Why VBAC is so important to me

November 2nd, 2015

Many know that I am passionate about VBAC and many know that I had a VBAC so I thought I would share my VBAC story. Following on from my last birth I started the contraception conversation with my hubby when my little boy was 6 months old. I was 2 months too late and after some nausea, becoming sore when breastfeeding and feeling overwhelmingly tired I did a pregnancy test. My hubby happened to call me whilst he was driving the cableway at Scenic World as the result was appearing on the stick, I gave him the news and he got a massive cheer from all on board!

I was extremely apprehensive, this would make only 14 months between births and I didn’t know what this meant in relation to VBAC. Before I made any announcements I buried my head in books and research papers to find out and after absorbing all the numbers I emerged and announced sadly to my husband that the time gap is too short, my uterine rupture rate is 2.7%. In his purely practical manner he switched that to a 97.3% chance of no uterine rupture and stated that it is far more dangerous to get in a car and drive to the hospital! That was enough to be convinced and I put away the research and planned my HBAC.

After my previous experience and again the lack of available homebirth midwives at the time I decided to hire a doula and utilise a good friend who was a midwife as my birth team. I avoided all antenatal care which was interesting as I was still working part time at a local hospital that does not support VBAC and the pregnancy flew by as a busy working mum with a one year old and my 3 older bonus kids in primary school. I did have a terrible time with back and SPD pain that I now know is due to having Ankylosing Spondylitis but that wasn’t known at the time.

Going at 37 weeks last time made me more prepared this time and I was able to get a belly cast and be all prepared by 37 weeks. I also had not been unwell with pneumonia this time and this little girl was head down, much less stressful!

During that 37th week I went walking crazy, I had my bub strapped to my back and I was out walking once or twice a day. I couldn’t help myself but go and walk! I had a hind water leak in the early hours of a Saturday morning and tightening’s were painful but irregular all weekend. I was getting exhausted and cranky and my birth team was in and out and left Sunday night. Monday morning and the tightening’s started up again, a self VE found I was only 1cm dilated. My birth team was now all elsewhere and I decided I didn’t want to freebirth with my hubby so I went in to a local tertiary hospital. I wasn’t prepared for the fight that ensued. The good news was that the contractions were picking up and that a VE found I was already 4-5cm with bulging membranes that they ruptured. The bad news was all the stuff they wanted me to consent to such as the epidural to get me ready for theatres, IV therapy, CTG, caesarean. I felt I was swamped but I somehow kept strong and declined the caesarean and the epidural. I was left alone for long periods thank goodness and as I knew the CTG machine I would pause and remove it so I could have a shower or walk around. When the registrar doctor came in she would tell me I was either too loud or too quiet and should go for a caesarean. I would glare at her and she would scurry out of the room. One time she came in and stated that if I didn’t have an epidural I would be one of those women that sucked that baby back up rather than push it out!!! I looked at her confused, not able to speak due to being in labour land but able to think, WTF is she talking about? She scurried out and my hubby chuckled, stating that if looks could kill she would be dead on the floor! I was told I was nil by mouth but the tempting purple wrapper of a chocolate bar was sticking up out of my bag teasing me so I ordered hubby to pass it to me and that he was to tell no-one! I devoured one half and said I would have the rest after I have pushed this baby out so don’t you dare touch it!

Throughout the day I was threatened with going to theatre at 4pm. I didn’t think I was clock watching but by 3.40pm I was on the birthing stool pushing. The Doctor wanted to check that I was fully dilated, not believing the midwife that had checked me on the stool and a team of midwives was trying to pick me up. Hubby was wise, he sat behind me and held me down and then I had to swear at them to announce I would not move. With the expletives came view of a head and the Doctor walked out of the room. The sensation was crazy, painful but crazy. She was birthed on the birthing stool and onto my chest at 4pm. My first words were “I did it!” over and over. I couldn’t believe the negativity and intimidation I had to put up with but I did it!

The high has never left me and I wondered if I was the only one to feel it. That led me to my Masters thesis. Having a VBAC was amazing. The birth could have been better without the battle but I also learnt so much from it. I felt all the fear from the staff and did it anyway. I believed in myself. I called on a colleague friend to assist me and she appeared whilst I was in transition. I needed her so I could say all my fears, she believed in me and that got me through. So there you are, one VBAC journey, but it is the one that has inspired me to spread the word about VBAC and respectful care in maternity.


Home birth Awareness Week

October 24th, 2015

24th October 2015
This week is homebirth awareness week so I thought I would share a piece I wrote earlier this year for our local paper, the Central West Daily. Let me give a bit of background. A beautiful client and her hubby did an interview with the CWD to announce their homebirth and we made the front page! The editorial that they published with that issue then stated that women chose to homebirth due to their wish to birth in a relaxing environment. I felt that this was not representative of the women that I serve so I wrote a letter to the editor and the following week it was published. Here is the piece:
I WOULD like to respond to your editorial published on January 17 on the discussion around women’s decisions about place of birth.
As a researcher in this area I thought I would offer a response based on the recent research and published guidelines on this matter.
Firstly you state that women choose to birth at home out of a desire to give birth in a familiar, relaxing environment. That is the mere tip of the iceberg on why women make this choice.
It has been found that women who choose to birth at home are making this decision for a variety of reasons.
The most common reason is to actively avoid unnecessary medical interventions that are more likely to occur when birthing in hospital (NICE, 2014; Catling-Paull, Dahlen and Homer, 2011; Coxon, Sandall and Fulop, 2014).
These interventions include a higher rate of episiotomy, medications, forceps or vacuum births and caesareans, with the latest Australian statistics showing a caesarean rate of 32.4 per cent (Hilder, 2014) compared to recent large international birthplace studies that showed intervention-free vaginal births at home to be over 80 per cent (Dixon, 2014; Walton, 2012).
Women also choose to birth at home to have an increased sense of control over their labour and birth decisions.
Birthing at home allows women to choose their healthcare provider, which in Australia is most commonly a privately practising midwife that provides continuity of care in the women’s own home throughout the pregnancy, labour and birth and up to six weeks postnatally. There are numerous studies that show that continuity of care with a known midwife increases women’s feelings of control during labour and birth, decreases the rates of women needing medication for pain relief in labour and increases normal vaginal birth rates (Sandall, 2013).
The big question around home birth is safety and the availability of life-saving interventions. Again we can turn to research for a rational response to this dilemma.
Large place-of-birth studies show that adverse outcomes for mothers and babies are not statistically different across the locations – home birth, birth centre or obstetric-led hospitals (Dixon, 2014; Walton, 2012).
Home birth continues to be a political and divisive topic and in Australia an option that a small, but growing, amount of women make, with 0.4 per cent of women choosing this option in 2012 (Hilder, 2014).
International research is showing the many benefits and cost-effectiveness of this option compared to the norm of hospital birthing.
Choosing to birth at home is all about facilitating women’s choice. As a privately practising eligible home-birth midwife it is an experience that I feel honoured to be able to assist the woman and her family with.
Walking alongside a woman during her pregnancy, labour and birth and post-birth journey is a wonderful opportunity for myself as a midwife to educate, encourage, advocate and support the woman during this extremely important life event.
Hazel Keedle, privately practising midwife


Welcome to the new blog!

October 23rd, 2015

Welcome to my new blog! For my first blog post I thought I would share my own birthing stories as they really did influence the direction that my life took. I got pregnant with my first baby the minute I qualified as a midwife! Seriously!!! I had had my suspicions that I was pregnant but the tests kept coming back as negative. I had completed my Graduate Diploma of Midwifery and all I needed to do was send in the files I had compiled for my follow through women. I sent them and the next morning I did another pregnancy test and hey presto it was positive! I was over the moon! I was very ready!!
I set about finding a homebirth midwife and planning my homebirth. I loved the idea of homebirth from the stories I heard from my granny who had attended homebirths as a district midwife in the UK and remember her saying “They are made in the home so should be born in the home!” At that time where I was living there was a severe lack of homebirth midwives but I finally found one who has since retired. I liked her but it wasn’t quite the relationship I was looking for and she never really won my hubby over. This is not the space to discuss her though as since she is not getting a chance to voice her opinion a one-sided account of a midwife – client relationship is not fair.
My pregnancy went along well, even getting married and having a honeymoon in New Zealand and working full time as a midwife, let alone my new role as (step) mum to three older children who were then 5, 7 and 9yrs old.
I had a late ultrasound and found out my suspicions were true; my little peanut was breech! I had a long discussion with my midwife and I came away thinking she was confident to support a breech homebirth and that she was very experienced in this. Looking back I was extremely naïve to the stresses this would have put her under and I had complete and utter faith in the process. Due to this I also didn’t put much effort into encouraging the bub to turn, I had one uncomfortable acupuncture session resulting in him turning transverse but then flipping back to breech.
No sooner was I on maternity leave that I was admitted back to the maternity I worked in with pneumonia. I was pretty sick and I even had a moment of ringing a distressed hubby saying goodbye, he rang the midwives desk and they came to see me and I was apparently quite blue! This was at about 34 -35 weeks. Back home I took my time in getting ready for the birth as I assumed I would go over my dates. Bub continued to stay breech although I seemed to be the only one who believed this but I was OK with it. 37 weeks came and as the only driver at home I took my big girl to Girl Guides. When I came home I disappeared into my room to read a book, something I rarely did! With a big pop then gush I had soaked the bed and shocked I called down to my hubby, he came in saying “What have you broken now?” then when he saw the bed he panicked!!!
I let the midwife know and as a typical first time mum I got excited way too early. Tightening’s did start fairly soon after but were mild and I rocked my way through them. I tried to sleep for a while and from about 4am I was up and sat in the bath listening to music. Everyone else was asleep and it was very peaceful. I was too. In the morning things ramped up a little and my midwife came out to see me. She requested a VE and declared he was breech and we were to transfer to hospital. My world came crashing down. This felt like the opposite of what we had discussed and I knew the local hospital would not support me for a vaginal breech. But I obliged. I went in. The ultrasound found a frank breech, a little compact bub; I was prepped for theatre and found out later that I was 8cm before they cut. I did get skin to skin in recovery, which at the time was unheard of in that hospital.
Recovery post caesarean wasn’t great and 10 days later I was back in hospital again with endometritis. Seriously how many admissions did I need for this planned homebirth!!!
So there you go, my first experience of maternity care as a woman and new mum! Now with the benefit of hindsight I can see how naïve and trusting I was but it has shaped so many events that I don’t feel regret, anger or disappointment. I have worked through it in many ways including my next birth and by being a homebirth midwife. That role has taught me so much, especially how to loosen the stiff upper lip of my English nursing heritage and to become raw and emotional with women when they need it most. I am so grateful for the women that have put so much into our relationship and only hope that I have served them as well as they deserve. I also have a few amazing midwife friends who I know I can turn to for support, debriefing and to share a glass of wine or two!! Their words of wisdom and comfort have helped me appraise my reactions and care at times when I have doubted myself.
That is more than long enough for this post. For the next one I will share my next birth, the triumphant one!