A Letter to Admin - HBAC Follow up to my last post

I am trying to veer away from this blog, everything is now on my new blog. You can read my follow up to my last post here: http://www.lifehathchanged.co.uk

Another Baby Damaged by HBAC - When will it end!

It pains me to write this post, yet another baby has been seriously injured, his mother choosing to HBAC at home instead of VBAC in a hospital environment.

I wish I wasn't writing this, I wish I didn't even need to write this blog to create awareness of the dangers of HBAC. Because if there was no need for me to write this then it would mean women were no longer attempting HBACs, and that would be a great thing. There should come a point in time where the government decide to outlaw the practice of HBAC. This is what I hope will happen. I'm not sure how it will happen, maybe we need to allow for a right for life prior to birth. At the moment (in the UK) The human rights act does not come into force until you are born, it is at this point you gain the right to life. I know this will throw up many moot points.. When does it start? At what point does a child inutero become a living being, a legal entity, an entity deserving of the right to life? I won't go into too much detail about my opinions on this in this post, as it's fitting of its own post at some point in the future. But I will say that I am not against abortion, and I would not want any change in the law to take that right away from a woman. However I do feel that once a child inutero is capable of sustaining life should it be born (24 - 26 weeks) then that child should have a right to life, a right to a safe birth, a birth that is not going to leave him/her with irreversible brain damage or complete loss of life.

I know there will be many pro-HBACers reading this post with distain in their mouths, and I'm not going to apologise if I offend you. But the process of birth really is not about you! You may have had an awful first birth in a hospital, your previous birth may have been traumatic, it probably (if you are reading this post) ended up in an emergency section! I am sorry for your loss, I am sorry that you did not gain the vaginal birth you had hoped for. I am sorry that you resent the fact that you had to have intervention that saved your childs life.

There is so much more to birth than the actual process. Surely the main objective is to produce a healthy baby, a baby you will cherish and nurture for the rest of its life. Surely as a mother your main purpose is to protect your child, to ensure that no harm within your power can come to him or her.

Now I am not blaming the mother. I know from my last sentence you probably feel like I am. But no. The problem is that we have a very active HBAC movement. This movement (I have experienced and been part of one of their groups) actively encourage women to labour at home after a previous section, and even after a previous rupture! (Don't get me started on that one!!)

The Pro HBAC movement are actively brainwashing these women into believing that home birth after a section is a safer option for them. That there is a lesser chance of complications if they birth at home. They throw fake statistics at these vulnerable mothers who desperately wish to avoid the trauma of their previous birth. They revel in the delight of every successful HBAC, showing these mothers to be how wonderful this is. Yet when something does go wrong, when a child dies after birth, when a child is born sleeping and when a child is left with irreversible brain damage they brush it under the carpet as fast as they can. They hide the fact that children are being killed, keeping the focus on the success cases, and putting the poor mums who suffer a loss to the back of the group. Deleting their posts, or on this occasion asking them to please stop posting about what happened.

See in their eyes, if you post a story of how HBAC didn't work out then you are a fear-mongerer, your story will be wiped and replaced with the latest success story! This group of women who supported you from the first step of your pregnancy, who encouraged you to HBAC, who made you truly believe that you were doing the right thing for you and your child will not be there for you when it goes wrong. You will be alone, you will feel lost, and this is so so so wrong.

One of the HBAC groups that this poor mother is a member of is headed by a lady who has never had a vaginal birth, never attempted a VBAC, and never attempted a HBAC. Yet this lady (whom I obviously can't name for legal reasons) is actively encouraging women to HBAC! Something she has no experience of. Is she trying to live out her dream of a natural home birth in these vulnerable young women? Who knows! All I know is that this group needs to be stopped. The mothers who are being brainwashed need to know the truth about home birth after a section. They need to be aware of the risks that they are taking. This is not fear-mongering! This is education! 

The other issue with HBAC, is that a lot of these women are also religious (and no I'm not going to go on an anti-religion rant), they believe that whatever happens is 'Gods Will' and unfortunately that is the case with the woman whose baby boy has been brain damaged recently. She is asking for prayers, there are comments stating that this is gods will!! I am sorry but I know of no god who would will this pain and devastation onto any mother! This was not gods will, this was a choice that was made by the mother. Whether that choice was right or wrong, ill-informed or pressurised it was still her choice that led to this happening, Not gods! God gave us the freedom to choose, he/she (if you believe) gave us free will! Everything that we do in life is determined by the choices that we make. Including the choice to HBAC! I know this is probably sounding brutal. But its important to remember that most of these women have been brainwashed into believing they are doing the right thing for their child. They are not to blame. The HBAC movement have so much they need to answer for!

HBAC - Should not be Home Birth After Cesarean... it should be Hurting Babies And Children... Because this is what it is doing on a daily basis!

It's not just the risk of rupture either, there are so many more factors involved. 

Was your previous section due to breech? Then your chances of breech are higher for this one, do you want to HBAC a breech baby knowing that should they start breathing before they are fully born that they could then be born still or suffer oxygen depravation resulting in permanent brain damage or get pneumonia from fluid on their lungs, or meconium ingestion.... 

Was your previous section due to a large baby that you struggled to birth and your child got into distress?? Do you really want to risk this happening again, outside of a medical facility where they CAN help and will intervene if needed? Also remember that if your first was a large baby then the chances are that number 2, 3 , 4 or 5 are going to be bigger still!

Was your previous section due to Shoulder Dystocia? Then the chances are it may happen again.

The dangers of HBAC are about so much more than the risk of rupture! And not forgetting that if you do rupture at home your baby is highly unlikely to survive. If by some miracle they do survive then they will be damaged for life.

We need to educate women about the risks. We need to create awareness. Babies are being hurt or killed by women attempting HBACs. It's about time it was stopped for good!

Apologies x

So sorry I haven't posted in a while. Life has been somewhat manic. I have 5 posts that I have started writing and are still in draft version as we speak. I will endeavour to get these finished and published as soon as I can.  A couple of them are on a HBAC rant, a couple in regards to Aspergers and then a lighthearted post that is almost finished entitled 'Three days in the life of a single mum' (My partner had to go to Germany for a few days and it was the first time I had been 100% responsible for the boys. It was an interesting few days juggling a young baby, a 4 year old with social issues, school runs, bed times and everything that goes with it. I have gained a new found respect for the single mums out there! You guys deserve medals on a daily basis! Respect!

Anyway, I will be updating again soon with some longer posts, but I just wanted to check in and apologise for being quiet.

Bella xxx

HBAC - Important Correction on statistics with Uterine Rupture

Just a quick post: I have been informed that my stats on Infant death in regards to Uterine Rupture at home are incorrect. Unfortunately they are worse than I had originally discovered.

The facts are that if you are attempting a HBAC and experience a uterine rupture then the survival rate is almost zero. On the very odd occasion where a baby has survived rupture during a HBAC there has been significant lasting brain damage, and/or the baby has passed away in the weeks following the birth. Once a mother ruptures there is only a 15 minute window to get the baby out. This isn't possible in a home birth environment, even if you are just around the corner from the hospital!

I will update my other posts accordingly, although it may not be done today as I have a very grumpy baby boy who has had his first set of vaccinations today, hence writing this very brief post to make people aware of just how unsafe a HBAC really is.

Bella xxx

HBAC - How I was almost led to believe the hype

After writing the first three follow up posts to my 'Why I am so against HBAC - DS2 birth experience' post I joined a group on facebook. The group is for women wanting a natural birth after caesarean, and for those who have attempted and want support. I thought it would be a good place to share my story, especially as the group supports VBAC, HBAC and Home Birth.

I initially asked if I could share my story prior to posting it and mentioned that I was anti HBAC but pro VBAC as long as it's in a facility equipped to deal with any eventuality. This much to my surprise went down like a ton of bricks!

When I did post my birth story (which I edited heavily) I was still targeted despite the fact that I am very much pro VBAC (which is one of the factors the group supports). I was given information and links to show that had I had my VBAC at home then the likelihood was that I would not have ruptured, and that I would not have needed intervention.

Here are some of the things I was told:

• If I had had a HBAC instead of a hospital VBAC the risk of rupture would have been much lower as I wouldn't have had all of the interventions.
• Ruptures have early signs - a trained home birth midwife would have picked up on the rupture in time to transfer me to hospital.
• Epidurals reduce the awareness of a rupture.
• Home birth midwives are more 'hands off' so tend to watch you rather than monitor, so they can detect a change in behaviour or appearance far better than a hospital midwife.
• Uterine Rupture is a rare occurrence and the chances increase with intervention.
• Having your waters broken for you can increase the risk of Placental Abruption.
• Epidurals are proven to lesson your chance of a successful VBAC
• I should have spoken to a Midwife who specialised in home birth and not my consultant obstetrician 

With the above being planted in my mind I actually started to question my thoughts in regards to HBAC! Would I have been better off at home? Would I have still ruptured?

I sent a message to Amy who runs 'The Skeptical OB' blog, I already knew the answer to my question, but I needed someone to snap me out of the doubts that were now forming in my mind.

Here is my message and her reply:

Hi,

Sorry to message you directly, I hope you don't find it unacceptable.

I've been writing about my birth story (failed VBAC/Uterine Rupture/Placental Abruption in hospital - outcome positive)

I joined a VBAC group who also support HBAC, on joining I was very anti HBAC. I felt it important to tell my story, that had I homebirthed, my baby (and potentially myself) would have died!

I couldn't understand how any mother would take the risk of a HBAC when there is a chance that if something were to go wrong they could lose their baby (to me their own life is irrelevant, that's their choice, but to risk the life of an unborn was beyond me)

Upon joining I posted my story, and I did mention that I was anti HBAC but also edited my story heavily so as not to offend anyone (although I did still manage to offend a lot of people)

I've been told and given links that apparently show that had I birthed at home I would probably not have suffered the complications, and that even if I had I would have been transferred in ample time as home midwives are trained to spot these things happening far better than hospital midwives....

I've been told that the epidural I had would have contributed to the rupture, and that having my waters broken could have caused the abruption. Combine these together and hey presto that's why I suffered my rupture.

I'm struggling with this in my head! My heart is saying that maybe had I been left alone I could have birthed naturally. But my head is still saying that there is a risk, and if there is any risk to an unborn then surely we should put that first, over and above what we view as our 'ideal' birth! Surely the outcome is all that matters. A healthy mother and baby!

I would really appreciate your input on this as I'm no going stir crazy and wondering if the epidural and waters being broken could have contributed to my rupture....

Also I've been advised by my consultant that I shouldn't have any further children now, as the risks are too high and I may not carry full term without rupturing. Again to me this made sense, and in all honesty I have never wanted more than two children. But I'm being told now that it is possible to birth after a rupture...

Please set my mind at rest and tell me I am not crazy. That my doctors are right and that my original opinion is the one I need to go with.

The women in the group are all wonderful women, and I can certainly relate to them in a lot of ways, but I am still struggling with the concept of HBAC ever being a safe option, and surely that's something I need to be spreading awareness of?

Many Thanks in advance.

Louise

------

Dear Louise,

There are many different factors that can affect the success of a VBAC and the risk of rupture. However, neither epidural or ruptured membranes are among those factors.

This issue has been looked at multiple times and there is NO evidence that VBAC is safe let alone safer than hospital VBAC. The risk of death of baby and/or mother is much higher at home.

Those who insist that what happened in the hospital would not have happened at home are trying to deal with their own cognitive dissonance. It is extremely important for them to believe that homebirth is safe as hospital birth and when they are presented with evidence that shows they are wrong, they will do almost anything to discount it so they can preserve their beliefs.

The important thing to understand about the women offering you false information is that it has nothing to do with you and nothing to do with the truth. If's all about them and their need  to justify their own dangerous choices.

As regards your consultant's advice, it's difficult for me to evaluate it without studying your medical records. The odds of a future rupture are higher than before, but it is possible to have a successful pregnancy and an early C-section (before labor ever begins) to reduce the risk somewhat.

I hope this information is helpful.

Sincerely,
Amy

I know that there will be many HBACers who will read this and think to themselves, oh she spoke to Dr Amy and then dismiss any common sense they may have gained from reading this blog! This is the sad reality of these groups. Dr Amy is a well know medical professional, she gave up her career to have her family and now blogs on various subjects including home birth and HBACs.

A lot of the HBAC community don't like her, she is labelled as a troll and a fear-mongerer! The reason behind this hatred is purely because Dr Amy tells it how it is! She doesn't beat around the bush trying to be nice when the facts are simple. HBAC mums are risking their children's lives in order to have the birth they choose! They blind themselves with the success stories and when someone comes along with a negative it is either swept under the carpet, dismissed or removed.

They lead the way for others to follow, armed with rose tinted glasses and ready to attack anyone who may have a different point of view.

SO after much thought on the matter I've revisited the comments that were raised in regards to my story:

• If I had had a HBAC instead of a hospital VBAC the risk of rupture would have been much lower as I wouldn't have had all of the interventions - Interventions do not increase the chance of rupture. If you are going to rupture you will, be that at home, in the car or in a hospital. The main difference is that if you rupture during a HBAC your child is three times more likely to die than if you had VBAC'd in a hospital
• Ruptures have early signs - a trained home birth midwife would have picked up on the rupture in time to transfer me to hospital - Every rupture is different, I felt my pain through my epidural. When it happened it happened fast and I was bleeding out straight away. There would not have been enough time for anyone to have got me to hospital. My baby and potentially myself would have died.
• Epidurals reduce the awareness of a rupture - I can't vouch for everyone, and I'm not a doctor, but I can assure you my epidural did not mask the pain of my rupture! It is a pain I never want to experience again, and I would not wish it on anyone.
• Home birth midwives are more 'hands off' so tend to watch you rather than monitor, so they can detect a change in behaviour or appearance far better than a hospital midwife - I was quite happy the minutes leading up to my rupture. Although babies heart rate had started to drop. This is something that a hands off midwife would not have picked up on!
• Uterine Rupture is a rare occurrence and the chances increase with intervention - When you think of rare what figures pop into your head? 1 in a million? 1 in ten thousand maybe?? What about 1 in 200! Does that still sound rare? Because to me thats a pretty real figure, and an accurate one at that 0.5% of women attempting a VBAC WILL rupture. Don't think it will be you? Well I didn't think it would be me either and it was! Now if you played a lottery where the odds were in your favour at 1 in 200 how many extra tickets would you buy? Because those are pretty good odds. But turn them against you and they are rare? Come on wake up and smell the coffee. Uterine Rupture is not a rare occurrence, its a common one, and thats why your doctor, your consultant, your friends, family and most other people are asking you to please go into hospital for your VBAC! They are not scare mongering you! The statistics are there. Please look at them, read the stories of the women who lost their children to HBAC and Uterine Rupture. It's very real and it happens more often than anyone cares to think about. How many babies need to die before this is taken more seriously!
• Having your waters broken for you can increase the risk of Placental Abruption - I can't comment on this as I've not seen the statistics. I would imagine if your placenta was already starting to come away then having your waters break in general could cause an abruption.
• Epidurals are proven to lesson your chance of a successful VBAC - Rubbish! 
• I should have spoken to a Midwife who specialised in home birth and not my consultant obstetrician - So I should trust a nurse over a Consultant OB who has spent 15 years of schooling and training to get to consultant status and has over 30 years experience under her belt? (talking in reference to my consultant). Consultants are not their to make our life hard, they don't want us to end up with a repeat section! Mine was fully VBAC supportive, stressing that if you can do it its much better for mum and baby. She also explained the risks to me, and I was fully aware of what could happen when I tried. Hence trying in a facility that was equipped to cope when my uterus ruptured.

So there we have it! I almost believed the hype that is HBAC! I'm leaving the group now as I can't stay there and read stories of mums going into labour! I don't want to be privy to the next death by HBAC! It's too heartbreaking to even contemplate.

Bella xxx

PS: My main blog site is now: http://www.lifehathchanged.co.uk 

Someone shoot the breastfeeding police! Please!!!

I know what you are thinking. You have read the title and you have assumed I am against breastfeeding! I am NOT!!

What I am against is the hype that states we MUST breastfeed, the stigma that comes from deciding to formula feed and the pressure from everyone!!!! Not everyone can breastfeed, this doesn't make them good or bad mothers, they are still mothers, and their child is still getting all of the nutrition required to thrive.

I've had two children and I attempted to breastfeed with both of them, I had different issues with DS1 and DS2 but ultimately chose to switch to formula with both of them. Yes I CHOSE to do this! So shoot me down right now :) I'm not a bad mother and my reasons were simple, yet I still had to fight off the breastfeeding police when I made my choice. Here's why I chose not to breastfeed:

DS1

He was my first born, and I had an idealistic view of breastfeeding for at least a year, after all breast is best (or at least this is what they pump down your throat every single day). I had initial difficulties in latching him on, which I believe is typical with a child born by emergency section. But I pushed through it and quickly established a great breastfeeding regime. I loved it! I loved how close I felt to my boy, breastfeeding really is a wonderful experience when it's all going well.

After around 6 weeks I developed an infection in my nipple. The pain was excruciating at every feed, but as per the advice of my 'breastfeeding support worker' I continued to push through the pain. I almost ended up chanting 'breast is best' whilst feeding, to try and convince myself that the wonderful experience now reduced to torture was in the best interests of my child.

I managed a week like that, I had topical cream to try and help, but the infection was getting worse. I remember looking at my left breast and it was red and peeling all over. My nipple had started to break away (Yes I was losing part of my nipple - and no it never grew back) I switched to a pump for my left breast (on the advice of my breastfeeding support worker) but still the pain continued.

I was miserable! My wonderful one on one feeding regime was hell. I explained all of this to my BSW and was told to 'push through the worst of it' I explained to her in one call that my nipple was literally falling off little by little. She laughed it off as though it was nothing...

Breast is Best, Breast is Best - Breast is...... NOT ALWAYS Best!

I made my choice to stop breastfeeding, it wasn't fair on myself or my little man! I was miserable, he was picking up on this and our wonderful feeding time was in tatters.

You would think that upon making this choice I would feel relieved. That I would be allowed to feed my child how I chose without fear or retribution! Wrong! I received calls several times a week from my BSW and from other BSW's that mine thought could help me! They were trying to convince me to keep my milk in with pumping, I told them straight that I wouldn't do this. I wanted to heal, and I was now enjoying the closeness and time I had regained feeding my son (albeit with a bottle).

I was made to feel guilty! My son would be much better on my breast! I hung up on that call!

A couple of weeks went by and I thought I was free of the breastfeeding police, when I started to get more calls.

REALLY!!!

They wanted to see if I wanted help bringing my milk back in so I could start breastfeeding again now I was healed.

I (and my 1 1/2 nipples lol) told the BSWs that I appreciated their thought but could they please leave me alone, I had made my choice and that was final.

I don't know why I put up with it for so long! But as a first time mum it is so easy to be swayed. If that happened to me now I would tell them to leave me alone from the onset.

DS2

Shoot forward 4 1/2 years, and yes I once again was planning on breastfeeding my second son. My birth with DS2 was far more traumatic than DS1 and thus is took even longer to try and get him latching correctly. But I pushed though it and by day 3 he was latching wonderfully. It does give you a real sense of achievement when you have struggled to finally have your child latched on, mother nature doing what she does best.

Due to the labour and DS2 being on an IV we didn't get his second official weigh in until day 6. He had lost almost 20% of his bodyweight! I knew he had dropped, and losing some is common in BF babies, but I was shocked at just how much he had lost!

My initial thought was that it was due to the sepsis infection.

The hospital midwives drew up a plan of action which went something like this:

1: Feed at the breast
2: Express any excess milk - feed it via cup
3: Top up with formula
4: Repeat every two hours

Whilst this doesn't sound too horrific the 2 hours starts from the start of the breastfeed! So I was getting literally 30 minutes before having to start the process all over again...

I was shocked at how little milk I was producing when they got me on the pump. With DS1 I could have fed 3 babies and still had some left to spare!

I had been unintentionally starving my child.

I continued with the regime for 2 days, over which my milk production continued to go down and not up as you would expect.

During this time I also had several visits from a BSW in hospital, who had great pleasure in telling me I was doing the right thing.

My milk production was now almost zero. everyone was encouraging me to continue but I chose to stop! I was tired so tired, trying to recover from a major operation, and I wasn't getting any quality time with my new baby boy!

---

I think that whilst breastfeeding is a wonderful thing, that people (especially BSWs) fail to see past the fact that 'Breast is Best' Maybe it is for some people, but it isn't for everyone.

As long as you have a happy and healthy mother and baby then it really should not matter how the mother chooses to feed her child.

So - Please.... Can somebody shoot the breastfeeding police!

Bella xxx

HBAC The Sinister Truth and myths debunked - Follow up to my anti HBAC post Part 3 of 4

I've done a lot of reading the last few days in regards to HBACs and studies conducted which has helped me greatly in writing this post.

I don't want to sound like an extreme anti HBAC protester, but the facts and the truths are out there when you look for them. Unfortunately most women and blinded by their desire for a natural home birth that they don't read enough into it and find out all of the facts.

If you are considering a HBAC then please read all of this post, follow the links and read those as well, then you can at least make an informed decision on what you want to do. It's also worth remembering that with a HBAC you are three times more likely to lose your child than you are with a hospital VBAC.

HBAC Vs Hospital VBAC

Most of the HBAC advocates and site will often tell you that a HBAC birth is just as safe as a hospital birth. They will also tell you that you are less likely to suffer complications with a HBAC than you are in hospital.

Whilst it may be true that you will probably suffer less complications (its a known fact that women left to their own devices in a comfortable environment will labour easier than those being interferred with), you can also labour in a hospital with a Doula and no intervention (unless there are problems that may affect the life of your child or yourself).

It is NOT true that home birth is as safe as a hospital environment, and that's not just in regards to HBAC either.

You may have been told that plenty of studies have been performed to show that home birth is as safe as a hospital birth. However were you told which country these studies were performed in? You can't use facts unless they apply to your country. Bear in mind the UK and the USA have different training requirements for maternity staff and health care systems in place that other countries do not have. You can't compare these studies when you take into account the fantastic healthcare system we are fortunate enough to have access to.

In face there have been studies on home birth in the USA, and all of them show that with a home birth the risk of ending up with the death of a baby is tripled when compared with a hospital birth.

The latest study (from the Midwives Alliance of North America) was conducted in 2014 (yes it really is a recent study) has been brilliantly surmised in an article on babymed which was written to debunk a claim that homebirth was safer than a hospital birth. Have a read of it here: http://www.babymed.com/blogs/danielle-repp/press-release-wrongfully-claims-home-birth-safe

To quote from the article:

"A baby is 3 to 6 times more likely to die at a home birth than in a hospital"

How can anyone even consider a HBAC when you take this into account? This is not about a womans right to labour in her own environment, this is about the right of your unborn child! The right that child has to be born alive!

The Skeptical OB also sums it up wonderfully in her article below:
http://www.skepticalob.com/2014/01/homebirth-midwives-reveal-death-rate-450-higher-than-hospital-birth-announce-that-it-shows-homebirth-is-safe.html

To quote from the Skeptical OB:

"To summarize, the MANA statistics show that homebirth as practiced in the US has a death rate 450% higher than hospital birth"

Another article that I reccomend reading from the Skeptical OB is 'Another HBAC, Another Rupture, Another Baby Dies'

http://www.skepticalob.com/2011/06/another-hbac-another-rupture-another.html

"How many dead babies is it going to take before homebirth advocates realize that they have absolutely no idea what they are doing, and that precious babies are dying preventable deaths as a result of their arrogance and ignorance?"

There are so many articles out there that the advocates don't want you to read. If you have time (and I urge you please make time ) please read the following articles/stories:

Homebirths linked to a higher rate of infant deaths: http://www.livescience.com/43050-home-births-newborn-death.html

Home birth after Caesarean: http://www.babymed.com/blogs/danielle-repp/hbac-home-birth-after-cesarean

Critique of homebirth: https://www.sciencebasedmedicine.org/a-critique-of-the-leading-study-of-american-homebirth/

Apgars in relation to birth setting: http://www.ajog.org/article/S0002-9378(13)00641-8/abstract

Perinatal outcome in relation to homebirth: http://www.ajog.org/article/s0002-9378(13)00630-3/fulltext

NB: In regards to the studies used they were all based on planned Home births with a midwife present. Accidental home births were not included as this would have swayed the data.

But My Midwife Assured me that she/he carries everything they need to cope with an emergency...

I've seen this in a lot of HBAC forums, women are being misled in regards to the safety of their labour.

Yes a midwife will carry certain items which will help with some complications that may arise but they are not equipped for all eventualities.

Yes a midwife will call for transfer to hospital in an emergency - but often this can be time consuming and if you suffer a rupture or haemorrhage then you need to be in theatre within 18 minutes to save the life of your child. Bear in mind it will take at least 5 - 10 minutes to get you out of the door and into some form of transport, then take into account journey time, getting out at the other end and the other factors that come into play when transferring. Unfortunately even for those living close to a hospital the transfer time is too long to save the life of the baby in a lot of cases.

What happens if your baby is born with breathing difficulties?  Can your midwife ventilate and intubate your baby? Unfortunately they can't do this, and a transfer is required. Again often transfers for this complication are not fast enough and you risk the life of your child or serious brain damage due to lack of oxygen.

There are hundreds of situations that can occur, and whilst your midwife is prepped for some he/she is not prepped for all of them.

Many Thanks to 'Doula Dani' for the following lists and exert that I took from her blog.

"Home birth midwives carry with them certain items to use in case of an emergency - b/c no matter how low risk a mom might be, emergencies can and do happen in childbirth and as such, they need to be prepared. I've heard or read many, many times from mothers/fathers/couples that have chosen home birth (or freestanding birth center) that “their midwife carries with them all the necessary equipment in case an emergency arises.” So I want to present a clear cut list for each setting of the equipment available in case of an emergency.

There is a slew of equipment needed and provided in both situations that I am not going to get into - such as gauze pads, chux pads, sterile gloves, etc. What I'm focusing on is the equipment used either to detect issues or for life saving measures."

Here's what a (typical) certified home birth midwife will bring with her to a home birth:

• Fetoscope or Doppler (or both) - to detect the heart rate of the baby
• One oxygen tank
• Infant mask (used with oxygen tank)
• Adult mask (used with oxygen tank)
• Blood pressure cuff
• Suturing items - to stitch tears for the mother
• Thermometer - to check for fever for mother, which can indicate uterine infection
• Lidocaine - to numb mom locally while she is being stitched up
• Pitocin - in case of postpartum hemorrhage
• Methergine - in case of postpartum hemorrhage
• Bulb syringe - to clear airways of the baby, especially in case resuscitation is needed
• IV equipment - if mom needs antibiotics in case of GBS or prolonged rupture of membranes
• Pegnancy and labor records and charting, including blood type - in case of transfer, to ensure accuracy and increase speed
• A midwife may or may not have an assistant with her
• Midwife should be current in the following skills:
• Neonatal Resuscitation (chest compressions and mouth-to-mouth)
• Basic Life Support (some may have Advanced Life Support training)

"I would ask your midwife ahead of time to make sure she carries (at least) these above items and has (at least) those certifications. The items should be in good working order, drugs should not be expired and midwife should be very familiar with exactly how to use each of these items and medications. Be your own advocate! Don't be afraid to ask questions ahead of time.

Now keep in mind, if the midwife is not certified she will not have access to things like Pitocin (or any medications), Oxygen, an IV, etc or any item that could get her in trouble with the law for practicing medicine without a license (at least, she will not have legal access to such items).

Ambulance:

A Paramedic will have the knowledge, skill and certain equipment to be able to help in the case of an emergency. However, while a Paramedic can certainly provide life saving support, they should not be considered a fool proof back-up plan. Quoting a Paramedic: “We can do neonate intubations but we do them SO seldom that it’s not a skill all medics are up to par on. This goes for babies & pregnancy in general. In an emergency childbirth scenario where minutes can make the difference in life and death, NOTHING in an ambulance can save a baby; it can only be a very temporary bandaid while we drive as fast as we can to the closest hospital.”

Response Time:
In a non-emergent transfer, travel time or response time will likely not be an issue. However, being "5 minutes from the hospital" may not be close enough when minutes can make the difference between a perfectly healthy life and death or neurological damage or injury or blood loss resulting in a transfusion or hysterectomy. Regardless of the scenario, emergency or not, a home birth transfer will take much longer than 5 minutes to get a laboring woman in her home (or birth center) to a hospital, in the right hands at the hospital, admitted, monitored and ready for a doctor to deliver a baby.

Hospital:

• All of the above listed home birth equipment and medications, plus…
• Electronic Fetal Monitor (EFM) - this detects the baby’s heart rate and the contractions. EFM vs Doppler gives nurses a much clearer picture of the baby's heart rate to make sure baby is getting all the oxygen baby needs. Heart rate variability is normal for the baby but it's important to know when changes to the heart rate occur in relation to when contractions happen. A heart rate of 155 BPM might sound healthy and wonderful when checked every 10 minutes or so but with decels at the end of a contraction, it can be a serious sign of distress. The decels may be so slight that unless you are looking at a print out (the EFM strip), you would not know they are happening.
• An endless supply of oxygen
• Cytotec - for postpartum hemorrhage
• Vacuum and/or forceps (though forceps are not common anymore) - if the baby’s health depends on immediate delivery, a vacuum can be used to help guide the baby through the birth canal while the mother pushes
• Blood Bank - for postpartum hemorrhage requiring a blood transfusion
• Operating Room and all personnel needed for an emergency c-section or for postpartum hemorrhage treatment/surgery (see Sara's birth of her son - an emergency surgical repair saved Sara's life after she suffered a cervical laceration; see Amber's experience as a doulaand Becky's birth of her second child - immediate emergency c-sections saved the lives of those two babies)
• Ventilator - a machine that facilitates breathing (see Christine's Birth Story of Baby Penelope and how a ventilator saved her daughter's life when she was born)
• Specialized diagnostic equipment and staff
• A skilled team of nurses and doctors that are current in the following skills (these skills are frequently used either on the job or through hospital drills):
• Neonatal Resuscitation
• Advanced Life Support
• Intubation (and obviously the equipment for such) – provides a much more effective way to oxygenate a person (of any age) compared to resuscitation

Also keep in mind, to be trained in Neonatal Resuscitation or Life Support every few years and practicing only on a dummy is very different than using those skills on-the-job in a true emergency, on a real mother or baby. In a hospital, you have other sets of eyes and hands to help, to shout direction or take over in case someone freezes or forgets under pressure, you have a back-up for your back-up for your back-up. They will be able to tend to baby AND mother at the same time, if needed.

From a nurse midwife student: "Not only is there a team full of certified, competent people, but in a hospital, they are running dystocia drills or practicing for other obstetric emergencies. These are people who have practiced working together, who have assigned roles, and in addition to all the drills, have seen their share of real emergencies. They not only have a pediatric and adult code teams, but depending on size and type of hospital, they may also have OB rapid response and code teams as well,as they do in my hospital. It's a well oiled machine."

Nurses will keep a watchful eye on mother/baby in the hospital not just during the immediate postpartum period but for the length of their stay, checking vitals and looking for signs of infection, breathing complications, arrhythmia, postpartum hemorrhage, seizure, undetected birth defects, etc.

It is true that an Operating Room may or may not be available immediately when an emergency c-section is needed. In some cases, a doctor can have a baby born via cesarean in less than 5 minutes, including travel time from the Labor and Delivery Room to the Operating Room. In other cases, it may take longer depending on the availability of the Operating Room, anesthesiologist and obstetrician. However, the added commute from a home or birth center will certainly not help facilitate a c-section any quicker – in addition to travel time, the hospital must do its due diligence to admit the mother and monitor the baby and mother before performing any emergency surgery. "

I stand by my opinion that HBACs carry a much greater risk than a VBAC in a hospital environment. There are so many factors that need to be taken into account. 

Yes it is your body, and yes you should trust it. But you should also plan for any eventuality. I can not imagine the pain that a mother would go through from losing a child, and I wan't to do as much as I can to prevent that from happening.

So please before you decide to go ahead with your HBAC, think about the risks, and take a moment to think about your unborn child and what would happen if you hit a serious complication. I've read so many heartbreaking stories in regards to women who have lost their babies via HBAC and VBAC in a birthing centre rather than a hospital. 

Annas Story (will bring you to tears) She lost her precious baby due to Uterine Rupture: http://navelgazingmidwife.squarespace.com/navelgazing-midwife-blog/2014/4/7/annas-uterine-rupture-story.html

I know I can't change the minds of some people in regards to HBAC, I'm just a mum afterall who had a failed VBAC and thanks her lucky stars every day that the outcome was positive. But if I can save just one life then that's all that matters.

I also want to add that I don't blame any of the mums who lost their babys through failed HBACS. They are innocent in a world of advocates brainwashing women that this practice is safe. I am 100% sure that if these mums knew all of the risks that they wouldn't have gambled their childs life. It's not something we do as mums. I blame the advocates and the fact that this has yet to be outlawed.

If you are a mum who has lost their baby - please don't blame yourself, instead focus on educating other mums on the dangers of HBAC. Lets work together to save lives so that your precious angels can look down knowing they have done what they came here to do. 

Much Love

Bella xxx

Strange Day

Well today has been a weird day so far, I've been researching for part 3 of my follow up on the HBAC post (which I will publish tomorrow) and dealing with a very stressed, agitated and clingy 4 year old as Daddy has gone away for a few days.

I'm a little concerned as to how he will cope at school. DH will be back Tuesday evening and do the school run Wednesday so all should be well then, but as any of you also dealing with a child who suffers from Social Issues/ Aspergers life can become very challenging when change is upon them! I guess I will just have to wait and see what happens. He was great this morning getting ready, but very clingy and  tearful when I dropped him off.

On a lighter note, I was asked to book the travel and accommodation for the guys before they left and somehow managed to book the ferry the wrong way around (Calais - Dover). I'm such a clutz at times, in hindsight the fact the website was in French as I was booking it should have been a dead give-away... All's well that ends well, thankfully they managed to get it sorted out and arrived safely in Germany yesterday afternoon.

Bella xxx

Follow up to my anti HBAC post Part 2 of 4 - Why I chose to try a VBAC (Vaginal Birth after Caesarean)

When I found out I was pregnant with DS2, I knew I wanted to try and have a normal vaginal delivery so I started to look into my options, I read into both VBAC  and HBAC. This post covers planned VBAC in hospital, why I chose to attempt one and the benefits and risks. I'll cover HBAC and Caesarean in my next two posts.

I had already had one caesarean and knew the recovery time would be much longer if I opted for an elective. However I must stress my last section was an emergency and elective sections are typically much easier to recover from as your body hasn't been through the stress of labour prior to the operation.

For me the main reasons for wanting a successful VBAC were as follows:

1. I wanted to experience giving birth 'normally'
2. Vaginal births are much better and less stressful for baby
3. Vaginal Births are much better and less stressful for mum
4. Recovery time is much faster
5. No limit on when you can drive (6 week driving ban after a section)

There are risks involved in trying for a VBAC, but to me the benefits outweighed the risks and considering that the risks involved in a vaginal delivery are lower than that of a section I came to the conclusion that as long as I laboured in hospital it would be a safe option. 

I wouldn't advocate trying for a VBAC in any facility that isn't equipped to handle a Caesarean just in case there is an emergency, especially as there is a 1 in 200 chance of Uterine Rupture! If you have been following my blog you will already know that I was that 1 in 200 and had I not have been in hospital or a facility equipped to cope with such an event then I would have lost my baby and potentially my own life too.

VBAC is also a preferred option for women who are planning more children. Whilst the risk between VBAC and a second Caesarean is minimal, the risks in a third or fourth Caesarean start to rise dramatically. So VBAC is a much better option for those wanting more children. For me it wasn't one of my reasons behind opting for VBAC as I don't plan on having more children, but if you are it is something to consider.

There are two main risks involved with a VBAC. The first is you may need to end up with another Caesarean, this is most likely if the reason for your first was failure to progress. For me this wasn't an issue as my first was due to malpositioning and I had managed to fully dilate and start pushing prior to my first section when DS1 decided to move and then get himself into distress. 25% of VBACs will end in a repeat section, the chance of a repeat section lowers to 10% if you like me did manage to progress to full dilation prior to the section.

The other risk involved with a VBAC is far more serious and is the Uterine Rupture. 1 in 200 VBACs will end up this way (0.5%) This is when the previous scar breaks open internally and baby breaks through the wall of the uterus into the abdominal cavity. This unfortunately is what happened to me.

If this does happen to you then like me you will need an immediate emergency Caesarean to prevent complications such as haemorrhage, brain damage to the baby or infant death. You may also need a hysterectomy if they can't fix your uterus after the rupture. Thankfully for me they managed to save my baby and my uterus and thus save me a life of hormone replacement.

Whilst the prospect of a Uterine Rupture is extremely scary, as long as you are in a facility that is ready to deal with it then the chances of perinatal death are greatly reduced. You will have staff on hand to immediately deal with the situation.

It is worth considering that 6.2% of uterine ruptures are associated with perinatal death and that 33% of women with uterine rupture will require an emergency caesarean. Whilst these statistics seem scary, bear in mind that rupture only occurs in 0.5% of VBAC's so the risk of perinatal death from attempting a VBAC stands at less than 0.005% (I can't vouch for the accuracy of this figure, but it is low)

It is also worth considering that for VBACs in a hospital environment or a facility equipped for an emergency section that the maternal mortality rate due to uterine rupture is 0%.

So whilst there are risks associated with a VBAC they are minimal, especially if you ensure that you labour in an environment equipped for an emergency.

I feel blessed that I was in a great hospital with fantastic staff on hand when mine ruptured, my outcome could have been so different had I laboured at home.

Overall I am pleased I tried, and I don't regret it at all. Yes I got unlucky, but as with anything you never know unless you try, and I felt secure in the knowledge that I was safe if/when the worst happened. It's always good to remember that 75 - 90% of VBACs are successful, so the odds are in your favour :) 

Bella xxx

Follow up to my anti HBAC post Part 1 of 4 - Pros and Cons of Home Birth in general

I can't believe the amount of views my last post has gained. I have had a few responses in regards to HBAC from people still advocating that it is safe and low risk.

I still stand by my opinion that HBAC is extremely dangerous, I'm a firm advocate for VBAC as the benefits of a vaginal birth are far greater for both mum and baby and despite my experience with a failed VBAC, Uterine Rupture and Placental Abruption I do not regret trying for a VBAC. 

The risk of Uterine Rupture in a VBAC is 0.5% or 1 in 200. There are sites that state the risk can be as high as 2% but I can not vouch for their accuracy. Whether it is 1 in 200 or 2 in 100 the risks are still high and not as low as the HBAC advocates would have you believe.

I do agree that with a home birth you are likely to suffer less complications as there isn't as much intervention. Your body is able to do what comes naturally without drugs and assistance and this can be extremely beneficial.

Over the next few posts I want to evaluate the risks and Benefits of Homebirth, VBAC, HBAC and Caesarean Section. You can then make your own mind up as to what you feel is safe for you and your baby, but as always my main purpose is to discourage as many women as possible from HBAC. I am not trying to brainwash you or strip away your rights as a mother. All I wish to do is inform you based on my own personal experience and research. If I manage to save just one baby from someone having read my blog then my work is complete.

This post will focus on Home Birth in general, links to all of the resources used will be at the bottom of the post.

Benefits of Home Birth (In general not HBAC) according to the Birthplace Study

(Thanks to The NCT for the following information)

• a lower risk of having a caesarean section,
• a lower risk of an assisted delivery, i.e. forceps or ventouse and
• less risk of haemorrhage.

"The study found that women planning a home birth were more likely than women planning for birth in other settings to have a ‘normal’ birth. In this context, normal birth is defined as labour that starts spontaneously without induction, progresses without the use of an epidural, and the baby is born without assistance from forceps or ventouse nor the need for an unplanned caesarean.

Birthplace results show 88% of planned home births were ‘normal births’ compared to fewer than 60% of planned obstetric unit births.

Other studies have shown that labour tends to progress well at home, where women feel relaxed and free to move as they wish. It is usual to have continuous care and support from a midwife that you have met, or come to know quite well, during pregnancy. You are also under less pressure to labour within strict time limits. This means there is less need for intervention, such as drugs to speed up labour, or delivery with forceps or ventouse.

As well as potential benefits, these interventions carry risks, and are more likely to be suggested if you have your baby in a hospital. Finally, there is less risk of infection at home, for both mother and baby.

Your midwife will monitor your baby's heart and your condition regularly through labour, and will advise that you transfer to hospital if she has any concerns about the health of either of you. The aim is to transfer well before a situation becomes an emergency."

Why do women choose planned home births? 

(Thanks to the Mayo Clinic for the following information)

" You might choose a planned home birth for many reasons, including:

• A desire to give birth in a familiar, relaxing environment surrounded by people of your choice
• A desire to wear your own clothes, take a shower or bath, eat, drink and move around freely during labor
• A desire to control your labor position or other aspects of the birthing process
• A desire to give birth without medical intervention, such as pain medication
• Cultural or religious norms or concerns
• A history of fast labor
• Lower cost "

Are there situations when a planned home birth isn't recommended?

(Thanks to the Mayo Clinic for the following information)

" A planned home birth isn't right for everyone. Your health care provider might caution against a planned home birth if you:

• Have diabetes, chronic hypertension, a seizure disorder or any chronic medical condition
• Previously had a C-section
• Develop a pregnancy complication, such as preeclampsia
• Are pregnant with multiples or your baby doesn't settle into a position that allows for a headfirst delivery
• Are less than 37 weeks or more than 41 weeks pregnant "

As you can see with a home birth you have a higher chance of a successful natural birth with no intervention 88% rather than the 60% who labour in hospital. I do struggle to make sense of the figures though. Considering the fact that more people choose to labour in hospital than choose a home birth I'm not convinced the percentages are wholly accurate and can't vouch for how they have been attained. I will agree that in my opinion the risk factor for complications does go down with a home birth.

However there are still risks that do need to be considered. According to the Mayo clinic (and again I can't vouch for the accuracy) Despite the fact that due to careful screening 'planned' home births have a lower risk of complications, they are also associated with a much higher risk of infant death than a hospital birth. I can only assume that this is down to the time taken to transfer a labouring woman to hospital once complications start. The risk of infant death with a home birth is double to triple that of a planned hospital birth. Whilst this sounds very dramatic the risk is still very low. 

There are studies that show the risk of infant death to be quadruple that of a hospital birth. In a study led by Dr Amos Grunebaum a professor of clinical obstetrics and gynecology at Cornell University's Weill Cornell Medical College. The researchers found that the absolute risk of a baby dying at birth or in the 28 days following delivery was 3.2 per 10,000 births when a midwife delivered the baby in a hospital, compared with 12.6 per 10,000 births when a midwife delivered the baby at home.

The risk is increased (in my opinion) in homebirth as there is no immediate access to critical care for mother and child. I needed immediate medical attention for both of my births. With DS1 my pregnancy was textbook and I even considered a homebirth myself. However I opted for a planned hospital birth with minimal intervention just to ensure that if anything should go wrong that I was in the right place at the right time. I lived a 20 minute drive from the hospital and this heavily influenced my decision, had I lived closer I may have chosen to birth naturally at home. I wrote about my birth experience with DS1 in a previous post so won't go into detail in this one.

With DS2 the concept of a homebirth didn't even cross my mind, I knew I wanted to try for a VBAC, but I wanted to be in a safe environment with access to immediate critical care if need be. Home birth (HBAC in my case) was not an option or something that I wanted to risk, and I'm pleased I chose to birth in hospital as without critical care within minutes I would have lost my son.

The choice to homebirth or not is ultimately one of the mother, and not one I would choose for myself in hindsight. Whilst there are risks, compared to a HBAC these risks are relatively low, and there will always be risks with any pregnancy or labour.

Opinions are all my own as is your choice to homebirth or not.

Bella xxx


Resources:

http://www.nct.org.uk/birth/home-birth-safe - Benefits of Home Birth
http://www.nct.org.uk/professional/research/pregnancy-birth-and-postnatal-care/birth/birthplace-study - Birthplace Study
http://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/home-birth/art-20046878 - Pros and Cons of home birth
http://www.webmd.com/baby/news/20140203/study-ties-home-births-to-higher-infant-death-rates - Home Birth leads to higher death rates

Why I am so against HBAC - DS2 Birth Experience

Before I explain why I am so against HBAC (Home Birth After Caesarean) I must say that I am not against home births in general, if a woman can safely birth in a comfortable environment without intervention then that could be a truly wonderful experience, and I wouldn't want to interfere with their choice. For me I am glad I didn't go with a home birth for my first son as it did end up in disaster and an emergency section. So had I opted for a home birth neither of us would be here today.

However the risks are very low and it is all down to a matter of choice. I would only advise if you did choose a home birth for your first child that you are within a short distance to the hospital just in case things do go wrong. I am however also aware that home births often have less complications so most of the time do not pose an issue.

With a HBAC the ball game changes completely. There is a 0.5% chance of Uterine Rupture. This seems relatively low until you consider that it is in fact 1 in 200! All of a sudden the chances are higher than you imagine.

When I fell pregnant with my second son I knew that I wanted to attempt a natural delivery and decided to try for a VBAC (Vaginal Birth after Caesarean)

It wasn't something that I had my absolute heart set on, but something that would have been nice to achieve if at all possible. I learned with DS1 that making too many plans for the birth  is pointless, you can't predict what will happen until the time comes.

My choice for a VBAC was for several reasons. Mainly I wanted if possible to experience a natural delivery, and with a 4 year old to run after I was hoping to be back on my feet as soon as possible. With DS1 I suffered an infection and it was 3 months before I was back on my feet. I weighed up the pros and cons of a VBAC versus an Elective Caesarean and decided that the benefits of a VBAC outweighed the risks.

My due date was 6th March 2015, although due to my size and the size of DS2 my consultant thought I may deliver a couple of weeks before this, so from 38 weeks we were on high alert and waiting for those first pangs of labour to start.

After what seemed like an eternity and 41 weeks down the line my contractions started (On the evening of Friday 13th of all days) We called DHs mum to come over and watch DS1 for us, and within an hour we were at the hospital.

My labour with DS2 was totally different to DS1, my waters never broke and the contractions were thick, fast and excruciating from the onset. We arrived at the hospital a little after 11pm and went through to triage where I was just 2cm dilated. Because of my previous section and the intensity of the contractions they kept me in to monitor me and by 4am I was 4cm dilated and moved to the delivery suite.

I felt like I had reached a huge milestone and that everything was going to work out as planned, I was very positive about achieving a natural birth. I did choose to have an epidural at the earliest opportunity. I'm a great believer that if there is something to assist with the pain then why suffer (and labour is very painful)

The anaesthetist arrived at around 5am, and by 6am I had my epidural in place and fully topped up (It took longer than expected as my body was fighting the tube going in). I was told to keep self administering every ten minutes to ensure that it was topped up to the maximum (my intention was to use and abuse it for the worst of the pain and then slow down once I got to 7-8cm so that I could let it ease off and feel when to push with the contractions)

I was examined again by my midwife at around ten past 6, my waters had still not broken and I was sat at 5cm dilated. At around 7.30am the midwife broke my waters to help speed things up a little. Once my waters had broken the contractions were back thick and fast (but pain free) and again I felt positive that all would be ok and that I could do this. I was examined again at around 8am and still no progression with dilation.

My contractions were starting to get a little more painful so I was topping up my epidural every ten minutes to try and counteract them. Then at around 8.30 I was hit with the most excruciating pain I have ever felt (and never wish to feel again) It was like one long contraction that never ended, combined with someone tearing my insides apart with red hot knives. The midwife immediately pressed the emergency button and examined me.

I looked down and had never seen so much blood in my life, I started to panic, all I cared about was my son being born alive. The consultant was in the room in less than 30 seconds, and before I could say anything I was being whisked into theatre.

My uterus had ruptured and taken out my placenta at the same time!

I can remember being told they would have to give me a general anaesthetic as they needed to act fast to save us both, I can also remember screaming at them to save my son. I didn't care what happened to me. Then it went black.

My son was born at 8.34am with an Apgar of 9, which is incredible considering the circumstances he was born in, and testimony to the speed and efficiency of the doctors. I didn't get to meet him until several hours later as they had to continue working on me once he was out.

Had I been at home, or even in a birthing unit without immediate access to a hospital then we would both had died. Once the uterus ruptures medical staff have just a few precious minutes to save the life of your unborn child, and then limited time after that to save you!

With a 1 in 200 chance of this happening I can not understand how anyone would want to take the risk and have a HBAC. I know that people have done it successfully and they continue to campaign for more women to try. But really? You may as well take a 200 shot revolver with two bullets (one for your child and one for yourself) and then play Russian Roulette.

It's simple math! More and more mothers and babies will die if the HBAC campaign continues, I've read the stories of mothers who have lost their babies due to Uterine Rupture and its heartbreaking!

I'm one of the lucky ones, and as I look at both of my boys I count my lucky stars that we are all here today!

So HBAC? Would you really want to take that chance with your childs life? I know I wouldn't!

Bella xxx