My VBAC story

A picture tells a thousand words. For the complete story of my kids’ births visit my website: www.casmccullough.com/stories.shtml.

There aren’t too many issues that would compel me to plan a last minute road trip to Canberra but when I read the draft legislation on registration of midwives, I realised that I had to go and be among the many mums and babies, small children and midwives doing just the same.

My passion for this cause doesn’t stem from my own experience of homebirth because I’ve never had a homebirth. My passion extends from my births, yes… but also from my anger that women’s rights are being completely eroded by this legislation. The legislation was put in place to protect consumers but what it is doing instead is putting a stranglehold on midwifery practice and ensuring it will forever be under the thumb of medical dominance.

It makes my skin crawl to think that midwives and women may be slapped with a $30,000 fine if they went ahead with a planned homebirth. And what of all the unplanned homebirths? What happens to a woman who planns a hospital birth but slips a baby out at home while her midwife is walking through the door? This legislation is unjust, and really, un-enforceable! Are they really going to fill jails with knitting circles full of wise women? It just makes no sense!

So, I am planning a trip to Canberra in September and am taking son no. 1 with me to give him insight into our democratic process. Only I don’t feel like I live in a democracy at the moment. Any government that thinks it can legislate away a basic human right cannot really call itself a democracy.

The freedom to choose what we do with our bodies is a basic human right and a basic tenet of democracy. What is happening to childbirth in Australia will force women to give birth in an institution and this may have extremely detrimental consequences for some women.

To be fair, perhaps the government should consider issuing fines to women who elect to have a caesarean for no medical reason… but then, that would be absurd wouldn’t it? So why is it any less so for a homebirth?

That the majority of people are too busy to understand the complexities and evidence behind the choice to birth a baby at home doesn’t surprise me. But it never ceases to astound me how quick people are to judge women who make this choice or who, indeed, feel they have no choice. Why do people believe what some pubescent journalist fresh out of uni says when nine times out of ten the information is at best superficial, at worst down right lies? And they certainly don’t improve their reporting accuracy as they get older…

Take the case of an opinion piece in the Daily Telegraph today http://www.news.com.au/dailytelegraph/story/0,22049,25298631-5001030,00.html.

The journalist, Fiona Connolly, claims “Home births are selfish, irresponsible, anti-reason and anti-progress.” She also has the audacity to compare birth in a poverty-stricken, war-torn Somali village with homebirth in the safe, leafy suburbs of Australia. Connolly fails to consider that women who homebirth in Australia DO have access to all the modern technology and a trained professional to assist them. Somali women in remote villages do not. I’m not really sure where the reason comes in to this argument.

What strikes me about this ill-informed piece was what was missing. What about the perinatal mortality rates of New Zealand and the UK and the Netherlands, all of which have state-sanctioned homebirth programs? Their perinatal mortality rates are not only comparable to or better than Australia’s but their intervention rates are better. Perinatal mortality rates in Australia are 10.1 per 10,000 live births. It is the same in New Zealand (despite their vastly smaller population which tends to skew statistics to look worse than they actually are). The UK’s perinatal mortality rate is 8 per 10,000 live births and the Netherlands 9 per 10,000 live births.

To support her point that all homebirthers care about are candles and home cooked meals, Connolly quotes various celebrities who have gushed over their homebirth experiences. But by pulling these quotes from the Homebirth Australia website she failed to do her homework and find out that Elle Macpherson birthed with the assistance of a private obstetrician in a birth centre. And where was the flippant quote from the great Australian thinker and journalist George Negus who’s wife Kristy was also a homebirther? Is Connolly seriously calling educated and philanthropic people like George and Kristy “selfish, irresponsible anti-reason and anti-progress?”

Another interesting nugget in Connolly’s rant is that she mistakenly believes that narcotics somehow make birth safer and that women who homebirth don’t have access to antibiotics, oxygen and oxytocic drugs. This is far from the truth. Most homebirthers are well aware of the need to obtain an oxygen tank, and oxytocic drugs from the local pharmacy prior to birth and organise this with their local GP (because midwives are prevented from prescribing these in Australia despite it being within their scope of practice). That said, most women who birth at home choose to avoid drugs and unnecessary antibiotics, not just because they want a beautiful birth experience but because they are informed and educated about the harm these can do to their babies. The fact is, we aren’t in a war torn country with no access to medical care when it is needed. Women who genuinely need antibiotics are referred by their midwife to a GP or to the hospital for treatment. But let’s not let the facts get in the way of a good homebirther-bashing.

That women have lost babies in childbirth is sad and tragic but we are not in a position to judge whether or not being at a hospital would have made any difference in any of these cases. We are also not in a position to judge whether being at home might have saved the woman who died from an amniotic fluid embolism or who’s baby’s throat was accidentally cut during surgical delivery. On mercifully rare occasions terrible things happen in childbirth in whatever environment a woman births in—be it home or hospital–but telling every woman that she should have no choice but to birth her baby in a hospital is not only irresponsible it is misogynistic and misguided.

Australia: Law et al, 2008 (AIHW)

New Zealand: NZHIS, 2006

UK: CEMACH, 2008 & NHS Information Centre 2008

Netherlands: Statline, 2008 (Statistical Yearbook 2004)

NB: It is important to note that different countries record perinatal statistics differently. The WHO standard is to report deaths from 22 weeks gestation. Most countries, however, seem to record rates from either 24 or 28 weeks. In order to present a more consistent picture, the 24 weeks has been used where possible.

Tuesday, 16 September

I could feel myself slipping away. Dizziness took hold of me as I struggled to walk to the toilet, my husband on one side, a ward nurse I don’t even remember now on the other. I could feel the whiteness of my skin, the shallowness of my breath. It was a futile endeavour. I lay back down on the bed, exhausted, unable to move, in pain.

The nurse came in to take my blood pressure. “That’s quite low!” he said. “I think we’d better get you in for that scan.” I had come in that morning at about 10.30am and had been waiting all day for a scan that would tell me whether or not my baby was stuck in a fallopian tube. Why was it taking so long?

He rushed out to see if he could hurry things along. My husband and my three year old Adam left to pick up our other children and try and find a babysitter. I waited there alone.

At about 5pm, a friendly face came to my side. I recognised her—Rebecca*. We’d done a course together at Community Health. We both had sons with Autism.

Rebecca was about to wheel me into the scan room herself when a wardy finally showed up. With the help of a nurse, Rebecca tried to roll me onto my back. My body seized. I couldn’t breathe and started to panic. She quickly called for help. The nurse gave me some oxygen and put a pillow under my right side so that I wasn’t flat on my back. It was better but I still felt pain with every breath.

It was easy to see that something was wrong straight away. There was no obvious baby blob in the uterus but there was something elsewhere. She then did a scan of my upper right side and found two large gall stones and a lot of excess fluid in my peritoneum. She didn’t say what that was at the time but told me the gall stones were benign. Thank goodness for small mercies, I thought to myself.

The ER doctor was called in and shown the damage. I kept asking, “Are you sure?” Rebecca was certain. The pregnancy was ectopic and my right fallopian tube had ruptured. I was bleeding out and didn’t even know it. That’s why I felt so much pain. That’s why I couldn’t breathe. The fluid was accumulated blood.

The registrar was called in and the nurse phoned my husband to come straight back. I began to cry for the baby I would never meet but didn’t understand that the hurrying around was more about saving my life than getting my baby out of me.

Within a short while, my husband and children had gathered around me. My boys looked perplexed, a bit scared. I reassured them that the doctor was going to make me all better. I found out later how scared my eldest was of losing his mum. I have wept many tears thinking about the unthinkable, what would have happened to them if I had died.

A midwife I knew came in and told my husband, Wayne, she’d take the boys home with her for the night so he could stay and wait for me to come out of surgery. Because I was a consumer representative at the hospital, I knew a lot of staff members in Maternity. They all came to see me at one point or another during my stay in hospital. They all offered support and help. It was humbling and deeply felt.

I had no fear of the anaesthetic. I just wanted it to be over. They rolled me on to the table gently and we waited for what seemed like an eternity for the surgeon to walk through the door. I could hear the anaesthetist say that he didn’t want to put me under until he saw the surgeon. I felt like a beached whale, unable to breathe. The surgeon came in and a mask went onto my face. I heard conversation and felt a funny sensation. The talking didn’t stop and I thought, ‘Why is it taking so long? It’s not working” but quickly realised that I had simply slipped into a dreamless sleep and had just been awoken in recovery. It was over, for now.

The registrar came to my bedside in recovery and said, “You are a very lucky young woman. The surgery took a long time, about 1.5 hours. We tried to do the keyhole surgery but there was too much blood so we had to do a cut through your caesarean scar to remove the tube and the products. The foetus was quite well developed and had a placenta….” I felt a pang of deep pain in my heart.

He went on to tell me that I had lost a lot of blood and that he was shocked at how stable I had been during the surgery. I had been given two units of blood and would probably need more…. All I could think about was my baby and I wondered what they had done with him/her. I wished I’d asked for the “products” to be kept for me but I hadn’t thought about it at the time. And now I had yet another scar on my belly.

The next morning, the registrar came in to see me, check my wounds and go over the surgery with me once more. He said that given the amount of blood I’d lost, he suspected that I’d sprung a slow leak up to a week prior to the surgery… My mind raced back to the week before.

Rewind to the Week Before…

Driving to school one morning I had felt a sudden sharp pain in my right side but it went away, so I didn’t bother to get it checked out. I flew to Melbourne on the Friday, feeling a bit unwell and bloated. The Sunday night I left Melbourne is when things started to go really wrong. I thought I had a gastro bug. My husband had been unwell the week before and I thought that I’d caught his bug. An hour before I had to catch my plane home, I rushed to the toilet and stayed there for half an hour with cramps and diarrhoea. Something was seriously wrong with me. Somehow I made it onto the flight and somehow made it home. When I got home I vomited everywhere and collapsed in bed.

The Monday evening I phoned the midwife we had planned to hire on and I talked over my symptoms with her. She thought I had gastro and said to get plenty of rest. I had pretty much done the bare minimum that day. That night I woke up with massive cramps in my abdomen and couldn’t stop vomiting. I begged Wayne to take me to hospital. I kept saying, “This is not normal, something’s wrong.”

Wayne thought I was just sick and talked me out of going to the hospital. The next morning he arranged for the boys to go to after school care and left me in bed, with Adam in front of the TV, while he went into work for a few hours.

I phoned my friend Deb (who’s also a midwife) and she listened while I recounted the events of the last two nights. Then she asked me if I thought it could be an ectopic pregnancy. I said I thought it was gastro or maybe kidney stones at worst. In hindsight I didn’t want to entertain the notion that I would lose my baby. Nevertheless, she said I should check in with my midwife and get her opinion. I did that and my midwife said that I should get things checked out. By the time I phoned Deb back, I was in agony again and told her I was calling an ambulance. She dropped everything and raced over to my house to collect Adam and got there just as the ambos were getting me into the van. Another friend, Kathy (who runs our local BaBs group), who had phoned me just after I’d phoned the ambulance, also raced over as she lived five minutes away. Adam retreated to his bedroom when the Ambulance officers took me outside so I was grateful that he had some support arrive at that moment.

After the Ambos took me away, Deb went to check on Adam and asked, “What’s wrong Adam?” “I’ve lost mummy,” he said. “Well, let’s go and find her then,” said Deb. She packed up his things with Kathy’s help and then drove to the hospital to look for me.

Deb arrived just as an A&E doctor came in to assess me. I told the Doctor I was eight weeks pregnant. She asked me if I had confirmed that with a blood test. I felt exasperated. No, I had taken a home pregnancy test. She drew my blood to “make sure I was really pregnant.” Deb asked about the scan but the Dr insisted she needed the blood HCG levels first. A&E was busy and the blood test took a long time to come back. They had given me some morphine and nausea medication for the pain and nausea but the pain never subsided. My mouth was dry and I asked for some water. I hadn’t really had any all morning. They refused, saying that my chart said Nil By Mouth. I asked for some ice chips instead and Deb went looking for some, giving me little bits at a time.

The Dr then came in and said she wanted to do a speculum exam to check for bleeding in my vagina. There was none and I wondered why they weren’t just doing a scan. It seemed like a massive waste of time. At about 2pm, Deb had to go but Wayne showed up just as she left. Throughout, Adam just sat there eating and playing. He was fantastic! I told him the Dr House would make me all better. It was after that, that things really started to go downhill.

The Aftermath…

Nights were the worst. The Nursing Unit Manager for birth suites had arranged for me to have a private room in the Maternity Ward, where all the gynaecological patients also go but there was a lot of noise which made sleep difficult. That first night, listening to babies crying, and some mothers crying was awful. Every night, I pretended that they weren’t actually babies but wild animals in the jungle. Mentally, it was the only way I could cope. I felt like that guy in I Am Legend, surrounded by a mutant mass of humanity gone wild.

I was in hospital for a week and it was the longest week of my life. I needed two more blood transfusions because I was still losing a lot of excess blood. That delayed my recovery somewhat. Then a cough developed into spiking fevers on the Friday night and I was sent off for an Xray the next day which showed my lungs had partially collapsed, probably from the surgery I was told.

On the Sunday I was referred to a medical registrar who ordered a preventative heparin injection and sent me off for a CT scan to assess whether or not I had a blood clot in my lungs (pulmonary embolism). This involved injecting a dye into my veins as I went through the large cylindrical CT machine. In the few days I had been in hospital I had been stabbed and jabbed no less than 27 times with about five recannulations. My veins weren’t coping too well with the massive amounts of antibiotics being pumped into them and the blood drawn each day to assess my haemoglobin levels. I was black and blue and looked like a junkie with needle holes all over my arms and hands. The worst was when they took blood out of my radial artery to check my blood gasses. The pain was excruciating. By the end of that Sunday, I just wanted to go home but they said I needed to stay another day for intravenous antibiotics because I had pneumonia…. Well at least it wasn’t a pulmonary embolism.

That last night on the ward I felt defeated. I thought they’d never let me out. I thought about my children who I had barely seen that past week. I missed them terribly. At that moment, one of the midwives I knew through our BaBs group walked in the door to see if I was okay. That happened a lot during my whole experience. At each moment where I felt alone or scared, someone familiar—a friend, my partner, a midwife I knew—walked through the door. I had a room full of flowers to remind me that people were thinking about me and not a day went by without several text messages and phone calls, sometimes more than I had the energy to handle.

I went home on the Tuesday, exactly one week after I had gone into A&E. Going home was definitely the best medicine. I couldn’t wait to hold and kiss my beautiful boys.

How this Has Changed Me…

As I sit here now pondering the events of the past few weeks, I feel a renewed sense of what is important and what I can just let slide. In many ways my near-death experience has overshadowed the loss of our baby (who we have named Angel Riley). I feel very blessed to be alive and make a point of taking quiet time in my day to appreciate just breathing. When my children need me I no longer tell them, “in a minute,” and when they come to me for a hug, a kiss or a cuddle I savour it all. Every day I have with them is so much more precious to me now.

Coming to terms with the fact that a pregnancy made me so sick was humbling and enlightening. In the back of my mind I knew that my previous caesareans put me at greater risk of an ectopic pregnancy but I never dreamed that one of my greatest fears would play out in the way it did. Now I not only carry an increased risk of another ectopic pregnancy but also have decreased fertility. I have accepted that I’ll need to get a scan when I get pregnant again to rule out another ectopic pregnancy. For me it is a cross I will reluctantly have to bear, but somehow it doesn’t seem so important to me now. What is important to me is avoiding another life-threatening disaster and losing my only fallopian tube. What is important is having a viable pregnancy next time around, hopefully with a happy outcome. What is important is to live every day like there is no tomorrow, to love my kids and my partner and be there for my loved ones and friends like they have been there for me these past few weeks. What is important is to be grateful for every day I have on this earth.

*not her real name.