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Making decisions about birth after caesarean

People's stories

Aged 40 and over

Interview 05

Interview 05

Age at Interview: 42
Background: Advertising manager with a three and a half year old daughter. Husband is a recruitment manager. Ethnic background: White British (English).

Brief outline:Had a very traumatic 1st birth, long labour, CS was offered only after baby went into distress. Felt excluded from decisions and treated unsympathetically. Felt pushed into VBAC with 2nd birth. Chose to go private instead and had planned CS.

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Elisabeth's story
Print First pregnancy and birth She had a complication free first pregnancy and had attended antenatal classes run by the NHS and the National Childbirth Trust (NCT). She felt persuaded by the NCT's promotion of 'natural birth' and was very keen to have a vaginal birth with as little intervention as possible. She went into labour late in the afternoon and arrived at hospital during the night. Despite strong contractions, she had difficulty dilating beyond 8 cm. In the morning, she received Oxytocin to help her along. At that point she also asked for an epidural, but the trainee doctor treating her did not manage to administer it despite eight attempts. Eventually, a more experienced consultant placed the epidural and she continued to labour until evening. When the baby started showing signs of distress, she was offered a Caesarean. The procedure itself was quick and mother and baby recovered well. However, the experience of hearing her baby's heartbeat drop after 27 hours of labour was extremely traumatic and still upsets her now when she talks about it. She was furious when she learned from her notes that the medical team had discussed the possibility of a caesarean earlier on without consulting her and had decided to let her labour on until her baby became distressed before raising the topic with her. Second pregnancy and birth The negative experiences surrounding her first birth influenced her decision-making about her next birth in a major way. Having had a miscarriage after her first birth, she was reluctant to think about how to give birth in any depth before the 20 week mark had passed. At her 20 week NHS consultation with a junior doctor, she received what she perceived to be extremely one-sided information pushing her to opt for a vaginal birth after caesarean (VBAC). She was also taken aback that despite her age and previous medical history, the hospital would not assure her that the medical staff involved in her care would be more experienced on this occasion. Feeling treated unsympathetically and not listened to by her local hospital, after much soul searching she decided to seek out a private consultant. She found having access to an experienced consultant who took her concerns seriously extremely reassuring. Seeing the same person over time enabled her to build a trusting relationship. Unlike her NHS experience, she did not feel pushed in any particular direction about how to give birth and thought that that the information she received was well-balanced. She also sought out further information from medical internet sites and the scientific literature at her own initiative and eventually booked a planned caesarean to be performed at 39 weeks. It was a difficult decision and she was pleased that all options would remain open to her until the last minute. When she experienced strong pelvic pains from week 36 onwards she was glad that with a planned caesarean, she would deliver slightly before her due date. On the day scheduled for her caesarean, she experienced several hours delay getting into the operating theatre due to an emergency. However, she experienced the wait as a minor nuisance in view of the smoothness of the rest of the operation. The epidural was administered without problems and the consultant talked her through every step of the procedure. She was overjoyed to hear her daughter's cries after only a short time. She still considers vaginal birth as the better option for mothers and babies in principle, but thinks that giving birth is much easier for some women than others. No woman should be made to feel inadequate for not being able to have a smooth vaginal birth. In her own case, she felt reassured that she had made the right choice in having a caesarean when her consultant told her after the birth that the baby's position would have made a vaginal delivery very unlikely. Despite the financial burden that taking the private route has placed on her and her husband, she is extremely satisfied with her decision. If she were to have a third child, she would consider going private again.

She thinks the emphasis on natural birth in her NCT classes made it harder for her to come to terms with her first caesarean. Knowing in advance how common caesarean is might have made it easier to accept.
Print Yeah, with hindsight, I must admit particularly NCT [National Childbirth Trust], they're very anti going for any surgery and I think I was a bit indoctrinated by that and looking back, that's a bad idea. Because you've got to think hundreds of years ago when they didn't have intervention you had dead women and dead babies didn't you? So, that's how I see it now. So, I think, I probably wouldn't recommend the NCT to, to everybody. Basically the NHS does, they did cover caesareans. I think the trouble is, it was something I didn't want to think about at the time, so I can't really argue about the information I got at the time. Perhaps they should say though, perhaps what they should do is to say that statistics are that this might happen, which are fairly high I understand. I mean, we're not really told that, so therefore it was a bit of a shock for… that's the other thing with me, I think it was all a shock that it didn't happen properly.

She felt treated unsympathetically by the consultant and was annoyed to find out she had been excluded from an initial discussion about caesarean.
Print Well, I was very keen to have a natural birth, been to NCT and all that stuff and basically… it just kind of, I didn't dilate properly. I had the full-on contractions, they were saying… so I basically, waters broke about five o'clock on a Sunday, they were, you know the intervals apart you're meant to go to hospital, so quite, I can't remember if it's two or three minutes, but quite quick. So I went to hospital about one in the morning. Then by nine the next morning still wasn't very dilated although having the contractions, so they put on extra stuff to make you contract more, it's, it's written in that letter. [Oxytocin?], yeah, and I then asked for an epidural. And this is when things started to go wrong because they got a trainee to do my epidural. And basically it wasn't in 'til about one o'clock in the afternoon and basically he did eight attempts? So I wasn't very happy about that, as you can imagine. And eventually the consultant did come and do it himself, but it's just the way, I don't know, the way he sort of said, well, the last time he said, “This is your last shot, you're just going to have to survive otherwise” and I just thought they were just very, a bit unkind considering I'd been in labour, full-on labour since, really one o'clock in the morning. It's, it's… so I wasn't in 'til midday. Anyway, this then went on and on 'til she was in distress and that's the- … I get upset when I talk about it… So that was seven o'clock in the evening, so you've got to bear in mind a long, long time. And then they did the caesarean. And to be honest, that went well and everything was fine. It's just very nerve-wracking and I actually don't think the hospital handled it that well, personally, because I think that was too long. I wasn't dilating, it was still only eight centimetres by that time and I just also think this whole anaesthetic thing. And then when I got my notes after, it said that the consultant had come in at one o'clock, so obviously when, quite a lot earlier and they'd discussed a caesarean with the midwives but not with me. And that really annoyed me, because at that point I know I'd have said, yes, do it. And then I would have missed out, you know, her getting distressed.

After some initial difficulties, breastfeeding her daughter was not a problem. Having her husband at home with her for the first two weeks was helpful.
Print And did it affect how you were able to feed your daughter at all? No, everything, that's the thing, I think I forgot, but I had a few tears for about two days and then she fed fine and to honest, I didn't think about it again, I just concentrated on her. So I've been lucky there because some people get a post-natal depression, this, that and the other and I didn't, even though I'd gone through that so, funny, isn't it? You breastfed? Yeah. And that you didn't have any problems with the scar or anything, being able to pick her up or? No, I was lucky. Yeah, I mean a bit but my husband was home for two weeks and then after that it wasn't too bad, so I think the surgery was fine.

Because of a previous miscarriage, she did not start to think about how to give birth until her hospital appointment at 20 weeks.
Print So, I, I basically didn't really think about it all until about twenty weeks. I think possibly, I'm not sure if I told you this before, but I had a miscarriage with the previous baby, so I kind of… it didn't become real until about twenty weeks and that was combined with my scan and my visit to my local hospital, [Hospital]. Where, obviously it was on my mind, but I hadn't really thought about it too much but I was, possibly at the back of my mind veering towards an elective caesarean because I had not had a good experience the previous time. I saw a junior, I saw, I think below registrar, so a junior doctor who was under the, you know, under the head obstetrician, who… so I sort of mentioned that I, I was thinking about options, but she basically totally recommended a natural birth. Told me that caesareans risk piercing your bladder, heavy bleeding, lots of things, but she mentioned nothing that can happen with natural births. So she tried to scare me off, wouldn't agree anything or really discuss anything and said, “Well, just see us at thirty-four weeks and we'll talk again”. So that was that. So I went away and had a think. And that's when I really started thinking and to be honest, I panicked and I thought, “Well, if they're going to be like that, I'm going to look into the private option”.

She felt that the risk information she received from NHS doctors was one-sided. She sought out a private consultant and thinks he has provided her with more balanced information.
Print What was your motive for seeking a private consultation? Because the girl, I just felt she was so… what with the information she gave me. I knew that there was two sides. I think, I think the fact they told me all the risks of a caesarean, nothing the other way, is wrong. I knew that, I mean, I'm not stupid. And the other thing, I'm forty-two and I said, obviously I had the bungle with my anaesthetic, I said could you guarantee me I'd have a consultant doing my anaesthetic and a consultant doing my surgery and she said, no, we can't do that and there's no extra risk to being forty-two, which is nonsense. Everyone says, everything you read, it's more risky as you get older, having a baby. So I just felt they were completely unsympathetic and, you know… I think they have their agenda, which is “push for a natural birth” and they're not really listening to you. So I thought, I'll just go elsewhere [laughs]. So the plan is to have the private consultant do the elective caesarean, [Up in London] you've got a date and you're happy? Yeah, I mean, I'm still nervous, I mean, things can still go wrong. But at least I know it's a top consultant, loads of experience, you know, he's done loads of them. I mean, that's the other thing, you know, that guy that did (the epidural), you see I was very… I've never really had much surgery or anything to do with hospitals in my life so I'm lucky. But that guy, the trainee putting in the needle eight times, I thought, what if they put a trainee doing my op? I was just worried, because it was horrendous. And the fact that they wouldn't address it for the second time. Now, I do believe, because people have said to me, you could fight the fight with them and keep going, but you know, I haven't the energy at the moment, you know, and also I think they only see special cases, like if you're really ill or if you're a smoker or, I don't know, I don't know what they take as a special case and give you a bit more better treatment. Twins? I don't know. So how would you say you feel about the information that you were given by the person locally? Bad information, you know, not both sides of the story, not taking into account what I, my previous experience. And also they're saying there's no extra risk to a caesarean when you're older. As far as I know, that is rubbish, so, not good. So you felt you were more able to discuss your fears and anxieties and, and what you wanted with this other person? Well, yeah, but then you're paying aren't you an awful lot of money, but then they have the time. But yes, yeah totally. I've been able to discuss everything and I've been given both sides and not pushed in either direction, which is probably hard for him, because for all I know he might have, he might think natural birth is best the second time but they don't, if you're professional you can keep away from that, can't you? So I just got both clear sides. But he did- well, the only thing he says is that at twenty weeks, when I went to see him, he said it is entirely reasonable to have an elective caesarean the second time if you've had a caesarean before, so I suppose that's the only thing he said positively about it, so, but that's not pushing you in either direction, but it's a reasonable request, which I wasn't made to feel locally.

She looked up information from official medical and scientific websites, but did not trust magazines or chatrooms as sources of information.
Print What I do... I do use the internet a heck of a lot, so... But I mean, I go... again, I use sites like Royal College of Obstetricians, Royal College of Paediatricians. I don't use the… and read papers and things like that, I find that interesting. So not women's mags and things like that? No. No, I don't buy those [laughs]. You want it from the horse's mouth? Yeah, no, I go to the proper websites, because the other thing I do know from the internet is that there's this... there's this one called "babycentre" which has a chat room on it. And a lot of what's on there is rubbish, that the women are chatting, they really don't know what they're talking about, so you have to be careful. But the Royal College of Obstetricians actually for this birth has lots of papers online you can just read, which is interesting. And how did you find reading them? Interesting, I find it really interesting. I was wondering, were you scared at all? No Especially after what you've been through the first time. It's funny, isn't it, because like, when I'm, yeah, I know, because even though it was horrific I can still read them dispassionately. I did a science degree myself so, I think I can - I'm quite a scientist so I quite enjoy it really, yeah [laughs].

Her previous birth was so traumatic that she feels very anxious about vaginal delivery. She thinks a repeat caesarean is safer for the baby and will put her worries to rest.
Print A lot of women, after they have one caesarean want another one, so I think it's quite normal, especially an emergency one. I think more common if you've had a breech and, and people want to try birth don't they, but, you know, I've had quite enough of that [laughs]. I think there's also sometimes women feel they've missed something? Yeah, and I don't have that, [You don't have that] yeah. What factors have most influenced your preferences regarding the mode of delivery this time? What factors, gosh. Probably, the most of it is the emotional one of thinking I can't bear to hear another baby in distress. I think the reason I've gone where I'm going is if I, you know, if I had taken the advice I was given, I was going for a natural birth at [hospital]. I was very nervous that again, I'd be, carry on too long 'til distress so that's another issue I was worried about. So it's really that, because medically, I'm not particularly pleased I'm having an operation and I think if I knew that I'd deliver naturally, fine, I'd have that option. Right. So if you could, could guarantee a hundred percent that you could have a good natural birth, you'd go for it [I'd go and have a go, yeah] but it's the indecision…? …because I'd be running around two weeks later wouldn't I? It's the, it's the not, not knowing and the fact that I've had one experience of things going horribly wrong, I just can't face it.

She found it helpful to use a decision aid that was not driven by any particular agenda and was happy that she could have changed her mind about having a caesarean until the last minute.
Print I thought about it and then as the pregnancy got more and more advanced, I got heavier and heavier. And another complication, I got an awful lot of pelvic pain by the end, it started actually, it did start more like about thirty-six weeks, I suppose. That's when I made my final decision, so I hadn't totally made a decision, but obviously I had used your tool in between. Now that was interesting, because obviously that was geared towards my thoughts and what was going through my mind, which again are things you don't necessarily consciously think about that much. You- it's all in the unconscious and, you know, I was probably veering towards an elective caesarean, to be honest, during that time. Then I did your survey, and that was very interesting because again, it was… it highlighted all the risks and my, but it had my priorities on the different risks. And interestingly enough, that came out elective caesarean, so that was kind of, a bit of a… very interesting for me. And, you know, I do think it was helpful, because it obviously was focused on my feelings, not anybody else's, no agendas, so that was helpful. So… so, I do believe about thirty-four weeks, I did see him and we booked in a date for the caesarean and time, which was quite funny, and it was two weeks before I was due, so it was quite funny. But again, I had, you know, it was quite good, again, I had the option, if I changed my mind at the last minute, I could. So that was great. But I think as I got bigger and heavier and I got these pelvic pains and I think by week sort of thirty-eight, I was due to have it on the week thirty-nine, I thought, “I'm going to go for this, I'm so uncomfortable”, and I was very, very scared of, you know, something going wrong with the natural birth, still so… So it was a combination of everything led me to, you know, I could have changed my mind right up until the last day so, you know, but, but also the tool did really help because it was my worries about the risks and not an agenda that natural birth is better. Which in many ways it is, but not necessarily if you've had a very difficult birth the first time.

She has no regrets about going private for her caesarean. The doctor told her after the birth that she would have been unlikely to deliver her daughter vaginally.
Print Did you ever have second thoughts or change your mind at all? I didn't at that point, no. I also had huge pelvic pains, so, you know, it all contributed to be the right decision, if you see what I mean. Sometimes, I think the powers work like that, but I had a lot of pain, which apparently was, it's sometimes due to if you've had a previous caesarean, you have scarring, so your baby's pushing on that. And then also, he came to see me after… we hadn't got to that and he said, “You know, it's amazing, but where your baby was”, he said “You'd have just struggled again. You carry them really high up, they're not engaged”, and I said, “Well, would she have engaged later?” and he said, “Well the thing is, looking at your anatomy, I don't think she would”, he said, “You made the right decision”, so it was amazing [laughs]. So I've no regrets at all. So it's some, something about the way I carry, perhaps my anatomy, the, the heads just don't get right down in my pelvis. So he said, “I suspect that's why it took so long last time”, and why she just wasn't going to come out. So, so it was amazing, so it all was the right decision. So… [smiles]. So with that in mind, what role do you see you had in the decision this time? Well, I made it totally, yeah, so that's great. And, I suppose I'm lucky that it turned out to be very much the right thing and went so well. I'd say the only… I suppose a few days, actually, to be true, the only doubt I had, had to be fair, because I did sometimes think, “Gosh, you know, is it unfair on”, I mean, obviously after what he said… Sometimes in the days before, while I was in this pain, I thought, “Is it unfair on her, bringing her out a week early?”, I used to worry about that slightly. “And what if she doesn't breathe?” or…or whatever, but obviously now I know it was the right decision for her as well. And did you have any reassurance from anyone at all that that would be okay, the fact that you were having her early and that you had these worries about…? From my own obstetrician, oh yes, totally. And you were reassured? Totally, yeah, I was. Because even the, the morning before, I said to him, “I'm still worried she won't breathe” And he said, “Well, you know”, he again, poor man, probably had to tell me about ten times. But I mean, women are nervous, you know, I suppose I was an anxious patient, though but for perhaps good reason, so for the umpteenth time he told me that it's very unlikely at, you know, I was in my thirty-ninth week and plus, even then he said, “Look, even if she does, we've got everything here, so don't worry”. So, you know, and I did feel very reassured about that, again, for the twentieth time [laughs]. So how would you say that you feel about the way that you delivered this time? I think it went really well and I'm, I'm probably really glad I made my decision. And I've no regrets about the money it cost, which was a lot, and, you know, we're not extremely wealthy but, you know, it was the price of a car and car versus baby is not, not a decision I have to think about.

Her experience in private care was much better than her previous caesarean. Last time she had felt anxious and out of control, but this time the atmosphere was pleasant and relaxed.
Print How did you feel this experience compared to last time? And this is obviously very important for us? Yeah, well, a hundred percent better. It just went really well, no, no… it was actually nice, and then obviously the hospital was that bit nicer, so, it was a pleasant experience, yeah. And how would you describe the first, in relation to that? Well, I mean, obviously… I was out of control, because you know, as you know, nobody really told me what was going on. I had issues like the, you know, in my notes later, I saw the consultant had spoken to the nursing staff at one o'clock in the day about possibly doing a caesarean. But nobody spoke to me, and it wasn't until seven o'clock so I struggled for twenty-seven hours, felt out of control. Obviously I did things like vomit a lot and things like that because it was such a nightmare. So obviously I had a very unpleasant time for myself, plus this, this epidural situation and plus then having an emergency operation, it's just, it's just horrible, so you know, I had a very pleasant experience in, in comparison. And this is, this is an odd-sounding question, but did having the elective caesarean meet your expectations of what you thought it was going to be like? It was more pleasant. I kind of thought I'd be more scared and, and you know, that, I don't know, I just… I suppose I had such bad memories of birth, it was pleasant, people talking, you could talk and, have a bit of a laugh even, I'm not joking, so it was pleasant, yeah, I remember we talked about, you know, we had a few jokes about names and daughters and, and it was just very pleasant, so that's nice [smiles].

She is pleased with her decision to go private to have the birth she wanted but she is aware that other women might not have that option.
Print I feel I was a bit bold with what I did, so you know, some people might think… so, so I feel quite, I suppose I feel quite good about that, because, you know, I'm not always that bold, so, I took things into my own hands and I feel quite good about that, that it all went well. And how realistic do you think it is that other women will have the level of choice? That is a, you know, they, they may not be able to. Although I think a lot of people, you know, in England, because we've had the NHS such a long time, people will buy a Mercedes but won't want to spend a penny on their health, you know? [laughs]. Well, I'll drive an old car and… so, you know, it's, it's ways of juggling things, but I do understand there'll be people that will not be able to make any, you know, make a choice like I did at all, under any circumstances. And do you know what I think they should do? They should argue as much as they… argue with the- whoever's talking to them as much as they can [laughs] to get what they want. As has happened a lot recently with these breast cancer drugs, and I mean, people power's coming to the fore. Now I can also see issues for the NHS for this, because they can't possibly afford it, or, but I'm kind of glad there's people power coming, but I also think there's going to have to be a bit of a culture shift in that the NHS can't pay for absolutely everything and that we're going, might have to pay for bits of our healthcare ourselves. And, you know, people will spend twenty thousand on a new kitchen; I wouldn't dream, you see I wouldn't dream of that, but then a lot of those people wouldn't dream of spending anything on their health, so… and they might have to shift because I don't think the NHS can afford it all. I can see that they're, they're a bit strapped.

She thinks the NHS have a hidden agenda to push women into vaginal birth to save costs.
Print I'd like to know, do you know what I would love to know is why the NHS have this agenda. Is it saving money or is it, is it, I mean they always portray it as for the patients' best interests [laughs]. But I'd just love, I'd be interested to know. I'd love to know, I would, would, just that I think, I just do think that locally you should be able to get an impartial, both sides, these are the risks, you make the decision. And then I wouldn't have to pay a fortune and travel away from home. And I do also think that they should let you see a proper consultant, especially if you're over forty, without any battle attached to it, it's a reasonable request.

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