous plug in pieces. The tightening and period type cramping continued. I was starting to open my bowels more frequently and often felt nauseous so I figured active labour was approaching. But I had to keep playing the waiting game which was mentally and emotionally draining.
Wednesday 15th November – I really sensed that establish labour was going to begin today. I felt an increase in the frequency and intensity of the intermittent tightening I was experiencing but nothing intense. In the late afternoon I became suspicious of wet patches in my undies – I had been thinking it was associated with increase in mucous discharge and losing my plug but was a little wary of a hind leak. I also felt that bub was moving less as the day progressed. I decided to called the midwife at the hospital and I was asked to come into the emergency department. I suspected it had more to do with the VBAC red flags rather than hind leak.
An amniotic fluid leak was confirmed in emergency so I was admitted to the delivery suite for further decision making. As I anticipated, being classified as a ‘Trial Of Labour
After Caesarean’ (TOLAC) patient, the midwife on duty said it was highly unlikely that I would be returning home. Thankfully on admission to delivery suite I was transferred over to cordless CTG monitoring so I had the freedom to move around. The registrar on duty was initially suspicious that baby had flipped into breech presentation, my heart sank at the thought that what everyone believed was a bum was a head – an ultrasound thankfully confirmed baby was head down but the amniotic fluid levels were low. I was still only 3cm dilated; to my surprise I had not made any progress over the past week. I agreed to an Artificial Rupture of Membranes (AROM) of my fore waters, as I could not determine when hind leak started and I was not readily progressing into established labour. Due to the infection risk, the registrar discussed use of IV antibiotics during labour but I declined and she was fully supportive of my decision.
Thursday 16th November (40+6) – I had surgical AROM probably just after 1am. I remember shaking uncontrollably as all this fluid gushed out between my legs. I recall stronger contractions starting within half hour of AROM but I was still happy and chatting with hubby and the midwife between surges. Gradually over the next few hours my contractions intensified and I kept wanting to use my bowels with every surge. I think I spent half my labour sitting on the toilet! After a few hours I was confirmed to be 5cm dilated; I honestly felt I couldn’t face labouring for another 5cm but midwife assured me the first 5cm take the longest. I ended up in the shower and there was an overwhelming sense that I couldn’t do this for much longer (I figure I was probably in transition then). Within what seemed like only an hour or so, I left the shower and went to the mat on the floor on all fours. With each contraction I was beginning to start involuntary pushing and saw several doctors appear at the time (midwife probably suspected I was approaching second stage and baby’s heart rate dropping). They confirmed I was 10cm and I felt I wanted to be leaning over the bed head to start actively pushing. I just remember rocking back and forth trying with everything I had in me to get baby to descend. I recall asking if my baby would come out but my husband and midwife kept reassuring me they could see more and more of the head, bub just needed to get around my tail bone. I was asked to try pushing on my side for few contractions to see if would help baby move further down (the first side helped). After continuing to push for multiple contractions, the doctors came in as baby’s heart rate kept dropping significantly and I needed to get baby out asap. I agreed to an episiotomy; I didn’t want to risk tearing from one opening to another and ultimately wanted to get my baby out nice and safe as a prompt delivery was needed. I ended up giving birth on my right side only a few pushes after having the episiotomy.
Our son was born at 7.32am that morning after a 3½ hour active labour. I was a bit delirious when I pulled up a big squishy newborn onto my chest. I think I was in a state of disbelief that I actually had a VBAC, no pain relief, just breathing and warm shower and a little help with the scissors to get him out at the end. I was also in shock when we discovered he weighed in at 4242gm – I was so glad that they were predicting a 50th centile baby as otherwise I may not have been able to have a TOLAC (goes to show just how inaccurate foetal ultrasound is at estimating weight in utero). I guess I am proof that you can totally VBAC a 4kg+ baby despite what many clinical guidelines say.
4 weeks later I am still trying to process the whole birth experience and realisation that ‘I did it’ despite all the resistance and doubt I encountered in pursuing a VBAC in the hospital system. When people ask what was my preferred mode of delivery having had both a surgical and natural birth, my immediate response is a vaginal birth hands down. Having a VBAC has been a very healing experience for me, but also made me appreciate why a caesarean section was lowest risk option for birthing my older daughter (she was a footling breech). The risk of cord prolapse was too great and with her feet coming first her head would have been very difficult to deliver with her health and safety too much at stake. It was hard enough getting her brother out head first, let alone the biggest part of a newborn out last.
I would love to hear your birth experiences, be it surgical or vaginal deliveries, planned or emergency caesareans, assisted deliveries or home birth. Please leave a comment below.