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Making decisions about birth after caesarean

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Interview 16

Interview 16

Age at Interview: 19
Background: Bar supervisor with one son aged twenty-two months. Lives with her partner.

Brief outline:Had emergency CS after 18 hours of labour due to 1st baby's large size and awkward position. Recovery was difficult, felt low and exhausted for one month. Same problems of size and position with 2nd pregnancy, advised to have planned CS. Planned CS was much better experience.

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Laura's story
Print First pregnancy and birth During her first pregnancy, she had received helpful information about vaginal delivery from her midwife but nothing about caesarean. She had not been offered the option to attend antenatal classes. She was hoping to deliver 'as natural as possible' with just gas and air for pain relief. Towards the end of her pregnancy, she became increasingly worried that her baby's head had not engaged properly but was told to just wait and see. She eventually went into labour six days past her due date. She came into hospital and had her waters broken when she was 4cm dilated. She managed fine on just gas and air at first and continued to labour up to 9cm. But her baby was in a back to back position and his head was so large that he got stuck in the birth canal. She laboured for a while longer and received Pethidine (a strong painkiller) which she had wanted to avoid. Then her baby started showing signs of distress and she was told that she would need an emergency caesarean. At that point, she felt too 'out of it' from the effect of the painkillers to even make sense of the consent form. The operation itself was less bad than she had expected. However, she lost a lot of blood and was too ill from the after-effects of the drugs to attend to her baby son for the first 24 hours after the birth. Looking back, she feels she missed out on early bonding. Even after returning home, she felt too weak and exhausted to breastfeed him. It took her almost a month to feel herself again, even though her scar healed very well. She had been about to take her driving test before giving birth, but as she was not allowed to drive for six weeks, she ended up having to retake lessons and it took her much longer to gain her licence. Looking back, she wishes she had received better informed about the likelihood of caesarean birth as it might have made her experience less of a shock. She also would have liked to have been offered a caesarean sooner instead of having to go through 18 hours of labour first. Second pregnancy and birth Her second pregnancy went smoothly, and although she had been told straight after her first birth that she might be more likely to need another caesarean, she was hoping to give birth to her second child vaginally. However, at her second appointment with a consultant she was told that her baby was large and his head lay high again, so she would be likely to experience similar problems as with her first child. The consultant advised her to book a planned caesarean. She felt positive about being more involved in the decision-making process this time. She found it helpful to have a midwife who herself had experienced emergency caesarean followed by a planned section. Being better informed on the subject, partly through her involvement in the DiAMOND trial, gave her more confidence to ask the questions she wanted answers to. A leaflet on the risks and benefits of different ways of giving birth she received from her consultant was also very helpful. But it would have been helful to have this information available to her earlier on in the pregnancy. After considering all the pros and cons, she decided to book a planned section. Her main motivation was to avoid another emergency caesarean after an exhausting labour which would leave her too ill to enjoy early contact with her baby. On the morning of the booked date, she went into hospital with her partner and her mother. She was prepared for the operating theatre and not allowed to eat or drink, but had to wait until 1pm before a slot was available to deliver her. The procedure itself took only 50 minutes. Having music playing and having her partner with her helped her relax. After the operation, she was sick and received antibiotics, but she recovered within a few hours and was able to have visitors. She felt a lot better and happier than after her previous caesarean and was able to stop taking painkillers after 5 days. She also managed to breastfeed for two weeks. She thinks having a choice about how to give birth gave her a sense of achievement she did not have after her first birth. She has no regrets about how her second child was born, even though she has been told that after two caesarean she won't be able to attempt vaginal birth with future pregnancies.

Knowing more about the likelihood of birth complications might have helped her cope better with her own experience of caesarean.
Print And what kind of information did you want when you were first pregnant? …probably they- I think they should give you more information on sort of the possibilities of it. Because I felt like after, I found it difficult because I felt like I'd failed. And I didn't know why. There's a lot… like I know a lot of people who've had babies, and they've had them naturally and I thought, well… basically you feel a bit of a… you've gone through all that and then you end up having a caesarean. I was in labour for sort of eighteen hours, and it just seemed a bit of a… I think they should give you a little bit more information on- on that subject, sort of that you could end up having a section in the end.

She felt very ill after the operation and took a good month to fully recover. She hadn't realised she would not be able to drive for 6 weeks and had to postpone her driving test.
Print I felt really weak, I felt ill actually, I got… and I felt really ill. I felt very dizzy and… get a bit worried about what's, what's wrong with you because you don't normally feel like that, it's something you don't experience, especially sort of after you've got a new baby you expect to feel like a bit more with it [laughs]. And how long were you like that? I was like that for a long time, even when I came out of hospital. I came out of hospital on the… I had him on the Tuesday and I came out on the Friday and on the Friday night I didn't get discharged until about eight o'clock at night. And I got home and I felt really, really terrible. I felt… you get worried, like you're thinking “oh my God, well, what's wrong with me?” But… no, it went on for quite a while. It went on… I didn't feel normal again for a good month, over a month. And did that surprise you? Yeah, because you expect to sort of bounce back quite quick, but you don't realise it is a major operation. I don't think, because it's so routine now, I think people get into the habit of thinking, “Oh well, it's…” or, “I'll go…” all these people having caesareans, they think “oh, I'll, I'll have a caesarean”, but it's not all that easy really. Okay. And did you have any long-term worries about either you or the baby being affected? Long-term? Not really, because my scar… I was lucky, I never had any problems with my, like the healing and that. I healed like brilliantly really. And did you worry that you were unable to do as much as you'd like to have done? Well, I was supposed to be drive… learning to drive and, because I, I was driving right up until I had my test in like a couple of months before he was due. And I failed, and I had it re-booked, and I had to cancel it because I had the section and you can't drive for six weeks. And obviously then, I had to have a couple more lessons before, so that took a lot longer than I would have liked. I think that's the main thing, you don't realise you can't drive, you can't do- the normal things, just like getting out of bed and things is a lot more difficult.

Her baby had to stay in special care and she felt very ill. She was grateful to have support from her grandmother and partner, but felt low about needing so much help.
Print Did your partner have to help you? Yeah, quite a lot. And was he good at doing that? Yeah, he was okay, but not… I found my… I was living, I'm living with my grandparents after when I… and they helped, they helped brilliantly, especially my nan. She was, it's like your washing and things you didn't realise, like, how difficult that would be if you were on your own doing. And did you… how did you feed your baby? I bottle-fed. And had you planned to breastfeed? I would have liked to have tried, but I just… after, I just didn't, I didn't have that, because as soon as he was born he was, he was taken because like he had to go to the special care as well. I didn't feel like I bonded very well with him and I, I felt so ill I just didn't want to… at the time. And did you have any problems going to the loo or resuming sex again after you'd had the section? …No, not really. It was just getting about really, it was getting up to get sort of around, yeah, because they try and get you up as soon as possible, which is… but you're so, it just feels… it's a feeling you don't ever feel so you don't really understand, and you've got all the other problems of having, after having a baby as well, plus that, it's like a bit-, takes you back. And did you feel anything about yourself? I, I think it got me down a little bit. I got to admit, I think I would have preferred to have… I think because I was so out of it and didn't get that time with him, I think, like after, it should be happy. Because I, I just wanted to go to sleep and they end up giving you an injection… I think I had a morphine injection so I was just out of it anyway, so like, all through the night after he was born, the first twenty-four hours after he was born, my partner looked after him, basically. I never, I couldn't… you can't get out of bed to go and get a bottle. You've got to call for someone to get it, and then they've got to get the baby and pass the baby to you, it's like everybody's doing things for you, you can't do anything for yourself. So, how long did you feel down for, do you think? Not long, it sort of picked up. It was only the first, when I was in hospital, because of the lack of sleep, because it's not just you, there's the other babies crying, and I think that was… once I came out of hospital and got back into my sort of own, I felt okay then.

She prepared a birth plan for her planned caesarean. She asked to have contact with the baby as soon as possible, as she regrets missing out on the first few hours with her first child.
Print I'm quite excited now. It's a bit worrying thinking that you know what day… so it is a bit confusing, because I know exactly the date and… You know your baby's birthday beforehand. And have you made a birth plan this time? Yeah, it's, definitely. I said to the midwife, I said well, when the baby's born, will I be able to have contact. That contact with him, because I felt like I missed out on that the first time, I felt… I don't know, I just didn't, I missed out. …I didn't get to hold him for a good, quite a few hours after, and I felt like I missed out that, and this time I don't want to. Okay. And how does your partner feel about you planning a section then? I think he's, he's worried about the operation. From… obviously for me, more so than like the baby, because there's more risk for me than there is for the baby… But he's quite happy to support me with my decision. He's never, he's said like you know what's best, really you've got a gut instinct really, and I know that if I left it, I just don't think… I think the same thing would happen. I think he would get stuck again, because he's a good size again, so…

Finding out about the risks can be scary, but she thinks it's better to know than not know. Computers can make information more easily accessible.
Print Do you think there are any benefits to using this kind of programme generally? Yeah, I think it all depends on why you're… what type of person… I think all people are different, I think that it… especially like the computer way I think. Because computers now, people are always using them, I think it's the easy way and people find it more… instead of sitting there reading through books and things like that, I think the computer makes it more accessible really now. And it easy, it is really easy to use I would say. Could you see there be… any harm to using something like that, any problems? Not really. Some people worry, don't they, more, and like facts and figures can worry people. Like when they say like… they do say like sort of how many people have major complications and things with the caesarean. That could scare some people, but I think I'd rather know than not know, than people say “Oh, you'll be fine” and then something does go wrong.

After she had booked her caesarean, she received a leaflet describing the pros and cons. It would have been good to have the information before meeting the consultant.
Print Like with the elective section, there was like, well… I've got a information sheet now of having an elective, and it tells you like the, the risks as well? And sort of, how likely things are to happen like and how at risk you are. And I suppose you've got to look at it… things over a sort of wider… you can't just look at things and think, “Oh well, because of that… I'm not going to do it because of that”, because you've just got to look at everything really. And where did you get the information sheet? Was that from the hospital? Yeah, that's what the consultant gave me, and that's really good. That's probably, apart from obviously with the DiAMOND study, that is the best information sheet. But I think they should have given you that, before you actually see the consultant and they say well, we've booked you in. I think you should get that the first time you go up and see the consultant… instead of after. Because like that-, that would be, that would have been sort of good for me to know before. If I wouldn't have been, like had all the information before, like the questionnaires and everything and the lady coming round with the computer and that for the information, I wouldn't' have known half of that stuff so I probably wouldn't have made… such an informed. Like the decision would've been a bit more… Not quite as sure. But with this information sheet, if they would have given me that before, that probably would have given me just as much information as what I got from the DiAMOND study really. So you think you should have had that before you'd seen the consultant and…? Yeah, because I seen the consultant, going back before Christmas, just before my twenty week scan. And there was sort of… they could have given you it then, if they knew… Although they don't know that you're definitely going to go in for a section, I think they should have given you that.

She thinks women are more likely to trust the advice of other women who have had a caesarean than doctors.
Print I would probably say like this research, like asking people, instead of just going by what doctors say and things like that, I think people who have been through it their self, I think they're probably the best sort of… because everyone's different and everyone has different sort of experiences with things, and I think that's the only way they're going to sort of give… I think women would probably listen more to people who've been through it themselves than doctors who just… I know they're medical people, but I think it's more important to listen to people, I'd probably has listened, obviously with your study as well it was more sort of about women who've had things, so I think that's why I listened to it more myself.

Having no choice over her first caesarean made her feel like she had failed. She is glad that she could make an informed decision to have a planned section with her second child.
Print So what do you think your role was in the decision making about the delivery, because the first time you didn't have that choice with the first birth? No, I feel like I had a lot more sort of choice in this one, a lot more… I don't know, I just felt more informed. I think because you've got no choice you feel worse because you feel like you've failed. This time it was my decision to do that, and when you've got people… some people did look and say, “Oh well, wouldn't you want to have a normal labour, wouldn't you like to try for a normal labour?” And at the end of the day I think if you… it's what you feel happy with, so… and I did feel happy with it... So yeah, I was quite… So how do you feel about the way that this baby was born? Brilliant, I feel differently actually than with… with [child's name] I felt, I just felt… after I felt ill and I felt like I'd failed. And I was quite, it got me quite down actually. But this time I was sort of… I couldn't believe how well I felt, I felt, like I felt too well, that I was going to… I was panicking that I was feeling too well really and that I was a lot more… I don't know, it just felt the way I would expect you to feel after you've had a baby, I felt this time. Unlike last time I didn't, I didn't feel… you're supposed to be happy when you've had a baby, but the first time I didn't. But this time I was just… it was really, really nice, it was a good experience.

She thinks women should not let themselves be influenced too much by the opinions of other people. It is more important to have accurate information.
Print And what advice do you think you would give to another woman who'd had a section and was planning her next delivery? Make sure you've got the information first, before you make any… because it's quite easy, and don't listen to anybody else. Like, obviously, listen to people but don't… because I had, I got to admit I had quite a few people saying, “Oh, oh well, you should really try for another normal delivery”. But then it's down to you and I think at the end of the day if you don't feel happy, you're got to… at the end of the day, they didn't have the information like I had, they didn't look at it, and then it weren't until I looked round and said well, do you realise that it's this many people try for a normal delivery after a section and don't, I said, and then, you just feel like you've failed again, so… and they, they did change their view… and they're quite, sort of quite happy now.

Her second caesarean gave her a sense of achievement because she had actively chosen to give birth that way.
Print Yeah, because I chose to have him that way and I feel that I… it's quite a big, I felt like it was quite a big part of me choosing to have this caesarean anyway. And I was fully… sort of more with it, fully aware of what was going on? this time. And I feel like that was sort of an achievement in itself. Going through, a lot of people who've had, who I know who've had normal deliveries, they've said, “Oh, you're brave to be like knowing what it's like and going for it again,” and so I felt that I had more… more sort of an achievement this time. And having an election section, was that like you thought it was going to be? I've watched it on sort of programmes on the tele, but it was more… it's strange actually, it was like you're watching it through somebody else, it wasn't… because you've got no pain, you just… I don't know, it was a really good experience. The midwives and everything, I think they made it… I suppose everybody's different, but like I found that they relaxed me. So yeah, it was a good experience.

She had to wait quite a long time beforehand, but the caesarean itself took less than an hour and was less scary than she had imagined.
Print Well they said in the morning to get there sort of quarter to eight in the morning, so my mum and my boyfriend came with me. And we were a bit late but then we were taken into sort of a room. It was like a… it's in the delivery suite, but is like a different, is not the sort of room that you go in when you've gone into labour usually, it's usually sort of overnight before you go into labour sort of thing. And I went in there and there was a lady had just had her caesarean next door, and they came and said that I was third on the list. So they said it should be… they try and do their electives in the morning. But obviously each one's different so they could overrun and it depends how long they take. So they said roughly around half past eleven I would be going down, so I was… then they came in, I saw an anaesthetist, she came in and was talking to me and just really sort of trying to keep me relaxed and just saying… explaining what they'll do and how they'll do it, sort of because it's different to your emergency because you actually walk down to theatre instead of being wheeled down, and they brought like a gown for me to put on. They said it's easier if you're ready because then we can take you straight down literally. Because they clean up obviously the theatre and then they want to take you straight down. So they'd given me a gown to put on and everything and they just said sort of you can't eat anything or drink anything, so I was like, “Oh” [sigh]. But in the end they had a lot of delays so it took right into… I think it was about half past one I went down, because all the others, there was a few problems with them. So… I went down about half past one and it was… it was completely different. They asked me what music I wanted on and it was really nice and relaxed. They were all really like sort of welcoming, they weren't… weren't scary, I thought it was going to be a bit, bit sort of… I don't know, you expect an operating theatre to be… because I didn't really remember it from the first time, but it was quite relaxing. Then they give me my… I had a spinal… they gave me that, and then I went numb, and then it all seemed to happen really quickly. They said if you don't feel well or… then just let us know because they said your blood pressure can drop and things. And so it was, it was quite a good experience. And then he was born at sort of just before two o'clock. So from the time I went down it only took sort of half an hour really before… and then he was born and then I was - I was the quickest one, all the others had been in for hours, like over an hour, and it was just over fifty minutes I was in the theatre, so wasn't very long.

After her first caesarean she didn't feel like herself and found it harder to bond with her baby.This time, having had the choice, she felt really well and happy.
Print So how do you feel about the way that this baby was born? Brilliant, I feel differently actually than with… with [child's name] I felt, I just felt… after I felt ill and I felt like I'd failed. And I was quite, it got me quite down actually. But this time I was sort of… I couldn't believe how well I felt, I felt, like I felt too well, that I was going to… I was panicking that I was feeling too well really and that I was a lot more… I don't know, it just felt the way I would expect you to feel after you've had a baby, I felt this time. Unlike last time I didn't, I didn't feel… you're supposed to be happy when you've had a baby, but the first time I didn't. But this time I was just… it was really, really nice, it was a good experience. And you said a little bit about the differences between having the emergency and the elective can you tell me a little bit more about how they're different? I found that with the emergency you're… because you're so… I think if you're in labour anyway you're tired, you're just… I had pain relief before that as well so I felt a bit sick and I just didn't feel myself. And I feel because you don't get that choice, it's just, “You've got to have it”, and that's that, I just felt depressed I think about that. And I didn't feed, like after I had [child's name] I didn't breast feed, this time I did. Only for two weeks, but… and I felt that, because I had that choice to do that. With the emergency, because I felt so ill I didn't want to, I just, I felt like… I found it harder to bond with him I think more so.

Because she did not have any control over her first birth, it was all the more important to her to be able to make an active decision to give birth to her next child by planned caesarean.
Print Obviously with the emergency [caesarean] you don't have a choice at all, I felt like I made quite a big… I could have if I wanted to go for a trial of labour I could have. The consultant never said, “Well you've got to have a caesarean, there's no choice.” That was my decision to have the caesarean. And how realistic do you think it is to encourage women to have more of a choice now? I think, yeah it is… it's not that, it's… women I think now they feel like if they don't… I felt, like I would have felt if I would have not been given the choice, they said, “Right, you've got to have a caesarean,” I probably would have felt worse because I'd have thought, "Well I got that choice taken away from me the first time, I want the choice the second time." But obviously they told me now that obviously if I have any more then I've got… they wouldn't give me a choice anymore.

She thinks women need to allow themselves time to consider all options rather than just have another caesarean by default.
Print If you were to give a message to other women now who are making this decision, what do you think you would tell them? Just that everybody's different and depending on your personal circumstances and why you've had a previous section and why? Things like that. Don't just look and say, “Right, I'm going to have another [section]”. Just take time and just let yourself sort of look into things and get as much information as you can, because it does help a lot. Well, it helped me.

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