Trial of Scar

I've just been reading this fantastic blog about the risks of VBAC after a difficult experience at my last hospital appointment.

Unfortunately, my hunch regarding the new midwife I've been assigned (younger, less opinionated) possibly being a better option in a scenario where I'm bringing my own independent midwife with me to hospital, turned out to be quite incorrect. Well, not incorrect in terms of her being younger and less opinionated - but rather that her lack of experience and knowledge means that her ability to form an opinion, or argument, seems to be heavily compromised.

I went in for my 39 week check and took her a copy of my birth plan to makes sure she knew exactly what I had in mind. She read through it,  mildly, pausing every now and then to say, "Mmm... but you will have to have [...]" – and just kept repeating this over and over, even though my birth plan clearly states that I intend to decline many routine tests and procedures as long as my labour is progressing normally. It was a very strange experience, because she wasn't being at all unpleasant - - just inadvertently dismissive of my independence and ability (and right) to decide these things of myself. After all, I've already been through ALL of it with my previous midwife and the Head of Obstetrics (whom my previous midwife ensured I met with, so that everything could be as clear as possible before the big day).

This was confusing and frustrating, so I was still getting my head around all of it when I met the back-up midwife again, whom I'd actually met before, but only in passing. Her first words to me were, "So what's the deal with your independent midwife??" I kind of laughed because I was so taken aback, and I think I had no choice but to answer her question with another question: "What do you mean, what's the deal with my independent midwife??"

What IS the deal? I mean, surely I couldn't possibly be wanting any extra support after everything I've already been through? Surely I couldn't need anything other than the superb, second-to-none experience of being shunted through the busy public hospital system; where everybody seems so attuned to my needs and desires?

Shit. I mean, I could have asked, "What's the deal with you being a midwife? Aren't you supposed to make it your job to support women in childbirth? Truly - are you being so passive-agressive as to suggest that I mean to threaten you by choosing to bring my independent midwife to support the two of us through this new experience? Are you suggesting that another midwife (who will, legally, be required to sit on her hands in the hospital setting) be able to somehow displace your sense of purpose and authority?

My answer, in the moment, was to invite these two women to tell me how they would like it to work. I said, clearly and simply enough, that the role of our IM is to support us at home until we are ready to come to hospital - and to help us make the decision about when it's time to come. After that, we're in the hospital so the hospital midwives are the ones who'll be looking after us.................. aren't they?????

Instead of diffusing the situation, this woman maintained eye contact and continued to press her point that she thought it created a "grey area" and made it confusing as to who was the one giving the care. I could tell she had obviously had some negative experiences and that was shaping her reaction to our IM. But she wasn't listening to me AT ALL, even though I was quite clearly telling her that we had no intention of being uncooperative on her "turf"; and that the whole purpose of discussing everything beforehand was to avoid confusion and the potential for conflict. Something that I was acutely aware of during my first birth.

I came away feeling that the whole thing had been pointless. All of this effort to get into a 1:1 midwifery-led care program... only to be told that my VBAC 'status' meant that my care would be under the watchful eye of the attending registrar and that no matter who my midwife was going to be, they would be taking their orders from elsewhere (and would either be powerless (midwife 1) - or completely unwilling (midwife 2) - to advocate on my behalf).

Midwife 1, in her uncertainty about a number of issues, has assured me that her boss will give me a call before our appointment on Wednesday. It just so happens that her boss knows my IM, and so it's really doing my head in to try and understand how this inexperienced midwife can be passing on information to me about my "rights" that seem to contradict everything I've been told by my initial caregivers. I can't imagine for a second that her boss, knowing my IM, and knowing the kind of birth I'm planning, would think that passing on a note that says 'YOU HAVE TO DO THIS. THE END',  would be remotely sufficient, or constructive, in my case.

I considered myself lucky to get into this 1:1 program. It has been a compromise since the beginning, as I was never in the catchment area for the midwife I was allocated; and instead of enjoying more relaxed appointments at a local clinic, the best she could do was meet me at the hospital. Now that I have my new midwife, I am meeting her at the hospital too.... only now I have found out that my original midwife was qualified to do water births (!!!) and that the new one isn't. Also, the back-up (snarky) midwife is qualified, but would be unwilling to do a water birth for a VBAC. But of course! (.... makes me wonder if this would be any old VBAC, or if I might be being given special treatment.)

When I speak to their boss, I really have to have it straight in my head the things I've been told are possible, and then things that have suddenly been taken off the table now that my baby is almost due.

I won't get into the stats here, but as I mentioned, the OB appt was to discuss the risks associated with things like uterine scar rupture, and he said that we had discussed it and that I understood the risks should I decline the monitoring. He didn't guarantee that another OB would respect that this conversation had taken place if I presented in labour and they didn't like the look of what was going on.... but if they didn't like the look of what was going on, then that would be a whole different ballgame! I'd be more than happy to have monitoring if things weren't progressing as they should. I just want to be able to reserve the right to not have it if things seem to be fine.

I had to ask about 3 times about the availability of a bath/birth pool. I was told 'yes' by the original midwife. 'Maybe' by the 2nd midwife... only if the telemetry (monitoring) works (which they infamously don't with interference/slipping out of position etc).... right down to eventually being told that there was the option of water birth and I hadn't even known about it!!! Except now that it's too late and I can't have it because I don't have a willing midwife. But hey, I'm supposed to get excited about the double showers instead.

I've been told I "have to" have a bung in the back of my hand in case I need emergency treatment. New midwife is insisting on this - probably her strongest opinion so far. She has also checked with her superiors and apparently I also "have to" have Syntometrine to contract my uterus when delivering the placenta, even though I was previously told this wouldn't be necessary if I'd had a natural birth.

Upon pressing and pressing these points with her over and over, I've managed to find out that her ideas are not her own; and whilst she has a mild, inoffensive manner and seems quite sympathetic; her style of talking in this way, without really thinking about what she's saying, reflects her inexperience and lack of confidence with independent decision making; dealing with senior staff; and ultimately being able to advocate on behalf of her clients. She is not really a midwife - she is more like a nurse - and that is disappointing to me. The only thing that she's had in common with my former midwife (the more experienced one) is that she has quite genuinely looked me in the eye and said, in earnest: "This is why you need to try and stay at home as long as possible". Because she knows that this is the only way I can truly - and freely - try and have the intervention-free experience I crave. This is the best advice a hospital midwife can give me, and the closest they can come to real advocacy.

It defeats the purpose of all their arguments about my supposed "safety", and their own convictions about the importance of upholding policy whilst in the hospital setting. If they truly believed I should have the monitoring, they would not encourage me to stay away for as long as possible. Nor would she offer (as she has) to take off the monitor for 10 minutes out of every 30. Dumbest suggestion I ever heard – Not just because it wouldn't make any difference to my comfort – but because it undermines the so called "need" for the monitoring to be C.O.N.T.I.N.U.O.U.S.... Yes? If I only need it on for 2/3 of the time, then why do I need it on at all? Why can't you just listen to the baby with a doppeler every 5 mins and check that everything's fine? Because the computer is the one who does the listening and the thinking – and takes the record that will be tendered as evidence in court!!!

So now I have to "rock up" to Sunshine the same way I had to "rock up" to The Womens' and find out whoever the hell is on duty at the time, and hope to god they're not a total wanker. If they were trying to dissuade me from bringing my own midwife, they couldn't have convinced me any more thoroughly that bringing my own midwife is absolutely necessary!

It will be interesting to see whether the coordinator actually calls me. They are all extremely busy and I am now feeling this thickening fog of apathy settling over the idea of meeting with my midwife again on Wednesday. I think the only way to cope with this situation is to decide that I don't care about anything they do or say - that the reason that I'm going to hospital is to get prompt treatment in the event that something awful happens... and to say no to everything that is offered to me before the point where - in my mind - I'm actually a "patient". In my mind, I'm not a hospital patient until there's something wrong with me, or my baby. Whether or not they like it, they will be witnessing my attempt at a completely natural, physiological birth - an event they may have no control over whatsoever... and will not have to accept liability for, as long as they don't interfere where they're not welcome.

After watching this incredibly moving photographic slideshow (warning: shows some surgical stuff, but no "rude" bits) about a couple going from an emergency CS experience to a VBAC at home in water, I feel like there is not even any point going to hospital. But it's not just about me, and that much I accept... at least at this point. Right now. Today. But who knows? I am poised to change my mind!

If feel ignored, rushed or neglected by the hospital staff, then I'm sure I will feel I'm in safer hands with my infinitely patient independent midwives who are truly looking out for the best interests of me, my baby and our family. People have said to me, oh but they're being paid! .... and to that I say; yes, but they're also not insured, and nothing could be more motivating - in my view - in terms of providing the best possible level of care. It is ridiculous to suggest that there's anything in it for them not to do so. But the hospital midwives? What's the worst that can happen to them if they're not entirely on their game, or show a less than caring attitude?

All of the fixation is on this 'Trial of Scar' - this supposed 'weakness' that exists in my physical womb. The hospital may treat me as though this is all I am - or all I have the potential to be; but to me, the term "Trial of Scar" is the best description of what I'm now facing in relation to the emotional scars from my first birth experience. Those scars are being seriously tried and trialled and I am aiming for there not to be a rupture - not to reopen old wounds. How can there be women who call themselves midwives who can't look a woman in the face and see that there is more to it than the rare threat of a medical emergency? Even if they failed to have any real conviction in that belief themselves; they should at least be able to reconcile their offer of support with the fact that by working in a hospital, they are automatically equipped to provide emergency treatment in the extremely unlikely event that it's needed... and to judge when a woman is truly at risk, whether or not a beeping machine tells them so.

Hey!! I can beep!! I can say.... something's not right here! .............I'm a real, live person!! ... I've got a real brain and real feelings!! Hello.....?? Can anybody hear me??? ..............