Interview 14

Age at interview: 36

Brief Outline:

Required treatment for thrombophilia and a streptococcal infection but pregnancy otherwise normal. Labour involved more intervention than she had wanted.

Background:

Children' 1, aged 8 months at time of interview. Occupations' Mother- marine policy officer, Father- environmental manager. Marital status' married. Ethnic background' White British.

She enjoyed both NHS and NCT antenatal classes. The NCT in particular gave her information to make her own choices about care.

Did you, did you do any antenatal classes?

Yes, my husband and I decided that we would do the standard antenatal classes that, provided by the local auth-, local health board, and then we also opted to do classes with the NCT, National Childbirth Trust, because we just felt that there were only, I think there were only four classes provided by the health board and it didn't seem very many, really, in terms of, you know, finding out about something completely new, and the NCT sort of series of classes was slightly, slightly longer. So we did the two in parallel and it was quite good actually. There was some repetition but it, it did mean that we felt quite well briefed on all sorts of things. And I think the NCT one was slightly more independent in terms of giving you the information if you needed to challenge anything that the health professionals might, might want to sort of steer you towards, giving you a bit more independent information to help you make up your mind.

What, what sort of things were they sort of equipping you to challenge if they were to arise?

Things like, well, it was basically what questions to ask if you were being pushed down a certain route perhaps for intervention during the pregnancy, or during the labour in particular. So, in terms of aspects of pain relief or the position that you were being asked to, to take for delivery, aspects to do with drugs you might be offered or, you know, the vitamin K injection that you're offered after the baby's born, that sort of thing. There were various, the various sort of interventions and just knowing the right questions to ask, or if there's a sudden, you know, emergency what are the sort of options that you have, so that you would be calm in that situation rather than being sort of slightly flustered and not quite knowing what to, what to ask.
 

During pregnancy she had a streptococcal infection, so she had to have intravenous antibiotics during labour.

I was tested at one point during the pregnancy and they found I had a urinary infection that was group B streptococcal infection and that apparently is a, is again a risk to the baby if it's transmitted during the birth. And for that reason I was told I was going to have to be on intravenous antibiotics during the labour as well, which was one more thing that I'd have to be wired up to when I was actually giving birth. So, yes, I, it was, it was unfortunate that again it was, it was something else that was kind of on a drip. But on the other hand, again I did some research and found that it was, seemed to be a good idea to go ahead with this treatment because it does minimise, minimise the risk and you can have a very sick baby if you don't have this treatment or if it does get infected. So it was worth, worth doing.
 

She needed daily injections of heparin during pregnancy because of a blood clotting disorder.

Yes, well, I had, I've had blood clots in the past and I was diagnosed as having a condition called Factor V Leiden, which means my blood is prone to clotting. And because pregnancy is an added risk of blood clotting we knew in advance that I would have to have treatment throughout the pregnancy for, to thin my blood. So I was put on low molecular weight heparin, which is a daily injection called Fragmin, which I was slightly concerned about being on it, partly because of, you know, whether there would be any risk to the, to the baby and also because the thought of having an injection every day for almost nine months was a bit off-putting. But in fact it wasn't, once we got into the routine of it, it wasn't a major thing at all, and it, and it went fine. And actually I think that probably reduces the risk of miscarriage a lot, because there's a risk of blood clotting in the placenta if you don't have this treatment. So it was, it worked out okay.

So and who discussed the sort of issues and risks around your condition with you?

Well, I, my GP primarily, initially. And I had already had contact with a consultant in [city] who had, who's a specialist in this condition, and she sent a letter to my GP explaining what the treatment should be. And then I went into [town], I went into the local hospital, and met with the consultant there and he confirmed that, what the, the treatment would be. And he was the person that I saw sort of now and again throughout the pregnancy to, to just discuss how things were progressing. He was very helpful.

So did you feel that, confident that that was being sort of looked after and..?

Yes, I did, I felt that everyone knew what the issue was and everyone seemed to be agreed on the treatment. I did actually also consult a few websites on, on the internet. And there was actually a support group for people suffering from this condition with a lot of information about pregnancy, and it confirmed that this was the appropriate treatment to be taking. And in fact at the very beginning, even before I got pregnant, I was slightly reluctant, wondering whether I would actually not, not do this and risk going ahead without having the injections. But having read some of the stories on the website I felt that it was very important that I did go through with this due to the risk of having a miscarriage.

What, what were some of the, what was some of the information that was available on this website?

There were quite a lot of personal stories about people who had lost babies at various stages in the pregnancy because of this condition and not having been diagnosed. And they were all basically saying, 'If only we'd known, we could have had the treatment'. There are no known problems to the baby. The risks to, I think there is a slight risk for, to the mother of blood, bone thinning, thinning over a period of time. But it's a minor sort of risk really compared to the sort of positive side of knowing you've got a much higher chance of having a healthy pregnancy. And that, that was all very clear on the website. So it was, it was mostly personal, it was, it's more a sort of exchange of information site between, between people with the condition.

She had a painful induction which was not what she wanted, but she was pleased to have managed the pain with a TENS machine and gas and air.

So did you feel disappointed about the way the labour went?

No, I don't think so. I mean at the time it was, it seemed a very long time but I was quite, I mean my main priority was not to, not to have an epidural or to, you know, I wanted to be aware of the whole process. And that was fine, that, that happened. I suppose it would have been, it would have been nice if it had been shorter and if we'd had a more cooperative midwife for the bulk of it. But in fact, you know, I was very pleased that, that I'd done it sort of almost without too much intervention in terms of pain relief and, yes, no, I mean it was, it was fine really.

Tell me again what did you do for pain relief?

I just used a TENS machine which I'd hired myself and then gas and air in, that the hospital provided.

Do you want to just explain what a TENS machine is?

A TENS machine is, it's a machine that you strap onto your back that, with little sort of pulses that you can then control the flow, it's sort of electrical pulses that dampen down your pain sensations and you have control over how quickly or how strongly the impulses are sent to you. So you can actually sort of switch it on and off to help you through your contraction and it's, it does actually help quite, quite well to block the pain out. And you can hire it in advance so you practise with it, but then obviously when the, when you're in labour it's, it's a whole new experience [laugh] sort of trying to work out when the contractions are coming and operate it. But, no, it was, it was quite useful.
 

Being on a drip and monitor made her less mobile in labour than she wanted, but a new midwife came on duty who helped her find a good position.

Did you make a birth plan?

Yes, we did make a birth plan and we sort of opted to go for the minimum intervention possible, but obviously acknowledging that that might change on the, on the day. But that, yes, we were just basically sort of saying we didn't want to have any more drugs and things than we, than we needed to.

And what actually happened on the day?

[laugh] Well, it wasn't, it wasn't too divergent. I did manage on a TENS machine and gas and air in terms of pain relief, which was what I was hoping to do.

But we did, because the labour got off to a good start and then slowed right down, they wanted me to have a, an artificial hormone drip to speed up the contractions. And we did go for that because it, otherwise it was, it seemed to be starting to be a slight problem for the, for the baby because it was taking too long. And in terms of the position that I had wanted, I had wanted to be quite free and able to move around, and that actually proved to be more of a problem because as the labour got progressively longer the midwife was very keen to have me wired up to all sorts of machinery. And she was far more interested in making sure that the machinery was, you know, the monitors and things were all wired up and that I wasn't, you know, interfering with the wiring, than helping me get into a good position. So that was, that was, wasn't really what we'd intended in the birth plan.

Did you challenge her at all?

We tried to, and my husband in particular because he was obviously less involved in actually [laugh] trying to give birth. But it was quite hard to challenge her and that was, that was, I think that was difficult, given that we'd been quite keen to sort of have, have a bit more control over the whole process. She kept sort of saying, almost sort of saying, 'Well, you know, it's your baby's health that's at risk'. And I think in retrospect that, that was a little bit over the top, it wasn't really that much of an issue. And when we had a different midwife for the final stage because the shifts changed she had a quite different approach, and I think if we'd had someone like that a bit earlier the whole thing might have gone quicker because I would have been in a better position. And also she wasn't particularly helpful at explaining what I needed to be doing at different points. And as soon as we got the new midwife then it was, it was a lot easier all round. So it was just a shame I think that we had that particular person who didn't seem as helpful as other midwives that we came across.

If you were to have a second pregnancy and you found yourself in a similar situation, what, how would you handle it then?

Well, I suppose I'd try to be a bit more forceful, but obviously it's difficult because you do to some extent have to trust their professional judgment, and if they are saying that there's a risk to the child then you do to some extent have to obviously pay heed to that. But I think they also, you know, it's a shame if they don't recognise that it's, the importance of a woman being able to choose her own position and to do what feels right and what feels natural. And hopefully that message is getting across to midwives more and more anyway. I think a lot of the midwives seem to be quite, quite switched on to that.