Being able to have some control during pregnancy and childbirth seemed important to many respondents but this meant different things to different women. Some women described how experiences in pregnancy had made them feel out of control of their bodies. Some women had experienced unpleasant physical symptoms including nausea and vomiting, vaginal
At the start of the pregnancy I was very happy to be pregnant, it was very wanted and planned. But I had really, really bad sickness… I was just very unwell and I was quite miserable being pregnant... I think it just knocked my confidence and I just thought: “Am I just being a wuss, can I not deal with this like other people can?”…I never made a birth plan, I just couldn't think about delivery. So I kind of think that is probably why… I wasn’t gutted at the thought of losing a normal delivery. Because I had never got to the point where I was getting excited about it, or planning it or thinking: “This is important to me.” (Aisha, planned CS, antenatal interview)
Eleanor’s description of decision making also suggests that feeling out of control of her body had impacted on her decisions. She recounted a negative experience when an obstetrician confronted her about her weight at the time she discovered her baby was breech:
In my mind I was like: “Oh, I’ll lose a bit of weight before I fall pregnant” and then I fell pregnant straight away… I’ve always had problems with my
weight…I’ve always struggled and I’ve always gone from one extreme to the other… she [the obstetric registrar] came in… and said: “You’re going to be here [antenatal clinic] ages because you need a scan because basically you've put on so much weight that your baby could be in danger.” And I was like: “What?” I was absolutely shocked… So I got really upset. (Eleanor, successful ECV, postnatal interview)
She went on to explain how this had contributed to a loss of faith in health professionals. She described various examples of when she had been given contradictory advice, not only about the implications of weight gain in pregnancy, but also in relation to the options for breech presentation:
I’m massively in favour of the whole skin-to-skin contact and I think that… wasn’t consistent in the hospital… When the doctor suggested I have a caesarean, I said: “Oh I don’t want a caesarean because I want skin-to-skin contact. And she went: “It’s not that important.” I was kind of like: “I’ve just been to four
workshops at your hospital where you’ve told me it’s categorically the main thing to do and they were like: “I know but at the end of the day, the birth of the baby is more important.” So I was like: “Be consistent!”… “I want an ECV.” (Eleanor, successful ECV, postnatal interview)
Thus, it appears that recognising inconsistency in the advice she was given made her more confident to ignore their recommendation to opt for CS and choose to attempt ECV. In this way, despite feeling undermined by the obstetrician, she appears able to take back control of
I don’t care what people say… the only thing a woman worries about when you’re pregnant is the pain. What is it going to be like if I have this? What is it going to be like if I have that? And some people say: “Ah well, I’ll just do what’s best for me baby.” But at the end of the day, you do want to do what’s best for you baby but at the same time, pain. The fear of pain takes over your decisions really… I feel like I have quite a low pain threshold… other people like me mam, who had three kids, said: “You should never have got pregnant if you didn’t want to have the pain. Stop being a baby…At some point in your pregnancy you’re going to have some kind of pain. Either you have a caesarean or you have natural childbirth. At some point you’ve got to expect a bit of pain so just get on with it.”… I know I don’t like pain, so it was a major issue for me. (Nina, successful ECV, workshop)
Women were particularly concerned about attempting a VBB which they anticipated would be more painful than labouring with a cephalic baby.
I would never choose to do it the other way [VBB]. Partly because I remember my mam being breech herself and my nanna had had a terrible time and had to go to hospital, because all her other babies had been born at home. So I thought there’d be a great deal of pain associated with me delivering [breech] and I was exhausted. (Grace, emergency CS, workshop)
For other women, having control meant avoiding the uncertainty about the outcome of an attempt at ECV or labouring vaginally. For example, for Sophie choosing a planned CS gave her control over the sort of birth she wanted as well as avoiding the risks she associated with ECV:
I just kept looking at the fact that I can [sic] have a planned section with, obviously the risks associated with section, or I can have them turn him unsuccessfully. I don’t know why, I just kept thinking something would go wrong… if I let them turn him… that to me seemed more invasive than having them cut us open… I didn’t want to have an emergency section… but if the ECV goes wrong I have to have a section anyway… I know planned surgery… I know it’s calm. (Sophie, planned CS, workshop)
Like Sophie, most respondents wanted to avoid an emergency CS which they perceived as more frightening and stressful than a planned CS:
something’s gone wrong. (Heather, unable to attempt ECV due to low AFI and planned CS, antenatal interview)
For some women control meant being able to choose when their baby would be born, usually by planning a CS.
This is just the best for me and obviously the best for the family… Maybe if he [her partner] hadn’t the time off, I would have thought maybe a little bit
differently about being on my own with my son… But this is just best, so everything can be organised. I’ve got a date, I’ve got someone to watch me son, he can go to school and everything can go back to normal…I just feel safer knowing I’ll go in on a morning. I don’t have to go into labour…. It’s nice to know when you’re baby’s coming as well and when your baby’s birthday is. (Tina, planned CS, antenatal interview)
Although most women with children wanted to avoid a CS (see above), Tina recognised the benefit of being able to schedule childcare around a planned CS.
Occasionally, women described exceptional circumstances which meant that being able to plan the timing of the birth was desirable. For example, Aisha’s mother had a terminal
illness, and her health had deteriorated during Aisha’s pregnancy. Aisha had therefore chosen to have a planned CS to bring forward the birth of her baby (compared with potentially having to wait several more weeks for labour after a successful ECV) to increase the likelihood of her mother being able to meet her baby:
So my Mum’s illness has been such a stressful factor in the past six months that I didn’t think she would be here now. So when I thought about a section, and the fact that it would be at 39 weeks rather than maybe I might go over and need to be induced. I just thought: “My Mum will see my baby!” Because she is so excited about it. I know it has given her a lot of strength and purpose… I appreciate it is not a typical reason, because logically I do think ECV would be a sensible route. But just with everything that has gone on… I just want to have my baby. (Aisha, planned CS, antenatal interview)