A Tale of Two Labours – By Nadia Raafat.
From c-section to home birthing, how one writer used the mistakes of her first birth to bring about the perfect second birth
I didn’t have any fear the first time – at least not during the pregnancy. But then I didn’t know what to expect. Regarding myself as an earth mother capable of a simple natural birth I imagined it would be a cinch – after all hadn’t millions of women birthed their babies before me? It couldn’t be that hard. Surely?
In retrospect I don’t think I had much respect for my first pregnancy. I was too busy with work, moving home and supporting my partner Angus (in the midst of a personal crisis) to bother with birth preparation. A yoga class here, a birth book there was about all I managed to squeeze into my busy schedule.
At 36 weeks I stopped working. It was Christmas Eve. I hadn’t written a birth plan, I hadn’t packed my bag and I had no idea how to breathe in labour. I wondered whether I was cutting things fine.
I was. A few nights later – still with nothing done – I bled heavily and had to go into hospital. They told me I was one centimetre dilated and could go into labour that night.
As I lay on the thin metal hospital bed afraid to move in case I triggered labour, I realised how far I was from being ready to birth my baby. I prayed that he or she would not come that night.
My prayers worked. But there was more bad news to come. The following morning whilst scanning me, they discovered the baby was breech. I was told that if it didn’t turn in the coming weeks I should prepare myself for a caesarean.
One week later I went into labour. I was at a retreat centre in the middle of the Dorset countryside – alone. My partner was in London.
In retrospect I should have seen the signs coming. The urge to walk six miles in the crisp January sunshine, the connection I felt with the natural world, the creative surge I felt at bedtime. But I didn’t. I went to bed on the 4th of January blissfully unaware of what was coming.
At 8am I was awoken by what felt like an icy hand squeezing and wringing my lower spine. I sat up in a state of red alert. My first thought was the right one – but I quickly put it to the back of my mind. This was nothing to worry about I told myself – just a few Braxton Hicks or my body reacting to all the previous night’s yoga.
I showered and dressed and shuffled quietly to breakfast. The cramps, far from easing off, had intensified. It was all I could do not to cry out in pain over my orange juice and tea.
As I was on a retreat – and certainly didn’t feel much like talking that morning – I opted to breakfast at the silent table. At least that way I wouldn’t have to either a) explain myself or b) fake it.
Even so… breakfast was an effort. My face must have registered the pain I was in because one of the retreatants approached the table and asked if I was ok? “Well, no.” I whispered. “Actually I am not.”
The news that I was labouring travelled fast – especially considering most of the retreatants were not supposed to be speaking. The hullabaloo served as a distraction from the increasingly nasty spasms I was experiencing as I readied myself to leave.
Bad news was waiting at the station. There would be no trains running through here today. The nearest station was twenty miles away. I checked the gaps between contractions – every 12 minutes. Call an ambulance advised my mother over the phone. For God’s sake don’t attempt to board a train. Take yourself to the nearest hospital.
Although still not fully accepting of the fact that I was now in labour, the idea of giving birth on an intercity 125 in view of all the Sunday excursionists – was enough to make me agree.
From the ambulance I rang Angus. “You’d better get down to Portsmouth,” I said. “We’re about to have a baby.” I felt strangely disconnected from him so I didn’t bother communicating how frightened I felt.
At St Mary’s hospital I was admitted, checked for dilation (2 cms) and ushered into a sparse, ill-equipped and very chilly room. I was left to labour. It was the last thing I felt like doing. I felt utterly alone.
The obstetrician came to see me and said she would be willing to deliver my baby naturally if that was what I wanted. But there were risks involved and if progress was slow I would have to have an emergency caesarean. I agreed.
For eight hours I laboured before I gave in to their pressure and my own negative beliefs. I wasn’t ready. I knew it. I wasn’t going to be able to birth my baby. I did everything wrong. My breath was shallow, my movements constricted, my body tense with fear. I was completely out of synch with the process of birth. And fear proved to be a formidable foe for Mother Nature that afternoon.
At 5pm I asked a midwife, to check me again. I was only 5cms dilated. How disheartening. “Is that all?” I said. In a last bid for a natural birth I asked for some gas and air. But it was hopeless. (The contractions were so strong I couldn’t even hold onto the mask) I simply threw up and developed an excruciating headache.
At 6pm I admitted failure and signed the caesarean section forms. On the way up to the operating table, I cried. To my mind, despite my efforts, despite the breech positioning, I had failed. I was not the earth mother I believed myself to be.
Rohan Ford-Robertson was delivered by emergency caesarean section at 6.32pm. His Agpar scores were low, he was off colour and he received a graze to the skin on the way out. But none of that mattered when they put him in my arms. My son had arrived safely. That was all that mattered now.
The second time around the fear was the first thing I felt. So much so that I sunk into a black depression. I felt sick at the prospect of having to deliver a second baby.
I could see the attraction of an elective caesarean. Nice and tidy. No pain and a baby in thirty minutes. But that just wasn’t me. Perhaps I was an earth mother after all. So here I was being given a second chance to prove myself. But the statistics were not encouraging. Only 33% of women follow a caesarean with a vaginal delivery (VBAC).
I went over the birth of my first son Rohan examining and analysing what had gone wrong. Yes, he had been breech. But I had also been without support, frightened and un-prepared. I don’t do hospitals well. They’re cold, noisy and bright places -the antithesis of the optimal environment for birth. I associate their smell with fear and death. Not babies. Because of my previous caesarean I would be catergorised as high risk; my scar might rupture leading to possible infant fatality. That meant there would be all sorts of restrictions placed on my labour. I couldn’t use the birth pool for pain relief, I couldn’t have an active labour and I would have to deliver the baby within a limited time. Otherwise intervention would be inevitable. No wonder only 33% of women went for a natural birth after caesarean. I quickly realised that only way I could keep the staff of the obstetric ward from intervening in my birth was to stay away from them altogether. I took the decision to have my baby at home.
Irresponsible, foolish and dangerous were just some of the adjectives used by the staff of St George’s hospital in Tooting to describe me and my hazardous plans. First they told me I would not be allowed. That infuriated me. I knew enough to realise I had the right to choose how my child was born. Then they intimidated me with talk of emergency helicopters, stillborn babies and, possibly, my own death.
Finally, after much persevering, I was given an appointment with the community midwife. She was nice enough. She’d had all her babies at home. But she didn’t want to deliver mine. She admitted in her nine years as a community midwife she had never delivered a vaginal birth after caesarean (VBAC) at home. She seemed to expect something to go wrong.
Exasperated in the extreme, I decided to dump the NHS and go private. If I was going to deliver this baby naturally, I was going to need encouragement and support – neither, of which I had encountered thus far.
Step forward Annie Francis, and the other wonderful women at South London Independent Midwives. AF may have cost me my Barbadian holiday but the woman was a godsend with hundreds of successful home births behind her – including VBACS. She told me that in her nine years as a midwife she had never witnessed a case of scar rupture. Annie restored my faith in my body’s ability to birth naturally.
I settled down to prepare for the birth. This time around I respected my pregnant state. No longer tied to an office job and already in the mother role, I embraced wholeheartedly my pregnant state and explored every aspect of giving birth. I started pregnancy yoga in earnest, I saw a hypnobirthing teacher, I had reflexology, I read birth stories, I attended NCT antenatal classes, and I read birthing books. I changed my diet, started swimming, I slept only on my left side. I even did perinatal massage. In short I treated my pregnancy with the attention it deserved. After all, I reasoned, if I was going to attempt a VBAC, I wanted to give it the best chance it had.
At 32 weeks I attended my last hospital appointment. The consultant, in a final bid to try and dissuade me, relayed to me the sorry news of a patient, like myself, who following an attempted home birth after a caesarean, suffered a serious scar rupture with the result that her baby was born seriously brain-damaged. He nearly succeeded. Later I found out he’d misrepresented the story. It’s true the mother’s scar ruptured. But it happened while she was in hospital. Sadly, the baby died.
I was thirty-eight weeks and four days the night I went into labour.
I reckon it was the Thai curry. Or maybe the baby was just ready to come.
I fell into bed at midnight with an aching back. I put it down to Braxton Hicks contractions and fell asleep.
At 2am I was woken by familiar spasms. That’s the great thing about the second time. You have a reference point. No longer able to lie in bed. I got up and spent the next half an hour on the loo emptying my bowels. (Another sign.) I felt sick with nerves. I knew my day of reckoning had come.
I called Annie who told me to try and get some sleep. What was she thinking, I wondered, as I paced the dark hallway like a nervous animal trying not to be intimidated by the intense contractions.
When I woke Angus my contractions were fifteen minutes apart. “I need help,” I whispered, “so as not to wake Rohan, our two-year-old son. “I’m not coping.”
It’s not the pain itself; it’s the anticipation of it that I can’t cope with. Angus took my hand, calmed me down and guided me through the contractions one after the other. Quake after quake shuddered through me. But with each one I uttered the mantra “That just brought me closer to meeting my baby.” Between contractions he rubbed my back and encouraged me to rest.
Around 4am something changed in the labour process. My mind switched off. I stopped anticipating the contractions. The oxytocin and endorphins kicked in and I began to withdraw into myself. When the midwives arrived around 4.30am, I hardly noticed them. Here was the labour I had instinctively felt must take place. The deeper the contractions came, the more my body began to surrender. With groggy amazement I witnessed this incredible process unfolding in my body.
Just after dawn – around 6.30: Annie invited me to feel inside for the baby’s head. Tentatively I inserted my fingers, unsure what to expect. I met a warm pulsating bulge – my baby’s head! I was fully dilated. I’d made it. Second stage was underway.
I felt the first urge to push fifteen minutes later whilst sitting on the loo. Not long afterwards my membranes ruptured and pale green water flooded out. “My baby’s coming!” I screamed with delight.
From there it took just 45 minutes for my son to touch down. I didn’t push. I bore down with the breath as I had been taught. And with each bearing down, I roared like a lioness. What the neighbours must have thought I don’t know.
At 7.24 Rohan woke and ran into the sitting room, clearly curious about all the noise. One minute later he saw me bear down for the last time and press my baby into the world.
In my notes next to the recorded time of 7.26 are the words: “I did it.”