A TALE OF TWO BIRTHS (and one knot)

Note: Birth is a sacred passage — a powerful and life-altering experience for a woman. Birth trauma and birth shame are very real, and having experienced both, I want to remind anyone reading this story who may have difficult feelings around birth that there is absolutely no ‘right’ way to birth. I don’t support any hierarchy of virtue around what kind of birth a woman chooses to have or ends up with through no choice of her own. Sharing a birth story is incredibly personal, but I share mine in the hopes that it connects with someone and may become a thread that weaves into their own thinking and planning for a future birth, or their processing and acceptance of a birth.

A few weeks ago I gave birth to a beautiful baby girl via a VBAC (Vaginal Birth After Caesarean).

Labour was a long hard marathon, with a posterior baby. After 40 hours of continuous early labour at home, with contractions around the clock, I arrived at hospital 4cm dilated but exhausted from two nights without sleep. I was experiencing "back labour” — with all the pain of each contraction concentrated in my lower back — right on my tailbone. I had already drained two sets of batteries with the TENS machine.

Despite all the planning, preparing, manifesting and working through huge self-doubt, I felt like my dream of a VBAC was quickly slipping away. I said (or sobbed) "I can't do this" at least one hundred times, from pure exhaustion.

But, 9 hours later, my daughter was in my arms and I'd had my VBAC.

Everything considered, it would be fair to say that this birth pushed my body and my mind to new limits - ones I couldn't have imagined - and yet, it was also the most positive and healing experience I could imagine.

 Here are the highlights:

• My baby was able to turn herself from posterior and (finally!) put me into active labour - with the help of my Doula, Amey's, guidance and my fiance Brad's own hands on my belly (via the magic that is 'Optimal Maternal Positioning').
• I had no induction, no breaking of my waters and basically no unwanted or unnecessary interventions.
• I had portable monitoring, so I could move freely.
• I got all the things straight after the birth that I wanted and had included in my birth plan. My baby was given straight to me by her father, and we had a golden hour (actually almost three!) of cuddling, without any checks or weighing. We delayed cord clamping until pulsating slowed to a stop, and my daughter was able to do a beautiful breast crawl to latch herself for her first feed.
• 15 hours later we were home and settling in as a family of four.

This was truly my dream birth, even though it followed such a long and arduous labour. For anyone to possibly understand how triumphant and empowered I felt (and still feel!), you have to first understand how far away it was from my first birthing experience.

I walked away from that birth, after an emergency caesarean, with more than just abdominal surgery to recover from. The private hospital system failed us. We ended up sourcing our own postpartum care for both me and my son, to try and pick up the pieces — we saw my GP, a privately practising midwife and lactation consultant, an Osteopath, a women's health Physiotherapist, two Paediatricians and Psychotherapist. It took at least six months for us to get our health on track and to feel like things were back in our control. It took even longer for us to feel like we were no longer on the back foot and to shake the anxious feeling that everything was always going to go wrong.

For my first birth, I'd had a ‘textbook’ pregnancy with zero issues. I was 28, fit and healthy. Pregnancy agreed with me to the point that two days before I gave birth I'd climbed a mountain. I had done the hospital’s antenatal classes, and a Calm Birth class, and was a private patient of Canberra's most booked private Obstetrician.

I went into labour spontaneously with a Hollywood-esque gush of broken waters at 38 weeks + 1 day. Unfortunately, shortly after heading straight into the private hospital, contractions slowed down and then stopped (about 6 hours after my membranes had ruptured). My beautiful son was born 12 hours after everything had come to that grinding halt — at close of business that following afternoon. What happened in those 12 hours I now understand to be the quintessential definition of a "cascade of interventions" — a procession of escalating efforts to restart and speed up my labour.

Postnatal care was disappointing. I spent the most part of the six days I stayed in hospital trying to advocate for myself (with the unwavering support of my partner) that my increasing pain levels needed investigation. Despite insisting that what I was feeling was something internal and wasn't just the expected "tenderness" around my C-section wound, I was discharged in awful pain (which was later discovered to be an internal infection) with an extremely unsettled newborn. I was struggling to establish breastfeeding because — unbeknownst to me — my son had severe lip and tongue ties.

Our decision to have another child was not made lightly — and in fact, our fears around birth played into it in a major way. Before we conceived our daughter, both my fiance and I were convinced we wanted as much control and predictability as we could have if we were to face birth again — which for us, meant a pact to opt for an elective caesarean through the same private Obstetrician.

And so that's what we did. We followed the same conveyer belt of care and had frequent checks and ultrasounds with our Obstetrician.

But, somewhere toward the end of the first trimester, a small seed of doubt and curiosity took root within me. My Obstetrician had already discussed with us that I was a good candidate for a VBAC and presented the risks of both options. But, despite my initial certainty around wanting an elective caesarean, as I looked toward it on the horizon, I started to question myself. I realised that in my mind, I'd created two scenarios — a repeat of the same or similar scary, where a disempowered labour would end in failure to progress, emergency intervention and a hard recovery...OR a planned, elective Caesarean. It was the fear of the former that had pushed me so strongly toward the latter. But what if there was another way?

The curiosity within led me to reach out to Amey Bencke - a birth doula who, ironically, I'd tried to book for my first pregnancy.

Meeting with Amey and deciding I wanted her support prenatally and for the birth - whatever that looked like - was the very first thread in what would eventually become the metaphorical ‘knot’ I described as growing inside my stomach — alongside my daughter. Amey gently talked through my options and pointed out that there was the opportunity for me to have a very different birth experience — one where I could have a vaginal birth but walk away well — mentally and physically. The challenge was that the model of care I'd chosen and my choice of Obstetrician limited me to birthing at the same private hospital again, which had a number of restrictive protocols when it came to VBACs and a very low success rate.

The second strand that wove itself into this knot was an invitation from a girlfriend and Mama of 3 to go and see BirthTime - the award winning Australian documentary that was being screened around Australia. I was 20 weeks pregnant the night I saw it. A mix up led to my friend and I not sitting together, so as I sat in anonymity in the dark theatre, surrounded mostly by passionate midwives, I wept quietly — for almost the entire 90 minutes. The film so beautifully captured what I'd been through and confirmed so many of my niggling feelings about the Australian healthcare system’s dominant approach to birth.

I started to feel a strong pull to the idea of attempting a VBAC, as I could now see it better aligned with my values. It could offer me the healing I was still seeking, and give my daughter the start to life that I wanted for her — the same one that I'd tried to give my son. But the fact remained that my choice of care was not optimising my chances of a VBAC. It seemed inconceivable to move away from my known Obstetrician, so for many weeks I just tried to accept that a VBAC at the same hospital was a long shot, but maybe I'd get lucky.

Fast forward to the third trimester and a little over 33 weeks, when I was home and in lockdown with my toddler and I started to get tightenings around my belly. I was uncomfortable, but encouraged myself that they were only Braxton Hicks and maybe a message that I needed to take it a little easier. But, when I found a very small bleed that afternoon, I called my fiance to come home and knew I needed to be checked out.

We headed to the private hospital, but COVID restrictions meant I had to go in on my own. I was set up for monitoring in the very same birthing suite where I'd laboured with my son — alone. I also had an encounter with a midwife who was memorable for all the wrong reasons from my experience two years earlier. As I sat quietly, listening to my baby's strong, rhythmic heartbeat on the monitor, I was overcome with a stifling visceral anxiety as the events of my first birth came flooding back.

Thankfully, the baby was fine and I was able to go home to rest only an hour or so later - but as I walked out the automatic doors, a quiet voice in my head said "You aren't coming back here. You can't birth your baby here".

And so there I found the final strand in the knot in my stomach — now tied up, and certain to keep me awake at night.

I didn't know what to do with it. It was such a huge leap to have already gone from wanting an elective caesarean at all costs, to being willing to try for a vaginal birth — but it was inconceivable for me to even consider changing my hospital and known care provider only weeks out from my due date.

My next catch up with my doula was a few days later and my new, pent up feelings about returning to the hospital came tumbling out my mouth. We talked through what a late change in care would look like and how it would work. We came up with a plan for what the remainder of my prenatal care could look like and how we could engage with the public hospital to help them support my VBAC. It felt absolutely wild to me, and even sort of irresponsible in a way, to even be discussing such a huge diversion in our plans — so I gave myself a week to think on it, which would allow me to finish up at work and have a bit more mental space to make a decision. During that week I reconnected with the angel of a private midwife that I'd found after my son's birth and who was an unbelievable support in our recovery. Despite being just across the border, booked up and unable to attend the birth, she offered to do the remainder of my antenatal care. She also took hours of her time to talk through and soundboard the decision, applying no pressure on me to go either way.

After a huge amount of thought, I just couldn't ignore the knot any more, so at 35 weeks I emailed my Obstetrician and thanked him for his services, and told him I would no longer be his patient. I called the private hospital and told them to cancel my booking and my admission forms — I would no longer be birthing there.

From the moment I made the decision I instantly felt lighter. And, what followed was five weeks of hybrid care from the public hospital and private midwife, as I navigated unexpectedly sailing past due date and the exhaustion of prodromal (stop-start) labour.

I won't go into an in-depth description of the birth itself — only to say it was hard, and made harder still by the empty energy tank I was starting with — but despite this it was everything I wanted. I felt respected and empowered. Every care provider I met was invested in me having a beautiful, healing experience, and I felt so supported.

I used gas for the final stages of active labour and the transition stage. I made it to full dilation and was nearly ready to push. It was then that I made the call (with much conviction!) that I wanted an epidural. I was told it was likely too late for it to take effect, but my body was truly spent and I knew I needed something to help me finish this epic marathon. Thankfully I managed to stay still enough for it to be placed, and my body afforded me a little break in labour to let it take effect before I needed to push. I was so fortunate to still be able to feel the strong pressure of each contraction, so pushed my baby down through my pelvis in just over an hour.

But even at this point I kept thinking that something would go wrong and I'd end up being whisked away for an emergency caesarean. So it wasn't until the moment that a midwife told me she'd seen a quick glimpse of my daughter's head that something finally clicked in my brain — I realised that I was actually going to be able to do this. With the very next contraction starting straight away, I breathed my baby down and out in just two giant pushes — as my fiance and the midwife were fumbling around to put gloves on.

She was finally here in my arms. Born into her father's hands to one of my favourite songs.

Shortly after she was born, the midwives took much interest in showing me her umbilical cord, still attached to my placenta — there, about half way along was a perfect "true knot" - apparently quite rare. I remember smiling at the realisation that the knot in my stomach really was there all along — weaved by my very own daughter — to guide me gently toward a different path.

Lauren (@saidnomumever)

xx