Guest Post- The HBAC of Ky (by Bec Gorman)

My Pregnancy Journey and HBAC of Ky- guest blog by Bec Gorman

This story begins with the birth of our first baby, Madison in September 2008. Our beautiful baby girl entered the world via ‘emergency’ caesarean after I was induced at 39 weeks for a mild case of pregnancy induced hypertension. Not knowing any better and being very impatient at the time, we happily agreed with the induction. It resulted in a very intense long 21 hour labour and a cascade of intervention (continuous monitoring laying on the bed, two pethidine injections, three epidurals, artificial rupture of membranes, syntocinon and three failed vacuum delivery attempts). After all of this, being stuck flat on my back feeling paralysed any wonder I couldn’t birth my baby girl! My blood pressure and Madison’s heart rate remained stable throughout the labour but she was ‘stuck’ in a right occiput posterior position. Off to theatre we rushed. After such an ordeal Madison’s first cry was music to our ears and we were delighted to finally meet her. She weighed 7lb11oz.

We planned to have our children from 18 months apart. When Madison was 10 months old we were thrilled to discover a second little darling was on their way. We now lived in a different city. Very early in the pregnancy we booked in with a private obstetrician and hospital because that’s the path we were familiar with from our first pregnancy. It wasn’t until I fell pregnant again that I really started to reflect on my birth experience with Madison – not something I wanted to endure again. I felt I had missed out on the real experience of birth, that the drugs and intervention had robbed me of a necessary experience of being a woman and mother. I became very determined to make this journey different and have a vaginal birth after caesarean (VBAC) but little did I know about the challenges I’d be up against in the private system. I started thinking about all my options to help me achieve a VBAC. Finding a doula was my first step. We will be forever grateful for the wonderful invaluable support, encouragement and friendship that our doula, Kylie gave us from day one.

At our first appointment with the obstetrician we stated our desire of a VBAC upfront. He seemed quite supportive and told us he had an 80% VBAC success rate. I was a little disbelieving and sure enough the hospital statistics told a much different story of ~11%. Kylie encouraged me to nut out his rules and regulations of a VBAC at my next appointment. So I did and asked him to lay it all out on the table so to speak. This time he told me that HE would decide at 37 weeks what type of birth I could have but it would most likely be a caesarean on Thursday 15th April (10 days before my EDD) and checked his calendar there and then! If he did let me have a ‘trial of labour’ I would be subject to all the ridiculous rules that go with it. As if I was going to wait out the next 20+ weeks for HIS verdict on how I could birth our baby and at his convenience! I left his office knowing I would never return.

I was no longer interested in obstetric care and wasn’t eligible (because I wanted a VBAC) for one to one midwifery care at the public hospital. I began to do loads of research and read everything I could get my hands on, particularly by authors such as Michel Odent, Ina May Gaskin, Janet Balaskas and Sheila Kitzinger. The things they had to say about birth resonated with me. We started to learn more about private midwifery care and home birth and realised that by taking charge of where and how I birthed, I would be able to increase the likelihood of a good and gentle outcome for both myself and our baby. So home birth was it!

Around the beginning of my third trimester we found the most fantastic private midwife. From the moment we met Rachele we knew she would be a perfect fit for our pregnancy journey and dream birth. She is incredibly compassionate, supportive, knowledgeable and trusting and respectful of the natural birthing process. Every time Rachele met with us we felt completely relaxed and supported in our decisions. We were very grateful for not only gaining a wonderful midwife but also another great friend.

I had one booking appointment at the public hospital (in case of transfer) at which the obstetrician had no hesitation in telling me I was making a very foolish decision to have a home birth after caesarean (HBAC) and it would be very irresponsible of me as a mother. He also told me my pelvis was probably too small since I was unable to birth an average size baby the first time. I challenged him to discuss the risks associated with multiple caesareans and the benefits of VBAC but he didn’t want to acknowledge any. I felt a little rattled after this appointment but in the end it actually gave me more determination to achieve my birth the way I wanted it and not be dictated to over a minuscule risk of uterine rupture.

My pregnancy was perfect, next to no morning sickness, no reflux, no aches and pains, no fatigue, no blood pressure issues and I never got impatient with it. I attribute this to being more physically active (regular daily walking of 2-3km, yoga and aqua aerobics), consuming a high protein and calcium diet, natal hypnotherapy, networking with other home birth mums who especially achieved a HBAC, maintaining a relaxed and positive mind and becoming much more informed and educated about active birth and birth being a natural normal physiological event – a big thanks goes to Peter Jackson and his Calmbirth class for contributing to this. Peter filled us with confidence and empowered me to trust my body and let birth unfold in the natural manner that my body was designed to do.
Throughout my pregnancy I became more and more comfortable with the idea of birth. I felt very prepared and wasn’t afraid. The perfect birth was to follow. From 38 weeks I started experiencing pre-labour symptoms – intermittent mild period-type pain, loose bowel motions and stronger braxton hicks (BH) tightenings. Each day and night we would talk to our baby and let him know how much we already loved him and that we couldn’t wait to meet him whenever he was ready. I would also tell him about the beautiful calm home birth we had prepared for him.

At around 8:30pm on the evening of my estimated due date, 25th April ’10, the strong BH tightenings returned. At first I didn’t think too much of it and just thought it might be another night like I’d had three of in the previous 10 days. I would get evenings of fairly regular BH that would ramp up before fizzling in the early hours of the morning. John and I stayed up watching TV for a couple of hours before I went to bed and listened to my Calmbirth CDs, relaxed and practising my breathing. The tightenings were coming irregularly, anything from about seven to 20 minutes apart. I dozed in and out of sleep for a couple of hours and woke at 1am for the usual bathroom visit. I couldn’t get back to sleep as it was a bit uncomfortable lying on my hips plus I was excited with anticipation that this might actually turn into labour. I paced around the house a little and sat on my fit ball surfing the net. But by 3am the tightenings were starting to fizzle and I was feeling sleepy so back to bed I went expecting to wake up later in the morning with things unchanged. I fell asleep straight away. At 3:44am I woke with a tightening that made me jump out of bed in a flash! This one felt much different in intensity and length. I had to run to the ensuite (bowels were in motion) and when I went to the toilet I noticed I was starting to lose my mucus plug. Woohoo! I thought...this is for real! I had to spend the next hour in the bathroom. At 5am the tightenings ramped up and were now coming regularly approximately 3-4 minutes apart and lasting around 60 seconds. I considered this the beginning of active labour. I woke John half an hour later telling him “Happy wedding anniversary babe, I think we are going to meet our little boy today!” After he realised what I said he jumped out of bed asking what he could do to help. He went about setting up my music, aromatherapy, lighting our birth candles and laying towels around the birth pool. At 6am I asked John to call Rachele, Kylie and my parents, who were to look after Madison. I found I had to concentrate through each tightening and focus on my breathing and it was most comfortable to kneel in a squat position on the floor and lean over pillows stacked on the side of our bed. In the breaks I would get up, chat and walk around to remain active.

Everyone had arrived by 7am and entered quietly into our calm, peaceful birthing environment. I hugged and kissed Madison goodbye for the day. Rachele monitored our baby’s heart rate by doppler and my pulse approximately every half an hour during this first stage of labour. They both remained stable throughout the entire labour. I was feeling hungry so attempted to eat some fruit but found it tasted sickly sweet and I soon vomited it back up. Sucking on ice chips and sips of water were much more palatable. I started to add a swaying hip movement to my upright semi-squat position and continued to breathe through each tightening with my birth team massaging and applying heat packs to my lower back and reminding me to slow and deepen my breathing when necessary.

Around 9am the birth pool was nearly full and I was starting to feel pressure in my bottom so I hopped in the warm water, submerged my body, stretched out and felt blissful! I even got a few power naps in. My mucus plug continued to come away in bits and pieces and the tightenings were still 3-4 minutes apart. At about 10:30am I was grunting at the peak of each tightening and feeling like I needed to push. I actually had not been watching the clock so had no idea of the time throughout labour and to me it had seemed to go so quickly. I was a bit concerned that maybe it wasn’t really time to push and I should hold off in case I wasn’t fully dilated plus my waters hadn’t broken yet...shouldn’t they have broken by now?, I thought. So I asked my team how far they thought I was (I didn’t want any internal examinations done). I got the reply “Further than you were at 5am! You’re doing great just trust your body and go with it”. I could tell by the smile on their faces and the twinkle in their eyes that my feeling to push was right. Everyone continued to participate in comforting me with massage, hot packs, pouring water over my head and back, aromatherapy and encouragement.

Over the next half an hour I started to push with each tightening. A few minutes later Rachele announced she could see something, maybe his head! Turns out it was actually the intact bag of forewaters. It was a very bizarre feeling birthing this ‘water balloon’ and having it dangle between my legs! Rachele was now monitoring baby’s heart rate every 4 minutes in between tightenings. After about 45 minutes of pushing I felt like I was getting nowhere and began to get panicky that maybe I couldn’t do this, maybe I wasn’t built to birth naturally (even though deep down I knew this wasn’t true). I began to doubt my ability but at no point did I ever want medical pain relief. Sure the sensations of these very strong tightenings were uncomfortable at their peak but nothing I felt I couldn’t cope with between the preparation I had done and the support around me. (To be honest the discomfort of my haemorrhoids was worse than the tightenings!). Everyone quickly brought me back in line with words of encouragement and positive affirmations so that I could focus on my breathing and visualisations again. The voice of my wonderful yoga teacher, Deb also popped into my head telling me that I could do it!

By this stage I was feeling rather wrinkly from being in the pool for a while and was starting to get cramps in my feet. Rachele and Kylie suggested I get out of the pool and use the assistance of gravity and try some new positions. I alternated between sitting on the toilet and standing leaning against John. Rachele suggested I feel for my baby’s head myself, so I did and to my surprise I felt him about 2cm away from crowning. ‘Wow’ I thought, he really is there! This excited me and spurred me on even more. With each push I could feel him move down slightly but then slip back up. I still had the intact bag of waters dangling between my legs, which was starting to annoy me and waiver my concentration from the task at hand. Rachele said I could break it off if it was bothering me. As amazing as I thought it would be to birth our baby in an intact membrane sac, I broke the bag off at 12:30pm and then his head came into view as I pushed. I got the hang of breathing him down and holding him there more so than trying to push really hard and then have him slip back up at the end of each tightening. This method felt much more effective. We were so close now! I needed a new position so John sat on the edge of the bed and I leant on his shoulder facing him in a standing squat position. Those weekly yoga squats and postures during pregnancy certainly paid off, thanks Deb!

Just after 1pm I could feel his head starting to crown. That ‘burning ring of fire’ really wasn’t that bad. Kylie placed a mirror on the floor below me so I could watch this amazing birth moment unfold. With the next tightening I birthed his head and nuchal hand (any wonder my stage two took a while!). I reached down and felt his warm wet head and was totally amazed. My only word was “Wowsers!” which I kept repeating. The next tightening came quickly and with one push I birthed the rest of his body which whooshed out followed by a massive gush of waters and membranes. It sounded like a water pipe bursting! Rachele took a classic catch (at 1:13pm after 8 hours of active labour) and immediately passed our beautiful baby boy, Ky Ambrose, up to me on the bed.
The room was filled with exclamations of cheer, joy, love, tears and one very loud newborn cry. It was all a little surreal for me at first and took a few moments to sink in that I actually did it...I birthed my 10lb baby at home after caesarean! I was quickly overjoyed with emotions that our dream had come true and overwhelmed with feelings of love, happiness and accomplishment. I will always cherish those first cuddles and immediate skin to skin contact. Ky breast crawled and fed perfectly within 30 minutes. I had looked forward to these moments for so long as I was unable to experience this with Madison.

We did not clamp his cord until after it stopped pulsating and then John had the privilege of cutting it. I had a normal physiological 3rd stage and birthed Ky’s placenta after about 45 minutes. Ky’s APGARS were 9 and 9, weight 10lb, length 53cm and HC 37cm. We snuggled in the comfort of our own bed for the rest of the afternoon. Madison excitedly returned home to meet her new little brother and we were an elated family of four.

In a way I am grateful for the birth experience I had with Madison as this allowed me to learn about the best things I could do to work with Ky to bring him earth side in the finest possible way. Ky’s birth was the most empowering moment of my life. This journey has changed me profoundly and I now wouldn’t give birth any other way.

My advice to any woman wanting a VBAC and/or a natural birth is to do your homework, trust your instincts, surround yourself with positive support, plan a joyous birth and be in control of your journey. Doing this allowed me to achieve the outcome I got. I don’t consider myself brave or crazy (as I have been told by many) for having a wonderful natural birth at home after caesarean, just simply educated. A woman’s body is designed perfectly for giving birth. I wish for more women to trust their bodies and believe in themselves and not be so scared of giving birth. I hope this story inspires women to do so.