Roles of partners & others in decision-making
The decision about how to give birth after a previous caesarean can be a very personal choice, and several women we spoke to felt strongly that it was down to each woman to choose the method of birth that felt right to her. Nevertheless, most women said that they had been influenced, at least to some extent, by other people. For many women, advice and information received from health professionals played an important role, but they also considered the views of their partners, family and other women when making the decision.
All women we talked to were with the father of the child they were expecting and all said their partner or husband would accompany them into hospital. Most women had discussed the decision of how to give birth with their partner and a couple of women who felt uncertain which way to go said they had 'talked about it a lot'. We asked women how their partners felt about their birth preference and whether they had reached the decision jointly or by themselves. We did not speak to women's partners directly, so the views represented here are women's perceptions of their partners' views.
- Age at interview:
- Waitress and student with a five year old son. Living with partner, who is a farm worker. Ethnic background: White British (Scottish).
'yeah, he's been very supportive, but, and asked me what I want as a birth and whether I want to breastfeed. And' but he's totally left the decision with me, but he knows as well as if it, you know if it comes to the birth and things go-, do go wrong or I have to have a section or a different type of birth like forceps or whatever, it has to be done, sort of thing '
'but he doesn't have a preference himself about'?
No, he's happy to go with what I feel' Because he says it is down to me at the end but' as long as I'm alright and the baby's alright, you know, so'
Some women said their partners did not have any strong opinions about how they should give birth and were just happy to support them in whichever decision they made. Several women were quite happy for their partners to take a backseat in the decision-making process and make up their mind by themselves, but a few others hinted that they would have liked their partner to take on a more active role. A few women thought it was 'a typical male thing' not to become too involved in the details of giving birth. However, one woman acknowledged that she didn't really know how her partner felt about things and described him as 'a bit of a closed book'.
- Age at interview:
- Former teacher with one son aged two. Husband is a lecturer in further education. Ethnic background: White British (English). Played by an actor.
He was kind of' at the beginning he was kind of like, 'Well, it's up to you, but I think you should probably have a planned caesarean.' Because I think he was quite worried about what happened to me before, and that it could have been potentially quite dangerous if they hadn't, if the midwife hadn't have been as vigilant as she was and kept checking his head position. If they'd have kept inducing me, he could have sort of come out like superman. It could have been quite' so I think he was, he was thinking that might be the safer option and maybe, you know, we've done it before, kind of thing, it's, you know.
And I was kind of agreeing with him, but then as it's gone on, he's like, 'Oh, it's your decision, I, you know, I can't say', you know' which is not that helpful really.
So how does he feel now that you've decided to have a trial labour?
I think he also is relieved the decision's been made, because I think he was completely fed up with me and as soon as I said, 'Okay then, I'll give it a go' to the doctor And he said, 'Oh, you've made the right decision'.
Some other women said their decision about how to give birth had been altered or influenced by their partners' views and concerns. A couple of women who had considered a vaginal birth at home agreed to go into hospital because their husbands were worried that a home birth after caesarean would be too risky*. Several women empathised with the emotional challenge men faced during birth: worrying about the risks to their partner and baby while being limited to playing a rather passive role for most of the process - something that can be “distressing and boring at the same time”, as one woman put it. A few other women said their partners had wanted them to have a caesarean because they perceived it as a safer option than a vaginal birth involving a lengthy labour. One woman said 'the thought of me going through all that again just terrifies him'. A couple of women also hinted that a caesarean would be more convenient for their husbands because they wouldn't have to spend long stretches of time in hospital with them and would be able to plan for the day.
- Age at interview:
- Nurse with one daughter aged two. Husband is an engineer. Ethnic background: White Irish. Played by an actor.
I almost wonder why I went into the birth suite because I was just doing what I was doing at home. I had no medical intervention or need, so it was just a lovely, lovely experience.
So why do you think you did go to the birthing suite?
I went to the birthing suite because I was given two risks. I was given the risk of being a VBAC or having, you know, having the section, and also the risk of possibly the baby's shoulder getting stuck. And so I went because of' it was strongly recommended, medically' not to deliver at home. Which was an option I'd thought about, to get away from any medical intervention.
And what made you think about not staying at home?
- Age at interview:
- Dentist with twins aged four and a half. Husband is also a dentist. Ethnic background: White British (Northern Irish).
And how does your husband feel about your intention to go for a trial for labour?
He's keen on that, yeah.
Why do you think he's keen?
Because I'll be recovered faster, hopefully [laughs]. No, I think it, actually there is an element of that, there is the practicality of it because, you know, we don't have any family that live close by and things like that, not being able to drive would be more of a problem then' I think, you know, he's just keen for me to be sort of' but he's keen for me to be sort of healthy and fit quickly, but on the other hand he would prefer a section if it was like, you know, required. He has no hang-ups about it or anything like that but I think he'd just prefer, I think he'd probably prefer that the baby was just born quickly and he didn't have to do anything' if he could have a day and he knew when it would be actually' [laughs].
A couple of women said their partners wanted them to have a vaginal birth because they hoped that they would recover more quickly than after a caesarean. One woman had been advised by her consultant to have a repeat caesarean. She said her partner would have liked her to have a water birth and thought that having a caesarean was 'cheating'.
- Age at interview:
- Nursery nurse with one child aged eighteen months. Her partner works for a removals company. Ethnic background: White Biritish (English).
You've booked an elective section this time, when did you make that decision in this pregnancy?
The last time I'd seen the consultant.
How many weeks were you then?
[Hesitation] I think about twenty-two.
And before that had you thought at all about having a natural delivery?
And can you say why you wanted to have a delivery that was natural to start with?
Just' just natural way really, it's sort of easier for recovery because of being in hospital for so long after. Don't really want to be away from little one. But apart from that'
So when did you start thinking about the fact that you thought you might want a section, did you think about that before you saw the consultant at all?
Yeah, I did think about it. My partner wanted me to have a natural birth. He asked the midwife about a water birth and they said no because I'd had a caesarean before couldn't have a water birth. But' so we weren't really sure, just wanted to see how it went really.
And why do you think your partner was keen for you to have a natural one this time?
He thinks it's cheating having a caesarean [laughs].
Why does he think it's cheating?
Because I haven't got to do anything.
That's a bit harsh isn't it?
So when you came' when did you come round to the idea of having a section then?
Well, since just seeing the consultant about twenty-two weeks, from about then really sort of'
You hadn't thought of it before then really?
Well, weren't really sure what' we'd not really thought about it because we weren't that far' weren't that far gone, didn't really...
Besides their partners' views, some women's decisions were also influenced by consideration for other family members. One woman, whose family lived abroad, was pleased that her having a planned caesarean meant that her family would be able to time their visit for the birth of the baby. Another woman worried whether she would have her baby in time to be a bridesmaid at her sister's wedding. One woman, who had been very ill after her first vaginal birth, felt much better after the birth of her second child by caesarean. She said booking another caesarean had helped to reassure her family. Other women thought vaginal birth might be better, because they were concerned that after a caesarean they might not be able to cuddle and lift their toddlers. (See also 'Reasons for wanting vaginal birth after caesarean' and 'Reasons for wanting a planned caesarean'.)
A few women mentioned that talking to other women had helped them in reaching a decision. A couple of women who had decided to attempt vaginal delivery said they had been encouraged by hearing about the experiences of friends who had gone through VBAC. Similarly, one woman who was considering a planned caesarean had felt reassured when friends who had experienced both emergency and planned caesarean told her that the difference was 'like night and day'.
I think perhaps when you've had a caesarean and to then have a natural labour, I mean, you're always going to have something on your mind like is this really the best decision to make, or it would be really nice to talk to a woman that's actually gone through this already. Because when you actually go to the hospital and they're saying, 'Oh, I'm not sure if you should have the caesarean', and then you're think well am I making the right decision, you know, what's going to happen to me, you know, is it really that bad a decision to make? And to speak to other women that have actually been through it I think can really help ease all your worries and put your mind at rest, and think well I can go for it then. I was lucky enough that I had a couple of friends that had been in a similar situation to me so I managed to talk to them. But it would be really nice I think.
However, a couple of women felt that the views of friends and acquaintances could put women under pressure sometimes or make them doubt their decisions. One woman was very keen to attempt vaginal delivery and her friends thought she was 'mad', but it hadn't put her off. Another young woman, who had decided on a planned caesarean, thought that the people who were criticising her decision didn't really know all the facts.
- Bar supervisor with one son aged twenty-two months. Lives with her partner.
And what advice do you think you would give to another woman who'd had a section and was planning her next delivery?
Make sure you've got the information first, before you make any' because it's quite easy, and don't listen to anybody else. Like, obviously, listen to people but don't' because I had, I got to admit I had quite a few people saying, 'Oh, oh well, you should really try for another normal delivery'. But then it's down to you and I think at the end of the day if you don't feel happy, you're got to' at the end of the day, they didn't have the information like I had, they didn't look at it, and then it weren't until I looked round and said well, do you realise that it's this many people try for a normal delivery after a section and don't, I said, and then, you just feel like you've failed again, so' and they, they did change their view' and they're quite, sort of quite happy now.
- Age at interview:
- Carer with a five year old son. Living with partner who works as an operations manager. Ethnic background: White British (Welsh).
I mean, I'd strongly promote vaginal birth to anybody because it has so many more benefits than a caesarean section but that's really just a opinion. And plenty of women think I'm mad for trying for it and that the caesarean section is the obvious one to go for.
Which women think you're mad?
The ones that aren't pregnant [laughs].
Right. Of course.
The ones that think it's just a, a quick cut and, it's easy, your baby's out type of thing.
So the ones that haven't had a section?
Yeah, or haven't perhaps had, or have had a labour that was really difficult.
With lots of pain, and they think that, you know, I mean, one friend has had an emergency caesarean as well, but I think she went through a painful labour, so she's had both sides of it. And she has said that, yeah, you don't know what you're letting yourself in for, you're mad, you should go for the section.
And that hasn't put you off?
It made me sort of think for, you know, a brief, a very brief amount of time [laughs]. But at the end of the day, everyone's got their reasons for their choices, haven't they?
A couple of women who had decided to have a planned caesarean said they found some of the media coverage on women's birth preferences unhelpful and ill-informed. They thought it was wrong for people without medical background to write judgmental opinion pieces that were likely to make many women feel guilty about their birth choices. However, negative press coverage of planned caesarean hadn't made them change their minds about what they thought was right for them.
- Age at interview:
- Industry regulator with one son aged three. Husband is a policeman. Ethnic background: White British (Scottish).
And in the abstract, aside from your situation, what do you think informs other women's choice?
I have to say the media, quite a lot.
Could you say why?
I think there's an awful lot of information on the television and in newspapers as well, you know, articles on' one of the main gripes I have, I have to say, is how they push breastfeeding so much. But I have noticed that there's more and more now on actual' in fact there was one in the paper last Sunday, the Herald, saying, what was it - oh, I can't remember. The headline was terrible though. Something, something section, you know, like, 'Why are so many women not having a natural delivery?' and then the author then went on to spout out about how she thought it was absolutely terrible and I basically read the title and just turned the page, because it, at the end of the day I think that type of information, where it's an author and not, not someone with a medical background giving their opinion, is not very useful at all and I do think that a lot of women pick up on these things in the press and the media, and that will sway the decision they make.
Absolutely, yeah. I mean, I read the headline and my husband actually read it as well and he just took it off me [laughs] it's like, 'You know, there's no point in even reading that'.
*National Institute of Clinical Excellence - NICE had advised that women who wish to have a VBAC should have ‘care during labour in a unit where there is immediate access to CS and on-site blood transfusion services. 