Interview 56

Age at interview: 32

Brief Outline: Two normal pregnancies. Felt well supported by midwives in making birthing choices. First birth was a water birth in hospital; hopes to have the same for second birth. More of this interview can be seen on the Healthtalkonline antenatal screening site as Interview 25.

Background: Children' 1, aged 17 months at time of interview. Occupation' self-employed consultant. Marital status' married. Ethnic background' White British.

Describes how she and her partner felt about the responsibility of deciding to have a baby.

But we had sort of talked in general terms just around the decision to have a child, really in terms of, you know, why we were, why we were having a baby [laugh], and what it meant I suppose to us, and the fact that we knew, in making that decision that, that there were some things which you can't control and that to some extent nature takes its course. And that I think, you know, we were very conscious that, we didn't assume we were going to get pregnant in the first place, for instance. We, we were sort of, we tried to manage on the basis of fairly low expectations, because I think, we both very much believe that it's not, it's not a human right to have a child, and that it's a responsibility that we both took very seriously. And I suppose that sort of affects our feelings about choices that you might make along the way in terms, of bringing a child into the world.

She went to the GP thinking she was 8 weeks pregnant and discovered she had not understood how to...

And at what point did you make contact with health care about the pregnancy?

It was about 8 weeks. Again I, I didn't see the point of rushing down to the GP's just to have something confirmed that I already knew. And I wasn't particularly aware of the fact, the need to get into the system, as it were. So it was, I think it was about 2 months in.

What prompted you to go at that point?

I think, I had a general awareness, because I've got three, I've got three sisters and they've all had children and I had a general awareness that there were scans available and that the 3 month sort of timescale was, was significant in some way, and so I thought, 'Well, if I go a month before that I can find out, you know, what's on offer and, and start to sort of get my head round what's, what, what the services are' really.

Did you know about things like folic acid and stuff before?

I did know about folic acid, yes. Yes. I think it was from general awareness, but also in terms of probably talking to other people around, around pregnancy and pre-conception.

Right, so you'd been taking it beforehand?

I'd been taking it beforehand, yes.

OK. And so who, you saw the GP when you went?

Mm, yeah.

And what was the response?

That was an interesting conversation, because I, [laugh] I thought I'd worked out when my due date was, and so sort of merrily pranced in to see the GP and was just expecting him to confirm it and give me sort of information about next steps. And the date he gave me was 3 weeks before what I expected him to say and it made me realise that I didn't actually understand how pregnancy is calculated [laugh]. And all this business about 40 weeks from the date of your last period. You know, I, I'd looked it up in, in a book and, and I couldn't quite work out the fact that it's calculated from a certain date at which point you're not pregnant at all. It didn't make sense to me and, and so I had to sort of do a bit of readjusting in my mind that it wasn't going to be sort of S-, into Septem, middle of September, it was probably going to be the end of August [laugh].

She had an excellent midwife who supported her in making informed choices about her own care.

I feel extremely fortunate in the midwife that I had. She was my key anchor person through the whole of my antenatal care and she was first class. And I think for me to say, for me to say that [laugh] means that she was really excellent, because I do tend to be quite discerning, I think, and possibly overcritical sometimes in the way that, that professionals interact with me. She, she has responsibility for training other midwives as part of her job , and so she's very much up to speed with the latest in thinking, clinical practice, and she's also sort of underta-, I know that she's undertaking a degree at the moment and  she's clearly continuing to develop herself as a midwife clinically.

She, but apart from her as a clinician, her as a person did make a big difference. She, she very much respected my need to express my own views about my pregnancy. The pregnancy went on beyond the due date and my little boy ended up being 11 days late and that, that was an example of, of her sort of collaboration with me I suppose in terms of how to proceed with my care, and it always felt that I was in control, which is very important to me. I suppose I was fairly well informed as a patient, as it were, and she said a couple of times to me, 'That's not the sort of thing most people ask me'. Or, she did say to me, 'You are very well informed', you know, and gave me that feedback. 

She was impressed by the way her midwife discussed evidence with her about clamping the umbilical...

That was an example of, of her sort of collaboration with me I suppose in terms of how to proceed with my care, and it always felt that I was in control, which is very important to me. I suppose I was fairly well informed as a patient, as it were, and she of-, she said a couple of times to me, “That's not the sort of thing most people ask me”. Or, she did say to me, “You are very well informed”, you know, and gave me that feedback.  

But she, there was one example where I discussed with her at the late stages of pregnancy the fact that I didn't understand the need to clamp the umbilical cord straight after delivery, because I'd done some reading around it and I'd talked to a couple of friends and I couldn't appreciate why that was done. And the only conclusion I could draw from what I'd read was that it was actually sort of from a clinical expedience point of view that that was done, in order that, “Let's clear up the mess, let's get this baby sort of separated, and then we can get onto clearing up” [laugh], at a basic level. Whereas I was, was reading some stuff that would suggest that there was actually some benefits in retaining the umbilical cord intact for several minutes after delivery, in order that some of the goodness, nutrients, oxygenated blood from the placenta could be taken in by the baby before that supply got finally cut off. 

Because otherwise the baby would possibly have to reproduce those blood cells and so on for itself. And that for me seemed a much stronger set of arguments in terms of the baby's needs and to some extent my needs as a mother than some need for a doctor to sort, to clear up the labour room quickly [laugh]. And so I went to her and sort of explained what I'd read and said, “Am I missing something here?” And she, and she was very honest with me and she said, “That is to do with clinical protocol, and yes, you're right, that to a large extent the protocols around clamping and cutting the umbilical cord are not necessarily based on the baby's best interests”. 

She ended up essentially saying that to me, which confirmed my suspicions, and I don't sort of have a problem with that as such, although I think it's a bit curious. What I was then concerned about was, was my ability to express my wishes to not have that protocol followed tightly with my delivery if possible, and that I could benefit from having, to leave, leaving the umbilical cord intact for some time before then, until it stopped pulsating, until it, before it was cut. And so we got into that level of discussion and I felt it was very important from my point of view to be able to have those conversations. 

And did you, were you able to put it into your birth plan?

Exac-, yes I did. I did put it in and it happened and, you know, I felt, I felt very happy about that. But I needed her guidance to some extent and I think I - you see, I'm not even sure that if she'd have come back to me and tried to sort of, tried to give me, justify the protocol-based approach, I don't think I was particularly open to persuasion, because the evidence wasn't there that that was sensible from my patient, my own perspective. And so she could, she could deal with me as a fairly challenging patient, I think, and I think, you know, that helped to build a rapport and helped me to respect her and to trust her.

She considered a home birth for her second baby but her water birth in hospital had been so good...

In terms of where to have the baby, I remember vividly the very first encounter with my midwife didn't actually characterise what the relationship was going to be like at all, in that I walked in and the first thing she said to me was, 'Where do you want to have your baby?' And I was totally thrown because, [laugh] because it made me feel as if I ought to know what the options were and so on. And, and I quite remember that, sort of feeling, 'Oh my word, you know, I'm not sure'. It didn't set a very positive tone for, for the relationship, but it actually proved to be a total one-off. So she was, she was the one who explained that I could go here locally within the city, or I could actually go across, across to the next authority if I wanted to. So I knew those were options and home, home birth was also discussed. It's been, it's been raised with me sort of proactively by my midwife this time in terms of whether I actually want a home birth and she said that she would happy to support me in that this time if I want to, given that I had a straightforward water birth last time. So I know, I've, I've been clear what the options are. So that's in terms of place.

And are you thinking about home birth now, or are you still planning a hospital delivery again?

I'm, no, we've, we've decided to use the hospital facilities, because I would very much like to have a water birth again if possible, and just in practical terms having a water pool in the house for maybe up to 4 weeks doesn't really feel very, very realistic. And although the environment where I gave birth was clearly clinical, the actual process in terms of who was there and how it happened was that essentially my husband and I gave birth. I gave birth with his, primarily with his support, and the midwives were in the background. And, and that was absolutely fine. And I suppose I, you know, I just feel given that the facilities, should anything go wrong, are 10 minutes down the road, I'm not sure how I would feel if anything went wrong, I was at home, and the 10 minutes it took to get there made a difference to the outcome of the birth. I don't feel strongly enough about being in my own environment to desire a home birth.

Do they have just the one pool?

They have two, although there was one out of, out of order last time. But they tell me that they're not used very much, so the chances of actually getting there and finding someone else is using it are fairly low. So it seems to be under-utilised.