Not many people realise that having a homebirth after previously having a Caesarean section is an option and while it’s not available through the Health Service Executive (HSE) here in Ireland hiring a private midwife is an option for those who can afford to do so. I am lucky enough to have been able to do this for my second pregnancy and acknowledge that not everyone has that privilege.

The World Health Organisation recommend that to save lives the national caesarean section rate should be between 10-15%. The rate in Irish maternity units in 2022 was 38.3%. This is important to note because it means that the topic of Vaginal Birth After Caesarean (VBAC) is a significant one in Ireland due to the number of women having caesarean births.

I am one of the women whose first birth ended with a caesarean and for whom this topic became important. I got home and got on with life with a newborn but as time went on realised I needed to heal from my birth trauma. As I went through this process I knew I wanted to avoid a caesarean for any subsequent births so started to research the topic of VBACs. One of the main concerns for VBACs is the possibility of uterine rupture (UR) due to scar separation. Research shows that uterine rupture in VBACs is rare. International research puts the rate at 0.7%. However, in the setting of a large Irish maternity hospital with strict guidelines for a Trial of Labour After Caesarean, the UR rate was 2 per 1000 overall, and 1 per 1000 for women in spontaneous labour who did not receive oxytocin augmentation (Turner et al, 2006). So the risk of rupture is rare but if this is the case then why are there so many stories of women being convinced to book an elective caesarean? Anecdotally some of the main reasons given by doctors seem to be that baby is measuring big, a twin pregnancy, or if a woman goes over her ‘due date’. My concern, having listening to many women’s stories was that scaremongering, without evidence to back it up, is often used to coerce women into 'elective' caesareans.

During my first pregnancy I thought that if all went well I would have a homebirth on my second. After the caesarean I thought this was no longer an option but as I researched VBACs and found them to be safe in most circumstances I thought I should be able to have a safe homebirth. Research shows that women are more likely to birth without intervention in a planned homebirth and that it is just as safe (if not safer) for low risk women. Having had a previous caesarean most care providers no longer considered me ‘low risk’ however as there was no reason for my set of circumstances to be repeated if I avoided induction the only additional risk was the slightly increased risk of UR. As this risk itself was still so low I lusted after homebirth but I knew it was against HSE policy so it would never be a reality. Then I heard of a private midwife company that had recently entered Ireland and was supporting mothers to have a Home Birth After Caesarean (HBAC). I refocused my research and started looking into the safety of HBACs. Again, from all the evidence I trawled through it became apparent that HBACs were actually very safe for uncomplicated pregnancies and that I was much more likely to be successful in my quest for a vaginal birth with this option as women who are cared for by midwives have a higher chance of having a VBAC. So when I got pregnant I contacted the private midwife company. I asked lots of questions and decided to send my notes from my previous birth to get reviewed by their obstetrician to see if I was a good candidate for HBAC. I was given the all clear and book my midwife, the wonderful Liz Halliday from Private Midwives Ireland.

This is my second son’s birth story.
 
I started loosing my plug on the Saturday night at 38 weeks and 3 days. I lost some more Sunday morning and had an increase in my Pelvic Girdle Pain. I thought it was a good sign that body was getting ready but didn't want to get too excited. I spent Sunday morning in bed while my husband brought our older son out shopping. I was lying there when at about midday I felt a bubble and a pop and some fluid leaking. I lay for a few minutes and decided to get up and put a pad on to see what was going on. Just as I got into the bathroom there was a big whoosh and waters flooded out. I text Liz to let her know what was going on and rang my husband but he didn't answer. I spoke to Liz then and as I wasn't having contractions arranged appointment for next day if nothing kicked off. Pains started shortly afterwards. They felt like period cramps at first so I thought not too much of it. My husband arrived home and I told him to take our first born for his “nap walk” and we'd decide what to do with him when they got back and he was asleep (as he still wouldn't nap at home without a walk!). But while he was gone the surges were coming regularly - every 3-5 mins and were getting stronger. I text him and told him to drop our son to his grandparents house around the corner instead of bringing him home. When he got back I asked him to call Liz and let her know what was going on, I think it was about 1.30pm, and she said to get in bath or shower and she was on the way. I got in and put in the plug and turned on the shower. I was on all fours and had the shower on my back. I didn't want to waste too much water, as would want to fill the pool later, so I was turning it on and off during surges. Liz arrived about 2.35pm and things were already fairly intense. I was still on all fours in the bath but had given up on the shower to save water. I was finding it difficult and hoping that things were at least progressing. She asked me would I like to be examined and I agreed. I was 5cm - that picked up my spirits a bit although I'm not sure I let that be known to anyone. A little while later I got out of bath because I thought I needed to do a poo but I couldn't sit on the toilet and Liz asked if the baby was to be born soon did I want to do birth in the bathroom or somewhere else, I had no idea that it could possibly be almost time! I had a few surges on all fours on the bathroom floor but pool wasn't full yet so then went into bedroom. I was told if I need to push that was ok but I wasn't having that urge yet and in my head I was thinking "already!?". Soon afterwards my husband shouted up that there was enough water in pool and so I made my way down the stairs. Liz said I could stop during the surges but I was determined to get in that pool! Surges were fierce intense and I was very vocal throughout, I was honestly surprised afterwards the police didn't show up with all the screaming I was doing! But even though it was all happening very fast and was extremely painful I wasn't afraid and I really think that helped. I had done a lot of preparation and Liz would repeat an affirmation to me now and again and at one stage she said that the surges were not more powerful than me as they were me. She also got my vision board that I had made and put it in front of me. These actions helped me refocus.

​I was on all fours in the pool with my head resting on the edge and my midwife suggested I move into a squat position to try help get things moving again. My husband held my hands and supported me in that position in the pool, he kept reminding me how well I was doing and his support was very important and really helped me manage the intensity. I felt every millimetre that I opened so as things progressed I knew roughly where we were and I was eager for the head to be born. At about this point the second midwife arrived, just as or before head was born in pool. Unfortunately, the rest of him didn't come on the next surge as his shoulder got stuck. I had asked my midwife antenatally what would happen in the event of shoulder dystocia as baby was predicted to be 'big' so when I was told to get out of the pool I knew what was happening so I practically jumped out. With some supra pubic pressure from my midwife all 9lbs 7oz of baby came flying into the world at 4.05pm caught by the second midwife, just four hours after it all started. I announced baby had arrived and scooped him up and checked the gender. We had another boy! We had skin to skin and I birthed the placenta at the edge of the couch about a half hour later. At around 5pm we called family and announced the news, to say people were surprised was an understatement! Our eldest had only been dropped to his grandparents house about 1pm. I needed to be checked then as there were concerns about a tear. I had gas and air for the check (first pain relief all day) and it was agreed that it was a probable 3rd degree and best option was to be checked and sutured in hospital. Ambulance arrived for non-emergency transfer and off me and baby went to the entertainment of all the neighbours as ambulance was blocking the road. Hospital agreed was 3rd degree tear and I was brought to theatre and given a spinal for the repair. I was kept in hospital for two nights.