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Making decisions about birth after caesarean

People's stories

Aged 36-39

Interview 07

Interview 07

Age at Interview: 37
Background: Teacher with a 2 year old daughter. Husband is an environmental engineer. Ethnic background: White British (Welsh).

Brief outline:Went 14 days overdue with 1st child, was induced, then had CS after 2 days of labour. Advised to have planned CS with 2nd child, booked for 10 days past due date, still hoping to go into labour. Surprised by her positive experience of 2nd caesarean.

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Sara's story
Print First pregnancy and birth Her first pregnancy was free of complications. She had attended a series of NHS antenatal classes which provided her with detailed information about birth and postnatal care. She had decided against making a birth plan as she felt conscious that her preference for a non-interventionist birth might be unrealistic. Also, ultimately she felt prepared to go along with whatever was best at the time for her and her baby. She went 14 days past her due date and then was asked into hospital for a scan. The scan showed too little fluid around the baby so a decision was made to induce her. After four attempts at inducing her over the course of two days and little progress, the baby started showing signs of distress and was eventually delivered by emergency caesarean. Both mother and baby recovered well, though she had problems breast-feeding her daughter and gave up after six weeks. Looking back, her experience was quite traumatic, even though she thinks the medical team did the right things at the right time. She would have liked to be informed about the implications of a caesarean at an earlier stage of her labour when the possibility was first mentioned instead of the rushed consent process after her baby went into distress. Second pregnancy and birth Her second pregnancy went smoothly and she was keen to attempt vaginal birth after caesarean (VBAC). She found out information about her options from health professionals and other women but felt slightly confused to be given conflicting pieces of advice from her midwives and her obstetrician. Her midwives encouraged her plans for VBAC, but at her 37 week appointment the obstetrician told her that her chances of a vaginal birth were small given her previous problems of going into labour. She was surprised that the hospital asked her to book a planned caesarean even though she wanted to take the option of waiting past her due date. It felt insensitive that when her and her partner went on a hospital visit, they were shown the natural birth suite - which would not be available to her - but not the operating theatre. She decided to book a caesarean for 10 days past her due date, still hoping that she might go into labour before then. The day before the booked date she met with the obstetrician to decide whether she wanted to be induced. Together they decided against induction and she returned the next morning to have the caesarean. The experience was very positive and in marked contrast to her first caesarean. The midwife talked her through each step of the procedure and she had music playing and photographs taken. She describes the experience as wonderful, relaxed and empowering. She had the same kind of difficulties with breast-feeding her second daughter as she had with her first born and wonders whether this is linked to caesarean birth. She does not agree with the practice of performing caesareans at women's request without medical necessity, but thinks that women who are unlikely to succeed with vaginal delivery should be offered a planned caesarean. She also thinks women should receive information about what a caesarean might mean for future pregnancies before becoming pregnant with their next child.

She decided against writing a birth plan because she thought her vision of an 'ideal birth' was unrealistic.
Print I was always very much one of these people that I didn't write a birth plan, I would go along with what was going to be best for the health of myself and the baby, so… Although in an ideal… I knew that in an ideal world I wanted all the sort of natural birth and, you know, no pain relief and everything, but I didn't write that down because I thought that's not being realistic, so…

It was a struggle to breastfeed her daughter after the exhausting birth. She had to top up her daughter's feeds with formula milk and stopped breastfeeding after 6 weeks.
Print Did you have any worries or concerns after you had [daughter] about maybe the way that she delivered affected her or you at all? I had lots of problems breastfeeding and I did feel that that might be because there wasn't, because it, because I was absolutely exhausted because I'd been induced over two days. And it had made me very ill, being induced, and I found that really hard, then the sort of, you know, putting her on and breastfeeding straight away, that was difficult. And was that something that you were able to do first time or did you not? I gave up at six weeks, I couldn't. And she constantly needed topping up. She was a big baby. And I found breastfeeding really hard. I didn't find bonding with [daughter] hard but the actual sort of breastfeeding was difficult. And was that with having a scar as well, did that, how did that affect…? I think it did at night time, the night feeds, sort of getting up and moving around. I found that really difficult, but, I mean, I've got a very supportive husband, he was fantastic so we did give it the best try we could and she was a big baby as well, and I didn't ever seem to produce enough milk so, and I don't know whether…that's something I didn't know about before, whether or not having a section affects, affected any of the sort of, the milk coming through or anything like that, that's something I still don't know actually, but that was something I wondered about. Because it seemed to be a long time before there was enough milk… to satisfy her and then, by which stage she was being topped up with formula and preferred that option.

She was disappointed to learn late in her pregnancy that her chances of having a vaginal birth were small. Being shown the birthing pool when she could not use it felt insensitive.
Print I would really like to have a natural birth, but having had an appointment yesterday with the doctors, I- I don't think that's very likely from what they've said to me. Which doctors was it yesterday that you saw at the hospital? It was at [Hospital]… Doctor…, I cannot remember her name, sorry. I don't think I even got given her name. So what, what was confusing about that, or what changed your mind? …I expressed that I wanted to have a natural birth but I felt that, having, I had to have an examination and a scan and everything and the Bishop's scale was reading very low already. And she basically, felt that looking at how my pregnancy was with [daughter] and the birth, that it was looking unlikely for me to have a normal, a natural birth. But what I think I was surprised about yesterday is that I had to make a decision about a section and I wasn't expecting to do that. So… and the decision as to whether to have it in two and half weeks or whether to go late, later and see if I went into labour naturally. So it was whether to have an elective, or, or wait and see? Yes. But, even with the wait and see I still had to book in an elective section. Which I thought- I thought if I went for the wait and see option, it would just be if- if I need a section, it would happen, not be booked in. I feel very strongly still in my mind that that's something I might, I really want to try and do, even though I've been told it's unlikely, that glimmer of, “It might still happen”. So the possibility is … …yes, yeah. I think as well, advice about, you know, I went on the hospital visit and they take you round the fabulous new birthing suite, which, I knew I wasn't going to be able to even go onto because I'd had a section for the first delivery and if, people don't know that, I think it's quite insensitive really. Because there's this lovely birthing pool and things and… But it's not for you? That's not going to happen for me, I know that. I mean, it's important to know that right from the start, but I think, sometimes it can seem a bit, harsh on people when they have to go on those visits.

She had conflicting advice from the community midwives and from staff at the hospital about her chances of having a vaginal birth.
Print More suited to my needs would be more contact with medical professionals, I think. But having said that, I, I felt like I had enough, I don't think I… because the midwives were so fantastic, so… I suppose that's one thing I found quite difficult, the conflicting advice between midwives and hospital, in that my midwife team were very, very keen for me to try and have a natural labour and to keep on sort of focusing on that. Whereas the hospital were, “It's very unlikely that's going to happen”, so I suppose that, the conflicting advice between those two sets of professionals, I found quite difficult.

The medical staff talked her through the delivery moment by moment. Having a first glance at her daughter still attached by the cord was wonderful.
Print I had to be in at seven o'clock in the morning and I was given a bed and obviously told not to eat and drink anything. And I was told exactly what was happening by nurses and they told me what time they were going to come and collect me, which they did. I suppose my only sort of nervous part then was that emergency sections would take preference over planned ones and I was a bit anxious because I did then want to get on with it. But that didn't happen, thankfully and went down to theatre and…it was very, it was quite surreal really because it was very different to my first delivery. Which was an emergency- an emergency section, because everything seemed to happen so fast the first time, and this time it was extremely relaxed. And what I really enjoyed about this delivery was the fact that I wasn't exhausted, and I wasn't absolutely terrified. This time I knew exactly, I was calm and had I'd had a good night's sleep, I felt completely ready to have the baby and the theatre team, I specifically asked them. I said I wanted to know everything that was happening, and they told me everything that was happening moment by moment, which was wonderful. And also I chose to be the first to sort of see the baby and they put the screen down and held her up by the cord so I was the, obviously well, they would have seen her first, but to say it was a girl. And that was a really wonderful moment. It was lovely. So, has it in any way revised your previous opinion that with the delivery… Mm …it maybe wasn't the section, it was the way, it was that you'd laboured before having a section, and it was having an emergency rather than a section per se? Yeah, I think that still, obviously out of choice, I would have loved to have had a natural childbirth just because that's the way I think you're meant to give birth, but, but having said that, you know, I've got friends that are pregnant at the moment and I've said to them all, if you have a section, it can be… wonderful. It doesn't mean it's not going to be wonderful, because I think people associate having a section with being quite scary and things have gone wrong. But it wasn't like that for the second time with me. Everything was fine, it just was the safest way for this baby to be delivered. And she was ten' two so I was quite glad I didn't have it naturally now [laughs].

The experience of planned caesarean was much better than she had expected. She felt calmer, better informed and more in control than she had done with her previous caesarean.
Print It was better than what I thought it was going to be like, because it was much calmer. Because it was, again, totally different to my first delivery. It was very relaxed, I had music playing that I wanted playing… and I was very informed, I knew everything that was happening and I mean, some people wouldn't want to know as much information as I did, that's a choice that I made. And I felt very… even though I wasn't in control obviously, but I felt as if I was in control of what was happening, because I knew what was going on. So, I felt quite empowered, even though I wasn't in control, obviously.

She would like other women to know that a planned caesarean can be a wonderful experience rather than something to be frightened of.
Print Is there anything about the delivery that you would have liked to have known now with hindsight? Well, I suppose only the fact that it can be really calm and wonderful and, I said to my midwife, I gave her a copy of the photograph that, of [baby's name] when she was born, because it just looks like it was a natural birth. And I said to her, “You should show that to people and say, “That was a section delivery.” Because I think women associate fear to it, I mean, when you go for your hospital visit they don't even show you the theatre. And I think actually, “Well, you should be showing it", because you do need to be prepared about what might happen. And not to frighten women but to actually say that, "It can be wonderful". That's one thing I felt about it all.

She thinks women should not be put under pressure to attempt vaginal birth if their chances of success are low - it will only make them feel guilty.
Print I think that women do need to be informed as much as possible and that you know, I think, I think… one thing I think is that…. I suppose and this goes against what I, what I really believe in, because I do think if you can have natural childbirth it's, that's what I would want, is that because it was a planned section, if there is, if the chances are that it isn't going to happen naturally, like it was with me, that women should be given… that it should be a section because everything was so calm and, and fantastic, but I mean… and if I'd gone ahead and been induced and then had, had a section it would all been a bit more sort of frantic and a bit more… not as safe. And I think that if there is no chance really… and I think you're really talking about the medical profession, particularly the midwives who, I just, they're fantastic, but they were really trying to push for me to go and try and have natural labour. And that wasn't going to happen. So it's this whole thing again with like… like breastfeeding, you know, I mean, I've, the pressure there with the breastfeeding, it's like almost the pressure with natural childbirth. It's a similar thing that… and then some women can't breastfeed and some women can't give birth naturally and so they live with guilt. And I just think that's wrong.

She thinks midwives are best placed to give women information, because they are the professionals that women see the most. Having a midwife she knew at her birth meant a lot to her.
Print Who is the most important health professional do you think to provide the pregnancy and delivery, delivery especially, information? Well for me, it was the midwife really, definitely, because that, that… but I think that's because they're the people that I had the most contact with, so they're the people that I got to know and the midwife was obviously, my midwife, one of the midwives that I'd met quite, on quite a few appointments was there for the delivery. And that, that meant an awful lot to me, the fact that she was there, because she was somebody that, she was a face that I knew in a room of, although they were fantastic people, I didn't know any one of them, you know. Oh, apart from the doctor, sorry, who I'd seen the day before.

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