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Jane's story
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First pregnancy and birth
She had a complication-free first pregnancy and was very satisfied with her antenatal care. Her antenatal classes provided her with useful information about birth interventions and pain relief. She appreciated having the same midwife throughout her pregnancy and felt able to discuss any concerns she had at the time. She had made a birth plan, hoping for a water birth with as little intervention as possible.
When she went past her due date, the hospital offered to induce her but she decided to wait a bit longer. However, when nothing had happened at 42 weeks, she came into hospital where she had a sweep and then had her waters broken. She received Oxytocin and eventually an epidural, but progress remained slow. Having monitors put on her baby's head meant she was unable to move around during labour which she found very difficult. After about 12 hours, her and her husband noticed a drop in the baby's heartbeat so they notified the midwife and she was prepared for an emergency caesarean. She felt involved in decision-making throughout and trusted the medical team to do what was best for her and the baby under the circumstances.
She stayed in hospital for five days after the birth. She was ready to go home after three days, but the midwives persuaded her to stay on and looking back, she is glad she followed their advice. She would have liked more instructions on how to look after her baby but felt reluctant to ask. Still, the extra time at hospital made her feel more confident that she could manage by herself when she got home. She recovered well and does not feel any disappointment about having delivered her first child by caesarean, though she was unaware at the time what it might mean for future pregnancies.
Current pregnancy
Her current pregnancy has been going well so far, though the baby is slightly bigger and sitting lower in the pelvis. The decision about how to give birth to her second child has been straightforward for her, as her health professionals' recommendation to have a vaginal birth was what she would have wanted anyway. She is keen to keep things as natural as possible and was glad to learn that she would not be induced. She has yet to make a birth plan, though.
Her information needs in this pregnancy have been quite different to her first pregnancy. She thinks the detailed knowledge about risks and benefits of different ways of giving birth that she got as a result of participating in the DiAMOND trial might have overwhelmed her if this was her first birth. She also thinks some women do not find it helpful to be given a 'choice', but would prefer to be told what's best for them by medical experts. |
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She was lucky to have the same midwife throughout her pregnancy and birth, so she could build a good rapport.
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And what was your relationship with your midwife like with your first pregnancy?
Very good, very good. In [town] which is where we lived, where [name of son] was delivered, they have a… you have a one to one with your midwife, so that's the only midwife you see. I'm not sure what it's called but they… its dedicated to that midwife, and the midwives you see on a regular basis and they come to the hospital when you go in to the maternity ward. And they come and see you afterwards as well. So it's really a nice connection and a very good rapport. So it's slightly different here because you see various… there's not a connection with the midwives as there was with my previous one. |
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She had trouble dilating and had a caesarean when her son's heart rate started dropping. She was pleased staff took her wishes into account and did not feel nervous about the operation.
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So how involved were you in the delivery do you feel?
On the actual…?
With decisions?
Yeah. I would say they were very good in terms of letting me carry on with… because I was overdue I actually went to see them the week before I went in for induction and they were quite keen to get me induced earlier and I was keen to wait. And they allowed me to do that. So I feel that they did listen to my best interests of what I wanted. And then actually when I went in for the induction because they felt it was getting to the stage where it needed to really be progressed… they were very good at listening to what I was saying during the time and I had a monitor put on me and… so I did feel I was involved, it wasn't indirect… But at the time when I then went into the… when I was induced and I had the monitors on I realised then I couldn't go in to the birthing pool and so you know it threw the whole of the birthing plan out. So at that point I knew that it would be completely different to what I was expecting so… but they were very good and they did continue to monitor and talk and… yeah, I did feel involved.
Good and did you have any particular anxieties or worries about having a section?
Well because I didn't know I was going to have that, it was literally the heart rate was reduced and that was it. I didn't have any time to think about it and to be honest, it was one of those let the medical professionals do what they think is right, so I wasn't nervous and I was not anxious at all when they came in and said right we're going to just take you in for a section. I just thought “well that's obviously the right thing to do” and with the heart rate reduced dramatically I just wanted to get the baby out, that was the important thing.
And do you think… I know it's partly to do with the time but do you think you weren't anxious because of the environment that had been created? Did you feel quite confident with what was going on?
I did yeah, everything was being monitored, they were doing the best they can for me to progress naturally, it wasn't happening, I wasn't dilating and I knew at that time that it was the right thing to do. You know it wasn't as though they'd rushed it and said “oh we're going to do it anyway, we've not given you an opportunity”. I had plenty of opportunity throughout that twenty four hours really and it wasn't happening. |
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She feels a bit more tentative than she used to since her caesarean, but her scar healed well and she thinks being an active person helped her to recover more quickly.
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Okay and did you have any trouble going to the loo or resuming your sex life after?
No I mean it was… obviously I'm assuming it was longer than what it would have been normally. Loo wise, no I think… they talk about the incontinence thing but I think that's been for a natural labour as well as a caesarean and that's not really affected me that much but it's when you sneeze and that sort of thing it's- a little bit different.
A bit more tentative?
Yes.
Okay that makes sense. And you still feel like that now?
Yes, yeah.
And did it affect how you felt about yourself at all … having a section?
No… I mean you obviously think about the scar because that's a personal thing isn't it? But I was soon into my bikini the next summer, so… [laughs].
And do you think that's because you're such an active person?
Most probably yeah because you know I do… I do go to the gym, I keep fit and it helps and you know… and it was a- it was a good section, I've been told it was a good scar in terms of the stitching and things, so... |
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She felt reluctant to ask staff for help, but was glad they convinced her to stay in hospital for a bit longer. Handling the baby with the midwife present made her more confident to do things by herself once she got home.
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And how did you feed your baby?
Breastfed.
And that wasn't complicated at all?
Tiring, because I was obviously tired after the operation. Not as mobile as I would have been, if I have had him naturally… and so I was really pretty exhausted but I persevered. And I had a lot of help so that did… that was good.
And was that at the hospital you had the help?
Not necessarily at the hospital, when I came home, the first sort of four days because I was in hospital about four or five days I was fortunate I had my own room, that was fantastic. But the midwives just popped in as they would go and see the other people on the ward and they expected you to ring the bell if you needed help and I'm one of those people that don't ring the bell. I can do this, you know, it was my first child as well so I don't need to support, so I was pretty tired because I just persevered with it and upon reflection I probably would've asked for a little bit more help.
So do you think more should have been offered?
Yeah I would've liked that, not knowing what they should've done, but I would've liked that.
And do you think that that's part of an expectation that you should know what you're doing?
Yeah absolutely and I think they want you to think that you know what you're doing so that you can cope when you get home. You know you have had a major operation but you've still got to breastfeed, you've still got to get up in the night or your partner has got to get the baby for you or whatever and you've still got to do that every… if you're breastfeeding it was quite regular for me you know every two hours so it was quite exhausting. And so I was thinking they were just preparing you for when you got home. Whether that was the case I don't know, whether they were just so busy and they forgot I was in the room I don't know, but… [slight laugh].
And did you feel confident when you came home?
Yes. I actually wanted to come home earlier though and they really persuaded me to stay and I'm so glad they did. I think I had a bit of... they call it the baby blues and a bit of the postnatal oh what's all this about and I just wanted my home comforts. But I know if I had gone home when I wanted to which was three days after, I wouldn't have been capable of- I think looking after the baby as efficiently as I did when I waited another two days.
Do you think you would've been overwhelmed?
I would have thought so yeah. I mean it showed me just a few more things like bathing the baby, and I had more opportunity to change the nappy with the midwife being there and just checking on the breastfeeding and little things that I think I would have missed out on. |
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She has no regrets about her caesarean. She felt involved in decision-making at all stages and her main concern was for her baby's health.
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And how did you feel about having a section?
Okay, fine yeah.
Was the birth or the delivery anything like you expected it to be?
Its funny isn't it because you think oh well I'm going to have a natural labour and it's going to pop out and everything and you… but because I had a section, that didn't concern me and so… I was just happy that the baby was out and well. And I suppose if I thought afterwards, “Oh that's a shame I didn't have that naturally”, I didn't think like that at all. My main concern was making sure that the baby was well, so…
And how do you feel now on reflection?
Same, same. I wouldn't have done it any other way you know, as long as the baby came out and it was… everything was okay. And I was okay.
And do you think that feeling was enhanced because you were allowed to labour for so long and go overdue and have that control?
Absolutely yes, definitely. |
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She wants to attempt VBAC but is not too worried about having interventions. Being connected to a monitor from early on might restrict her mobility.
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And how do you feel now that the choice is becoming more of an imminent one?
Same, I'm just trying to go with the flow and see what happens.
Have you made a birth plan this time?
No! [laughs]. Although the midwife reminded me of that today. I had an appointment this morning with the midwife and she suggested I just take a look at, you know, maybe what I do and don't want. Because obviously if everything starts off naturally then I need to decide about the pain relief and that sort of thing, so I will do, I will have a look at that. But what they… I can't do is have the birthing pool this time because they'd have to put the monitor on straightaway.
And how do you feel about that?
Well, a bit disappointed because I would have liked to have had that. …So I'll have to think about the pain relief side and…
But again is staying active something that's important to you this time?
It is although I don't know whether I'll be able to do that this time because I might have a monitor put on me… depending on where I'm up to… I'll probably have a monitor put on me because of having a previous section. |
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She wanted to know how feasible it was for her to attempt vaginal birth and was relieved to learn that she would not be induced.
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And what kind of information have you wanted this time?
…I've actually just wanted to know if I can have it naturally again if that's… well not again because I didn't have it the first time - but if I could try and have it naturally. Having a friend who… it's stayed in my mind, she had a caesarean the first time and then had it naturally the second and… I'm thinking I hope I can do that. But just… I just made- just really wanted them to tell me if that's feasible. Which it is, now. And just to go with the flow again, see what happens.
…I wasn't aware that they wouldn't induce me so that was very useful to have that information, they provided that voluntarily. You know… I thought I would go through that same process. To be honest I'm glad that's not the case really, I don't fancy lying on a bed for sixteen hours with a monitor on me if they get to the stage where they've broke the waters and nothing is happening, then you know that's it.
Does that reassure you more this time?
It does, it does, yeah. |
