Marisa Ines' Home Waterbirth After 2 Cesareans

Marisa Ines, born 30 June 2001, 8 pounds 4 ounces, 21 inches.

My first child, daughter Hannelore, was born by an emergency cesarean in 1995. Although we had planned for a home birth, I had an undiagnosed low-lying placenta with an extra lobe ("succenturiate"). As I began to go into labour, this low-lying lobe abrupted, or separated from the uterine wall, causing a major hemorrhage. I woke in the middle of the night, two days before my due date, soaking wet, thinking my water had broken, only to discover that it was blood, not amniotic fluid, that was soaking my sheets.

We rushed to the hospital, and Hannelore was delivered safely while I was under general anaesthesia. Luckily, because the major placental lobe was still attached, Hannelore was never in any grave risk (although since the succenturiate condition was undiagnosed, they didn't know that until later). I had lost quite a lot of blood and needed major transfusions.

I first saw Hannelore in the recovery room, when she was maybe an hour old, and it was one of the happiest moments of my life to see her so perfect and alive and content. Because of the drugs and the cesarean wound, we were both a bit dopey and slow to establish breastfeeding, but as time went on, I felt such gratitude that the technology was there to help us when it was needed. Nonetheless, I still longed for a more natural, less traumatic birth experience. For my next pregnancy, in 1997, we also planned a home birth, against the advice of some of the NHS (National Health Service) midwives in my area. I discussed the existing studies about vaginal birth after cesarean with my consultant obstetrician, and he had to agree that for a non-repeating cause such as I suffered with Hannelore, there was no real reason not to try for a home birth. Unfortunately, I had another very low lying placenta (partial placenta previa), this time diagnosed by ultrasound scans early on, and therefore my son Tarik was delivered by a planned cesarean under spinal anaesthesia at 38 weeks.

This was much less traumatic than Hannelore's birth, and much calmer. My husband Andrew was able to be present and watch the whole thing. But once the baby was born, Andrew and Tarik left the operating theatre to get him cleaned up, and it was nearly half an hour before I was allowed to hold him in my arms. I found this excrutiating. Tarik was more alert than Hannelore had been, but still was a bit dopey from the drugs, and I suffered as much as I could without painkillers for the wound, so that he might be alert enough to feed well.

Caring for an infant and a 2-year-old with a cesarean scar is no picnic, although the recovery was so much easier than after Hannelore's birth because I hadn't lost so much blood. I became pregnant again two years later, but suffered a miscarriage, followed by a botched D&C which left me with a pelvic infection which we feared would render me sterile. Four months later I had another miscarriage, but six months after that I became pregnant again, and the pregnancy proceeded normally. This time the placenta was nice and high, but because of my history, the NHS professionals were unanimous in agreeing that even though a vaginal birth after 2 cesareans was perfectly possible, I needed to have a hospital delivery. I agreed, and began to think about how I could ensure a hospital birth which emulated as much as possible the home birth experience I wanted.

I started to look for a doula; someone experienced with birth who could labour with me at home for as long as we could, in order to minimize my hospital stay (and therefore minimize the time for interventions to be suggested). Through website searches I discovered the Association of Independent Midwives, and there I found Peggy, a qualified midwife who agreed to act as a doula or labour support, meeting with me a few times before birth, coming to labour with me at home, and coming with me to the hospital as a friend and supporter. I felt very comfortable with this, because I knew her midwife training would help me feel very secure about staying at home for a long slow labour, and I wouldn't be tempted to go in too early.

I also hired a birthing pool, to help me labour in. The pool was scheduled to arrive a week before my due date. Since I had never actually been in labour with the other two, I didn't know what to expect, and wanted to have something non-chemical on hand to help with the pain.

Tuesday, ten days before my due date, I felt odd all day, with loads of Braxton-Hicks and I asked Andrew not to go to an out-of-town evening event as he had planned. I just had a feeling that "something was up." Wednesday morning I had significant bloody show, and rang my sister Beth in the States to ask her to try to change her ticket to come a bit earlier. I also rang the pool hire, and the sweet man said he would do his very best, but it was unlikely to arrive before Friday. Thursday I began to have "real" contractions, which I could handle on my own.

I spent some time on the birth ball, and lots of time walking around, and by Thursday evening, the contractions were quite regular and required my full attention, though not yet hugely painful. We rang Peggy and she arrived around 10 pm. By that time, I had the news that my sister Beth had managed to change her ticket, and would be arriving at Heathrow in the morning. We arranged for a friend to go and pick her up, but after watching me through a few contractions, Peggy said "I'm not sure if this baby is going to wait for Auntie's arrival!"

I was sad at the thought of having neither my sister nor the pool to labour in, and I wonder now if that mental state didn't affect the progress of my labour. I laboured through the night, and the three of us developed techniques for coping. Mostly when a contraction started I would put my arms around Andrew's neck, and Peggy would apply counter pressure against my back, or hold a hot water bottle against my belly from behind. But as the night wore on, the contractions didn't seem to be getting any stronger, and if anything, they were weakening a bit. I ate and rested as best I could, and by 10 am on Friday morning our blessed pool man arrived, and while he was setting things up, my sister did too.

I was thrilled with both arrivals, and itching to get into the pool, so the minute it was filled I jumped in to try it out. Actually, this was probably a mistake. I should have waited until I "needed" it for pain relief, but it looked so comfy and inviting, and I was dying to see what it was like. Being in the pool, however, spaced out my contractions significantly. I used the time to rest a bit, but soon felt that I needed to get out and move around if I really wanted anything to happen.

My sister and I went for a long walk around the park, and the contractions picked up a little bit, but they still weren't really, really hard. Finally, when evening fell, the contractions seemed to be less strong, and we began to wonder whether we shouldn't think about going to the hospital, if only so that a change of scenery might kick start things a little. Through the whole labour up to that point we had been keeping track of the baby's heartbeat, and everything was absolutely perfect. Baby was healthy and happy. I was tired, but not exhausted, and I had been eating, drinking, and going to the bathroom regularly, so I was in pretty good shape too.

Before we decided whether to go to the hospital, I asked Peggy to check my dilation for the first time. If I was not dilated enough, I didn't want to go to the hospital, as long as baby and I were both okay, because there is nothing they could do for me there, aside from interventions that I didn't want.

Peggy checked and after almost 24 hours I was only 3 cm, although I was 100% effaced. I think everyone was afraid that I would be terribly discouraged by this news, but in fact I felt liberated. I knew that I wouldn't have to go to the hospital then, and we resolved that everyone would try to get some sleep and we would re-evaluate in the morning. I took some homeopathic chamomilla and lay down on my bed with my husband. I dozed, still having contractions, while Andrew slept soundly.

At about 1 am, the contractions started feeling strong enough that I needed some help getting through them. After a while, my sister came in as well, and there followed my favourite part of the labour. We developed a wonderful rhythm where I would lie down and drift almost immediately into a deeply restful sleep as I listened to the sweet low voices of my loved ones chatting . . . for about 4 minutes. Then I would wake up as I feelt a contraction coming. I would stand up and hold onto Andrew while Beth applied heat to my back or belly and we'd breathe through another contraction. Then I would walk down the hall to the bathroom, wee, drink some water, come back to the bedroom, lie back down and drift immediately to sleep again. This went on for about 6 hours. It was so lovely and calm and peaceful, and I loved lying and listening to the soft murmur of beloved voices.

In the morning, we woke Peggy, and I decided I needed to get really serious about this birth business. It was now 32 hours since Peggy had arrived Thursday night. I began walking up and down the stairs, and up and down the garden, trying to provoke harder contractions. Finally, at about 11:30 am the contractions began to get really painful. "Okay" I thought, "this is it - this is where real labour begins. A few hours of this and we'll be ready to go to the hospital."

I was having some trouble keeping on top of the contractions, so I decided to get into the pool. It was wonderful. I immediately felt more relaxed and on top of things again. I was kneeling, with my arms over the padded rim holding onto Andrew. But I continued to move my legs, "marching" under the water to provoke a contraction whenever I thought one was too long in coming.

After only a few contractions (maybe 4 or 5), I felt the oddest sensation. It was as though something shifted, moved inside me. I realize now that it was the baby's head moving out of the uterus and into the birth canal. At the end of the next contraction, I shouted "Oh my god, I have to push!!" And that's when all hell broke loose! "Call the midwives" I shouted, and poor Beth ran around trying to find the number "It's on the phone list." "Which one?" "It's programmed in my mobile phone, if you could . . . Oh my god!!" Another contraction ripped through me and I writhed, biting poor Andrew's thumb. "Get me a towel to bite!" I instructed, with surprising clarity.

Beth finally found the number. "They say to get in the car and come to the hospital." "I'm not going anywhere" I yelled. "Tell them to send someone here." "Okay, they are contacting your midwife who's out on her beat, and they are also sending two midwives from the hospital, and an ambulance as well." "AAAaaaaaarrrrrrrgggghhhhhhh!" I screamed as I pushed again. The sensation was overwhelming. I was screaming, shrieking with it, but it wasn't scarily painful, just overwhelmingly intense.

I reached down and felt a very weird rubbery bubble or balloon coming out of my vagina. "Oh my god, what's wrong with the baby's head?" "That's not the baby's head, that is your amniotic sac - that's amniotic fluid inside the membranes you're feeling there." Peggy reassured me.

Moments later there was knock on the door, and Sue, my favourite community midwife, the one who had been doing my antenatal care, walked in. She was coincidentally right in the neighbourhood when she got the call. She brought in all her delivery gear, but upon seeing me in the tub, turned to Peggy. "I have never done an underwater delivery before. Would you like to continue?" and, although strictly not really legal, since I was not registered as her patient, Peggy agreed (even though she risked her license if anyone reported her). I bless both of them for being willing to bend the rules a bit for my sake. If I had had to get out of the water at that point, it would have been awful.

"The head is out" I shouted. It emerged in the caul, and through the caul Peggy saw an odd colour liquid being expelled through the baby's nose and mouth. It was actually just normal amniotic fluid which looked a strange colour because it was being seen through the caul under water, but it unnerved Peggy a bit. "Come on" she said "let's get this baby out." Feeling the urgency, I pushed with all my might before the next contraction came, as Peggy reached down and helped the shoulders out. In retrospect, this was another mistake, because I tore quite badly at this point. I think if we had all been calmer and waited for the next contraction, I might have avoided a tear altogether. But hindsight, as they say, is 20/20.

About this time there was another knock at the door, and the two midwives from the hospital arrived. I stood up and we manouevered the baby back between my legs into Andrew's arms. "It's a girl!" he said. We held her together, and then Andrew cut the cord. "Welcome, Marisa Ines!"

There was a lot of blood in the water because of the tear, and the midwives asked me to get out of the tub so they could make sure it wasn't a postpartum haemorrhage. I sat on the comfy chair and cuddled Marisa for a while, until the midwives began getting concerned about the placenta. They asked me to stand up and try going to the bathroom, because they thought maybe a full bladder was inhibiting the delivery of the placenta. As I sat on the toilet, the placenta just fell out into it.

The midwives then had a look at my tear. "I'm afraid this is beyond my skill to stitch" Sue said. The hospital midwives agreed, and said that I should go to the hospital, where I would probably be given an epidural in order to stitch it up, because it was such a large tear. I was almost in tears. Here, after successfully (if inadvertently) having the intervention-free home waterbirth I had always dreamed of, I was being told I'd need to leave my home and baby, go to the hospital, get the epidural I had worked so hard to avoid and stay there for hours until it wore off, for some stitches? "What happens if I don't go?" I asked. "Could I go tomorrow morning instead? Is there any problem in waiting a bit?" Sue said she wanted to check to make sure that the tear was not into my rectum, so I lay on the floor and she performed a vaginal/rectal exam. She kept apologizing, but it really wasn't the slightest bit uncomfortable. "Well, the rectum is intact," she said, "but the space between the tear and the rectum is very small indeed."

"I'm going to wait, then" I said. After the hospital midwives left, I spoke frankly to Peggy. She was hesitant about expressing her opinion in front of the hospital midwives because they could have gotten her into big trouble for practicing outside her own district without authorisation - it could have cost her her license. She advised me that if I didn't want to go to the hospital for stitches, it was possible for the tear to heal naturally without them, but I would have to be absolutely dedicated to the process.

It meant 4 or 5 days essentially in bed, with my legs together. It meant no sitting, no climbing stairs, and extraordinary caution when emptying my bowels. It meant eating very, very well and dosing with vitamins and homeopathic remedies. It meant extraordinary attention to cleanliness. Generally, it would put a large burden on my husband and sister to look after the rest of the family while I mended. Andrew and Beth were willing, so we decided to go for it.

When Sue came to check the tear a day later, she was astonished - "It looks so very pink and healthy and it's not swollen!" She said she never realized that the black and blue, bruised, raw, puffy wounds she was accustomed to seeing were actually a result of the stitching, not the tearing! Several days later, the other community midwife could hardly believe her eyes - I think she didn't believe the tear had been as severe as was noted in my notes, because it had healed so well. The amazing thing to me was that the tear never ever hurt, not even the slightest bit. It didn't hurt when it happened, and it didn't hurt at any time during the recovery either. And compared to my two previous experiences of trying to care for newborns while suffering a major abdominal wound, I was in heaven!!

From the beginning, Marisa was different than the others - much more alert, much more interactive. I am sure that the lack of drugs in her delivery and early life have a lot to do with that. It was so very wonderful to be at home, in my own bed, recovering. It was so nice not to have to deal with medical personnel and horrible hospital food! Although my home water VBA2C wasn't exactly a planned one, I would highly recommend it to anyone!

-- Melanie W.