Making decisions about birth after caesarean

Well, my consultant, the consultant that I saw at the [hospital], I found was a bit disappointing because he didn't seem too informed on, on my case. It seemed like he hadn't read my notes. And it seemed like he was just following a sort of automatic advice-giving session, where he wasn't taking into consideration my, my information and was just trying to push me into putting off the decision or going for a vaginal birth. Whereas the midwife' yeah, obviously given the information that was supplied to her about my background, she was quite, she quite agreed that I was right to go for the caesarean and that I was' she backed me really. I mean, I think after, straight after I'd given, I gave birth to [son's name] with the caesarean after the [induction], I took the decision that if I did have another child [laughs] it would be with an elective caesarean. So it was really something that I had, I was quite determined to do when I took the decision' quite early on. 
 

Were you given any information at the time, after you'd had a section about the fact that it might have implications for a future delivery? Did anybody kind of debrief you afterwards that because you'd had a section, that you might have to deliver by section again the next time around?

Only one thing was said to me, and then it wasn't ever followed up. One thing was' who' I think it was my midwife, my local midwife that I know, said to me that it was unusual, the reason why I had a caesarean, that his positioning, that was quite unusual and that I may have to' it could have been because he had a big head, and the shape of his head, or it could have been me, it could have been the shape of my pelvis and that, if I was ever to get pregnant again, they would probably scan or x-ray or something, my pelvis to see. Because obviously if it was my shape, that it would have to be another caesarean. And, I remember her saying that, but at the time you think, 'Oh, I'm never getting pregnant again!' But then I remember saying to my doctor at some point about it, when obviously it did come into my mind that I might get pregnant again, and he said' sort of dismissed it and said, 'Oh, well, that's something we'd think about if you got pregnant again.' And then once I was pregnant, I did mention it to, either him or my midwife, and they said, 'Oh well, we wouldn't scan you now you're pregnant' or something. So it was' that has remained, has remained something a bit strange really, that that was said and then' nothing after. It never seemed to be the right time.
 

What was your motive for seeking a private consultation? 

Because the girl, I just felt she was so - what with the information she gave me. I knew that there was two sides. I think, I think the fact they told me all the risks of a caesarean, nothing the other way, is wrong. I knew that, I mean, I'm not stupid. And the other thing, I'm forty-two and I said, obviously I had the bungle with my anaesthetic, I said could you guarantee me I'd have a consultant doing my anaesthetic and a consultant doing my surgery and she said, no, we can't do that and there's no extra risk to being forty-two, which is nonsense. Everyone says, everything you read, it's more risky as you get older, having a baby. So I just felt they were completely unsympathetic and, you know - I think they have their agenda, which is 'push for a natural birth' and they're not really listening to you. So I thought, I'll just go elsewhere [laughs].

So the plan is to have the private consultant do the elective caesarean, [Up in London] you've got a date and you're happy?

Yeah, I mean, I'm still nervous, I mean, things can still go wrong. But at least I know it's a top consultant, loads of experience, you know, he's done loads of them. I mean, that's the other thing, you know, that guy that did (the epidural), you see I was very' I've never really had much surgery or anything to do with hospitals in my life so I'm lucky. But that guy, the trainee putting in the needle eight times, I thought, what if they put a trainee doing my op? I was just worried, because it was horrendous. And the fact that they wouldn't address it for the second time. Now, I do believe, because people have said to me, you could fight the fight with them and keep going, but you know, I haven't the energy at the moment, you know, and also I think they only see special cases, like if you're really ill or if you're a smoker or, I don't know, I don't know what they take as a special case and give you a bit more better treatment. Twins? I don't know.

So how would you say you feel about the information that you were given by the person locally?

Bad information, you know, not both sides of the story, not taking into account what I, my previous experience. And also they're saying there's no extra risk to a caesarean when you're older. As far as I know, that is rubbish, so, not good.

So you felt you were more able to discuss your fears and anxieties and, and what you wanted with this other person?

Well, yeah, but then you're paying aren't you an awful lot of money, but then they have the time. But yes, yeah totally. I've been able to discuss everything and I've been given both sides and not pushed in either direction, which is probably hard for him, because for all I know he might have, he might think natural birth is best the second time but they don't, if you're professional you can keep away from that, can't you? So I just got both clear sides. But he did- well, the only thing he says is that at twenty weeks, when I went to see him, he said it is entirely reasonable to have an elective caesarean the second time if you've had a caesarean before, so I suppose that's the only thing he said positively about it, so, but that's not pushing you in either direction, but it's a reasonable request, which I wasn't made to feel locally.
 

Well, I mean - I'd probably say my doctor doesn't, hasn't really given me any information as such, and the midwife I think she only tends to give you the information if you ask more, because I don't know whether they sort of want to panic you so much - if that's the right way of putting it.

But I mean, with the study, like I said, it'll say, 'This is what can happen, these are the risks', so you've got them there in black and white. If you choose to read them, you know, that's up to you, if you don't then' but they're there if you, you know, you've got a query or something, but yeah, I'd say like with the midwife it's more if you've got the concern you bring it up to her and she would sort of let you know rather than, you know, 'Well you can have this problem, you can have that problem', so, yeah.
 

Who do you think is the most appropriate healthcare provider to give the information that women need?

Midwives.

That was emphatic?

mm 

Why not the hospital consultant or '?

Because they're so litigiously minded. They're so' and also it's a medical model. Birthing is a medical' Sorry, I'm just ' I wish I could remember the book. I did read one book and I'm not a person into these sort of home birthing sort of very, dare I say it, hippy sort of naturalistic approach to birthing' But this book just said, 'Look, everyone does this', you know? Medics do it because they've changed it, you know, women used to lie on their back and deliver and that kind of thing. That's not the way you do it. It was very much of a sort of a positive sort of approach to it. A woman's approach to it, rather than' And even if the consultant is female, it still doesn't matter, the medical model is that, you know, we're just getting away from the idea of delivering women in stirrups. They're very much into interventions, which are almost conducive to having a section because they reduce your mobility, they have to monitor, they have to intervene, whereas actually the best thing is just to let it go, let it go naturally. It's just a, it's a medical need, really, to take over a situation and to help the women, I think. I think it's also the medical code, you know, they really do need to' they want to make you comfortable, they want to give you drugs to make you more comfortable. They want to make things better, but actually, standing back and not doing anything, observing and letting the woman do it is almost the best. So it sounds very, very negative unfortunately, but it's just the way. 

But the midwives were very much more' pro the idea of me delivering naturally, supporting what I wanted and even when a double risk had come through, they were relatively happy to support me at home, despite the huge risk.