Susan - Interview 01

Age at interview: 30

Brief Outline:

First child born by emergency CS. She felt disappointed with the process and keen to give birth to her 2nd child vaginally, but discovered at her 20 week scan that her placenta covered her cervix (placenta previa) so she would need another CS.

Background:

Married bank manager with a 17 month old daughter. Husband is a policeman. Ethnic background: White British (English).

More about me...

First pregnancy and birth

Her first pregnancy was planned and went very smoothly up to the point of giving birth. She had attended antenatal classes and browsed magazines and the internet for information about non-interventionist birth methods, planning to have a water birth and use TENS (a non-evasive method of pain control using electrical currents). However, after her waters broke, she had to be induced. She then received strong painkillers (Pethidine) as well as Oxytocin and an epidural and eventually was told that she'd have to have a caesarean.

The effects of the painkillers meant she did not feel in a fit state to challenge the decisions that were being made. In hindsight, she feels that if her labour had been managed differently the caesarean might have been avoided. However, she is grateful to have delivered a healthy baby. She had no complications after the delivery and was able to breastfeed her daughter.

Second pregnancy and birth

Her second pregnancy was also planned, and her and her husband conceived as soon as they started trying. She was keen to have a vaginal birth with her second child and actively sought out web-based information about VBAC. Wanting to take an active role in decision-making, she downloaded clinical guideline documents to prepare herself for discussions with health professionals.

At the 20 week scan it was discovered that her placenta was blocking the cervix (placenta praevia) and it was explained to her that she would require another caesarean. Bleeding at 30 weeks led to a diagnosis of anaemia and meant she was in hospital for some time. Her caesarean was scheduled at 38 weeks. She felt disappointed but resigned. As the decision was taken out of her hands she does not blame herself for not attempting a vaginal delivery.

She was prepared for the operating theatre the night before her planned caesarean. In the morning, she received an epidural,  listened to music and talked to her husband while the caesarean was performed behind a screen. After 10 minutes she was handed her newborn son and the whole procedure took less than an hour. She recovered well and was able to breastfeed. Initially her son lost some weight, so she had to return to hospital to feed him up, but she was able to return home a few days later and her son has been gaining weight steadily since then.

Comparing her two experiences of caesarean, she feels much more positive about her second birth as she was much better informed and prepared. On the first occasion, having gone through several hours of labour, she felt exhausted and also very worried about the baby being in distress. Being emotionally unprepared meant she found it much harder to recover from the experience. She thinks her decision not to have any more children (at least not in the next five years) has been strongly influenced by having two caesareans with the associated problems of being unable to lift or drive for 6 weeks. Overall, she feels it's a good thing that women have a choice about their mode of delivery but that 'real choice' is diminished to some extent by the 'conveyor belt culture' of medical interventions. She thinks women should be prepared for interventions to happen during birth so they don't feel disappointed with their first birth experience.

She thinks having access to trustworthy information is particularly important during a first...

Yes, I think for the first pregnancies definitely. Subsequent ones, I probably wouldn't bother, but first pregnancies, you're reading everything and looking at everything that you can get your hands on. So something that's interactive and has got facts that you can trust because it's from a trusted source, rather than from say a mother and baby magazine that might be pushing some particular angle, would be very useful for first pregnancies.
 

She would have liked to be more involved in decisions about her care, but once she experienced...

Once I was in the hospital, prior to the Pethidine I just wanted any kind of pain relief, so I wasn't paying attention, I was in labour, I was nine centimetres, I'd had nothing, so it was just like 'I don't care what you're saying, just do it, just give me the shot, whatever.' So if they'd have given me a fact sheet or a DVD to watch or a little talk, a little demonstration, I would not have been interested, I wouldn't have wanted to know, 'Just want the drugs, I want the pain relief now,' so' once I'm in labour I don't want to know, I just want the pain relief.

And before you'd got to that stage, how involved would you have liked to have been in the decision process? You described it like a conveyer belt?

Yeah, before I would have liked to be a lot more involved, I would have liked to have planned, you know, so and so's going to be with me now and we're going to try this method and we're going to try that method, and I would have liked to have been a lot more involved because then I would have felt more in control. Whereas once I was in labour I didn't have any control over anything.

She felt left alone during the first stage of labour, then received several unwanted...

So the pregnancy was really easy and really smooth. And the labour, on the due date my waters broke at about midnight, which was early hours of Saturday morning, and nothing else happened. So I had a quick check-up on Saturday at teatime and they said come back Sunday to be induced. Went back Sunday to be induced and they used a pessary for the initial induction. Then obviously you couldn't wait around on the labour ward for the induction to take effect, so they sent me to one of the other wards, which I think was a postnatal ward but it was empty. And I spent a few hours there on my own. A midwife would check me every few hours or so, but I basically got to nine centimetres without anyone with me, without any gas and air or any pain relief, because there was none available even though I wanted it. And when I was at nine centimetres they gave me a shot of Pethidine, which knocked me out, and by now it's some time on the Sunday night. The Pethidine really knocked me out and the next few hours are a complete blur. The next thing I remember I was in the delivery suite and they were telling me I needed a drip in my arm to give me' Oxytocin I think it is to speed up the contractions, so therefore I would need an epidural. Both of these things I hadn't wanted, but told me I had to have one so I had to have one. And that made the contractions too fast so that they weren't effective enough, so then they gave me some other drug I think to slow the contractions back down again, which' so they slowed down. And then they said if I hadn't progressed' I'm still nine centimetres, I got to nine centimetres on the ward on my own, but still nine centimetres now a few hours later. So they said if you haven't made any progress in the next two hours then we'll have to do a C-section. So that's what happened. 

And at the time I couldn't argue with anyone because I was just off my head on Pethidine, but really I think' I left the hospital healthy with a healthy baby a few days later, so I shouldn't complain I suppose, but I feel that if the' if the labour had been managed differently, if I'd had a midwife with me, if I'd had gas and air, if I'd been encouraged to be mobile rather than giving Pethidine and then just flat on my back and everything stopped, then I think I wouldn't have needed the C-section the first time round. And I'm very squeamish and I don't like needles so having an epidural was horrendous, and having a C-section was just a complete nightmare. 

So how would you describe how you feel about that experience now looking back? 

Bitter I would say, a bit angry, a bit upset that I didn't' that it didn't go' it may be that I just haven't fully understood, perhaps the baby was in distress and I just didn't realise at the time, perhaps they, you know, didn't want to alarm me that that might have been why. But as far as I can see, I only had a C-section because I was induced around sort of Sunday lunchtime, got to nine centimetres, stayed at nine centimetres, because I was flat on my back with all these drugs, and then by the early hours of Monday morning, you know, I was taking up too much time, taking up too much space, 'so if you haven't finished in the next two hours we're just going to chop it out and send you on your way,' so'

She thinks having someone explain to her why things happened the way they did might help her come...

Now the next question sounds ridiculous, but was the birth like you expected it to be?

[Laughs] No, but I had unrealistic ideas.

Do you think so?

Yeah I think so, I think I was fooling myself. One of my friends had recently had a water birth and it had just gone so wonderfully and, you know, two pushes and it was out. And I thought, 'Oh yeah, that's what I'll do too.' I knew I was fooling myself but I'm still sticking to that dream, yeah.

So how do you feel about the way that [daughter] was born now?

Well it's sort of faded over time, but I'm still disappointed about the way it went, but there's nothing that can be done to change it, and it would be nice to look back over my notes or have a chat with somebody that was there, you know, and wasn't on Pethidine and so knew what was going on, and perhaps that they would be able to explain why certain steps were taken at certain stages and then I would be able to accept it a bit more.

She had decided early on that she wanted to attempt vaginal delivery and looked at various...

So I did do a little bit of digging around and read up on vaginal birth after C-sections and tried to scare my midwife by saying I wanted a home birth and she just laughed at me, because it was the same midwife as last time. But yeah, I did read up on it in a lot more detail just to find out would I have to have a C-section as a matter of course or would I have to' would I have any options or choices.

And can you remember the kind of sites that you looked at then?

Started off with just the, the sort of Mum's Net chat sites and then followed various links, and the one that I ended up on when I was really wanting to find out about a VBAC was the NICE, National Institute for Clinical Excellence, that one, and I printed off a whole chunk of paperwork to read, everything. So I thought, 'Right, I'm going to know everything that they know now, I'm going to do as much as I can to find out.' [Laughs].

She wanted to be more in control than she had been with her previous birth and prove to herself...

Well, because of the complications I'd had delivering [daughter] I really wanted another go at doing it as I see properly, and I know there's no proper or not proper way, but I wanted to do it and just prove to myself I suppose that I could just deliver vaginally and that it would all be wonderful and that I'd have a lot more control and would stand up for my own choices and decisions rather than just being part of a process, almost being a slab of meat there that they're doing the doctoring to and ensuring I delivered healthily but' I just wanted to be more in control this time round and do it myself.

Her low-lying placenta meant that she had to have another caesarean. Looking back, she thinks the...

It was a fait accompli, so I had no- I've got no emotional baggage, I suppose about having chosen that. If I'd been given the option, I mean, in the early stages of the pregnancy, I thought I had the option, and at that time I was thinking, 'Well, I'd really like a natural delivery', but part of me was saying, 'Perhaps I should go for an elective because it's easy and I don't have to push and it won't hurt at the time and you know when it's going to happen'. So there was a temptation towards that. And I think if I'd have had the choice right to the end and chosen the elective, a part of me would always then be thinking, 'I should have given it a try, doing it 'properly' i.e. naturally'. 

And I think if I'd left it and intended to choose a natural delivery, part of me would be saying, when I was one day overdue, 'Why didn't I choose an elective, I would have had it by now'.

So, in some ways this takes the pressure off'?

'it does, yeah'

'this was out of your hands?

Yeah.

She felt squeamish about the operation and tried to ignore it as much as possible. Having her...

The night before the C-section, one of the nurses came round to make sure I was all prepared. 'Nil by mouth from midnight onwards, and they gave me a couple of little tablets, I think, to settle your stomach, so you don't react to the anaesthetic. On the morning itself, the surgeon came and talked to me again. He'd come previously for me to sign the consent forms a couple of days previously, but he came to talk to me and so did the anaesthetist, and make sure I was all ready for it and I that I didn't have any final questions and then my husband and I went down to the delivery suites and sat about for a little while, maybe an hour or so, whilst they were all getting ready. I had the two, I can't remember what they're called' to give you blood transfusions, they put in the little pipe, the little thing ready, I can't remember what the word is for that?

Canula?

Canula, thank you. I had canulas put into both of my hands, ready, because they were expecting a lot of blood loss, so they wanted two canulas in, ready to give me loads and loads of blood, so I was sitting there with these in my hands and trying not to look at my hands, because I'm very squeamish so from that point onwards I was like, 'I can't look'. And then I think I actually walked into the operating theatre, all in my gown with my stockings on and my canulas in my hand, I had to sit on the edge of the bed, sit up very straight and still for the anaesthetist to put the spinal in, in my back, which didn't take too long, and then leant back, and then they started the actual procedure. Shall I describe the procedure?

Okay, first of all, after having the spinal, or if you have an epidural it's the same, they check that you've gone numb, they're sort of pinching your toes and, and spraying something saying, 'When do you feel this?' and 'When does it stop feeling cold?' and working out, you know, that you're totally numb where you should be. And then they put up the big screen so you can't see anything, and you're obviously lying on your back, and you can't see anything sort of past mid-chest level. And the bed itself is tilted slightly to the left, which is I think so that all your innards are nicely out of the way when they chop you up. So [smiles], 'and then they actually performed the procedure, which I ignored as much as possible. Obviously you can't see anything and my husband was up talking to me, the anaesthetist also talks to you; they're really nice. And you can have a CD on of your choice, just to take you mind off of it and listen to some music. A couple of minutes later, you're presented with a baby, and it's all bundled up. They check it, check that it's breathing and everything and bundle it all up in a blanket and then give it to, and there's just about space for the baby to balance between your face and this, this sheet screen that's up. So the baby's there, and you can look at it and kiss and cuddle it and everything and that's quite nice, and whilst they're doing that, whilst you're distracted with the baby then they're delivering the placenta and stitching you back together again. So, getting the baby out is the quickest part. Once they start, then you've probably got a baby within ten minutes and then they're just patching you up again, which probably takes about three quarters of an hour.

Even though it wasn't what she had wanted, her planned caesarean was a much calmer experience...

With my first section, which was an emergency section, I didn't know that they were going to tilt the bed a little bit to the left before they started, so when I felt that I thought that I was going to slide off and I was a bit worried by that, but they explained what was happening. But the second time round with the elective section, because I'd had one before anyway I knew exactly what would happen, and plus with an elective compared to an emergency, the elective was much more calm. You're sitting there waiting around really, rather then being rushed in and everyone panicking, it's all very slow paced and if I was worried there was plenty of opportunity to ask whoever any questions.

The procedures themselves, I'm sure, are technically the same, however the experience of them - an emergency section, you've probably already been in labour for quite some time, so you're probably already in a lot of pain and you're probably already exhausted and the baby is often also showing signs of exhaustion or distress of some kind. So you're going into it in a tired and worried frame of mind and your body also is, is exhausted. You have less opportunity to prepare your own thoughts about the section because you weren't intending to have one and so you haven't asked any questions about how you'll cope afterwards, how the procedure itself takes place, what sort of anaesthetic's going to be used, how things are going to take place. So you're less mentally prepared, you're less physically prepared. So I think that actually also affects your recovery. Physically, you're exhausted beforehand and so it takes longer to recover because you, you've run a marathon and then had major surgery Rather then being rested up in bed and feeling quite calm and then having surgery. Emotionally, you don't have time to come to terms with it if you've having an emergency section because whilst it, the whole thing probably takes an hour to organise and, and get all the staff in place, but that however, isn't long enough for you to get your head round it, if you thought you were just going to go in and have a baby and go out again. 

She would caution women that once they have had an intervention, others are likely to follow and...

I think it's lovely to have a choice. But you've got to actually be able to back that up and provide a choice. When I went in with my first baby, I was thinking that I'd have a midwife with me the whole time. That I'd be able to make a decision about whether I wanted this form of pain relief or that form of pain relief, in a normal rational way. But when you're halfway through having a baby, you can't think in a normal rational way and quite often, even if you can think straight, you may not have the opportunity to do so. Once you start having any type of intervention during the delivery, you are then on a conveyor belt and one intervention then leads onto the next to the next to the next, so if you start with a' if you have an epidural, that then slows you down, so then you have another drug to speed you up again, and by then of course you're lying flat on the back so you can't move around. Once you have something, be prepared to go all the way and have all the different interventions and once you're on that conveyor belt, you can't say no, the choice is pretty much out of your hands.