‘May you live in Interesting Times’, so the ancient curse goes. This year has been full of twists and turns, and if you’re pregnant, it comes with added anxiety about what that will be like. Will you be able to give birth where you want, with whom you want to support you? Usually I try to give advice that’s applicable on a national scale – but at the moment, with seemingly each NHS Trust making up their own rules as they go along, and those rules changing frequently, it’s impossible to know what the situation is on an individual level. So what I have done is focus on publishing individual experiences as a clue to what may be possible right now, and how other people have approached and experienced birthing in a time of Covid. This is an excerpt of Tannice’s Covid-19 Birth Story, published with permission. You can read the full version here.
Tannice’s Covid-19 Birth Story
“Giving birth at home was something I’d wanted since after my first was born in 2016. Admittedly, when I was pregnant with my first, the idea of giving birth at home never even crossed my mind. As I was a “high risk” pregnancy, due to my high BMI, it was never even presented as an option.
My first labour was augmented with syntocinon – synthetic oxytocin – presumably because stress caused my contractions to slow down. After the shift change of midwives, I started to lose energy and momentum. I was also stressed by being prevented from eating (I had gestational diabetes and had thrown up my dinner from the night before after being a little too liberal with wonderful entonox).
I did all I was told during that labour – from having an epidural as a matter of course (in case my fat body couldn’t give birth naturally and I’d need a caesarean, they said) to readily agreeing to induction because of the gestational diabetes, I simply toed the line entirely.
Unfortunately “doing as you’re told” isn’t always the protective act you’d hope when it comes to labour and birth. It was not as beautiful an experience as I’d hoped. Whilst I narrowly avoided an emergency caesarean, I did beg for an episiotomy as I was so exhausted. I simply wanted it all to be over. Which wasn’t the way I’d imagined I’d feel about my daughter’s birth at all.
By the time I was pregnant with my second, however, the trauma of the first birth lent itself to my husband and I loving the idea of home birth.
Sadly, my second child was breech and I was taken to hospital gravely ill from a pulmonary embolism that kept me in the high dependency unit for about 10 days at 35 weeks’ pregnant. Now I’ve had my third child in a pool, at home, I realise that it would have been far tougher were I struggling to breathe, too. So I don’t regret the caesarean that I had with my middle child.
How safe is a home birth during a pandemic?
Many home birth services were suspended at the height of the first wave of the Coronavirus pandemic: the main reason being that paramedics were unable to provide category 1 (the highest emergency level) support for those giving birth at home. There were also concerns about sending midwives into a home setting with respect to distancing from other members of the household and the extended amount of time that the requisite two midwives would have to spend potentially exposed to Coronavirus in any asymptomatic but infected household. The viral load on those midwives was a consideration all hospital trusts had to factor in.
However, there is no question that, when you purely look at the safety of a birthing dyad – mother and baby – it is quite clear that a home birth is safest for them. At a home birth you have just two midwives, the birthing person, the birth partner and any other members of the extended family, who can be asked to distance. This limits potential transmission to any of the family within the home. With Covid-19 restrictions on visiting, antenatal appointments, scans and attendance at birth (usually you must be in established labour – 6cm – before your chosen birth partner can join you) people having babies are struggling for support.
Midwives do have policies designed to protect themselves and can of course wear as high a level of PPE as they think is prudent, but given they are in someone else’s home, they may feel uncomfortable insisting that, for example, the birth partner wears a mask or that other occupants of the home may not be present. This all serves to make the environment more tense and thereby will affect the birthing family’s experience. It’s essential, then, that the midwives attending feel comfortable doing so. Their hospital trust have a duty of care to them, too, at least under the Health and Safety Act 1974, if not just morally and ethically.
What’s it like to have a home birth?
All in all, my home birth was a magical experience. I started having contractions as early as 22nd August but my son was not born until 11 September. We called out the midwives that first night and were close to calling several times again on various evenings until, on 10 September at around 8:30pm, the day after a stretch and sweep, my waters broke.
I was disheartened when the midwives decided that things were not progressing and that they would leave. I got back in my pool and was in a great deal of pain as the contractions continued. They came closer together and were even stronger than before so we called the midwives back a few hours later, after calling my parents to come and take care of our two older children. They were convinced there was a monster in the house after hearing my contraction-induced moaning!
I was suddenly worried what would happen if I needed to transfer in for a repeat caesarean. Having previously been convinced it wouldn’t be necessary, I was suddenly struggling with the pain. After so long of having what’s called prodromal labour, I was exhausted from constant contractions and the anxiety around the increase in Covid cases across the country was making me suspect home birth could again be suspended.
That day I’d done an interview with local TV station, KMTV, talking about my fears about this very such problem.
The midwives returned with entonox and boy… was I glad to have it. So glad in fact that I blew through the remaining 1.5 tanks (I’d used half the first time they attended) and we were on. From waters breaking to Ares’ birth at 7:30am, the whole labour was 11 hours. The most primal and intensive experience of my life, his birth put me firmly in control of my environment and my body.
When I’d finally done all the work and he emerged, in my home, all I could shriek was “I did it!” and “I made him and I did it!”
I was truly elated and felt so very healed from the varied trauma of my first two births. I loved my body again and felt so connected to my own being that I felt the anxiety and historical grief melt away.
‘Advocating’ for the birth you want? It shouldn’t even be in our vocabulary
I had to advocate hard to get the birth I wanted. I had done so much research into home birth in preparation to birth my second child that I know everything I needed to about my rights and the NHS’ responsibilities to me under the law.
Of course, we hadn’t factored in the suspension of home births across the UK due to an unprecedented pandemic – but I did know the (small) risks involved when wanting a home birth after caesarean (HBAC). It wasn’t long after my first son was extracted from me that I began reading about HBAC. I carefully scoured the literature for all the factors involved in successful vaginal birth after caesarean (VBAC) to inform my decision to birth my last child at home.
To sum up this weighty defence and advocation of birthing at home, the evidence is persuasive and significant. Historically, women have birthed in their own environment for far longer than they have within hospitals. Whilst I’m not against intervention, it’s hard to really know which interventions were truly necessary.
Birth Trauma Awareness Week
The medical profession will always, of course, err on the side of caution. But survival of mother and baby alone is not the only marker of a good birth. Ares was born during Birth Trauma Awareness week (7-13 September 2020). So many laid bare their traumatic experiences on social media that I felt almost guilty, despite my own history, that I’d had such a wonderful final birth.
We can have better births. We should never underestimate the importance of informed consent, personal choice, bodily autonomy and sovereignty. One shouldn’t need to know the system inside out to be able to get a good birth.
Once I had come down from the elation of my greatest birth of three, I realised something quite sad. I was celebrating not having been traumatised from the final birth I’ll ever have. Not to have been devastated by iatrogenic harm, discompassionate medical staff and a lack of postnatal care. I’d had a good birth. Sad really. It’s not much to ask for.”
Thanks Tannice for Sharing Your Covid-19 Birth Story!
And welcome to the world, baby Ares! Don’t forget, this is only an excerpt. You can read the full version of Tannice’s story, including links to articles for reference here.
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If you’d like to read more Birth Stories, you can find them here.