Review: The Baby’s Coming by Virginia Howes

This book tells the inspiring story of Virginia Howes and how she came to be an independent midwife, which she has been doing for 14 years. It’s not a typical career path though: young mum, kissogram, midwife! It’s written in a lovely, friendly, down-to-earth style, and you feel as though you are sitting down and having a nice cup of tea and a chat with Virginia as she tells her stories.

Virginia’s book gives a good insight into hospital birth and working on a maternity ward, from describing her own birth experiences (I assumed she must have had all lovely positive home births which is not the case) and while she was training. I know things have improved since then but I do feel that a lot of what is considered normal practice in hospitals is done for the convenience of the hospital staff, and not necessarily to the benefit of the mother and baby. There is also an element of luck involved as to what type of midwife you get when you arrive – one that wants to be in control of the situation or one who is happy to take a woman-centred approach.

However the absolute best thing about this book is the birth stories. If you’ve ever had a baby, are expecting one or would like to have one, this book is full of lovely stories that will bring a tear to your eye. Some are heartwarming, some funny, some dramatic and some very sad. They are all well worth reading. If you’re a midwife or thinking of becoming one you should definitely read this book and think hard about the type of midwife you want to be.

This book also makes me a bit sad that not all women have access to this kind of care during pregnancy and birth. Having had Virginia as my independent midwife during my second pregnancy, I know from first-hand experience that it makes such a difference to have continuity of care and have someone that you know and trust, and who knows you, your history and your wishes, at the birth. It was lovely to be treated like a person rather than a disaster waiting to happen. Sadly this type of care might not be available much longer as Independent Midwifery will become illegal due to EU Legislation which means independent midwifes have to have insurance – yet no insurance is currently available for them to buy!

I read this book in under a week – no mean feat with a 3 year old and a newborn baby in the house! I found it unputdownable, and I’ve already lent it to one of my friends who is expecting. It was really interesting to learn about Virginia’s life and what led her to become a midwife. I’d just like to know if my birth story might feature in one of Virginia’s future books!

Is The ‘Birth Experience’ Really Important?

The phrase ‘positive birth experience’ conjours up two images: one of treating birth as a spiritual experience, peacefully wallowing in a birth pool with candles and new age music playing and dining on the placenta afterwards, the other approaching it as some sort of athletic endurance event with no medication allowed and a fair amount of blood, sweat and tears.  In my opinion, what is important about the birth experience is not necessarily what happened, but how you feel about what happened, whether you gave birth at on a labour ward, in a midwife-led unit, or at home, whether you had a vaginal birth or a c-section.

There is also the school of thought that ‘a healthy baby is all that matters’.  Well, no, getting pregnant does not make you a vessel for your unborn child.  A pregnant woman is still a human being with rights and feelings.  Being pregnant doesn’t give anyone the right to bully you, frighten you, or do things to you without your consent.  You still have the right to make decisions and choices about what happens during pregnancy, labour and birth.  And what mum would knowingly make a decision that harms her baby anyway?  Other people say that it is just one day of your life and so it doesn’t really matter what happens – but I would argue that it is a momentous occasion and what happens can affect you for a long time afterwards.

Adjusting to life as a new mum can be a challenge.  There is a steep learning curve involved.  There is a lot to come to terms with; suddenly going from one being to two, lack of sleep, learning how to take care of a newborn, and the physical healing process from the birth.  Getting off to a good start, and feeling happy and positive makes it much easier.  Or, to put it another way, if you start of full of negative feelings, anxiety, fear or unhappiness, it makes it much harder.

I’ve had one negative and one positive birth experience.  The negative one (my first birth) left me feeling very anxious, like my body was stuck on ‘high alert’ all the time, and this affected how I felt about myself as a mother, and how I dealt with the day-to-day challenges of looking after a tiny person who has very limited communication.  I jumped every time my baby made a sound and dreaded her waking up, I felt like a terrible mother and went into a panic when my baby cried because I felt like I wasn’t good enough.  I remember people asking me ‘are you enjoying it?’ (being a mum) and although I smiled and said yes, inside I was thinking ‘What??? Are you mad???’.  I was exhausted not just from the disturbed nights but from being anxious and angry all the time, and trying to process and come to terms with what had happened.  It took me over a year before I felt anything like  ‘normal’ again, and it was over two years (and some counselling) before I felt ready to face another pregnancy.

The positive birth, on the other hand, left me on a high.  It was a planned home VBAC that ended in hospital (click for the full story).  When they placed my baby on my chest I felt like I could take on the world, I was totally relaxed and happy.  I would willingly do it all again, and I actually feel a bit sad that we don’t plan to have any more children.  This time I feel full of energy and love (although exhausted at the end of the day of course!).  I think it is telling that my second baby has started smiling two weeks earlier than my first, because I am smiling at her all day!  I expected life with two small children to be a case of grit your teeth and get through it, but if you asked me now ‘are you enjoying it?’ the answer would be a resounding ‘Yes!’.

Coming back to the phrase ‘birth experience’ – I don’t think a positive birth is dependent on a checklist of what you should or should not do.  It is possible to find a home birth traumatic, and a c-section wonderful.  I think really it comes down to knowing what you want, and making the right choices to make it happen.  Obviously sometimes there are special circumstances, and things don’t go to plan, but if you feel calm and in control of what is happening then you will feel strong and empowered rather than frightened or even traumatised.   The ripple effect of how you feel about your birth can affect your life, and your whole family, for a long time afterwards.

My VBAC Success Story

Things have been a bit quiet on the blog lately, because our baby girl finally arrived!  Here is the story of how she came into the world… My first birth was an emergency c-section after a failed induction.  This time I had planned a home water birth (HWBAC) with an independent midwife.  My partner and I also had HypnoBirthing classes during the pregnancy (I used the self-hypnosis CDs in my first pregnancy which didn’t help me at all).

It was about 2am and my 3-year-old woke up, needing to be tucked back into bed, and I realised I was having contractions about 10-15 minutes apart.  They just felt like my belly was going hard and tight and I practised my hypnobirthing breathing with each one.  I tried to go back to sleep but I was too excited so I came downstairs and started listening to my hypnobirthing CD so that I was at least resting.  About 4.30 in the morning I went to the loo and felt a pop as my waters released.  After that the contractions started coming every 4-5 minutes, but they were still easily manageable.  I woke my husband up so that he could help me time the contractions and because I was hoping things would move along quickly!  About 5.30am he decided we should call the midwife but she said that I was too happy and chatty and that she would phone back later.

Our daughter woke up at around 6.30am as usual and came downstairs.  My husband got her dressed and made her breakfast.  I was still quite happy breathing through the contractions at this point and we explained that the baby was coming today!  She was very excited to hear this!  Over the next few hours things gradually got more intense and I started making quite a lot of noise with each contraction (apologies to the neighbours!).  We had explained previously that mummy might make some funny noises and we laughed about how I sounded like a dinosaur.  The midwife came over at around 10.30am and examined me but said that it was still early (later I found out I was still only 1cm!) and that she would be back later that afternoon.  I was quite disappointed as I felt like I’d already been going for ages!

As things progressed I was finding it more difficult to focus, I was getting noisier and couldn’t find any comfortable  position, even between contractions.  At about 1pm we decided to send my daughter to a friend’s house, thinking it would only be a few more hours, as I felt I needed more support from my husband, and she was beginning to get a bit upset by the noise.  We also phoned my hypnobirthing teacher and asked her to come over.  When she arrived she helped me focus on getting into a rhythm with each contraction, and we all ended up chanting ‘5, 4, 3, 2, 1, relax’ together which helped me immensely.  She also made me repeat over and over ‘I can do it, I will do it’ which really helped me to find some more strength from somewhere.  We also tried a few different things to help speed things along and try to ensure baby was in a good position and to get me more comfortable, like walking up and down the  stairs.  I also got in the pool for a while but I was surprised to find that it didn’t help at all!

Then my midwife arrived (timings are a bit hazy by this point!) and said she would stay this time.  I checked myself and realised that I could feel the head coming down!  I also started having a massive urge to push with each contraction.  It was like nothing I had ever imagined.  My hypnobirthing training had led me to expect that I could gently breathe down the baby with each surge, but it was like my whole body just decided it was time to PUSH!!!!! and there was nothing I could do about it.  So instead of breathing the baby down I just tried to let go and not resist the pushing, and let my body get on with it.  I was determined to get the baby out before my daughter’s bedtime so that she could come home.   I kept expecting the midwife to say she could see the head at any moment but nothing happened.  After about 2 hours I checked myself again and realised that the head hadn’t moved at all.  Not one tiny bit! I was devastated!  My midwife examined me to confirm and we tried a few different things to try and help baby move down, but she wasn’t budging.  After another half an hour I realised we were getting nowhere fast and asked to go to hospital.  My midwife agreed that we had tried everything and hadn’t made any progress, and that we did need medical intervention.

My midwife called an ambulance and we transferred to hospital.  When we arrived I started using gas and air because I was exhausted from all the pushing and I really wanted to stop.  A doctor came and said that they would try ventouse, otherwise it would be a c-section.  I was scared at the prospect of another c-section (I have a *huge* phobia of hospitals and surgery) but thanks to the hypnobirthing I was able to stay calm and relaxed, I also realised that there really wasn’t much choice at this point.  However we had a massive delay because there was one emergency after another, and only one theatre, and so we ended up waiting a further 4 HOURS before it was my turn to go into theatre, all the while pushing and trying not to!  So in total I was pushing for 7 hours – luckily it didn’t feel like that long, and I stayed calm the whole time, which I think is down to hypnobirthing again.

Once I got into theatre I had a spinal block which was blessed relief after all that pushing.  I was relieved that things were finally coming to an end and was even able to laugh and joke with the hospital staff.  They did an episiotomy and used the ventouse, and with 2 massive pushes/pulls the baby was out.  I couldn’t believe it! I had done it!  It wasn’t quite the lovely peaceful home water birth I had imagined but I was still over the moon!  I felt like the strongest woman in the world, like I could do anything now.  When they put my baby on my chest I was so happy, it was the best feeling in the whole world.  It was amazing.  In fact I’d say I’m still on a high now, 4 weeks later.

I am so thankful to my husband for being there and supporting me, my hypnobirthing teacher for going over and above the call of duty and helping me out on the day, and my fantastic midwife for being completely respectful and making me feel like every decision was my decision.  Between the three of them I felt calm and relaxed throughout the whole experience, even when we transferred to hospital, and although things didn’t quite go to plan it was still a really positive experience which has helped to heal a lot of the hurt from my first birth.

Planning a positive home VBAC/HBAC

I’ve blogged previously about my reasons for planning a home VBAC (vaginal birth after caesarean).  Today I want to write about the steps you can take to ensure that it goes smoothly, and is a positive experience.  I don’t want to talk in terms of ‘success’ because I don’t think that birth is an achievement, and if things don’t go according to plan it is not a ‘failure’.  But I don’t think there’s any harm in being clear about what you want and doing everything you can to give yourself the best chance of getting what you want.  Many of these points also apply for a hospital VBAC.

Do your research

You need to be 100% confident in your decision.  It’s good to have a clear understanding of exactly what the risks and benefits are of having a home birth.  There may be people along the way who will question your choices, whether out of ignorance or curiosity, and it’s good to be prepared and be able to answer them.  I’ve included a list of the reading I’ve done in my previous post Planning a HBAC – Why?.

Talk to your partner

Support is so important.  Share your research with your partner.  Make sure they are on your side from the beginning, so that you can stand united.

Think about your birth preferences

I think most women who are planning a VBAC really just want to have a birth where they feel in control of what is going on.  So it’s a good idea to be clear in your mind about what you really want.  This applies if you are having a hospital VBAC or a repeat ceasarean as well.  I prefer to call this birth ‘preferences’ rather than a birth ‘plan’ because it feels more flexible.  If you’re having a home birth this is less of an issue, but it’s still worth considering.  It’s also important to talk your preferences through with your midwife in advance, so that they are aware of what you want and there are no surprises on the day.  Some issues you might want to think about are:

  • Do you want routine VEs?  If so, do you want to know what the result is or just be told that you are progressing or not.
  • What pain relief would you like to use?
  • Would you like to use water – a birth pool, bath or shower?
  • Cord clamping/cutting and placenta – would you like a managed (by injection) or physiological third stage?

Release any fears

If you had a difficult experience first time around then you may have some unresolved fears or anxieties.  It is best to deal with them as soon as possible so that you can relax and enjoy your pregnancy.  Fear can also hold back labour, so even though it is hard, it is important to face it head on.  You can do this in whatever way feels most comfortable to you.  You might like to talk to a sympathetic friend or family member or try formal counselling (CBT is particularly good if you have anxiety or any post traumatic stress).  Writing or journalling can help you to explore your feelings more privately (there are some excellent activities in the book Birthing from Within that can help with this).  You can write a letter to anyone who you feel may have let you down in your previous birth and then burn it.  Hypnobirthing courses include a emotional release session, which allows you to let go of any lingering fears in a very safe way, without even having to consciously think about them, and the natal hypnotherapy VBAC CD has a fear release session on one of the discs.

Support for the birth

Do your best to ensure you have plenty of support for the birth itself.  If your birth partner is going to be your partner, mum, sister or someone else make sure they are clued up about VBAC and talk to them about your birth preferences so they can advocate for you while you are in labour.  You might like to consider hiring a doula, preferably one with experience of attending VBACs at home, as they will be able to reassure you and speak up for you, as well as encouraging your partner to support you.  You can also find support online, for example on Facebook there are home birth and VBAC groups where women share birth stories, ask questions and get advice from each other.

Independent midwives

Most NHS midwives have never attended a HBAC, and as they are trained to view VBACs as high risk, and used to managing them under strict hospital protocols, they may be nervous or find it difficult to support you at the birth.  In some areas home births are attended by whoever is on call, so you may not even have met the midwives who attend your birth.   An independent midwife is one that is self-employed and operates independently from the NHS, and can offer you continuity of care throughout pregnancy, birth and postnatally.  They mostly attend home births and are experienced at working with women who are considered ‘high risk’ by the NHS, including VBACs.  They are expensive but you may feel that it is money well spent to have someone who is experienced at attending HBACs, and who can give you one-to-one care throughout your pregnancy, during labour and afterwards.

Positive brainwashing

Surround yourself with positive images and thoughts about birth.  Our culture and media is full of messages that birth is painful and scary, when in fact it does not have to be.  Avoid watching programmes like OBEM as those shows tend to focus on the dramatic, with things going wrong.  There are lots of lovely home birth videos on YouTube.  Read positive birth stories.  One book that has really helped me is Ina May’s Guide to Childbirth, which has lots of positive birth stories which really make birth seem like no big deal, and also explains about the physiological processes of birth.  Hypnobirthing is also fantastic for this as you listen to positive birth affirmations daily, which helps you to think positively about your body and labour and birth.

Although there are obviously no guarantees when it comes to childbirth, I think it is worth approaching labour and birth as positively and proactively as you can.  My hypnobirthing teacher suggested planning it in the same way as you plan your wedding day – instead of thinking about all the things that could go wrong, plan for it to be a happy occasion, and work hard to prepare yourself, don’t just leave it to chance.  At the very least I feel that using this approach has helped me to relax and enjoy my pregnancy so much more this time around, and I’m hoping that no matter what happens, my birth experience will be a calm and positive one.

Have you had/are you planning a home birth after caesarean?  What are you doing to prepare yourself?  What do you feel helped you to have a positive experience?

Planning a HBAC (Home Birth After Caesarean) – Why?

I had my first daughter by emergency caesarean just over 3 years ago.  I am currently expecting baby number 2 in early February next year.  I live in the UK and In my area, I can choose whether to have a repeat caesarean, a hospital birth or a home birth.  I am automatically classed as ‘high risk’ by the NHS, but despite this I am planning to have the baby at home.

High risk

After a caesarean section, in subsequent pregnancies there is a small risk of scar rupture during labour.  The actual level of risk is about 0.2-0.5% according to the most recent studies (older studies have included medically induced labours which increases the risk).  The risk of the baby dying is even smaller (about 1 in 10,000), and the overall risk of uterine rupture is no different to first pregnancies – there was no mention of this risk in my first pregnancy, but now that I have had a caesarean it is the first thing that midwives want to talk about.  There are other things that can go wrong in any pregnancy but none of them are singled out to the same degree as scar rupture is for VBAC mothers, if they are even mentioned at all.

The NHS doesn’t distinguish between different levels of risk and so this slight increase is automatically classed as ‘high risk’.  In my area, this means that I am not ‘allowed’ in a midwife led unit (MLU) and have to choose between the hospital labour ward or home birth.  This seems rather illogical to me, to allow me to give birth at home but not in the MLU,  but I was told that they do not admit so-called ‘high-risk’ women because it can affect their success rates.

Hospital protocols

Women having VBAC in hospital are usually advised to have continuous fetal monitoring (CFM) which involves having two monitors strapped to your stomach, which are attached by wires to a machine that continuously monitors uterine contractions and the baby’s heartrate.  One of the early warning signs of scar rupture can be a drop in the baby’s heartrate so this monitoring aims to detect any problems early. However, it still requires a human being to check the readings, and in a busy hospital ward there is no guarantee that there will be enough midwives available to do this regularly.  It also restricts movement as mothers are usually confined to the bed on their back, which is known to increase the likelihood of further intervention.  In addition, it is not the only indication of a scar rupture, and on VBAC forums online there are stories from women who have experienced scar rupture where the baby’s heartrate did not drop.

Other hospital protocols for VBAC labours include having an IV or cannula placed on admission, early admission to hospital, and restrictions on the length of the first and second stages of labour.  None of these protocols are based on research and there is no evidence that they improve safety for mother or baby.  They do however interfere with the natural progression of labour and increase the chances of intervention.  It is important to remember that none of these protocols are legally binding and if you do choose a hospital VBAC, you don’t have to go along with them if you don’t want to.

Early warning signs

As mentioned above, the most well-known indicator of a possible scar rupture is a drop in the baby’s heartrate.  This can be monitored by CFM in hospital, or via intermittent monitoring using a handheld device (the same kind that is used to check the baby’s heartrate during pregnancy).  There are other indicators which include a spike in the mother’s temperature, a drop in the mother’s pulse, pain in between contractions, unexplained bleeding, and the mother’s instinct that something is wrong.  An attentive midwife would easily spot these signs, and in the case of a home birth would call an ambulance straight away to transfer the mother to hospital.

Personal Choice

At the end of the day, it’s a matter of weighing up the different risks and benefits of each option: repeat CS, hospital VBAC or HBAC.  Personally I would support any woman to make the choice that she feels most comfortable with, and I can understand why someone might choose any of those options – it’s a very individual thing.  If you had your first baby by elective caesarean then a repeat CS might seem like the safe option, as you’ve been through it before (and also makes it easier to arrange childcare).  Some people will feel safer planning a hospital VBAC, knowing that if anything does go wrong they are in a building full of doctors and medical equipment.  And some people will feel more comfortable at home, where they have much more control over the environment and feel more relaxed (and you may not even need to arrange childcare!).

Myself, I am opting for a home birth after carefully considering the pros and cons of each option.  From the research I have done (see below), it seems that the risk of having any intervention is lower for women planning a home birth, although I understand that if something does go wrong, there is the added delay of having to wait for an ambulance and transfer to hospital.  I don’t feel like a hospital birth is the right choice for me as I have a phobia of hospitals and doctors, and fear can slow or even stop labour from progressing.  In addition, during my first labour I was on CFM most of the time and I found being stuck on the bed extremely uncomfortable, and made me feel trapped and even more scared.  For these reasons, I feel that my chances of success are far, far greater at home, and the benefits of being at home outweigh the risks.  It also means my 3-year-old daughter can be present at the birth, which is important to us, although we will have some friends on standby to pick her up if she becomes distressed or bored, or in an emergency.

Further Reading

There are two books I would highly recommend, the first is Birth after Caesarean by Jenny Lesley (available from AIMS) which has a very balanced and sensitive approach to both VBAC and planned caesarean.The second is Vaginal Birth After Caesarean: The VBAC Handbook* by Helen Churchill and Wendy Savage which again discusses the pros and cons of VBAC and caesarean and has advice on maximising your chances of success if you choose to plan a VBAC.

There are a lot of resources online about VBAC and HBAC, the following are ones found particularly helpful, several of which are from midwifery publications and websites:

Sources

*Disclosure: This is an affiliate link and I will receive compensation if you choose to buy this book after clicking on this link.