A four day long HBAC

Caro and Santi (both from Argentina) had hired my co-doula Becky and myself as their doulas, they were planning a HBAC (home birth after cesarean) after having had what their considered to be an unnecessary elective caesarean with their first child.

We met several times during Caro’s pregnancy, and built a lovely rapport together, getting to know them and their toddler son Max.

They were both delightful and warm and friendly, and very well informed and researched.

As Santi stayed at home to look after Max, I accompanied Caro to her hypnobirthing classes.

This is the story of their birth, shared with their permission. It lasted 4 days, the longest birth I have ever attended in my 6 years as a doula.

Day 1

Caro texted us on Saturday morning (40 weeks and 5 days) to let us know that her waters had just broken.

We kept in touch throughout the day.

She lost some mucus around 10am, and started having mild, period cramp like contractions, soon after.

She napped and ate, and rested throughout the day, keeping us updated.

On their request I provided Caro and Santiago with evidence based papers to read about the risks of induction versus caesarean should they go beyond the 48h deadline after her waters had broken.

Caro called the hospital around 10pm. They asked her to go in, which she declined.

The hospitals send midwives to her home to listen to the baby’s heart instead.

Caro declined a vaginal examination at this stage.

The midwives booked an appointment for her on Monday afternoon at the hospital.

Day 2

Sunday morning around 2:30 am Caro texted us a screen shot of her contraction timer showing 40 sec to 1 min long contractions about 3 to 6 min apart.

I called her. We agreed I should come and support her. I arrived at her house around 3am.

She was having quite regular contractions but she was very “with it” and alert and I could tell this was early labour still.

We filled the pool. Caro got in but things slowed down so she got out.

Becky joined us around 7am.

At day break things slowed right down.

Max and Caro’s mother got up and join us . We shared a lovely breakfast of scones and jam.

We hung out in the house/garden throughout the morning.

It was a gorgeous, warm and sunny spring day.

Caro was still having regular contractions but there were only 5/10 min apart.

Santi and I went to get the most gorgeous takeaway lunch from a local South American restaurant.

I went home around 3pm to get some sleep and spend some time with my family (it was my husband’s birthday that day).

Becky spent some time lying in the garden with Caro, and rubbing her back during contractions.

Caro messaged me around 9pm, contractions still irregular, and about one min long.

I went to sleep after that. Becky had gone back home by then to rest too.

Caro texted us around 10pm as her contractions were about 1 min long and 5/7 min apart. She found them harder to cope with. She messaged again around 11pm,by then her contractions were 4/6 min apart and 1 min long.

Day 3

Becky and I came back to her house around midnight. We spent another night of supporting her, both in and out of the pool.

At some point in the night Caro experienced a lot of pressure in her bottom, and we got quite excited believing that baby was on his way, but it wasn’t time yet.

I was amazed that Caro wasn’t exhausted at this stage, but somehow she managed to sleep between contractions and recover enough to cope.

In the morning Becky went to sleep upstairs and I had a nap on the sofa.

A midwife came in the morning to assess things. Caro agreed to a vaginal examination (she had been in labour for nearly 48h by now) and was found to be only 2/3cm dilated. I had a big wobble at this point. I also believed her baby to be back to back, hence the pressure in her bottom.

The midwife also said that her baby was only 3/5 engaged.

I suggested to Caro that she does some engagement spinning babies techniques, namely a technique called the bump lift, consisting in flattening her back against the wall and lifting her bump, and we also did some rebozo sifting on her belly. It seemed to help a bit, and her contractions got stronger.

Becky and I had a chat and agree we should tag team and she sent me home to rest. At home I had some food then a nap, then came back at 2pm.

I brought some loo roll with me as I’d noticed they’d run out, and I knew they wouldn’t find the time to go out shopping for some!

Caro and Santi were snoozing upstairs when I got back. Becky told me they have agreed to a visit from the midwives, but that they only wanted to check the baby’s heart rate and mum’s vitals but not have any vaginal examinations, nor hear any talk about risks.

Becky left and the midwives arrived. I met them downstairs and explained Caro’s wishes. They weren’t pleased by my request, and one of them said sharply that she had to tell her (about the risks) as she had a duty to protect the baby. I explained that after the previous talk of risks, Caro’s contractions stopped for over 2h, and therefore it really wasn’t a good idea.

The midwives came upstairs. I crouched on the floor feeling like a mama bear, ready to pounce if the talk of risks rears its ugly head. Surprisingly, they did the checks and only mentioned to Caro and Santi that they needed to know that they are going against medical advice.

At this stage, Caro and Santi agreed that they would go for a caesarean early the next morning (Tuesday) should she not have given birth yet.

The midwives left.

I carried on supporting Caro through the afternoon. Her contractions were still spaced out. Santi had a good long nap with Max

Late afternoon I spoke to Becky and she told me to go home. We agreed we could have another night and day, possibly in hospital with a caesarean, after today.

When I relayed our plan to Caro and Santi, Caro got upset and told me that I had lost faith in her, and she was right. I was by this point extremely weary and tired, and this affected my emotions a lot. I apologised profusely.

Santi was also worried about doing bedtime without our support. I explained that we were happy to help but really need some sleep ourselves and Caro’s mum could support her during that time.

I went home to sleep around 8pm.

Day 4

Becky called me around 1h30 am saying Caro was pushing. I got dressed and drove very quickly as I was worried I might miss the birth!

When I got there I could tell Caro was nowhere near birthing yet. Her contractions were still not quite strong enough.

Two midwives arrived at around 2am, both really lovely community midwives, calm and compassionate. One of them examined Caro and she was 5/6 cm dilated. This was hard for me to hear as I was really hoping she was ready to push her baby out!

Caro carried on labouring through the night.

When shift change was due to happen I explained to the midwives how important it was to have a supportive, confident midwife just like them replacing them. I asked for a particular community midwife whom I knew, and who Caro liked a lot. They organised for her to come :-).

She was incredibly calm and supportive.

We had a chat with Santi explaining that Caro’s mother needed to take Max out of the house for the day because Caro really needs some peace and quiet to get on with her labour. She left for the day soon after that.

I went shopping for some food as we hadn’t got much left in the house.

Sometimes in the morning, the midwife did another vaginal examination (in the pool!) and Caro was still only 6cm dilated and hadn’t progressed.

This was a down point. I asked specific questions to the midwife, especially if baby was back to back and asynclitic, and she confirmed this. Her baby seemed to have completely more than one turn around the pelvis several times already, from being OP, then OA then OP again.

I took my spinning babies handbook out of my bag again, and with Becky’s help we helped Caro into an inversion. During about 3 contractions, I used my rebozo to do vigorously do shaking the apples on her bottom. It took all of us to support her through it, as you can imagine this wasn’t the comfiest thing to do at this stage. Then I did a sacro-tuberous ligament release and also a standing sacral release. Caro immediately said that she has felt the baby turn and that her back pain was gone. Her contractions cranked up big time and I knew we had changed things for the better.

A vaginal examination around 3pm showed that she was 7cm dilated.

Caro got back into the pool and carried on labouring. Contractions were really powerful at this stage, and I was feeling very hopeful.

Becky supported Caro by saying ” longgg deeep slowwww breaths” as she had a few wobbles.

Eventually Caro started to show signs of pushing 🙂

Around 5 pm there was another shift change, I am worried because one of the midwives is the one who talked about risks the day before. I was worried that the change of midwives at such a crucial time could upset Caro’s labour. The midwife in question hadn’t given me a good vibe the day before.

By then Caro has been pushing for a while.

I suggested to Santi that he supports her pushing by standing on the edge of the pool with a rebozo around his shoulders for her to pull on.

Becky tried to make sure that the other midwife, not the one we had a bad gut feeling about, came into the room instead but that didn’t work.

So I worked hard on changing my feelings towards her to positive ones.

Luckily she turned out to be much more relaxed than I thought.

Caro carried on pushing.

At some point she shouted “I’m fucking doing it”, and she sure was!

She soon started feeling some stinging.

Caro’s baby son Leo was born in the pool in her living room around 6h30 pm, after 4 days of labour.

When he was born, the emotion in the room was incredible. There wasn’t a dry eye in the room, even the midwives were crying.

I cried and laughed at the same time for the first time in my life, with the cheer joy and relief. It was the most incredible feeling.

Becky and I hugged each other like loonies.

I sobbed some more. I litterally shook with it.

This was one of the most emotional births I have ever been at.

After the birth I suggested to Becky that she goes home to sleep straight away as she was still on call for someone else. I stayed to support Caro and make sure she and baby were comfy

I help her take a shower, and she was elated by the fact that she could walk around straight after the birth- a stark contrast to her previous caesarean.

Caro was soon tucked up in bed with her new son Leo, and a nice chunk of groaning cake.

I left around 9pm with a huge smile on my face.

Reflection

When I reflect on this birth several months later, I am still amazed at Caro’s resilience, at her belief in herself, and at the unwavering support of her husband.

I also can’t believe I managed to support them for that long, with so little sleep, if I had been told that the birth would have been this long in advance I’m not sure I could have coped with it. But in the middle of it you just dig deep and get on with it.

This is also the first birth where I experienced my first true miracle with the spinning babies and rebozo techniques.

I teach rebozo techniques workshops, and Caro’s birth completely changed my outlook and the way I teach. It really anchored in my heart that this simple tool can really work miracles.

I went on to have several similar miracles with such techniques at other births (though not quite at long!) since.

This birth also illustrates to the extreme the commitment doulas make to their clients, and how much emotional investment be put in this job.

I asked Caro to share her incredible birth story because I hope it will give other women the belief that they too can have an incredibly empowering birth after cesarean.

For doulas, this birth illustrates how awesome shared care doula support can be. I can’t imagine how I would have survived without Becky, both in the fact that we supported each other, and the ability to tag team and get some rest!

The day after the birth, Becky went to a study day at the hospital, and she lost count of how many midwives approached her and asked “what did you do?” about the amazing effect of the inversion with the rebozo. I am hoping to train the midwives in my local hospital to do this too.

Caro is now a life long friend and is planning to become a doula.

When I think back about her birth, all I feel is tremendous gratitude and joy.

Becky and I shortly after the birth

 

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4 Comments

  1. Verina Henchy on January 19, 2019 at 9:41 am

    Hi Sophie

    What a lovely HBAC story! This story does indeed show the importance of Continuity of Carers (you and Becky) and how important it is to be patient.

    I am left wondering if the role of doula becomes a little blurred in scenarios like this and ask for your views on that. As I understand the doula role, it is to offer emotional support and comfort measures yet what you describe in this blog could be interpreted as an intervention.

    intervention
    noun [ C or U ] UK ​ /ˌɪn.təˈven.ʃən/ US ​ /ˌɪn.t̬ɚˈven.ʃən/

    C2 action taken to intentionally become involved in a difficult situation in order to improve it or prevent it from getting worse:

    If we teach our clients spinning babies techniques prior to birth and then invite them to practice what they’ve learnt, is that an intervention?

    Learning to be a ‘don’t-la’ can be as important as learning to be a doula and I fear that if we transcend that boundary on a regular basis, we may require greater regulation, a different type of training and maybe even a different title.

    What are your thoughts?

    • sophie on January 19, 2019 at 11:09 am

      A very important question, Verina, thank you for asking it!
      I agree with you about the importance of being versus doing, and it’s something I stress highly when teaching rebozo techniques, because the last thing I want is for doulas to go all rebozo blazing at their clients after the training.
      For me as for many other things in our work, it’s all about the intention behind the action, and being mindful about it.
      It’s about belief in her ability to birth her baby, and it’s about gentle support that is only provided when needed. I guess this could be said about much of the other comfort measures doulas can offer to support women during labour, like touch etc.
      If the woman is coping and progressing well with her labour, my rebozo doesn’t gets out of my bag.
      I tell people I train that, on a subtle level, we can communicate to someone that they cannot do it without our help, so I’m very wary of this.
      My approach is also that the comfort measures are designed to help comfort the mother, to relax her body, and manage the contractions more easily, rather than “fixing” something.
      I also get a strong sense of when things are stuck these days, and I know how challenging contractions working against something feel, so my aim is to help comfort through that.
      However, sometimes, with hindsight (isn’t hindsight a wonderful thing?) I really wish I had done something sooner.
      My desire to learn these techniques was spanned by a year when every single labour I supported was over 30h long and ended up in some massive intervention.
      I show these techniques to my clients during pregnancy because they have been shown to help balance the pelvis and associated soft tissues, and therefore increase the chances of having a well aligned baby. As we live a fairly sedentary lifestyle compared to our ancestors, maybe these things are needed for our time when they weren’t before?
      During labour, I always weight out of the balance and pros and cons of offering techniques, most of the techniques I offer are passive ones (gentle wrapping and rocking) rather than “big guns” ones like the one I describe in this blog post.
      But, again, I agree with you. Where does the support stop and the intervention begins? It’s something I keep balancing in my mind like a tightrope walker at all times.
      At the end of the day, when I know that a major obstetric intervention is looming (or has been suggested), then these techniques feel more gentle, supportive and respectful than their medical counterparts.

  2. Verina on January 19, 2019 at 11:50 am

    That’s a helpful explanation of where you’re ‘coming from’ Sophie. Particularly helpful for new doulas who may think that we are there to ‘fix’ or ‘prevent’. Mostly I believe we are there simply to walk beside our clients offering them company and reassurance! I also rarely attend long births these days but that’s about ME and MY journey. I no longer jump into my superwomen pants at the first twinge – I encourage my clients to continue unobserved for as long as possible and therefore arrive further along the process when the mother is more actively engaged in the process herself.

  3. Paula on January 29, 2019 at 4:59 pm

    Awww, this was lovely to read. Amazing team work!

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