Why the new NICE guidelines are important to me
Like many pregnant women, I have been unable to avoid the current news storm which has been rumbling for a number of days. Since the National Institute for Health and Clinical Excellence (NICE) revealed its revised plans for pregnant women requesting caesarean sections, a number of articles have been written and social media has been talking.
The proposed guidelines suggest that all women should be allowed to request a c-section, whether or not she has a medical reason. Does this mean that the NHS is finally taking emotional wellbeing into account? For me, and the thousands of other women who have previously suffered a traumatic birth, this is a major step in the right direction.
My daughter was born seven years ago via ‘emergency’ section, after induction. She had become distressed after the umbilical cord became wrapped around her neck, body and foot. Each contraction caused her oxygen levels to drop and despite all the pushing in the world, I was unable to deliver her ‘naturally’.
This experience was not, at the time, traumatic for me. The midwives and the surgeons made sure that I was informed about every little detail as they worked to save our lives. I was - and always will be - eternally grateful to them.
The story doesn’t end there. When I discovered I was pregnant again in March 2009, I started to obsess about the birth straight away. I didn’t want another emergency section, since I had had a good few years to realise just how lucky I had been. My daughter and I had been spared, but many were not. I had no faith in my body or my own ability to be able to give birth naturally. I was scared. I wanted a planned section.
I struggled emotionally throughout my second pregnancy. I was literally torn between wanting a ‘natural’ birth - thanks to those who insisted that it was the best thing all round - and wanting a calm and relaxed atmosphere in which to give birth.
I had never felt that my section had cheated me from a natural experience which many were telling me was now my right to demand. I didn’t want to spend long, agonising hours in labour only to find that the only way I would deliver my baby would be on an operating table. It made more sense to cut out all of that pain and fear in the middle.
Of course, there were no medical reasons why I wasn’t able to give birth vaginally to my son. I was only 31, healthy, low BMI, no medical complications. My pregnancy was ‘text book’. My fears and rapidly declining mental state was not. The dreams, the anxiety and the fears were locked inside. The one and only chance I had to expose them was at my 36-week consultant appointment, during which my section date would be agreed.
I met with a reluctant registrar. I was told that my son was too small and that a planned section at 38 weeks would be dangerous. I was told that my son would not become tangled in his cord as my daughter had and that I would not be scanned to check.
I was, however, given a date for a planned section, in the ‘unlikely event’ that I should go overdue. Three days before I was due to go ‘under the knife’ my hospital called to tell me that they needed to put back my surgery date by four days. The night after I was supposed to have given birth to my son in a nice, calm operating theatre, I went into labour.
I was terrified. The staff at my hospital did not know how to deal with me and instead, they left me to it. They were determined that I was going to have a natural birth and decided that as little intervention as possible was the best course of action. Despite having been told I was a ‘high risk’ patient, I was left for just over ten hours without an examination and with very little pain relief. I had seen one doctor, who told me I was not in labour, which left me feeling even more frightened and confused. Eventually, a midwife offered to examine me and I was taken straight to a delivery room at six centimetres dilated. From there, I progressed quickly, which meant that my requested epidural did not work properly. I was in agony- and terrified.
At 6.35 pm my son’s repeatedly dropping heart rate failed to recover for the last time and in that silence I knew something had gone terribly wrong. Having already asked whether I could have a section now, or whether I needed one, and being told quite firmly that ‘NO’ I would deliver this baby naturally, I was, at this point, beside myself.
The silence seemed to stretch on forever before I was rushed to the theatre and put under general anaesthetic to become a mother once more. According to my notes, the surgeon put his knife to my skin at 6.37 pm. That was the longest two minutes of my life.
I missed the first hour of my son’s life. I missed the fact that a tube was inserted into his throat to resuscitate him and I missed his first cries. I will never forgive myself for that. People have since asked me why I blame myself for this, and to me it is simple. I wasn’t forceful enough. I never told anyone how scared I was and how much I wanted a planned section. I didn’t make sure I was listened to.
The new guidelines have a real significance for me. I am now 24 weeks along and one month ago. I met with my consultant to discuss my method of delivery. Again, I was told that I had no real medical reason to have a planned section, despite, in my case specifically, there being a 40 per cent chance of my scars rupturing. Again, I felt that my fears and my desires for a calm birth were not being listened to.
More than that, my emotional wellbeing was not being respected. I may not have a medical reason for wanting a planned section, but I certainly think I have a psychological one.
My son was eight months old when I approached my GP to confess how I was feeling. He diagnosed Post Natal Depression and I was left with a nasty taste in my mouth. It wasn’t enough to prescribe me some pills and send me on my way. I needed to talk. I still need to talk. One of the most important parts of the new guidelines states that an intervention for evaluation includes ‘psychological outcomes (postnatal depression, post-traumatic stress disorder, self-esteem, mother–infant bonding)’ and cites a previous traumatic birth as a major reason for a section being a reasonable choice. It also states that these women should be offered ‘intensive midwifery support’ and referrals to mental health professionals.
For me, the most significant part of the proposed new guidelines comes right towards the end of the document. One single sentence sums up all of my feelings, emotions and fears so succinctly while at the same time absolves me from the so-called ‘too posh to push’ brigade.
‘Crash’ CS is a psychologically traumatic event for women and their partners’.
I welcome the new guidelines, in particular the highlighting of the necessity to counsel women appropriately and to understand fully their reasons for wanting a planned section. I only hope the guidelines are passed and that this happens in time for me to finally get the birth I deserve.
See also:
 revealed its revised plans for pregnant women requesting caesarean sections, a number of articles have been written and social media has been talking.){kind=link}
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