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VBAC (Vaginal Birth After Caesarean) or Caesarean?

A recurring question that has been on my mind now for a good few months. The decision feels much more weighty this time round.

In my first pregnancy with Charlotte and Esme, I had an emergency C-section at 26+6 weeks. This was due to Charlotte’s heart rate plummeting after her waters broke at 24+3 weeks and then us both catching an infection. In my second pregnancy with Archie, I was determined to have a natural labour. At the time, it was something I felt robbed of after having all control taken away from me and delivering the girls so prematurely. I felt incredibly desperate to experience having a natural birth. From the excitement of my waters breaking, the hurried, nervous drive to the hospital to the contractions, pushing him out, to having him in my arms. I never questioned the possibility of having another c-section. In the end, at six days overdue, I was induced due to my anxiety feeling like it was taking over and lack of movements. I have never regretted it and felt thankful for having that opportunity. However, giving birth is giving birth, and having a vaginal birth wasn’t exactly as “rosy” as I had hoped or imagined. I was quite badly sick, the contractions came on thick and fast, with no signs of my cervix dilating and I was utterly exhausted. When the midwife suggested there were other methods of pain relief, I soon received an epidural. For the next four (ish!!) hours, I was a totally different person and thoroughly enjoyed giving birth to Archie. By the time it came to push, I was giddy with excitement. I ended up having to pretend I was back in a rowing boat, in order to get my game head on that I needed to push when the contractions arrived.

Recovery was really difficult after each birth. With the emergency c-section, I wasn’t given much time to rest due to visiting the hospital every day, expressing and the intense nature of the neonatal and intensive care unit. I can remember it being extremely painful and that’s with rose tinted glasses. With the vbac, whilst I had no trouble with my scar, I tore badly, got an infection, haemorrhoids and could barely walk or sit down for two week, not exactly pleasant either.

Recovery with this baby is something that has played on my mind a lot and is one of the reasons I’m hoping to go into labour naturally. Although after saying that, I have also heard very positive stories about people recovering well after a c-section or after being induced. I guess every baby, every delivery, every Mummy’s body are all very different and what is important is about making a decision that is right for me, at the right time.

Favouring a c-section

It was around thirty weeks pregnant, with this baby, that I started to think a lot about how I wished to deliver this baby. For those next five weeks, I felt adamant that I wanted a c-section. There was great reassurance when those who I asked replied saying they had had a planned c-section, especially when the reasoning behind this was to do with their mental health as opposed to the baby’s position or previous births.

I felt terrified, still do, of delivering this baby, of hearing the midwife or consultant say they can’t hear a heartbeat, of not bringing home a baby and my arms being empty. After losing Esme at seven weeks old and witnessing death, everything becomes so real. The difference between one breath and taking another. As simple as that and then they’re gone. This fear of it happening again still feels incredibly raw and sensitive, too easy for it to just happen again.

Having an early planned c-section, seemed to remove some of that fear. Even though it would mean going into theatre, it felt like a safer choice.

But with that choice, came the recovery after major surgery, the looking after a baby plus Charlotte (five years old) and Archie (three years old). Of not having the freedom to lift them or to drive or do school runs. I know I have family to help, but I also know that I like my independence and this is something I found very difficult after my first c-section.

What I’m also conscious of, is being in theatre and having flashbacks of when the girls were born. Yes it would be very different circumstances with it being planned but the fear, the memories, the feelings of being helpless and lying on the theatre bed, wondering whether my babies’ are alive or not and everything being totally out of my control sometimes feel too much and too difficult to separate. Becoming lost or trapped in a flashback or memory is a difficult place to break out of. Once back in the real world, the feelings of being in that flashback make it difficult to step back into real life. I have learnt tools to cope with these situations, such as deep breathing and stepping outside of my thoughts and becoming the observer and understanding why I am experiencing such intense feelings, remembering those memories and reminding myself that this is not now. It’s hard though and exhausting and with PTSD, you never quite know when these flashbacks are going to happen. What I have to remember with my PTSD is feeling proud of myself. That I experienced trauma, I have found the courage to get help to process it and I can now live my life alongside it.

The flip side to this, is if I was to have a c-section and everything went smoothly and the baby was placed straight onto my chest rather than life support machines, would I receive lots of healing from this? There are so many thoughts and questions.

At my next community midwife appointment, around 32 weeks pregnant, I explained how the delivery was beginning to feel overwhelming. She referred me to the Birth Choices Consultant. I wasn’t even aware this role existed and looked forward to my appointment.

Birth Choices Consultant

At 33 weeks pregnant, I had my first appointment with the Birth Choices Consultant and have had them fortnightly since (currently 38 weeks pregnant). They have helped me so much throughout my third trimester. The appointment consists of talking about how I’m currently thinking about birth, where is my headspace at, offering guidance, listening to the baby’s heartbeat and feeling his position. She is wonderful and provides the nurturing and support that I crave to help me mentally throughout this final stage. She listens empathetically about my fears, about having another loss or another child with a disability due to a complication at birth, she’s there for me.

In that first appointment, she immediately removed the pressure of making a decision about giving birth. We had time on our side to get to that point. Her main priority was getting me in the right headspace to make a decision that was right for me. I didn’t have to make any choices, plan any c-section appointments, I just had to take each day/week as it came and she’d see me again in a fortnight. I left her room feeling on cloud nine, all pressures of how to deliver this baby alleviated.

My control feeling like it was taken away from me

The following week I had my second appointment with this consultant. What I didn’t realise after this appointment, was how anxious I felt upon leaving and how he had spent the past twenty minutes removing any control I felt I had over my birth.

I wish my husband had been there to support me but due to covid restrictions he wasn’t allowed.

Throughout the appointment, the consultant made it clear that he didn’t agree with planned c-sections and repeated himself in various ways, “If I took you into theatre to see a c-section that would definitely make up your mind.” or scoffed, “Why would you want to cut through your abdominal muscles when you have already shown you can deliver naturally?” I replied, “I had a really bad tear and recovery was very painful. His answer, “Yes but nothing compared to a c-section.” Not exactly sure how he so confidently knows this but he went on to mention that he’d had over thirty years experience in this. This felt like it took away any respect he had for me making a decision based on my past experiences.

After he’d scanned the baby, he questioned, “Would you say your decision to have a c-section was to do with your head… yes… so fear & anxiety? Wouldn’t you say they were irrational things to base your decision on to have such intrusive surgery?”

I wanted to share this experience with you, because I spent the next ten days in an overwhelmingly anxious state. I couldn’t make sense of how I was feeling. Noone had ever spoken to me in such a direct way before that I believed it was ok to be treated and spoken to like this. That it was ok to to be told that how I felt mentally and physically weren’t interlinked. That past experiences were irrelevant to how I should make decisions.

I felt ashamed I had my mental health struggles, coping with loss, fear of premature birth, raising a child with a disability, fear of being totally out of any control of my baby & body, embarrassed that I was bringing them into consideration on what I was interpreting from him as attacking my body for no reason other than what was in my head – that my thoughts were just thoughts, the fears were a thing of the past, they should be seen as insignificant with this pregnancy.

It wasn’t until voicing these thoughts out loud with my Birth Choices Consultant that I became so emotional and upset that what he’d said wasn’t right. It was only upon seeing her reaction did I realise why I had been so anxious for the past ten days – knitting, unable to stop, waking up for hours on end during the night, beginning to doubt myself again. She told me that it’s not ok for someone to talk to me like that, to separate the mind & body. She changed my consultant and assured me I wouldn’t be seeing him again and to forget everything he’d said.

I left her appointment feeling comforted and heard but I also felt so vulnerable, upset and hurt. That I had ignored and lost respect for myself that it wasn’t ok to be spoken to like that. I felt like he had taken my control away and made me feel like a participant in the birth of my son. I felt angry, embarrassed that I had acted so confidently with him, agreed with him and let him control my birth, with complete disregard to my mental health or how I was actually feeling. I didn’t want to show I was terrified that this baby had to come out in some way. I wanted to match his confidence and feel so upset that this meant I thought it was ok to ignore my mind and solely focus on my body. Which in fact is not how being a human or giving birth work at all. No one had ever spoken to me like this, had separated mind and body to black & white before. I began to doubt everything I’d learnt about myself, my mind, my feelings and trust him. That scares me. It scares me that I was so vulnerable and easy to fall for what he was saying when his words really weren’t ok.

As much as I try to forget what the consultant said, his questioning of why I’m having a c-section remains loud in my head but I am no longer taking his words personally nor feeling hurt or angry for how I responded or reacted. Self compassion is a wonderful thing to have learnt.

Where I’m at now

I’m currently 38 weeks and desperately hoping to go into labour naturally. At each appointment, the baby has had his head firmly down and been in a great position. I’m thinking that’s his way of saying, “trust me.”. I have decided to see what happens and go with the flow up until my due date.

What I can’t yet answer is what will happen when I get to my due date. With the wonderful support from my Birth Choices Consultant, we have decided to see my due date as a pause, a reset, to place no pressure on making a decision about how to deliver this baby if he hasn’t arrived naturally by then. My cervix and the position of the baby will be checked, and also how I am feeling physically and mentally, where is my headspace at? We will then make a decision taking all that into account.

I feel so close yet so far to meeting him. My body is really hurting and I’m barely sleeping. Then getting anxious I’m not feeling him move. And generally just feeling done and exhausted. Then a tinge of sadness that I know I’ll miss my bump. But then the feelings of excitement come, that maybe I might actually experience my waters breaking in the middle of the night and have that panicked drive to hospital, that the baby is coming!! And that fills my head and heart with so much hope and giddiness!!