A HBAC Success Story

Successful homebirth after caesarean!!

Raised BMI

HBAC

Large baby

MH

I Opted out of NHS care, hired an independent midwife, Amanda Garside, who has a passion for VBAC/HBAC and had gained lots of experience to support families such as ours.

The evidence shows, and has done for a while, that birth outcomes are more positive and satisfaction rates are higher, when there is continuity of carer in maternity care.

I met Amanda when very newly pregnant and was discharged from her care at 34 days postnatal. By NHS standards, I had a high risk pregnancy, but I put complete trust in my body and baby. Planning the labour and birth with Amanda was so exciting and I honestly couldn't wait to do it! We spent time going over all the details, my preferences, potentional reasons for transfer and what the evidence currently says about my individual circumstances, not the general population. This was done in my own home, with my partner present and for as long as needed. We followed Covid measures throughout.

Unfortunately, independent midwives do not currently have insurance to provide labour and birth care! So my labour and home birth was attended by two experienced NHS midwives. With all the planning and preparing we had done, I felt confident going into labour, even if it wasn't my independent midwife attending-luckily I had some downright brilliant NHS midwives attend! 

Birth story :- I'd been having uncomfortable braxton hicks for a couple of weeks, some would feel slightly more cramp like but it never progressed anywhere. After reaching 41 weeks, Amanda offered holistic acupuncture procedure-, I got a couple of tightenings, they felt similar to what I had experienced before and fully believed I had another week of pregnancy to go. Amanda's 'midwife senses' as she called it, told her that it would be very soon, if not that night. I laughed. My first pregnancy ended at 42+1. Amanda dropped off the birth pool and all the kit, she provided this as part of her care package, having made sure all pieces were present and the pool was fit for purpose. She also gave us a quick lesson in setting it up, it really eased my husband to know it was all in working order, as this was his job. Encouraged by Amanda's feelings following the acupuncture, I spent that evening trying to promote oxytocin, hubby helped kindly. Around midnight, about an hour after 'adult time', I started feeling tightenings, a bit like period cramp. By 1.30 I had started timing them, as I couldn't ignore them so thought I may as well. I spent a lot of time in the bathroom, which each surge I needed the toilet. I filled up my water bottle and started to make preparations for the idea that this was actually happening. I turned on all the Christmas lights and started reciting my affirmations. Around 4.50am the surges were very intense, I felt a lot of discomfort on my pubic bone and it was incredibly sharp. I knew it wasn't scar pain, it very much felt like bone on bone. At 5.15am I woke hubby and said I thought it was time to fill the pool! He had heard me pottering about throughout the night, we bed share with our 3 year old, who was sleeping soundly. 05.46am I was beginning to lose control, the pool was filling but I was crying during surges, I knew I was still early on in this labour journey. At 6am our 3 year old woke, he gave me a cuddle and reminded me to breathe. That gave me a burst of oxytocin! The surges continued and my 3yo told me I was too loud. Initially I was hoping I would be able to control myself more and have him present to witness the arrival of his sibling, but he started to get upset seeing me in discomfort so I asked my sister and her husband to look after him (they are our support bubble). At 06.15am I called the midwives and whilst on the phone had a surge that I felt aided baby to descend - after hearing that, the midwives said they were on their way. I kept saying to them that I felt it was still early, I was just struggling and I was a wimp my husband bless him, then started chanting my affirmations! I'm not sure exactly what time but between 7 and 730am I got into the pool. As I expected, it helped immensely and the surges settled a bit, they spaced out and were more manageable, this was a welcome thing and I used the opportunity to hydrate myself and focus my breathing again. 2 NHS midwives arrived with a boat load of equipment. With the surges having spaced and coping a lot better, the midwives offered an examination to assess- I accepted this. My cervix was still a little high, small amount of thickness, but 4cm dilated. It was shift handover time and so the midwives contacted the delivery suite to inform them and request a day shift midwife to attend. I got back into the pool I requested entonox around 8 15am I spent the next 4.5 hours labouring in the pool, moving around as my body told me to and trying to focus on my up breathing.

 

 

The surges were incredibly powerful, I was loving that bit, but then the public bone discomfort was coming, I was adamant that I couldn't do it. I was envisaging going into hospital for a spinal. I snapped out of it when I was reminded that I absolutely could do this. I still retained that I couldn't. One midwife noted that I was swaying my hips in a way, that she thought may have been my body subconsciously trying to get baby to rotate head. This would also account for the incredible bone on bone discomfort. They were very careful to ensure that I described what I was feeling accurately. It was definitely not scar pain, all bone! At this point we mutually decided that a ve might help understand what was happening. I was then 8cm dilated, baby had descended into pelvis, membranes were bulging and baby felt OA. I had a large bloody show following this and again, hopped back into the pool. We topped up the hot water and my hubby managed to scald me with some hot water during a surge - I let out a very loud shriek! I had begun screaming during surges and felt myself losing control. I optimistically tried to tell myself that maybe I was hitting transition. At this point I had been powering through the entonox and the midwives had to get more. I continued to listen to my body in terms of positioning. I was encouraged to mobilise but I couldn't face leaving the water, I knew it would help things progress but I just couldn't! Eventually I began making some grunty, pushy sounds at the end of surges. I continued to trust my body and just coped as best I could, my husband sat behind me chanting 'strong, long and powerful' to remind me how to breathe. The 4 hour routine vaginal examination time came up, it was offered as protocol with the reassurance that it was no issue if I declined. My last labour stalled at 8cm and resulted in an 'emergency' caesarean, so I opted to have the assessment. It was some time after 3pm, I now had an anterior rim, baby was at ischial spines and my waters were bulging. I just knew that we would have a baby once those waters were gone. My waters broke as the examination finished, I felt relief! Momentarily! At this point I was lying on the sofa, I was encouraged to mobilise, but I really couldn't move! The heaviness in my pelvis was immeasurable. I desperately knew how beneficial it would be to flip to all fours or something but I felt I physically couldn't move! My affirmations were on the wall next to the sofa I was on, so I started reading them over and over again, giving myself that last bit of oomph. Things get a little hazy around this point. Around 4pm, I was actively pushing with each surge. I gave throaty screams throughout, something that makes me glad to live in a detached house. By doing this though, I feel like it helped open everything up. I followed my body's urges and his head began to crown, I felt my vulva stretching and a little sharp pain, which turned out to be a clitoral tear. His head came slowly and I was encouraged to push. His body was a tad awkward to birth and my midwife aided him. We had immediate skin to skin and a 30 minute physiological 3rd stage.

 

The placenta was impressively large! It was checked, bagged up and thrown into my freezer, right next to the placenta I made to nourish my 3 year old when he was on the inside. I spent an hour having skin to skin cuddles on the sofa and baby latched at just 35 minutes old.. My husband made me the pate on toast I had been craving for the entire pregnancy! After baby finished I consented to his checks and weigh whilst I attempted to pee. Whilst sat on the toilet I hear some very shocked voices as they announce my little baby weighed 11lb 10oz! We checked my perineum and I had a small second degree tear that I opted not to have sutured. At a couple hours old, baby was intermittently grunting, and a little bit jittery, he also had a one off temperature of 37.6. We transferred in for a neonatal review. They suspected infection, I highly doubted that being the case but my mind was filled with 'what ifs', so I agreed to iv antibiotics for baby. Whilst inserting the cannula, they took some blood samples. Whilst the bloods showed no infection and antibiotics were stopped, they did show that he had 'polycythemia', raised haemaglobin, raised red cell count (haematocrit) , low platelets. We spent a week in hospital and after way too many blood samples later we were discharged. They put it down to the cord clamping being delayed too long. I still can't comphrehend this, he only got what was his. Perhaps if we studied the bloods of infants who receive OPTIMAL cord clamping, we will discover that these values are normal for them.

 

After being discharged from the hospital, care resumed back to Amanda for postnatal care. In terms of postnatal support, Amanda and I came to an agreement in terms of level of support required. I felt, after having a baby already and having good knowledge of newborns, that I needed minimal input. I was aware this could change and was reassured by Amanda that we could add any additional visits as required. Amanda was always at the other end of the phone, we had a handful of visits, spanning a month and was discharged from her care at 34 days postnatal, talk about continuity!

Would I recommend an independent midwife? 100%!!

Would I recommend Amanda? 1000%!!