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Susannah's story
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First pregnancy and birth
Her son was a planned pregnancy. She had previously miscarried at 12 weeks, but with him she had a complication-free pregnancy. She had attended antenatal classes which focussed mainly on the management of labour and only mentioned caesarean in passing. She assumed that she would have a vaginal birth and had made a birth plan, hoping to get by with just gas and air for pain relief.
One day before her due date she had a show (a blob of mucus from the cervix) and became concerned when she couldn't feel her son's movements. She called the midwife and was advised to go into hospital. She had her waters broken and meconium was found to be present. Her son was still not moving, so she was rushed into theatre for an emergency caesarean. She was very concerned for her son's well-being as he took a long time to cry after the delivery. Also, she felt very sick from the anaesthetic and was unable to hold and feed him until several hours later. However, they both recovered quickly after the operation and she managed to breastfeed him and bond with him very well.
While she feels slightly odd about having become a mother without any experience of labour or even contractions, she has no regrets about the caesarean and is glad that decisions were made quickly enough to ensure his safety. She was offered counselling by the hospital but did not feel the need to take it up.
Second pregnancy and birth
Her second pregnancy was also planned. As soon as she became pregnant again, she asked to see a consultant to find out whether she could have a vaginal birth. She had been told that vaginal birth after caesarean (VBAC) was possible in principle, but was unsure what her chances were, given the problems with her placenta causing reduced fetal movement. She saw a consultant around 20 weeks. He encouraged her to attempt VBAC and arranged for regular growth and CTG scans during the third trimester, which she found very reassuring.
She would have liked for her team of midwives to have supported her more actively given that she was hoping to experience vaginal birth for the first time. She felt a little abandoned by them. She had hoped to refresh her memory about labour management and options for pain relief by attending a parent-craft class for second time mothers, but found that most women there had had vaginal births previously and were not interested to go into detail about this. She also ordered a book about caesarean birth and found the information helpful to gain a better understanding of what had happened at her son's birth and what was likely to happen this time round.
She had experienced Braxton Hicks contractions ('false labour') from 39 weeks onwards, but a day before her due date contractions started to become stronger and more regular, so she went into hospital in the early hours on a Wednesday. Her waters broke and she had very painful contractions for several hours but did not dilate at all. Contractions then stopped again and she was transferred to the antenatal ward. She continued to experience intermittent painful contractions and received strong pain relief which, however, did not help her much. She felt very frustrated about the lack of progress and uncomfortable about making pained noises in the environment of the antenatal ward. Being told on the Thursday that she would have to be induced if the baby was not delivered within the next 24 hours made her consider a caesarean. However, by Thursday afternoon she had started to dilate and was transferred back to the labour ward on Friday morning. From then on, she dilated steadily and experienced the remainder of her labour as much more straightforward and less painful than the long start. Her daughter was eventually born on Friday afternoon.
The baby had to be given oxygen but was well otherwise. She experienced strong bleeding after the birth and had to have blood clots removed surgically, which proved another very painful experience. She also needed a catheter in her bladder for two days after the operation, which meant that it was very difficult to move or pick up her daughter without assistance. This stood in contrast to the quick recovery she had after her caesarean. She attempted to breastfeed her daughter but experienced strong pain. The treatment for thrush she received proved ineffective. Problems with her milk flow and pain lasted for two months after the birth, so she switched to bottle feeding.
Her and her husband are not planning to have any more children, though this decision is independent of the way she gave birth. Despite the complications she experienced, she feels very proud to have had a vaginal birth. At the same time though, she thinks that there may be too much emphasis on it amongst both women and health professionals. Still, she is glad to have experienced giving birth both ways and thinks it has given her a unique experience to share with each of her two children. |
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Her antenatal classes did not cover caesarean in detail. At the time she didn't want to ask questions, but with hindsight, more information on reasons and recovery would have been helpful.
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…so I went to all the antenatal classes and there was lots of information about labour, but none about Caesareans! I think they mentioned in once [laughs]. You know, that this sort of could happen. I think that's probably why I hadn't… I know, I knew Caesareans happen, but it was almost like they don't happen to many people. So I think that's why I kind of hadn't thought about them until it sort of happened really.
So thinking back now with hindsight, would you have wanted more information about sections?
Yeah, yep.
And can you think what kind of information?
What happens really and why, you know, why you might have to have one and… Because I think like if your baby's breech or something you probably get spoken to about it by the midwife on a one to one, but not in the antenatal classes. …So yeah, why you'd have to have one and what it entails, what they actually do. And the recovery and things afterwards.
And was the information that you were given about having a Caesarean useful?
I don't remember. I mean, they mentioned it in an antenatal class and I'd read books and things so I, I knew what a Caesarean was and I knew roughly what happens… but, you know, when it was happening… I sort of found out more afterwards really I suppose.
And you said you had this team, team of midwives?
Yeah.
Do you think that they checked how you were feeling about, your anxieties about your pregnancy and how you were going to deliver?
No it was all sort… it's all talked about that everything will be okay, but I suppose that's the only way to go about it really. But I mean, there was lots of information about labour and birth at the antenatal classes and you could ask questions and things, but I- I suppose I didn't, I didn't think to ask questions about a Caesarean. Because it's just sort of glossed over. |
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Her son experienced breathing difficulties and had a low Apgar score at birth. Feeling very sick herself meant she was unable to hold him until several hours later.
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I recovered quickly, I didn't have any complications with my scar or anything. …And luckily [Son] was a good feeder because I think that would be a concern. Now I know about sections, you know that possibly… because I was sick from one of the drugs so I was… my blood pressure went really low and I was sick. It was three o'clock the operation and I was being sick for the rest of that day. So I didn't actually get to hold [Son] or feed him for several hours.
And you carried on breast feeding after that?
Yep, but I think the first feed was probably two or three hours after he was born.
Okay. And did you have any worries immediately after that you or the baby were in some way harmed or affected by the way he was born?
I did when he was delivered because he didn't cry for ages. And they had to suck the meconium out, it hadn't gone down too far, and they had to help him to breathe and he had a low score* initially. But there was a paediatrician and everything there and… it was all very stressful, the actual operation.
*APGAR score (a measure of the baby's condition at birth). |
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She would have liked to attend antenatal classes to refresh her knowledge of labour and pain relief. Women in the parentcraft classes had other interests.
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I went to one, the revision parentcraft class, which is for second time mums. And you could ask, you know, what you wanted generally, but it was very quick. And that was quite interesting because there was one other girl in there that had had a Caesarean and she wanted to know …she wanted to revise labour and pain relief and things because we obviously didn't retain the information last time because we didn't use it. And most other people were like not wanting to talk about that because they could remember that. They're wanting to talk about how they're going to, you know, how the baby would interact with, or how the toddler would interact with the baby and all that sort of thing more. Whereas obviously I wanted…
So it wasn't an issue to them, it wasn't on their radar…
No, no.
Right, did you speak to the woman who had a section?
Whereas for me I, I didn't know because she rushed off afterwards. We did talk about that, we did talk about labour and things but, you know, you did feel… I did actually mention earlier on in the pregnancy that I might like to go to antenatal classes but they didn't tell- they didn't mention it to me and I sort of forgot how, you know, it sort of went by and I haven't been invited so… so I don't know whether that would have been useful. |
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She asked to see a consultant early on in her pregnancy to find out whether the problems with her placenta that had led to her previous caesarean were likely to happen again.
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…I asked at my booking in appointment with the midwife, you know, obviously I was… that was one of my questions as soon as I knew I was pregnant, but they just said, “Oh you, you know, you'll have to see.” That's when I knew I wouldn't be under midwife only care. But it was all sort of, you know, “You've got to wait until you see the doctor.” …they wouldn't comment on anything.
No, and to be honest for me it's always been that… it's not like [Son] was breech or I had pre-eclampsia, it's not like one of the conditions that you read in a book, so you know whether it's likely to happen again or not. My thing was, I know why I had the Caesarean because he wasn't moving and my placenta wasn't functioning properly, but my whole thing was I know I could, I could try labour if my scar was up to it, but would the placenta thing happen again. So I had to find that out from a doctor, so I couldn't visualise, you know, because they might have said to me, “Yeah, it looks like you don't go into labour early enough or something so we'll have to do a planned Caesarean at… early.”
And when did you discuss that with the doctor?
That was in this pregnancy when I…
Can you remember when?
It was about twenty weeks I think. Because I asked to see him quite early because as soon as I knew I was pregnant I wanted to have a vague idea about whether I'd definitely have to have a Caesarean or not. So I requested to see the consultant… Because I think sometimes you don't get to see them till later on. |
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A book on caesarean helped her to understand better what went on during her last birth, but it could not tell her how likely it was for complications to happen again.
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…is there any other sources of information that you've looked at or you've contacted?
I mean, I ordered the Caesarean birth book, I can't remember exactly what the title is, from the NCT. Because it's actually quite difficult to find… specific books on things like that and it mentioned there is a website about Caesarean births, I can't remember what the address is, but on… the writers of that book have got this website. So yeah, I did that fairly early on and that obviously talks through about a Caesarean and things. But again it wasn't specific to me so I didn't… it doesn't mention my condition. It mentions if babies are in distress, which is really what [Son] was, but, you know, there could be lots of different reasons for that.
Sorry, I'm just scribbling.
It's alright.
And was that useful information?
Yeah I think so. I mean, just to sort of remind myself, because I didn't have that information before I had the other operation or afterwards really. So it was sort of almost good to read what did happen last time and then sort of, you know… I think that's more what it was, about what happened to me last time and trying to find out if it's likely to happen again. But you can't find that out from books. |
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She thought having a caesarean would make things difficult for her two-year-old. He would not understand why she could not play with him and might blame himself or the baby.
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You don't want to be labelled because you've had a Caesarean you know that you'll want another one, and it's also quite annoying when people think that it's the easy option [laughing] because it's not.
Yes, you put them right?
Yes, and especially with the second pregnancy because, to be honest, if I have to have one I have to have one and that's fine and I'll have to deal with it, but it's going to be really difficult with a two-year-old because I couldn't… it's difficult to remember actually, you know, something to remind me of how much I… what I couldn't do. I mean, I couldn't hardly get into bed or anything because I couldn't get the angle, yeah, so it will be very difficult. And he'll be… I don't want me not, me not to be touching him or to be worried, you know, I'd like to be able to hug him and carry on because I've got worries about, you know, the sibling rivalry thing. So I'm sort of like, you know, be careful with me, you know. I don't want to sort of make him think that he's done something. It'll just be generally more complicated. |
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She knew that her chances of having a repeat caesarean were higher than those of other mothers, but she wanted to know what vaginal birth was like.
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What's your preference now for wanting to deliver this time, if you could tell me a bit more about that?
Naturally if I can. I'd like to have a go at it I think, I think that's… you know, I'd like to see what it feels like and I'm quite determined, you know, to do it I think [slight laugh] if I can. But I know that the likelihood of me having a Caesarean is obviously higher than someone that hasn't got a scar.
And why is it important for you to have a go naturally do you think?
…because that's they way they're supposed to come out I think and I kind of just want to know that I can do it, you know… I think when you, you know, when you're a mum and people, or you talk to someone that's pregnant and they're talking about birth, and it's funny that I don't know what it feels like even though I've got a son. So I know everything else but I don't know that. |
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She thinks without the extra information she got from the decision aid she might have felt overwhelmed by the task of reaching a decision by herself.
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To be honest, I felt like a lot of it was left down to me, you know, even when I went to see the consultant. He didn't sort of say, “Right, this is what we're going to do with you and this is how it's going to be”. Even their attitude was you know, “What do you want to do?”. And I think if I hadn't have had the information already on board, because I already had seen your program when I saw the consultant, if I hadn't had all that information, I might have felt a bit sort of overwhelmed by that… you know, that much choice sort of thing… not knowing, not knowing what was involved. |
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Her experience was very different from expected. She spent 3 days in hospital with painful contractions but not dilating. After the birth she had to have blood clots removed from her womb.
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I went in Tuesday night and that was Wednesday morning. And then my husband came in and I was getting on and off painful contractions but, you know, they'd come and they'd be quite regular and then they'd go away again so… It was getting quite painful and I can't remember whether it was Wednesday or Thursday that I'd had the strongest pain tablets they could give me and then I had Pethidine on that ward, because that was the most they could give me. And they were still talking about sending me home, even though my waters had broken and I was in pain. I said, “There's no way I can go home like this. I can't cope with the…”. They were just so painful and I was on this antenatal ward and other people were there, you know, because they were having tests or something early in pregnancy, and there's me having these contractions trying not to be noisy in the middle of the night, you know, while I'm in pain.
And then on the Thursday I was one centimetre dilated finally, in the afternoon and so I was like, “Right, okay, great, something might be happening”. And then the Thursday night the contractions were still really painful but they changed, so I thought that maybe something might be happening now, and then in the morning, Friday morning I was four centimetres. And then they moved me to the delivery suite in the morning of that day and then basically I dilated a centimetre an hour so I think I went like eleven o'clock four centimetres dilated and I got in the bath for a bit, but it was really strange. The contractions were less painful and I hardly had any contractions to get, you know, from four centimetres to ten, you know, I could probably count them on one hand.
So, yeah, then basically at five o'clock I think, in the evening I'd had Pethidine again, and loads of gas and air and at five o'clock I was ten centimetres and then I started pushing and then she was born twenty-five minutes later.
So that bit was really, you know, quick and straightforward. But it was a really out of body experience I think, because of the gas and air. I just …and I felt like really on a mission to do it. I was like I don't know, maybe you're like that anyway the first time, you probably are, because it's probably a natural thing, but I was just like, “Right, I'm really going to do this”, [laughs] you know, “Nothing can stop me now”, not after like being in hospital since the Tuesday night to the Friday. but then… so that was all fine, and she was fine, but then I went for a bath afterwards and I was really bleeding heavily. And I said, “I don't”, you know, “I really am bleeding, you know, I know you bleed afterwards anyway but this seems like a lot of blood” and then basically they had loads of doctors come in and I was bleeding from where the placenta was and I had some clots or something, I'm not entirely sure what was what, but then the doctor came in and she had my legs in stirrups and everything and she was picking out these clots from where my placenta was, and it was really, really painful. I was in tears, really stressed out, like [daughter's name] was in the cot at the side but, you know, it was all… people were everywhere and the midwife was sort of saying, you know, to the doctor, you know, “Be careful, don't…” because she was just really going for it and just like not-, like I was really like beside myself, you know, and this doctor was just… and I know she had to do it, but she was really just sort of, you know, carrying on with it, just ignoring me. So that was really awful.
But that didn't, after that, obviously the bleeding stopped and everything and that was fine. But, and I felt at the time, “Oh that was awful, that I had to have that”, you know, it wasn't like a straightforward… I was so pleased with myself that I had a natural delivery, I was so proud of myself and then it was like “Oh”, you know, that bit afterwards was like, horrible, but then it's really weird because when I tell people, I forget that bit, I can't remember that bit. I forget to say… so obviously I'm not remembering that bit much.
So, because your labour went on for days, at any point did they, did they suggest that you might need a section?
Sorry, I saw the consultant on the, I think it was on the Thursday and they basically said that if I hadn't, if nothing was happening on the Friday, which was the day I delivered in the end, then they would induce me with the… gel, because I thought they wouldn't use gels, but they said that they thought it would be okay. …So they were going to use the gel.
And did, and how did you feel about that when they said…
I thought, yeah, well, basically the Thursday night I was saying to my husband, “I want a caesarean, I'm-, I can't take this any more, you know, I'm just so-, I haven't slept since like, Monday night. And it's really painful, nothing's happening, you know”, I was getting really, you know, “Why, why is nothing happening, it's so painful!” I don't know” [laughs]. |
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She feels proud to have achieved VBAC but also glad to have experienced both ways of giving birth and is grateful to have another healthy baby.
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So how do you feel now about the way that [daughter's name] was delivered this time? How do you feel about this birth?
I'm really proud of myself, that I did it. And it was, I'm really pleased that I've experienced both… You know, afterwards I felt, you know, I was looking at her thinking, “I can't believe I pushed you out!”. You know? [laughs]. Because it was a really amazing thing, and I think it's nice, because you just don't know how you'll feel ever about a baby, do you, when it's born, the bonding and, because it was a second baby and things and I was really sort of thinking, “Oh, I hope I can love her as much as, you know, the first one”. So that was, it was really nice to have felt that, you know, I had a different experience with her [smiles].
No, my general sort of thought on it is, to be honest, I don't think it would have matter now, if I'd had a C-section... It, you know, it can be made into a big thing about having a natural birth after a caesarean that it's going to be so different, you know.
And I actually just think, you know, you're just happy to have another, you know, healthy baby, and actually although I was really, really pleased that I had a natural birth and very proud of myself, like I say, and really determined to do it, and I really was, I was so glad that I'd done it and that I managed to, or had the chance to. Actually you know, if I'd have had a C-section I would have, I think I would have just, you know, been happy that she was okay, because it did go on so long for me, so I did feel quite, well, very tired by it. |
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Compared to her caesarean, vaginal birth felt lengthy and drawn-out. She had a lot more pain before the birth and found she was not offered the same level of pain relief afterwards.
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I know it's very difficult to compare the experiences, but how did this delivery compare to the caesarean section the first time?
I think they're just so different, because the caesarean, with [son's name] it was an emergency C-section so I didn't, you know, I didn't know that I was going to have the baby that day, I didn't, I hadn't had any Braxton Hicks contractions, I hadn't felt any, I never felt contractions at all with him. And when I went in they said, “Oh, you know, you're one to two centimetres dilated” and I hadn't felt anything, [laughs] So I was in very, very early labour and then yeah, as I say, I was, you know rushed in and had… that was it, you know it was done. So it was quick and… I didn't feel tired or, there wasn't any waiting. And I was surprised with that how quickly you do, you do get up and about. I mean, obviously yeah, you've got a scar and you've got to be careful but you know, considering that you've had a major operation and you've had, you know, you can't walk because you've got the spinal block and catheter and everything, you know, you're very quickly in the bath and walking around and stuff and encouraged to do that. So, although you've got to be careful because of the scar, it's not like you're in bed for a few weeks.
And this one, there was all the sort of trauma beforehand, the waiting and a lot of pain, because obviously with a caesarean as well, you've got the pain relief for the operation and afterwards they make sure you've got, you know, I was on painkillers for six weeks so I didn't actually feel any pain… when I came home. Because they're more aware that you might be in pain. So, you know, with this delivery there was a lot of pain before, apart from the, you know, the actual delivery and you sort of aren't offered much pain relief because you have had a natural delivery. And obviously I was in pain with the breastfeeding so I was on a lot of painkillers for that in the end, as well. But that's not, not to do with the actual delivery.
And in terms of the recovery, because you had such a long labour, that was the majority of a week, how long do you think it took you to feel your normal self again after?
Oh, quite quickly, although I mean, I was in hospital until the Sunday lunchtime and I wanted to come home then. Because I had thought that I'd want to spend sort of, you know, because you could obviously come out quickly if you had a natural birth sometimes, and it's all fine. But I thought, “Oh, I'd like to spend a bit of time in hospital because I want to get to know [daughter's name], you know, and let [son's name] be at home and not have to worry about it so much, because he can't see it. And, but then I really wanted to get home [laughs]. So I was like, “Oh no, I've got to wait 'til the Sunday, until they take the catheter out”. |
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She thinks it is good to have a plan but remain flexible at the same time. Experiencing vaginal birth does not make you a better person.
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And if you were to give a message to other women that were making the decision about how to deliver the second time, what message would you send to other women?
Yeah, get as much information as possible, and definitely have a plan, but then, like you always have to be with this business, you know, you have to be really open minded to it…you know, and you really do. You can't like have your heart set on, “I really want to experience a natural birth” and to be honest, I'd say it's not the be all and end all. I don't really feel that I'm a better person, you know, and I don't feel, you know, that she's a better baby or anything because I had a natural birth. |
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Health professionals need to be aware that women who have had a caesarean without labour may need more information about labour and pain relief than other second time mothers.
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And if you were to give a message to the health professionals that give information to women who are planning a second delivery what information do you think health professionals should be providing, what message would you send to them?
I think they need to, what, for the second time, you mean? I think, yeah, they need to remember that you know, you've had a C-section so you might need a bit more... If you are going to try for a natural birth, you might need a bit more information about that, because as a second time mum you're sort of thought, you know, you don't see the midwives as often and you have one, and you could ask to go to the normal ante-natal classes, but usually you have one, if you're lucky, you know, to meet other second time mums. But you know, you might want a bit more information about labour and pain relief and things if you didn't experience it the first time. |
