Making decisions about labour, induction and birth
For women diagnosed with pre-eclampsia or HELLP syndrome, doctors usually explained that the only way to stop the condition getting more serious was to deliver the baby and the placenta connecting mother and baby. This often meant cutting the pregnancy short if it looked like the pregnant woman or her unborn baby were becoming extremely unwell. Kate had HELLP syndrome and initially thought she would have to put up with her severe epigastric pain until her due date, before she realised her baby would be born early. Kay’s consultant was very direct about the fact that, in an emergency situation, she would need a caesarean or otherwise “you could die”. Balancing risks
For some women, serious problems with pre-eclampsia or HELLP syndrome meant that babies born prematurely could be very unwell and unable to survive at such a young age. As Kay explained, having pre-eclampsia from 25 weeks into her pregnancy meant lots of extra risks for her baby compared to if she had developed it in the last few weeks before the due date. Some women met with a paediatrician or neonatologist who helped explain the impact and long-term prospects for babies born early. Women said this was really important to help them and their partners know more about what lay ahead – although, as Josie said, “nothing really prepares you” for the real thing.
But, having pre-eclampsia does not mean that a woman will definitely have her baby early or that the baby will be very poorly. Some women we spoke to had reached full term (9 months [40 weeks]) and a few had been overdue.
When women are ill, decisions have to be made about how long it is safe to keep a pregnancy going. This can be a balance between, firstly, giving the unborn baby more time to grow and, secondly, delivering the baby before the health problems become very dangerous and potentially fatal for both mother and baby. Of the women we talked to who had been in this situation, they were usually already staying in the hospital and being monitored for signs of a shift in this balance. Julie gave birth at 41 weeks and thought the situation might have escalated less if she had been induced earlier. The best course of action was not always obvious and there might need to be discussion about benefits, risks and preferences between the different people involved (e.g. between pregnant women and their doctors and/or midwives, and amongst individual medical professionals). The ideal situation is when decisions about the best course of action are made in partnership and, ultimately, the woman must agree to any plan about when and how she gives birth to her baby. Some women we spoke to felt this was the case, but others felt their experiences highlighted room for improvement.
Deciding factors in birth choices
Some women were induced and some others had a caesarean section as soon as it was decided their baby needed to be born. A few women we spoke to had naturally gone into labour. These decisions could be prompted by signs that the pregnancy was becoming very dangerous for mother and baby – the mother might have extremely high blood pressure or blood tests results showing a serious problem (e.g. very ‘off’ platelets for Paige and Helen X indicating risks of serious bleeding; severe liver problems for Tracey and Emma). Claire was induced when she started to feel very unwell, but then given a caesarean section when her condition deteriorated with an irregular heartbeat, blood poisoning and fluid on her lungs: “there was just a million and one things that they were just like ‘right, we’re not happy’”. How the illness might develop varies widely. So doctors advised women about when it would be best to deliver their baby at very different stages. While Mairi reached 39 weeks, Aileen in her second pregnancy had her baby at the end of 30 weeks.
It was often signs that their unborn baby was struggling (sometimes called fetal distress) which led to a decision that a caesarean section would be the safest course of action. Some of the women found out that their high blood pressure had caused the placenta to detach from the uterine wall (placental abruption). As Betty’s doctors explained, this is serious: “if they don’t get the baby out quickly enough there won't be enough oxygen”. Limited choices and reconciling expectations with reality
Their illness often meant women felt they lost control over birth options; this could be disappointing and frightening. While women had different preferences about the kind of birth they wanted (some had hoped for a vaginal delivery, including options such as water birth, and others had wanted a caesarean section), pre-eclampsia often meant that the reality of birth ended up being very different to what they had hoped for. Julie “was hoping for a natural water birth. I thought it was just going to all beautiful and lovely”. Mairi remembered asking her consultant if a water birth would be possible: “he looked at me in horror and said that there was no way I was going anywhere else other than a bed, and I remember thinking, 'It's a bit unfair,' but now I realise why”.
Lots of women said they had tried to keep an open mind about birth options, knowing that things may not go to plan. Aileen was happy to go with “whatever is best for my baby and for myself”. Betty’s preference had always been for a caesarean so she wasn’t “fazed” when she was told it would be. One consideration for some women was that a caesarean operation would mean that they could not drive for six weeks afterwards. You can read more about women’s actual experiences of labour, induction and birth here.