Interview 29

Age at interview: 38

Brief Outline:

1st child delivered with forceps and ventouse. Had bad tear, lost lots of blood. Planned caesarean with 2nd child 16 months later on advice of doctors. Struggled to decide how to deliver 3rd child, pessimistic about her chance of having VBAC, feels planned CS is the safer option.

Background:

Manager with two children aged three and four. Husband is an electrician. Ethnic background: White British.

More about me...

Previous pregnancies and births

She had a vaginal birth with her first child assisted by ventouse and forceps. She experienced a bad tear and lost a lot of blood. She was offered a blood transfusion but refused, put off by the possible risks. Looking back, she felt that the information she gained from antenatal classes had failed to prepare her adequately for what might go wrong during labour and birth. It took her several months to recover from the first birth. When she became pregnant again just seven months later, the doctors advised her to have a planned caesarean. 

Her experience of antenatal care has been mixed. While she experienced the health professionals she came into contact with as friendly and supportive, she rarely saw the same person twice and found it cumbersome to retell her medical history over and over again. Not being able to build a more personal relationship inhibited her to share her concerns about having a caesarean. However, on the day itself she was impressed with the level of support from the staff before, after and during the operation. She was surprised by how nervous she felt beforehand and a little taken aback by the amount of people in the operating theatre. The procedure itself was 'quick and straightforward'. She felt glad that her second baby had been delivered healthily, though a bit sad for herself that she did not have a 'normal birth'. She experienced deep pain in her scar for almost a year afterwards but was assured that this was part of the normal healing process.

Current pregnancy

In her current pregnancy, which wasn't planned, she has been feeling a lot more tired than in the previous ones. She experienced low blood pressure and anaemia, which had affected her previously, but also nausea and mobility problems because of the baby dropping low early on in the pregnancy. In planning how to deliver her third child, her desire to have a 'normal birth' conflicted with her expectation that she was likely to experience complications. Her uppermost concern was to ensure the safety of her baby and she worried that if she attempted vaginal birth there might be a point when the baby would struggle to emerge but caesarean was no longer an option. 

She felt under pressure from friends and relatives to come to a decision and would have liked to discuss her options with an obstetrician early on. Doctors telling her that the decision was 'up to her' made her feel unsupported rather than empowered. Even though she feels anxious about having another major operation, she now has booked a caesarean as she thinks this is the safer option for the baby and at least there is nothing she can do right or wrong about it. 

More generally, she tries to educate herself about health and healthcare by gathering information from the internet, though she finds it can be a scary process. She usually looks at information aimed at doctors rather than patients, even though it can be difficult to understand. She feels that she doesn't have sufficient medical knowledge to play an active part in decision-making and would not necessarily have the confidence to challenge a doctor's recommendation.

There was no continuity of care during any of her pregnancies. She found it hard having to re-tell her medical history to every new person she dealt with.

And what was your relationship like with your midwives in your last pregnancy?

To be honest throughout each pregnancy there's not been a sort of continuity at all, I don't think I've' it's very rarely that I've seen the same midwife twice which you know, they're all very nice and they're all pleasant, I'm not criticising that but they all are starting from scratch with your notes. But I think that's just the way that surgeries seem to run.

And what about seeing Obstetricians how was that in the last pregnancy?

I think I just saw them hardly at all.

And you said that it was more of a discussion the decision about how you were going to deliver that time; did you feel that you were included in'?

It was' yeah not with my own GP. My GP I was with at the time I didn't really have much to do during the pregnancy because it was joint care with [Hospital] so it was a doctor at the [Hospital]. But again at [Hospital] you don't see the same doctor twice. I think that's what I found hardest about anything that you're starting again with everybody. And every time they look at your notes and they make the same comments and they ask the same questions and you're thinking just you know'

Talk to each other?

Yeah.

Okay so did you make a birth plan with the last pregnancy?

No because it was' I'm assuming because it was a caesarean I don't think we actually did any sort of detailed thing with that.

So in what ways do you think your treatment or care could have been better last time?

For the caesarean?

Mmm in terms of preparation, information provision?

Basically just to see the same face. I don't think there was anything that they could really tell you, I think once you know you're going for a caesarean part of your mind just shuts off from it, or part of my mind because you know what's going to happen and it takes away the thinking, because you know you're not going to have any control at all.

She was nervous about being awake during her planned caesarean, but it made a big difference that the anaesthetist talked to her throughout the operation.

And what were your concerns with it being an elected section, was there anything that you were particularly worried about?

Feeling it [laughs].

And did you discuss that with anyone?

Yes they told me that you wouldn't actually feel any pain but that you would feel it happening and I was glad that they'd said that because you do feel everything. And that made me feel better because I knew' I think I would have thought that they hadn't put a strong enough epidural in if I hadn't known that.

And how do you feel now about having had the elective section last time?

Fine.

And was it like you expected it to be?

No.

Could you say why?

There were a lot more people in the operating theatre than I'd thought. There were a lot of' I don't know whether they were students or whatever but it felt like the whole room was full and also I was a lot more stressed that I thought I was going to be. The first time you're so busy being in pain and you know dealing with that that you're not being yourself so you don't have time to feel panicked. But this time you're going in and you're not in labour, you're just going in as sort of cold normal and that' I got really frightened being sort of going into that place and having to have the injection and the anaesthetic started to come too high up and the anaesthetist said that she might have to put me under because if it came too far up it would effect my breathing or something, and that scared me' The way the anaesthetist, she talked all the time the operation was going on, she was making comments to me and was being so nice and calming that she made a big difference.

She experienced deep pain from her scar for almost a year but was reassured by the doctor that they were normal healing pains.

The only worry was that the pain, sort of deep pain from the scar went on for I'd say almost a year. Sort of twinges and that's' I went to see the doctor about that and she just said well you've had a' it's the nerve endings knitting and just expect it. So after I'd been told that and I knew it wasn't anything going wrong. And obviously you worry about the stitches coming open.

She does not think there is much point making a birth plan for a planned caesarean. It's more important to have her husband there to support her on the day.

And have you made a birth plan with this pregnancy?

I was asked by the' I can't' I think I was asked by the midwife at the GP about doing a birth plan but there was nothing really much to say about it. I think the way I see birth plans, whether its right or wrong is for the first one it was quite detailed and it was would you want intervention, would you want this, would you want that and I didn't, I said I didn't really see the point in doing for a caesarean because it's not, I don't see it as the same.

And how do you think your husband feels now about pending '?

[Laughs] It's hard to say, I mean he's happy. I mean there's absolutely no question of him not coming you know he's come to every appointment and everything so he's been very supportive. And on the actual day, if its anything like last time I had' I don't think' I needed him there, I needed to have somebody there that I knew so you know it's helpful.

And what about feeding this time, have you thought that far ahead?

I'll just try breastfeeding again, if it works, it works.

She thinks women are likely to look for information that confirms rather than challenges the birth preference they already have.

Where else have you looked for information, you've said about the internet. Have you looked at any books or magazines?

Not magazines no.

So it's been mostly the internet?

Yeah.

And what' to what extent has the information that you've got helped inform you decision do you think?

I think you look for information that supports what your mind is thinking anyway. I think I could have probably gone either way. If I'd gone in with an open mind, which I don't think I probably did I would have found information' you know you look for what you want to look for don't you?

She has used websites where women share their experiences but also sites designed for health professionals some can be difficult to understand.

I mean it's a horrible thing the internet, but I would always go on that if I felt that it was necessary.

Is there anywhere in particular that you look when you go on the internet?

I try and go on the ones that are aimed at doctors rather than' which is stupid because then you don't understand it but just to try and get the facts that the doctors are getting rather than what they want people to know. But a mix of both really.

Did you find them scary at all?

Sometimes.

But generally you feel like you're more informed having looked at them?

Yeah.

And where have you got the most information from with this pregnancy do you think?

It's hard to say really because I think when you get to your third pregnancy I think there's a bit of' well it's a true assumption that you know quite a lot of things anyway, or you should know by then. So I don't think there's the same level of discussion, obviously I didn't go to any antenatal classes apart from the first time. What I've always done is you go on these baby world sites and ones where they've got you know people putting messages of their own experiences. So I've sort of gone onto those a bit.

Has that been useful?

It's quite comforting.

After a very difficult first birth and a comparatively easy planned caesarean, she feels safer leaving things in the hands of medical staff from start to finish for her third birth.

So overall for you what's the most important thing that's informed your decision this time to go for the elective section? What's been the one thing that's really made you want to go for a'?

The security of knowing that it's going to happen on a certain date and that it's going to be medical intervention right from the start instead of if something goes wrong. You see I've never been one of these people that think that they should have a home birth, I always think that doctors and midwives are the right people and they've got the experience to deal with it. I don't think that the mother always does know best.

And are there any other factors that have been really important for you in your own personal decision do you think?

I had quite a lot of pressure from my family who thought' who remembered how ill I was or looked according to them after the first time and they said that I looked a lot better the second time. So they were not wanting me to go through you know a bad birth experience.

She was surprised that the consultant just asked about her preference rather than engage her in discussion. She had expected more of a two-way process.

And do you feel that you've had the right quality of information for you this time?

Yeah. The only thing is, at the time when the decision was actually made... the doctor that saw me - I felt that it could have' which is probably a good thing, but it wasn't particularly a discussion. It was more, 'Have you thought about what you want to do?' 'That's fine... I agree with that', ...and that was sort of it. It wasn't a sort of real two way process.

So they didn't really give you enough information for you to make a really informed decision, or they didn't really discuss it?

They sort of did that afterwards. It was a bit of a... you know, literally... "What do you want to do?" And then when I said I was thinking about this [caesarean], they said, "Right, well, we'll just have to outline..." Almost as if it was read out... "This will happen", "You need to bear in mind this, that, and the other". But it was not exactly rushed but it was sort of just a sort of practiced'

All day?

Yeah. 

And what about the relevance of the information, do you feel that it was tailored enough to your own needs?

Yeah.

And the timing? Because you said before about the timing of the decision, do you think you'd have liked that earlier do you think?

I would have probably liked a chat with a doctor earlier on... but it wasn't essential. I think in a way you get a lot of pressure from family and friends as well and part of me wanted to know so that I could stop them asking me what I was going to do.