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Making decisions about birth after caesarean

Previous pregnancy and caesarean birth: Women's expectations for their previous births

Interview 25

Interview 25

Age at Interview: 36
Background: Web programmer with one daughter aged twenty-one months. Husband is an aeronautical engineer. Ethnic background: White British (English).

Brief outline:Wanted intervention-free birth, but was induced when 14 days overdue. Laboured for 19 hours, accepted CS when baby became distressed. Felt involved in decision-making, but disappointed afterwards. Keen to experience vaginal birth with 2nd child.

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Christine's story
Print Previous pregnancy and birth Her first pregnancy was planned and without complications. She found the antenatal classes she attended very useful. She also talked to friends about their experiences and bought a couple of books to gather further information. She read up on birthing positions and practiced yoga and breathing techniques to help her through labour. She was clear in her mind that she wanted to have a birth that was as free from intervention as possible. Her birth plan asked for, ideally, a water birth with just gas and air for pain relief and without an epidural. She went 13 days past her due date and then came into hospital to be induced. After seven hours of strong contractions, she was taken to the delivery suite, but had only dilated 3cms. She then had her waters broken and laboured for another few hours, but became increasingly tired and exhausted. She asked for an epidural but after she had it her labour seemed to slow down. When her baby started showing signs of distress the doctors suggested a caesarean and she agreed. Looking back, she thinks the doctors involved her in decision-making as much as possible at the time. Under the effects of the gas and air and because things happened very quickly, she did not spend a long time thinking about pros and cons. Her main concern was for her daughter to be delivered as quickly as possible. After the caesarean, she felt a sense of disappointment and that her body had let her down. She was glad, though, that neither her nor the baby experienced complications. She recovered well from the operation and managed to breastfeed for six months. Current pregnancy Her second pregnancy was also planned, but she experienced more sickness than with her first child. She had not been informed about what a caesarean might mean for future pregnancies and was surprised how little information there was available. She was keen to attempt vaginal birth with her second child and was pleased to find out that it was a possibility. She was a little disappointed though, to learn that she would not be able to use the birthing pool. She feels reassured that she will be closely monitored during labour, but is slightly concerned that being connected to a monitor will limit how much she can move around. She has made another birth plan and hopes to get by with just gas and air this time. Her and her husband have not decided yet whether to have more children after this one, but she doesn't think that how she gives birth will influence her decision. Her advice to other women is to keep an open mind about birth and gather as much information as possible beforehand.

She had clear ideas about what she wanted her birth to be like: she had prepared with yoga and breathing and wanted to avoid an epidural.
Print I was very keen to have a water birth with just gas and air, a natural birth in the hospital, you know, skin to skin, all that sort of thing. So I had quite a clear idea of what I wanted. And do you remember if you made a birth plan with that pregnancy? Yes, I did. And was that the kind of thing you were talking about earlier, about skin to skin and keeping it it natural. Was there anything else that was really important to you? [laughing] I didn't want an epidural, which was… I was really quite against that, but at, you know, at the time… Why was that, do you think? I think I was worried about having an injection into the spine and the possible after-effects of it, the possibility of being paralysed, or, you know, difficulty walking. I just wanted to have the most natural birth that I could and it, unfortunately was… didn't happen that way. And also, I didn't want to be in hospital long. I, I wasn't actually in hospital very long, but I didn't want to be in there for days and days and days, which I've heard some people have been. And also the recovery period, because it's six weeks and you can't drive, and so it was all, all that sort of… And it's just, wasn't natural, I suppose. And it's an operation, which has its own possible complications. And was the birth in any way like you thought it was going to be? No, because I thought I'd spend more time at home, and I'd gone to [hesitation] yoga classes and learned about different positions and breathing and all that sort of thing, and none of that came into play at all really and it was far more hospital based because I had to go in and be induced.

She found her antenatal classes the most useful source of information. They included a visit to the local hospital and information on birth assists and caesarean.
Print How, how you wanted, what the information was that you wanted to know. What were the important things? Well, I suppose things like, oh, just about the labour. How, you know, the different sort of, not forms of labour, sort of, just the different areas of labour; how long this, the first bit, I can't think of the terminology… Stages? …the stages, thank you, so how long the stages last, the sort of pain that's involved, different pain relief available, sort of where you can have it, like at home or in the hospital, whether water birth was available, you know, all that sort of information really. And what information were you given? Quite a lot by the midwives actually. They had a lot of leaflets on different things, and I also went to the ante-natal classes, which I found very useful. And having friends that have already had children, I just sort of picked their brains about their experiences, and bought a couple of books, not too many books. And what was the most useful, do you think? Probably talking to people who have already been there, and the ante-natal classes, actually. And were they NHS classes? Yes. And, can you remember if they covered anything about the possibility of having a section, or maybe an instrumental delivery? Yes, when we visited the hospital, they went through all that, the sort of forceps and, ventouse and those sort of things, but… yeah, I think they did talk about caesarean, but I think it was often sort of assumed that most people would go through a normal delivery, and you're given the statistics about how many people have caesareans. I think it was one in three or something, and three of us in our class actually did have caesareans, but not a lot more than that really.

She was grateful to have a healthy baby but couldn't help feeling disappointed about the way she had given birth. She felt her body had let her down, though with time these feelings have faded a bit.
Print I think I was more concerned about [daughter's name] and whether she was okay, and the fact that she was distressed… I, I just wanted her to be delivered as fast as possible, to make sure that she was alright. So, any other worries about me didn't really sort of come into play, if you like. And how did you feel after, about the fact that you'd had a section? Really quite disappointed. Right. Could you say a bit more about that? I just felt that my body had let me down a bit and it, it wasn't something that I'd planned for or sort of… I just assumed that I'd have a natural birth and, and I don't know, I just felt that I'd let myself down a bit, which might sound completely daft [laughs]. No, it's a common, it's a common feeling… …and I think even now, talking about it, I still think, you know, but then I think, you know, I've got a great daughter and she's healthy and she's fine. Is that how you feel about it now? I still sometimes feel a bit disappointed about it. But, not so much now. It does sort of fade over time, I think.

She was surprised at how little information there was available for pregnant women who have had a previous caesarean.
Print And did you have any information at the time about the implications of having a section for another delivery? No. And do you feel that you had that information at all? No, not really. I mean, to be honest, if I hadn't taken part in this study, I'd have felt very in the dark about it. That's interesting. I'll just write that down. Could you say in what way? I just, I feel that it seems to be that possibly the midwife expects the hospital to talk to me about it and maybe the hospital expects the midwife to talk to me about it. Is it something that you were surprised about? Yeah, I suppose so. I thought there'd be lots of leaflets and information and, you know, have a… I mean, we, we only talked to the hospital last week and the midwife said that we should have talked to them at the twenty week scan, and it was a very quick consultation.

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