Why I chose an independent midwife

Women choose independent midwives for many reasons. Here Diana Clement gives her reasons for choosing one.

I'm someone who thinks twice before spending 50 pence. So it may seem odd that I'd pay £2,000 for a service I could get for free from the NHS. But could I?

My first birth experience went from bad to utter disaster. I'd planned a home birth. In the end I had a caesarean. It was an outcome that I could not have contemplated and certainly didn't come to terms with until very recently.
When I fell pregnant second time around I thought initially I would choose to go to hospital. I lacked confidence in my ability to labour and give birth naturally. And I was scared that I would be the one in 200 women whose scar tears open under pressure from contractions. This I knew had a high chance of resulting in my or the baby's death.

But then I started reading anything and everything I could find about vaginal birth after caesareans [VBACs]. In her website www.homebirth.org Angela Horn writes: "Around 75% of VBAC candidates do give birth vaginally, but the remaining 25% who have repeat caesareans will do so for many reasons - rarely for uterine rupture." It was when I read that home VBACs had a much higher success rate than planned hospital VBACs that I really started thinking.

Soon after I wrote to the head of obstetrics and gynaecology at Pembury Hospital explaining that should I give birth there I would expect to use the birthing pool and did not accept that continuous fetal monitoring was appropriate for me. The latter, I had read time and time again, was used as a poor replacement for one-to-one midwifery care. The reply, which included a copy of Pembury's "guidelines" [rules] for VBAC births, convinced me that should I walk through the swinging doors into the labour ward I would have my heckles up - not a good situation for a labouring woman. Among other things I would be given a vaginal examination on arrival, followed by two-hourly vaginal examinations. If this wasn't enough to put me off giving birth at Pembury, I was told that hand-held monitoring was out of the question. That meant labouring on my back with a continuous monitor on. As far as I could see, the hospital saw me as a walking uterus threatening rupture. For much of the next couple of days I struggled with the idea, but eventually realised that I had little choice but to plan a homebirth.

Pembury's guidelines did, interestingly, say they would send a midwife to home if a woman "insists on home birth". But I feared that on the day I would be sent a midwife who didn't have confidence in me or experience with VBACs and I would be transferred to hospital forthwith. Had I ended up with another caesarean, I would have never known if it was in my best interests or due to a lack of experience by the midwife, insufficient care, or obstetric anxiety.

Choosing an independent midwife was not difficult. A friend of mine had employed Ashford-based Virginia Howes for a hospital birth and I was very impressed with Virginia's skills as an advocate. Pembury and Maidstone hospitals do not allow independent midwives to practice - although many other hospitals do. But they can attend as doulas [birth partners]. This was sufficient for me. If I needed to transfer from home to hospital, I had an experienced professional with me who had my best interests at heart.

As it transpired, I went into labour naturally, and the birth was trouble-free, if long. Virginia monitored me regularly and checked for signs of the uterus rupturing, but nothing went wrong. The first stage was 18 hours and the second, an hour and a half. I often wonder what would have happened if I'd gone to hospital. My labour was only minutely bearable when I was in the pool. I couldn't bear to be on dry land - let alone on my back with a continuous monitor. Pembury's rules also said that a registrar must be called if the active second stage continued for more than 30 minutes. Mine took three times that. Would I have been pressured to have a caesarean at that stage? Ultimately, all I know is that Virginia had the experience and the confidence in me to let a perfectly normal birth progress to a natural conclusion.

Coughing up the £2,000 for Virginia's services hurt. But I would still employ her if I had my time over again. If I'd had another caesarean, my partner Cliff would have had to take weeks of unpaid leave off work as we don't have close family support. It would have cost us just as much.

For more information contact Independent Midwives Association www.ima-acceptance.org.uk