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Gillian's story
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First pregnancy and birth
Her first, planned, pregnancy was a twin pregnancy without any major complications. However, during a routine check at 38 weeks she was admitted to hospital for high blood pressure and went into labour shortly after. She was given Oxytocin but had difficulty dilating beyond 9cm. The medical team were concerned about the effects of a lengthy birth process for the second twin and discussed a caesarean with her. Expecting twins, she had been somewhat prepared for the possibility. As progress remained slow it seemed to be the safest option. While it was an 'emergency' caesarean she did not experience the procedure as rushed. She felt that her concerns had been addressed in the decision-making process. Her own medical background helped in her communication with the medical team. Both twins were delivered healthily within two minutes of each other.
She recovered well in due course though at first had some problems breast-feeding her twins. The first couple of weeks were very difficult but she persevered and things got easier after the first month. She feels very practical about having had a Caesarean but has found that when she talks about how her twins were born other people's reactions can sometimes be a bit judgemental.
Second pregnancy and birth
She was keen from the start of her second, planned, pregnancy to have a vaginal birth. As the reasons for why she had been unable to deliver her twins vaginally were not clear, she was uncertain about the likelihood of having one. Her obstetrician and midwife were generally supportive of her decision, but did not provide her with the probabilistic information she would have liked. Additional information she received through taking part in the DiAMOND trial confirmed her decision to attempt vaginal birth. She views caesarean as major surgery and would be reluctant to have a planned caesarean because of the long recovery period and not having family living locally to support her.
She had been told that if the baby was late, a caesarean might still be necessary as induction is more risky after a previous caesarean. However, her blood pressure remained normal and her consultant and midwife were supportive in letting her go past her due date. She was worried that she might run out of time for a vaginal birth, but medical staff just kept a close eye on her and eventually told her to come in for an induction a fortnight after her due date. Her labour was faster and more painful than she had expected, and she delivered her baby within 3 ½ hours of being induced.
In retrospect, she feels vaginal birth was far more straightforward and easier than her experience of twin caesarean. While she felt a bit tired and sore, she was able to get up within half an hour of giving birth and could care for the baby and her other children from the next day onward. She thinks that health professionals should encourage women to chose the birth that is best from a medical point of view and not what women themselves may think is best. In particular, when presenting risk information, heath professionals should put more emphasis on the advantage of a quicker recovery after VBAC. |
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The decision to deliver her twins by caesarean was made in consultation with her. It did not feel like an emergency.
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Well, I was admitted to hospital with high blood pressure, I think it was about thirty eight weeks, at the routine check. And then… because I was in hospital when I went into labour so then I was also put on… I wasn't induced but I was then put on Oxytocin to try and speed things along, and it was fairly slow progression. But I got to nine centimetres with the first twin but it wasn't really progressing and then with the second twin was not unstable, but, they were starting to sort of think it was taking a very long time for a delivery with two children to have to deliver [laughs], so it wasn't an… it was an emergency section, but it wasn't, you know, an emergency as in 'We need to rush through that'. It was talked through with me and we decided that that was probably the best way to go, so they were both delivered by section then, so… |
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The first few days of breastfeeding her twins were terrible, but she was determined not to give up, and it go easier after the first month.
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And how did you feed them?
I breastfed them.
And did you have any problems with that?
I did have at the start, yeah. I had about the first, well, the first few days were terrible and then the first couple of weeks were not great either, but after about three weeks it was okay. I just decided I wasn't going to give up really, so…
…and was that because of the section and having had the scar or was it just with having twins, or?
I think a combination of having twins, having the delivery I had and not having breastfed children before so…
Oh, well done for persevering, I guess that must have been quite a nightmare at times?
I thought it was gonna be hard. It was once they got a little bit bigger it was, once they were past I'd say the first month, it was okay, but, I think, I could see why people gave up, would give up. I mean, if I hadn't been so stubborn, I think I probably would have given up [laughs]. |
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She feels happy about how her twins were born, but found that other women can be quite judgemental when she tells them that she had a caesarean.
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And how do you feel now about the way that your babies were born?
I'm actually happy about the way my babies were born because at the end of the day, my main objective was to have two healthy babies and, you know, I don't have any hang-ups about the fact that it wasn't, they weren't naturally born or anything.
And, do you have any long-term concerns about either the effects of the delivery on them or you at all?
…not really, apart from the fact that it's quite funny that the second twin is now the first twin and the first twin should have been - they're the wrong way round, if you see the pictures, scan pictures and things, but whether that will affect them as they get older [laughs] stole my birthright [laughs].
And did you have any feelings about yourself at all that were different after the section?
…possibly not at the time but more so now because people speak to you as if you've had a natural delivery and now that I'm having a second child and then when you tell them you've had a section, they go, “Oh”, which is sort of strange, like and you don't, because like people tell you all the gory details of their birth now because you've got children and then you sort of say, “Oh, okay” whatever and then they ask you how far apart they were born and then you say, “Two minutes”, and they go “Oh, wow, how's that?” And, “It's because it's a section.” And I sort of feel it's a little stigmatised, but maybe that's just the circles I particularly move in, but … |
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She assumed that after her first caesarean she was likely to need another one. Once she learned that she could attempt vaginal birth she wanted to know all the pros and cons.
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What kind of information have you wanted with this pregnancy?
Basically, the sort of, the pros and cons of having had a section versus not having had a section, on a previous pregnancy and what that might mean for delivery… again for myself, really, as well as for the baby, but more for myself.
Okay. That's really important. If I can ask you a little bit more about that. How aware were you of the implications of having had a section before you became pregnant again?
Well, I think I always thought… at the time I asked, when I'd had the section I asked the doctor on my check-up what would be the, you know, and they said well, the twins weren't overly-big so maybe I'd have to have a section again, but they didn't really have a reason as to why I hadn't been able to deliver them. So, I kind of thought it was always at the back of my mind but it wasn't a reason for sort of not having another pregnancy or anything like that. And when I was… I presumed that the chances were that I would probably have to have another section. I wasn't actually sure on what the protocols on- on that were.
And have you sought out more information about that with this pregnancy?
Yes |
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She thinks giving women balanced information about all possible risks might conflict with giving them reassurance and encouragement about their birth preference.
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And who do you think the most useful, or most appropriate health professional is to provide this kind of information?
I suppose your midwife. Tricky, because I had sort of hospital and health, you know, health centre care, so it was sort of split between both... maybe, you know, I suppose if you have your sort of doctor or your midwife that you see, they might be the best informed person. As I say, a couple again, I've not had… I suppose it's hard because you're torn between that bit of the person that's trying to give you the information based on they want you to make the best decision for, for you versus the fact that they've got all the information in front of them, which is your, their health concerns as well, so sometimes I think that maybe… not a conflict of interests, that's maybe the wrong words, but you have to give people, you know, all the risks and that's just the way that life is, just these days it sometimes can come across a bit negative from health professionals these days, whereas then they're trying to tell you, “Actually have a, have a natural delivery”, so it can sometimes be a wee bit conflicting. |
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Her reasons for wanting a vaginal birth after caesarean were mainly practical - a quicker recovery so that she would be able to drive and look after her other children.
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And how do you want to deliver this time?
Oh, I'll go for a trial of labour this time, I think.
And could you say why?
I, purely because of the fact that if you have a section, you can't drive for four to six weeks, it takes ages to recover, it's hard to bend and I've got two four year old children at- at the minute, so if I could avoid it, I would avoid it. |
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She initially struggled to reach a decision because she thought her doctor and midwife might be withholding information about low chances of her having a VBAC.
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Basically they just went through, discussing my sort of previous pregnancy, my discussion on whether I would have a section this time or not and at that point in time I wasn't actually clear as to- as to how I wanted to go, so they arranged for me to have some time to think about it and, and come back. When I saw the midwife, but I had made a decision then so I didn't see the obstetrician again.
And can you tell me a little bit more about why there was an indecision there about what way to deliver?
Mainly because I felt at that point in time although I had the information in front of me, I wasn't a hundred percent sure I was getting all the information I required from the sort of medical team. I was sort of, I didn't want them to tell me, “Oh… you'll have to have it this way”, but I had a sort of sneaking, unless, you know, at that time, that I might be, being allowed and (encouraged) to go with the trial labour even though at the back of their heads they knew that I was going to end up with a section, and I think I'd have rather been told that there wasn't a possibility than, than, “It's up to you to decide”, even though it's going to be taken out of your hands anyway. But then I explained that to the midwife the next time I went in that that was kind of what my concern was and she said, well, you know, obviously there wasn't really a clear explanation for why, I hadn't managed to deliver my first twin, even after all that length of time, so, you know, it was possibly worth a, worth a try and it was obviously more difficult with twins in the circumstances, high blood pressure and things, so, that was kind of fine. But at the time I didn't feel I was maybe getting all the information and I'm aware it's because of informed consent, you can't tell the patient, “You have to have this”, but on the other hand, I think I'd have felt comfortable if they'd have said, “Well, you can have a trial labour, but in your particular circumstances there's a ninety-five percent chance it's going to be a section anyway because of x, y and z”, rather than sort of say, “Well, everybody's entitled to try”, you know, so, but, that's why I couldn't make up my mind originally, so… |
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Her husband is keen for her to have a VBAC because he thinks she will recover more quickly and it would be difficult if she could not drive.
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And how does your husband feel about your intention to go for a trial for labour?
He's keen on that, yeah.
Why do you think he's keen?
Because I'll be recovered faster, hopefully [laughs]. No, I think it, actually there is an element of that, there is the practicality of it because, you know, we don't have any family that live close by and things like that, not being able to drive would be more of a problem then… I think, you know, he's just keen for me to be sort of… but he's keen for me to be sort of healthy and fit quickly, but on the other hand he would prefer a section if it was like, you know, required. He has no hang-ups about it or anything like that but I think he'd just prefer, I think he'd probably prefer that the baby was just born quickly and he didn't have to do anything… if he could have a day and he knew when it would be actually… [laughs]. |
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She went 14 days past her due date. After she was induced she had a short painful labour and delivered within three and a half hours.
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Well, I had to be induced in the end, as it turned out. She was about two… I was about fourteen days, I think after my due date. Basically, I went in… to the hospital. I was… I had three sweeps to see if they could start the delivery normally but, or start the delivery, whatever, but that didn't work over the space of three weeks [laughs]. and then I just had to wait until there was a space on the Thursday that she was born and I went in about lunchtime. And they spent probably more time getting the line in than we did actually having the baby. Since the line was in, it was about three and a half hours start to finish, natural delivery. Quite, quite painful, but [laughs] quite fast, much faster than I anticipated so, but other than that it was a fairly… uncomplicated, event-free sort of delivery, I mean… Comparing it with the last time I thought, “Gosh, that was so easy actually”, [laughs]. In retrospect, maybe not at the time [laughs]. But certainly afterwards, I thought it was definitely so much easier because I was on my feet within about half an hour of… her being born. I had to have some stitches but that in itself was okay, there wasn't any difficulty. It was a lot less hassle than having a section, that was for sure. But yeah, I mean, as far as I'm… I don't know, I've sort of had experience of a long labour and then a caesarean versus a very quick labour with her, I mean, it didn't seem to be… there was no complications, there was no… they turned the induction off after about an hour, just because it was going quite fast on its own, so. And out she came! Relatively simply [laughs]. |
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Her vaginal birth was painful, but she was back on her feet much more quickly and able to hold and feed her daughter comfortably.
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I would… it's obviously more painful to have children, there's no doubt about that, because obviously you get an epidural for it, but having said that, you know, having a quick natural delivery and on your feet straight away is nothing in comparison to not being able to bend properly or drive your car, which is very important when you've got other children that are still in nursery at that point in time fairly quickly and things like that. I mean the, being able to hold her and feed her quite comfortably and things like that makes an awful lot of a difference. Because you just sort of… it's nice just to be up and about and back with your family and things like that quickly as well. |
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She thinks it is important that health professionals encourage women to make the choice that is best for them rather than what they think is best.
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To what extents do you think that health service users should be involved in making decisions about healthcare?
[Laughs] as much as they can. Provided they have a clear understanding of exactly what's involved at the end of the day, but, you know… I think there's some occasions where that may need to be taken out of their hands. I suppose it depends on the person's understanding of the situation, but…
…well, that's something as well that's quite important for us to work out. I mean, obviously, choice is a nice idea but you think choice is not for everyone?
I think that sometimes people make a choice, it could be the wrong choice, or it could be the right, you know… I think and, I think there's a lot of, well, on all fronts of healthcare, there's a lot of media influence on what people believe is right for them because they've seen it on TV and it's not, you know, it's not the right, right way to proceed, so…
I think it's essential that people are encouraged to a choice that is the best, maybe not what they think is the best. I think it's important that people actually realise that, like, you know, there is other… there are other options. Just because you've had this as your first, or certainly, I don't know if it makes a difference if it's your first delivery or your second delivery that's a section, I don't know, I don't know the statistics on that, but certainly I think you know, people should be informed, well informed that it's perfectly possible and… Because a couple of people have said to me, “Oh, goodness, I didn't think it would be, you know, I know you were keen, but I didn't think it would be possible”, so I suppose other people want the easy option these days then anyway, but I think, yeah, it should be encouraged. …I wouldn't necessarily say it's easy having a section but that's what it comes across as, that's sort of perceived like that. |
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She found it helpful to use a decision aid that allowed her to revisit information and think about her preferences outside the hospital environment.
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Probably, actually, probably about eighty-five percent of the decision was based on actually having a chance to think about the information out of the… a hospital setting, a home setting.
So is that another important factor about it, the fact that it was here and not in somewhere in hospital?
Well, I think that when you're somewhere clinical… you know, sometimes, I, I felt confident to say I couldn't, I hadn't made a decision. I didn't feel under any sort of pressure that I had to have made a decision there and then but it gave me a chance to go away and sort of think about it again with information at my fingertips. Whereas if I'd just gone away, I would have just gone away with the sort of verbal conversation that we had, kind of thing, which was, you know, as weeks go by, you don't retain the information or you're not really sure exactly what's been, been said to you, so I thought that was quite useful. |
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She understands that health professionals have to inform women about all the risks but thinks they could do more to encourage women that VBAC is possible.
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And what message would you send to health professionals who advise women on this decision?
I would say that they need to obviously encourage and promote the fact that it's possible, and try and dissuade right at the very start sort of negative image of, “Oh, you can't possibly do this”, understanding that they have to give people sort of the full facts tha… the reason why you've had a section in the first place might influence the reason why you might need one again, or not need one again. But I think from a very early sort of stage in pregnancy, they should be promoting you know, “You'll be able to have your… a good chance of being able to have your baby naturally”, rather than sort of even mentioning the word section again. I think you know, if that wasn't brought in until a later, later stage it might be… |
