Bettina – Three births across two countries: UK NHS care, Australian private care, and choosing caesarean birth

Conception and Early Pregnancy in London

Bettina and her husband Adam moved to London in 2015, initially planning to stay permanently. “We actually said, no, we’re moving to London” when people asked about buying a house or having children. After four years of London life, they decided to start trying for a baby, conceiving George “relatively quickly and easily after a couple of months of trying.”

Her first trimester brought the typical challenges of morning sickness, though Bettina notes it “wasn’t just morning sickness. I think it would go through to the afternoon.” More concerning was first trimester bleeding, which led to an emotional hospital visit. “I had my first bleed at work when I was about 10 or 11 weeks pregnant. And I told a friend of mine, I actually burst into tears and I said to her, hey, firstly, I’m actually pregnant. Secondly, I’m having a bleed and I need to go into hospital.”

The bleeding was diagnosed as cervical ectropion, a common pregnancy condition where sensitive cells spread to the outside of the cervix due to hormonal changes.

Navigating NHS Care and Birth Education

Bettina chose to birth at Chelsea and Westminster Hospital, attracted by their integrated birth unit. “I wanted to birth there because they actually had an integrated birth unit. So I wanted to be like part of that birth unit because in the UK basically you get the choice of home births, hospital births or if you’re low risk a birth unit.”

Her birth education came primarily through reading, including Millie Hill’s “The Positive Birth Book” and “Give Birth Like a Feminist,” Ina May Gaskin’s work, and Rachel Reed’s “Why Induction Matters.” She also discovered Sophie’s podcast in 2019, providing a connection to Australian birth experiences whilst living abroad.

First Birth: A Long Labour in London

At 40+5 weeks, Bettina went into spontaneous labour. “I started feeling some like period cramps and kind of thought, oh, I don’t know what this is, but I should try and go to sleep.” The contractions quickly established a pattern, and bleeding prompted a trip to hospital via London black cab.

“I got in the cab and I do remember the cabbie just like staring at his rear view. And I just thought, please just get me to hospital. Like just look straight and drive.”

Due to the bleeding, she was transferred from the birth unit to the labour ward. Her labour progressed well initially, but the pushing stage proved challenging. “I ended up being fully dilated for the full two hours. So I ended up having quite a big baby. George was just under four kilos. It was my first birth and I’m not a particularly big person.”

After two hours of pushing and the threat of an episiotomy, Bettina found her final reserves: “Despite me trying everything for two hours, it was seeing those tools that actually got me to push George out.” She avoided the episiotomy but sustained a second-degree tear and experienced a postpartum haemorrhage.

Postpartum Challenges and Mental Health

The early days with George were particularly difficult due to severe reflux. “George had really severe reflux and he was a baby that honestly was waking every 45 minutes to two hours max until seven months old when I sleep trained him.”

This led to postpartum depression, which Bettina initially dismissed as baby blues. “At first I kind of thought this feels wrong, but I was quite often told, you know, you just had a baby. This is probably the baby blues.” When George’s sleep improved at seven months but her mood didn’t, she sought help from her GP and started medication.

Interestingly, Bettina later discovered that her first birth had caused some physical trauma that manifested years later. “I ended up discovering it was my body’s response to birth trauma. And what got rid of it was I had some red light therapy… She zapped my brain through my throat and she was the one that said to me, you need to talk to me about your first birth.”

Returning to Australia and Second Pregnancy

COVID-19 and the challenges of new parenthood without family support prompted their return to Australia when George was six months old. “We realised how hard it was to have a baby there with no support, but also childcare in the UK is incredibly cost prohibitive.”

Her second pregnancy brought different challenges, including severe nausea. “With her, I was just vomiting. I didn’t have HG, but I was vomiting like probably twice a day, once to twice a day.” She also dealt with a low-lying placenta that fortunately moved by 32 weeks.

Bettina was surprised by the differences in Australian maternity care: “When we moved back to Australia, I was really shocked that continuity of care wasn’t standard as part of the public system. And I was shocked because I had it in the UK through the public system.”

She chose private care with obstetrician Dr Emma Chesterman, making her decision based on birth philosophy: “When she told me that she delivered twins vaginally, I was like, yep, you’re my girl.”

Second Birth: A Quick and Empowering Experience

Eleanor’s birth was dramatically different from her first. After her waters broke at home, Bettina initially planned to labour at home longer. However, rapid progression meant she was 7cm dilated when checked at hospital.

“Another midwife came up to me and at that point said, hi, I know you’ve been seen to, but do you mind if we actually check you? And I just remember somebody saying, call her husband now and call her obstetrician. She’s seven centimetres.”

The birth itself was incredibly empowering: “I was on all fours and I could feel that sensation of my daughter Eleanor descending. And it was so empowering because that first time around, had lost feeling and I couldn’t feel, I couldn’t really feel like the baby moving through the birth canal.”

Eleanor was born without tears, weighing 4.05kg. “I birthed her head in one push and then the next push was her body… I didn’t tear in that birth either. Which was amazing.”

Third Pregnancy and the Decision for Caesarean

Bettina’s third pregnancy was planned, though she miscalculated timing and nearly missed maternity leave eligibility. This pregnancy brought different preparation, including hiring doula Grace from At Your Side Doula Services.

“I had a really good experience in the private hospital. But at the same time, you know, I knew that private hospital, you know, is associated with higher intervention… I was also really aware that I had had a unicorn birth. So I at that point decided to bring on a doula because I just thought if things don’t go my way, I want somebody advocating for me.”

Her doula challenged her to think more deeply about consent and choices, including discussions about GBS swabs and CTG monitoring. Bettina also completed additional birth education, including Dr Kristin Small’s CTG course and modules from The Birth Class.

Waters Breaking Without Labour

At 39+2 weeks, Bettina’s waters broke but labour didn’t establish. “I went to bed, no problem. Woke up the next morning. I thought I’m still pregnant… I had nothing like no tightening, no niggles, no contractions, not one.”

After 36 hours with ruptured membranes and knowing the statistics from Rachel Reed’s research, Bettina made the decision for caesarean birth. “Something like only 10% of women’s waters break as the first signs of labor. So I was in that 10%. By 12 hours, 85% of those women have gone into spontaneous labor. by 24 hours, think it ups to something like 97%. So I was coming up to 36 hours and I was in the 3% of the 10%.”

Advocating for Caesarean Birth

Despite her obstetrician’s preference for induction, Bettina advocated for her choice: “I rang my obstetrician and I said, I’d like a C-section… She said, it’s your third birth. It’s different going through an induction third time as it is the first time.”

At hospital, Bettina had to clarify her consent: “The first thing the midwife said was, so your obstetrician told me you’re getting an induction. And I said, no. I’ve not consented to one.”

Her decision was vindicated when her obstetrician checked her dilation during surgery: “She said to me, you were one centimetre and she had a 38 centimetre head and I knew, and she was posterior and she almost went so far as to say like, you were right.”

Reflections on Birth Choices

Bettina’s story demonstrates that positive birth experiences come from feeling informed and supported in your choices, regardless of the mode of birth. “I feel like I made the right decision for me. It was my choice and that in itself felt very empowering.”

Her experience across two healthcare systems, three different birth experiences, and various challenges including postpartum depression, prolapse, and feeding difficulties provides valuable insights for anyone navigating their own birth journey.

Key Takeaways:

• Birth experiences can vary dramatically, even for the same person
• Postpartum depression can occur even after positive birth experiences
• Advocacy and informed consent are crucial in all birth settings
• Different healthcare systems offer different models of care
• Physical birth trauma can manifest in unexpected ways
• Positive birth experiences are about feeling respected and supported in your choices

This episode offers hope and practical insights for anyone preparing for birth, dealing with complications, or making difficult decisions about their care.