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Amanda's story
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First pregnancy and birth
Her first pregnancy was easy and free of complications. At her 12 week scan, she found out that she was expecting twins. She knew that a twin pregnancy would increase her chances of having a caesarean. As she felt generally apprehensive about vaginal birth and birth assists such as forceps, she decided early on to have a planned caesarean. She felt relieved that a twin pregnancy was likely to be seen as a sufficient medical reason to grant her wish and therefore free her from the stigma of just choosing 'the easy option'.
As a GP, she spent 6 months in obstetrics and gynaecology during her training, and felt as informed as she wants to be about the risks and complications of different ways of giving birth. She did not feel the need to make a birth plan for her delivery. More generally, she likes to be fully involved in decision-making about her care and feels confident in her interactions with other health professionals. For her information needs she typically uses the internet.
She felt extremely happy with the antenatal and hospital care she received and described her first caesarean as a very positive and stress-free experience. Her waters broke in the early hours of the morning of the day she had booked for her caesarean, and her twins were delivered seven hours later. She recovered well from the procedure itself. However, in the period after the birth, she developed lichen sclerosus (a chronic inflammatory skin disorder affecting the genital area) and subsequently had to have a small operation to remove a vulval fissure.
Current pregnancy
When she fell pregnant again, she thought long and hard about how she should give birth. Eventually she decided to have another planned caesarean. The main reason was her fear that she might tear during vaginal delivery, which then might give trigger further complications due to her lichen sclerosus. As she was preparing to move abroad for a year soon after the birth she was keen to avoid anything that would make her more likely to need hospital care while out of the country. She booked her second caesarean for 39 weeks.
She does not plan on having further children after her current pregnancy, but this decision is independent of her birth experience. |
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She felt scared about vaginal birth and was relieved that being pregnant with twins meant that her request for a planned caesarean was granted without problems. Played by an actor.
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Well… I actually chose to have a section, the first time… really because the thought of pushing two of them out would have had me in bits for months beforehand. So we moved to here when I was twenty-eight weeks' and I just asked the consultant, [laughing] “Can I have a caesarean?” And she went, “Yes, that's fine”. Because she'd quoted that my chances of having one in the end were about seventy-five percent or something like that.
And I thought, “Well… I can't, you know, I don't want to push one out and then have a section.” So I, thought, “Yes, that's great”. So, I was due to go and see her and discuss going in for a planned section when my waters broke and, at four in the morning, I went in that day and had the caesarean at eleven.
And how many weeks were you when you made the decision to have a section?
Oh, as soon as I heard - twelve weeks I think.
So, prior to knowing that you had twins, did you have a preference about how you wanted to deliver?
Not really. I mean, having sort of seen quite a lot of births, I think the whole natural birth thing scares the-, you know… Oh, it's scary! [slight laugh]. So in some ways, when I found out that I was having twins, it was great, because I thought, “Great - no-one's going to argue with me now! I can have a caesarean.” So… but I mean, if it had been one, obviously, I would have… had it naturally, well, tried to. |
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Her delivery of twins by planned caesarean was a very positive and stress-free experience. Played by an actor.
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How do you feel now about the fact that you had a section?
I think it was fantastic. I just think it was the best thing for me. And I'm, I was very happy that I'd made that decision, because the whole thing was completely stress-free. And… I recovered really quickly. I couldn't have asked for it to have been any better.
Was it like you thought it would be?
…Yeah, I guess it probably was. It was as good as I'd hoped, yeah. |
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She chose a planned caesarean to minimise the risk of her lichen sclerosus returning. It annoys her that people who don't know her reasons might think she is taking 'the easy option'. Played by an actor.
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So, what's the overriding factor for you for having a section?
Why I'm having it? It's the lichen sclerosis, which is fairly stable, just now. And I really don't want to go in tear and… then have to go through another day case operation, but… and also we're going to Australia for a year in July and then what would happen if we were out there, would I have to have it there, and it's just…
Yeah, bit of a nightmare, isn't it?
Yeah.
And you, you say that you would have liked to… you thought about the possibility of having a vaginal delivery. Is there any way that you would have tried for a trial of labour?
…Well, if I hadn't had the lichen sclerosus, definitely. I mean, I guess, there's a small part of me, even though I'm ninety-nine percent sure, there's a small part of me that if I went into labour now and if things were going great… I would be sort of partly tempted to carry on. …But it's a very small part [slight laughs]. There's, there's a little bit of pressure that I sort of feel in some ways I should be… going for a normal delivery. And that, a lot of people who maybe don't know the reason will perceive that I'm… I don't know, just being lazy or don't want to go through the pain or whatever. …so that does slightly annoy me. And in many ways, it would be great to have a normal delivery, because hopefully my recovery would be faster and I wouldn't have to, you know, wait for several weeks to drive but…so still, I'm pretty sure that a section is probably the right thing to do.
I mean, you say you feel this pressure from outside, but do you really see it as an easy option yourself?
Well I don't, I don't actually. No, really I mean, I did go so well the last time, but it's just with the boys… it's completely different this time. So, I don't want to not be able to drive for four weeks or whatever. I think it was about three or four weeks the last time. Because they're not going to want to be stuck in the house. Well, thankfully people will be coming over, so it won't be an issue, but… And I don't really particularly want to have another spinal or have another catheter in, but… So no, I don't think it's an easy option, but maybe…I don't know. |
