By Michelle Bromley-Hesketh, 28th May 2021
Editorial note (Celia Kitzinger): I contacted Michelle Bromley-Hesketh after she posted several tweets about the judgment by Holman J, as reported in the press and covered by my blog post. She said it made her “very angry”, and she was concerned that pregnant women reading about the case – especially those with mental illnesses – would fear being coerced into hospital.
She also tweeted about her own experience.
So, I asked Michelle – who is now a doula and counsellor/psychotherapist – to describe her own experience of choosing a home birth in the context of agoraphobia. Her youngest son was born at home in April 2013. This is her story. Michelle hopes it will inspire other women with mental illness to know that a home birth is possible – and that it can be (as it was for her) an empowering and healing experience.
My most important message is this: It’s possible to be agoraphobic (or to have a mental illness of another kind) and still have capacity to make your own decisions about how you want to give birth. You can still choose a home birth – and it can be wonderful. I know, because I did this.
I have had agoraphobia since the birth of my first child, in hospital in 2005, when I had severe post-natal depression and developed a fear of hospitals. I can now actually go into hospitals if it’s for treatment for my children, or other people, but when it’s for me I get all the symptoms – panic, heart racing, sweaty, breathing difficulties. In an emergency situation I will be okay, but planned trips for my care can fill me with dread. But even at the height of my agoraphobia, emergency situations wouldn’t faze me.
I wanted to have my second child (in 2007) at home but at that time I believed (without looking at the research) that hospital was safer. She was born really quickly and I had a sense of holding the baby in to get to hospital in time to give birth there, and then her shoulders got stuck and had to be freed. I just thought, “I don’t want to do that again!”. It was a huge amount of anxiety.
My third pregnancy in 2013 was a complete shock. I thought my family was complete with the two children I already had. I was in a new relationship and we definitely were not planning to have any children between us. By this time, I had begun training as a doula and I knew that home birth could be safe. I’d done my research and I knew I wanted to birth at home.
I was told that medically it “wasn’t advisable” – partly because I’d refused a lot of antenatal care during pregnancy and I hadn’t had any blood tests except for one finger-prick iron test. I got some very good therapy during pregnancy that enabled me to have that one blood test.
I also went to 43 weeks (by my dates) – but the scan from the hospital put my dates back 2 whole weeks, which gave me breathing time for NHS induction protocol to kick in. By their dates, I went into labour at 41 weeks. I wasn’t worried. I knew what I was doing.
There was a large element of agoraphobia in my decision to give birth at home, but I am confident that I’d have gone into hospital if there had been an emergency.
I definitely feel I had the mental capacity to make the decision to have a home birth. When I was preparing for this home birth, I read lots of information and weighed up the pros and cons of home versus hospital, taking into account all the relevant factors, but especially considering that home birth would be safe, that I could transfer in an emergency, and that my agoraphobia and fear of hospitals would mean that home birth would be a much better experience for me. I didn’t want the trauma and the panic. A big driver for deciding on a home birth was that I would feel that I was in a safe space, that I would be the person in control: midwives would be guests coming into my space where I hold the power.
My decision to give birth at home was far more informed and considered than my earlier decisions to give birth in hospital were. Back then I didn’t really weigh up any information about home vs. hospital – I just assumed that hospital was safer. It was an uninformed choice: I was going along with what was expected.
I did experience some degree of coercion with my home birth. I was told that I would die or my baby would die – and that’s very scary, especially if you’re already fearful and anxious. Some people treated me like a naughty child. Others treated me as if I had three heads.
The birth was a healing experience. I trusted myself and my body more than I’ve ever done before or since.
The midwife, Lynn, introduced herself, asked questions about what I wanted to happen and worked with me beautifully. We called my parents to come and keep an eye on the older two children, so we could concentrate on me and the new baby.
I had a birthing pool (it took my partner 2 hours to fill it up) but thought, ” hmm I feel comfy enough doing what I’m doing” and the thought of getting a contraction with one leg in one leg out put me off so I decided to not get in.
Much of my labour I was on my knees on the settee with my face planted into a pillow on the back of the settee, with my partner rubbing my back. My mum just sat quietly watching in the corner, which felt empowering. She seemed calm and just a “mother/ women” energy. Something quite ancient and primal. She has since said that it was an empowering experience for her too.
I began howling and growling, swore a little too, but was inward and imagining thing moving and opening. My dad, who was upstairs throughout, said my sounds were very different to those my mum made and were very animalistic and primal.
My baby descended. I hardly pushed. Waters now popped. (First time this has happened naturally in my births). I had a panicky moment which I think was me actually realising I was having a baby in next minute and requested gas and air for the first time. The midwife went to retrieve it from her car. I had one slight puff, which was definitely a psychological thing and my baby came out! I felt the familiar “flop” feeling and he’d landed on the settee – at 4:13am on 23rd April 2013 weighing 8lb 9oz (he wasn’t weighed until an hour later). I turned over and picked him up and immediately he reached for the breast and we stayed there for ages! The moment felt wonderful and magical and very healing and cleansing even though I had NO idea I needed healing/cleansing. Wonderful!
I will never forget the experience. Amazing, magical, wonderful. I truly felt like a goddess for months afterwards. The high wouldn’t leave and when I think about it, I still smile and feel all tingly!
It’s hard to make decisions that other people think are “unwise” – especially then they threaten you with death and serious injury. But I have learnt so much more about childbirth since my hospital births, and it was this knowledge that supported me in making my choices. Knowledge really is power!
Although my baby breastfed immediately after birth, he didn’t feed again for more than 14 hours. I myself had no concerns – he was full of mucus and just needed some time. But the midwives wanted me to go into hospital to get him examined. I said “You want me to go to hospital with my 14-hour old baby? Dream on!” They said I was putting my baby at risk. They said they might need to ring social services and get the duty social worker to come if I refused to go to hospital. Then the GP turned up – but by the time they showed him into the house I had my baby feeding at my breast. If I hadn’t been knowledgeable, at that point I’d have been whisked into hospital for no reason.
On my medical records on the computer, when the GP opens them, there’s a red flag that says “history of Severe Mental Illness” – that’s my depression, anxiety and agoraphobia. That makes health professionals feel concerned and then they try to control what you do.
I still believe I could have coped with an emergency transfer, because I would have accepted the need for it. But to be forced into hospital by punitive people who think they know better than me, without any emergency, before I was even in labour – that would have been awful.
If anyone had insisted that I must give birth in hospital and be admitted before my due date – as happened to the poor woman in the court case recently – I think I would have run away. I would have not told anyone when I went into labour. I would have given birth on my own without any health care professionals in attendance, rather than be forced into hospital – and of course that’s much more dangerous than a planned home birth with midwives. The only way they could have got me into hospital would have been to sedate me and force me. My phobias and panic would have been through the roof and the whole experience would have had a long-term negative impact on me as a woman and mother and would have exaggerated my agoraphobia.
I know that a lot of women will be scared and anxious by the media reports of this case. I want to reach out to them and say that having agoraphobia, or tokophobia, or any other kind of mental illness, doesn’t automatically strip you of the right to make your own choices. They have to prove that you lack capacity to make your own decisions about childbirth – they can’t just assume it because of your diagnosis.
There is support out there if you need it from the childbirth organisations (listed below) who understand the importance of listening to women and empowering them to give birth in the way that is best for them.
Michelle Bromley-Hesketh is founder of Snowdrop Doula Community Interest Company, a mother of three, a doula and counsellor/psychotherapist. Michelle’s interests and expertise are in perinatal mental health, trauma and complex needs, and informed choice. She tweets @michellebee34.
Other organisations that can help
Image credit: Jodi Hall Photography