How do babies happen?

[ailbhe]

Well, when a man and a woman love each other very much...

They go see the obstetrician, along with the community midwife, and discuss birth.

We met my community midwife first. She's been looking into vaginal delivery after third and fourth degree tears, and spoken to a midwife with lots of experience, and they suggest a homebirth. If I have a homebirth, I can avoid pressure to escalate the level of intervention. I can choose to transfer to hospital for a section at any time, based on a feeling that things aren't going right or on the advice of my midwives, and I can refuse epidural, augmentation of labour with syntocinon, et cetera. I quite like the sound of this - I can have a go at a vaginal delivery and if it's not working I can have a section and they can all say "I told you so" and be happy.

Then we all went to see the obstetrician, and tried to find out precisely why I am being advised to have a section (we didn't mention homebirth to the obstetrician) and we got very, very vague answers. The only definite answer was "Well, if I were in your position I'd want a section." That's not what I call sound medical reasoning, so I choose to ignore it for the purposes of informed decision-making.

The baby is growing on its curve, is a fairly normal size, and is beautifully positioned - and so is the placenta. If it weren't for my torn up genitals et cetera, I'd be on schedule for an easy birth.

If I have a planned section, it will be on 15th August, a Tuesday, and it will be performed by a woman I'll meet in the next few weeks (I must update my calendars). I'll be able to discuss my c-section birth plan with her, as outlined and revised here, and find out what she's like. I will also quite likely be able to meet the anaesthetist, though that is lower priority because in my experience anaesthetists are lovely people.

Then we went to book my various appointments and I passed the obstetrician who delivered Linnea, and had only a small lurch to my stomach. He walked close to me again later, and I heard his voice, and again I felt a clenching of my stomach - but not more. No urge to run, no urge to vomit, no shaking, no crying, no incoherence. So now I know what he looks like - I can remember it, from seeing it today without trauma, on a conscious level. It's all very interesting (at least to me) and I feel pleased and somehow proud.

Then we had a cup of tea with the midwife and she talked to us about things. She is going to try to find me an independent midwife in my area with experience of delivering babies to women who have previously had third or fourth degree tears. She is also going to try to find actual statistics on maternal injury rates in women who have vaginal deliveries after severe tears or other complications. She's happy to be on call for me and attend the birth of my baby whether it's a planned section or an unplannable vaginal delivery in my own home. The expert she consulted recommends that I do perineal massage, not necessarily to stretch the tissue (as that may not be possible due to scarring) but to accustom me to the sensation of pressure on it, as that might be upsetting and it's best to get that over with before birth itself. I'll buy some sweet almond oil tomorrow, I suppose.

My own midwife reckons that because I have once managed to dilate to 10cm, and because all my tissues are well-stretched ahead of time, and because I have no intention of allowing myself to be trapped on my back again, I have a good chance of a vaginal delivery. But she wants more information for me to make a decision with first.

So we have two plans running concurrently, which is the way I prefer to manage things anyway. I believe in backups.

Comments

[nicolap.livejournal.com]

Your midwife sound so wonderful. And her digging for information all sounds very promising. She's giving you facts, so you can make informed choices. I like that.

Lots and lots of luck, however you decide to do things.

[datagoddess.livejournal.com]

Oh, yay!! Between the possibility of a homebirth and being able to hear/see the ass who delivered Linnea, sounds like a lot of positive things today!!

[kcobweb.livejournal.com]

Informed choices and backup plans - it all sounds good to me.

[buzzy-bee.livejournal.com]

Er. Yay! I've always wondered whether all this was an option but never wanted to say anything. Am so happy it might be coming together (and if it doesn't, it will be for *good reasons*.

[ailbhe]

It basicalyl wasn't an option because everyone told me it wasn't an option and I was too traumatised to do any research myself. My midwife will never pressure me into anything, so she asked when I was booking with her "How do you feel about the section?" and I said "resigned" and she left it at that, apart from giving me lots of information about sections and promising to be in theatre with me. Then a few weeks ago I said "Of course, coming up to c-day, I'm getting more nightmares and so on," and she said "Is a section still what you want?" and I burst into floods of tears and said "Noooooooo!"

Since it's not what I want, she's trying to find me another way :)

I *love* my midwife.

[thereyougothen.livejournal.com]

it's very nice to read a post like this from you. your midwife sounds like exactly waht a midwife should be. and while i'm glad she's seeking out an independent for you, i'm very glad that she herself isn't an independent, and women don't need spare cash to afford her, she sounds a real find.
my fingers are crossed for you, and if a homebirth turns out to be a good plan, i will be cheering!

[ailbhe]

If this goes to plan, there'll be a midwife in the NHS with experience of normal vaginal delivery after severe 3rd degree tear, too. They're not common (there isn't one associated with my hospital, for example).

The community midwives around here are very good. They're just up against what she calls The Medics :)

[ellipunk.livejournal.com]

Brilliant. You definitely have nothing to lose by informing yourself!!
Good luck, whatever way things turn out!

[kalmn.livejournal.com]

you are so damn brave. *hug*

[ailbhe]

Basically, we're only interested in a normal vaginal birth. If it's going to be another litany of interventions, we're going straight to section.

Women do better at home, in general, as long as they're with experienced midwives who don't have a wholegrain axe to grind (and I think very few do).

[hfnuala.livejournal.com]

This is great news. Especially the bit about being able to run into the Obs from Linnea's birth and manage.

*fingers crossed*

[the-warwick.livejournal.com]

I want to hug and kiss your midwife. I'm not exactly the most demonstrative bloke on the planet either. Such a wonderful person to try to make this birth happen the way you'd love it to.

[pir-anha.livejournal.com]

your midwife keeps on rocking. and so do you.

Then we went to book my various appointments and I passed the obstetrician who delivered Linnea, and had only a small lurch to my stomach.

yay! this is just so excellent.

[k425.livejournal.com]

This sounds so good. The Obs should know better, especially with a midwife present, but didn't, so yah boo sucks to them. On the other hand, yay for decent midwives. Yours sounds like a gem, and as others have said, she wouldn't suggest a homebirth if she didn't think it were a feasible, reasonable option.

The reasons you've given for homebirth are pretty much what my reasons were, and would be again if I were ever to do it again.

[radegund.livejournal.com]

Oh, I'm delighted to read this. Your midwife rocks.

The obstetrician's inability to give you a sound reason why you were being advised to have a section reminds me of what happened when I questioned H. St's no-eating-in-labour policy. Vague handwaving and incomprehension that the Word of a Doctor wasn't enough. Also "you won't feel like eating, you know" - not unlike "in your position I'd want a section". *raspberry* to them. Yah.

[naath.livejournal.com]

No eating in labour - if they have to do a C section (which is unlikely but possible) they want you to not have eaten recently (food + anaesthesia = bad). Or at least that would seem to make sense.

[radegund.livejournal.com]

[Um. This was meant to be a quick, moderate response. It turned into a bit of a rant. Sorry! Don't worry - I'm not ranting at you...]

Yes, certainly, it makes sense in the abstract to minimise the risk of aspirating vomited stomach contents while under general anaesthesia. But from my perspective, this risk was far less than the risk of my being inordinately distressed during labour by being denied nutrition. In my opinion, the policy is inappropriate in the context of labour - and more: it's yet another decision imposed on women by a male-dominated medical establishment. Preventing a labouring woman from eating ignores, or at least glosses over, the sheer physical effort required to give birth to a child.

I did a lot of reading up in August 2004, just before I had my son, and I'm fairly sure that I understand the reasons for the policy as well as a non-medic can. The basis for it, worldwide, seems to be a study in anaesthetics done in the 1950s. Since then, it has been deemed safest to require fasting before general anaesthesia - a policy that has probably saved many thousands of lives over the years. But as I say, I believe an exception should be made for labour, given the unique circumstances - and my reading in 2004 suggested that best practice in several countries has moved in this direction. I requested (and got) an exemption from the hospital's policy for personal reasons, and if I have another hospital birth I will do so again.

You might be interested in this post describing my personal experience.

(But what I was commenting to Ailbhe about was the attitude I encountered - everyone just seemed totally gobsmacked that I went on questioning the policy until I had a solution I was satisfied with. Which, argh.)

[radegund.livejournal.com]

Curses!

</i>

[ailbhe]

Thanks for this. The very idea!

I still want that "Feminists: We Whine" tshirt, pls, when you do a run of 'em. Or you could send me a graphic and I'll add it to my Cafepress collection.

[naath.livejournal.com]

A friend of mine was incorrectly advised that her sterilisation would be under a local and that she needed to not eat for 6 hours prior. Turned out it was a general (usually 12 hours no food). She was vomiting most of the way home...

So, it *can* be bad for you.

[(Anonymous)]

So, it *can* be bad for you.

Yes, of course it can! Forgive my bluntness, but I think you're missing my point. I never said it couldn't be bad for you.

To clarify, I'm happy to accept that an operation under general anaesthetic is ideally undergone on an empty stomach. That seems well established. But I believe that labour and birth are not really "about" the possibility of general anaesthetic, and in my opinion (for reasons I've already outlined), denying nutrition to labouring women is inappropriate.

In my own case, as I said in the post I linked to above, I would far rather accept the risk that I might have an adverse reaction to a general anaesthetic (which I believe is administered in 1-2% of cases in the hospital where I gave birth) than submit to a prohibition that is CERTAIN to cause me distress just when I need it least. This is a known issue with me: if I can't eat, I panic. Therefore, I secured an exemption from the hospital's policy, which allowed me to take in calories, at least (specifically, isotonic drinks) - and I was very glad of it on the day.

As I said in my first response to you, though, my comment to Ailbhe was more about the reaction of the medics to my request than about the substance of it.

[naath.livejournal.com]

Yes indeed. A stupid policy, especially in your case. Muppets.

Damn LJ!

[radegund.livejournal.com]

Yes, that anonymous comment was from me :-)

[ailbhe]

Food and general anaesthesia bad. My midwife knows better than to suggest I have a section under general. Heh.

[naath.livejournal.com]

Of course you don't want that! I mean, who *would*? But doctors are strange and sometimes think you need it.

[ailbhe]

I will withold consent. I can't imagine why anyone would consent to an unnecessary general anaesthetic unless they were unaware that doctors aren't allowed to commit assault any more than random passers by with needles are (I was so unaware, last time, and was forced to consent to a number of things when I should actually have been calling the police to report an attempted assault on my person).

[londonn7.livejournal.com]

I also think you are really brave, particularly since you had to encounter your former obstetrician today. Not to make light of it, but this birth is far more exciting than the Brangelina shite!! You will have so much positive karma from LJ alone when the time comes.

[ailbhe]

Brangelina?

[londonn7.livejournal.com]

Brad, Angelina, Namibia, etc. Have I lowered the tone of this entire dialogue?

[ailbhe]

I am an ostrich. I now know what you're talking about because it was discussed in an LJ breastfeeding community. That's pretty scary.

[ms-interpret.livejournal.com]

I hope it goes stunningly well. I was in a similar position with my latest child. For my first, I had very bad tearing (3rd degree, "one more mm and it woulda been 4th"). No one told me I needed to have a C-section for the second one. I did end up needing one as it turned out, but it went very well. Recovery has been *much* easier, that's for sure.

Best of luck to you.

[ailbhe]

Some people heal up quite well after a 3rd degree tear. Mine was... complicated. Only through one ring, not both, but Y-shaped. And listed in my notes as "minor" which was we in the industry call "an arse-covering LIE" and meant that I didn't get my repair surgery until Linnea was 8 months old.

I'm confident that this will go much better than last time. It can't possibly be worse.

[ms-interpret.livejournal.com]

*nod* Yes, everyone is different. Mine healed fairly well, though I was quite incontinent for about 2 years after.

Your story sounds more like my best friend's. She had 4th degree tears, also listed as minor. She had repair surgery at 6 months, and then a repair of the repair at 11 months. They seriously screwed up with her. She even had trouble rolling over in bed for months. She has since vaginally delivered two more, so it can be done.

Good luck!

[supermouse.livejournal.com]

Wow. You've come so far. The news about the homebirth is both very unexpected and absolutely brilliant.

Of course, I'll be worried to death, but your midwife sounds absolutely brilliant.

Best wishes and many *hugs* and hope and crossed fingers and everything.

[helenprev.livejournal.com]

I love your midwife!

I am so pleased and excited for you that things are looking so positive, and I totally agree with you about backup plans.

[sashajwolf.livejournal.com]

Wow, well done, all of you!

[tiggsybabes.livejournal.com]

Excellent :) A home birth sounds fab :)

[dreamalynn.livejournal.com]

I am wholly and utterly delighted at this development. Huzzah!

[flybabydizzy.livejournal.com]

Its a shame you don't live in Gloucestershire as we have an amazing birth centre here that don't do interventions at all (Stroud Maternity

yeah, so amazing they keep trying to close it, like everything else here that isn't Gloucester!
Diz, in Dursley

back to the original news
fantastic, Ailbhe! a great option

[naath.livejournal.com]

Neat. Midwives are so very very cool (and doctors so very clueless it seems).

[tafagirl.livejournal.com]

It's great to hear such a positive midwife story, she sounds like a gem! And congrats to you for the "small lurch" when you saw The OB ...

[merryhouse.livejournal.com]

um.... AOL to everyone, really. Big hugs on coping with Big Nasty Man...

[pauamma]

Here's to a pleasant, stress-free birth for everyone involved, whatever it takes. :-)

Difficult births

[(Anonymous)]

Your obstetrician sounds rather like the one I had in my first pregnancy! I think your idea of a plan and a back-up plan is good: a normal birth OR a C-section, with no chance of a half-way house.
I had an emergency C-section with my daughter (now 16) and would have preferred to have been awake - it's very odd to go to sleep pregnant and wake up with a baby.
I wish you all the very best, whatever happens.
I don't want to be anonymous but can't find a way to leave my identity: anyway, it's Daphne here, back from the Lake District and catching up!