Janet: Attempted VBAC in hospital de Sant Pau
My first son was born by emergency ceasarean in 2009. I had wanted a natural birth at the time and hadn't even considered that a cesarean would happen to me and despite my lovely, healthy son, the birth took a lot of coming to terms with. Second time around I was determined to have a VBAC and during the pregnancy was delighted that both the midwife at the CAP and, later the staff at the hospital were completely supportive of my decision and saw no reason why it wouldnt be possible. After a healthy pregnancy and at 40 weeks and 5 days I woke in the night to feel some stronger than usual Braxton Hicks contractions and an ominous trickle of water between my legs. My waters had broken in my previous labour so I knew exactly what it was but as it was 4am I decided to try and get back to sleep and see what happened by morning. When morning arrived, not a lot was happenng, no more waters and no more contractions. I took my son to playgroup and briskly walked home to bounce on my birthing ball, listening to soothing music and trying to get contractions started. I was aware that, according to the hospital, there is a risk of infection once your waters have broken and that, in line with to their policy I should probably go there to be checked out but I wanted to give my body time to get things started on its own. Unfotunately, despite trying various methods of getting contractions to start nothing happened. At about 4pm some more waters came out and when my partner arrived home at 5pm I decided to go to the hospital - cheerily saying I would just get checked out and would then come back! Once there I was examined, it was confirmed that my waters had broken and I was told that, in line with their protocol, I would be staying there. I was gutted - I knew that I was now on a time limit to start labour naturally and I also knew that an induced labour could jeapordise my chances of a VBAC.
Despite endless walking of hospital corridors during the evening, my contractions still failed to become strong or regular and at midnight I agreed to have prostaglandin gel applied to my cervix in an attempt to get things started. The staff who were attending me were completely understanding of my desire to do things as naturally as possible but also had to comply with hospital guidelines which gave me a time limit to have the baby after waters breaking. During the night, my labour became more established and by morning I was having incredibly strong and painful contractions which unfortunatley were still not in a regular pattern and I was only a couple of centimetres dilated. The dilation rooms in the new hospital are great, they have adjustable lighting levels (I found I wanted it to be as dark as possible) and really strong showers and the midwives offered me lots of options to try and reduce the pain naturally, I tried the birth ball and a bar on the bed to hold as well as a hot cushion on my back and a few power showers which really helped. This continued throughout the morning but although the contractions were frequent they were still not regular and the midwives started to suggest that we should use oxytocin to get them into a regular pattern. They knew from my birth plan that I didnt want oxytocin as I had found it to be painful and unhelpful last time but time was running out so with reluctance from me and apologies from them we tried it but at a very low dose. By mid afternoon I was starting to tire and was not coping with the pain so well and thoughts of epidurals began to enter my mind - my birth plan clearly stated that I did not want an epidural and nobody had tried to presuade me to have one at any point but I eventually asked for one and, when the anethasist came, he was able to give me a low dose epidural so I could still feel what was going on but not feel pain. After this they were able to up the dose of oxytocin and I started to dilate faster. When I was about 6cm I was examined by a doctor who said that the baby was in a posterior position. By this point my waters were completely out and felt like the baby's head was knocking on my cervix! I tried lying in different positions to move the baby to the anterior presentation and the labour contnued for several hours until eventually I was 10 centimetres dilated and, to my great delight, went into the birthing room to start pushing. Although you have to move rooms at this point you are kept on the same bed - they just wheel you through on it and adjust it to a birthing postion. The baby had still not turned from the posteror postion so as I pushed the doctor was trying to turn him manually which I have since dscovered is by no means common practice everywhere, in lots of places they would have just sent me for a c-section as soon as the posterior position was discovered. Eventually, after 3 hours of attempted pushing and turning, the baby was still not moving and the doctor started to debate whether the baby would be born using forceps or by cesarean. He clearly dd not want the birth to be a cesarean but eventually decided that as he was still so high up in the birth canal and was starting to show signs of distress, a c-section was the safest way to deliver him. My big, healthy, lovely son was born at 9.20pm and I had a quick cuddle with him before he was given to his daddy while they stitched me up.
This time round I have found the cesarean much easier to come to terms with and that is all due to the amazing doctor who spent so long trying to turn him when, given my history and the presentation of the baby etc, he could have ordered a c-section at any time and also the fantastic midwives who gave me and my baby every chance they could to have a natural birth. Of course Sant Pau is a hospital and so some degree of medicalization of the birth process is inevitable but I really feel that, within the restrictions they have, they do all they can to promote natural birth and breastfeeding.
Peta: Hospital Sant Pau
I'd had what was like a heavy period pain on and off during the night then managed to go back to sleep. My husband got me up at 8.50 in the morning two days after I was due. I wasn't feeling great, then about 20 minutes later my waters broke in our bathroom and they were really dark. So a little bit of panic set in and I started to have more and more violent contractions. We were running around the flat trying to get my daughter ready to spend the night somewhere and trying to work out who to pack her off with when I told my husband I was going to have to go to the hospital. So I started walking there (it's two blocks away). He came out of the house with our pram and couldn't see me (I'd turned the corner) and started worrying I'd collapsed in the street. I was almost at the hospital, having stopped every 10 paces for a contraction, when he started shouting at me to wait while he caught up but all I wanted to do was get to the hospital door before the next contraction. We rushed into the lift and walked to the labour wing. They examined me and I was 7cm and writhing around with contractions. They basically took me straight into the delivery suite and told me to start pushing to ease the pain. Eventually he came flying out with a ventouse, they cut the cord from around his neck and then left us there for an hour or more with the lights down while we had a bit of a feed. He was born at 10.05am!! weighing 3.1kg, actually a bit less than my daughter. We spent two nights in with no problems - except lack of sleep, then walked home. All in all I was very, very lucky because it was so quick but very painful!
Olga: Homebirth with Mireia from MareNostrum
I had planned a homebirth from the start as my sister also gave birth at home back in my native Russia and had a great experience. I knew I needed thorough preparation so I researched well the subject, used the Natal Hypnotherapy CDs throughout the pregnancy, swam twice a week, frequently used the birth ball, went to yoga for pregnant women classes, and really looked after my nutrition and generally the emotional and physical state. My husband and I followed the birth preparation course at MareNostrum in Barcelona and were happy with all the midwives we met there. In parallel we went to all our appointments at Tecnon in Barcelona but doctors there were a big disappointment. They prescribed unnecessary tests and antibiotics, and were keen to do a scan at every visit so in the end I just had to refuse them except for the main ones. This was however better than the first doctor that I went to in Sant Cugat where we live – on mentioning that we were thinking about home birth she said that we were irresponsible parents, almost threatened me with a law suit and said that Hospital General de Catalunya (we live right next to it) would not accept me in case of an emergency, which is a complete lie!
Anyway, I felt very well throughout the pregnancy and was looking forward to the birth. And that day came two weeks before the due date, on Monday 23 June. Contractions started on Sunday at 7-8 in the morning; they were light, and I had almost a normal day, just stopping when the contraction was coming and wiggling my bottom. Then at night they got more intense, I put on candles and peppermint oil in the burner, the birth music was playing, and I went on all fours on the bed and spent 22.00-3am like this. Then contractions got even stronger (well, there was no going back!) and my husband suggested I go in the bath. This was my last ‘remedy’ and I did not want to use it yet but he insisted, and so I did. The problem was that my back was sticking out of the water and all I wanted was heat on my lower back. Only afterwards did it occur to us that we could have used the shower to pour hot water on me. But in the heat of the moment I just got disappointed that it did not help and got out of the water. The contractions got quite regular and strong by then, every 2-3 minutes and I asked my husband to call Mireia, our midwife from Mare Nostrum, I was desperate for her to come and do something! When she came I was 6cm dilated and this really disappointed me as I thought the baby was about to come out, but here you go, patience… I sat on the birth ball and it worked for a while, and then on the birth stool. By that time, the pain was really strong but luckily the body took care of that, and now I remember little of it, the feeling was as if I was drugged, everything was in the haze, and I was falling asleep in between the contractions. My husband was running between me and the microwave to heat the socks filled with rice and put them on my back. This was making a huge difference to me, so he was constantly on the move. Mireia filled the pool in the meantime and there I went at 10 in the morning. It felt great, the contractions stopped for about five minutes and gave me a break. From what Mireia told me I spent two hours in the pool in transition, and one hour in the pushing stage. My preparation served me well then, as I kept repeating positive phrases from the tapes I was listening to, and also I was thinking: if my mom did it four times and my sister did it, I can too! I also thought about the baby, that he should not be scared, and that he should do it at his own rhythm. I felt it was very important to keep control over your mind, if not it was easy to start panicking. Anyway, finally I felt that ‘ring of fire’, and with a ‘gluc’ the head came out. Then with the next contraction his body was born. My husband and Mireia got him under the water and brought him up to the surface. We saw that his whole body was still in the amniotic bag – I did not break waters, so in the end it probably was not too bad for him… it was unbelievable to see this little human being emerge from the dark water, as if out of nowhere, and realise it had been inside of you. He started shouting for life and did that for a while! We sat there marvelling at him until Mireia said he might be getting cold and that I should get out of the pool. So I did, with him in my arms and the umbilical cord between my legs. I lay on the sofa and he breastfed a little, the placenta was born and my husband cut the cord. It was still unbelievable, surreal. Then I had a shower and we moved to the bedroom where we continued staring at each other in amazement! Mireia did a great job of cleaning up everything, she checked that we were all fine (I had a little tear but it did not need stitching) and left.
Looking back I am really glad we did it that way, it was only us doing it, it was gentle, on our terms, a family event, as I hoped it would be… We feel we gave our baby the best possible start in life, he is calm and happy. Mireia is a real professional, she created for us the feeling of privacy and was in control at the same time. We spoke English throughout the birth which was fantastic for me as my Spanish became all of a sudden non-existent! I would not change a thing about the experience.
Michelle: Homebirth after a caesarean
I had planned to have my first baby at home. Unfortunately it didn't turn out that way and I had to have an emergency C-section. It took months to recover emotionally and physically from this invasive procedure, and as a result I never fully bonded with my son. We still have a complicated relationship and he is very nervous and slightly hyperactive. When I became pregnant with my second child, I persisted with my dream to have a homebirth. Luckily I found Dr. Guillem Hernández and Marisa (midwife) who were willing to help me after having had a C-section. When the big day arrived (Christmas day) both Guillem and Marisa were amazing. Guillem's philosophy is the female body carries an innate wisdom in the birthing process and his only role is to oversee this and make sure everything goes smoothly. He will only intervene if necessary, but having him there is a great security. During the birth both Marisa and Guillem had a natural solution for every "complication". Any of these complications would have resulted in an invasive procedure in the hospital. They were also EXTREMELY patient with the process, in the hospital I would have ended up with another C-section because things were taking a while to proceed due to the scar tissue from my previous C-section. Marisa also provided relaxation techniques and tricks to make the "pain" and process very manageable. When Tahlia eventually came out, Guillem was very careful to let my body to the pushing and to not pull on her neck. I am convinced that this avoided the all so common spine and spinal cord trauma that almost all babies experience. I am also convinced that is why Tahlia was such a contrast to her brother: calm, a great sleeper, bonded and healthy. To this day she has NEVER had a drug in her body (never a vaccination, antibiotic, panadol.) and continues to thrive as a happy four year old. So, not only was this a great way for her to enter the world, but it was so much easier for my body as well. 24 hours after Tahlia was born I went for a 5 km. jog! I am baffled by women who say that they are scared of the pain of childbirth so opt for a scheduled C-section or epidural. And yet, in order to avoid this 24 hours of discomfort, they will suffer for the weeks that it takes to recover from a hospital birth! Trust me ladies, that 24 hours of hard work is well worth it, and you and your baby are worth it!!
Anitha: Clinica Remei
I had Louis at the Clinica Remei on 17 March 2006. I was happy with the treatment. My issue was that I did not know enough about birth techiniques so wonder whether it was really necessary to have an enema and episiotomy. Talking to other mums later it seemed these two procedures may not have really been necessary though my son was premature so the episiotomy meant it was less work/stressful for him to come out. Again as my son was premature, I had not talked enough with my gynecologist about what kind of birth I wanted - to be cut or not, pain relief, epidural. As it was, it worked out fine but next time I would be more prepared.
I went to pre-natal classes (in Catalan) and found them to be a complete waste of time. I did not go to the post-natal classes as I thought a) waste of money and b) felt as if the classes were just for the instructors to make more money - not actually to help the new mother.
Zoe: Homebirth with Mare Nostrum
I had a wonderful homebirth with Inma Marcos, an independent midwife who operates though the Mare Nostrum centre, and a doula called Imma Sarriez from Mares Doulas, both highly recommended.
I also visited the Seguridad Social midwives throughout the pregnancy; they orchestrated the blood tests and ultrasounds. I found them clinical and often downright rude, but luckily I was clued up and confident enough to refuse routine (and in my opinion) invasive procedures like internal examinations. They didn’t feel my belly once or check the position of the baby as opposed to Inma who told me late on in my pregnancy that the baby was posterior. Luckily, with special exercises, we turned him.
The actual birth was a wonderful experience - considerate, natural and on my own terms. Apart from how I felt, it was important to me that the baby was respected and treated with care- no bright lights, strange people and smells, no unnecessary washing and dressing, and no injections - we opted for the oral doses of vitamin K. I do not understand the desire for a hospital birth, for me hospital is where you go when you are ill, and pregnancy is not a sickness. The homebirth made me feel proud of my body, my experience and my rights as a woman.
Esther: Homebirth with Titania-Tascó
When pregnant with my son (now 18 months old) I started seeing a private gynecologist as we had private health insurance. After getting informed about the birthing options available here and realising that a natural birth was going to be hard to come by, I started looking at other options. After a weekend prenatal course with the association Titania-Tascó I felt very confident about having a homebirth with them. From then on, I saw my gynecologist for routine checkups and scans and also had a monthly checkup at Titania. When I went into labour the midwives, Tere and Pepi, came to the house. They were incredibly calm and relaxed and had total confidence in me at all times. I also had my partner with me and two friends. The birth itself was much longer than I'd imagined and the contractions were certainly painful, although choosing my posture well and some very effective back massage helped bring the pain down considerably. However, it was also a very joyful experience and it was wonderful to be surrounded by people who were all so supportive. I am now pregnant with my second son and plan to have him at home with Titania-Tascó again.
Rachel: Hospital Maternitat
I gave birth to both of my children in the Hospital Clinica Casa Maternitat, under seguridad social as I don’t have private healthcare. The first time was in August 2005 when I was 29 and while this hospital was automatically allocated due to the CAP I was attending for my antenatal care, I was also very happy about this as this hospital has a protocol for natural birth. It is quite typical to have an epidural during labour here in Spain, but apart from the effects that this can have on mother and baby, the thought of having an injection in my spine also freaked me out. Of course no hospital will force you to have an epidural, but with having a protocol the Casa Maternitat supposedly offer more support for a natural birth.
Antenatal care
I was perfectly happy with the antenatal care I received once I was referred to the hospital towards the end of each pregnancy. First appointment ‘booking in’ with a midwife, then subsequent appointments with the obstetrician. Unless he/she is on holiday when you’re due an appointment, you’ll see the same doc each time, but they will not necessarily attend your labour as it depends on whether it’s their shift in the labour ward.
I was overdue with both babies, and at 40 weeks started foetal monitoring (where they measure any uterine contractions, baby’s heartbeat and movements), and ultrasounds to check baby is OK. They allow your partner or a companion to be with you if you choose. At 41 weeks they repeated the monitoring and ultrasound, then it became every 2 days. At 12 days overdue I went into labour with my first baby – my waters broke and within 2-3 hours I was having contractions – more about the actual birth in the next section.
With my second baby I reached 42 weeks and decided to be induced. I’d had absolutely no contractions and my cervix was still long and closed, so showing no signs. I was never pressured by the obstetrician to be induced at this point – I was fine, baby was fine, but she told me that the performance of the placenta can diminish after this point and that this can be gradual or more sudden, so I’d be required to go into hospital every day for foetal monitoring after 42 weeks. I’d already noticed less movement from baby for the last few days and had been in once ‘de urgencias’ to check baby was OK, and he was, but as it was Friday with the weekend ahead I decided I didn’t want to be worrying myself at home. So she sent us home for lunch and told us to come back in the afternoon to be induced – more about the birth further down.
First labour
I arrived at hospital around midnight, about 3 hours after my waters had broken. I was taken to ‘urgencias’ for foetal monitoring. Unfortunately your partner is not allowed to accompany you for this which is absurd, but it’s apparently because there are two women to a room with only a privacy curtain – as if your partner is going to be interested in what’s going on with the other woman anyway! But there you go.
My contractions were quite infrequent at this point, so I was sent upstairs to the ward to wait until they became more regular and uncomfortable. My husband was there with me. It was a shared room (most rooms are double, though if available you can pay for a private room). At about 4/5am they were 4 minutes apart and I called the nurse, who said she’d arrange for us to go down to the dilation suite for monitoring.
There are 4 dilation rooms at the Maternitat – two with windows, two without. We were put in one without, bad luck… The rooms each have private toilet with sink, equipped with bed, birthing ball, stool, chair, and the four rooms share a shower that you’re free to use as desired.
Baby was doing fine but the contractions were becoming more uncomfortable so we decided to stay down in the dilation room rather than go back up to the ward. I had taken along a TENS machine (bought in the UK) which I was using to manage the discomfort. I had written this into my birth plan, and all the staff attending me had read my birth plan. The midwives basically leave you to it, checking you every so often. You are required to have foetal monitoring for 20 minutes every hour under the protocol, and they can see the readings from their central station outside the rooms.
The midwives encouraged me to drink juice and eat some biscuits around breakfast time, even though I really didn’t feel like it. I was in a lot of discomfort as the morning went on. At no point did they push the epidural. It was me who initiated the idea, asking at which point it would be too late… I wasn’t dilating very fast, and on top of feeling exhausted from not having slept all night (nor had I napped the day before, silly of me…), I was no longer managing the pain very well and losing control of my breathing techniques. Baby was also suffering – heartbeat dropping dramatically with each contraction, which were now coming with only 30 seconds rest between, and lasting about 1 minute each. Around 2pm we decided to have an epidural.
I was scared, in pain, feeling almost delirious and wanted my husband to be with me while they administered it. They wouldn’t allow him in as they transferred me to the delivery suite. One midwife tried to persuade the doctor, but he wouldn’t budge. The midwife was very supportive though. Once done, my husband was allowed back through. I was now on my back with legs in stirrups, exactly what I hadn’t wanted, but I was too tired and too out of it to care by now. Apparently I dozed off a bit during the next hour or so. I’d actually asked for not too much epidural as I still wanted to be able to feel enough to push my baby out – I was still a bit uncomfortable, but no longer in pain.
About 4pm I really started getting the urge to push, so the midwife said to go ahead. But then baby was really distressed (of course foetal monitoring is continuous once you’ve had an epidural), and wouldn’t turn to be born, the umbilical cord was wrapped twice round baby’s neck, so before I knew it they were preparing to deliver my baby using forceps. My husband had to leave while they gave me an episiotomy and used the forceps, only allowed back in as our baby daughter was just being born at 4.30pm. The cord was cut immediately because of it being wrapped round her neck, she was put straight to my breast, but was very pale and exhausted so had to go in an incubator for 10 minutes, and I said to my husband to go with her. They delivered the placenta by hand and then stitched me up and I don’t remember much about it. I just remember quite a lot of staff being present for the birth and afterwards – it’s a teaching hospital so that’s what you get…
While the birth wasn’t at all the experience I’d hoped for, I actually believe that in another hospital it might have ended in an emergency caesarean, so for that I’m grateful I was in a hospital where they are confident and skilled in using forceps. Actually when my daughter was a couple of months old I took her to see a cranial osteopath to check everything was OK, which is was with no damage done by the forceps, although there was some residual tension in her skull which the osteopath released in a couple of sessions.
So all in all I was happy with my experience at the Maternitat to want to go back there for my second baby, and this time I actually had to request the hospital as the automatic one from my local CAP is the Hospital del Mar.
Second birth
I arrived at ‘urgencias’ about 4pm to be induced, where I had to have foetal monitoring – without husband present, as before… After this they then did a vaginal ultrasound, even though I’d already had an external one that morning and everything was fine – just their protocol to do another when you go in to be induced. It was about 6pm when they finally took us to a dilation room (I asked for a room with a window and got one this time!), and gave me the prostaglandin strip. This would be left in place for up to 24 hours, and if nothing happened then they’d put me on an oxytocin drip. I was required to lie in bed and be monitored for 2 hours, and then as still nothing was happening I was shown up to the ward. I had dinner and sent my husband home, figuring that if we were in for a long wait he might as well get some decent sleep in bed at home. At 10pm I felt my first period-pain like twinges, but nothing major and went to sleep. At midnight I woke up and quickly realised I was in ‘proper’ labour. I felt my waters break about 15 minutes later, called the nurse and she asked me to tell her when my contractions were 4-5 minutes apart. 10 minutes later I called her to tell her they were less than 2 minutes apart! I’d called my husband to rush back!
By the time he arrived around 1am I’d been moved down to the dilation suite – I’d asked to walk rather than be pushed in a wheelchair as I could cope better with the contractions standing. I was 4cm dilated. Things progressed rather quickly. This time I’d brought with me a CD player to listen to relaxation music, a beanbag and extra pillows to get comfortable during and between contractions, and all of the midwives attending me were happy for me to get on with it as I wished – they’d all read my birth plan and respected what I wanted, especially not talking to me during my contractions so I could concentrate on my Hypnobirthing relaxation and visualisation techniques. I was allowed to be on my knees during foetal monitoring as I wanted to avoid being on my back, but when baby’s hearbeat seemed to be slowing during contractions they did ask me to try lying on my back to see if this helped him.
It actually didn’t, and as I approached transition the obstetrician came in and said they’d need to do a ph test (where they take blood from baby’s head) to check his oxygen levels. For this I’d need to go through to the delivery suite, but I was having such intense contractions that I kept saying hang on, wait a minute, I can’t move now, and before I knew it they were saying right, this baby has to be born now – PUSH! I was actually on my back on the bed, but at that point I didn’t feel I could move anyway and at least I was in control of where my feet were and not in stirrups. It all happened very quickly and with manual help from the midwife my son was born in 5-10 minutes at 3.25am. I tore where I’d had my episiotomy the first time round, but it was external only. As they hadn’t had time to do the ph test, they explained that they’d have to cut the cord straight away to test that for oxygen, and luckily the results were fine. Baby was put straight to my breast and left there for well over an hour while they stitched me up – it took a long time as I haemorrhaged badly after the birth and they had to give me syntocin to stop the bleeding. There were only three midwives present during this birth, and the obstetrician looking on but playing no part. So again this wasn’t quite the calm experience I’d hoped for, but perhaps the speed of my labour had something to do with that, and maybe that was down to being induced. Anyway, I managed a natural birth, and I honestly feel that I recovered from this birth much more quickly than the first one – both emotionally and physically. My son is generally more chilled than my daughter, but I don’t actually believe this has too much to do with the birth itself – I noticed he was different in utero compared to my lively daughter who used to kick me non-stop!
Post-partum
Your baby stays with you in your room in the Maternitat, apart from a couple of times a day when they’re taken to the nursery for checking over. But if the ‘queue’ is long you can ask them to come back and fetch baby from you when the wait will be shorter so they’ll be away from you less time. The staff, in my experience, have been pro-breastfeeding. However, my daughter showed up with jaundice after her 48 hour heel prick test, so we had to stay in hospital a couple more days while she had phototherapy. She was still with me the whole time. But the staff then encouraged me to top her up with formula saying she’d need the extra energy to reduce her billirubin count. I knew no better, but have since read that this isn’t true – breast milk is best to help with this.
I had problems breastfeeding my daughter and gave up after a few weeks, but I actually don’t believe it was to do with supplementing her at such an early stage. I experienced exactly the same difficulties with my son and this time got help and discovered he had a suction problem (not a latching on problem), and he’d never had a bottle before. So I think it’s probably just something about my babies’ breastfeeding ‘style’ rather than bad advice at the hospital with my daughter.
With my son there were no post partum issues, and we went home after the standard couple of days. They no longer do a 6 week post-partum check at the hospital, whereas two years ago you used to see a midwife at the end of your’ cuarentena’. Now you only see your gynecologist at the CAP where you had your antenatal care.Send your birth experience to info@barcelonabirth.net
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