Losing control of the delivery

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I write this article knowing that this time last year I was still ignoring the fact that one day the baby making my bump get bigger and bigger was going to have to come out one way or another!

As December 2014 arrived and the 20-week scan had been reassuringly normal, I started to join some antenatal groups – Pilates and yoga. It was at these groups where I started to be exposed to other pregnant women, outside of my social group and my workplace. I was the new recruit, and as such the other women tended to be further along in their pregnancies. I’m not sure when most women start to think about the labour process and delivery of their baby but these women were all far enough along to be putting bags together, thinking about pain management in labour, etc. I admitted at these groups that I continued to live in blissful ignorance of how our little girl was going to arrive into the world.

That last sentence is perhaps not strictly true. As a medical student and doctor I did attend a number of labours – both straightforward and complicated, but mostly complicated.  I think I wanted to be completely ignorant to the birthing process but unfortunately knew too much to be in such a situation. Instead I was trying to block all my previous experience out and hide from the reality of the situation. I had tried to leave it a suitably long time between the last delivery I was in attendance of, and having my own child to help this situation. In my head I had visions of complicated labours, forceps, a ventouse, big needles, tears and episiotomies, and CTGs (electronic fetal monitoring).

So I eventually decided, around January time, that I might need to start thinking about this more seriously. There was a page in my maternity notes for me to complete my desired birth plan. Whilst many aspects seemed pretty easy to know what I did and didn’t want there were some more tricky areas. Things that I wasn’t too sure about what the answer should be. But in the back of my mind my greatest fear – being overdue and needing to be induced. A lot of the concern surrounded the little chart in my notes, produced at the scan. It gave a rough estimate of what the birth weight of my baby would be. If born 2 weeks late she was looking to be around 9lbs or so. I am 5”3’ and petite. I grimaced every time I thought about the prospect of delivering at 9lbs baby, and the ease with which such size of baby would pass through my birth canal! So my secret hope was that she would be delivered by 40-weeks. Another worry I had was the process of induction, and the success of them. In my time as a doctor I had seen many women being induced. I had done many weeks of on calls in the hospital, returning 12 hours later to find a woman still waiting for something to happen, seeing the drips they were given, the epidurals required to deal with the painful contractions that lasted for days, the need for assistance from use of a ventouse, to requiring a caesarean because nothings happening. I heard the experiences of friends and acquaintances who’d undergone inductions. I realised I just didn’t want that experience. My birth plan was for a labour that was as active as possible – I wanted to keep up and about for as long as possible. I felt that an induction had the potential to be quite the opposite. I worried that I would end up required an epidural early on to manage pain, and this would affect my ability to keep active. I also was very keen to avoid labouring for a long time, and then requiring a caesarean. I know that a labour that wasn’t induced could potentially be much the same but I really didn’t have control of when I would enter labour spontaneously, whereas I should have some control over being induced. I also knew that I wouldn’t be prepared to put my baby at risk, as may occur if you choose to continue to wait. Many sources agree that the risk of stillbirth is higher after 42-weeks of pregnancy. So I decided that should I be overdue I would wish for a caesarean to be planned on the date that I would otherwise be induced. I discussed this with my husband and he fully supported this decision. It was then time to broach the topic with my midwife.

I was nervous, as I know many midwives are keen for women to have as normal a birth as possible. However, my midwife was lovely. She asked a few questions to investigate my decision making process and offer further support in making such decisions. She then referred me to a consultant obstetrician for further discussion. I attended this appointment with my student midwife sister. We were there for more than an hour speaking to one, and then another, consultant. They questioned my decision making, the amount of experience I had in obstetrics, what my husband thought and his degree of experience, whether I had ‘tocophobia’ (the fear of giving birth!) and whether I wanted to have counselling. When in fact I had ‘melonophobia’ (the fear of giving birth to a baby the size of a melon!). They gave me statistics about induction and caesarean, they gave me other options – more sweeps for example. I took it all in, and felt that I was reasonable and listened to all other options. I just felt they couldn’t offer me what I really needed, which was reassurance that I wouldn’t be put through an induction, it be a long drawn out process and potentially end up having a caesarean anyway, in an emergency setting. I had prepared in advance of the appointment and knew that guidance stated maternal choice was a reason for caesarean.

In the end I was pencilled in for a caesarean for a date that would occur if I were 12 days overdue, with a plan that I would have cervical sweeps if they were possible at 40 and 41 weeks. My final decision was made because of my strong belief that I could live with any decision that I have made and is my own. In such circumstances if anything bad happened I could blame myself. However, had I been convinced to have an induction and anything went wrong I would hold the blame against those who convinced me to make the decision. I really didn’t want to live with such feeling. Throughout the appointment I kept reiterating that I felt this was all hypothetical and hopefully she would arrive on time. I was proved right, as the conversation clearly spurred her out and she came to the world safe and sound two days later!

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