Caesarean Choice

Teresa Wilson was determined that second time around: birth would be in her control and opted for an elective section.

For many women, the birth that I experienced with my son Sean, now three, would have made them contact VBAC (Vaginal Birth after Caesarean) without hesitation in order to have a successful vaginal delivery'. Not for me, though. My 19-hour labour of non-progression, non-dilation leading to fetal distress and an emergency section led me to one inevitable conclusion: childbirth is a painful, distressing experience. I felt I had all the pain without the joy of seeing my son enter the world - the bit that makes it all worthwhile. There I was, un-conscious, only able to greet him after about eight hours of recovery, from the anaesthetic. To me, this was far from acceptable. less than ideal and I wasn't prepared to take the risk again.

The first reaction from the medical profession was - forget it. They were insisting that I had a trial of labour first. What an emotive expression: to me this would have been a replay of birth number one. But I eventually got my way after writing to the consultant obstetrician and asking my GP to do the same. The section was agreed to on the grounds, amongst other things. that my first baby never engaged and dilation didn't progress well. possibly indicating that my pelvic outlet was too narrow and that there was every chance that a similar labour could result if I tried a second time.

Having this battle behind me was a tremendous relief which, in fact, hadn't realised until I knew I could go ahead with the section. From then on I thoroughly enjoyed my pregnancy the knowledge that the birth would be as I wished.

Of course, there were fears. What if the anaesthetic didn't work? or if it did permanent damage? What if the baby wasn't ready to be born and had difficulty breathing? And the fact is that more risks are involved with caesareans. Was I being selfish and irresponsible? These considerations had to be addressed, but after much thought I knew I was doing the right thing in the circumstances and was prepared to stand by my decision and its consequences.

My other concern was my husband. He'd attended two previous births. both of which were traumatic. He felt queasy at the sight of an elastoplast. Could I expect him to be there with me? I decided not. It was too much to expect of him, and frankly, I didn't want to worry about how he was coping. I had enough on my plate. However, as the pregnancy progressed I began to think it would be nice to have a familiar face close by. Some time later, Richard and I were talking one night about the birth (again) and he told me that of course he would be there. He also said that he'd felt that there was a party going on and no-one had given him the opportunity to say that he wanted to come. I was delighted to have been so wrong about him, and learned a lesson from it.

I found that one of the slightly wicked delights of a planned section is that you can make all the arrangements beforehand, knowing when the baby will arrive. Maybe this lack of spontaneity reduces the pleasure for some, but for me it was a godsend. My mother has work commitments and lives 200 miles away. It was a blessing for her to be able to book leave and be here for my son and stepson with plenty of notice.

The preparation for the birth started the day before the due date with a visit to the hospital in the afternoon; in my local hospital it's possible to return home again overnight, which I preferred to do. So the visit was to have blood taken and to sit with a trace on the baby's heartbeat.

The anaesthetist also visited to check details, as did one of the house obstetricians. Finally I was given two tablets to take home with me. These were to reduce acidity in the stomach shame - they're not pre-meds, I couldn't help thinking.

I did sleep that night, which surprised me, but I was awake bright, early - and nervous. We were due at the hospital at 8am, and when we arrived we still didn't know our place on the list for that morning. In fact there were only two of us due to be delivered and the other woman had gone into labour in the early hours. So I was number one on the list.

I guess one of the worst parts of the morning was waiting in my gown to be taken to the theatre. Richard and I were very quiet. How could it be possible that in half an hour we'd be holding our baby?

Then it was our turn and now I can't remember anything about the walk from ward to theatre. Once in there, there was no delay. Richard held my hand as I curled forward to receive the local anaesthetic and spinal block: a one-off injection, denser than an epidural and lasting for a couple of hours. This was my biggest fear - but it was totally painless and within seconds I was going numb and my legs were swung onto the table. Richard then disappeared to gown up and returned with the surgeons and, daft though it sounds, I really didn't recognise him and wondered why on earth this green-clad doctor kept on raising his eyebrows at me.

The staff couldn't have been more supportive or informative. Contrary to what I'd heard, the operation took longer than I'd expected: about 15 or 20 minutes. Richard was back on hand-holding and intense-eye-contact duty, but had the sense to ask whether I wanted to talk/be chatted to, or not. I just wanted to concentrate on what was happening which, incidentally, neither of us could see unless we made a special effort, and we both thought we'd give that a miss.

I was also warned that I may start to feel very nauseous as my blood pressure dropped in response to the anaesthetic. It did and I did, so I was glad of the warning.

I didn't feel lots of tugging and pulling, but suddenly, to our delight, we heard the cry that announced our daughter Alexandra's arrival. That cry was magical to me and made up for all that I'd missed at Sean's birth.

My only complaint? I had to ask and ask to put her to the breast as soon as possible.

'Oh no dear, you can't do that in the theatre.'
'Oh no dear, we're just going to clean her up.'
'Oh no dear, we'll just set up the drip,' and so on.

I got her, in the end, and I didn't let go for a long time.

The other 'well-known fact' about sections is the relatively slow recovery and initial lack of mobility. I don't know how a natural birth feels so I can't compare, but two or three hours after the birth I had all my sensations back, and 24 hours later my catheter and drip had gone and I was able to walk. And for that 24 hours, Alex was cuddled up in bed with me, so mobility was less important. Of course, the wound was very sore for a couple of days and I had some very severe afterpains: painkillers were definitely necessary for me, but it was for a short period and then the recovery was quick. When Alex was three weeks old I could barely feel wound. Also, I successfully initiated breasffeeding both my children.

I am not endorsing sections as a preferable alternative to vaginal delivery, but I do think that one shouldn't feel guilty about wanting a better quality of birth the second time around if the first one has been pretty disastrous. Not everybody has the conviction that they can achieve this in a vaginal delivery. What a shame, I feel, that so many women have poor first experiences, some I feel sure, as a result of over-intervention, lack of support, fear and so on. But my second birth was the best I could have, on my terms.

First published in NCT New Generation March 1994

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