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Making decisions about birth after caesarean

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Aged 36-39

Interview 12

Interview 12

Age at Interview: 37
Background: Nurse with one daughter aged two. Husband is an engineer. Ethnic background: White Irish. Played by an actor.

Brief outline:Keen on vaginal birth with 1st child, felt she lost control at hospital, had various interventions and emergency CS. Decided to have VBAC with 2nd child against consultant's advice, but supported by doula and midwife. Very pleased with unassisted birth.

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Sally's story
Print First pregnancy and birth She had an easy first pregnancy. She had attended antenatal classes and was hoping for an intervention-free birth, ideally using the birthing pool. She had been told that her baby was very large, so the possibility of a caesarean was at the back of her mind but she thought of it as a routine procedure rather than major surgery. She came into hospital after a day of relatively mild contractions and had dilated to 5cms. Because of her baby's large size, she was monitored with ultrasound, which meant that she was unable to use the pool. At home she had managed well with a TENS machine (a non-evasive method of pain control using electrical currents), but at hospital the pain quickly got worse and she asked for an epidural. Then her labour slowed down and she received Oxytocin to help her progress. She had her waters broken and a small amount of meconium was found, so she had a caesarean. Recovery from the operation was very slow and uncomfortable. She felt frustrated that she could not pick up her baby daughter. She had difficulty breast-feeding and her daughter was losing so much weight that she needed to be re-admitted to hospital two weeks later. She felt very guilty and thought these complication were due to the caesarean. Looking back, she thinks her antenatal and hospital care was overly medicalised. She would have liked to be offered her more positive strategies for managing labour with a large baby instead of treating her as a problem case. Second pregnancy and birth She had not been told about the implications of a caesarean for future pregnancies, but gathered information at her own initiative from books and websites as well as from talking to friends. Even before she became pregnant again, she had made up her mind that she did not want to repeat the medical experience of labour and birth she had with her first child. Her and her husband attended NCT classes, and at the recommendation of her cousin who had had a VBAC, she also hired a doula (a experienced woman giving emotional and practical but non-medical support to mothers before, during and after birth). She felt that her obstetrician was not supportive of her plans and asked to be transferred to a hospital that had a birthing suite. She had considered a home birth, but as there were additional concerns about the baby's shoulder getting stuck (shoulder dystocia) her husband was keen to have hospital back up in place. She phoned the midwifery team early in the morning after her contractions had started. Her labour slowed down around lunchtime but picked up again when her favourite midwife arrived to support her. By evening, she had dilated to 5cm and went into hospital with her husband, her midwife and her doula. The atmosphere in the birthing suite was very relaxed and she used hypnotherapeutic music, yoga positions and a TENS machine for pain relief. The birth of her daughter without medical interventions was a deeply emotional experience. Looking back, she thinks the trusting relationship she had formed with her midwife was crucial for giving her the confidence to give birth vaginally. Having her support helped her manage the more difficult moments during birth. Comparing her experience of caesarean and vaginal birth, she was surprised that her recovery from vaginal birth was not as quick as she had expected. She felt very tender in her pelvic floor for several weeks, and while she thought that bonding with her second child was more instantaneous, she experienced the same difficulties breastfeeding as she had with her first child. Nevertheless, she feels strongly that vaginal birth was the right choice for her and would deliver the same way again in a future pregnancy. She thinks her nursing background helped her in negotiating the healthcare that she wanted. Her wish would be for the health professionals supporting women through pregnancy and birth to be less concerned with risk management and more positive and empowering in their approach.

Having been told that her baby was large, she would have liked to receive better information and support to prepare for his birth. Played by an actor.
Print Can you remember the kind of information that you wanted when you were pregnant the first time? …Not really. Everything really, I suppose [laughs]. A lot of things, I read an awful lot… And what information did you get, did you get everything… or some of it? Some of it, I didn't read it in as much detail as I have done. So in what ways could it have been better, the information provision in your first pregnancy? I'd say now in my second pregnancy as well, possibly not as medicalised, possibly the fact that when I was told that I was having a large baby, ways of dealing with it. Maybe perineal massage, you know, to avoid episiotomies. The likelihood of the pain being uncomfortable if the position of the child was wrong, um… other ways of managing it. And psychological support rather than it being completely labeled as someone who's having a large baby… and therefore a potential difficulty.

She was mistaken to expect a quick recovery. Not being able to drive and having no family nearby made things even harder. Played by an actor.
Print Unfortunately because I'm a nurse I had this preconception that it was only a section so therefore it wasn't major surgery and I'd recover quickly, and I didn't… Because I overdid it probably, ran around too quickly…The first few weeks are just so restricted in comparison to other people that have given birth naturally. One of my friends had given birth naturally and she was running around, driving. Whereas for myself having no family around, I was very restricted not being able to… drive, and also not being able to walk places and get anywhere. And the difficulty of getting out of bed just to pick up my child was really horrible. Just everything was really, really hard after having a section… looking back.

She thought her caesarean caused her problems with breastfeeding. She felt awful when her daughter had to be readmitted to hospital after losing weight. Played by an actor.
Print How do you feel now about having had a section? How do I feel now? …well additional to just having a section, my daughter after a week of being born ended up going back into hospital having lost twenty percent of her body weight. So awful, terrible. I believe it's the cause of her inability to feed and… yeah, blame that on having a section. Did you try and breastfeed? I did, I tried to breastfeed. And how did you get on with that? I didn't, I don't think the milk came in. Despite having asked for loads of support and stuff, it just didn't come in, and it was just various different things. It was myself, I'd pushed myself too much, so therefore the milk hadn't come in, but no one explained to me that if you have a section it could possibly be quite difficult. They didn't actually explain that if it was a big baby it was going to be quite demanding as well.

She wanted to keep her next birth as intervention-free as possible and employed a doula - a non-medical birth helper who gives physical and emotional support to the mother during labour. Played by an actor.
Print I want to have a natural delivery, I don't want any interventions, I do not want any drugs, and I hope to deliver outside the hospital environment as much as I possibly can. This morning I've just had an appointment with the consultant in another hospital who said that I can go to a birth suite rather than coming into… a ward to deliver. Okay, that's important for us to know. So it's not just about avoiding interventions, it's also about the whole medical environment… Absolutely. …the ambience and everything? It's about the interventions and the being taken over, because…. as you're labeled as a VBAC there's interventions and monitoring and stuff. And I know that doesn't help, and I believe that's where I fell down in labour last time. I suppose one thing I didn't mention, which I found very strong from my last labour, was that just as I was getting the epidural in, my husband was very, very supportive throughout the contractions, but just as I was getting the epidural in, the midwife just looked at me and visualised… looked at me and sort of breathed me… just helped me breathe through the contraction. And it was then after reflection I realised that actually I could have got through it because she got me through one of the worst contractions ever. Right And as a result of that I've actually employed a Doula to help me during labour as well.

She gathered information from as many sources as possible, but her decision to attempt VBAC was made independently of what she found out. Represented by an actor.
Print So where did you get the best information from? If you had to cite one source of where you got the most important information? Oh, I got it everywhere. I did… I mean, I've done research and studying and stuff like that, so I would say: everything. I went online and spoke to support groups and just everywhere, absolutely everywhere, midwives, everything. But I had made up my mind I was going to do it anyway, despite all the information. Everywhere, so there wasn't any one, one particular… that one book, and unfortunately I can't remember, that reference, was very helpful towards the end in the psychological sort of, "You can do it", "It's a natural process", way.

She thinks information to women should be provided by midwives instead of doctors, because birth has become too medical and midwives have a more positive approach. Played by an actor.
Print Who do you think is the most appropriate healthcare provider to give the information that women need? Midwives. That was emphatic? mm Why not the hospital consultant or …? Because they're so litigiously minded. They're so… and also it's a medical model. Birthing is a medical… Sorry, I'm just … I wish I could remember the book. I did read one book and I'm not a person into these sort of home birthing sort of very, dare I say it, hippy sort of naturalistic approach to birthing… But this book just said, “Look, everyone does this”, you know? Medics do it because they've changed it, you know, women used to lie on their back and deliver and that kind of thing. That's not the way you do it. It was very much of a sort of a positive sort of approach to it. A woman's approach to it, rather than… And even if the consultant is female, it still doesn't matter, the medical model is that, you know, we're just getting away from the idea of delivering women in stirrups. They're very much into interventions, which are almost conducive to having a section because they reduce your mobility, they have to monitor, they have to intervene, whereas actually the best thing is just to let it go, let it go naturally. It's just a, it's a medical need, really, to take over a situation and to help the women, I think. I think it's also the medical code, you know, they really do need to… they want to make you comfortable, they want to give you drugs to make you more comfortable. They want to make things better, but actually, standing back and not doing anything, observing and letting the woman do it is almost the best. So it sounds very, very negative unfortunately, but it's just the way. But the midwives were very much more… pro the idea of me delivering naturally, supporting what I wanted and even when a double risk had come through, they were relatively happy to support me at home, despite the huge risk.

She thinks women who had a VBAC are the best source of information for pregnant women who want to do it. She got a helpful tip from another woman to use hypnotherapy tapes during labour. Represented by an actor.
Print I personally think, I mean, this is talking about other women that have done it, actually normal birth stories are definitely… I think you, you believe that more so than you believe medics and midwives. You believe women that have done it. I really do think. So summaries of birthing experiences may be… you know, people like me that have delivered would be a really supportive thing. Information, the fact that it's a natural thing, maybe not so medicalised, so look, if you… mind over matter, even hypnotherapy, and God forbid, I never thought I'd ever think about that, but you know, that kind of thing. How did you get into going down that road? I go to yoga classes, and there was a lady there, a lady who recommended it and said that she had a beautiful birthing experience. And I was just hanging on straws and really, you know, despite being really strong to everyone, I actually, beneath, behind everything I was kind of slightly concerned that it wasn't going to happen. So I was grasping at straws and doing anything, so, it was a recommendation from another woman, and it worked. And because the end few weeks of my pregnancy, I was under quite a lot of stress over the fact that people were saying to me, “Come into hospital”, and, you know, “You are at risk of” oh gosh, exploding, that's a good way of describing it, but yeah, rupturing, it's almost like that, “You're going to die, your child's going to die, come into hospital”, so I needed something psychologically to get me through that and I listened to these tapes and it just said, “You're going to do it, you can do it”, and that's what I needed. And I think in business, they work, they work a positive thought is definitely the way forward. So… yeah, positive thought.

Her midwife was very supportive of her decision to attempt vaginal birth even though her consultant advised her against VBAC. Played by an actor.
Print I saw a midwife and I made a very strong bond with one of the midwives in the team and she regularly sort of supported me. And she was on the phone as well, if I needed to talk. Because there was an additional thing as well that they wanted me to have a section for. Because my baby on the scan - I can't remember was it the thirty-six week scan... Looked as though she was going to be quite big and her head circumference was smaller than her shoulder, I think. So there was a risk of shoulder dystocia, I think it is… yeah… So I had two risks: having another section and the possibility of the shoulders getting stuck. And my midwife was very supportive over the idea of VBAC, she would come home, come into my home and talk to me and reassure me about any issues, and, at times when I was having these negotiations with the consultant, you know, I found it quite difficult because I had to be very strong and she was there as a supporting network saying, “Yes, you can do this” and “We'll be there for you”. And actually this midwife delivered me, wanted to deliver me and she ended up working a night shift to deliver me, she was feeling that strongly about my need to deliver naturally. So she was a very, very strong supporting influence for me, which made a huge difference.

She had considered a home birth, but her husband wanted her to have the baby in hospital, because he was concerned about the risk. Played by an actor.
Print I almost wonder why I went into the birth suite because I was just doing what I was doing at home. I had no medical intervention or need, so it was just a lovely, lovely experience. So why do you think you did go to the birthing suite? I went to the birthing suite because I was given two risks. I was given the risk of being a VBAC or having, you know, having the section, and also the risk of possibly the baby's shoulder getting stuck. And so I went because of… it was strongly recommended, medically… not to deliver at home. Which was an option I'd thought about, to get away from any medical intervention. And what made you think about not staying at home? My husband [laughs]. I think it's very difficult for men because they're not in control and they don't have those sort of feelings, so it's… And it's a risk for them, you know, it's their wife and their baby that they're risking. Whereas we only think about our babies really, we don't think about ourselves, so, well, not so blatant as that, but you know, I don't know, it's just… My husband was very, very concerned about the risk.

She had a painful labour but felt well-supported by her husband, midwife and doula. She wanted to let her body do its job without interventions in an environment that felt safe to her. Played by an actor.
Print I went into labour early hours of the morning. I phoned the midwifery team. I knew my favourite midwife was on duty so it was sort of almost planned that day was the day I was going to do it. I started getting contractions and they started getting a bit more regular, sort of ten, fifteen, ten to five minutes. Because I was, I'd had a section previously, the midwives wanted me to contact them early so I rang them and I had them here at about five, six o'clock in the morning. Additionally I had also employed a doula. And… she arrived as well and the contractions continued and my daughter then was woken up at seven and following that, my labour stopped really, because my daughter was there and I went into a different sort of mode and it was coming on and off every twenty minutes, half an hour and then it came to lunchtime and my, my labour had stopped, effectively, it was every sort of half hourly. And so everyone left and I was at home with my husband just chilling out and reading the newspaper and it was very nice. Looking back, if I had gone into hospital, I would have been there for quite a long time. I continued having contractions, but just chilling out, being at home and, and sort of every half hour kind of thing, and about five o'clock that evening, the contractions started getting more regularly. Everyone came back, I got my midwife, my special midwife arrived at five o'clock. She had finished her day's work, she was ready to support me through it and sometimes people say that that's - that's why people deliver because they feel comfortable, they're in their comfortable zone, so the person that supported me was there, everyone was ready to deliver me and my contractions became quite strong and regular and they were every five minutes or so. And I can't really remember all the details now as it's thirteen weeks but I was in full on labour and she examined me and I'd dilated to five, six centimetres. Over the next sort of three to four hours, they were getting regular strong contractions. I was doing a lot of yoga positions, using a TENS machine as well and I had the midwife and the doula supporting me pushing and my back, for back pain and back pressure. And… I just had a lot of support and things done for me and like one-to-one attention makes a difference, again. I don't think I would have got that in hospital. Not at any time did I feel anxious or worried or concerned about my baby, or the lack of monitoring as everyone's been pushing for the section. I had full faith in the people that were around me. And I think I probably would have had some form of sixth sense to know that something was wrong, possibly. …I continued on in full labour for three to four hours and as a result of the… decisions that we had made to go into hospital because there was a risk of shoulder dystocia, we went in when I felt as if the time was right, and it was about nine o'clock. Ten to nine, where I was, the TENS machine wasn't really working and I was beginning to use Entonox and I thought, “This is the time to go in”. It was quite a funny feeling, getting in with the Entonox attached and in pyjamas and two women running after me and my husband and in the back of the car looking like, God, I don't know what, a screaming banshee… And it looked quite funny, but I did it, and I got in there and I still walked through the doors and felt really comfortable and supported. I walked into the birthing suite and there wasn't any sign of any medical interventions, any machinery, it was just the exact same people that were with me at home and I felt really comfortable about it. I continued to labour quite strongly, and it was a very, very painful labour. And… just did everything I needed to do; yoga positioning, again… birthing ball, mattress, and I forgot to mention at this stage, and I should really, that I actually was using a hypnotherapy tape prior to delivery and I had that music on in the background and subconsciously I was listening to that, and any time the music would stop, I would shout for it to be put on, and it was a very subconscious, and it was definitely working for me, and I'm not the kind of person that's kind of believing of that, but someone recommended it and it, it really worked for me. Because birthing is in the mind and everyone does it, and you need to be strong and believe that you can do it, and it really, really worked, so during this process, I'm in this room with this music going on, as my husband described it as elevator music and it just was working for me and I went into my own sort of thoughts and continued to sort of labour this, this baby. And I got to ten centimetres and through the pushing stage, nobody was talking in the room, but if I needed anything they were there. And I was just in my own little zone, pushing my baby out without physically pushing, it was just my body doing it. At the end of labour when I delivered her, at seven minutes past twelve, I think I only pushed once or twice, physically pushed… because my body had done it and I had believed I was going to do it. The hypnotherapy had worked for me, I was going to do it no matter what and it worked and I delivered my child at seven minutes past twelve, and… I feel quite emotional now, because I haven't talked about it for a while and my baby was put on my chest, and I just turned round to my husband and said, “I told you I'd do it”. I think it's nice for people to know that women can cry with this… unless you're… and my midwife cried, which is very touching, as she's a very, very experienced midwife. And I do believe my doula as well, who was also very experienced. And we both cried because it was very emotional and a very, very fantastic experience… Interestingly enough, as soon as I delivered, I turned round to my husband, and said, “Mm, turn that blooming elevator music off!” So subconsciously, because the music was the most important music to me and it was doing everything for me, but as soon as I delivered, I just said, “No, please, turn that rubbish off!” and wanted caffeine, which I hadn't had for months and months in my pregnancy. And that was it. It was a lovely, lovely delivery.

Her recovery after VBAC was not as quick as she had expected and she had to revise her belief that her difficulties feeding her first child were related to her caesarean birth. Played by an actor.
Print Well, it was very interesting because one of the very strong reasons why I wanted to deliver naturally was so that I would not have difficulties breastfeeding my daughter because my first-born had difficulties. And despite everything I did- I ended up not being able to feed my second daughter, so that wasn't the reason, so I've discovered that wasn't the reason. …and despite thinking, you know, having a section was the worst thing, having the recovery, it actually took me quite a long time to recover from a natural delivery as well, so it wasn't… the grass is always greener elsewhere, it wasn't as… perfect - no, it was perfect, and I think emotionally it definitely, it was a great thing to do, definitely would want to deliver naturally next time. But it wasn't as easily recoverable as I thought it was going to be in comparison with section. …How do I feel? I think, yes, definitely the better way to deliver because, psychologically I think it's, it's just better for you. …I think for the child as well; I think it's a natural way, there's a difference in my… I'm not sure if this is particularly different but she seems to a lot more physical than my other daughter. That could be coincidental, so whether that adrenalin she had when she was first delivered made a difference, I don't know, but I'm sure there's something better for them being delivered naturally than having been pulled out unnaturally by a section.

She thinks as a nurse with an insight into the medical system she was more able to assert her wishes than other women might have been in the same situation. Played by an actor.
Print I think it was because I am a nurse and so I... I know kind of how to play the system to a certain degree, so I had a relatively good choice. I had full choice, I had full option to do what I wanted to do. I think if I hadn't been so strong and adamant then I don't think it would have been… I think I would have been easily taken over, so me personally, I was strong enough to fight the sort of system and say, “No, I'm not going to go through that”, but with other people, I'm not sure. I think they may have been overrun. That was my next question really, how realistic do you think it is for us to encourage women to have more of a choice? I think they should be encouraged to have more of a choice. They did tell me I could have a VBAC and it was a, “Yes, we definitely hope you can but you know, there's these sort of negative kind of things”. I think it's the negative input that you constantly get in the medical sort of interventions that really turn the idea, or reduce the likelihood that you're going to delivery naturally, unless you're pig-headed like me and say, “I'm going to do it and there you go”.

She thinks birth is a very natural thing and medical interventions are likely to hinder rather than help. She believes in the power of positive thinking. Represented by an actor.
Print I would just urge anyone to, to think twice about having to have medical intervention because birthing is a very natural thing. My daughter was eight pound seven, and a big baby, and I did rip. But eh… I did it naturally and I think you can put your mind to anything and you can do it. And I think, another reason why I knew that I could do it was that I'm a nurse and I have seen all the kind of people that will, will recover from surgery adequately because they've got it in their mind, they know that they're going to do it, and positive thinking is definitely the way.

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