25/06/2026
This is a story about vaginal birth after caesarean and bleeding in pregnancy.
Hasnaa and Cam’s first baby, daughter Eliana, was born by emergency caesarean when she presented at 38 weeks (38/40) with vaginal bleeding which was thought to represent a placental abruption (placenta separates from the uterus too early). Eliana was born in good condition.
Because of this, Hasnaa never had the chance to experience normal birth and was keen to try a vaginal birth after caesarean (VBAC). She had a history of Hashimotos thyroiditis which was stable without medication. She was otherwise fit and healthy and had a normal BMI.
I met her in her second pregnancy. We discussed the risks of VBAC in detail, but there was no reason why she could not attempt a VBAC. She had fresh bleeding occurring every week from 6 to 10 weeks. Each time I checked on the baby and the heartbeat remained normal. At 10 weeks, I examined her and discovered a large cervical polyp. I removed this in my office and it was confirmed to be benign. From here, her bleeding stopped completely.
At her 20/40 scan, it was found that she had an anterior placenta previa, meaning the placenta was attached to the front wall of the uterus and was covering her cervix. If the placenta is covering the cervix by the time you are in labour, a vaginal birth is not possible. However, a significant proportion of these will resolve by term, so we were cautiously optimistic.
Fortunately, a repeat scan at 32/40 confirmed that her placenta was now clear of her cervix. A VBAC was still a possibility.
The remainder of her pregnancy progressed normally. At 39+2/40, the symptoms of pregnancy were weighing her down so I offered a vaginal examination (VE) and membrane sweep. Her cervix was 3cm dilated, 1cm long and soft – ready for labour. I performed a membrane sweep at her request.
At 40/40 she presented in early labour to . 4 hours later, VE showed her cervix was 4cm dilated, fully effaced (thin cervix), marking the beginning of her ‘active phase’ of labour. She had a 50ml intrapartum haemorrhage and the bleeding continued slowly, though her CTG (fetal heart rate tracing) remained normal. Three hours later, she had another larger gush of blood but she was now 7cm dilated. Because of her ongoing bleeding, I ruptured her membranes to expedite labour. 5 minutes later she was fully dilated. She was in the zone, had her music playing and lighting set up. She was provided the best possible care by Midwives Ella and Lizzie (who also doubled as photographer!). She pushed standing and on all fours for 40 minutes, culminating in the normal birth of baby Raphael (3100g) who was born healthily to the song ‘Now We Are Free’, from the movie Gladiator. At her request, cord clamping was delayed until cessation of pulsation (7 mins). Once the placenta was born, she had an 800ml postpartum haemorrhage which was successfully treated with medications and uterine pressure. A small first degree tear was repaired.
Hasnaa and Cam were delighted to meet baby Raphael. Hasnaa was proud that she was able to experience the birth she missed out on in her first pregnancy. Congratulations Hasnaa and Cam on the safe arrival of baby Raphael. I wish you all the best as the kids grow up together!
