Pre-eclampsia and high blood pressure in pregnancy

Experiences of labour, induction and birth

Because pre-eclampsia can be very dangerous, women’s birth options were sometimes limited for those we interviewed. Many had caesareans sections – either as an emergency or planned. 

However, having pre-eclampsia does not mean that a pregnant woman will definitely need a caesarean section. Some women went into labour naturally or were induced, and a number went on to have vaginal deliveries. This was the case for Angela, though it’s an unanswered question for her as to “why didn’t I end up with an emergency caesarean as opposed to somebody else?” Julie and Philippa had both been overdue and were induced. As Julie found, sometimes inductions don’t work or the situation becomes more serious and so a caesarean section may be needed anyway.
Labour and induction

Some women we spoke to had been induced or naturally went into labour. For some, labour starting or being induced earlier than expected came as a huge shock. Lyndsey remembered a moment when she was sat alone in the labour ward and thinking “what the hell am I doing here? I’m not meant to be here for a good three, four, five weeks”. Some women were unsure what to expect from labour.
During labour, women were usually monitored very closely. This often included ongoing monitoring of their blood pressure, other vital signs and the baby’s heartbeat. However, some found this monitoring overwhelming. Dominie felt she had “lost a lot of control because I had tubes and wires everywhere”. 

Some women had a midwife in the room with them at all times. If they got on well, this presence could be very reassuring. Dominie remembered a “compassionate and caring” midwife who looked after her during labour. Olivia said she had some midwives who “didn’t give a crap” but was glad to also have a student midwife who was more supportive and “coached me through the last bit”.
At any point during labour or following an induction, the situation could change and require a switch to caesarean section. Sometimes there was a serious complication with the pregnant woman or unborn baby’s health, or she reached a point of being too ill and exhausted to continue with a vaginal birth. It could sometimes become a medical emergency. Hanna coped well with her contractions at first and hoped it would mean an easy birth. But after her waters broke, she was “engulfed” with pain, became very ill and had to be rushed into surgery. Emma reached a point where she had no strength and “things were shutting down”.
Vaginal births

Some women had vaginal deliveries and did not need surgery. Sometimes extra help from midwives and doctors was necessary, such as an episiotomy (when a cut is made to make the vaginal opening wider to fit the baby’s head) and/or use of forceps (to help pull the baby out).
As with all pregnancies, induction, labour and vaginal birth can be very painful. To cope with this, some women requested pain-relief. Nicola found it very painful when the midwife tried to break her waters so she had an epidural before the second attempt was made. However, not all the women we spoke to had pain-relief – either because they didn’t want the options offered to them or they had asked but not received it. Sometimes the woman was too far into labour for a certain type of pain-relief (such as an epidural/spinal anaesthetic). Other times it was unclear why they weren’t given pain-relief and, if it was for a medical reason, this was not always explained.

Some women talked about the benefits of giving birth vaginally over a caesarean. Dominie said her preference had always been a vaginal birth because it would hopefully mean fewer restrictions on driving (as women who have had caesarean sections cannot usually drive for six weeks).
Caesarean sections (c-sections)

Some women felt they were given no choice by their doctors about having anything other than a caesarean section. Caesarean sections were sometimes needed if induction and/or labour had not gone to plan, and were sometimes a medical emergency.

Sometimes there was not much time to explain about the surgery or midwives and doctors weren’t very forthcoming with information. Hanna called a friend who was a nurse so that she could explain it to her. Claire didn’t ask many questions as she was feeling very unwell.
Most women we spoke to who had caesarean sections were given local anaesthetics, which meant they were awake throughout the operation but couldn’t feel any pain. Their partners were usually allowed to come into the operating theatre. Stewart tried to reassure his wife, Claire, throughout the operation. Samantha X said her husband helped “make it feel a lot less scary than it actually was”. Aileen has a medical background and so felt she had more insight into “what’s going on inside me” compared to her husband, and so she worried about how he was coping.

Helen X, Janine and Tracey needed general anaesthetics and so they were asleep during the surgery. Some partners found it very hard to be separated from the pregnant woman and not knowing what was happening. This situation was often very different to what they had imagined. As Michael explained, “I’d always envisioned that I’d be in with my partner, helping her, and then the baby would pop out and there the three of us would be together. So what actually happened in reality was quite different. I was waiting in a room down the hallway for a doctor to come and tell me it had happened”.
Whilst the run-up to a caesarean section could be quite chaotic, most women found that it was calm and efficient in the operating theatre. Aileen said that “it wasn’t a traumatic experience; it was a very good experience I must say”. Julie and Samantha X both said the set-up in the operating theatre was like a “well-oiled machine”. However, the emergency meant there could be a lot of different medical professionals in theatre. Some women found this overwhelming. Betty was “absolutely astonished by the number of people”. Mairi thought it was good that everyone introduced themselves but did so briefly and efficiently. 

Most women were surprised at how quickly the delivery happened. For those who had a local anaesthetic (e.g. an epidural), there was no pain but they could usually feel some tugging as the surgery happened. Aileen described the feeling as like “having a good old rummage in your handbag”.
A caesarean section could mean that the pregnant women didn’t go into labour or have contractions at any point. Whilst this could be a good thing, especially for those worried about the pain, it sometimes made women feel they had missed out on a ‘normal’ part of (vaginal) births. As Lyndsey said of her own experience, “it wasn’t really labour [laughs] as such, so I didn’t really give birth, you know. Well I suppose I did in a way but not in the way that I thought I would”. This could be upsetting; some women felt it affected early bonding and that it could have a lasting emotional impact.

A few people talked about there being stigma associated with caesarean sections, even if these were emergencies and not the woman’s preferred choice. Kelly had heard other people talk negatively about women who have caesarean sections as being ‘too posh to push’.

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