|
Samantha's story
|
|
|
First pregnancy and birth
Her first pregnancy was planned and without major complications. She had made a birth plan and was keen to keep things as natural as possible, using just TENS (a non-evasive method of pain control using electrical currents). She came into hospital after her waters had broken but was sent home as contractions hadn't started yet. She returned the next day with contractions at 3 minute intervals, but was sent back again and tried to manage at home with the TENS machine. She went into hospital again later that night after becoming very uncomfortable and was transferred to the labour ward. She then had gas and air and eventually also an epidural. By afternoon on the next day, she still hadn't dilated much and the medical team advised that she should have a caesarean. She agreed and her son was delivered just 20 minutes later. Looking back, she didn't experience the process as threatening or rushed in any way but doesn't think there was much scope for her to be involved in decision-making as things happened so quickly.
She breastfed her son for 16 months. She was happy that neither of them had suffered complications, but felt cheated to have missed out on 'natural birth'. These feelings lasted for for 6 - 8 months after the birth. Gradually, she became more reconciled with what had happened.
Second pregnancy and birth
She experienced a lot more nausea being pregnant with her 2nd child. From early on in the pregnancy, she had thought of asking for a planned caesarean. She was keen to avoid at all costs her previous experience of a long drawn out labour followed by an emergency caesarean. It helped when her obstetrician told her that she would have made the same decision in her shoes. Additional information she gained through being involved in the DiAMOND trial also reassured her that she had made the right choice. She did not feel put under pressure in any way and thinks she could have changed her mind and attempted vaginal birth at any point.
She came into hospital in the morning of the day booked for the operation but had to wait a few hours for a slot in the operating theatre to become available. She felt slightly anxious about the wait and disliked the feeling of being in a queue. However, being familiar with the steps involved in caesarean from her previous experience helped her to prepare emotionally for the operation. The staff were very relaxed and talked her through what was happening. Compared to her previous caesarean, when she had been subdued by painkillers, she felt more aware of what was going on.
She had a sore tummy for several weeks but recovered well overall. Her baby was jaundiced and needed to return to hospital for blood tests several times. She thinks being born by caesarean might have made it more difficult for her daughter to recover from jaundice, but otherwise she has been very healthy since. Looking back, she is happy with the decision she made but planned caesarean is not an experience that she would like to repeat. Her decision to not have any further children is at least partly influenced by her personal experience of childbirth.
She thinks pregnant women are likely to want not just options but guidance in making what for them is a very important decision. Health professionals need to be good listeners and should be prepared to give women honest advice based on their professional experience. |
|
|
|
Her previous caesarean happened very quickly, but it did not feel stressful. She can't recall signing a consent form. Played by an actor.
|
|
|
And is there any way that you can think that the information that you got could have been better?
Perhaps at the very, very end, you know, the… The caesarean happened very quickly, which, looking back was the best way really for it to happen and, it was in no way kind of an emergency, I didn't feel, there was no kind of stress or pressure put on me to think that this was, you know, a sort of stressful situation. It was very, very nicely done, really, if you can have a caesarean that's nicely done. So in that sort of way… but it just seemed to happen very quickly, you know. One minute they were sort of asking me to see if you can push and then the next they were sort of “you know I think you've had it and we'll go for the caesarean now”.
And how involved did you feel in that decision?
It happened quite quickly, I would say, and I didn't sign anything, which I found quite interesting. There was no consent, but maybe that's just practice, I don't really know. |
|
|
|
She felt empowered by the information she got from taking part in the DiAMOND trial but at the same time did not want to burden other mothers with the knowledge she had gained. Represented by an actor.
|
|
|
And to what extent, if any, do you think that the information program helped you prepare and plan for the delivery this time?
Yes, I think it informed me fully about what, as I said, you know, the benefits and the risks. I think that's something that you constantly kind of think about but in a way, in a much more informed way through the program. Because other mothers that I knew at the time, expecting when I did …and we would, you know, in conversation discuss various sort of little things and they didn't seem to know and I didn't really want to often burden them with the information that I had got from the program. So in that way, I felt empowered by it, if you can put it like that. So it gave me food for thought really. |
|
|
|
The consultant told her that in her position she, too, would have opted for a caesarean. This helped to reassure her that she had made the right choice. Played by an actor.
|
|
|
I met a consultant last week who had a little bit of a, an examination of my tummy, and sent me for an extra scan, because they thought perhaps the baby might be slightly small.
But I met with a, a female, a registrar about two months ago and I think she was… she really went over the birth plan with me, which I found most helpful. She was expecting a baby herself so I think she kind of understood.
Right. And can you tell me a little bit more about the discussion that you had with her?
Yeah. She had a good look at the notes and said, “You know, really, I think if I was in your shoes then I would go for a section, too”. She said just perhaps failure to progress was maybe slightly small or maybe it was a big baby, or, you know, whatever, but just for health reasons, on this occasion she said, “I really think that, you know, that would be best for you”. So that helped tremendously. |
|
|
|
She went along with her consultant's advice to have a repeat caesarean but did not feel put under pressure in any way. Played by an actor.
|
|
|
And to what extent, if any, was your decision informed by the information program that you saw at the start of the study?
A large part of that was determined through the program and also on the advice of the consultant at the hospital before delivery. She thought it would be best if I did have a section.
If you can explain what role the information program had in that decision?
Just the benefits to the baby, mainly, and obviously the risks and also, in a selfish way, for myself too.
Because I know that you specifically said about having uterine rupture and you were also concerned about breathing problems weren't you?
The breathing aspects, mm.
And what information did the consultant give you?
Just from, from previous delivery, how difficult it had been and the way in which it had resulted in a caesarean in the end and she felt that perhaps it would be best if, you know, we did a planned section and didn't attempt in any way to go ahead with normal delivery.
And to what extent did your view change during your pregnancy, if at all?
I wouldn't say so. I think after the experience, from the first time, once I'd kind of come to terms with having had a caesarean, which I believe is quite normal for people to have in the beginning, that you felt a bit cheated by the fact that it wasn't a normal delivery, after that, I didn't change at all in my own mind, it was going to be a caesarean.
And what do you think your role was in the, the decision-making and the process, this time?
Despite the consultant, you know, telling me that perhaps that would be the best way to go originally, I still think that, you know, if I really had wished to, to try it naturally then, you know, they would have gone with that decision. In no way was I being pressurised into having a selective caesarean, or an elective, should I say, caesarean, but I felt that really, I was the one who had made the final decision and had made the decision in the first place, that's what I was going to have. |
|
|
|
The atmosphere in theatre was relaxed and professional. But it felt a bit as though she was 'a job to be done' in a queue and it was not an experience she wants to repeat. Played by an actor.
|
|
|
My time to go to hospital was nine o'clock in the morning and I arrived there at nine. I had hoped that it would go ahead at about eleven o'clock, had been kept waiting in the maternity ward, I suppose you would call it and from nine onwards and was told that there'd been some delay, that there were going to be two other little sort of minor operations before mine so I wasn't taken away until half past twelve, one o'clock. It was good because the anaesthetist came to visit me on the ward and explained everything, as did the surgeon. And they were very clear in what, in the instructions that they gave, and answering questions and queries I had, then were taken away and the delivery of the baby came at about ten past two in the afternoon so it had been quite a long wait, it had been sort of five hours after the, the original entering into hospital. So in that aspect it wasn't particularly pleasing. However the baby was healthy and, and everything seemed to be okay and then we were back out of theatre by about three o'clock and up on the ward from then on for about two days.
And what was the actual delivery like?
…well, longer than I remember the last time. They had the, they did say to me that because it was, you know, the previous scarring it perhaps would need a little bit of extra time to stitch up, to make sure the repairs were done properly, which… it put my mind at rest, you know, that nothing was wrong, that everything was going hopefully to plan. And they talked to me through the- more or less the procedure and certainly the staff on the, in the theatre that day, were quite relaxed and everything seemed to be very kind of easy-going. In no way was it stressful or I felt pressurised so in that way, everyone was most helpful and very good at what they were doing, I'm glad to say. [sighs] It wasn't an experience I would like to repeat, you know, again, but if it has to be done and that's the way I wanted it done then I understand, and they worked very professionally to see it to the end.
And was your husband with you in theatre?
Yes.
How was he?
Yes, I think he too found it very calm and very straightforward, which was good…
I think knowing, you know, that it was going to be a caesarean, in my mind, kind of helped in a way, so it wasn't the unknown. I kind of knew what was going to happen. The experience perhaps wasn't… I think the first time, because I had had gas and an epidural and had taken forty hours to see if I could have the first baby, I think at that time, I was perhaps a little bit more not quite with the situation, and therefore the caesarean seemed to happen much more quickly. I mean it wasn't an emergency caesarean, I didn't feel it was an emergency caesarean the first time. Everything seemed to happen in a very kind of pleasant kind of atmosphere, helped by the staff in the theatre. And on this occasion, too, it was very easy-going and quite relaxed. But you just kind of felt that you were in a queue in this, in this instance, which I can understand, you know, it was one of many that were happening that day, so it was kind of… it was just a job to be done [sighs].
Are you okay to go on?
Yes, thank you [laughs].
And to what extent, if any, did this delivery meet your expectations? Was it like you thought it was going to be?
Yes, I suppose so, yes. I mean, any surgery is not pleasant. I don't think, you know, I don't think you can sort of kid yourself that it's all going to be a hunky-dory experience. And you come out of it with a pretty sore tummy at the end of it all. It does take several weeks to kind of heal, so you know, it's… but then again, you haven't had to go through the forty hour labour or however long you kind of put yourself through. |
|
|
|
She thinks health professionals need to be good listeners and should be prepared to give straightforward advice based on their professional experience. Played by an actor.
|
|
|
What message would you send to health professionals who give advice to women in this situation?
…I think to listen very carefully, to be good listeners, but also to give very straightforward advice, because I think as a pregnant person, I think you are looking for advice. I think it's something you do perhaps once or twice in your life and therefore it's something which is quite a big decision to make. And they've seen many pregnancies and many deliveries, I think they have to be prepared to give honest advice from their experience. |
