Pregnancy, Birth and Beyond

http://www.pregnancy.com.au/birth-choices/vbac/vbac-stories/along-came-ava.shtml

Along came Ava

In 2007, pregnant for the first time, I knew I wanted one thing: continuity of care. Based on the experiences of those around me, I had formed the opinion that birth was a medical event.

Along Came Ava (square)

Our journey to a home birth after two c-sections

By Kelly Lanfranca

In 2007, pregnant for the first time, I knew I wanted one thing: continuity of care. Based on the experiences of those around me, I had formed the opinion that birth was a medical event. Therefore I had determined that the only option for us was to find a private obstetrician to ensure continuity of care and that ever-so-important medical expertise. I wish that back then someone would have told me that the decisions you make for your first birth will affect you for the rest of your life. I wish that someone would have told me that although birth is one day is still requires a lot of preparation. My first pregnancy ended in an elective c-section because we were told that baby was too big and too high and a natural birth was just not going to happen. My second pregnancy ended in an emergency c-section because after spontaneously going into labour I was told that our baby was distressed and I was not progressing. It felt wrong, and I felt robbed.

Then came 2011, and alas we were fortunate enough to be having a third child. I was annoyed that I had let the system dictate my first two births and adamant that it was not happening again. I had read that statistically your chances of a vaginal birth after c-section were higher in a public hospital, so I started there. I called the local public hospital’s antenatal clinic and set out my story, I’d had 2 possibly unnecessary c-sections, was planning a vaginal birth, and didn’t want any trouble. They put me in touch with a caseload midwife who was eager to take me on, I was told this was my best bet. I was excited, this time would be different.  I had also read that statistics show having a Doula decreases intervention rates and increases positive outcomes, so I was certain we needed Jacinda, an acupuncturist and Doula who I met during my second pregnancy.

At 18 weeks I received a phone call from my caseload midwife advising that the team had agreed that I would be fighting an uphill battle against hospital policy and procedure to have the birth I wanted. She arranged an appointment with a public obstetrician to “seek permission” for a trial of labour. I called Jacinda, flabbergasted and afraid that I’d never find someone who would believe that I was capable of giving birth. She suggested we look into homebirth, an idea way out of my comfort zone. I agreed to speak to a couple of independent midwives, but we also decided to meet with the public obstetrician to hear what he had to say.

I spoke to four independent midwives about homebirth, about my c-sections, about the risks of repeat c-section versus the risks of vaginal birth, and I could not believe how supported I felt. They all gave me the impression that I was perfectly capable of giving birth, that I was not insane for wanting to try. When I saw the public obstetrician however, he could not understand why I wished to deliver my baby vaginally. He agreed that there were a number of risks of repeat c-section, he stated that my first two c-sections were down to “Dr having a holiday booked and just bad luck”, he even informed me that I had a “favourable pelvis for childbirth”. In conclusion he said he would allow a trial of scar but with conditions and that if he was not on duty on the day I went into labour, no other obstetrician there would agree to this.

Mark and I knew that if we stuck with the hospital, we would end up with another c-section. But we still weren’t entirely comfortable about the idea of giving birth at home, so we asked an independent midwife to come and meet with us. Hazel was passionate about VBAC in particular and after chatting with us for a couple of hours and answering every fathomable question with a well researched and evidence based answer, she had us buzzing with excitement. We were going to do this, we were going to bring a child into the world in our home! We went to see our beloved, trusted GP to tell him the plan and his response was “Oh no, you can’t do that, your uterus doesn’t work, you need to have another c-section.” I laughed it off.

A few weeks later Hazel called to say her family had to relocate to Orange and she could no longer be our midwife. I was now about 22 weeks and panicking, what if we couldn’t find another midwife?  I met Emma and instantly loved everything she stood for, her passion, her energy, her intelligence, and her faith in the human body. PLEASE BE MY MIDWIFE!! It turned out that Emma worked as part of a Private Practice of Midwives, and when you book with them you have a second midwife attend the birth. I loved the idea of this, there is safety in numbers after all. Melanie would be my second midwife.

The rest of my pregnancy was a dream. Prenatal visits with Emma were relaxed, we talked about any concerns we had and made plans for the birth. Finally, here was the continuity of care I had longed for since 2007, this was bliss. Jacinda and I talked through my fears, came up with coping strategies, and prepared for birth. My confidence was now at 100%, I had found a birth team who believed in and supported me. We went to a local GP to get a script for some medication (syntocinon just in case, etc) and he lectured us about homebirth being far too risky and that babies were not consumable goods that you could just throw away and try again. We laughed that off too.

At 41 weeks I developed terrible back pain and Melanie told me that the baby had turned around and was now posterior. Excellent. On Saturday night I had a show and the following day, I woke in the morning feeling like something was starting. I had mild contractions throughout the day and night, and then it stopped. And then nothing. Emma came to visit on Monday, and she said that the baby now appeared to be anterior, so she suggested that the early labour I had experienced was just to help turn the baby around.

A contraction woke me at 3am Tuesday morning, it was now Hunter’s second birthday. By 6:30am, they were so strong that I could no longer lie in bed. They were coming about every 7 minutes and I just had to move through them. We had made plans to take the boys out for Hunter’s birthday but I stayed home and laboured alone. I was quite tired, so I tried to get some rest. Lying down slowed the contractions, so I knew that it was still early. Each time one came I just had to get up, it was involuntary. I would either hop up onto my hands and knees and swing my hips in a circle, or stand at the ensuite sink and sway. I had decided that soften, open, release were to be my key words, so with each contraction I would take a deep breath through my nose and on the exhale I would say those three words.

After a couple of hours in the bedroom, I needed a change of scenery, it just wasn’t working for me anymore. I decided some fresh air would be nice so I went out into the back yard. When a contraction came I would pace Mark’s beautiful garden, and I would look at the plants, the water fountain and the Buddha while breathing and saying soften, open, release. This was so calming and refreshing, just what I needed. But then the silence of the house became deafening, so I went in and turned some music on, and then with each contraction I would dance around. Finally my boys came home, and as much as I enjoyed the time alone, I was so happy to see them. We had lunch together and then put them down for a nap.

Now it was time to try a bath. Again the contractions slowed right down and it was lovely just to get some rest after spending so long pacing and dancing! After 45 minutes my three year old burst into the bathroom declaring that he needed to do a poo, the moment was lost, and I got out. I found that pacing around the dining table furiously shaking my hands was a good way to distract myself from the pain. On some occasions, Mark would hold an ice pack to the small of my back while I swayed through contractions and this felt good, but I needed more of a distraction. I decided to cook some Bolognese sauce, Hunter loved pasta and it was his birthday after all. So at around 4pm I started grating carrot, capsicum, onion and mushroom to make a healthy dinner. By now I’d stopped timing contractions, it was too consuming.

Jacinda had told me that sometimes it’s not the regularity of contractions that indicates a woman has reached established labour, but her demeanour between contractions. So when I burst into tears at 530pm, we knew something was happening and Mark asked me to call Jacinda and Emma. Emma said I was sounding like I was doing very well and that I was now establishing and that she would come whenever I needed her to. During the ten minute conversation with Emma I had three powerful contractions and I realised how close together they now were. While this was going on, Mark was trying to get the boys fed, bathed and in bed an hour ahead of schedule, and he was successful!

Jacinda arrived shortly after 6pm and it felt so good to see a fresh face. We stayed in the bedroom, where I would rest on the floor between contractions and rock on the fit ball breathing through them. From the moment Jacinda arrived, I didn’t once check the time. Mark joined us once the boys were in bed, and we realised we hadn’t filled the pool yet nor did we know how long it would take, so off he went again!

It was just before dark when Jacinda suggested I get in the pool so we headed to the lounge room. Ah, the serenity. The heat of the water and the sensation against my skin was just what I needed. I was so incredibly relaxed. I decided it was time to call Emma, I needed to know that our baby was ok. When she arrived she was so discreet I hardly noticed, and I was so focused that I could barely acknowledge her. She observed me and checked the baby’s heart rate and assured me that we were both doing really well.

I must say, I felt like a goddess. Here I was, laying in a pool, surrounded by gentle, caring people catering to my needs. I was constantly offered drinks, I was fanned, water was poured over me, cold compresses held to my face and neck, music played, and hot water added to the pool on request. There was no place in the world I would rather be. But then it started to get really hard. The breaks were shorter, the contractions were longer, the pain was more painful. At some point I started really chanting OPEN and OUT on the out breath and found that I could not handle the contraction without yelling these words. I also started banging the side of the pool with my hands, the motion seemed a good distraction from the pain.

The pain in my back became quite unbearable so Emma tried applying pressure, which really helped. Mark then got in the pool, as I kneeled on all fours he pressed hard on my back while Jacinda held my hands. A few times I complained that it was getting too hard and taking too long and Emma would reassure me that I was doing a fantastic job and making great progress.

Finally something started to change. It wasn’t anything I had control over, but what my body did with contractions turned from coping through them to working with them. It was at this point that I asked Emma if we should check to see how dilated I was because I was afraid of pushing if I wasn’t yet there. Emma was amazing. She told me to listen to my body, it knew what to do. She suggested we get through a few more contractions and if I wasn’t sure she would check dilation. Only a few contractions later I felt my water break and Emma again reassured me that this was a sign of great progress and to just go with it. My body took over. My yelling OPEN and OUT during contractions suddenly turned to silent pushing, I could feel my pelvis opening up, feel my baby coming down. I felt the head emerging and I pushed and panted and pushed and panted, feeling myself stretch and stretch. Her head popped out and I had to breathe deep and wait for the next contraction, and her body was then born. My oh my what a strange feeling that was, I felt her kicking and twisting inside me as she wriggled out and I exclaimed “What the f*** is that?!”

It was 12:16am... “Sit back and pick up your baby!” Emma instructed. This two seconds lasted an eternity, and as I reached my hands into the water and lifted out my beautiful baby girl I was in absolute awe of what had just happened. She took her first breath in my arms with Mark right there with us. We confirmed that she was in fact a girl, and just sat there holding her, amazed by her, absorbing the moment. Mark went and got the boys out of bed. Emma suggested I get out of the pool, so holding my baby in my arms, I climbed out and onto the lounge. The cord had stopped pulsing so Mark clamped and cut it. Jordan was too tired to participate and wanted to go back to bed, but Hunter was mesmerised and refused to leave his sister’s side.

I sat feeding Ava, trying to work with the contractions push the placenta out, but I just couldn’t. I could feel myself fading and Emma and Melanie were starting to worry. An hour after Ava was born, Emma removed my placenta using controlled cord traction and then discovered that I had a third degree tear. It was recommended that we go to hospital to have it stitched, so Ava and I were dressed and packed into the car. Before dressing Ava, Emma weighed her. My 5 foot 2, 55kg body, had just given birth to a 4.54kg baby!

We got to hospital at about 3am. The obstetrician wanted to repair the tear under a general anaesthetic and I agreed. Emma stayed, taking care of Ava while I was under and bringing her to me in recovery. After several hours of declaring my intention to leave I was finally given scripts and instructions and signed a form to say I was leaving against medical advice, and I was at home in my own bed with my three beautiful children by lunch time. Bliss.

Would I do it again? In a heartbeat. What an amazing experience. It felt so right. Yes I ended up in hospital, but I gave birth to a 4.54kg baby! How could I push that out and not need some stitches? I am so proud, I want to take my baby to every doctor who said I couldn’t give birth and say “I did it!” I’ve recovered beautifully, my baby is now one week old and I am on top of the world. I am so incredibly thankful to have found Jacinda, Emma and Melanie and to have such an amazing supportive husband. All it took was for them to believe in me. I can’t wait to do it all over again.  

Published 31/8/12