Most respondents explained that keeping their baby safe was their main priority. I’m more concerned about the baby than anything else. (Heather, unable to attempt ECV due to low AFI and planned CS, antenatal interview)
I think the main information that I took into account was: was there any risk to the baby… or is there any risk it could jeopardise your pregnancy by doing it [ECV]? So I think that was important. (Catherine, successful ECV, design workshop) It is possible that social pressures mean women feel required to say this as the protection and nurture of children, beginning in pregnancy, remains central to normative constructs of motherhood (Oakley, 1981; Ruddick, 1990; Miller, 2005). However, respondents shared more details about what this value meant to them, which suggested it was fundamental to them. For example, many respondents explained they would do anything to protect their baby, including accepting risks to themselves. Tina explained that she opted straight for a planned CS, rather than attempt ECV, because she perceived it would be safer for her baby but had accepted that a CS might not be the safest option for her:
I had to go on my gut and it’s: “No” [to ECV]…everyone else had said they’ve either had it done and they’ve been in pain or it’s triggered something. But I just didn’t want that to happen to me and you always think you’re the one it’s going to
I think he was more worried about me, ‘cause to him I was the only person that was important at that point in time. That’s what he kept saying that, “You’ve felt the baby and you know that the baby’s there, but to me you’re the person that has to make the decision as, as it’s going to happen to you. And at the moment the baby’s just, it’s something that’s moved in your stomach… I don’t know it [the baby].” He felt like he didn’t have a connection to her until she was born. (Eleanor, successful ECV, workshop)
Laura’s account of decision making also suggested that women see their unborn babies as separate beings and feel responsible for the decisions they make on their baby’s behalf:
If you’re making a decision about yourself that’s fine… but it’s not just me it’s my baby and that’s where I found it hard…If…something bad happens I’ll have to live with that for the rest of my life… especially when it’s this close to being born, you’ve went that long protecting your baby and doing everything you can. (Laura, successful ECV, antenatal interview)
She suggests that the desire to protect one’s baby is instinctive throughout pregnancy. Other women’s accounts also supported this view. For example, Sophie described how she disliked other people touching her pregnant abdomen:
I didn’t even like letting the [sic], when they were palpating me stomach to be honest. And I was quite protective about who touched me bump… I didn’t like it, you know, random people in the supermarket, “Ee, how many weeks are you?” I would go, take a step back. So maybes that had something to do with it [decision not to attempt ECV]… I was really protective of me bump. (Sophie, planned CS, workshop)
Keeping their baby safe may feel particularly important to women with a breech baby as they are constantly being told about the risks to their baby, including the risk of death (see Chapter 6). For example, Grace explained that was why she had chosen to have a CS rather than attempt a VBB when diagnosed with breech presentation in the second stage of labour:
I thought it… was a no-brainer, if there’s danger to the baby… I think in my own brain I just magnified them [the risks] as they [the baby] would get stuck, that it would just be harder and they’d be stuck in the birth canal and all of those situations. And the last thing you do when you go in to have a baby is to not to take, you want to take your baby home. You know, you don’t want to have that
want to consider a VBB as this sort of birth was generally perceived as risky for babies. Specific risks women were concerned about included: injury to their baby; cord prolapse; fetal distress; labour not progressing; the need for forceps to assist with delivery; and the likelihood of needing an emergency CS.
I was very dismissive of that idea… if you’ve got a small pelvis it could be very difficult for you and obviously the cord… can come out first and the baby can get distressed which I would want to avoid at any costs… and I said to her [the midwife] straight away I wouldn’t consider it because it’s too risky. (Laura, successful ECV, antenatal interview)
Many women described the mechanics of a VBB as problematic because the smaller legs and buttocks of the baby would be born before the larger head:
There could be a little bit of bumps coming out and obviously the birth, the fluid and things coming out and breathing and with the head coming out last, the bum coming out first and it can be a bit of a strain on the head and they might have to use forceps or to try and help… it just didn’t sound appealing at all. (Lynne, unable to attempt ECV due to low AFI and planned CS, antenatal interview) Several respondents believed that a VBB would be stressful for them as they would be anxious about a poor outcome, and to avoid this opted for either ECV or planned CS:
I just don’t like the idea of it…I think I would feel quite panicked… that the baby would get hurt… I would just be worried about the baby’s safety and that’s kind of paramount really…it just feels risky I think, so why if you can avoid the risk then avoid it really. (Samantha, planned ECV, antenatal interview)
As well as the specific risks associated with breech birth, for some respondents, previous negative experiences in pregnancy heightened their desire to protect their baby. Several respondents disclosed previous pregnancy loss, and suggested that these experiences had influenced their decision making about breech presentation by making them more cautious about potential risks to the baby. Emily shared the anxieties which she and her husband had had:
I think as well with my husband he was – because we’ve had so many miscarriages – he was very nervous about the idea of me having a natural childbirth. (Emily, unsuccessful ECV and planned CS)
I was told the options with regards to the manual turn… But obviously I didn’t want to take that risk, given my history… In the end, I decided to go for the caesarean section. The reason being really because of the background. You know, the two years that we’ve took to have [name of baby]. And I was
disappointed, I really, really wanted a natural birth, but I knew…that going into labour with a breech baby, wouldn’t really be good for me or her. (Georgina, planned CS, postnatal interview)
As well as past experiences of pregnancy loss, respondents described how other experiences of pregnancy complications also contributed to the importance of wanting to keep their baby safe. Tina had given birth to her first son at 34 weeks and he had required admission to the Neonatal Intensive Care Unit (NICU). Her experiences of this and of tube feeding her son on the postnatal ward had influenced her decision to have a planned CS, which she believed would be safer for her baby than an ECV.
I want to do this as safely for her as possible. Because I spent a lot of time in with me son in hospital, and I just didn’t like it… I don’t want to have another baby with tubes. (Tina, planned CS, antenatal interview)
A planned CS was generally perceived as safe for babies but riskier for mothers (see below): I think probably from the baby’s point of view it’s less risky but obviously from the mother’s point of view, it’s more risky. (Alison, successful ECV and emergency CS, postnatal interview)
However, some women, like Laura, were concerned about possible risks to their babies from a planned CS:
…it [the baby] has not decided it wants to come so you’re bringing a baby out before it’s time… they can be a bit more mucousy and sometimes have a bit more breathing difficulties. They have to give them oxygen because they haven’t been through the birth canal. (Laura, successful ECV, antenatal interview)