UK

2014/03/05

Laura Kilduff

“When the baby’s heart rate was dropping I wasn’t worried about me, it was purely about the baby and howRead more →

2014/03/05

Camila Maglaya

“I always say – we’re not always rich back home – but we do whatever we can, we speak out.”Read more →

2014/03/05

Dr Angela Davis

“There’s a strong cultural message that somehow having an elective C-section is an ‘easier’ way to give birth.” Dr AngelaRead more →

2014/02/05

Dr Amy Keightley

“In the UK we have swabs with a radio band so that if you lose one in the body duringRead more →

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Laura Kilduff

“When the baby’s heart rate was dropping I wasn’t worried about me, it was purely about the baby and how we were going to get him out safely.”

Laura Kilduff is 33 years old and lives in Oxfordshire, U.K. She is a Chartered Occupational Psychologist and runs her own business from home. Her first child, Charlie, was born by emergency caesarean section last year.

What were your concerns going in to your pregnancy?

The main thing – which must be similar to every woman around the world having their first child – was fear of the unknown. You can ask what a contraction feels like, but no one can properly describe it. Everyone seems to have a different experience. So at night, when you can’t sleep, you’re on your iPhone Googling questions – and the answers are always the worst.

You wind yourself into this ball of tension and worry about what is going to happen.

How did you prepare? Was the possibility of C-section discussed?

I took an antenatal course. That environment of women together, sharing fears and experiences, it was so important. But the option of caesarean section was mostly glossed over – we focused on that ‘ideal’ natural birth.

It’s something cultural we seem to be going through in the U.K. at the moment – births have to be natural and if it’s not natural the sense is that it’s unnatural.

So I went into it not really thinking a C-section would happen. Everyone talks about the candles, the birthing room, the pool! All this lovely stuff. Although in the end – with nine in the group – only one had that ‘ideal’, everyone else had a lot of intervention.

What happened at the hospital?

I went into labour the night before I was scheduled to be induced, two weeks past my due date. They put me in a room at the hospital and I said, “I don’t think I need an induction, I think labour is on its way!” They put a monitor on my tummy to check the baby’s heart rate – it kept dropping suddenly, and he was obviously in a bit of distress.

I was there three hours, four hours, contractions getting painful and stronger. But whenever I had a contraction the baby’s heart rate dropped, and they didn’t know why. At this point the consultant looked at all the print outs and said there’s a possibility you may need a C-section.

We’re lucky in this country in that we have some fantastic anaesthetists, great surgeons and nurses, and you have to trust that they know when it’s needed, necessary. I’m not medical, but I could see and hear the beeps of when the baby’s heart rated dropped – I knew something was wrong.

And then…

I was on a gurney and on the way to theatre in less than five minutes. It turns out the baby’s head was pressing on the cord, so during contractions he wasn’t getting enough oxygen.

You have to be strong. You’re in tears because of the pain, so you look to the people around you, to reassure you.

Although what you’re not really prepared for is the number of them. At least two anesthetists, two surgeons, the midwife, a couple of nurses, my husband. You’re in pain and surrounded by all these people, most of whom you’ve never met before – you just have to trust them. Half an hour max and he’ll be with you.

What was it like after the operation?

You don’t realize how debilitating it is; the first night you can’t really move at all. I couldn’t pick up the baby, and I was only just about ready to walk by the time we left the hospital. The recovery is much longer than you think as well. You stumble down the road and turn back after five minutes, exhausted. You can’t push the pram because it puts pressure on the stitches. And you need a lot of time for your muscles to recover.

Then there’s that question of a second baby – because of the incision there’s more of a risk, so do you have to have another C-section?

Has this experience changed the way you think about the issue of women’s health worldwide?

You hear stories in the media of women who haven’t survived, or had stillbirths. You can’t imagine it. And thank god I didn’t have to. When the baby’s heart rate was dropping I wasn’t worried about me, it was purely about the baby and how we were going to get him out safely. And whether he would be ok when he came out.

After the birth a lot of people said ‘oh, you had an emergency C-section – it must have been awful’ – but childbirth is pretty horrific generally, for the child and the mum! You need that awareness that it isn’t an easy thing to do – there’s going to be pain and upheaval whether or not you have an operation.

It was the right thing for me. The baby came out in 10 minutes. He was fine, cried quickly. They stiched me up and then we went back to the delivery room to bond with him.

Actually, nine months later it’s almost hard recalling it – you mentally block out a lot of what happens, that’s nature’s way.

You can’t forget if you don’t have the baby there.

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Camila Maglaya

“I always say – we’re not always rich back home – but we do whatever we can, we speak out.”

Camila is a senior staff nurse at Great Ormond Street Hospital. She moved to London from the Philippines a few years ago.

How hard is it to get a caesarean section?

It’s not easy to have surgery unless it’s really urgent. Even when it is urgent. Sometimes there’s nothing to do but surgery – like for a woman in obstructed labour – but if you don’t have the money, you don’t have the C-section.

Or if you can get to a hospital that caters to the really poor people, you have to get through a lot of red tape, pass a process, meet the criteria, how urgent are you really…It’s tedious and it’s dangerous. Before you can be seen you’re at the end point already.

How do people handle this?

Some families will just accept it. This is what I’m receiving because I’m poor. They’re used to it. They have that mentality ‘I’ll always have the second type of services.’

But some of them of course still fight for what they deserve. For their mother, their sister, their child. They will go to the complaint system. But it’s a long process.

And when you lose someone you love, and you know they could have been saved – the grief is still the same, the loss is still the same. Whatever standard of life you live, you go through the same process.

What can you do to change the system?

You can only fight for it – you don’t know if you’re going to change the result, even if you get the surgery.

I always say – we’re not always rich back home – but we do whatever we can, we speak out. Then at least you’ve done what you can, and you pray and hope that the next time it happens there will be a better outcome – if not for your family, for someone else.

Why is access to surgery so important?

It’s the difference between rich and poor. It’s poverty, isn’t it. If you have money, you can do everything.

But health should be the ultimate equal opportunity. Rich or poor, a woman or a man. Whatever standard you are in life, you should have an equal chance at this. If one needs surgery – it should be given.

 

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Dr Angela Davis

“There’s a strong cultural message that somehow having an elective C-section is an ‘easier’ way to give birth.”

Dr Angela Davis is a historian at the University of Warwick, interested in motherhood, parenting and childcare.

Your research has focused primarily on 20th century Britain. Is it possible to talk about universalities of childbirth beyond a particular place or time?

Yes there is universality in the process of birth – but it’s also something which is quite contextually-specific. For women giving birth in the U.K. it’s still a leap into the unknown, the fears are there – but it’s very different to when you’re giving birth in a time or place with a high maternal mortality risk.

Even women giving birth in the U.K. sixty years ago – their mothers’ generation would have had a much more risky experience. They knew those stories, that much more striking association with death which we haven’t really had for he last 40, 50 years.

How have access and attitudes towards Caesarean sections changed since the 1900s?

Small numbers of C-sections were done for hundreds of years but without antibiotics, without blood transfusion, usually resulted in mothers dying. Being able to do a safe C-section was a dramatic improvement and for certain groups of women – for instance those with complicating factors (like rickets, which can deform the pelvis) who were never going to have a good outcome, it was transformative. It allowed them to have a healthy pregnancy and birth.

Rates in the U.K. climbed throughout the second half of the 20th century with a dramatic increase in the last decade, for reasons that aren’t just medical.

When they’re used routinely – perhaps unnecessarily, like as a matter of protocol for a second birth following a C-section delivery – you need to question the evidence-base more closely.

Why do you think this has happened?

Misinformation. Not on a medical level but on a cultural level; the threat of litigation, the influence of the media. There’s a strong cultural message that somehow having an elective C-section is an ‘easier’ way to give birth. When of course the fact is – in this country or any other – it’s major surgery.

If you talk to a woman who has had one the idea that it’s easier – risk of infection, complications with breastfeeding – there’s a gulf between the image and the reality.

Obstetric fistula is a traumatic consequence of obstructed labour – did you come across much discussion of this in your research?

It’s constantly present in women’s stories, but not something that was frequently talked about.

There are many accounts of women living with the legacies of frequent childbirth, but these are the things that really changed after the introduction of the National Health Service (NHS). Suddenly in the 1940s there’s a huge rush of people getting all these conditions they’d been living with for a long time, fixed.

One woman I spoke to had a very difficult experience with fistula. But it was picked up after the birth, she had the surgery and went on to have more children successfully. It was weeks, rather than a lifetime.

Is it helpful to look at the global context?

There are big questions that apply everywhere – the importance placed on reproduction, the resources that are made available, and the relationship between women and the high-level policy decisions that are being made about a women’s issue. Because if it concerned men, the whole thing would be treated very differently everywhere.

And there’s a lot that we can learn from one another – not just taking a ‘western’ approach and applying it on a global scale, but vice versa, seeing what works well in different contexts. Still, you need to be cautious.

Why is that?

There’s an element in the U.K. that goes against women and those who criticize their care. It’s easy to say that if you were in this or that country you’d really have something to be concerned about. When the point is – no one should be in that scenario to begin with.

You need women to be well-informed, empower them to know their bodies, their choices – but you need a system that empowers them as well.

What impact do you think personal storytelling can have in changing opinion and practice?

It’s so important. Most of the effective campaigning groups – AIMS, NCT – started with women sharing their stories. There’s an immediacy that touches people in ways that statistics can’t.

Stories are part of the universal, the global context. We can identify with stories of women giving birth in other places, even if you know the context is different – there’s something about having a child you can identify with. These personal stories are really vital.

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Dr Amy Keightley

“In the UK we have swabs with a radio band so that if you lose one in the body during the operation you can identify it.”

Amy is an Obstetric and Gynaecology Registrar, recently returned from Hoima Hospital in Uganda, currently working at Lincoln County Hospital.

C-sections make up an enormous proportion of all surgeries in low-resource settings.

Yes, but the C-section rate in Uganda, if you look at the place as a whole, is actually very low. There’s not a lot of access to healthcare, and then you arrive at these facilities with a high volume of operations being done in a relatively small space – pockets of high-risk women, clumped together.

Without the training and experience of managing difficult labour, you can end up seeing C-section as a safer way out – without addressing the long-term consequences, and how risky the operation is itself.

So you get this situation where lower-risk women get surgery, and women who needed a C-section three days ago are waiting, waiting, waiting for days, because the theatre is always full.

What are the immediate risks?

Horrible post-natal infection; risk that the surgeon will pick up HIV or hepatitis because they don’t have the right equipment or training.

Resources are a huge problem. In the U.K. there’s someone whose whole job it is to look after the surgical instruments, keep track of equipment. And you can use swabs with a radio band so that if you lose one in the body during the operation you can identify it.

In low-resource settings there’s much smaller theatre teams, and the surgeon may not have someone to assist. The swabs are much smaller and harder to count, and one maternal death we saw was from a swab left in the abdomen – she died of sepsis.

Is the anaesthesia dangerous?

9 times out of 10 the anaesthesia is absolutely fine – but when something goes wrong, it suddenly makes the whole thing very dangerous.

When I arrived, a woman died of a high spinal – an anaesthetic that goes too far up the spine so that the patient can’t breath – because the anaesthesia provider hadn’t been trained to manage the emergency. In the U.K. that would never happen; the patient would be intubated, ventilated, or the anaesthesia would be reversed. Instead, a woman came in for a C-section and died from spinal anaesthesia.

And the long-term consequences?

There’s the impact for the next baby. In the U.K. we can offer mothers a second C-section if they choose, or monitor the second pregnancy closely to make sure that her scar doesn’t rupture.

But in Uganda, what will she do when she goes back to her village, three days walk away, and is laboring with the next one? Who will monitor them when the baby is obstructed? Who will be there to deliver her safely?

What is the impact on hospital staff?

We had two doctors running 4000 deliveries a year, 24 hours a day – no breaks, no weekends. We were losing about 5 women a month, roughly, we were losing babies every day. It’s crisis mode the whole time, and you could never even find half an hour to sit with everyone together because the workload doesn’t ever stop.