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Gillian's story
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First pregnancy and birth
She had a difficult first pregnancy with extreme sickness throughout and needed to go into hospital on several occasions to get rehydrated. She had attended antenatal classes, but found them more useful for making contact with other pregnant women than as a source of information. To find out about what she wanted to know, she mainly used books and the internet. Having felt so uncomfortable during her pregnancy, she hoped that at least her labour might be easier. However, she did not rule out any form of pain relief, should she feel she needed it at the time.
When her waters broke and contractions started, she stayed at home initially but went into hospital 24 later once labour had become quite painful. She was told that she had not yet reached 'advanced labour' and was sent home again but by evening the same day she was in so much pain that her husband rushed back to the hospital with her. She was examined and it was found that her baby was in a double breech position. He had become stuck in the birth canal and she was rushed into the operating theatre for an emergency caesarean.
After the operation, she was relieved that her son was healthy, but felt disappointed that her actual experience was so far removed from the birth she had hoped for. She also felt very sick immediately after the caesarean which she blamed on the anaesthetic. She thought if staff had picked up earlier on her baby being breech, it would have allowed her to choose a planned caesarean instead. As it was, she was in too much pain to play any active part in decision-making. Her husband found the experience of seeing her in so much discomfort without being able to help very distressing. They both were in a state of shock for the first few weeks of parenthood. She attempted to breastfeed her son but had to give up after three weeks. She felt very low for about six month and thought that she had failed as a mother. Looking back, she thinks she might have had postnatal depression. She gradually recovered with her husband's support, but her previous negative experiences of pregnancy, labour and breastfeeding made her feel doubtful about having further children. She thinks it would have been useful to have more detailed information on the risks and benefits of different ways of giving birth after caesarean before becoming pregnant again.
Second pregnancy and birth
Her second pregnancy happened more quickly than she had expected, and proved as uncomfortable as her first in terms of recurring sickness. She got tips on managing sickness from the internet but didn't find anything that would help her. She was disappointed not to have as much access to antenatal care as she had with her first pregnancy. She would have liked to go to antenatal classes again to make contact with other mothers. She felt very uncertain about how to deliver her second child but was leaning more towards a planned caesarean. In thinking about her options, she was influenced by friends who had had positive experiences of planned caesarean and emphasised how different a planned caesarean was to an emergency section. She eventually booked a caesarean, but thought that if she went into labour beforehand and made good progress she would give vaginal birth delivery another try. She gathered information about birth after caesarean from various websites and even looked up research in a medical library, but actively avoided watching TV programs or reading newspaper articles written by non-specialists.
A few days before the planned caesarean, her waters broke late in the evening and she experienced mild contractions, but wasn't sure whether it might be 'false labour'. Contractions became a lot stronger during the night and she went into hospital early the next morning. When she found out she was only 2cm dilated, she asked the staff to go ahead with a caesarean. However, the operating theatre was busy and by the time a slot became available the consultant advised her that the baby's head had moved so far down the birth canal that performing a caesarean would carry additional risks. Before she could reach a decision, she had entered the final stage of labour and her son was born 10 minutes later. Looking back, she is very pleased about how she delivered. She recovered much more quickly and did not experience the low mood that she had felt after her first birth. Breastfeeding proved problematic again but being far more mobile and less tired meant she bonded very well with her baby regardless.
Looking back, she thinks what made her previous experience so traumatic was not the caesarean itself, but the long and exhausting labour beforehand. Even though she is pleased with how things worked out for her this time, she still would stick by her decision for a planned caesarean in principle. |
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She thinks that sometimes it can be better not to know too much and to put your trust in the professionals instead.
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Is there any way you could have been more prepared, do you think?
I don't think so really, because one of the few things I have learned is that sometimes a little bit of information is not a good thing. At the end of the day you're putting yourself in the hands of the professionals and they kind of know best, so you don't really want to know too much.
Okay. So you think you could possibly know too much and that it would be a bit scary?
I think that's my own fault though, because I did read up on it an awful lot. |
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She got most of her information from books and the internet and saw the antenatal classes mainly as an opportunity to get to know other mothers-to-be.
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And what information did you want with that pregnancy? What did you want to know?
Throughout my whole pregnancy, I was just so ill, I wasn't really, I was just kind of looking to, to have the baby eventually out. I think that made me want a natural pregnancy more because I'd had such an awful pregnancy, sorry, labour, I wanted a, a bit more natural labour, but it just wasn't meant to be.
And did you go to ante-natal classes?
I did, yes.
And how useful were they?
Most useful thing about them for me was… I tend to, I know you shouldn't, but I tend to read a lot of books and go on the internet and things like that. They were good to meet other mums, who were going to have babies the same age as me. It didn't work out that way because I went back to work very, very quickly, so, it wasn't quite as good as I'd expected, but I was really looking more for companion side of things from ante-natal classes.
Right. And you said that you looked at books and the internet as well. What kind of information did you get from there?
Just information on, you know, what pain relief was available, what sort of things could go wrong, just really anything to do with, with labour really. |
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She experienced postnatal depression for several months after the birth. Her husband's support helped her through it, though she worried that it might return if she had another baby.
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I was never actually diagnosed with post-natal depression but I do think I had it, and I think that was maybe a combination of the pregnancy, the labour and the failure with the breastfeeding.
Why do you, what makes you think that you, you did have depression? Could you explain why you think that was?
I was just… I couldn't sleep at all, I was absolutely terrified the whole time. I would wake up in the middle of the night, pulling at the bed sheets, thinking [son's name] was falling out of bed and I just didn't feel I was coping at all. I felt like I was a bad mother and I just hadn't managed anything right. I hadn't managed the pregnancy, I hadn't managed the labour, I hadn't managed the feeding.
And how long did you feel like that for?
It would be about six months.
And what, what changed to make you feel better?
My husband finally sat me down and he was like, “Well, this is ridiculous, you know. You are a good mum and these were things that you couldn't have done anything about, so”, that was basically it.
And did that help?
It did, yeah. Just the fact that he was being so supportive.
And is that a worry this time for you?
It is actually. I'm quite concerned I'm going to get post-natal depression.
Have you, have you talked about that with anyone?
No. |
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With hindsight, it would have been helpful to know more about the different kinds of pain relief available during labour before a caesarean.
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And now you've been through your second delivery, is there anything at all that you think you would have liked to have known more about?
Pain relief would have been… a wee bit more information on that. I, I'm not, I can't remember whether or not that was in the program or not, but the fact that you're having, if you have a section rather than a natural delivery, and also which point in your labour you can have different pain relief. I wasn't aware that you could only have morphine or gas and air if you were having a section, and I didn't realise that once you were in advanced labour you couldn't get anything other than gas and air. I think I would have been shouting a wee bit louder going, “I need some please, now!” |
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Health professionals thought that as a second time mother she needed less support, but she would have liked more information and a chance to go to antenatal classes again.
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Because with it being my second, I didn't really get that much information. I was actually quite disappointed in that… I, you don't obviously get as many appointments with your second and I also wasn't able to attend ante-natal classes because they were full. And first time mums obviously would have to go. So I did, I did feel with my second that you were kind of, “Okay, you've done it before, so away you go”, but I kind of felt well, yeah, I've done it before but I had problems the first time, which is why I really need a wee bit more information, but there's only so many staff and so many places in classes and things, so I understand why, why I couldn't go to classes and things. |
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She thinks a planned caesarean will allow her to bond better with her baby because she will be far less exhausted than she was after the long labour and emergency caesarean of her previous birth.
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And how have you wanted to deliver this time? What have been your thoughts about that?
It's been varied, but I've finally decided on an elective section.
So, if you can talk me through why you varied and, and why you've come down on the side of a section this time?
For the same reasons as I wanted a natural birth the first time; mainly bonding with, with the baby. That's kind of made me think, “Well, maybe I should go for a natural delivery if I can”, but then I think about it and I think well, I don't, I don't really believe that the problems I had after I had [son's name] were due to the section. I think they were more to do with it being an emergency section, whereas I think if it's an elective section then that would be fine because I'd be more with it. I wouldn't be so tired, I would be able to feed him straight away myself rather than having to have him latched on, and that sort of thing.
I've got quite a few friends who are in the same position as me. They've had an emergency section the first time round and they've then gone on to have a second, and I have asked them, and they've all said that, you know, an elective section compared to an emergency section is like night and day, and none of them have had any problems or complications afterwards. They said it was fantastic, so, I have to say I've been swayed a bit by what, what they've said as well. |
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She changed her mind throughout her pregnancy and kept her options open by booking a caesarean for after her due date.
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So, have you got the section booked now?
I have, yes.
But if you were to start labouring naturally and everything looked okay…?
I think what I would do is, I mean, well, I know from my first time round that these things don't happen within a couple hours so I think I would, if it happened in the same order, where my waters broke and I had contractions and whatever, I would wait until they were regular and getting close together, and then once I got to the hospital, I think I'd make the final decision. If I was given advice that I was progressing well and that the, the head was definitely in the right position then I might still try for a natural…
You sound uncertain?
Yeah. I am quite uncertain really. I think the thing that makes me so uncertain is that there are risks on both sides, it's not that one is so much more problematic than the other, they are very much balanced. Where one's better than the other then the other one has positives as well. So it is really difficult to make a definite, definite, definite decision. So, again, I'm kind of going back to the, well, maybe see how things go a wee bit, but then if I haven't gone naturally by my date, then that's fine, it'll be an elective. |
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She thinks negative media coverage of women who have a caesarean is unhelpful and could sway women in their decision when they might have very good reasons for wanting a caesarean.
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And in the abstract, aside from your situation, what do you think informs other women's choice?
I have to say the media, quite a lot.
Could you say why?
I think there's an awful lot of information on the television and in newspapers as well, you know, articles on… one of the main gripes I have, I have to say, is how they push breastfeeding so much. But I have noticed that there's more and more now on actual… in fact there was one in the paper last Sunday, the Herald, saying, what was it - oh, I can't remember. The headline was terrible though. Something, something section, you know, like, “Why are so many women not having a natural delivery?” and then the author then went on to spout out about how she thought it was absolutely terrible and I basically read the title and just turned the page, because it, at the end of the day I think that type of information, where it's an author and not, not someone with a medical background giving their opinion, is not very useful at all and I do think that a lot of women pick up on these things in the press and the media, and that will sway the decision they make.
And for women like yourself, do you find that that kind of thing puts pressure on you and then can add to your feeling of feeling bad about the delivery?
Absolutely, yeah. I mean, I read the headline and my husband actually read it as well and he just took it off me [laughs] it's like, “You know, there's no point in even reading that”. |
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She went into labour before the date booked for her caesarean. By the time the theatre was available she was in advanced labour and was advised that it would be safer to carry on with vaginal birth.
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It was about ten o'clock on Saturday night my, I thought my waters had broken but I wasn't too sure. And I laboured through the night, but I wasn't sure if it was Braxton Hicks or whether I was actually going into labour. At five o'clock on the Sunday morning I realised that it was the, the real thing so I phoned the hospital and we went up. It must have been about half past seven when I got to the hospital and I was examined. I was only two centimetres at that stage, so I decided I would just have the elective section and [pause].
And were you admitted then?
I was admitted but the theatre was busy because they'd had a really busy night so I was put in the side bay and told I'd get taken in as soon as, as there was a space for me and they came back about an hour later just to check how I was doing and I was about seven centimetres by this point so I was told I couldn't have any pain relief because I was having the elective section, but I could have morphine or gas and air, so I asked for morphine [laughs] [okay] and by the time she went away to organise the morphine and came back, it was too late to have any pain relief and I got pushed very hastily into a side room and he came out in about, well, it seemed like about ten minutes.
Okay. So, at what time do you think that your mind was changed from having the section to having a natural delivery? At what point in that process do you think that happened?
To be honest, I didn't actually change my mind. The consultant… when the midwife realised I was, I was in advanced labour and I was ready to push, the consultant came round and he apologised for the wait because the theatre was busy and everything and he explained to me that because the head was so far down, that there was added complications with a caesarean that there wouldn't have been if I'd had it initially and he strongly advised me to have a natural delivery, but at that point I could actually feel that he was literally going to be any minute so I thought, “Oh well” and it was nice of him to say, you know, “We're really sorry and would you still like an elective section but it's more dangerous for the baby and we really don't have time anyway”, but it just all happened so fast.
So what do you think now was your role in the decision-making when it came to the actual labour?
When it came to the final labour, I don't think I had any choice at all. I think it was all down to the fact that the hospital was busy, the theatre was busy and everything went so quickly that there wasn't time for me to have a section, but I don't think I actually changed my mind.
And what was the actual delivery like for you?
Absolutely fine, no problems at all. Yeah. With hindsight, and now that he's here, I'm actually glad I had a natural delivery because it was, it was quite easy, I have to say, a lot easier than I thought it would be. I guess I was just very lucky and my recovery was fine. I mean I was at the gym and swimming four days after he was born so, it was a lot easier with having a second that had a natural delivery. |
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She thinks it's important that health professionals take into account women's past experiences and support them in their decision-making without trying to persuade them.
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And if you were to send a message to health professionals who inform women at this stage, when they're making the second decision, what would you think health professionals ought to think about?
…I think they need to take into account the emotional state of the woman as well. I mean, if you've had a really tough time the first time then it might change how you, you know, you wouldn't, this is going to sound terrible, but sometimes some of them can be a little bit pushy in putting forward their own personal belief in what's best for you. Some are very good and they just, they just give you the information and they, they try to answer your questions and don't sway you either way. It's a bit like with the breastfeeding but then you do get some who, they may not come right out and say it directly but you can tell that they have a personal preference to what you should be doing, and I think it's very important that they don't try and persuade you either way. |
