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 

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

DS1 Birth Experience - Birth Plans out the window :)

It seems so long ago now but I can remember the experience as if it were yesterday. I had planned a natural birth and set out a very detailed birth plan, which I was encouraged to write by my midwife at the time. I had agreed with my partner to at least birth at the hospital as a precaution, especially as this was our first child and we were stepping into the unknown.

My pregnancy had been textbook, absolutely perfect, I was a walking example of exactly how the perfect pregnancy should go. Asides from the usual heartburn and aches and pains which I don't think any new mum to be can escape from :)

My birth plan looked something like this:

1: Natural birth with no intervention please (I would like my body to tell me what to do, and if I need advice I will ask)
2: Water birth (If the pool is available)
3: Ideally no male doctors or male intervention
4: Partner present throughout
5: No drugs only gas and air
6: Private room please once the delivery is complete

Of course the actual birth plan was a lot more detailed, but those were the salient points that meant so much to me back then.

I remember waking up at 1am in the morning feeling a little strange, I swung my legs out of bed and instantly my waters broke, nothing could prepare me for the amount of fluid my body had held for 9 months. The contractions started the moment my waters broke at an even 5 minutes apart, so I woke up my partner and let him know that baby was well and truly on the way.

By 3am I felt it was time to head on up to the hospital, unfortunately when we got there I was only 3cm dilated so they sent me home. By 5am I was back on the phone to the midwife, she assured me that being my first pregnancy that I wouldn't be in active labour yet as it takes a lot longer. I however wanted to go back to the hospital and get checked out. After all I was contracting every 2 1/2 minutes and the pain was pretty intense.

Once back at the hospital it was confirmed that I was in active labour and I was moved to the delivery ward where a midwife was allocated to me. All was going well, I dilated fairly quickly and managed to survive on gas and air until around 4pm. At that point DS1 decided to change position and thus I was now labouring back to back. Labour itself is pretty painful but spine on spine through contractions is agony. It was at this point 15 hours after going into labour that I opted for an epidural.

Despite my original hesitations I was surprised at how easy it was for the epidural to be put in place. I was also pleased that I got to control the amount of medication that was administered, it gave me full control and allowed me to block most of the pain whist still being able to move around and feel my contractions.

Unfortunately just as I reached the pushing stage DS1 decided to move again for a final time, and managed to wedge himself into the side of my pelvis a little too well. Despite the midwifes best efforts we couldn't move him back into position and DS1 was now in distress.

My midwife pressed the emergency button and within seconds my room was full of people. I was told they would be taking me into theatre to try vontouse and forceps, the fact we were going to attempt this in theatre was a precautionary measure in case DS1's distress levels increased.

My partner was sent off to scrub up and given a surgical gown to wear so that he could still be with me. I had to sign various amounts of paperwork as a precaution and then I was wheeled off to theatre. The process from emergency button pressed to me arriving in theatre took all of around 2 minutes!

Once in theatre we all did our best to get DS1 to move into position so that I could give a final few pushes and get him out naturally. Hospitals are always wary of giving caesarean sections if they can avoid them, but unfortunately DS1 started to get even more distressed and we lost his heartbeat.

I was told that they needed to perform an emergency section there and then, my epidural was topped up (thank goodness I had one in place) and within seconds they were pulling DS1 from within me.

I couldn't see what was happening as there was a screen in front of me, but I waited for a cry, I needed to hear him make some kind of noise but there was nothing. At that moment in time my whole world crashed down around me. My boy had stopped breathing and was in resuss.

There are no words to describe the torment I was going through. Thankfully for me we had a great team of doctors and a few minutes after he was taken from me I heard a *meh* not a scream, not a cry, just a small sound. It was enough to know he was fine, and he was placed in my partners arms whilst they finished stitching me up. A few minutes later I held my son for the first time and my world was once again complete.

I learned a lot from my experience, and I am truly grateful that I was in the right place at the right time. Had I birthed at home my son and myself would not be alive today.

As for birth plans.... Well I say throw them out the window right now. All that matters is that your little one and yourself come out the other end of childbirth happy and healthy. How you get there is irrelevant :)

Much love

Bella xxx