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Interview 14

Interview 14

Age at Interview: 22
Background: Customer service officer with one son aged three and a half. Living with partner, who works as a forklift driver. Ethnic background: White British (English).

Brief outline:Admitted to hospital with pre-eclampsia, 1st child was born 6 weeks premature and had to spend 10 days in SCBU. Found it very difficult to decide how to give birth to 2nd child, worried about risks either way. Had vaginal birth assisted by ventouse.

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Kelly's story
Print First pregnancy and birth Her first pregnancy was planned. She had regular visits from her midwife and attended a 'young mum's bump club'. Both provided her with useful information about labour and pain relief. However, caesarean was not addressed, and she did not seek out information about it as she assumed she would have a vaginal birth. Six weeks before her due date, she was admitted to hospital with symptoms of pre-eclampsia. She found herself waking up on the hospital ward in the middle of the night and twenty minutes later was rushed into theatre for an emergency caesarean. She was able to leave hospital after four days, but her son had to stay in the Special Care Baby Unit (SCBU) for 10 days after his premature birth. Returning home without a bump or a baby was very different from how she had imagined motherhood. She was unable to hold or bath her son at the SCBU, but visited him daily so he could be tube-fed the breast milk she had expressed. It took her almost 10 weeks to recover from the caesarean and feel confident about moving around with her son. In conversations with other mothers she has felt weary of being branded 'too posh to push' and has been eager to explain that her caesarean was necessary for medical reasons. Second pregnancy and birth Her second pregnancy wasn't planned, and she had a scan at six weeks to confirm it. She felt quite worried about the pregnancy all the way through as she was afraid that the pre-eclampsia might return and her second child might also be born prematurely. From midterm onwards, she started agonising about the best way to deliver him. Her own preference was for a vaginal birth as she hoped it would mean a shorter recovery. But she was put off by the possible complications associated with both caesarean and vaginal birth and was looking for reassurance from health professionals. She asked lots of questions of her midwife and doctor, but they only gave her general information and emphasised that the decision was up to her. Taking part in the DiAMOND trial provided her with more detailed information about risks and benefits of different ways of giving birth. She also watched programmes on the Health Discovery Channel in search of an answer on what would be best for her. She made two birth plans so that she would be prepared either way. On the morning that she started to feel contractions, she took a long walk with her mother to help things along if they should turn out to be 'the real thing'. She went into hospital in the afternoon and was told she had dilated by 1cm. As she was coping well with the pain at that point, she returned home until the evening when the contractions became a lot stronger and her waters broke. She went back into hospital with her mother, feeling very nervous. But the atmosphere in the delivery suite and the laid-back attitude of her midwife helped her to relax. Her labour was brief, but because the baby was positioned sideways she experienced considerable pain during the pushing stage. Feeling already 'spaced out' from the gas and air and Pethidine she had had for pain relief, she panicked when the medical team told her they would need to use a ventouse and brought additional staff into the room. However, she found that the ventouse did not feel any worse to her than the pain she was experiencing anyway, and her baby was delivered successfully after 4½ hours of labour. She experienced some bleeding immediately after the birth, but her mother and her baby distracted her. She was upset when she first saw the mark on her baby's head left by the ventouse, but it disappeared within a few hours. She was able to breastfeed him straightaway and thinks that bonding with him was helped by the fact that she recovered very quickly and could return home on the day of the birth. She thinks the experience of vaginal birth has made her feel confident to attempt it again if she was to have another child. She would advise other women to take time over the decision of how to give birth after caesarean and find out all the facts before making up their minds. She thinks health professionals should talk women through the risks and complications in as much detail as possible. They should also provide written material for reference after appointments as sometimes information can feel overwhelming and it can be difficult to take it all in at once.

She read pregnancy magazines to help her make up her mind about how to give birth.
Print So what that's saying is, other than the midwife and the doctor, have you got any information from anywhere else, like magazines, or the internet, or friends? Yeah, I've had my head in magazines all through pregnancy, actually. Although, I know everything, I'm sort of waiting… I read stories about, you know, there's normal birth after caesareans and things. So that's about the only other information I've had really. And what sort of magazines, are these women's magazines, or pregnancy magazines? Pregnancy magazines, yeah.

Her son was born prematurely and had to stay in special care. Tube-feeding him with the milk she had expressed was the only thing she could do to care for him.
Print And do you feel that having a section affected your son in any way? I mean, the fact that he was prem and you didn't spend time together, did that worry you at all? Yeah, I didn't get any post-natal depression, but I did sort of… I didn't feel how I thought I would feel until I brought him home. For the first ten days I didn't really… it wasn't reality that I was a mum, if you see what I mean. That must have been weird, having had a baby and not-, not being with him? Yeah, because I come home after about four days, because obviously I needed to get premature things and everything ready. So, you know, my bump was gone and I had no baby… and it was a bit strange. Do you think it had any long-term effects on your son at all? No. And do you think it had any long-term effects on you? No, no. And how did you feed your son? Breastfed, I breastfed him. And how did you find that? I found it fine. I mean, when he was in special care, it was the only thing I could do, if you know what I mean, because I couldn't bath him or hold him much, so I used to express it off and take it down and they tube-fed it to him. And did that make you feel closer to him? Yeah, that's, I think that was the one good thing about it really.

Her baby's premature birth was a shock. She did not feel like a Mum until he was able to come home. She is keen for others to know that she did not choose to have a caesarean.
Print And how do you feel now about the fact that you had a section? Well, I'd say I didn't enjoy it at all, but…obviously I wasn't prepared at all for it so it was a bit of a shock, and obviously [Son] was in the baby unit for ten days, so I sort of felt like he was took away, if you see what I mean, for the first week… But… wouldn't, wouldn't really like one again. Right. So, would you say the birth was like you expected it to be? It was, or it wasn't, sorry? It wasn't? No. And do you feel that having a section affected your son in any way? I mean, the fact that he was prem and you didn't spend time together, did that worry you at all? Yeah, I didn't get any post-natal depression, but I did sort of… I didn't feel how I thought I would feel until I brought him home. For the first ten days I didn't really… it wasn't reality that I was a mum, if you see what I mean. That must have been weird, having had a baby and not-, not being with him. Yeah, because I come home after about four days, because obviously I needed to get premature things and everything ready. So, you know, my bump was gone and I had no baby… and it was a bit strange. And did you feel different about yourself at all, the fact that you'd had a section? …I did in a way, because a lot of this… you know, you've got the rumours about, “Too posh to push”, sort of thing, so a lot of people will judge you because you've had a caesarean, but obviously in my case it… I didn't have a choice anyway, so… Did you feel that people did judge you at all? No, not- not my friends and family, because obviously they, they all was aware of why I had to have it. But when you're sort of talking to other mums now… Do they find it a bit odd that you had a section? Yeah, yeah.

She had felt very ill after her previous caesarean and wanted to avoid another lengthy recovery and the need for extra support.
Print What do you think is the one overriding factor that made you want to have a natural delivery? Mainly because I found that all the aftercare of a caesarean, which was very hard. I needed a lot of family support and I sort of felt like… they were helping me because I didn't know what to do, although it wasn't really, they were helping me because… I wasn't very well, you know, I wasn't a hundred percent so that was the main thing really.

She was very worried about making the wrong decision.
Print I've wanted someone to tell me what the right option is really. But nobody, obviously the doctors and midwife, they, they don't really necessarily recommend which one. They, they keep saying, “It's up to you, it's up to you” and giving me the benefits and the risks, so I'm still sort of thinking, “Oh, is it all down to me? Am I going to make the right one?” Whereas if somebody said, “We think you should do this”, I would go by that. And how have you got on with your midwife in this pregnancy? Fine. Yeah, yeah. Has she been able to answer any of your questions? Yeah, I mean, we only discussed birth plan-wise yesterday, and she didn't really seem concerned about having… attempting for a normal delivery. And I've had a few talks with the consultant at the hospital and, it's the same really, they, they're not really concerned either way. Right. How do you feel about that? About that they're not worried. Has that made you less worried? Not really, because I sort of think they don't understand that I am worried, if you see what I mean. Yeah, I do… So you've been able to discuss your fears and your expectations have you, this time? A little bit, a little bit, yeah. So how involved do you want to be in the decision, because it sounds from what you've been saying like you want them to make the decision for you? Yeah, yeah. Why do you think you want them to tell you? Because I think they've had a lot more experience with this, and I know they say the percentages on the risks and everything, but I just think it - from a medical opinion I think it would be better if they took reign and said, “This is what you should do”.

She would have liked her doctor and midwife to tell her which way to go instead of leaving things up to her.
Print I've wanted someone to tell me what the right option is really. But nobody-, obviously the doctors and midwife, they, they don't really necessarily recommend which one. They, they keep saying, “It's up to you, it's up to you” and giving me the benefits and the- the risks, so I'm still sort of thinking, “Oh, is it all down to me? Am I going to make the right one?” Whereas if somebody said, “We think you should do this”, I would go by that. And how have you got on with your midwife in this pregnancy? Fine. Yeah, yeah. Has she been able to answer any of your questions? Yeah, I mean, we only discussed birth plan-wise yesterday, and she didn't really seem concerned about having… attempting for a normal delivery. And I've had a few talks with the consultant at the hospital and, it's the same really, they, they're not really concerned either way. Right. How do you feel about that? About that they're not worried. Has that made you less worried? Not really, because I sort of think they don't understand that I am worried, if you see what I mean. Yeah, I do. …So you've been able to discuss your fears and your expectations have you, this time? A little bit, a little bit, yeah. So how involved do you want to be in the decision, because it sounds from what you've been saying like you want them to make the decision for you? Yeah, yeah. Why do you think you want them to tell you? Because I think they've had a lot more experience with this, and I know they say the percentages on the risks and everything, but I just think it - from a medical opinion I think it would be better if they took reign and said, “This is what you should do”.

Her baby was positioned sideways and had to be delivered with the help of a suction cup. She was concerned when she first saw the mark it had left on her baby's head.
Print Yeah, well, in the morning, I woke up at six o'clock in the morning with very mild tightenings, which I never had before, but I weren't sure if they were Braxton Hicks so I was timing them 'til ten o'clock in the morning and I thought, “Oh, something might be happening now”. So I went to see my mum because I thought, “I need to be around a woman who's been through it all”, and she took me from a long walk to try and help it along if it, if it was the day. And it was. I went into hospital about three o'clock, they done a check and I was only one centimetre dilated, which - I was coping with the pain, I thought I was going to go through the whole thing without any pain relief [laughing] because it was really mild. So they said, “Go home and when you get, when they become a bit stronger, or you feel like you need pain relief, then come back in”. And then by quarter to nine, my waters went at home, which I thought was really strange, because I never had any of that the first time round, and then by half past nine, I was running to the hospital in my mum's car, couldn't wait to get there, needed to get there. And I was on the gas and air the minute I got in the room and they were so relaxed in there. Like, I kept going on about I'm having a vaginal birth after caesarean, you know, bring the team in to be prepared, as I was expecting. And this chilled-out midwife - and she pottered around the little room as if I was just any other woman having a normal delivery, so that relaxed me a little bit. And then I was only in labour a total of four and a half hours, and an hour and a half of that was pushing, because he was coming out sideways, so he wouldn't come down properly. So they went and got the ventouse thingy, which frightened me then because there was a few more members of the hospital in the room so I though, “Ooh, something's going wrong ”, and also I felt not really with it, because of the gas and air, and I had a bit of Pethidine as well. And they were trying their hardest to help me push and encourage me, but I must admit I was at the stage where I felt a bit spaced out on the gas and air, I was panicking because… obviously I was in pain and... there was bits leaking and all that sort of thing and I really thought I was bleeding. I was terrified that I was bleeding and I had my eyes closed all the way through it. So I kept saying, “Oh, just take me down for a caesarean”, and I was begging them for a caesarean! [slight laugh]. But I was fully dilated and it was on its way, it just needed a bit of help with that suction cup, so that was what happened. Out he come and there was no problems at all. I had a bit of a bleed after, which that then frightened me a bit, but I was… my mum was so busy distracting me from what the doctors were doing that I wasn't really aware, I was just admiring the new baby, so… It went really well, I think I had a perfect labour compared to some of my friends who's had, you know, twenty, forty hours of it, so… I think I've done really well in the end. I'd do it again, a lot more relaxed, I know that much. So, that was more relaxed? Yeah. Yeah, and I felt a lot better after, as well. And how was your baby after the baby was born, because obviously, the baby had the ventouse? Oh yeah, I did cry about that. When he was first born and they showed me him, obviously he had this big mark on his head, I really thought he was going to stay like it. I know they don't, because I've heard about it before, but at the time, you know, I was really upset, and I thought, because he looked a bit deformed, to be honest [slight laugh]. So I thought perhaps he had some sort of disability that I wasn't aware of [right] that was what crossed my mind, and they were all reassuring me, everybody was, so… …how long did he have a pointy head for? It was, well, in the morning, it wasn't pointy, I mean, I had him at 1.37 in the morning and I fed him at six o'clock in the morning for his first proper feed, and he didn't have a lump, it was just bright, like a bright red bruise. So… he just looked like he was in pain really, and I, you know, I felt sorry for him, but he wasn't, he was fine, and he slept for days, other than waking up for feeds so …

She had worried about things going wrong during VBAC, but looking back she thinks bonding with her baby and getting into an independent routine was a lot easier this time round.
Print Could you just tell me a little bit more about how they're different, between having a natural delivery and a section? Mainly… mainly the aftercare, but again, I had an emergency caesarean, I think they must be a big difference with having an emergency caesarean and a planned caesarean. Because obviously when it's an emergency, you're not prepared, you're not sure what's going on, especially if it's your first one. And you really do feel like you're sat on Casualty and you've got, you know, that anything could happen to you, you really feel like that, so… I don't know. Having a normal delivery, you do feel scared, because you're waiting, especially once you know the pros and cons, you're waiting for something to happen, and in your own mind, you're sure that something bad is going to happen. But I think that a lot of that is the gas and air, all the emotions, the pain that you're in. I think if you were thinking on it, on a clear head like I am now, then I'd definitely say it was a better option to have a natural delivery. I remember when we met before, you said you felt like you'd been cheated? yeah Because you hadn't had the labour, do you feel, “Right, I've done that”, now? Yeah, because I've been sat there with my friends now and we all have our little opinion on it and I have more of an opinion because I've got experience of both now. But I think you bond with the baby a lot better having a vaginal delivery. Right. And could you explain why you think that is? I think it's just that after, how you yourself feel after, because I mean, I love my first son to bits, you know, and I loved him the minute he was born, but because, when you have a caesarean, you're in so much pain, you feel like all your insides are going to fall out, it's really horrible. And you're like that for several - they say six weeks, but I think it's about ten weeks before you start feeling a bit more relaxed about the… you know, about your tummy area, but whereas on a natural delivery, like a vaginal delivery, I don't know, I just… although I had a few stitches, I wasn't bouncing around the hospital, but you know, it was a lot easier to get up and out of bed and attend to the baby myself, rather than waiting on other people to help. So I think you just automatically get into the swing of things and a routine better from having a natural delivery.

Making a choice about how to give birth to her second child was difficult because she felt uncertain which was the best option. Now she feels more confident about making future birth choices.
Print I don't know, because the choice was so left to me, I did feel like I had a choice to make, and it was all down to me. But obviously I wasn't quite sure which one was the best choice. So I definitely think now, obviously if it was the third time round, that what the choice I make would be the best choice. And how much of a choice do you think women generally have when they're, when they're thinking about how to deliver? I mean, if you think about your friends that you've got around you, how realistic do you think it is for us to encourage women to, to think about having a choice and to make their own plans? Yeah, I think everyone gets the… the choice and I pretty much, as far as I know, that everyone, the health professionals are prepared to go by your decision. Obviously, if it's down to fears, then I think the only thing they can do is just reassure you, but overall it is down to the woman individually on how they feel and what they want to do.

She would advise women not to rush into a decision but to take their time and talk to others before making up their minds.
Print If you could give a message to other women who are facing the decision about what to do in their second delivery, what would you say to other women? Just not to make the decision straight away, to do all the research, talk to people or look at something like this on your website, really have a look around and find out what other people's experiences is, and what's happened to them. And then make your decision. You know, you've got a nine month's pregnancy, so you don't have to decide straight away. I do think you've got a nice bit of leeway, but you should do it as the end is nearing, so that you're prepared.

Before her VBAC, she would have found it helpful if doctors and midwives could have advised her which way of giving birth was the best option for her.
Print And what, what message would you send to health professionals who counsel women and advise them about this decision? One to obviously really go into detail about the pros and the cons, let them take that information home with them so they've got it there all the time, so if things, we forget things, they can sit there and read up about it in more detail. And it obviously would be really nice for them to advise you what the, the best option is, but obviously this study might maybe help them do that, they might be able to work out what the best option is.

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