AIMS Journal, 2009, Vol 21 No 4
Lucy Christopher looks at the impact of holistic care for her VBAC
Four years ago, I had had a traumatic emergency caesarean with my daughter, which resulted in difficulty bonding, depression and problems breastfeeding. During early pregnancy with my second child, I became deeply worried about the clinical attitude of the obstetric staff. They insisted that due to the nature of my first birth, I would have to have constant monitoring throughout my entire second labour. There was no discussion.
Since my first labour I educated myself in natural childbirth theory, and knew I needed this in order to avoid a similar outcome second time round, but there seemed to be no way to change my impending care plan.
I met a doula but just couldn't afford one; the lovely trainee I met was not available for my dates. I was stuck. I was five months pregnant and seriously worried that I was going to end up where I found myself during my daughter's birth - in a hospital, with a midwife who didn't know me, panicking; failure to progress, and a caesarean.
I had heard of the Albany midwives through a friend, and although I didn't hold out much hope of getting onto their list half-way through my pregnancy, I struck gold, and they had space for me.
Fran came to meet me. From the very star t, I suddenly found myself experiencing a type of care entirely new to me. Far from the previous examples of rushed and harassed midwives who didn't seem to know or care about my questions and previous experiences, Fran made it clear that she was on my side and would support me in the kind of birth I desperately wanted. She was not in any rush, she listened to my worries and concerns patiently over the phone and in person; the first step to a new experience in childbirth.
Finally, I could make a choice about what type of birth I felt would give the best outcome. As the weeks went by, the team made sure I had met most of the other midwives in case my two weren't free - a new experience entirely. When labour came, almost exactly on time, I hardly knew until almost fully dilated, as I had become so relaxed in the care of these wonderful midwives, who showed total confidence in my ability to do what came naturally. It is this belief that underpins the entire process of natural childbirth. This is exactly as it should be.
Stanley got stuck on the way out, and Fran and I decided to call an ambulance as my blood pressure was raised and contractions were extremely strong. Fran took the VBAC risk factor very seriously, and at no time did I feel that it was overlooked. I felt totally cared for, all the time, feeling tremendously empowered as I laboured with no pain relief until the last moments. This was the same woman who had cried for an epidural four years earlier!
I had a ventouse delivery and surgical removal of my placenta; not an entirely natural birth, but a heck of a lot closer than I may have had otherwise. Certainly, being hooked up to fetal monitors from the first contraction was the worst thing I could have imagined. Thanks to the Albany Midwives, I pretty much avoided this.
I also credit them, through this process, with my successful breastfeeding, and strong bonding with my son. When I look back at my daughter's birth now, I feel less sad and regretful. Stanley's bir th went a long way to making me feel I did as much as I could to bring him into the world through my own efforts.
I will always feel very grateful to King's College Hospital for supporting the Albany Midwives team, and hope that they continue to do so. I had a great experience, and Becky from Albany visited me the day after the birth, again a new experience. She may have had a busy day ahead, but never showed signs of needing to dash off. After pleading to go home a day early, the kindly King's midwives did one last examination and agreed. They were delightful and, for me, a total contrast to last time.
It is a mystery to me why the Albany model is not the norm. Surely if women feel they have the choice to labour however they choose, and they get to know the midwives guiding them through labour, the outcome will be better than having terrified women in hospitals with tag-teams who have never met them before? Birth is a natural process and as such depends on confidence and reassurance; this confidence, with vast knowledge and mines of experience, is key to the Albany model of care.
Even while in labour I noticed the relationship the Albany midwives had with the consultants. This seems to be an entirely desirable scenario when it comes to childbirth; ideally, the woman isn't so much a patient as an active participant - with the midwife as her ally and representative. If more clinical staff accepted this as the perfect balance, there would surely be less stress and feeling of 'lack of control' on the woman's part. I have very clear recollections of the 'full and frank' discussions between midwife and consultant, and the fact that Fran would always ask my permission before agreeing to any interventions.
If more women could have the Albany model of care, I feel strongly that they would avoid the type of birth experience that I had first time round. Surely aiming for natural childbirth with the support of a known team is more cost-effective than failure to progress and emergency surgery for women who were just feeling confused and unsupported in the first place. I will always be grateful to the Albany Midwives for the deep impact they've had on my life - because childbirth really does impact on everything that comes after, physically and psychologically, for the mother and the whole family.
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