I Like Babies, But I Prefer Mothers

When people find out what you do for a living, as a doula, they tend to assume that you really love babies.

And it’s reassuring that in the future I’ll be able to have baby cuddles, especially as I might not have any more of my own.

But I didn’t get into this work because I love babies, it’s because I love women. I realised the other day I have *one* photo of me holding a baby because it doesn’t even occur to me to ask to hold them.

They are beautiful. They are a miracle.

But the mother?

She is a goddess. A warrior.

Attending a birth is like falling in love. You become entirely focussed on this one person, to the point that nothing else matters. Time becomes blurry. You learn to anticipate what they need, sense changes in their body language, it’s an intricate dance going on between the mother, her baby and her birth supporters.

Once I heard a consultant say that she was there for the baby, to the point that she was overriding the parent’s wishes. It still astounds me that a professional genuinely believes she cares about a baby’s safety more than the parents.

And it made me realise that I didn’t feel that way at all. In that moment my heart was breaking for the mother.

I am not there for the babies. That’s not what called me to this work. I am there for the mother. I believe that her role is to stay in tune with her baby and her body and tell you what she needs. If you just stop to listen she will tell you all that you need to know.

I adore the babies and I will be crying alongside you as you welcome yours into the world. My doula babies still bring tears to my eyes today.

Because they were birthed by you - through your strength and beauty and determination, your courage and perseverance. The way you surrender yourself to the process and look around you in childlike wonder. The way you just know.

The way in your postpartum vulnerability, you glow.

You are my favourite.

Jenny Wren's Quick Guide to: VBAC

Congratulations!

When you find out you’re pregnant after a previous caesarean, it can be daunting and difficult to navigate your birth options. Almost certainly at your booking-in appointment you were told you were “high-risk” and immediately put under consultant-led care. Maybe you have attended consultant appointments and been told how you will be giving birth.

I wanted to write something to summarise the information I usually give mums planning their VBAC (Vaginal Birth After Caesarean) from my experience of supporting them. I will also be writing a guide to caesarean for those who decide this is the right option for them too. 

VBAC is a safe and rational option and NICE guidelines state that women should be supported in this choice for up to 4 previous caesareans. Often mums are treated like one big walking risk, but I want to get specific….

What are the main risks?

What is not always explained to mums is that when they have a caesarean this impacts future pregnancies. One of the risks is placenta accreta where the placenta attaches abnormally into the womb and can increase the rate of haemorrhage and miscarriage. The other risk is placenta previa which is where the placenta covers the cervix. These risks increase with each caesarean.

The main risk usually talked about is scar rupture and this is the basis on which caregivers usually plan a mother’s labour for her. The risk of rupture is 0.5%, that is, 1 in 200. Of that 0.5%, 6% of those ruptures are considered “catastrophic”, which is to say, resulting in perinatal death.

Induction of labour may not be recommended as the synthetic oxytocin (syntocinon) may increase risk of rupture so it’s important to make a plan should you go “post-dates” whether you would prefer to have a planned caesarean section or try other methods of induction with their associated risks.

For these reasons caregivers usually recommend giving birth in a consultant-led unit and having continuous monitoring, as any variations in the baby’s heartbeat are early indicators that a rupture may occur. 

What makes VBAC less likely to happen?

Continuous monitoring and being in a consultant-led unit both reduce the chance of a VBAC as they increase the risk of intervention. Currently there is no evidence that continuous monitoring improves outcomes over intermittent monitoring via Doppler. Continuous monitoring reduces the ability to move and have an active labour.

If you wish to have continuous monitoring, the alternatives are a fetal scalp monitor or wireless monitoring which would enable you to use a birth pool. However, the scalp monitor requires your waters to be broken (which is an intervention) and the wireless monitoring may not be reliable or caregivers may be reluctant to use it. You can request intermittent monitoring and a waterbirth on the consultant-led unit if a pool is available.

The chance of a successful VBAC in this setting is around 60-80%, which is about the same as the chance of any first time mum having a vaginal delivery.

What makes VBAC more likely to happen?

The rate of successful VBAC in a home setting has been reported to be as high as 90%. The benefits of being at home are that you have minimal risk of intervention and are in control. Some women make this decision based on how close they live to their local hospital if an emergency occurs.

Having a doula reduces the risk of caesarean section.

If you don’t want to give birth at home or on a consultant-led unit, a compromise may be a midwifery-led unit, or MLU. However, they do not usually accept VBAC and it is up to you to negotiate if that is where you would like to give birth. They may not say yes. You will need to make an appointment with your head of midwifery or consultant midwife and if necessary, get your birth plan agreed and signed so you do not have any problems on the day when you arrive in labour.

Your greatest asset will be a strong birth partner and advocate for when you are in labour to speak up for what you want when you may not be able to.

When negotiating - ask for facts, just like I have given you. Any emotional blackmail or incorrect information is unacceptable. If you decide that VBAC is right for you and you have anybody who is unsupportive, you are entitled to decline their care and request somebody else. Ask yourself - who prioritises the baby's safety more than the mother? Nobody. Your job is to make the decisions that are right for you and birth in the manner in which YOU feel safest. 

Any additional risk factors beyond previous caesarean will need to be taken into account when making your decision. However, you can feel confident that VBAC is successful the majority of the time.

Remember this is YOUR body, YOUR baby and YOUR birth.

My Small Motherhood Achievement

I think it was a birthday present. We didn’t manage to save them all but the Paddington Snap had been quickly stashed in my backpack where it slowly worked its way down to coexist alongside sand from last year’s summer, some socks and a bow-tie.

I haven’t been the most present mother lately and tensions are running high at home, with my boy determined to defy even the slightest instruction in his quest for autonomy, his desire to be heard. He is lonely, he is bored. He wants to play fight and most days I just long for peace and calm.

“Judah can you just—"
“Can you NOT"
“Please just—"

More often that not it is mummy who needs to be put in time out.

We were at baby group on Friday and yet again Judah was bored. He began to rifle through my bag, as he is wont to do, and out came the cards. Baby Violet was asleep in the sling so I found that I had time to play with him. I let him win a couple of times but he was pretty quick. I liked it when we were nearly the same speed and he ended up hitting my hand. I love his laugh.

He is such a traditional little child really, an Enid Blyton boy, who would love nothing more to be packed off for the day with a picnic and some jolly chums to play cards and have adventures.

I think he sensed that he had found a "way in" (he is so smart) and again today when the baby was napping and I sat down next to him on the sofa and there was no whining, no stroppiness, he simply asked if we could play Paddington snap.

I love the way he says Paddington snap.

I love the way he says he has sharp eyes to spot the match and furrows his brow.

I love the way he enunciates dramatically, putting emphasis in all the right places. He is a born performer.

I love the way he indignantly insists that he is paying attention after I win.

I love the way he marvels that there is a clock called BIG BEN.

I felt no frustration, only love.

There was eye contact, communication, jokes, good-natured competition. I marvelled at his humour and his charm.

It was then that I realised I have been so stressed about him not getting ‘quality time’. We go to soft play so he can burn off energy and I can work on my phone. We go to play dates so he can socialise with other children and I can vent to another mum. We run around everywhere on these insane errands and life admin. The game of snap took ten minutes. But he loved every second.

The vision in my head I have of ‘quality time’ tends to be us baking together, painting together, adventuring together, and a lot of the time is totally unrealistic. I will always fail and resent myself for it. I was allowing that resentment to bubble over and spoil any chance we ever had for connection.

The baby woke up and I popped her in her high chair, she is getting so big now… she is able to watch now...

What if quality time was pockets of ten minutes in an ordinary day where he gets undivided attention?

What if that was enough?

The guilt on my chest might lift and I might find that without that pressure I could feel more free to watch and enjoy the child I have in front of me, not the one in my head who is missing out on all the things I’m not giving him.

With small achievements comes confidence and I know this applies to most of our journey as parents. I remember the first time I took both children out together. I remember when I cracked doing bedtime with them both. It's the little things that seem insurmountable at the time. 

So thank you to whoever gifted us the Paddington snap - I never knew how useful it would be!