Women, Midwives, Everyone-You Have Every Reason To Be Concerned.

For the past few weeks I’ve had this grey cloud hanging over my head. It stops me from returning to sleep when I wake in the night to feed my baby. When I do eventually get to sleep I wake up hoping that it was just a nightmare but then the realisation returns in the form of the grey cloud and heavy heart that I just can’t ignore nor can I remain silent about. My mind is haunted with the knowledge that pregnant women have had their chosen midwife taken away from them, a midwife who they know and trust. I hear from women that they are experiencing feelings of fear, vulnerability, helplessness, solitude, all adding to their feelings of anxiety. Feelings I can relate to. I worry for these women and the impact these feelings are having on the future of their growing babies.

I have started to write my thoughts down to help offload them and aid my pathway back to sleep. The notes are getting longer and new worries are being added to the list as the plot thickens and as I hear others share their concerns.

It all started when I received a message informing me that when the clock struck 12 on the previous evening of 11 January 2017 independent midwives were forbidden to attend women during labour and birth. If they were found to be doing so they would be stuck off the registrar and a fitness to practice investigation would be commenced. This was due to a decision made by the Nursing and Midwifery Council (NMC) as they feel the indemnity cover provided by IMUK is inappropriate. You can read their official statement here. You can also hear the chief executive of the NMC Jackie Smith being interviewed by Beverly Turner for LBC about the latest decision here. After listening to this interview I am finding it hard to believe that Jackie Smith, who doesn’t seem to understand what makes an independent midwife different from other midwives, nor can she specify what form of indemnity would be considered sufficient, who actually said in this public interview that it is for independent midwives to determine what level of indemnity is sufficient, has been able to stop independent midwives supporting women who have hired them due to insufficient indemnity?

IMUK followed the NMC guidance about professional indemnity arrangements and ensured that each midwife HAS in place cover that is relevant for her role and scope of practice. Each midwife is confident that she has done this!

So what is the issue here?

Is there something I am missing?

How has this been allowed to happen?

Why hasn’t someone who has the power seen just how ridiculous this whole situation is and put a stop to it immediately for the safety of women?

Why hasn’t this made the headlines?

This news felt like a punch in the stomach, a kick in the teeth. It has only been a matter of weeks since I had experienced a form of care that I had never experienced at any of my previous 3 births. It was a form of care that met my needs physically, emotionally, fully respected my choices and ensured I was safe whilst I birthed my baby. This new found care was provide to me by an independent midwife called Kay Hardie. It was a revelation, a gold standard form of care that has my full support and approval. The type of care that I would only ever expect and seek for my daughter, my nieces, my loved ones, my friends and for all women. You see thats why I feel so sad, because I know that mainstream forms of maternity care cannot guarantee that women are cared for and supported at birth by a midwife they know and trust. For some women the alternative forms of care are now their only option. I have spoke to women who will now choose to birth alone rather than birth in an environment where they have experienced traumatic care and the reason they choose an independent midwife in the first place.

It is no secret that the NHS maternity system is in crisis and that there is a shortage of 3,500 midwives. Over a third of current midwives are due to retire which will only add to the shortage. Newly qualified midwives are experiencing depression and are being signed off sick due to the pressure they are facing at work, you can read an example of a brave midwife sharing her story here. Many fantastic midwives are suffering burn out due to extended shifts, lack of breaks and support when needed. Bullying is also an issue for both midwives and women within the NHS maternity system. Recruiting new midwives is not going to be easy now that the bursaries have been cut – fees for midwifery training runs into the thousands. Midwifery is no longer a profession that can be pursued by everyone due to its affordability. We know that midwives are struggling to provide the best maternity care, both women and midwives are suffering the consequences. In the current climate things will only deteriorate even more.

There are many fantastic midwives working in the NHS, striving each day to ensure women receive the individualised women centred care they deserve. But how long can they keep their momentum up in a system that is in crisis. How many of these midwives have found it easier to serve the system rather then women which was their original intention. How many of these midwives have morphed into obstetric nurses without even realising?

Midwives don’t let this happen, put your heads above the parapet and fight for your profession, for your autonomy, and your right to truly be with woman as intended.

It would seem that as the number of midwives fall, medicalisation of birth rises as does prenatal mental health. Are all three linked? I find this a huge concern for women and society as a whole.

“We hear from our members everyday that they are struggling to provide the best maternity care they can because of understaffing. We know if there were enough midwives their time could be spent helping new mothers to breast feed or to stop smoking. The less time midwives have with women the more likely it is that signs of post natal depression for example could be missed”

Taken from the RCM website

I would argue that that if there were enough midwives, women may be offered the gold standard of care is continuity of CARER. This type of care ensures trust, honesty, privacy, respect, dignity, autonomy, one message, choice, individualised care and information. The type of care that is guaranteed and that I experienced with an independent midwife.

Instead the NMC has forbidden around 80 midwives to support women and their families during birth, meaning that this year a potential 960 families will be added to the workload of midwives who are already struggling to provide best care for women. This figure will rise as time goes on.

I completely agree with Rebecca Schiller from Birthrights when she wrote to Jackie Smith and said that the actions of the NMC “appear designed to cause maximum disruption and damage to independent midwives and the women they care for,” adding that, “we do not believe that these are the actions of a responsible regulator.”

Who is actually benefiting from the NMC’S decision?

It’s not women.

It’s not NHS midwives.

It’s not independent midwives.

It’s not even society as a whole.

Since this decision has been made by the NMC it has also brought in question midwives supporting or being presenting at friends or family’s births an example of this can be seen here. It has been brought to my attention that some NHS midwives are being told that they are not insured to attend a friend or family’s birth either?  I have also been told that If a midwife has been supporting a woman antenatally and the woman goes into labour when the said midwife is not on the working rota then the midwife is also not allowed to attend the birth. This completely goes against evidence and research that shows that having continued midwifery care and being supported at birth by someone you know and trust can enhance the physiologic labour process reducing the need for obstetric intervention and increases a woman’s feeling of control and competence. Women are also less likely to experience pre term birth and are at lower risk of losing their baby. The benefits of continuity of carer are huge and should be what the NMC are striving for for all women, not putting barriers in the way for those who are ensuring this!

For many women across the country hiring an independent midwife is the only  guaranteed form of support for them to birth their babies at home feeling safe and secure. Some trusts offer no home birth service at all, whilst other trusts have been known to ask a woman who has planned her home birth to come into hospital due to staff shortages. This can be very distressing for a woman to have her plans for birth abolished at the last minute. The negative effect on a woman’s emotional well being can stay with her for life.

If England had a fantastic maternity service that met the needs and facilitated all choices for women it wouldn’t be such a concern but the harsh reality is that it doesn’t and women and midwives are suffering as a result. The NMC have removed a woman’s right to choose who she wants to support her at birth and for some women, where they choose to birth. It also denies many midwives their right to work as self employed individuals forcing them to work for an institution facing working conditions that are proving difficult for many midwives. Independent midwives are also suffering financially being that they cannot provide the full service that women want. The NMC has also put an end to Statutory Supervision of Midwives and the role of the Local Supervising Authority Midwife Officers (LSAMO) from the end of March 2017. I am very concerned about this decision. The LSA has been a huge form of support for me in the past offering support outside of the trust that I believe was acting on cultural beliefs embedded in the trust that was a huge barrier in gaining the care I needed. I see women who are struggling to find support almost daily, most of whom are making choices outside of guidance, often only finding solace in the form of a Supervisor of Midwives (SoM). I cannot help but wonder if it is the lack of midwifery leadership within the Nursing and Midwifery council that has made these decisions that affect women’s care possible.

I am pleased to see that many are finding the actions of the NMC concerning. This is triggering alliances to be formed to protect women’s rights and the midwifery profession. The Association of Radical Midwives have launched a campaign in response to recent developments to demand a separate regulation for midwives as recommended by the law commission. You can join the campaign and find out more information on #savethemidwife here.

Women who make choices outside of the national guidance struggle to have their voice heard and their choices supported. It can prove very stressful and only those who are prepared to battle and go up against the system might stand a chance of achieving the birth they hope for.

I myself am a woman who made choices outside of guidance.

I am a woman who is known by many who work within the trust responsible for my care. They know my story, they know that I am well read and that my decisions are made based on researching evidence based information. I am a woman who story has been used for training on supporting women who make choices outside of guidance. I am a women who still struggles to have my voice heard and gain the necessary support for my birth choices.

I know the midwives who I came into contact with during my care want to support my choices, but it seems that their confidence to act autonomously and provide me with the support I needed is suppressed by the demands of the system. The system that determines a woman’s care not by her individualised choices, but by what the institution will allow once its met the criteria of every box ticking policy. When the care package looks familiar to the senior obstetrician. Only when I have sat through every pain staking conversation that emphasises only the risks of my choices,( with no discussion regarding the risks of the recommended care path) when I have acknowledged that my choices potentially threaten the life of baby and I and only when I sign on the dotted line to confirm this conversation has taken place, will I then be offered a care package that only considers my physical needs of my bodily functions, so long as my body conforms to general expectations and time limits, constantly reminding me of interventions I should be prepared to accept as recommended.

I found this institutionalised care made no provision for my emotional and mental well being. It made no acknowledgement of my previous personal experiences or understood how these experiences shaped my choices and still haunt my memories.

The holistic aspect of midwifery seems to have been washed away whilst sanitising the hospital environment leaving the care feeling cold like the white bare walls that surrounded me at each appointment. Written communication forms that of a template once again meeting the needs of the system with no benefits or individualised care plan in place that supported my choices. This care not only fails women but it fails the midwifery profession slowly eradicating anything that is integral to it beliefs.

I had poured my heart out and explained my reasons for choosing to birth at home and away from the hospital.

I didn’t want to experience painful sweeps whilst being told to count back from 10 and bare it.

I didn’t want routine examinations that left me feeling violated and that had put my baby and I at risk being that my membranes had ruptured.

I didn’t want strangers entering my birth space without acknowledging me yet observing my genitalia that was fully exposed.

I didn’t want my midwife to fall asleep because her priority was to observe the technology that was monitoring me.

I didn’t want to be stitched up by a newly qualified midwife who had told me she wasn’t experienced enough to suture me, but was made to regardless, who once she had finished was told to redo the whole thing. She was then advised to buy some pork and practice her suturing on that whilst I was lying there feeling scared and in pain.

I didn’t want to lay in a bed feeling out of control fearing for my life.

These were just a few of the reasons why I didn’t want to birth in hospital and asked to for assurance that I would be supported by a midwife who was confident in caring for me at home and who was experienced enough to ensure my safety but competent to support me at home unless it was only in my best interest to transfer to hospital.

I was told I could not have a bespoke package and they did not know who would be scheduled to work at the time of me going into labour. They could not guarantee me a midwife I know and trusted.

By 37 weeks I was left feeling drained, my voice fell quiet, my mind felt unstable, my body and my baby was begging me for some relief. I needed to feel cared for.

I needed to exercise my right and ensure I had a midwife I knew and trusted, I couldn’t birth any other way.

It was then that I made the decision to hire an independent midwife. My primary concern was only to feel safe and supported, to know that Kay was experienced and competent to care for me. I needed to feel fully supported in my birth choices and know that Kay had the necessary skills to act should birth take a turn in the wrong direction, to be able trust that she would transfer me to her colleagues in the  NHS should she feel that that was the best place for me.

Indemnity was not my priority, indemnity would not ensure my safety. I was made aware of the issue with the indemnity and hired Kay Hardie regardless. Indemnity insurance would only be of benefit to me in the event that my baby or I suffered due to negligence and only if this was proven would the indemnity be relevant. Taking this into consideration I would have hired Kay regardless as the need to feel safe far exceeded the ability to sue her, this thought didn’t even enter my mind. I find it insulting that the NMC claim to have our best interests at heart by making this their priority whilst denying some women their only chance of feeling safe whilst birthing their baby.

Compared to my previous experience, some of which could be considered negligent and comprising my safety, Kay’s care was superior and left little room for negligence.

I believed and trusted her and this was reciprocated. I was the only woman in the room, the first priority, the only focus. My voice was listened to, I was treated with dignity, my privacy maintained, my sanity protected.

If you have a daughter, a niece, a wife or care about women and society as a whole, then you too should be concerned about the NMC latest decisions. One day a woman who is close to you may find themselves pregnant with limited choices regarding her maternity care and birth, possibly limited or no midwifery support, during a monumental time of her life. This is a time when a women leaves her footprint on the world and time when a mother is born. Birth has the ability to shape a woman for life and will effect who she is as a mother and a member of society as a whole.

I would urge the NMC to be transparent and admit they have made a huge mistake by reinstating independent midwives right to practice in their full capacity and support women during birth. I would also urge the NMC to bring independent midwives into hospitals for training, to share their knowledge, expertise and experiences of supporting women outside of the hospital setting. Bring the art of midwifery back into the heart of maternity care and provide women with the holistic care they are missing.

If you would like to join the alliance and #savethemidwife you can found out how to here.

A Beautiful Birth At Last

img_8235After two previous traumatic Caesarean sections, followed by a hospital vba2c, my home birth was everything I have learnt that birth can be.

It’s truly wonderful to end my birthing days with the most beautiful, empowering birth.

It was instinctive, intimate, undisturbed, empowering, peaceful and I was in control at every moment.

I didn’t have anyone tell me what position to be in.

I decided when It was time to get in the pool.

No one told me when I could push or not push.

No one knew the size of my cervix at any point.

My movements weren’t limited or hindered by machines or technology.

Time did not dictate my fate…

I had chosen not to have any vaginal examinations because I didn’t need someone to tell me what my body and my baby were doing. There was no medical indication to do so.  Instinctively I knew that everything was OK and my body was working just fine.

In the early hours of the morning I felt my membranes rupture. I lay in bed making the most of the rest as I felt the familiar feeling of contractions waving through my abdomen every so often.

As the dawn broke I decided that we should get the pool inflated as I knew that today I would give birth to my baby.

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Around 9am my midwife had arrived and was sitting across the room quietly drinking her tea.

I danced and swayed through each contraction and found my body wanting to lunge lower to the ground as labour progressed.

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I wanted to be upright at all times. I couldn’t image lying down and I wasn’t expected to.

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When my legs felt tired from dancing and the contractions felt too intense to dance through, I knew it was time to take comfort by the warm water that was ready to take the weight of my body. I got in and floated star shaped for a while before finding comfort leaning on the edge of the pool.

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I was not distracted or disturbed at any point. I remained focussed, using all my concentration and will to feel my baby inside my body moving into my birth canal. I didn’t need pain relief, I just needed peace and tranquility around me to focus solely on my breathing and my baby. The more intense the contractions were the more I found myself panting.

I felt a sense of panic for a moment but reminded myself this meant that it was highly likely that my baby was soon to enter the world. This thought kept my mind on track.

After just over an hour of being in the water I felt my body pushing my baby out so went with it and the head was born. I rested with the head between my legs for a few minutes. My midwife asked if I was having contractions. I was but they were restful contractions and my body did not bare down with them, so I remained restful. Seven minutes later I felt my body bearing down with the contraction so I went with it. My baby was born, I did not tear, I didn’t need stitches.

My midwife gently pushed my baby through my legs. I scooped my baby from the bottom of the pool into my arms to see the cord wrapped around her neck. With the help of my midwife we looped the cord twice from around the neck.

With all of my children peering over the rim of the pool I discovered our new family member was a girl. I cried with happiness saying “this is amazing.”

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There I sat cradling my baby and feeding her for nearly an hour. I took in her beauty, I studied her face and observed her body from head to toe, in awe of the miracle my body had grown. I knew I was flipping amazing! I knew women were flipping amazing!

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Protected by the water and the safety of the surrounding inflatable pool it was just her and I. Nobody took her, nobody tried.

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Eventually I felt ready to share her with the rest of our family. My husband then tied her cord and my eldest son cut the cord so she could be cuddled by her brothers whilst I watched on in euphoria.

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Eventually I left the pool for more skin to skin and a sausage sandwich. I gave birth the placenta just under 3 hours later. My labour and birth was everything I had dreamed of. My sons had witnessed first hand that birth can be beautiful. In my children’s own words they describe my birth to be exciting and astonishing. I hope this positive image stays with them and prepares them for adulthood, for the time they support their partners and welcome their own children into the world.

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I knew this was going to be my last pregnancy and birth. I had spent the last three years since my previous hospital Vba2c, researching and gaining as much knowledge about physiological birth as I could. I didn’t fear birth but I did fear surgery.

I knew that this time I didn’t want to be observed and have numerous strangers entering my birth space.

I knew that everyone in my birth space needed to be free from fear and have my very best interests at heart.

I knew that I didn’t want routine examinations and various fingers inside me to check that my labour was conforming to expectations.

I knew that I needed to feel safe in the hands of those caring for me.

I knew that I needed to move, eat and drink freely.

I wanted to be certain that my individual needs were at the heart of the care I was receiving.

I put my Trust in those that were caring for me, despite the warning signs and red flags until I reached 37 weeks. It was then that the reality hit me that those responsible for my care did not trust my ability to make informed decisions regarding my birth. They were so caught up in ticking boxes, outlining risks and providing care that met the needs of the system that they failed to see or listen to the woman that was stood before them. A women whom they knew, a women who had work alongside them to improve maternity care for all women. They failed to provide the individualised care I needed to support my birth plans and make me feel safe which in turn led to them failing me.

Once again at nearly 37 weeks pregnant, I found my self feeling vulnerable, fearing for my safety and reduced to tears.

I knew that the lasting effects of this birth had the ability to heal me, shape me or break me. I knew this birth had the power to determine who I was as a mother, as a wife and as a women in society.

I didn’t want to battle again at this stage in my pregnancy. I knew I needed to remain calm during the last weeks of my pregnancy. It was then that I knew I had no choice but to privately hire the care I needed to support my plans for birth.

When I interviewed my midwife and heard her say “Michelle, I don’t intend to treat you any differently than any other woman I have cared for.” I could have cried, from that moment I knew Kay was the midwife for me. At last I would be cared for as woman and not the risk labels that were part of my history.

Giving birth to my daughter has made me more determined to join all those striving to improve maternity services for women.

I want all women to not just to be heard but be listened to.

I want women to feel safe and supported during pregnancy and birth.

I want women to have real choices in pregnancy and birth and be fully aware of their options.

I want women to have continuity of carer throughout pregnancy and birth.

I want women to receive care governed by their individual needs and not care that is determined by a system.

I want women to receive care that caters for their physical and emotional needs.

I want women to feel in control and making the decisions through their pregnancy and birth.

I want women to be given the knowledge to understand pregnancy and birth and encouraged to use their voice and ask questions.

I want women to feel that birth is a positive experience even if it didn’t go as planned.

I want women to be treated with dignity and respect.

I want women to enter the post natal period feeling whole and emotionally well knowing how to access on going support should they need it.

High Risk Pregnancy – My Perception of Risk and My Choices Explained

 

This week I attended a conference at City University London called Positive Birth Conference 2016: Informed Choice. You can follow the hashtag #citypbc2016 to find out more about the day.

There were some wonderful speakers including both health care professionals and women. There were various themes around positive birth and informed choice. Themes included choice of place of birth, risk perception in high risk pregnancy, breech birth, medical intervention and the effects on women, midwifery care and whether maternity services enable choice.

I found the discussions really interesting being that I carry the ‘high risk’ label and have made choices that others perhaps wouldn’t make or recommend.

Due to time restricted appointments at hospitals and lack of continuity, it is very hard for health care professionals to fully understand the individual woman behind her choices, or for the women to feel able to fully disclose her thoughts regarding her pregnancy and birth.

I have recorded a short film explaining the choices that I have made in my fourth pregnancy and the reasons behind my choices.

If you are interested in the choices women make in relation to their maternity care and birth then you may like to attend a conference I am organising called Women’s Voices Conference 2016. For more information about the conference and for tickets please click here.

What i think the National Maternity Review needs to know.

Women want to be given unbiased truthful information to enable us to make informed choices about our care.

Women want to be treated as individuals.

Women want to be at the centre of all decisions made about our care.

Women want to be listened to.

We all know that any pregnancy comes with risks but it’s important that these risks are not the main focus, and that the women’s feelings are considered. The label “high risk” often makes women feel like a disaster waiting to happen. It can create a mindset filled with trepidation, fear and anxiety. This can have a negative effect the woman’s emotional wellbeing and that of her baby. Risk is associated with many factors during pregnancy, i.e. previous caesarean, age, gestational diabetes, high blood pressure, multiple pregnancy, previous miscarriage, previous pre term labour, foetal presentation, post dates, growth of baby, infection, BMI, the list goes on and it can be quite daunting and creates limitations for many women. When a woman has this label her care is often consultant led ensuring that medical support is in place as a precaution. This is great, but it is so important that every woman has equal midwifery input into her care to balance the woman’s needs. The word ‘Midwife’ means ‘with woman’ we must not forget this and its importance. Even though there may be need for medical assistance we must not forget that the women is at some point going to give birth and will need the support of a midwife, her knowledge of childbirth and her care. This combined expertise of midwife and doctor, if needed, ensures that the risk and benefits of choices are considered, but it also helps to maximise safety and a positive birth experience.

Society needs to trust a woman’s ability to birth, to acknowledge and respect her intuition and instinctive ability to know and understand her body and to feel confident about its capabilities. We need to provide education about birth so that women feel fully engaged in the process. We should encourage women to use their voice and question or discuss any concerns they may have. We need to fully facilitate women making informed choices about their birth, their babies and their maternity experience. The focus of maternity care needs to ensure it is truly women centred. Opportunities to discuss fear or trauma in the past, whether it was result of previous pregnancy or a life event that could affect her ability to birth should be identified and appropriate support offered to address these fears and negative feelings. A doula or one to one care should be offered, as continuity of care is linked to better birthing outcomes.

Every pregnancy should be treated as a fresh new journey addressing problems if and when they arise, whilst carefully considering previous history. By identifying a women’s needs and wishes early on, care can then be tailored to suit. Truthful unbiased information can then be given to ensure informed choices are being made, putting the women in an empowering position of feeling that she is in control of her body and her birth. A woman who feels in control is better at digesting information and is more able to have open discussions, building trust and respect for those caring for her. Birth should not be approached with trepidation but with knowledge, understanding and support.

Birth has become very medicalised and Caesarean section rates are continually rising. It is often discussed in the tabloids and by organisations such as The World Health Organisation. So what is being done to resolve this? I believe that perinatal metal health disorders particularly post natal depression, has increased in line with the over medicalisation of birth. Whilst no one disputes that a healthy mother and child are a primary outcome, a mentally traumatised mother is not actually healthy and physical well being is not the only parameter we should be looking at.

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It would be really great if the maternity review could address this and put some real action in place to reduce caesarean rates and ensure interventions are offered only when medically necessary and after a full unbiased consultation with the women.

My opinions are based on my own experience and are similar to that of many women I liaise with on a daily basis. I hear stories from women across the country that have very similar themes to my own maternity experience.

In brief, here are the elements of my care that left me feeling disempowered, vulnerable, and sceptical about the birth ideology and what it represented.

  • At booking in I was labelled high risk, trepidation set in and from that moment I felt like I was a disaster waiting to happen.
  • My Care was consultant led so didn’t have any midwifery input into my care plan.
  • My birth wishes were denied due to 2 previous c sections even though reasons for these sections would not necessarily occur in third pregnancy and there was no robust evidence to deny my request.
  • Care was given based on carers personal perception of risk, no discussions regarding my own considerations regarding risk perception took place.
  • My previous surgical notes were not accessed or considered when decisions about mode of birth were being discussed instead the mode of birth was made on a systematic belief.
  • Access to services like the ‘VBAC’ clinic was denied due to my care givers personal views and labels accorded to me.
  •  Information given to me was biased focusing only on the risks of birth. The risks of third and fourth surgery were never spoken of even when I raised this as a personal concern.
  • Birth discussions did not happen until 36 weeks leaving very little time for planning to take place and for any questions that I had to be explored. This proved to be very stressful and pressurising.
  • I was booked for surgery without my consent even though I had expressed I did not want surgery.
  • I had called ahead and tried to discuss this with the midwife on the phone but was told that it was my consultant who would make that decision. (Feedback that I have received in response to telling my story at midwifery training events is that sometimes midwives feel they are not supported by their peers when wanting to support women and her wishes when they are outside of the norm? “On your head be it” is a phrase that has been used.)
  • No consideration was given to my emotional well being during discussions that focused on risk.
  • I was told I could die leaving my children motherless, which was very upsetting, and made me question my mental health.
  • No one responded to my request for help and support and I had been told that they had never experienced anyone give birth after 2 c sections?? Guidelines are clear that a lack of care provider training and/or experience is not a reason to deny choice. Care providers have a responsibility to find another health professional who can meet those care needs.
  • Fear based practice was evident, as a result my individual needs and wants were neglected.
  • Interventions were offered to reduce risks without any discussion regarding alternative options. Information should have been given to enable me to make informed choices.
  • My ability to birth was constantly questioned and doubted. This made me feel inadequate and less of a woman.
  • No consideration was given to my future life plans I was ridiculed for mentioning them and reminded to focus on here and now.
  • Risk of uterine rupture was constantly focussed on and described as a major catastrophe, yet women are being offered induction daily with this possible risk not being highlighted in such a way?

I consider that ignoring my wishes, scare mongering and the emotional blackmail that i suffered were all breaches of the health professional codes of conduct and medical guidance on interacting with patients. Regulatory organisations state that a patient’s informed choices must be respected, even if the individual professional is not in agreement. Some health professionals feel they can simply ignore the requirements of their regulating organisations and violate legal and human rights. Are there any plans in place to address this as part of the National Maternity review?
Here are the elements of my care that made me feel empowered, happy and confident. Most of the points below discuss situations after I had transferred my care.

  • Previous pregnancies and complications were not considered a threat to this pregnancy.
  • I was told that 2 previous c sections did increase my risk but even though the risk was there, it was small and put into perspective alongside risks to surgery and future pregnancies.
  • Midwifery support. This was absolutely key to restoring my strength and emotional well being.
  • I was able to openly discuss the risk and the benefits of a vaginal birth with the main focus being on me as the individual and my own perception of risk. Consideration was constantly given to my feelings and my wishes. I felt respected and empowered and in control of my body and fully supported. – The new consultant Shevi (sp?) discussed risks and benefits to both surgery and VBAC.
  • The conversations were very balanced and open.
  • The conversation was very informative and I felt that I was supported either way.
  • Impact on my future pregnancies were also discussed and recognised as an important factor to consider.
  • The consultant midwife attended the consultant appointment with me, supported and contributed to the discussions. I was at the centre of these discussions facilitating real ‘Woman centred’ care. Our unity was my maternity experience.
  • I left these appointments feeling informed, supported, happy and empowered as I was able to make educated choices about my care.
  • Faith in my body and my ability to birth were never doubted. I was given some great advice on active birthing, what to expect and the physiological changes that would happen to my body were fully explained so I really felt that I understood birth.
  • My midwife discussed Oxytocin and its important role in birth so in turn encouraged me to be happy.

Just sitting having these lovely, very womanly discussions were so important. I felt excited to about giving birth and grateful that I was being given the opportunity to experience it. All women should feel empowered, in control and supported during pregnancy and birth.

It is a very vulnerable time for women and there is no way out. Consideration should be given to the woman’s emotional well being as well as her physical needs. It is not about ‘allowing’ or ‘not allowing’ it’s about considering, facilitating and supporting.

Experiencing birth has truly been life changing for me. The positive effects I am experiencing have been overwhelming and surface in some way on a daily basis. I want all women to have the best possible chance of having a positive birth experience and I hope the National Maternity review does too.
Yours sincerely

Michelle Quashie

Featured

Strong Since Birth

 

Having children was always something my husband and I had looked forward to. We would often imagine what our future family would be like. My husband had unfortunately lost his only brother at the age of 31, so had always expressed his desire to have at least 3 children. I come from a large extended family so felt I would rather have 4 children than 3. In 2005 after two and a half years of trying to conceive and one miscarriage we finally conceived, and our journey as parents began……

At 32 weeks pregnant I had noticed lack of foetal movement and my instincts felt that something wasn’t right. I went to triage and was monitored for the next 24 hours. Decelerations were apparent and they gradually became more frequent, eventually signalling that the baby was in distress. One minute I was sitting eating lunch and the next I was having an emergency caesarean section (EMCS). Our son was born and resuscitated on delivery. He was then admitted to neonatal intensive care unit (NICU) and I wasn’t able to see him for 24 hours. It was all very rushed and I remained in shock. This was not how I had imagined my transition into parenthood to be? I was however grateful that my son was alive and apparently beautiful. I was yet to meet him…

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When my son was 5 months old I discovered I was pregnant again, although we hadn’t planned this pregnancy we both felt blessed. At 24 weeks I had a bleed followed by several more. I was diagnosed with having placenta previa grade 4. This was a very hard time for us and my husband had to take time from working to care for my son and me. I was under strict instructions not to lift or do anything other than sit and rest because of the risk of haemorrhage. It was expressed that this could potentially be life threatening. I was also diagnosed with gestational diabetes so had to maintain a restricted diet. Eventually following another bleed, at 33 weeks I was admitted to hospital on full bed rest until the baby arrived. I felt so depressed and being parted from my first son made me very emotional. I was in hospital for his first birthday whilst my family celebrated. Inside I feared that I would not bond with my baby as I was already resenting him for the situation I found myself in. I just wanted to make it through this pregnancy and return to being a mom to my child.

At 37 weeks I haemorrhaged and it was scary. I sat on the toilet whilst the blood poured down my legs. I pulled the emergency cord and I felt grateful to be in hospital. The reality of this scenario was something that I had totally underestimated. I signed the consent form to have a hysterectomy and was rushed into theatre for a crash section under general aesthetic. I can remember my body violently shaking whilst lying on the cold operating table. The medics were rushing around getting blood into me and preparing me for surgery. I knew nothing more as I had blacked out……. When I woke I had drips attached and bloods being administered along with a catheter and a Bakri balloon inserted, to stop the internal bleeding. Although I lay there helpless and vulnerable I was grateful for mine and my son’s life. There was also the added bonus of my uterus still contained inside of me. I lay looking at my son in his crib wishing to cradle him and celebrate that we had made it through a very tough time, but I couldn’t move. I loved him so much and couldn’t believe I ever doubted that I would. I needed to recover and gain strength so I could care for my family again.

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The years went by and as much as we both wanted more children, we were both fearful of what another pregnancy may bring. Eventually, 7 years after my last baby we decided to try for another baby. I was fortunate enough to fall pregnant quite soon. At my booking appointment I was categorised as being “high risk” so it was explained that my care would be consultant led. I asked if I could have a natural birth this time but was told no and that it was not allowed after 2 c sections. Being unsure of how the pregnancy would unfold I didn’t contemplate questioning this decision. I had accepted the decisions made by others regarding my care and my birth and wasn’t aware that there were any alternatives. The months went by and I felt fantastic! I was screened for gestational diabetes and the result was negative. My scans had shown that my placenta was not covering my cervix. My baby was growing perfectly and I was still attending a kickboxing exercise class at 5 months pregnant.

My 36/37 week appointment with my consultant was approaching. I had understood that at this appointment my caesarean section would be discussed. The thought of surgery and my memories of my previous experiences including recovery depressed me. I felt too well and healthy to end this pregnancy in surgery.

My appointment was in three days and whilst browsing on the internet I typed “natural birth after 2 caesareans”. I was so excited by what I found. I became engrossed in a world that I never knew existed, the world of vaginal birth after 2 caesareans (VBA2C)…. I joined forums and spoke to women in my situation; I read guidelines applicable to my situation. I also read the risks involved with a third c section and the implications of those risks on a fourth pregnancy. The more knowledge I gathered the more I believed I was a suitable candidate for a VBA2C. My mum had given birth and had been asked to give talks on her breathing techniques. My sister had given birth 3 times, one of them being a homebirth to which I had witnessed. I began to question why I was to undergo major abdominal surgery for no apparent medical reason other than the fact I had had 2 previous caesarean sections? I then began to wonder why all this information was not discussed with me by those that were responsible for my care. Maybe it was because I had not actually met my consultant yet and only met various different members of his team.

I called ahead of my appointment and expressed that I wanted to meet my consultant and discuss the possibility of a vbac. I felt that by speaking to the most senior member of the team I would have the opportunity to discuss all of my options in depth and could compare the rationale behind each mode of delivery. I would respect their opinion as they would know best? I was told that he was not available and that I would need to see his registrar. I didn’t feel happy with this so tried to arrange an appointment with my previous consultant that was also based at my hospital. This was not possible so I accepted the appointment with the registrar. When I met with the registrar, I explained that I had been looking at the possibility of vaginal birth after caesarean (VBAC) versus another C-section and explained to her some of my reasons for wanting a VBAC.

• Risk of infection.
• Difficultly looking after 3 children after having major abdominal surgery.
• Risk associated with 4 pregnancies after 3rd c section, i.e. placenta previa/ accreta.
• My children seeing me looking poorly.
• Higher chance of NICU admission.
• Risk of respiratory problems.
• Higher chance of hysterectomy.
• Scarring and adhesions.

The main risk I could find associated with a vaginal birth was risk of rupture at 0.8%, This figure also included those labours that were augmented and the catastrophic risk included in this statistic was in fact much smaller. I felt that the benefits of a vaginal birth being successful were huge. So that meant a 99.2% that a rupture would not occur? This statistic of 99.2% seemed to me to be better than those associated with elective caesarean section (ELCS).
I was met with a negative response. I was told I could definitely not have a VBAC and that I was ridiculous to suggest it. During our conversation the registrar emphasised the risk and catastrophe I would be facing if I were to attempt a VBAC. Only some of her comments are listed below

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• VBAC was not an option, C section was a must.
• 80 % chance of uterine rupture.
• Why think about fourth pregnancy just focus on the current one.
• I had never dilated and wasn’t sure if I could do so, so would not risk me labouring.
• I would not find “anyone” that would support me.
• In her previous employment she had met someone like me and that no one wanted them on their watch!!!!
• If I went into labour naturally I would automatically be taken in for EMCS. Trail of labour after caesarean (TOLAC) was not an option.

I then explained that I had researched the Royal College of Obstetricians and Gynaecologist (RCOG) guidelines and National Institute for Health and Care Excellence (NICE) guidelines and that was my grounds for believing I was a suitable candidate and that vba2c was a safe option. I asked if she knew of the guidelines I was referring to? She then explained that she wasn’t as she didn’t have time to go on computers much?? I asked her to access them on her computer whilst I was present. She displayed the guidelines on her computer and began reading. She expressed that they were applicable to 1 previous c section and did not apply to my situation. I then highlighted the relevant section within the guidelines.

RCOG guidelines
“Women with a prior history of two uncomplicated low transverse caesarean sections, in an otherwise uncomplicated pregnancy at term, with no contraindication for vaginal birth, who have been fully informed by a consultant obstetrician, may be considered suitable for planned VBAC.”

NICE quality standards states
“Clinically there is little or no difference in the risk associated with a planned caesarean section and a planned vaginal birth in women who have had up to 4 previous caesarean sections. If a woman chooses to plan a vaginal birth after she has previously given birth by caesarean section, she should be fully supported in her choice.”

I requested that she print them off so I could keep them alongside my handheld notes. She then left the room to retrieve the documents from the printer. My husband and I sat in the room for what felt like eternity. My husband then began questioning my motives and the validity of the information I was quoting. He felt that they should know what they were talking about; after all they were the professionals. I asked him to be quite and leave me to do the talking.

The registrar then returned holding the guidelines and was accompanied by a man that turned out to be my consultant; the one that was originally supposed to be on leave therefore was unavailable for my appointment? He introduced himself and acknowledged my request for a vba2c and the fact that I was aware of the applicable guidelines. He then began to explain that although the guidelines were in place, very few obstetricians agreed with them or felt happy caring for a woman that wanted to attempt a vbac after more than 1 c section: He explained that it was important that we both felt happy with the chosen method of birth and suggested that I go away and discuss this with my husband and to take more time to consider my options. He wanted me to take into account the following:

• Although the guidelines were in place, very few obstetricians felt comfortable with a woman attempting a VBAC after 2 or more c sections.
• If I were to rupture it is catastrophic.
• I could be that catastrophe and he wouldn’t want his name associated with that.
He asked my husband, “What was more important…? A natural birth or me being a mother to my other children??? “

Neither the consultant nor the registrar had looked at my medical history or referenced my notes to support their decisions. We got up to leave and the registrars parting words were said through smiles, “I have booked your c section so you don’t miss your spot and labour ward will be in contact with the date.” I left the building in turmoil! My face was bright red, my eyes were blood shot and I felt shaky inside. My husband began to side with the doctors and said he thinks it’s better if I just have a caesarean as he didn’t want to lose me, he felt it was just not worth it and that the doctors were the professionals and therefore knew what was for the best. He agreed with them that the most important thing was that I was alive and well to parent my children. This was something that I would never jeopardise. My children were my driving force at all times. He then went on to explain that he thinks they thought I had fallen from a tree and banged my head, implying that they thought I was mad judging by the way they had spoke to me. I had nothing left inside so I just remained quite.

I got home and I found my big blanket and buried myself on the sofa underneath for protection. I felt scared, vulnerable and disempowered. I had been told that if were to go into labour I would be taken straight into theatre for surgery. To me that felt threatening and left me fearful. I remained on the sofa for the rest of the evening not interacting with my children as I felt void and numb. Maybe I was going mad?

I woke the next morning, grateful for a fresh new day. I sat drinking my tea evaluating the consultant meeting. I began to feel concerned. Was the care that I was receiving evidence based? What happened to informed consent? Was I being coerced into surgery? Were my best interests at the centre of those responsible for my cares’ decisions? I decided to get a second opinion from someone outside of my hospital. After all it had been pointed out that they were all of the same opinion and that no one would support me.

I managed to contact the Local Supervising Authority Midwifery Officer (LSAMO) and spoke to a lady called Kate Brintworth. I explained my desire to have a VBA2C and the reasoning behind my decision. I explained the options I was facing and how that left me feeling. Kate expressed that she was concerned that I was feeling vulnerable and that I was now approaching 38 weeks with no birth plan in place. She would arrange to put me in contact with Cathy Walton, the Consultant midwife for Kings College Hospital, for some support and that I would have an opportunity to explore my options. She also reassured me that I wasn’t going mad and that my requests were valid. On the Wednesday Cathy Walton called and listened to my concerns. She offered to be a mediator and would liaise with those responsible for my care with a view to arranging another meeting hoping that the outcome would be more reassuring. Cathy had spoken to the clinical lead and the Supervisor of Midwives (SOM) and had reassured me that they would be in touch. Cathy had expressed that she was there if I needed her in the meantime. Cathy’s’ offer of support made me feel safer and stronger.

By Thursday evening I called the SOM as I hadn’t yet had a response. She explained that she hadn’t accessed my notes so could not discuss it any further and would contact me when she had done so. Friday came and so I called again as I was feeling anxious that the weekend was approaching and here I was approaching 38 weeks pregnant and still had no new options or a birth plan in place. Once again the SOM said she hadn’t had time to look at my notes and that she was extremely busy. By now I was very concerned at the way I was being treated and my confidence in their ability to care for me was dwindling. I was concerned that I may go into labour over the weekend so I decided that I would write a letter and hand deliver it in order to try and gain some control over my care and my body. I addressed the letter to the Chief executive, my consultant, the SOM and what I believed was the Head of Midwifery. Some Extracts from the letter are listed below.

• “Unless there are any medical contraindications that occurred during my previous C section’s that will impact on the success of a VBA2C, I will not be pursuing an elective Caesarean section.”
• “I would therefore like you to put any necessary arrangements in place to support and assist me with this. Please could you confirm in writing that you have done so?”
• “I am hoping this meeting will be less stressful and will take place on Monday, as I will be over 37 weeks pregnant with no birth plan in place.”
• “Should you feel that there is medical reason to prevent me having a VBAC please notify me ASAP.
Also if you feel you are unable to provide the support I need please also notify me ASAP.”                                                             I would not willingly allow anyone to carry out major abdominal surgery for no apparent medical reason. Surely that alone posed a major risk?

At 7 pm that evening the SOM left a message on my answering machine to say she would call me on Monday to arrange an appointment for later that week. I spent the weekend lying on the sofa scared to move in case I provoked labour. I had never experienced any form of labour, nor had I any antenatal classes so did not know what to expect or signs to look for. By Monday afternoon I still hadn’t heard from my hospital so I called Cathy Walton and asked if I could see a consultant at Kings College Hospital. I wanted an opinion that was based on my medical history and relevant evidence. It was really important for me to know if there was a medical reason for a repeat caesarean.

An appointment was made for the following day. I prepared myself for the battle that believed I was about to face. I sat with the new consultant and explained my reasoning for my wanting a VBA2C and my belief that I was a suitable candidate. To my utter disbelief the consultant had accessed my medical history and she stated the following:
• She felt I was fully informed.
• Aware of associated risks of c/section and VBAC.
• A successful VBAC was the safest option pending future pregnancy.
• No medical reason to prevent VBAC as an option.
• Fully supportive of VBAC pending scan and position of my placenta.

I had worked myself up for nothing? I sat in the room with Cathy and the consultant and I cried! Here I was with not 1 but 2 ladies that supported my birth choice. The fear and the worry rolled down my face and away from my mind in the form of tears. I began to relax and feel safe. The next day I had the scan and my placenta was in a good location for a vaginal birth.

Still not having heard anything from my hospital, at 38 weeks I decided to transfer my care and start preparing to give birth. Part of the care I had agreed to involved me having sweeps from 39 weeks to maximise my chance of going into spontaneous labour. I hadn’t researched this type of intervention and went along with it. At exactly 40 weeks I noticed I had some pink discharge and some watery looking blood. Never having been in this situation before I wondered if this was a sign of rupture? I went to Triage and after examination it was confirmed that my waters were leaking. It was suggested that I could go home and hopefully I would start contracting and that labour would begin. I agreed to return to the labour ward the following day. I went home a prayed for my labour to start, but unfortunately nothing happened.

I returned to labour ward the following day and the doctor in charge suggested that as it was approaching 48 hours of my waters leaking he could examine me and if my waters were intact he would artificially rupture my membranes (ARM) with a view to start labour and that if nothing had happened in 2 hours they would perform a c section… I explained that I wasn’t happy with this suggestion and refused an examination. I asked if there were alternative options? He then explained that as mine and the babies observations were good I could go home and hope labour would start. He asked me to take some pre operative medication and to fast from 7pm that evening and return for surgery at 9 am the next day. I got home and I sat and looked at the pre op medication and I felt defeated! Taking this medication was like submitting to surgery. I then reflected over my previous surgeries and reasoned that they had both been performed immediately after meals. With that in mind I decided I was not going to take this medication as I was not giving up hope just yet. I also felt that fasting wasn’t good as I believed I needed all the energy I could get if I were to go into labour and I believed I would.

I decided I was going to try everything within my power to start labour. I called an acupuncturist and she came to my house and gave me a course of acupuncture so strong that it caused involuntary movements. I ordered an Indian and thoroughly enjoyed eating it. I walked nearly 10k. I used my breast pump for nipple stimulation. I drank the juice of 8 pineapples and I had my friend round and we laughed and joked. I went to bed at 11pm exhausted but feeling at peace that what was going to be would be and it was now down to nature.

I woke at 7am having had the best night’s sleep ever! I hadn’t even woken to go to the toilet? Perhaps that was the reason that urine was trickling down my legs as I made my way to the bathroom? It was in fact my waters and at 7.06am on Sunday morning at 40+3 my contractions began! At 10 am I called the labour ward and explained that I was in labour and that I would stay at home until I felt the time was right to come in. I enjoyed this feeling of being in labour. I felt so lucky that here I was swaying rhythmically as the contractions waved through my body. I was going to embrace this experience. I ate throughout the day and I laboured with my children by my side whilst I rocked on my birthing ball. I walked around my house as my mum mopped the liquor that was flowing from me with each contraction. As I embraced these feelings I began to feel stronger with each contraction. By 4pm that afternoon my mum was expressing that she thought I should be in the hospital as she was envisioning delivering the baby. I was trying to hide my discomfort from my children so I agreed.

I was examined on arrival at the hospital, I was 4cm dilated and my fore waters were still intact. I was surprised as I had been losing so much fluid. I joked that I may give birth to a tadpole? The same doctor that I had seen the day before came bounding into my room full of smiles. He explained that it was good news that I was 4cm and was in labour and that as my waters were bulging but intact. He then suggested that he would break them and speed up labour due to risk of infection?? If the baby is not born in 2 hours he would carry out a c section? It was then that I politely but firmly said that I had no intention of having a caesarean, especially not in fear of risk of infection that myself and the baby were showing no signs of? The risk of infection due to surgery amongst other risks was of a greater concern to me. I explained whilst swaying side to side with contractions that here I was in labour and what a big achievement that this was for me. I expressed that I intended to let the labour take its course. I made it quite clear that I would only consider a caesarean if it was a true medical emergency and that mine or my baby’s’ life were being compromised. I then asked him to leave the room so I could continue to labour and stated that doctors were no longer permitted to enter, except in the case of an emergency.
I then continued to labour on the floor, on my knees remaining as active as possible and taking regular trips to the toilet. I refused all pain relief as I feared that I would lose control leading to interventions. I just requested Paracetamol and used gas an air when needed. My baby was OP and I found that leaning forward helped to relieve the pain in my back. I found myself in a trance like state and could not contemplate talking to anyone. I remember questioning in my thoughts how women could use their energy to shout out? The act of childbirth and all that was happening to my body consumed and silenced me. I began to feel the urge to push at around 4am the following day. The midwives felt it was not time yet but my body was taking over. I surrendered to these feelings as my physical being took charge. I began to push and 10 minutes later my beautiful son was born! I had just experienced the most amazing thing ever! I had given birth!

There is no other experience that can compare to this.
I felt physically and emotionally strong. My maternal being was in full force and I now felt complete as a woman. I had finally put Mother Nature’s gift to the test and it proved to be everything I had hoped for and so much more.

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I finally get to hold my baby. No drips, catheters or balloons. Up and walking the same day.

MRS INDEPENDANT!!

Mother Nature’s Gift
A Women’s ability to give birth is miraculous. Every woman has the right to experience this if they choose and if it is possible.
I wanted to experience my body doing what it was made to do.
No woman should be denied and prevented from giving birth because of another person’s subjective views and fears.
My final thought
BY
Michelle Quashie

MY MOTIVES EXPLAINED

Since publishing my birth story I have received an overwhelming positive public response. The messages of support and appreciation have touched my heart. I feel proud that a momentous time in my life has been so inspiring to others. I would like to thank you for your encouraging words. My birth story has been viewed by well over 1000 people worldwide including countries such as Japan, Trinidad, Mexico and Australia and so on. Here I include some of those fantastic responses:

“This is such an amazing story! I had a vba2c in February last year but I had a fight on my hands, and I wish that I had had your strength and courage to keep Drs away. It was a nightmare experience, but I got there in the end. I hope this story can be seen by as many health care professionals as possible and maybe change some minds so fewer women have to find the strength it takes to allow nature to take its course. Thank you so much for sharing!”  Lisa

“This is amazing, it made me cry. I’m 35+3 and hoping for a VBA2C. Hubby and I are getting ready for my appointment next week with the consultant team, the last one with the OB’s was awful and my Husband told them off for bullying me and not offering support but instead backing me in to a corner. Since then I’ve felt scared, doubting my decisions and crying on a daily basis. I only want to be supported in my decision to give it a chance, and like you I’d researched the risks associated with the VBA2C and a third section. This is so inspiring, I’m so glad you done it. I really hope I can do it too. Well done, and thank you so much for sharing. Just what I needed xx” Natalie

“Tears into eyes… Sadness at first but joy also for that last paragraph. You are such an amazing woman! I had my first baby by c sect and was also determined not to go through that again. I had an amazing midwife who backed me and my husband up and said let’s go for it! Felt so powerful when I gave birth to my son! Incredible x keep inspiring x” Mel

“Michelle I have verbally heard your story before but reading it here again is very moving. I think you strongly express what I also believe as a HWBAC and mother of 2 that all women need to feel empowered and be able to choose what happens to them. This cannot happen if they do not get good objective medical opinion and treatment. I was lucky, like you to find supporters towards the end of my pregnancy but I felt that all of the earlier uncertainty and stress was an unnecessary bi product of ill informed carers. How we birth is as important as birthing itself and it is beyond the time when good care should be provided that suits the individuals needs. Until this is happening throughout the UK we will continue to see post natal struggles with physical and mental issues caused directly by that low standard of care provision.” Rachel

My story has similar traits to thousands of other women’s stories that I have read on a daily basis over the past two years. It was reading these stories that inspired me to believe in myself and my body. It was such stories that gave me the courage to find my voice and question the choices made by others about my care and my birth. I am part of a community of women that often find our voices are not being heard. We are quite often presented with limited information regarding our options during pregnancy and birth. This deprives us of our choices and could be considered a tactical way to gain our consent to various procedures. This is then considered informed consent, the legality of this I question? How can gaining consent in this way be considered ‘informed’?  I intend to personally address this issue. Watch this space!

My intention is not to criticize or to draw negative attention to our strained maternity service. I have told a truthful account of my experience. Parts of my care were unethical and inconsiderate. This type of care left me feeling vulnerable and scared and probably had a negative effect on my baby. What I do realise is that this kind of care is not standard, but it happens. Change will not happen unless this kind of care is exposed. Some show resistance to change, probably because change exposes weaknesses leaving some feeling disempowered. Many will go to great lengths to form allies and keep control of a practice that feels familiar and safe. This has been displayed through public media recently. I am hopeful that as this kind of care giver is out of date maybe one day it will be a breed that is extinct!

Pregnancy and birth has always proven to be a daunting experience ravelled in fear. I would say that it has been one of the most stressful times of my life. I have always felt like a vessel to carry my baby and that others were responsible for bringing my babies into the world safely and that I should be fully compliant. Navigating  emotions when I had suddenly  ‘given birth’ and being responsible to feed them whilst feeling numb, in pain and weak was somewhat overwhelming, however I have always managed to live up to expectations.  My last pregnancy itself was different  being that I was healthy and it was problem free. Being in control of the decisions that were made in my pregnancy and birth felt good. Learning about the birthing process reduced my fears as I understood what was happening to my body. If caesarean had presented to be medically necessary, my experience would have still been a positive one as I felt in control of my birth and my body and was at the centre of all decisions. The surge of oxytocin and endorphins that happens at birth has proved to be hugely beneficial to my physical and mental state. I am still on such a high I wonder if these hormones have ever faded? When I gave birth I also gave birth to a new women.

Many women share their stories in private groups and forums due to the fact they are personal and feel safe and comforted knowing that like-minded women will receive them warmly. There are a number of reasons that I chose to share my story out in the public domain. Through my journey I felt l was struggling alone on a path that had many hurdles, stormy weathers and emotional upheavals, however, I made it through to the finish line holding my baby and I deserve to celebrate that!

I want to inspire all women including those that have not found groups like ‘VBAC Support group UK’ and such forms of support.

I want women to know that they have a choice.

I want women to know that it’s ok to speak up if you’re not happy.

I want women to know how to navigate the maternity system and know that there will be someone within the service that will be there to support you and your choices.

I want women to know its ok to expose those that practice unethically.

I want women to know that they should be at the centre of the pregnancy and birth process.

I want women to know that they can be in the driving seat of their birth experience.

I want women to know that if they are told that they are ‘allowed’ or not ‘allowed’ to do something that this is a warning sign and maybe your care provider needs to be reminded that it is your body, your birth and your choice!

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My birth story was not the end it was only just the beginning!

Strong Since Birth

 

Having children was always something my husband and I had looked forward to. We would often imagine what our future family would be like. My husband had unfortunately lost his only brother at the age of 31, so had always expressed his desire to have at least 3 children. I come from a large extended family so felt I would rather have 4 children than 3. In 2005 after two and a half years of trying to conceive and one miscarriage we finally conceived, and our journey as parents began……

At 32 weeks pregnant I had noticed lack of foetal movement and my instincts felt that something wasn’t right. I went to triage and was monitored for the next 24 hours. Decelerations were apparent and they gradually became more frequent, eventually signalling that the baby was in distress. One minute I was sitting eating lunch and the next I was having an emergency caesarean section (EMCS). Our son was born and resuscitated on delivery. He was then admitted to neonatal intensive care unit (NICU) and I wasn’t able to see him for 24 hours. It was all very rushed and I remained in shock. This was not how I had imagined my transition into parenthood to be? I was however grateful that my son was alive and apparently beautiful. I was yet to meet him…

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When my son was 5 months old I discovered I was pregnant again, although we hadn’t planned this pregnancy we both felt blessed. At 24 weeks I had a bleed followed by several more. I was diagnosed with having placenta previa grade 4. This was a very hard time for us and my husband had to take time from working to care for my son and me. I was under strict instructions not to lift or do anything other than sit and rest because of the risk of haemorrhage. It was expressed that this could potentially be life threatening. I was also diagnosed with gestational diabetes so had to maintain a restricted diet. Eventually following another bleed, at 33 weeks I was admitted to hospital on full bed rest until the baby arrived. I felt so depressed and being parted from my first son made me very emotional. I was in hospital for his first birthday whilst my family celebrated. Inside I feared that I would not bond with my baby as I was already resenting him for the situation I found myself in. I just wanted to make it through this pregnancy and return to being a mom to my child.

At 37 weeks I haemorrhaged and it was scary. I sat on the toilet whilst the blood poured down my legs. I pulled the emergency cord and I felt grateful to be in hospital. The reality of this scenario was something that I had totally underestimated. I signed the consent form to have a hysterectomy and was rushed into theatre for a crash section under general aesthetic. I can remember my body violently shaking whilst lying on the cold operating table. The medics were rushing around getting blood into me and preparing me for surgery. I knew nothing more as I had blacked out……. When I woke I had drips attached and bloods being administered along with a catheter and a Bakri balloon inserted, to stop the internal bleeding. Although I lay there helpless and venerable I was grateful for mine and my son’s life. There was also the added bonus of my uterus still contained inside of me. I lay looking at my son in his crib wishing to cradle him and celebrate that we had made it through a very tough time, but I couldn’t move. I loved him so much and couldn’t believe I ever doubted that I would. I needed to recover and gain strength so I could care for my family again.

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The years went by and as much as we both wanted more children, we were both fearful of what another pregnancy may bring. Eventually, 7 years after my last baby we decided to try for another baby. I was fortunate enough to fall pregnant quite soon. At my booking appointment I was categorised as being “high risk” so it was explained that my care would be consultant led. I asked if I could have a natural birth this time but was told no and that it was not allowed after 2 c sections. Being unsure of how the pregnancy would unfold I didn’t contemplate questioning this decision. I had accepted the decisions made by others regarding my care and my birth and wasn’t aware that there were any alternatives. The months went by and I felt fantastic! I was screened for gestational diabetes and the result was negative. My scans had shown that my placenta was not covering my cervix. My baby was growing perfectly and I was still attending a kickboxing exercise class at 5 months pregnant.

My 36/37 week appointment with my consultant was approaching. I had understood that at this appointment my caesarean section would be discussed. The thought of surgery and my memories of my previous experiences including recovery depressed me. I felt too well and healthy to end this pregnancy in surgery. My appointment was in three days and whilst browsing on the internet I typed “natural birth after 2 caesareans”. I was so excited by what I found. I became engrossed in a world that I never knew existed, the world of vaginal birth after 2 caesareans (VBA2C)…. I joined forums and spoke to women in my situation; I read guidelines applicable to my situation. I also read the risks involved with a third c section and the implications of those risks on a fourth pregnancy. The more knowledge I gathered the more I believed I was a suitable candidate for a VBA2C. My mum had given birth and had been asked to give talks on her breathing techniques. My sister had given birth 3 times, one of them being a homebirth to which I had witnessed. I began to question why I was to undergo major abdominal surgery for no apparent medical reason other than the fact I had had 2 previous caesarean sections? I then began to wonder why all this information was not discussed with me by those that were responsible for my care. Maybe it was because I had not actually met my consultant yet and only met various different members of his team.

I called ahead of my appointment and expressed that I wanted to meet my consultant and discuss the possibility of a vbac. I felt that by speaking to the most senior member of the team I would have the opportunity to discuss all of my options in depth and could compare the rationale behind each mode of delivery. I would respect their opinion as they would know best? I was told that he was not available and that I would need to see his registrar. I didn’t feel happy with this so tried to arrange an appointment with my previous consultant that was also based at my hospital. This was not possible so I accepted the appointment with the registrar. When I met with the registrar, I explained that I had been looking at the possibility of vaginal birth after caesarean (VBAC) versus another C-section and explained to her some of my reasons for wanting a VBAC.

• Risk of infection.
• Difficultly looking after 3 children after having major abdominal surgery.
• Risk associated with 4 pregnancies after 3rd c section, i.e. placenta previa/ accreta.
• My children seeing me looking poorly.
• Higher chance of NICU admission.
• Risk of respiratory problems.
• Higher chance of hysterectomy.
• Scarring and adhesions.

The main risk I could find associated with a vaginal birth was risk of rupture at 0.8%, This figure also included those labours that were augmented and the catastrophic risk included in this statistic was in fact much smaller. I felt that the benefits of a vaginal birth being successful were huge. So that meant a 99.2% that a rupture would not occur? This static of 99.2% seemed to me to be better than those associated with elective caesarean section (ELCS).
I was met with a negative response. I was told I could definitely not have a VBAC and that I was ridiculous to suggest it. During our conversation the registrar emphasised the risk and catastrophe I would be facing if I were to attempt a VBAC. Only some of her comments are listed below

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• VBAC was not an option, C section was a must.
• 80 % chance of uterine rupture.
• Why think about fourth pregnancy just focus on the current one.
• I had never dilated and wasn’t sure if I could do so, so would not risk me labouring.
• I would not find “anyone” that would support me.
• In her previous employment she had met someone like me and that no one wanted them on their watch!!!!
• If I went into labour naturally I would automatically be taken in for EMCS. Trail of labour after caesarean (TOLAC) was not an option.

I then explained that I had researched the Royal College of Obstetricians and Gynaecologist (RCOG) guidelines and National Institute for Health and Care Excellence (NICE) guidelines and that was my grounds for believing I was a suitable candidate. I asked if she knew of the guidelines I was referring to? She then explained that she wasn’t as she didn’t have time to go on computers much?? I asked her to access them on her computer whilst I was present. She displayed the guidelines on her computer and began reading. She expressed that they were applicable to 1 previous c section and did not apply to my situation. I then highlighted the relevant section within the guidelines.

RCOG guidelines
“Women with a prior history of two uncomplicated low transverse caesarean sections, in an otherwise uncomplicated pregnancy at term, with no contraindication for vaginal birth, who have been fully informed by a consultant obstetrician, may be considered suitable for planned VBAC.”

NICE quality standards states
“Clinically there is little or no difference in the risk associated with a planned caesarean section and a planned vaginal birth in women who have had up to 4 previous caesarean sections. If a woman chooses to plan a vaginal birth after she has previously given birth by caesarean section, she should be fully supported in her choice.”

I requested that she print them off so I could keep them alongside my handheld notes. She then left the room to retrieve the documents from the printer. My husband and I sat in the room for what felt like eternity. My husband then began questioning my motives and the validity of the information I was quoting. He felt that they should know what they were talking about; after all they were the professionals. I asked him to be quite and leave me to do the talking.

The registrar then returned holding the guidelines and was accompanied by a man that turned out to be my consultant; the one that was originally supposed to be on leave therefore was unavailable for my appointment? He introduced himself and acknowledged my request for a vba2c and the fact that I was aware of the applicable guidelines. He then began to explain that although the guidelines were in place, very few obstetricians agreed with them or felt happy caring for a woman that wanted to attempt a vbac after more than 1 c section: He explained that it was important that we both felt happy with the chosen method of birth and suggested that I go away and discuss this with my husband and to take more time to consider my options. He wanted me to take into account the following:

• Although the guidelines were in place, very few obstetricians felt comfortable with a woman attempting a VBAC after 2 or more c sections.
• If I were to rupture it is catastrophic.
• I could be that catastrophe and he wouldn’t want his name associated with that.
He asked my husband, “What was more important…? A natural birth or me being a mother to my other children??? “

Neither the consultant nor the registrar had looked at my medical history or referenced my notes to support their decisions. We got up to leave and the registrars parting words were said through smiles, “I have booked your c section so you don’t miss your spot and labour ward will be in contact with the date.” I left the building in turmoil! My face was bright red, my eyes were blood shot and I felt shaky inside. My husband began to side with the doctors and said he thinks it’s better if I just have a caesarean as he didn’t want to lose me, he felt it was just not worth it and that the doctors were the professionals and therefore knew what was for the best. He agreed with them that the most important thing was that I was alive and well to parent my children. This was something that I would never jeopardise. My children were my driving force at all times. He then went on to explain that he thinks they thought I had fallen from a tree and banged my head, implying that they thought I was mad judging by the way they had spoke to me. I had nothing left inside so I just remained quite.

I got home and I found my big blanket and buried myself on the sofa underneath for protection. I felt scared, vulnerable and disempowered. I had been told that if were to go into labour I would be taken straight into theatre for surgery. To me that felt threatening and left me fearful. I remained on the sofa for the rest of the evening not interacting with my children as I felt void and numb. Maybe I was going mad?

I woke the next morning, grateful for a fresh new day. I sat drinking my tea evaluating the consultant meeting. I began to feel concerned. Was the care that I was receiving evidence based? What happened to informed consent? Was I being coerced into surgery? Were my best interests at the centre of those responsible for my cares’ decisions? I decided to get a second opinion from someone outside of my hospital. After all it had been pointed out that they were all of the same opinion and that no one would support me.

I managed to contact the Local Supervising Authority Midwifery Officer (LSAMO) and spoke to a lady called Kate Brintworth. I explained my desire to have a VBA2C and the reasoning behind my decision. I explained the options I was facing and how that left me feeling. Kate expressed that she was concerned that I was feeling vulnerable and that I was now approaching 38 weeks with no birth plan in place. She would arrange to put me in contact with Cathy Walton, the Consultant midwife for Kings College Hospital, for some support and that I would have an opportunity to explore my options. She also reassured me that I wasn’t going mad and that my requests were valid. On the Wednesday Cathy Walton called and listened to my concerns. She offered to be a mediator and would liaise with those responsible for my care with a view to arranging another meeting hoping that the outcome would be more reassuring. Cathy had spoken to the clinical lead and the Supervisor of Midwives (SOM) and had reassured me that they would be in touch. Cathy had expressed that she was there if I needed her in the meantime. Cathy’s’ offer of support made me feel safer and stronger.

By Thursday evening I called the SOM as I hadn’t yet had a response. She explained that she hadn’t accessed my notes so could not discuss it any further and would contact me when she had done so. Friday came and so I called again as I was feeling anxious that the weekend was approaching and here I was approaching 38 weeks pregnant and still had no new options or a birth plan in place. Once again the SOM said she hadn’t had time to look at my notes and that she was extremely busy. By now I was very concerned at the way I was being treated and my confidence in their ability to care for me was dwindling. I was concerned that I may go into labour over the weekend so I decided that I would write a letter and hand deliver it in order to try and gain some control over my care and my body. I addressed the letter to the Chief executive, my consultant, the SOM and what I believed was the Head of Midwifery. Some Extracts from the letter are listed below.

• “Unless there are any medical contraindications that occurred during my previous C section’s that will impact on the success of a VBA2C, I will not be pursuing an elective Caesarean section.”
• “I would therefore like you to put any necessary arrangements in place to support and assist me with this. Please could you confirm in writing that you have done so?”
• “I am hoping this meeting will be less stressful and will take place on Monday, as I will be over 37 weeks pregnant with no birth plan in place.”
• “Should you feel that there is medical reason to prevent me having a VBAC please notify me ASAP.
Also if you feel you are unable to provide the support I need please also notify me ASAP.”                                                             I would not willingly allow anyone to carry out major abdominal surgery for no apparent medical reason. Surely that alone posed a major risk?

At 7 pm that evening the SOM left a message on my answering machine to say she would call me on Monday to arrange an appointment for later that week. I spent the weekend lying on the sofa scared to move in case I provoked labour. I had never experienced any form of labour, nor had I any antenatal classes so did not know what to expect or signs to look for. By Monday afternoon I still hadn’t heard from my hospital so I called Cathy Walton and asked if I could see a consultant at Kings College Hospital. I wanted an opinion that was based on my medical history and relevant evidence. It was really important for me to know if there was a medical reason for a repeat caesarean.

An appointment was made for the following day. I prepared myself for the battle that believed I was about to face. I sat with the new consultant and explained my reasoning for my wanting a VBA2C and my belief that I was a suitable candidate. To my utter disbelief the consultant had accessed my medical history and she stated the following:
• She felt I was fully informed.
• Aware of associated risks of c/section and VBAC.
• A successful VBAC was the safest option pending future pregnancy.
• No medical reason to prevent VBAC as an option.
• Fully supportive of VBAC pending scan and position of my placenta.

I had worked myself up for nothing? I sat in the room with Cathy and the consultant and I cried! Here I was with not 1 but 2 ladies that supported my birth choice. The fear and the worry rolled down my face and away from my mind in the form of tears. I began to relax and feel safe. The next day I had the scan and my placenta was in a good location for a vaginal birth.

Still not having heard anything from my hospital, at 38 weeks I decided to transfer my care and start preparing to give birth. Part of the care I had agreed to involved me having sweeps from 39 weeks to maximise my chance of going into spontaneous labour. I hadn’t researched this type of intervention and went along with it. At exactly 40 weeks I noticed I had some pink discharge and some watery looking blood. Never having been in this situation before I wondered if this was a sign of rupture? I went to Triage and after examination it was confirmed that my waters were leaking. It was suggested that I could go home and hopefully I would start contracting and that labour would begin. I agreed to return to the labour ward the following day. I went home a prayed for my labour to start, but unfortunately nothing happened.

I returned to labour ward the following day and the doctor in charge suggested that as it was approaching 48 hours of my waters leaking he could examine me and if my waters were intact he would artificially rupture my membranes (ARM) with a view to start labour and that if nothing had happened in 2 hours they would perform a c section… I explained that I wasn’t happy with this suggestion and refused an examination. I asked if there were alternative options? He then explained that as mine and the babies observations were good I could go home and hope labour would start. He asked me to take some pre operative medication and to fast from 7pm that evening and return for surgery at 9 am the next day. I got home and I sat and looked at the pre op medication and I felt defeated! Taking this medication was like submitting to surgery. I then reflected over my previous surgeries and reasoned that they had both been performed immediately after meals. With that in mind I decided I was not going to take this medication as I was not giving up hope just yet. I also felt that fasting wasn’t good as I believed I needed all the energy I could get if I were to go into labour and I believed I would.

I decided I was going to try everything within my power to start labour. I called an acupuncturist and she came to my house and gave me a course of acupuncture so strong that it caused involuntary movements. I ordered an Indian and thoroughly enjoyed eating it. I walked nearly 10k. I used my breast pump for nipple stimulation. I drank the juice of 8 pineapples and I had my friend round and we laughed and joked. I went to bed at 11pm exhausted but feeling at peace that what was going to be would be and it was now down to nature.

I woke at 7am having had the best night’s sleep ever! I hadn’t even woken to go to the toilet? Perhaps that was the reason that urine was trickling down my legs as I made my way to the bathroom? It was in fact my waters and at 7.06am on Sunday morning at 40+3 my contractions began! At 10 am I called the labour ward and explained that I was in labour and that I would stay at home until I felt the time was right to come in. I enjoyed this feeling of being in labour. I felt so lucky that here I was swaying rhythmically as the contractions waved through my body. I was going to embrace this experience. I ate throughout the day and I laboured with my children by my side whilst I rocked on my birthing ball. I walked around my house as my mum mopped the liquor that was flowing from me with each contraction. As I embraced these feelings I began to feel stronger with each contraction. By 4pm that afternoon my mum was expressing that she thought I should be in the hospital as she was envisioning delivering the baby. I was trying to hide my discomfort from my children so I agreed.

I was examined on arrival at the hospital, I was 4cm dilated and my fore waters were still intact. I was surprised as I had been losing so much fluid. I joked that I may give birth to a tadpole? The same doctor that I had seen the day before came bounding into my room full of smiles. He explained that it was good news that I was 4cm and was in labour and that as my waters were bulging but intact. He then suggested that he would break them and speed up labour due to risk of infection?? If the baby is not born in 2 hours he would carry out a c section? It was then that I politely but firmly said that I had no intention of having a caesarean, especially not in fear of risk of infection that myself and the baby were showing no signs of? The risk of infection due to surgery amongst other risks was of a greater concern to me. I explained whilst swaying side to side with contractions that here I was in labour and what a big achievement that this was for me. I expressed that I intended to let the labour take its course. I made it quite clear that I would only consider a caesarean if it was a true medical emergency and that mine or my baby’s’ life were being compromised. I then asked him to leave the room so I could continue to labour and stated that doctors were no longer permitted to enter, except in the case of an emergency.
I then continued to labour on the floor, on my knees remaining as active as possible and taking regular trips to the toilet. I refused all pain relief as I feared that I would lose control leading to interventions. I just requested Paracetamol and used gas an air when needed. My baby was OP and I found that leaning forward helped to relieve the pain in my back. I found myself in a trance like state and could not contemplate talking to anyone. I remember questioning in my thoughts how women could use their energy to shout out? The act of childbirth and all that was happening to my body consumed and silenced me. I began to feel the urge to push at around 4am the following day. The midwives felt it was not time yet but my body was taking over. I surrendered to these feelings as my physical being took charge. I began to push and 10 minutes later my beautiful son was born! I had just experienced the most amazing thing ever! I had given birth!

There is no other experience that can compare to this.
I felt physically and emotionally strong. My maternal being was in full force and I now felt complete as a woman. I had finally put Mother Nature’s gift to the test and it proved to be everything I had hoped for and so much more.

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I finally get to hold my baby. No drips, catheters or balloons. Up and walking the same day.

MRS INDEPENDANT!!

Mother Nature’s Gift
A Women’s ability to give birth is miraculous. Every woman has the right to experience this if they choose and if it is possible.
I wanted to experience my body doing what it was made to do.
No woman should be denied and prevented from giving birth because of another person’s subjective views and fears.
My final thought
BY
Michelle Quashie