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Silvana's story
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First pregnancy and birth
She had a complication free first pregnancy and prepared intensively for birth. She attended parent-craft and antenatal classes, bought books and looked up information on the internet. Both her sisters had to have emergency caesareans because they did not dilate, but she was optimistic that her experience might be different so she did not read up on caesarean in great detail. She had made a birth plan and was hoping to have a water birth.
When she had gone two weeks past her due date, she was asked into hospital to be induced. She had pessaries and a drip but still did not manage to go into labour. After a frustrating two day wait, her and her husband opted for an epidural caesarean. She felt calm about the procedure and fully involved in the decision-making process. The medical team were very supportive and put on the music she had brought for the delivery suite in the operating theatre. Looking back, she wishes she had opted for the caesarean sooner. At first, she struggled to breast-feed her son and thinks the drugs she received before his birth might have been responsible for this.
Second pregnancy and birth
She decided that she wanted a planned caesarean with her second child even before she had conceived again. She was keen to avoid the total exhaustion she had felt after three days of trying and waiting before her first caesarean. She had also come to terms with the fact that it was extremely unlikely that she would ever give birth vaginally given her own and her sisters' medical history. She had a very good relationship to her midwife in her first pregnancy, but did not feel the same bond with the one she had in her second pregnancy, so she asked to be transferred back to her original midwife. She felt confident that her medical history would be a sufficient reason to convince health professionals of the need for a planned caesarean, but encountered a consultant who tried to persuade her to delay the decision. However, this only made her more determined and she succeeded in getting a date booked early, allowing her to plan for the time around the operation.
The day before the date, she had some checks done at the hospital. She returned with her husband the following morning to have the caesarean, but had to wait for several hours while the medical team dealt with two emergency caesareans. She felt very impatient but not anxious. She had given permission for a trainee doctor to attempt setting her epidural, but after several failed attempts a consultant had to take over. The caesarean itself was very straightforward, and she returned home with her baby daughter the next day. Neither of them had any complications. She enjoyed the sense of calm and control that accompanied her second birth delivery and is very happy to have stuck with her decision to have a planned caesarean. She thinks that ultimately the decision about how to give birth should be made by each woman and not be dictated by policy. Health professionals should take time to listen to women's particular circumstances before advising them individually instead of just giving general advice. |
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Both her sisters had needed caesareans, but she still hoped that she might be able to break 'family tradition' and give birth vaginally.
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I didn't, I never went into labour, it was ridiculous. I, I was induced after-, at forty-two weeks and basically, after trying the-, well, they started off with the pessaries and then I was on the drip, I can't remember the substance in the drip, but I'm sure you know. And it started off on a Wednesday afternoon, and by Friday afternoon, we opted for… the caesarean, emergency caesarean because I- my cervix hadn't even softened, apparently, never mind… dilated. And, can I add that the same thing happened to my two sisters, exactly the same thing. They were induced and then they were… their cervix didn't dilate and so they had emergency caesareans, but I thought I'd give it a try, you know, didn't think maybe, maybe I'd be different.
So this happened to your sisters before you?
Yeah
So you kind of in the back of your mind had thought this was something that might happen?
Yeah …yeah, I think they were, yeah.
Oh right.
But I wanted to go for it anyway.
And was this a planned pregnancy, your son?
Yeah.
And had you had any complications when you were pregnant?
No, with the first pregnancy, nothing at all, absolutely nothing; just a little bit of water retention, but… no vomiting, nothing.
And had you an idea in your mind about how you wanted to deliver your first baby?
I would have liked to have been, to have had a water birth, to have had a natural birth; to have been the first in the family to have achieved one really [laughs]. But yeah… it wasn't to be.
And do you remember the kind of information that you'd looked for in your first pregnancy? About, you know, knowing in the back of your mind that your sisters had this problem, had you specifically sought any information about sections?
Oh, gosh, no, no I didn't really, not, not that much about sections, but I certainly… I was working at home at the time and I just read up on, on the whole pregnancy and childbirth and labour, and I just read up it - everything and any books I could get my hands on and got.… Got books from the library and I did, I did read a little bit of caesarean but I really did think that maybe… I'd be the one who broke the chain [laughs].
And what was the information like that you got? Did you, did you get all the information that you wanted, do you think?
Yeah, I got loads. I mean, I bought about two or three books, I went on the internet and, I don't know… there's a baby centre website that I, I got a lot of information from and I obviously spoke to my midwife, who I got on really well with. I went to parentcraft classes, also had NCT antenatal classes with my husband. |
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She was fully involved in the decision to have a caesarean and was able to play her CD in the operating theatre.
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And how involved would you say that you were in the decision about the delivery?
Oh, a hundred percent. Yeah, even, even, yeah, the decision for the caesarean, even though it had been three days that I'd been there, induced, I was very aware of what, what I was deciding to do.
And while you were in hospital, were you able to discuss any anxieties or fears that you had about the section then, once there was a move to that being the way that you were going to deliver?
Yeah, I remember, yeah, there was a- a trainee midwife that I spoke to about it. Yeah, and I asked her things like, you know, about recovery and the, the kind of anaesthetic. But yeah, I remember, I was very aware of what was going on and she answered my questions and I was okay. I wasn't too worried about the caesarean.
I seem to remember the trainee midwife spending a lot of time with us, just explaining what was going to happen.
So you felt happy with that?
Oh, yeah, and I remember they were really nice the way they… I had music at the time in the- in the labour room and they let us put the CD on in the- in the operating room and… [that's nice] and, yeah, they were really, really sweet. |
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She was surprised by the speed of her recovery and was astonished that she could have a shower the day after the operation.
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Well, it was even better, because as I said, I thought I'd have to like spend two or three days in bed, but I was up on my feet the next day.
And was that you initiated that getting up?
No, no, no, it was the people at [Hospital]. I remember my caesarean was at about five o'clock in the afternoon, and the next morning a really lovely lady came along and helped me to the shower, got me up and I was just flabbergasted and she was just, you know, “Get in, get in the shower, on your feet, have a wash, you'll feel better”, and I did.
And that's what you wanted?
Yeah, and I stayed… I was on my feet instantly. I didn't go back to bed. |
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Her baby would not feed for the first 24 hours. She thinks this was due to the effects of the painkillers she was given to cope with the pain of being induced.
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And what were your concerns or worries about having a section?
Well, I was concerned that it would take a long time to get back on my feet. And I was very surprised that the very next day, I was up having a shower [slight laugh]. But, yeah, I was concerned how long it would take for me to, to get, as I said to get back on my feet, and about breastfeeding. I was very adamant that I wanted to breastfeed. So, I was hoping that it wouldn't obstruct any breastfeeding.
And how did you feel about having a section?
Sorry, whereas in fact, the fact that I had been induced for three days meant that at a certain point I was given Pethidine*. I accepted Pethidine because I was completely out of it and it was that, that led to me, I was pretty sure, having difficulties breastfeeding. Because it took about twenty-four, just over twenty-four hours to get my little boy to latch on because he was half-asleep. So, yeah, it was, it was not the caesarean but maybe the insistence of trying to induce.
*Pethidine is a strong pain killer that may sedate the baby. |
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She feels very practical about her caesarean. It was important to attempt vaginal delivery, but she had no doubts that surgery was the only option in the end.
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And you didn't have any worries about any effects on yourself, kind of emotionally about the fact that you'd had to have a section?
No. I felt quite practical about it. I know people say things like feeling failures because they didn't, you know, but absolutely not. I'm a very practical person.
Good. And what about your husband? Did he have any…?
Actually, I think I was very brave to have tried, considering the background.
That's very true, actually.
But that's why I'm very, very sure of the fact that this time I'm, I just want to go into, straight into the elective caesarean.
And overall, how would you sum up that you feel about the way that your son was born?
Fine... I think that was, yeah… I was, I think… I don't think it could've gone any other way because I wouldn't have wanted an elective caesarean without even trying, but at the same time… no, no, no, that was it, that was fine. I mean I wish it had, maybe we'd come to the conclusion that I wasn't going to dilate within twenty-four hours instead of forty-eight [laughs]. But I suppose it couldn't be avoided, and I was quite happy with him being born by caesarean in the end. As, as I say I feel quite satisfied that at least we tried.
So, how did you feel about having the section?
I was, at the end I was very… very pleased to have the section.
Just get it over with.
Yeah, absolutely.
And was it like you thought it would be?
Yeah. Well, it was even better, because as I said, I thought I'd have to like spend two or three days in bed, but I was up on my feet the next day. |
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She was disappointed that the consultant she saw at the hospital was just going through standard advice rather than tailoring the information to her personal situation.
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Well, my consultant, the consultant that I saw at the [hospital], I found was a bit disappointing because he didn't seem too informed on, on my case. It seemed like he hadn't read my notes. And it seemed like he was just following a sort of automatic advice-giving session, where he wasn't taking into consideration my, my information and was just trying to push me into putting off the decision or going for a vaginal birth. Whereas the midwife… yeah, obviously given the information that was supplied to her about my background, she was quite, she quite agreed that I was right to go for the caesarean and that I was… she backed me really. I mean, I think after, straight after I'd given, I gave birth to [son's name] with the caesarean after the [induction], I took the decision that if I did have another child [laughs] it would be with an elective caesarean. So it was really something that I had, I was quite determined to do when I took the decision… quite early on. |
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She was convinced that she would not go into labour naturally because of her previous experience and family history. It made her confident that she would not be denied a caesarean.
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…you know, I just had such a horrible, awful and traumatic three days before that caesarean that I just, I just really would never go through that again. And it was just such a horrible way to start off being a mother, because I was just so tired and I was just so battered, and exhausted, that I hope that this time I'm much calmer. I'm quite happy about going there for the caesarean now, so, I'm hoping that the day after the caesarean I'll be quite rested and… and quite ready to start looking after my second baby. So it's, it's like all of this is behind my decision.
If I had had some doubts that I may be would not have been able to have an elective caesarean at the end of the second pregnancy, I might have hesitated about getting pregnant a second time. Because it was just such a horrible experience being induced and... and trying to, to get into labour and not. …Those two or three days were just so horrific, and just the fact that I was quite certain I could have the elected caesarean made me quite calm.
And when were you told that you could have an elected caesarean with a next baby?
I just assumed so, to tell you the truth. And then when I saw… because I know because of my background it would be difficult for somebody to deny me a caesarean… whereas with the first birth I'm sure you can't just… well, I don't think it would be right to just instantly want an elective caesarean, but I think that I was pretty certain that after my, with my track record, nobody could really deny me an elected caesarean for my second child. |
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She was convinced that a caesarean was the best option for her given her previous medical history, so she wanted the doctor to book a date straightaway rather than delay the decision.
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And from the outset, you've had a preference about how you want to deliver this time, you've wanted to go for an elective section?
Oh, yeah, absolutely.
And that's been from the beginning, and…
Yeah, well, even from when we were trying to conceive. And as I said, I was, I was completely certain that I would get the elected caesarean.
And at no point have you changed your mind?
No. When I went for my twenty week scan… I was speaking to the, to the consultant and he was trying to put, put off my decision. But… even just talking about it with him, even just, that, that slightest, slightest doubt that I might not be allowed to have an elected caesarean just really agitated me at the time and I just said - I said, “No, I'm not leaving here 'til I've got the date plan”. |
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She feels it was right for her to have full control over the decision to have her second child by planned caesarean and thinks every woman should be offered a choice.
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A lot of people wouldn't agree with me, but I really liked the fact that I knew when it was going to happen, I was very, I felt very much in control and, and I avoided all that, you know, all that… yeah all that pain and upset that, that came about before [son's name]'s birth, with the same, with the same results.
How much of a choice do you feel that you had, personally this time?
Oh, a hundred percent. Even though, you know, the consultant maybe tried to talk me out of it, but I knew that in the end I could, you know, I could… I had every right to the elective caesarean.
And how, how realistic do you think it is for us to encourage other women to have a choice?
Oh, it's wonderful, it's great. Every woman should have a choice… definitely. I'm not saying every woman should have a caesarean, at all, but they definitely should be informed, and decide for themselves what they want to go through, absolutely. I feel very strongly about that. |
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She thinks it is important to seek information and advice from health professionals, but in the end the decision rests with each woman individually.
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So if you were to give a message to other women who were making this decision about their second delivery, what would you say to other women?
To get, to gather all the information they can and then make the decision on their own, because it's, it's their body [laughs] and it's their baby.
Obviously, it helps to have the backing of your partner, but I think the final decision rests with the... with the mother, definitely.
You can get advice, I think from, from your partner and your midwife and your consultant, but I think at the end of the day you really have to just sit down, think about it and make that decision on your own. |
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It is important for consultants to know their patients' individual circumstances so they don't give advice that is irrelevant.
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Well, my consultant, the consultant that I saw at the [hospital], I found was a bit disappointing because he didn't seem too informed on, on my case. It seemed like he hadn't read my notes. And it seemed like he was just following a sort of automatic advice-giving session, where he wasn't taking into consideration my-, my information and was just trying to push me into putting off the decision or going for a vaginal birth. Whereas the midwife… yeah, obviously given the information that was supplied to her about my background, she was quite, she quite agreed that I was right to, to go for the caesarean and that I was… she backed me really. I mean, I think after, straight after I'd given, I gave birth to [son's name] with the caesarean after the [induction], I took the decision that if I did have another child [laughs] it would be with an elective caesarean. So it was really something that I had, I was quite determined to do when I took the decision… quite early on. |
