The hospital I would prefer to give birth in (actually the only one I’m prepared to give birth in) is about to be taken over by a company called Circle; in fact, it will be taken over in the same month (quite possibly the same day) that Marmite is due to be born). This is fairly appropriate, since I am going around in circles about how on earth to get this baby on the outside with a 100% survival rate for the two of us and my sanity intact. Mostly I’m trying desperately not to think about it but with perhaps just 12 weeks at most to go, it is beginning to be a good bit harder not to think. So much will depend on the circumstances near the end, but so much also involves everything that has gone before, for me, all my children, Freddie and Josie in particular.
What really matters is that Marmite and I both survive, with all our health and faculties in one piece. Max has to survive the day too, as do the four girls who will be waiting at home.
Nobody knows why Freddie is dead. No one has been able to explain to me why a straight forward labour, well monitored and attended by not only an impartial onlooker but also an experienced midwife and a consultant, resulted in a baby with oxygen blood levels just the right side of a stillbirth. No one has explained why that happened when there didn’t appear to be a cord accident. No one can explain why he followed no obvious pattern and why when the country is full of the survivors of traumatic births, albeit damaged, Freddie died within a few days. He wasn’t even being discussed as the top end of damaged. He could breathe on his own. He could move. He could look at me and try to make noises. But he died – and surprised everyone but me by doing so.
So I have no idea what I’m trying to avoid. I have no idea whether I should avoid another normal birth, because I have no idea if he is dead because of that 3 hour, smooth as silk active labour where he never showed any signs of distress. Two consultants, a midwife and a doula have assured me that had that been my first delivery, at no time would anything different have happened. That delivery was never a vbac only because I wanted it, no one was umming and aaahing about taking me to theatre. 3 hours from 2cm to delivery.
It could be that Marmite is cooking up exactly the same outcome, for all I know 🙁
I do know that no one thinks going to 40 weeks is a good idea.
I don’t do early labour; the earliest of mine was due date Maddy.
I’ve had 3 sections, the last of which was now over 7 years ago. My last consultant (who retired straight after Freddie 🙁 ) was prepared to let me have one gentle induction attempt. My new one isn’t.
So I can’t be induced unless I happen to be in a position where breaking my waters is easy at say, tops, 38w 4d.
I’m not renown for well positioned babies; Freddie was the best of them. This baby has lots of stuff in its favour, my weight is good, the placenta position is good. But none of that is going to make me go into labour at 38 weeks.
So if I can’t be induced, I’m going to have to have a caesarean for the sake of sense and sanity.
It seems like that is the easy option.
I can plan it. I can organise it. It will be calm, organised and people who matter to me (my midwife, my doula, ‘my’ paediatrician, my consultant and the girls) can all be organised to be in the right place at the right time.
Except it won’t be calm, because I won’t be calm. Because the last time I had a section I ended up with 25cm bruises down my arm from injections that they removed references to from my notes, I was vomiting, I was bleeding heavily, I felt like I was falling off the table, I pushed my baby away and I heard people shouting at me to stay still while I was sick, I heard people saying “stay awake, stay with us” and my husband thought I had died and left the room. My notes say “normal caesarean”. I was FINE and so was Josie, before we went into theatre. There was not even a good reason for it to end that way.
I can’t even begin to imagine putting myself in that position again. It doesn’t matter what people say is most normal or most common, I know only too well what else can happen with statistics. It doesn’t matter that elective ones are different, they don’t ALWAYS go well. I already know I’m scarred and messed up in there.
I can see the positives and then I start to list all the things that frighten me about that as an option.
Actually getting there, with no adrenalin, and no’ need’.
Operating theatre lights. Panic.
Suction machines. Panic.
Epidural. I have a really dodgy back, already made worse by previous ones and getting them in is always horrid, painful, upsetting and leaves me in huge discomfort for weeks.
Knowing there is every chance the baby will be surprised to be born and need sorting out away from me.
The days of coughing and spluttering afterwards while he chokes up congealing amniotic fluid and has to be sucked out because he’s struggling to breathe. Happened with Fran, going to be all too close to watching Freddie.
The big one, the HUGE HUGE thing. What if this baby has to go to SCBU? I won’t be able to go too, I might never even see him alive. I’ll be in a bed, in a room, utterly out of my wits with fear and I won’t even get the time I got with Freddie.
What if he dies and I’m stuck in hospital recovering and can’t get away? I won’t be able to be with my girls (who will almost certainly not be allowed in because, again, the hospital will be closed down because of vomit bugs. Max won’t be able to care for all of us.
Even if it all goes well, it will mean 2-3 days in the same ward I paced up and down in while Freddie tried to live. I’m not going to cope with crying babies, being on my own, sympathy, lack of sympathy, accidental malfunctions of care.
Even if it goes well, there are the stockings and the overwhelming fear I have of bloodclots, the recovery, the Clexane injections, the wound checks and the miserable numbness and the coughing and sneezing and not being able to get about easily or drive or have the endorphins that make feeding easy and coping with a newborn easy.
And I know, because I’ve done it three times, that I don’t mentally recover well from caesarean birth. I just don’t. It does something to my hormones and my sense of well being and connection to people. It gives me nightmares and low self worth and I cut off and feel bad and I don’t enjoy mothering after it particularly well. I’m not sure that those things, risking those things, on top of the emotions of a rainbow baby, are a good idea. On top of another dead baby, they’d be a very bad thing indeed.
It’s just not an easy option.
So that takes me back to VBAC. I can’t be induced. I can’t seriously wait till 40 weeks, never mind beyond, not only because of my sanity and the rest of the families’ sanity, but medically.
I can’t be induced without some risk.
Induction ups my ‘maybe’ rupture risk of about 1%-ish to a bit more like 2% – but, quite understandably, not something a health professional can be forced to take on. That’s only 4 times my risk of another random neonatal death, which everyone assures me won’t happen. I wouldn’t give up my job on a 1 in 50 chance of winning the lottery, the fact that Freddie’s birth was smooth is a good thing. But.
I could even have a a totally different random event. A PPH. A cord accident. A baby who gets stuck. A long drawn out labour that ends in an emergency section.
I could have a perfectly smooth birth if I wait to 40 weeks+ and a baby who screams.
I could have another dead baby to say goodbye to.
I could die.
I could lose my womb.
I could go home that afternoon with a happy baby and a happy mummy to relatively emotionally intact children.
I could have all those things happen, bar the last, if I have a section.
If I’m too scared of random natural birth events to have another VBAC, I have to have a section.
But what on earth do I do if I’m too scared to have a section and can’t have a VBAC because I can’t be induced and I can’t make myself go into labour at a time that is sensible and safe?
What if I VBAC but the obvious concerns and stress it will cause me and Max and my carers means it is clinical and complicated and anxious and breaks all the good things and all the healing I got from Freddie’s birth?
I don’t feel like I have a single option that looks safe, risk free, outcome assured and emotionally manageable at the moment.
And through all of this, I know, I just know, that what really matters is a screaming baby who comes home.
But what if I make the choice that means this time it is ME that doesn’t come home? What if I make the choice to do it the ‘easy’ way and he doesn’t breathe and I never even get to hold his hand while he’s alive?
To be honest, and I know this might seem a small thing, what if it all goes well and I come to pieces so badly afterwards, like has happened before, that it turns out to be the straw that breaks the back of the camel that is our marriage. Because Max will NOT understand, if I lurch from neonatal death trauma, to birth trauma. He will not be forgiving of that because he will simply not get it.
Knowledge and experience isn’t empowering me at this point, it’s just terrifying me. It’s not like I can stop the clock either. One way or another, this baby is going to have to come out.
Edit: I’ve had a few emails suggesting that I opt for a home birth to reduce the stress. Just to clarify; I swapped hospitals after the girls and I love my new hospital, which has treated me with care and respect throughout. Freddie’s birth was perfect and couldn’t really have been more perfect if it had occurred at home. Leaving aside the remote possibility that somehow the car drive caused his distress (unlikely given he didn’t appear to be in distress when we arrived), all a home birth would have done for me would leave me feeling he could have been saved if he’d been in hospital and everyone else would think so too. Nothing would persuade me to give birth away from a SCBU unit now. I really appreciate the care and thought in emailing me, but it isn’t an option I want to consider.
Ah Merry.
Like I said on fb, my options are so much easier than yours. I have no idea about anything helpful I can say, other than bloody hell. And sympathise from hundreds of miles away.
Emma xxx
Oh Merry, I wish you didnt have to go through this. I cant even imagine how you feel right now, all the emotions and choices/non-choices. I just want to send (((hugs))) thoughts and prayers which I know arent enough. 🙁
Probably no help at all since you already identify there are no options in pregnancy and delivery which are ‘safe, risk free, outcome assured and emotionally manageable’ and either way you’ll have the attendant panic of whatever ends up happening but have you considered looking at the alternative therapy approaches which may help during that day – hypnotherapy, visualization and the like? Although they won’t change what is happening they may give you some control back over how you cope with it. Sorry if it sounds unhelpful and trite and I’m sure you’ve explored all avenues but thought it might be worth a mention.
The saddest thing is I used hypo CDs to get through preparing for freddies birth. I used to cry uncontrollably at the handing you the baby bit. I don’t think I could bring myself to listen to one now 🙁 I think I have come to the end of just about every coping strategy going 🙁
Oh goodness Merry – you are under such great stress and it’s not a ‘mental health’ issue (Post Traumatic Stress Syndrome yes, I would think and multiple traumas at that) – but – it’s a really normal reaction to everything you have been through which is just so huge. It just seems so wrong that you haven’t been given the ability other than through your blog etc to offload all these concerns and worries and sheer sadness. These concerns that you raise are not just ‘what ifs’ but are based on your experiences so far. I just wish our NHS would help mothers, help women and not leave us in a state of utter fear.
I hope and wish for everything to go as well as it can, for you to find the small piece of you that I hope is still in there, that isn’t in the past or dreading the future, but is able to find a now, a one day/moment at a time now and that gives you a sanctuary from the understandable fears you have.
Oh I have, counselling and armfuls of sympathetic carers. But no one has the perfect scenario for me. What they want (and me) is a successful outcome. Healthy mum, healthy baby. And if that is achieved, all is well. But when I leave the doors, it’s over for them, just as it doesn’t start till I arrive. I’m already in it though and whatever mess I leave in, even with a healthy baby, my bit is still just beginning.
Totally inadequate reply but didn’t want to just read and go. Can’t begin to imagine your anguish in all of this, and wishing there was something I could do to help you. Sending love anyway. xx
Pray for a breech baby? That would make it easy!
Please email me if you want. This was exactly the situation I was in with Juliet, just a few months ago. Couldn’t be induced, wanted a VBAC but didn’t want to (nor would they let me) wait til 40w or beyond. My mind was such a mess as no option sounded right or safe and I just wanted a crystal ball. I can only hope that if you do end up with another c/s that you recover brilliantly and Marmite is fit, alert and healthy and nurses like a little champ. That’s how it was for me, so I hope hope hope it is that way for you.
Oh Merry, I really feel for you.
xo
Oh Merry. It wasn’t half as complicated for me but I can still feel shivers of recognition running down my spine reading this. I’m sorry that you can’t be induced as I felt I was lucky to have that option. And I nearly didn’t take the early induction because of the HUGE HUGE thing that you’ve mentioned. That I did not want to go back to SCBU or NICU. Not that there would have been a choice but . . . . you know.
Oh for a crystal ball. I wish there was a way that you could know what would be right for you and for Marmite. If you do end up with a C section then I wish for exactly the same as Sally. I just hope that everything goes as well as it possibly can, that you and Marmite are happy and healthy and safe.
And, if it helps at all, I was extremely worried about worried about that final thing, totally falling apart if everything all went well. And yes, that my husband would NOT understand that at all. Wish it could all be easier, thinking of you xo
See I was so worried, that I typed ‘worried about’ twice! xo
Merry, why are they not happy for you to be induced?I had precipitate labours, and we nearly lost Daniel at birth following a way-too-quick bathroom floor home birth. When I got pregnant again I didn’t want any unnecessary risk. First my consultant said no induction before 38 weeks, but that was too late for comfort because I’d had spontaneous labour earlier than that…in the end I went in at just over 36 weeks, and all they had to do was break the waters and she came without any further intervention.
Though induction doesn’t effect the VBAC/c-section deliberations, does it?
I remember what happened with Daniel. It’s been in my head every time since, as a thing to remember to guard against.
Induction with drugs is a problem in two ways. Prostin gel can dissolve scar tissue. Its now reasonably common after one section but just more of a leap of faith with 2+. I really don’t want to risk a rupture for a genuine reason. I’d be happy with one go and lots of care but my consultant isn’t. A drip is just a no no. And I loath drips, I was so glad not to have one with Freddie, it’s the only time I haven’t.
Breaking my waters is the only option. As I tend to have less than perfectly positioned babies and tend to be hermetically sealed even in early labour, it will take a miracle for that to be possible.
Debbie – I think induction does impact on the VBAC / section decision, because there is a much higher risk of uterine rupture with induction, because the contractions are stronger. That is why many doctors are not willing to induce you for a VBAC, or will only use a low dose.
Dear Merry – oh, this is all so hard! Please feel free to ignore this suggestion if it isn’t right for you, but I have found accupuncture really helpful (for fertility & pain issues) and I understand that good accupuncturists have very good results for bringing on labour without an induction. Is that something you’d be willing to try – eg from 36-7 weeks? (though if you want to try this strategy, it would probably be good to start seeing the accupuncturist earlier so that you can build some rapport) I know that doesn’t solve all the difficulties with a VBAC, but it is sounding like you’re really not keen on having another section.
It almost feels like you feel trapped between two options that have both given you awful past experiences – whichever way you go, you’re going to need to somehow let those experiences stay in the past and not act as predictors for this birth. Though that is much easier said than done – both logically and emotionally. The awful bit is, that no one can give you that 100% guarantee – there is a leap you will have to make – trusting in your carers, your baby and your own body. Sending lots of love and hand squeezing for the difficult decisions ahead xxxx h
You know what, I really might just look into that. Combined with the steroids we plan, it just might help. It’s not likely to hurt, anyway. Thanks 🙂
Merry, I so wish I could take away all this worry for you. Birthing Ernest wasn’t so complicated, but I recognise an awful lot of what you write here, including not being able to listen to the hypnobirthing tapes.
I really just wanted someone to take my hand and tell me what to do, but no one could. And of course there are no guarantees, we know that all too well.
I did manage to find a couple of small ways to at least keep a lid on my insanity, and they were golden breath breathing and emotional freedom technique, plus listening to a tape of the ocean and imagining I was on Christians beach…that just about kept a lid on everything,long enough to get him born.
I will be here, thinking of you. I know that when I was in hospital it helped knowing so many were keeping us in the hearts and minds, maybe that’s silly, but when you have so little else to cling on to it seems important.
Merry, I’m so sorry that you are going through all this.
Sometimes stepping back from all those thoughts and fears of ‘what if’ and trying to let go of all the possible outcomes can help make the right decision clearer to you. I hope that you will come to a decision that will give you peace.
Whatever happens, you will be alright. xx
Dear Merry
I have thought about this post a lot, trying to see a way through the fog. A number of things occur to me, and perhaps they will help to make things clearer.
1. Sadly, neither VBAC nor c/section offer any *guarantee* about outcome for either you or Marmite (or any mother or baby) although the risks are different.
2. Both VBAC and c/section have negative associations for you
3. A vaginal delivery is likely to be better for your physical and mental well-being post delivery, based on what you have said
4. An elective section is the only way of guaranteeing a delivery at the optimum gestation for you and marmite
5. Options for an induced VBAC at the optimum gestation are very limited
Given what you have said, it seems – on this basis – that your ideal scenario would be a spontaneous (short) labour and VBAC by around 38 weeks. You know, you shouldn’t rule it out. All babies are different, and I know several women who’ve languished to 42 weeks in some pregnancies and then been caught out by a baby that arrived at 36 weeks next time round. Perhaps you could whisper to marmite now and again, and tell him that he should come then…
Setting aside the risk and anxiety associated with the different options (they are not going to go away – or help you make a decision) then I guess my approach would be to hope for a spontaneous VBAC at a suitable gestation, but to use any/all acceptable means of *encouraging* labour to start at that time (I’m thinking sweeps, hill/stair climbing, nipple tweaking, herbal remedies or whatever – your mileage may vary). The next option (for me anyway) would be the induction through ARM with a c-section as the final back-up plan.
I dont know if that’s helpful? Probably not – and it’s probably nothing you haven’t heard already from those wiser than I. But how about this – find yourself a mantra, something that you can say to yourself now and during labour/birth (however or whenever that happens). I had two things I said: I trust my body and I’m planning to birth my baby gently. The mind is a powerful thing, and even if you don’t really believe in the mantra you choose, just saying it to yourself over and again will help you to believe it. (I know it sounds all hippy dippy, but it’s worth a try isnt it? It doesn’t involve any drugs and it’s completely free!!!)
As Jeanette said – you know that whatever happens the collective will and spirit of many women will be with you.
x
I think this is going to be where I have to get myself to. Today I’m in a very negative “this must have been my fault and only a live baby matters; the rest I have to suck up” state. Somehow I’ve got to get beyond that and beat a hopeful path I think.
Please feel free to ignore this but where is the evidence that 40 weeks is more of a risk? Could there be daily monitoring from 38 weeks with scans to look at placental blood flow/function??
I think, since we just don’t know why Freddie died, no one really wants the risk. I think she’d be happy for me to go TO 40 weeks, but not really beyond, just in case. It’s an old saggy womb now. And frankly I don’t want another in-utero random accident, if that is what it was.
Mostly it comes down to my sanity though. This is hard enough but going to term just isn’t something I can deal with, so it is a toss up between balancing my possible outcomes against Marmite’s.
Merry, I’m coming to this very belatedly as I’ve had little internet time this week. Reading this brought me back so, so powerfully to Toby’s pregnancy (and Emma’s birth 🙁 ). As you know, our circumstances are similar. Emma was a VBA2C – an, as you say, smooth as silk, beautiful labour. Toby was a planned section at 38+3. Unlike you, I never truly put any plans in place to try to VBAC again. I just felt I couldn’t – I had none of the fight left that I had with Emma’s pregnancy and birth and I know longer felt able to stand my ground with my husband about VBAC being safer, when my VBAC baby was dead. Even though we have no idea why. The difference between us, is that my first two sections whilst emotionally very difficult were fairly straightforward and so I honestly felt I shouldn’t make a fuss about having another one. Which is not the case at all for you. As it was, my planned section was one of the good ones (and my after care was superb) but waiting to go down to surgery was truly the second worse thing I’ve ever had to do – only burying a child tops it. You don’t know whether yours will be a good one until it happens, as people have said. I’m not having any more babies but if I were – I’d be in your position considering (much more seriously than I did with Toby) a vba3c. That was very long winded and all about me and I don’t really have anything helpful to say but I wanted you to know that I understand the torturous labyrinth you find yourself in, completely.
Merry, I am also reading this very belatedly, but didn’t want to leave without commenting. I am sorry you are feeling this way, I really just want to give you a big hug, although I suppose a miraculously simple solution to your dilemma would be more useful. Obviously I don’t have one, but just some thoughts… I think, like Jenny, my main question is are you sure it wouldn’t be possible to go to 40 weeks with loads of monitoring? I realise I don’t have an understanding of what it is like to be in your situation, so I’m always a bit wary of commenting on this kind of thing. But I think you know I care, and just hope you can ignore anything that isn’t helpful. So having said that… the area where my experience does overlap with yours is in having had a c-section (very stressful, led to feeding problems and post-natal depression) and then having had a vbac – in the end 3 vbacs – which was so much better. The first vbac was a forceps delivery, but still better than a c-section. I had pnd again but more mildly the second time. And the last two deliveries were straightforward with no drugs, and I felt amazing afterwards and that I could do anything, and that feeling lasted for ages – which helped with the feeding and I’m sure it’s why I had no depression after those two births. So I tend to be a bit fanatical about vbacs, although I completely understand that it is more complicated in your case. I just wish for you that you will have that experience, of a normal birth, a healthy baby, a natural high to set you up for the first few months… for what it’s worth I will pray that will happen, come early little marmite! And I will pray for you as you make your decision, for peace of mind whatever you decide. My gut feeling is that what happened with freddie is not because you went to term or because you had a vbac, but who am I to say? In the end it’s your gut feeling that counts. Trust your instincts and try not to place too heavy a burden on yourself. As in every aspect of parenting you can only do your best with the knowledge you have at the time. Wish I could say something more helpful. You are never far from my thoughts. Lots of love xx
You are right, but please, no one else suggest going to 40 weeks. It isn’t going to happen. I don’t want to. I won’t mentally survived the time and nor will my children. I want this baby out, as sensibly as possible, as early as is safe. That’s my whole problem. This is not the time for me to carry on being fanatical about ‘natural’. I just want us to survive, mentally and physically, and escape as soon as possible. That’s my only big reason to have a normal delivery now, not because I trust vbac any more, but because I can get out straight after. and I live 20 miles from my preferred hospital so daily monitoring is just too expensive and difficult to achieve. And daily monitoring doesn’t stop sudden death, it won’t make me feel better. Plus spontaneous labour at home doesn’t appeal much. Freddie was born in 3 hours, I really don’t fancy accidental home or car birth. That would be beyond terrifying.
This sounds awfully grumpy. It isn’t meant to at all. Sorry 🙂