When my sons were young we attended a wedding in Ghana and as the speeches were taking place my two-year-old started insisting that he wanted some of my drink. I was too hot, my aseobi was tight and scratchy, and I did not want to be the parent whose child started crying while the audience was hushed.
The problem was I also did not really want to give him wine. What would all these beautiful Ghanaian's think of this Sierra Leonean in-law? After a few failed distraction attempts it occurred to me that it was highly unlikely my son would have a taste for alcohol. I lifted the glass towards his mouth, feeling the eyes of everyone on the table on us. The total disgust that appeared on his face once he had a sip, made everyone on the table exhale with laughter. Job done – he was quiet again.
In that moment I was a radical mother, able to weigh up the pros and cons of the different options, based on probability and, dare I say it, the natural way of things. I had shifted my focus from what everyone else thought, to what I knew in my gut. But I had not been radical enough during my pregnancies, in the three-year period leading up to that wedding. Hence ending up with two caesareans that I knew could have been avoided. In the years after my second caesarean, alongside the general adulting of your average young family, I did some learning, forgiving and preparation related to birth.
It started with my Psychology Master's dissertation, titled Preferences and Outcomes of Pregnant Women of African and Caribbean Heritage During the Covid Pandemic. The research unexpectedly planted the seed that home birth could have been safer for me, and, for many women, it is just as safe to give birth at home as it was to give birth in hospital. Many of the respondents in the studies had felt unseen by medical professionals or, worse, were traumatised by previous hospital births. Despite popular narrative, people who freebirth and/or homebirth are not homogeneously irresponsible, hippie-dippy individuals who go against the system simply for the sake of being different. From LGBTQ+ individuals who had faced prejudice, to pregnant midwives determined to avoid the obstetric violence they had witnessed, people who chose to birth outside of hospital spend an incredible amount of time educating themselves about birth, and do the necessary planning to have a calm, safe and sometimes ecstatic birth. I was elated to be awarded a distinction for my dissertation, but the true reward was the new perspective I had gained. I realised that if I ever became pregnant again, I had more choices than general society and most medically trained professionals would have me believe.
Whilst my studies allowed me to logically understand why giving birth in hospitals was usually no safer than homebirth, it was a long psychological and emotional journey for me to actually act on what I knew. Initially my husband and I ruled out homebirth. Yet, there is no such thing as a risk-free birth, so I needed to get to the point where I could comfortably swap the many risks of birthing in hospital with the fewer risks of birthing at home. By far, the most impactful exercise for my mental shift was listening to and reading about other women who had had successful and unsuccessful VBACs. I devoured podcasts of women all over the world; joined a surprisingly good VBAC webinar organised by my hospital trust; enrolled on a mediocre online VBAC course; read several books; spent hours in a coffee shop talking to a woman of Scottish heritage who had had two homebirths; and spent even more hours in the same coffee shop, talking to a woman of Guianese heritage who had given birth to twins at home, after three caesareans.
From early on in my pregnancy, I focused on building my birth team. Initially, I was hell bent on using an independent midwife and a doula. That seemed to be the perfect mix of having someone medically trained, yet confident about physiological birth, with someone who acknowledged the spirituality of birth and would almost mother me if I needed that when the time came. However, the first local independent midwife team I came across, via Google, would be on holiday during my baby's due date window. Then I came across an experienced midwife on Instagram, but she no longer offered the independent service. Due to how much her insurer charged her for every birth, the cost of her service would be at least £9000, which would be inaccessible for most families. She recommended I contact a certain group of private midwives instead. That group said that the midwife that covered my area had already been booked.
After these obstacles it became clear that the NHS might play a bigger role in my pregnancy than I had initially hoped. This made me very nervous. So I went into every NHS interaction with the opposite approach I had taken in my previous pregnancies. This time I went in with the stories of other women in my head. This time I went in knowing not to allow someone to perform a sweep without my consent. This time it was everyone else's job to inform, respect and listen to me. I would listen to and be more trusting of anyone who approached me in that manner. In my booking-in appointment I requested continuity of care. Again, my dissertation research had come in handy, because it had alerted me to the increased satisfaction and positive outcomes for women who receive continuity of care. To some extent, I felt a degree of continuity of care from the NHS, but I needed more than just the risk-focused care the NHS could offer.
Thus, I worked out and then invested in my own definition of continuity of care. It needed to be holistic. Looking back now, my pregnancy team can be divided into three groups. Firstly, the wider community of professionals who would help monitor and maintain both my physical and mental health, and my baby's health and position. Secondly, the virtual sisterhood of experts. And lastly, the group who would be with me from as early as possible and, crucially, be at the birth itself.
First, to my professional community. It consisted of the NHS individuals and teams; chiropractic care; coaching; and pregnancy yoga classes, which I attended almost every week from week 14 to week 40 of pregnancy.
Some NHS individuals were certainly not on my team. I was apparently under obstetric consultant care due to my VBAC intention. There is so much to unpack about the conversation I eventually had with the consultant obstetrician, including why I initially wanted to cancel it, and why I would not have spoken to him if the consultant midwife had not agreed to attend.
However, the one thing I can easily mention is he seemed to think the main reason why people want homebirths is because it enables easier childcare arrangements for their older children. Another example: when I was around 38 weeks two community midwives I'd never met turned up at my house, saying one of about eight results from my last scan had been re-examined, and my baby was now deemed to be in an emergency situation. Strange, given I'd been feeling my baby moving all day. After it was clear they wouldn't leave, I abandoned the book I'd been reading during that glorious early summer evening and went to the hospital. Once I arrived I was reminded of exactly why I was not safe there.
A midwife was sent into my room to take my bloods. Just before the needle pierced my skin, it occurred to me to ask why she needed them. She said it was because 'they' needed bloods that were no more than three days old, because 'they' were preparing for me to have a caesarean. So much for informed consent. Needless to say, I was livid, asked to speak to one of 'them' as soon as possible, then left the hospital having made it clear to the doctor that this baby was coming out unless she decided otherwise.
With NHS pressure mounting, I was beyond grateful for the incredible social media community of genuine physiological birth experts. However, it was time to stop simply consuming, at distance, content from other experts. My husband and I decided, with a generous nudge from our doulas, to engage further, book a private second opinion from a fetal medicine centre to work out whether the level of pressure from the NHS was warranted. In short, it wasn't.
My Welcome Party was made up of my husband, my best friend, two doulas and my retired-midwife aunty. Almost by happy accident, I also had photographs taken by a visual storyteller. The main things I wanted my husband to do was hide any fear he may have, and to catch the baby. He did both with aplomb! When it came to my best friend, the plan was a little more detailed. Once she got over the initial surprise of being invited to the birth, I asked her to accompany me to hypnobirthing classes that took place over three Saturdays. It was important to me that she had an opportunity to unlearn at least some of the negative perceptions and scaremongering that our society promotes in relation to birth.
I came across one half of a doula duo while scouring a doula directory. Now, as not all midwives or doctors are the same, not all doulas are the same. How can I keep this praise short? Let's put it this way: how many NHS midwives can dedicate three hours to help a woman process grief and legacy that is affecting her confidence around birth?
Speaking of seats, my aunty metaphorically straddled both the professional and personal when it came to my homebirth team. She had been an NHS midwife for thirty years, eventually becoming a consultant midwife. Thus, it gave me peace of mind to know she was there if medical help was needed. I was acutely aware that, initially, she really hoped I would call the NHS homebirth team when baby was on its way. But once the birth was actually happening, she was a steady presence as the doulas transitioned from dancing with me to soca tunes, to creating the rhythmic and sensual atmosphere to support my husband and I zone in moments before baby arrived. In the end, we needed my aunty most when the rest of my Welcome Party held their breath for a few moments, because no one had expected that my baby would make an en caul appearance.
A recent report found that the option of homebirth is increasingly being taken away from families. Maybe that's why, in the UK, we can't seem to get beyond 2% of people giving birth at home, despite it being cheaper than hospital birth, and it being just as safe as hospital birth for many birthers. I'm now passionate about increasing awareness around the possibility of homebirth, not just because it can be healing, but because it can set the tone for a calm and confident introduction into first-time parenthood, rather than a traumatic and disempowering one.