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Making decisions about birth after caesarean

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Aged 31-35

Interview 03

Interview 03

Age at Interview: 32
Background: Carer with a five year old son. Living with partner who works as an operations manager. Ethnic background: White British (Welsh).

Brief outline:Very keen to have intervention-free birth with 1st child, laboured to 9cm, then had CS when baby passed meconium. Felt cheated and upset long after. Wanted VBAC with 2nd child but opted for CS when 2 weeks overdue. Planned CS was much better than expected.

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Pamela's story
Print First pregnancy and birth She had a fairly easy first pregnancy, though she experienced breathlessness and swelling of her fingers towards the end. She attended antenatal classes but did not find them very useful. She relied mainly on the information she received as part of her pregnancy pack. Having embraced the 'natural way' in her general lifestyle, she was keen to deliver with as few interventions as possible and was hoping to have a water birth. Her mother had come to stay with her for the birth and she was anxious to have the baby while her mother was around. Two weeks past her due date she went into hospital and was induced. She then went into the birthing pool, but after two hours in the pool her labour had slowed down so much that the medical team gave her a drip and epidural to help her dilate. The following eight hours of labour were traumatic: she had frequent check-ups from a changing set of doctors whenever her baby's heartbeat dropped slightly. Her midwife seemed inexperienced and there was very little privacy. She laboured to 9cm, but then her baby started passing meconium and she was taken for a caesarean. Looking back, she was grateful to have delivered a healthy baby but felt cheated not to have experienced vaginal birth. She thought the medical team made a mistake by letting her use the pool too early. She would have liked to be given more time to try and give birth vaginally. She also wished she had gathered more information about complications to be better prepared for the situation. At first, she found it difficult to bond with her son and felt jealous of mothers who could attend to their babies with more ease. However, she managed to breastfeed her son for nine months and this helped her to develop a strong bond with him. Second pregnancy and birth Her second pregnancy was more difficult than the first one. She felt nauseous, tired and emotional throughout. The negative experience of her previous caesarean and the way her labour was managed played an important part in her decision to attempt vaginal birth with her second child. At the same time, she felt better prepared for a repeat caesarean if she should need one and was pleased to learn that she would not be induced. She had searched for additional information on the internet and prepared a more detailed birth plan than with her first pregnancy. As her due date passed and time went on, she became increasingly resigned to the possibility of a planned caesarean and eventually went into hospital at 42 weeks. She experienced a lot of pain being given the local anaesthetic. After that though, knowing what to expect and having chatty and kind staff who she knew from her first birth helped to make her caesarean a surprisingly positive experience. She was overjoyed to hear her newborn son cry. Having him placed next to her face helped to distract her from being sewn up. Both her and her son recovered well and she now feels quite content about how he was born. She thinks having had better information and more realistic expectations than with her first birth have greatly assisted her in coming to terms with her experience. Overall, she feels that deciding about ways of delivering is not a real choice but something that is dictated by circumstance and medical necessity. Nevertheless, she thinks it is important for women to be aware of options and consequences and that health professionals should take an active role in providing information about risks and complications.

She didn't consider the possibility of caesarean and not knowing anything about it made the experience particularly traumatic.
Print And can you remember what kind of delivery you didn't want? Hmm... You see, I don't remember having much knowledge of caesarean sections at all, at all. I think that's why, when it actually happened, it was so traumatic for me because I, I really didn't anticipate it ever happening.

She wanted to keep things as natural as possible and thought a water birth sounded ideal for mother and baby.
Print You said you wanted natural and no interventions and a water birth? If you can tell me how you came to that decision? Mm… The water birth I think because I'd- I'd heard somewhere in my past that the babies coming from a liquid environment and into another environment, that for them it was, the transitional was good if they were coming through water, type of thing. …And that it's relaxing for the mum and baby, that it's a case as well of, I don't know because I've since found out that, you know, out of water it could have been the same but you bring the baby up and onto you and everything. It just, I don't know, something about it just, something that I'd heard in my past about it stayed with me. I really thought it sounded ideal for the baby and mum. And what about the naturalness? The naturalness of it, that's just me all round. That's me in every aspect really, you know, try and give baby organic feed, breastfeed, all the way down the line, sort of… …so part of a wider philosophy really, in what's best for the baby? Yeah, yeah. And for me [laughs] and for my family.

She felt that the relationship with her team of midwives was very basic and businesslike.
Print What information did you actually get? If you can remember where you got the information from? In the pregnancy pack. And did you go to antenatal classes? Yes, I did antenatal classes but I don't remember getting a great deal from that, to be honest. Right, but the pack was more…? …the pack was more useful, I think. And what was your relationship like with your midwife with the first pregnancy, or midwives? Hm… Basic, very basic, very businesslike really, come in-… They're lovely, but it was kind of “come in, do what had to be done, go” type thing. There's one who I've got much more of a… I don't know, friendly relationship with now second time round from remembering her from the first time and they are very friendly, but it's just down to basics and then “off you go”, type of thing.

She had wanted as natural a birth as possible, but after her labour slowed down she felt she lost control and went along with interventions she had wanted to avoid.
Print I went two weeks overdue, he didn't, as far as I recall he didn't engage either and so they induced me. I wanted a water birth and was very, very set on having as natural a birth as possible with as little intervention as possible and as little drugs, doing it as much as I could. They induced me, and then they put me in the birthing pool, which slowed down my labour. So two hours later when I got out, I was only a centimetre dilated and so they decided to speed that up with the drip? and epidural. I kind of went along with it all because my mum was, my mum had been waiting for two weeks with me and she was going to go back home to the South-East coast and I kind of wanted the baby out before she went really, so… I wasn't, wasn't really thinking about if I had any choices and I kind of went with their medical expertise as well. yeah, it wasn't very nice, the sort of loss of control of it over, you know, that it just went, it went from going the way I wanted to completely swinging the other way. To being fully drugged-up and out of my control, but got on with it, and it lasted eight hours. I got to nine centimetres dilated… It was quite traumatic because I had a trainee midwife and so whenever they lost the heartbeat she'd bang on the red button and the doctor on duty would come in and I got to meet nearly every doctor on duty that night, with all the changes of shift and everything as well so… And then of course the doctor would come in and perhaps he'd have others with him. It always seemed like there was quite a lot of people there, and they'd either turn me over or, well, yeah, really turn me over I think it was, get me into another position and then it would be another twenty minutes later they'd lose the heartbeat again and the same again. So I ended up being quite sort of traumatised by that, I think. They took blood from the baby's head a few times and then I got to nine centimetres and they were all sort of, “Oh, it looks like your baby's going to be here within half an hour,” and I got really elated, and then I stopped dilating and so they whizzed me into surgery because he passed meconium.

She felt disappointed to have had a child without having gone through labour. It was very different from how she had imagined the birth.
Print So, we were talking about the fact that you felt traumatised about having the section so that, this is a very stupid question now, but was your birth like you expected it to be? No… Not at all. Can you elaborate on that a little bit? I didn't feel a single contraction. And that… I felt quite cheated by that, because that's the whole part and parcel of giving birth. And that's quite odd now because I'm facing that again with fear, thinking, you know, I'm hearing women say how painful it is and that scares me but it's still very important to feel that because, to me, that's part of childbirth and, you know, you do hear people say that they forget the pain. So not, not feeling sure I'd felt a contraction, I was in the water and I felt something but I wasn't too sure if it was. So I'd envisaged the pain and the shouting and screaming and pacing around and in fact I sat there in a pool doing the crossword with my mum and my friend [slight laugh]… that seemed very abstract, and the next thing I know it all seemed very medical and just totally away from what I'd expected because I was lying there out of control, unable to do anything.

She thinks mistakes may have been made in how her labour was managed. Six years on it still upsets her to talk about how her son was born and and how different it was to the birth she had hoped for.
Print It's funny, because three years ago I would have had a different outlook, but now I can see that it was probably a mistake on their part to put me in the water so soon… But obviously, at the end of the day it's really just that last centimetre of dilation that I just didn't do in time… for them. So how do you feel now about the way that your baby was born? …Glad that he was healthy and happy really. With nearly six years gone by, it's… it easier to think, “Just be grateful that he was born okay”, that he was born healthy, rather… and don't dwell on what I missed out, or how I felt because at the end of the day we did bond. It may have taken a few weeks but we have bonded, he's a wonderful little boy. Time heals everything doesn't it, I guess. It was really initially afterwards and times when I feel emotional like now, when I'm going to be talking about it and reflecting on it. It's like anything, if you're feeling emotional then something traumatic will make you, make it come out. But… basically, I don't really know how to feel about it because, like I say I feel they, they put me in the birthing pool too soon, which was their mistake. And, you know, I can't help but wonder how things would have gone if they hadn't done that. Would I have built up contractions slowly and would it all have gone okay? I mean, I got to nine centimetres but then I don't think they ever really explained why… that half-hour made all the difference. He was saying, you know, you've got to nine centimetres, we should see a baby in the next half-hour and I'm up on the roof really excited. Why was it, why did it have to be half-hour? It's meconium I think, isn't it, it just boils down to the meconium. But then I hear other stories about somebody's left, or their baby had passed meconium twice and, you know, they were allowed to do that and they were disgusted that there, that nothing was done about that, so you can't really sort of win. But yeah, I just feel, I feel mixed, very mixed.

She found it helpful that her doctor tried to find out what she wanted and offered her reassurance rather than just providing her with routine factual information.
Print Yeah, I probably paid more attention to what the doctors have said. I've had two appointments with the doctors at the hospital and I probably listened more intently than I possibly did the first time round to what they've said. The second one, Dr [Doctor] was fantastic because she really, really tried to get to the root of what I wanted. And that was really important. She wasn't just reeling off at me the facts and the medical situation, she was actually trying to find out what I wanted and she reassured me that it wouldn't be what it was before, that the drip wouldn't even come into it. I feel more… prepared to have a caesarean …if it comes to it. I'm psyched up for it this time, I'm ready. I know what it'll incorporate and I'm sure it'll be for the best, if it happens. I think I can be more reasonable about it this time. Having been there, there's more risks second time round so it makes more sense, if it's necessary, to go for it. I don't know [laughs].

Other women's reactions to her decision to attempt vaginal birth made her reconsider for a short time, but she decided to give it a go anyway.
Print I mean, I'd strongly promote vaginal birth to anybody because it has so many more benefits than a caesarean section but that's really just a opinion. And plenty of women think I'm mad for trying for it and that the caesarean section is the obvious one to go for. Which women think you're mad? The ones that aren't pregnant [laughs]. Right. Of course. The ones that think it's just a, a quick cut and, it's easy, your baby's out type of thing. So the ones that haven't had a section? Yeah, or haven't perhaps had, or have had a labour that was really difficult. Right With lots of pain, and they think that, you know, I mean, one friend has had an emergency caesarean as well, but I think she went through a painful labour, so she's had both sides of it. And she has said that, yeah, you don't know what you're letting yourself in for, you're mad, you should go for the section. And that hasn't put you off? It made me sort of think for, you know, a brief, a very brief amount of time [laughs]. But at the end of the day, everyone's got their reasons for their choices, haven't they?

The anaesthetic hurt but the operation was quick and straightforward and the medical team created a relaxed and pleasant atmosphere.
Print I went in early, was lucky to get the first slot in the delivery list… and went into theatre, and it was about forty minutes from when I went in to when he was born. The local anaesthetic hurt a lot, [slight laugh] ready for the epidural, they did about six local anaesthetics and that hurt a lot. And it took quite a long time to get the epidural in, but once it was done, it was done really, and then it was quick and easy and over. And [son's name] was with us. And what was the sensation like of having someone deliver you like that? Okay, because I'd been there before. This was better because I was expecting it. I knew what I was expecting as well. I knew what was going to happen. I could take in a bit more because I wasn't in a panic, as I was with the emergency caesarean. Everything was really quick as well, with the first one, but the second one, I was quite surprised at how relaxed the staff were, and, you know, and it was their first caesarean of the day and they were very jovial and really, really relaxed me. I don't even remember the midwife being there in the first one, but the midwife this time round was fantastic. She was a distraction and really concerned about my well-being and concerned in making sure that I was okay and cracking jokes and the anaesthetist was chatting away to us, and it was a lot more pleasant, a lot more pleasant.

She had wanted a vaginal birth but when she went past 42 weeks without going into labour planned caesarean seemed the only conclusion.
Print The elective was not out of choice. It's called elective just because you have to have it, in a way [yeah]. But to me, it was almost, yeah, it wasn't out of choice at all. I didn't elect to have it, it was just that I wasn't going to fight the medics and go over forty-two weeks just in case there were difficulties with the placenta. I didn't want to take the risk, but I don't consider that I made the choice to have the caesarean, really [slight laugh]. I think it was… the only conclusion. I think I got to the last week and I thought, I think, as in forty-one weeks' term, and I thought, “Right, it really doesn't look like I'm going to have a natural birth”, so I kind of wanted to have the elective section a bit earlier if possible [right] but I spoke to them and they just said if there was an available position they would let me know, but otherwise it stayed the same, which was a day before forty-two weeks. Which I was fine with as well. That was okay.

She thinks it's a good idea to encourage choice as far as possible, but at the same time women need to be aware that things might not go to plan.
Print Nobody really has a choice, do they? What happens, happens. And I had to accept that at the end of the day, there was no choice, it was out of my hands. …I feel happy that I was allowed to try for a natural birth. …And I felt happy about the fact that, if I didn't have him naturally that they were going to take me into theatre rather than try to induce me, because basically the …I don't know if I mentioned to you last time, but the consultant sat with me and looked through my notes and, I think this was before I saw you, and she said to me, “We won't put you through what you went through last time”, and to me that was a huge relief. It meant there wasn't going to be a- you know, an attempt at labour that would end up being a disappointment. It was clear cut. If I didn't have him, I knew I was going to have a caesarean. …Because last time it was very much as case of my hopes were high that it was going to happen naturally, and then of course I crashed down even harder when I had to have an emergency caesarean so, knowing was better, definitely. So how realistic do you think it is to encourage women to be involved in their decision-making? Very, yeah, but they need to know of all consequences that could occur. …That, at any time, if you're having a natural labour, at any time things could change and it might not go that way.

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