Interview 04

Age at interview: 33

Brief Outline: Normal pregnancy. Breech presentation resolved through successful ECV. Induction at 42 weeks. Forceps delivery. Difficulty with breastfeeding. Importance of managing expectations of pregnancy and birth realistically.

Background: Children' 1, aged 17 months at time of interview. Occupations' Mother- publisher, Father- environmental consultant. Marital status' married. Ethnic background' White British.

She wanted to have her children close together so she planned an 18-month gap.

What made you choose to have baby now?

Well I had very strong reasons actually. My sister and I are very close together, I mean close emotionally and close in age. And I always dreamt all my life of having two children close together so once I'd had the first one it was just a question of waiting then for the right time to have the next one. And this was just perfect timing. I wanted them to be eighteen months apart so we were very lucky.

So did you get it spot on?

Yeah, [laughing] yeah almost to the day, which was great. The due date is almost literally almost eighteen months from my first baby's birth. So that was, if it arrives on time it will be great.

She expected more reaction from the midwife to the news she was pregnant. More informal contact...

What was the care like in the first trimester of pregnancy?

Both times it's been quite sort of hands off. I think that the first time you're pregnant you go to the midwife expecting fireworks and, and people to say 'Oh that's absolutely fantastic' and of course to the healthcare professional it's just another person, we're just another appointment that morning. And I felt it was quite low key whereas perhaps I think I would have preferred a bit more, I perhaps would have preferred more appointments at the beginning and fewer in the middle. Because it would- you go in and you say you're pregnant and they say, 'Well, come back in twelve weeks' which seems like a huge amount of time.

So yes, I was quite surprised at how, how sort of non-interventionist they were at the beginning. But then having said that I wouldn't want, I mean it's an interesting balance, because you wouldn't want them to be too medicalised, I mean I just said that I want it to be all natural so, it's interesting the sort of balance. I suppose it would be nice to have people to go to, maybe just to go and talk to rather than actually having anything going on. You wouldn't necessarily need to have any tests or procedures, but it would be nice maybe to go and see the midwife every month just for a ten minute chat. That would have been reassuring.

What would you have wanted to discuss with her for those ten minutes?

I'm not sure, maybe things like, things like diet, things like how you're feeling physically, any sort of morning sickness, those sorts of things. Things that you can do to help that like ginger, or some natural things and just have a bit of a chat with someone who knew what they're talking about and who could say "everything seems to be going fine". 

With the second pregnancy are you still, did you still find that you would have liked more contact within the first trimester?

Possibly, I certainly wouldn't have minded having more contact. I don't feel I needed it so much, but certainly if I'd had the opportunity to have appointments I certainly would have gone. So yeah, I think I would have probably, on balance, I would have liked to have more.

She worried something might be wrong with the baby right up to the birth.

Did you worry with the first one about something going wrong or about miscarriage or something like that?

Yes, of course. Yes. I worried about miscarriage, although that wasn't the sort of biggest concern. I mean obviously I was concerned about that, I think everyone is, but that wasn't a sort of major concern because I haven't had a lot of history of problems and there weren't many histories of miscarriages in my family and things, so I didn't - that was obviously an issue but it wasn't a sort of overriding issue. I suppose I was more worried about there being something wrong with the baby, because we didn't have many scans, we only had the twenty week scan with my first baby because we realised that, just for us personally, the scan result wouldn't have made any difference, so there was no point in having them. And I wasn't particularly encouraged to have them by health professionals. They didn't - it seemed to be something that one would have to go out of one's way to organise and they didn't seem to imply that they were particularly necessary, so, and we didn't feel they were particularly necessary either, so we didn't have the scans, but then subsequently that meant that we didn't actually know that everything was okay. So we still had that doubt right until up until he was born. So it was kind of a mixed blessing whether we had the scans or not.

Did you feel that you didn't want to have the scans because you wouldn't have done anything about it anyway?

Exactly, yeah, yeah. I had that discussion with the midwife and she said, 'What would you do?' because when we were talking about the scans she said, 'What would you do if you had a certain result from this scan?' and I said, 'Oh I don't think we would do anything.' She said, 'Well there's no point in having them then'. Which was quite right, but it did mean that there was the added anxiety of not having been told that everything was fine. And I understand that the scans can't do that necessarily so in fact it probably - we wouldn't have been able to be told that everything was fine anyway, but you we still didn't have any kind of medical confirmation until, except for the twenty week scan, which was fine.

Some pregnancy books set unrealistic expectations about the perfect natural birth. Women who need...

I think I just desperately hoped I would be good enough mother, and that everything would go well. And I had also a lot of expectations about having a natural birth and I felt that there was quite a lot of literature about how it was almost in one's own control to have a natural birth. And I felt afterwards, after we didn't have such a natural birth as we had hoped, I felt quite cross with some of that literature. I had a book on active birth from the seventies that someone had given me, and it said things like if you communicate correctly with your baby it will get into the right position and there was a sort of sense that you were a failure if you, if you had pain relief, and there was a sense of failure if you didn't have this wonderful natural birth at home. So I was quite cross about that, that there was that expectation for women.

That's very interesting. When, what do you think is a more realistic approach to that issue?

I think, I think people should be told to be much more open minded, and that often you don't have any control and that it's important not to feel that it's anything to do with you, ultimately. And to listen to medical professionals who know what they're talking about, and if they say you need to be induced, they probably have a good reason for that. And if they say you need forceps then they probably have a good reason for that. And sometimes you have to surrender control, I think, because you just can't say, 'I'm going to do this at home and it's all going to be wonderful and natural", because I know lots of people for whom that hasn't been the experience and it's ultimately been right that they should have some sort of medical intervention for the sake of their health and the baby's health. 

She was disappointed to have an induction and forceps birth, but it helped that staff explained...

No, I think it's important that you know why something is happening if someone suggests that they do something. For example with my induction it was only really later that I was told the statistics about what could happen to the baby if it wasn't induced and I think as long, I think one can never be too kind of informed. I think perhaps medical people think that you, because it's clear to them why they're doing something, it's probably completely obvious to them that it needs to happen, it doesn't necessarily mean that the patient knows why. And you may have read it but you might like to be told another - you know, even if you've been told, you know, you want to reassured a hundred times as to why they're doing something. So I think you can never be told too many things.

Was it quite important to you that people bothered to come round the next day and explain things to you?

Yes, I was very impressed and reassured when people came round and talked to me afterwards. Because it makes you feel that you're less on a conveyor belt, otherwise you're just in, you have a delivery and then you're out. You don't necessarily meet the people who were involved in the actual delivery in the aftercare so both can be very good but they're not really connected necessarily. But I was impressed that the people who were involved in the delivery did sort of do the follow-up the next day, and that was very nice.

Did it help you feel okay about the fact that your birth hadn't gone to plan because they had bothered to speak to you?

Yes, absolutely, it was very helpful that people followed it up and explained it. Especially as afterwards you're in a much better position to be able to talk to the person and to be able to think about it. Actually I'm sure that if people tried to explain these procedure whilst you were actually in the throes of giving birth you wouldn't actually be able to hear, you wouldn't be interested in listening. You just want it to be over with, you just want them to get on with it. So having these sort of detailed discussions about why we're doing this at that time is probably not the most appropriate. And it's only afterwards when you can actually sit down and talk to them that that's probably the most appropriate time to discuss it anyway.

An obstetrician turned the baby from breech position to head down using external cephalic version.

Okay this is your second pregnancy isn't it? 

Mm hmm.

Do you want to tell me a little bit about the first pregnancy and delivery? 

Right. The first pregnancy was fine, actually. I mean, it was through the summer so it was quite hot and I was quite large. It was always going to be a big baby so, you know, I felt really quite sort of encumbered by it, but it was fine. I had slightly high blood pressure, but nothing out of the ordinary. And then at about thirty weeks it was discovered that the baby was breech so then there was quite a lot of anxiety because I desperately didn't want to have a caesarean, and I knew that was sort of the natural outcome of having a breech baby, so I did lots of things to try and turn the baby myself, like lots of scrubbing floors and lots of exercises. And as it got closer and closer to the due date I spent quite a lot of money seeing lots of people like acupuncturists and chiropractors and people like that, who all thought they could do something to move the baby, but nothing happened. And then we had an ECV treatment at the hospital and that was successful, and that was very straightforward.

Tell me about the ECV?

It was basically where, it was all, it was quite straightforward. The obstetrician just literally put her hands on my tummy and moved the baby round like this.

What does ECV stand for?

It stands for I think it stands for external cephalic version, I think. Meaning it's a turning of the baby from, from outside. And it was quite manual, we were in the delivery suite and I was all hooked up and things so it seemed it was, that was sort of hi-tech but the actual procedure itself was just literally the hands of the obstetrician, that was it. And she managed to move the baby round.

She had not expected to find breastfeeding so difficult. A La Leche counsellor encouraged her to...

I think I was surprised how difficult breastfeeding was, because I'd assumed that that was the least of your worries and that once the birth was over it was sort of plain sailing after that. And of course one knows about sleepless nights, but no one had really told me that breastfeeding would be so difficult and I was quite shocked by that.

Tell me about that experience.

Well it was just very, very painful for me. Very painful in all respects and very difficult and that, that was, that was just quite a shock because I hadn't anticipated that it would be so hard. And of course once you look into it, then you realise that it is quite difficult, and it is acknowledged to be quite difficult, and it is acknowledged as a skill that you have to learn. But going into it I had no idea about that. So perhaps that's something that could be emphasised in the run up, but then you don't want to put people off. Because once I'd started doing it I was determined that I would do it. And maybe if I'd known beforehand that it was going to be so hard I wouldn't even ever started trying.

Can you just sort of talk me through, you know, when you first tried what went wrong and who tried to help you and so on?

When I first, I don't thing I realised that anything was wrong for a couple of days. The baby was feeding perfectly well and he was putting on weight, so that was fine. As far as he was concerned everything was fine. But my problem was that it was very, very painful. I had a very a huge engorgement so that the actual breasts themselves were really painful. And sometimes I couldn't have, even hold the baby to me because they were so painful. And the nipples were very sore and bleeding. 

And it was just a very, very, very painful experience. So every time I knew it was feeding time I would tense up with pain because it was just going to be agony. And I just hadn't anticipated that at all, so, but I contacted the La Leche League and they were absolutely brilliant, and the lady who ran it locally came round and she was wonderful and she really helped me. 

What did she advise?

Well she, she sort of gave me some practical tips about positioning but she also was very sympathetic and said, 'Yes it does hurt' and, 'I know it hurts' and, 'You're doing a really good job to keep going' and, 'Well done' and, 'This is the right thing to do but I know it's hard.' And I've not, I can't quite put my finger on what she did but somehow she was just very inspirational and very kind and very understanding, and she kind of got me through it. And the midwives also tried to help, so everybody tried and everybody understood.

Did you feel emotionally upset because it was difficult?

Mmm, yes, but I also felt emotionally determined to do it and quite pleased that I, that I was doing it and the fact that the baby was putting on weight was a reassurance that I felt that ultimately it was okay because it was getting into him and he was feeding happily himself. So I was upset that it wasn't as easy and it wasn't this beautiful picture of this lovely baby suckling beautifully and everything being fantastic. So that was a disappointment but I, I was determined to keep going.

She believes there is unrealistic pressure from society and women themselves to conform to an...

Do you think that people sometimes put unrealistic expectations on themselves?

Mmm, yes, absolutely, absolutely and I think-

In what way?

Well, I think one just feels, you have this image that everything has to work just perfectly from the start, and if it doesn't somehow it's your fault, and there's this ideal that you'll just have this baby beautifully at home and then you'll pick it up and you'll breastfeed serenely, and there is that image. I'm not sure where that comes from, but I felt that pressure a lot, and if I didn't conform to this absolute ideal there was some sort of a failure. And I think that's just so unfair and so unrealistic.

Where do you think that pressure comes from?

I'm not sure, but there's a pressure in society that somehow you have to do it in a certain way, and that if you're not doing it in a the most natural way any kind of intervention is a sort of reduction in the sort of ideal. I don't know where it comes from, actually. Because it doesn't, it doesn't actually come from health professionals, I don't feel. I think they're very supportive. I don't think it necessarily comes from them. I think perhaps it just comes from oneself, that you just want to do everything right.