Delivering real choice after a Caesarean

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... LOUISE McCANN felt like a “freak” when her first baby was delivered by Caesarean section, after attempts over three days to induce her failed.

In the immediate aftermath, she was just glad Darragh had finally been born and they were both okay. “It is only down the line, when the initial elation wears off, you kind of think what went wrong?”

It was a question that came back to haunt her when she was pregnant again within a year. Everything had been fine the first time until she went overdue; she was 28 years of age and had had a straightforward pregnancy.

“I was a bit naive, it being my first baby, and I assumed that if I was being induced it was going to work.”

... “I found out later I wasn’t ready to be induced.”

On her second pregnancy she was determined to try for a VBAC ... She found the consultant initially supportive but, at 38 weeks, he told her to prepare herself for another section.

She believed he was trying to scare her into it by overstating the risks of a VBAC. “He was throwing stats at me and I would have to come back and say, ‘I looked that up and it is not true’.”

McCann was resolute that there was no need for a section; she was healthy, there were no complications and she had not even gone full term at that stage.

... women who go into spontaneous labour after one previous section have about 80 per cent chance of vaginal delivery ...

“When a woman has an unhappy experience with a first labour, she does not want to repeat the experience ...

As the second pregnancy progresses, inevitably the memories flood back and they get extremely anxious. They are assured the same thing won’t happen.

... “Women who have had a normal birth and then a section can never understand why somebody would elect for a section,”

... “The majority of women who have had a section and then a normal birth say, ‘I am glad I did that’.”

... research in Scandinavian countries shows that if women are debriefed and counselled after an emergency section, they are more likely to opt for VBAC.

[Debriefing gives] you some closure on what happened and help you plan for the next pregnancy ...

... "Women are not getting the information to make an informed decision as to what is the safest option in their case.”

Generally, VBAC is associated with a lower risk of complications, for both mother and baby, than a repeat section.

... To people who argue that all that matters is a healthy baby, not the method of delivery, she says that is exactly where VBAC comes in. “If that in the end is all that you care about, then VBAC is something you should seriously consider.”

... “Every woman’s circumstances are different,” he adds, “but the best way is to go into labour spontaneously.”

That is what Louise McCann was holding out for in her second pregnancy. The consultant scheduled her for a section at 12 days overdue – although she had no intention of going in – but she went into labour at home in Naas, Co Kildare the night before.

“Things had been progressing well at home, but when I arrived in the hospital everything stopped – I suppose it was nerves and fear.

“They were trying to push me for induction and telling me I had 12 hours and that was it ..."

When her daughter ... arrived, 12 and a half hours later, McCann was relieved that she was healthy and had been born without unnecessary surgery.

... Less than a year later she was pregnant again. Having had a VBAC, there was no pressure on her this time and she was allowed to opt for the midwifery scheme – something which had been ruled out when her history was just one section.

... Ruth Doggett was in labour for 12 hours with her twins before it was decided to deliver them by Caesarean section.

... The official reason given was “failure to progress” ... However, she says, “if I was doing it again, having learned more about sections and things, I probably would have fought that more.”

When Iseult and Lachlan were 15 months old, Doggett became pregnant again. She wanted a home birth but was told that having had a section, she was considered too high risk – nor was she eligible for the midwifery scheme.

Although she had gone private for her twins, she did not want to be under the care of one consultant this time.

“Consultants are great but they all have their own opinions and, [by] not knowing them well enough, it is hard to tell will they really have the same values and beliefs that you have – especially when the day comes.”

She opted for semi-private care, where she was seeing midwives and registrars. “I found it fantastic. Every doctor had a different view of my situation, so it reaffirmed my belief that I had to trust my own instincts and my own bit of research of what was best for me and my baby. Then take all the information I was getting and make a decision for myself.”

She was very keen to try for a VBAC and medical staff were supportive, telling her she had a 70 per cent chance of having one.

However, she took issue with some of the hospital’s policies for VBACs, such as that she would be allowed only seven hours of active labour, after which she would need to have a section.

“I was really concerned about that – the possibility of being on a clock and saying I had seven hours to give birth, to me that was just crazy.”

She was told she would need continuous monitoring because of the risk of scar separation (which is less than 1 per cent when women go into spontaneous labour), but she wanted intermittent monitoring so she could be free to move. Also there was a policy for induction at 10 days overdue, but she wanted to be allowed to go 14 days over.

As it turned out, she went into labour at five days over, early one Thursday morning last April. She spent the day at home ... “I wanted to get as close to delivery at home so I would not be on the clock.”

At 10pm she went into hospital to be checked. “I was 4cm [dilated] , the baby’s head was down ...

Then Doggett was questioned about things she had specified in her birth plan – such as longer time limits and no continuous monitoring. A registrar explained all the risks and asked her, she says, was she prepared to be in labour 24 hours, to have her baby flat-lining at birth or to have cerebral palsy.

“It was an awful thing to be asked. I said, ‘I want what is happening to me in my labour to be dealt with; I don’t want to be dealt with on the basis of statistics. Obviously I want my baby to be healthy’.”

Although she was sent to the delivery ward, she remained at 4cm. “I actually love being in labour, I know that it is a strange thing to say. I don’t find it painful; it is just a cramp. It is quite an exciting time.”

But, conscious of the clock ticking, she was becoming stressed as she heard talk of another section. However, then she was told she was not in established labour and was being moved back to the labour ward where she should try to get some sleep.

On Friday, one registrar said if nothing was happening by 6pm she should have her waters broken. But then word came down from a consultant that, “if I did not want any interruptions or interventions and everything was progressing fine – slow but no distress – that there was no need to get involved”.

She was delighted with that news and was moved into the pre-natal ward. “It was fantastic; I could eat what I wanted and I was off the clock. I relaxed completely there.”

By 10pm she felt the contractions changing and by 1am needed her Tens machine. She was found to be 7cm dilated and moved to the delivery suite.

She agreed to her waters being broken when she was almost 10cm dilated. “Nothing happened for about 15 minutes then the second phase started and that was incredible.” One and a half hours later, at 6.50am on the Saturday morning, Caelan was born, weighing 9lb 9oz.

... “being able to deliver him myself was empowering and kind of healing in lots of ways.”

Melissa Maimann, Essential Birth Consulting 0400 418 448