Jane – Hospital Sant Pau

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.