Telegraph Birth Guide: 'I couldn't have done it without her help'
Last Updated: 12:01am BST 28/04/2008
Page 1 of 3
Rowan Pelling on the independent midwife who coached her towards the home birth she thought she'd never have
Telegraph Birth Guide - get the birth you want
When I found out I was pregnant with my second child, I knew exactly what I sought in my ideal midwife. I told my husband I wanted a "white witch" - the kind of earthy, charismatic wise woman whose understanding of the uterus owed as much to vocation, experience and instinct as to medical textbooks.
The reason for my quest was that - despite being 40 years old with one previous Caesarean section, rendering me a "high risk" labour - I was, to my astonishment, considering a home birth. I am hardly the masochistic, tree-hugging yoga freak of natural childbirth cliché, after all.
Indeed, I love my creature comforts and abhor physical exertion. So I had much sympathy for aghast friends who wailed: "Doesn't that mean no drugs?" and: "What if something goes wrong?" An obstetrician warned me sternly of the "small but real" risk of my Caesarean scar rupturing.
But after several years spent scrutinising British maternity services and all the relevant data, I had been persuaded that skilfully overseen home births were as safe as hospital ones - some would say safer, as there's less threat of contracting MRSA.
Key to my decision was the research I carried out with midwives and mothers at the Albany Midwifery Practice, a pioneering community-based group of self-employed midwives in Peckham, south-east London, and part of the King's College Hospital NHS Trust.
Every woman is assigned two midwives to attend to her throughout pregnancy and is guaranteed to have at least one of those named carers by her side during labour. In addition, I discovered that the majority of the NHS's 25,093 midwives each worked on more than 28 births per year, the figure recommended in the Safer Childbirth Report, with some involved in the delivery of 40 babies.
But what makes the Albany practice unique is the fact that no woman has to choose where she wants to give birth until she goes into labour. Tellingly, when the choice is left to maternal instinct, most of its patients choose to give birth at home - some 75 per cent, as opposed to just 1.8 per cent nationally. Of those Albany mothers I spoke to, none talked of feeling "abandoned" or "out of control", phrases often used in the same breath by critics of home births.
My observation of the Albany midwives at work made it clear that home birth actually offered mothers far more control and genuine choice over the way they laboured. The first time I gave birth, in hospital, I thought I, the patient, would be the one at the centre of things; but the minute I was on the ward, my choices were restricted by the relative inexperience of my young midwives and the medics' ticking clock. When my labour slowed, no one looked for likely causes; instead, I was given a drug, Syntocinon, to "speed things up". My panic-strewn and agonising progress to an emergency C-section was, in retrospect, depressingly predictable.
But I also knew I could not have a home birth unless I found a midwife who could persuade me to believe in birth as a normal, natural process, rather than an emergency-in-waiting. If I failed to find that practitioner, I'd decided - somewhat perversely - that I'd rather have an elective Caesarean section than risk the vagaries of a labour ward again.
I was contemplating these polarised options last autumn when a chance playground conversation led me to the extraordinary Jane Evans, an independent midwife based in Hertfordshire who is renowned in natural birth circles for her skill in birthing breech babies and twins. The minute Jane walked through my door I knew from her long grey hair, wry gaze and kooky, striped socks that I'd found my white witch.
Jane's centre of gravity was so strong I felt myself immediately in her reassuring orbit. She coaxed the story of my first labour from me and fired off questions. How far had I dilated? (Nine centimetres.) How had my scar healed? (Swiftly and well.) Finally, she looked at me and said she could see absolutely no reason why I couldn't give birth naturally at home. And I began to believe her. Having said that, it took me three months to commit myself to the home birth process. The effort of will required to overcome the residual terror from my first labour and to believe in my body often seemed insurmountable. Jane reminded me of a horse-whisperer standing in a paddock while a crazy mare careered round her, knowing that eventually it would stop its jig and walk straight to her.
In early January, I finally bit the bullet, phoned Jane, and said I would like to hire her to attend my home birth. Suddenly I was on a different track. From Jane's regular home visits, I gathered all the advice you would normally have to seek from a GP, a community midwife, a nutritionist, a shrink, a priest, a life coach and an ante-natal teacher. I was amazed by how Jane could tell exactly how the baby was lying and judge his growth through her hands on my belly; during my last pregnancy, I had to have a scan to get this kind of information. As Jane's visits progressed, I could feel we were developing the camaraderie and trust, not to mention black humour, which seemed essential in approaching childbirth with confidence.
Most of my friends still thought I was being eccentric in my birth choices. One said cynically: "You mean you've paid several thousand pounds not to have an epidural?" And that, curiously, was exactly the point. I was beginning to understand why people climb mountains or walk to the North Pole: you need to go into training and the actual process is unbelievably arduous and painful… but then there's the - ah! - endorphin-flooded exhilaration when you reach your goal. At least, that's the theory.
In the small hours of Monday, March 17, I was about to put the theory into practice. The first contractions started tweaking shortly after midnight and Jane arrived at 7am. She found me kneeling on my grandfather's old armchair in the front room, munching toast and listening to the Today programme.
It became clear as the labour slowly progressed that my biggest enemy was my own head. I was constantly resisting the tidal flow of my own body. This is when the groundwork we had put in over the proceeding months really kicked in: Jane worked with me to find reserves of energy, helping me find positions that best dealt with the pain and keeping me on the move when my willpower faltered. With her trained hand, she was able to recognise my unborn baby's steady heartbeat. This proved far more reassuring than my earlier experience with a hospital's taped-on monitor that panicked me with unexplained bleeps and then flatlined every time the baby turned.
When I needed rallying, Jane was vocal - "There's only one person in here who can get that baby out, Rowan!" - and fell silent during long bouts of contractions when we both withdrew into a meditative state. I felt I was coping until around 5.30pm when I hit a slough of despond. I didn't know I was experiencing a textbook case of a tough transition period (before a woman moves to pushing), when you start fantasising about morphine, Caesareans and shooting your husband. Jane rallied me magnificently, like a games mistress telling the lacrosse team to pull their finger out and do the business.
I eventually staggered from the sofa to my feet and set about pushing, which didn't come instinctively to me. Jane literally had to put her hands on my lower back as I clung to grandpa's chair, talking me through the down-force I needed to generate. "Spread the energy down through your hips and bottom," she guided. Eventually my husband was commandeered into supporting me by sitting on a birthing ball and locking his arms under my armpits, and I suddenly grasped what pushing meant. At the same moment I heard a strange, guttural howl and realised it came from me.
After 20 minutes of this, however, the baby's head was still no lower and Jane realised that he had turned so that his spine was facing mine, a problem I had encountered during my first labour. She made me move immediately so that I was back on my knees clinging onto the wings of the armchair and suddenly - suddenly! - I felt the baby's head begin to descend. The pain was now so overwhelming that I had moved beyond comprehending or minding it. I could find the strength to rise to meet it because it was bringing me my baby. This was the instinctive pushing I had heard about, when your body takes over.
My second son was born at 10.15pm, and I can honestly say that when his head came through, it was the most emotional moment of my life. My husband said he will never forget the way Jane moved with lightning speed to catch him, simultaneously twisting him round to release the umbilical cord that had become entwined twice round his neck. My boy opened his eyes and was immediately, gloriously present, while the atmosphere in the room was one of sheer wonder. "I always said you could birth that baby," said Jane happily.
Jane was as invaluable after the birth as during it. She got my son on my breast within the hour, helped me birth my placenta (which is now in the deepfreeze waiting to be planted under a rose bush) and supported me as I crawled upstairs to bed. She visited daily for the first five days and then at regular intervals for a month, making sure my body was recovering and helping me with breastfeeding.
My positive experience of labour not only exorcised those old ghosts from my first birth, it gave me an incredibly strong bond with my new son. As my normally parsimonious husband said of Jane's £3,000 fee: "She was worth every penny and more."
Sadly, there are not nearly enough Jane Evanses to go round. It's only now that I fully comprehend how a positive experience of childbirth helps you bond with your baby and dramatically decreases the chance of post-natal depression.
Clearly, many women can't afford the option of hiring an independent midwife, and even when independents volunteer their services for free (which they often do with desperate mothers), the NHS can be hostile to practitioners they frequently regard as renegades because they won't kowtow to hospital protocols.
The Independent Midwives Association (IMA) is campaigning for a new model of maternal care where independents and like-minded midwives can contract their services in to the NHS and make their extraordinary home-birth skills more widely available, but Primary Care Trusts still need to be persuaded.
The IMA is urging all women to write to PCTs and demand that such a gold standard of care be available to all. Surely British mothers deserve no less.
co-ordinatorChiswick and Hammersmith Home Birth Group
We meet approx every six weeks to discuss and support home birthing parents locally. contact tel 0870 4239260