Interview 20

Age at interview: 31

Brief Outline:

Went 8 days overdue with 1st child, laboured for 48 hours. Had epidural and then emergency CS when child became distressed. Easy recovery but felt wrong about having planned CS with 2nd child. Considered it during labour but persevered and had vaginal birth assisted by forceps.

Background:

University lecturer with one daughter aged fifteen months. Living with partner, who works as a postman. Ethnic background: White British (Scottish).

More about me...

First pregnancy and birth

Her first pregnancy was planned and complication free. She found antenatal classes useful for making contact with other first time mothers, but did not feel that she learned a lot. She bought a book about pregnancy, but was more interested in week to week development than in researching birth and felt she knew as much as she needed to know at that point in time. She had made a birth plan and hoped for an intervention-free birth but remained open-minded about what might happen. Her relationship with her midwives was good but she would have preferred to see the same person over time to be able to build a relationship.

She was surprised when she went past her due date, as other women in her family had had their children early. It upset her to be told that she might need to be induced and she worried that this would mean losing control and the likelihood of further interventions. She was relieved when her contractions started spontaneously, though the hospital sent her back home at first. She returned the next day and laboured to 5cm, then stopped dilating. She then received Syntocinon and an epidural. After she had laboured for 48 hours, the baby started showing signs of distress and the medical team suggested a caesarean. She was happy to consent as she felt that she had tried the best she could. She was able to discuss what having a caesarean might mean for future pregnancies and felt fully involved in the decision-making process. She recovered very well and returned home two days later. Her daughter was healthy and she managed to breastfeed her.

Second pregnancy and birth

Her second pregnancy came as a surprise and turned out to be more difficult than the first one, with more nausea and backache and the added stress of having to look after her toddler. She decided early on to attempt a vaginal birth with her second child as she wanted to keep her options open for future pregnancies. Another reason was the wish to be as independent as possible after the birth so she could drive and look after her young daughter. While she could understand the appeal of a planned caesarean in terms of being able to plan for the date, she found the idea 'morally suspect'. She felt that she had more need for discussion with health professionals than in her first pregnancy. However, some of the information she gathered from doctors, midwifes and other women was conflicting.

She started to have infrequent contractions one week before her due date, but stayed at home for another 24 hours to make sure they were 'the real thing'. By the time she came into hospital, contractions were very painful and she considered a caesarean after all. However, after she had an epidural she became much more comfortable and felt able to continue her labour. Her son was born six hours later assisted by forceps. 

Looking back, she feels very pleased to have allowed herself the extra time to have a vaginal birth even though she felt very sore for a week after the birth. Comparing recovery after her caesarean and after her vaginal birth with forceps, she found the latter more painful. However, being given strong painkillers after her caesarean could have been responsible for the difference. She was pleased to be able to look after both her baby and toddler and managed to breastfeed her son. 

She would advise other women to keep an open mind about birth and not be too fixed in their ideas. At the same time, though, she thinks it is important for women to be involved in decision-making and feel in control as much as they can during the process of labour and birth.

She bought a book but didn't actually read the section on birth and felt that other women often told her more than she needed to know.

So, if you think about the information that you'd wanted when you were pregnant the first time, what, what did you want to know?

I can't remember there being anything specific that I wanted to know, I mean, I think I did what most sort of middle class women do when they get pregnant, which is buy a book and then read it, and then, you know... And I had a, I have a book from - och, one of the big London hospitals, I think it's published by, and it goes through it week by week and I, I looked at it, you know, every week and sort of checked what was going on. I don't think I actually read the section on birth. One of my friends who had a baby said not to read it until closer to the time, but I went to ante-natal classes as well, but I don't think I actually felt that there was anything in particular that I wanted to know. And partly as well, because as soon as you get pregnant, people who have got children start telling you their stories and so, often you have more information than you really need.

She didn't make a detailed birth plan - while she hoped to avoid interventions, she didn't feel that strongly about it.

I mean, I think, I think the midwives, the community midwives probably asked me about the birth plan and did I have one, but I think because I hadn't' I didn't have any strong feelings about' I think because I didn't have any strong feelings about it, I felt that it wasn't actually a particularly big decision, because I wasn't, you know, I wasn't one of these people who sort of said, 'Oh, no, I definitely want to have a natural delivery and I'm not going to have an epidural and I'm not going to have any, you know, pain relief, I'm just going to breathe through it.' I mean, I wasn't, I wasn't like that at all. I think my, my kind of feeling about it was that I wanted to, you know, I wanted to have what I think most people want to have, which is a natural delivery without having to have intervention and without having to have sort of lots of pain relief and things like that, but then everyone wants that, everyone wants to be able to just sort of pop the baby out in four hours, but I think at the same time, I was kind of thinking, 'Well, if it doesn't work that way then, you know, then it doesn't work that way'.

The doctor consulted her about whether she wanted to labour for a while longer and she was able to discuss her concerns about what a caesarean might mean for future pregnancies.

And did anybody discuss with you at the time the implications of having a section with a first delivery for a future delivery?

I think I' I think I asked a question about it. I'm pretty sure I did. I can't remember what it was now [slight laugh]. But I think it was, it was something to do with what, what effect would it have on the future and the doctor who was, I think it must have been a woman, was quite reassuring about it. I mean, I didn't feel that she pressured me into it at all, because she did say that if we wanted, if I wanted to wait another hour or what-have-you then, that was fine, but she just, she, you know, she didn't think there was an awful lot of point in it but if I wanted to wait, that was fine.

So' they, you didn't have any worries that you would have to have a section again with another delivery or anything?

I. I think I wasn't very, I wasn't very sure one way or the other to be honest. I think' I think that might have been what I asked. I think I might have, I think I might have said, 'But if I have one now, will I always' will I have to have another one?' Because I think I had' I don't know if I had it in my head from, you know, reading about people like Victoria Beckham, or what-have-you but, if you have one, you have, you know, you have two or three or whatever. But, I think that was what I' I know I asked her a question about it and it was definitely to do with the future, because I thought it was quite prescient of me, considering the state I was in by that stage.

She had no problems breast-feeding after her caesarean. Her daughter seemed to know what to do.

And how did you feed her?

I breastfed her.

And that was okay? That wasn't difficult?

Yeah, no, it was absolutely fine. Again, I mean, she, more because she seemed to know what to do than anything else, but no, I mean, I never really' she was a bit, she was a bit of a colicky baby, well, not so much colic, but just kind of a bit windy, so we had a few kind of moments with that, but generally speaking she was a very, you know, she still is a very good feeder. And'

She felt fine about having had a caesarean. It didn't make her feel different about herself, though she thinks she was lucky to recover quickly and for her scar to heal so well.

Did you feel differently about yourself at all, after the section?

Not really, I don't think. No, I mean, I think because it's, it's such a small scar and you can't, and it healed very well as well, and so it wasn't as if I felt that, you know, it wasn't as if I felt that I had been disfigured by it or anything like that (to baby) No, naughty baby, no. Go and see daddy. But I think because' I think I kind of felt that there are so' I mean, your body is so different after you've had a baby anyway' there's so many things to, that you know, to, to adjust to like having different sized, you know, having different sized boobs and trying to get your stomach back and things like that, that to be honest, it was only one of a number of things, and I, I would say I probably thought about it a lot less than I thought about how much I weighed, for example.

She felt that having a caesarean without medical necessity was wrong, though it would have suited her to bring the birth date forward. She also wanted to keep her options open for future births.

I think my' sort of my ideal scenario is to' would be to have a natural birth, you know, this time. I, I really didn't want, and I don't want an elective section. I mean, I kind of feel that if, if the same thing happens again, then that's just it, maybe it's just, you know, something to do with, with the way that I'm built or something, but, I, I didn't feel that I wanted to actually arrange to have a, a section. My sister's getting married' the baby's due on [date] and my sister's getting married on [later date] and I'm technically supposed to be a bridesmaid and there was a bit of pressure initially to have an elective section, particularly when I found out that they tend to do them slightly earlier, so, you know, it might be the week before the sixteenth, but I just felt that that was just a really morally suspect reason for doing it, you know, it was very much a bit like being too posh to push, kind of thing.

And it's an odd idea, but why, it seems an odd question, but why do you want a natural delivery this time?

I think initially it was because I had... I was under the impression that if I had section this' if I had another section then that would rule out having any kind of natural delivery and I just didn't like the idea of removing that element of choice. 

She felt reassured in her decision to attempt vaginal birth when the consultant told her she would not be left to labour for as long as she did with her first child.

I think because I'd been there before I was a bit more confident about what to expect and, because people had, you know, because various doctors or midwives or what-have-you at the ante-natal appointments had made, you know, they'd all looked at the notes and asked me about how, you know, about [daughter's name] birth. And the doctor, I think it was the consultant who had said' I'm pretty sure it was the consultant who had said that there was no way that they would let me labour for as long as I'd, you know, he said, 'We wouldn't let you labour for as long as you did with your first child anyway', and I think that was quite significant, because I just, you know, the first time I was there, I was in labour at home the whole day and then I was in labour in the hospital for, you know, nearly twenty-four hours as well before they finally decided that they were going to give me a section. 
 

She found recovery after her forceps delivery more painful than after her caesarean. It took 10 days before she could sit down without thinking about it.

And' about the differences and, and comparing the recovery but could you say a little bit more about why you think it's different between having a section with that previously and the vaginal delivery with forceps this time?

Well I think, I think because you, because you've had, because you've had a section and they send you home and they say don't do this and don't do that and, you know, and, and because you've got these, you know, these big stitches, well, these big staples and they give you nice strong painkillers to take the edge off it, I think you're perhaps, or other people as well are probably more aware [baby burping] of the fact that you've had quite a traumatic time, whereas a forceps delivery, I think... I mean [husband's name]'s mum had a forceps delivery and, and so I think probably people who've been through it perhaps know a bit more than, you know, but, but when they, I mean, when they send you home and just tell you to take paracetamol and, I mean, it was really, it took really about ten days before I could sit down without thinking about it, kind of thing [slight laugh]. And it really was a lot, a lot more uncomfortable, a lot more painful than I remember it being after [daughter's name] was born, which is, you know, which is an odd thing but, but, because you would think that sort of, the, you know, the kind of major surgery that a section is, you would think that would be worse, but it really wasn't.

She thinks women should be involved in decision-making as much as possible but at the same time the idea of patient choice can be taken too far.

I think, you know, in the past there was certainly much more of a tendency to treat doctors as, you know, doctors had the final word, and in fact what they said was gospel and, and obviously, you know, doctors were aware of that as well and, and that had an impact on sort of patient care and respect for the patient and stuff like that. I think there is a possibility that in some cases, we go a bit too far the other way and because people get, can get more information, these days as well, and are aware that they can have more information, I think there is a lot more you know, and because the government talks about patient choice and things like that, I think it must be much more difficult to be a doctor now because, although you may think that you know the best thing for your patient, if your patient has other ideas, you're now duty bound to kind of listen to them and, and to, you know, to take that into consideration. And you may, you may have to do things you don't agree with because the patient wants you to. But in, in a situation like this where, you know, I think, where people can be very badly, well, where women can be very badly affected by the way that they have their babies, and I think because having a baby is different from having an illness, you know, I mean, you're, emotionally you're all over the place before and after and you may not be at your most rational [laughs] and then you've got this little person making huge demands on you as well, I think, you know, if you can have the choice and if you can feel that you're in control of it, I think that probably is, you know, is the best option because I think if you, I think if you've, if you have to cope with the idea that you, you know, you wanted things to happen a certain way and they didn't, you know, you weren't allowed to have things happen that way, I think that must be quite, that must be quite hard actually. 

She thinks health professionals need to allow women sufficient time to discuss their options. Hospital appointments often can feel rushed.

And what message would you give to health professionals who, who provide the information to women making this decision?

I think to be honest that... I mean, the best thing probably is that, is to be able to spend time discussing it with somebody, if that's what they want. I mean, that's probably what's at the biggest, well, apart from money, I think that's probably what's at the highest premium in healthcare is time. You know, time to spend with, with your patients and I think particularly with things like ante-natal clinics where you're coming in to have your blood pressure done and things like that, there's often a big, you know, there's often a lot of people to get through. We're quite lucky here because there's not that many, you know, it's not particularly densely populated area, so the midwives are always quite happy to chat to you, but I think you are always aware that there's somebody else in the waiting room, you know, so '