Interview 06

Age at interview: 38

Brief Outline: First pregnancy through ICSI IVF. Experienced hyper ovarian stimulation. Induced at 42 weeks with birth by emergency section. Second pregnancy occurred naturally 7 months after birth of first child.

Background: Children' 1, aged 15 months at time of interview. Occupations' Mother- GP, Father- physicist. Marital status' married. Ethnic background' White British.

She expected IVF to be stressful but it was not as bad as she anticipated.

How did you feel about having to go down the IVF route?

I think we were rather disappointed to have to do that [laughs] and, and do the IVF treatment because, you know, we'd always hoped it would just happen naturally and we tried for several months and then, you know, realised that nothing very much was happening, and then we tried for several more months, and then went to see my GP, and she felt that because we'd been trying for almost a year that we should, we should, sort of, think about, you know, if we would take it any further. And I realised at that time that, you know, we'd be starting down this road of, you know, lots of investigations and trips to the hospital and-. But we felt that we really wanted to do it because, you know, we wanted to get pregnant so we felt it was worthwhile pursuing at that time. 

Do you think that because you're a doctor you felt particularly discouraged at knowing what it might involve?

Yes, I think, as a doctor I'd seen several patients going through infertility treatment, in particular IVF and I knew it could be very stressful and I knew that the chances of success are actually not that high. They're, they're lower than people think. They're only about 25% for, for each cycle.

And as, as you get older the success rate goes down, so we- I was already in my, sort of, mid-thirties by the time we started doing it and I realised that the success rate wasn't going to be very high. So yes, it was a bit with a sinking heart but it wasn't - the whole experience of IVF wasn't as bad as I thought it would be personally.

It was, you know, the staff were very kind, and very accommodating with visits to the hospital and it was it, it wasn't as bad as I thought it might be.

What- now tell me what, what did you imagine it might be like? [laughs]

[laughing] Well, I think from, from patients I'd heard that doing IVF treatment, the hormone injections made you feel very uncomfortable, made you feel very bloated. And I'd heard some horror stories about the egg retrieval where they, when they take the eggs out with, with under sedation and take them away to be fertilised. And I'd, I'd read sort of in magazines and, and heard from several patients that that could be very uncomfortable so I wasn't looking forward to that.

In the event was it better than you expected?

I think my personal experience of, of the egg retrieval and IVF was, was probably better than I expected. I was quite lucky because I was very sensitive to the sedation, so I just tended to fall asleep and wake up when it was all over. Which I think is probably the best way to be. So yeah I think I was quite lucky, yes.

Men may find it difficult when their partner is having fertility treatment, and it can strain the...

Did the IVF experience have an impact on your husband? What was it like for him, do you know?

Yes I think the IVF experience did have an impact on my husband. It's difficult for him I think, because the treatment was very much centred on, on myself. You know, obviously they have to take semen samples from, from your husband or partner but, you know, the hormone injections, the scans, it was all focussed on me and all he could do was to be supportive and, you know, come with me and stay with me; especially the day where we had the egg retrieval which was the worst bit of the whole cycle, really. And it's, yeah, I think it, it, it is very difficult for the male partner, I think.

I mean, what kind of strain does it put on couples, do you think, to go through that?

I think it can put a lot of strain on couples. I think, especially after you've been trying for a while I think you start to think, "Do we actually really want children now?" Something- you know, a decision we made several years ago and, you know, we'd hoped that it would just happen normally and suddenly it becomes this huge thing where you're spending vast amounts of time and money on treatment which isn't working, and it makes you re-evaluate, I think , you know, 'Is this really what we want to do?' So yes I, I - and, and it may be that each partner has slightly different views on that, you know and it's difficult to decide where to draw the line and do both partners want to draw the line at the same time? I think, I think that can be quite stressful.

She developed bloating, sharp pain and sickness in early pregnancy. This was caused by ovarian...

We did three cycles of IVF and on the third cycle we were, we were successful.

And then what happened? [laughs]

Right. Well I then, they told me that I would know within, in sort of, ten days whether I was, whether or not I was pregnant and they told me the symptoms to, to look out for and I was suspicious that I might be pregnant because I suddenly started to feel very sick and started vomiting and in fact I was actually working a weekend shift and I was actually at a patient's house visiting them and they had vomiting and diarrhoea and I had to rush to the bathroom and be sick myself which they thought was rather amusing, I think. 

But then I actually started to feel more and more unwell and my stomach got more and more bloated, so I contacted the hospital and they asked me to come up, and they, they examined me and took a pregnancy test which was positive but they took some blood tests and they were concerned that I might have this ovarian hyper stimulation syndrome. Because my hormone levels had been very high on that IVF attempt they were aware that it might be a complication, so they told me to go home and just rest. But things got worse over the next few days and I was getting more and more bloated. I had lots and lots of fluid in my stomach and that was irritating the bottom of my lungs which was giving me what we call pleuritic type pain which is a sharp pain going up to your shoulders which is very uncomfortable. And I just couldn't keep any fluids down. So after a few days I was admitted to the hospital and they put up a drip and I was in hospital for several days and then, then the fluid started to go down again, so I was, I was allowed home then. And I felt sick probably for about the first six weeks of the pregnancy and then that eventually just settled down to just to normal morning sickness. And the rest of the pregnancy was straightforward after that. 

Is that complication potentially serious?

It is. I think you can get it in mild, moderate and severe forms and if you have - I had moderate, apparently - but if you have it in the severe form you, you can, you know, you can be very ill and in intensive care and- but that's very rare, it's, you know, it's a rare complication.

Professionals do not always realise what an effect their words have on people. There was little...

I think one sort of thing that surprised me was how important exactly what people say to you is, and I don't think I had cottoned on to that before. That somebody can say something which they probably only mean as a throwaway line but when you're the patient you, it has enormous importance for you and you go home and you think about that particular phrase and the words that they used and wonder, you know, did that have any special meaning? Was there a- more of an implication than they said?

So I think I've become much more aware of that. The other thing was I think I was surprised at how I felt about seeing a different doctor every time I went to the antenatal clinic and I hadn't really thought that that would be that important to me but in fact it was. And I saw somebody different every time I went which wasn't entirely satisfactory. This was at the antenatal clinic rather than the IVF clinic. 

At the IVF clinic I, I suppose because I was there longer, spending longer there you build up a good relationship with one or two people and that was I think very important, really, because they supported you through that stressful time. And I know that the antenatal clinic is different because they're busy and they're only seeing you for a short time. But I think that I, I was surprised at how important it seemed to me to see the same person at the clinic when I went.

Did it- I mean how did it make you feel that you weren't able to see the same person every time?

I think I was slightly disappointed that I didn't see the same person every time. And also because I got slightly conflicting messages from two different doctors that I saw at one appointment and then one that I saw four weeks later. So I felt that maybe there wasn't much continuity- much communication within the team, which surprised me a bit. And it disappointed me a bit as well.

Did you point this out to them?

I pointed it out later on to the consultant because the fact that- on the same day that I had seen one doctor I saw the consultant later and I told her that two members of her team had given me different advice and, you know, she was very nice about it and said, you know, that maybe we wouldn't in retrospect have given you the advice last time that we gave you if we'd, you know, if we'd thought about it. So yes I did point it out to her and she took it on board I think.

The birth did not go as expected, but having a written birth plan was still useful.

Did you, did you make a birth plan?

I did make a birth plan but it sort of went out the window half the way through [laughs].

And what was in this fantasy document?

In the fantasy birth plan we had that we were going to start with the TENS machine for pain relief and then work our way through the analgesia up to an epidural, but hopefully a normal delivery. But because I had to be induced everything, everything changed, because they had to artificially rupture my membrane and use prostaglandin gel and then put up the drip so it was, it was all completely different from the very start.

Do you think there is much point in people making birth plans?

I think it is a good idea to make a birth plan because I think it is a good idea to have thought about what you would like to do in labour before you actually get there. I think you have to realise, though, it would probably have to be very flexible because things change, things happen and you can't predict entirely what's going to happen. But I think if the birth plan is there, and it's written down then at least the midwives and staff know what your original ideas were and what you originally thought you would like to do. And try and stick with that and bring up things that are just, that are written in the birth plan. 

She considered trying a vaginal birth after her previous caesarean, but decided to have another...

Do you have the choice of having a, would you have had the choice of having a natural delivery?

After having the first caesarean section, yes. You can, you have the choice of having another elective caesarean section or a vaginal delivery and I had to be under consultant care this time so that they could discuss that fully with me. And there are advantages and disadvantages. There's a slightly, well, there's a ten times increased perinatal mortality which is, you know, the baby dying around the time of birth with a natural delivery because of the risk of the uterus rupturing after a caesarean section but then - after a normal delivery I should say. But there's actually a slightly higher risk to the mother having a caesarean section. So you're weighing one set of risks against another. So I had to discuss that all with the consultant and come to some decision about what to do.

How did you make that decision? I mean...

It was very difficult to decide whether to have an elective caesarean section or whether to go for a vaginal delivery. There were several factors, one was that the consultant felt that if I was trying to have three or four pregnancies then she would very much advise that I tried for a vaginal delivery because each section technically gets more difficult to do and you're slightly more at increased risk of having complications. I also had to weigh the fact that there is an increased risk to the baby having a vaginal delivery but an increased risk to me having an elective caesarean section. So it was a very difficult decision but in the end I decided that probably we were only going to have two children, so probably the safest thing for the baby to have the elective section. And as I recovered very quickly from the last time and I didn't have any complications and I'm hopeful that it will all be the same this time.

The decision to have an emergency caesarean happened very quickly when the baby became distressed...

Alright. I didn't go into labour myself. I had to be induced at forty-two weeks because there was no sign of my daughter being born. And they ruptured my membranes but nothing much happened and then he put up the drip with the Syntocinon [oxytocin] which is to try and make the pregnancy, to try and make the labour become established and the uterus contract. And as soon as they did that my daughter's heart beat started to go down and come up again and then go down again. So they were, the staff were rather anxious about that. And that happened several times and then it suddenly just dropped down and then stayed down for several minutes, so that time they said, 'No, you know, the baby's distressed. You need to have an emergency caesarean section,' so that, that happened within about ten minutes.

Mmm. How did that, how did that feel to suddenly have your labour taken over by all these people?

It was, it was very strange having labour taken over by other people. It was a bit like something out of ER. Something, you know, you were lying in the room with just yourself and a midwife and then suddenly she pressed a button and I think they could read the tracing in the doctors' office and about fifteen people rushed into the room. You know, several doctors and several midwives and then you were just being rushed on the trolley down to theatre. And it happened so incredibly quickly. I think, I knew it was a possibility because the - earlier on in the day they'd been watching the heart beat going down and I'd, I'd had, I'd had an epidural earlier on and the anaesthetist said, you know, "I might be seeing you later on" because, you know, he'd seen the tracing as well. So there was some suggestion that it might have to happen, so it wasn't completely a surprise. But it was, the speed at which it happened was, was quite a surprise really.

Did, were you disappointed to have a caesarean rather than a natural delivery?

Yes, I think I was slightly disappointed. I think I'd hoped to have a normal, natural delivery and - really because I hadn't managed to get pregnant myself, and I hadn't managed to go into labour myself, so I thought it would be quite nice to do something normally, but it wasn't to be. And in the end it, it wasn't a big issue, I don't think, for me, because, you know, we had a healthy baby which, you know, at one stage we didn't think we would have. And that was the main thing. And I think in the end, you know, several months later how I delivered wasn't a feature at all. It was the end result was by far the most important thing for me.