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Ciara

Age at interview: 35
Age at diagnosis: 33
Brief Outline: After the birth of her first daughter, Ciara had severe pain in her abdomen and developed septicaemia. She was on antibiotics for several weeks.
Background: Ciara is a qualified barrister, married with two daughters (age 6 months and 2 '). White British.

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Ciara delivered her first child in a birthingpool, with no pain relief at her local hospital. She was encouraged to take syntocinon for the 3rd stage to deliver the placenta. Almost immediately she developed a severe pain in her stomach, to the side. She asked for morphine and was given one dose. However, she felt that no one really took her concerns seriously and she was discharged home. She was monitored in the community by the local midwife. After a week the baby had lost 15% of her birth weight which made the midwives concerned. After 11 days she was sent back into another local hospital to have the baby checked over for dehydration etc. Although she mentioned the pain, and was feeling very hot during the whole day they were at hospital no one checked her or picked up a problem. She was swabbed but it took 10 days for the results to come back, and she was prescribed some oral antibiotics for a uterine infection. She called an out of hours doctor out at 2 weeks, who prescribed antibiotics for a suspected urinary tract infection, but the didn’t seem to take effect. She finally went to her GP at 3 weeks + 2 days to speak to him about pain etc. He immediately sent her to the local hospital were she was admitted and put on intravenous antibiotics. Scans showed that she had retained products and “multiple” abscesses on her spleen. She spent a week in hospital, on strong antibiotics before finally being discharged. This involved giving her an ECG to check for endocarditis (an infection on the valves of the heart). 
 
Ciara felt that there was so much focus on the baby that no one listened to her concerns about being in pain for several weeks. Obvious warning signs were missed. She is concerned that the bad (anxious and stressful) experience of the early weeks affected her bonding with her daughter. She was so concerned about a re-run of a difficult post-birth experience that she opted for a planned caesarian section for her second daughter born 6 months ago.
 
 
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After her first daughter was born, Ciara developed a pain in her side, which did not subside for...

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So where did we go then? I think, almost immediately after the placenta was delivered I had acute abdominal pain, and [sighs] it was so, it was so bad that I actually couldn’t hold [first daughter] on my, I couldn’t have her touching me anywhere near my stomach and I just assumed that that was normal to feel like that. That that was, that was what you felt like after you’d had a natural birth or anything, delivered a baby, that you’d sort of suffer pain. And it was really uncomfortable. And I felt really sad that this whole sort of moment was supposed to be joyous when you know, when your baby is born, and it was, believe me, in the water, I didn’t, I don’t remember, it was after I’d been taken out of the water and delivered the placenta that I started to feel the pain. 
 
And I was thoroughly irritated by it, because I really wanted to bond with my baby and sort of feel good about everything, but I was in so much pain, and I mentioned it to the midwives and I was told categorically by the midwife who at that stage had taken over, to dry my eyes, I had just given birth and it was supposed to feel like that. So nothing was done about it.
 
I wondered whether it was may be something to do with my Crohn’s. I kept thinking it was something to do with my bowel, because it felt like it was in that area and I wondered if my bowel had been so contorted by the pregnancy that now it was all sort of starting to go back into place, sort of arranging itself back to where it should have been, post-delivery, that that was what was causing the pain. So I kept assuming it was that. And I may be even mentioned that to a few of the staff on duty that I had these pains and that I wondered if that was may be what it was, but nothing was done about it, so nobody investigated it. And I subsequent to that I think that it may have been that my uterus had gone into some sort of spasm because it was trying to contract down but there was still bits of placenta left behind. I just don’t know. But all I can say is that I was in agony. And that [husband] my husband, had to hold [first daughter] for quite a lot of that early bonding process because I was in too much pain.
 
Three weeks plus two days later, I think that three weeks and two days later I went to the GP’s surgery and the emergency surgery and waited around for several hours to see the GP and when I went in and explained my situation, he said, “You’ve just had a baby. You’re having acute abdominal pain. It could be appendicitis. It does sound like it could be…” Sorry I should mention as well I had a high fever. So my temperature was spiking and it had been all weekend. And the antibiotics that had been prescribed that weekend weren’t bringing it down. He said, “I’m a bit concerned that it might be something else going on. I’m going to get you admitted to A & E.” He said, “I would call an ambulance, because I think it’s that serious, but I think it’s probably quicker if you husband drives you. But I will have, I will fax this information through to them so that someone is there to deal with you as soon you get there.”
 
So my husband drove me to [local hospital] A & E and sure enough they had received the information about me and they did attend to me immediately. And very well. So I had, I think various doctors came to see me. The accident and emergency doctors came to take the history, and within about half an hour of that a gynaecologist was by my bedside and they were going through the options of what could possibly be wrong, but obviously one of the main concerns was that there might be retained products and that’s what they were going to sort of… They were going to do a test, they were going to do a scan
 

Ciara felt her symptoms (abdominal pain) were not listened to by midwives. She was admitted to...

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In those early hours after the birth?
 
Hm. There needs to be equal focus on Mother and baby by the community midwife. There was too much focus solely on, on [first daughter] failure to gain weight in those early days and that was obviously important, but it was a bit of a red herring because I think if you look at something sort of holistically and you take it in context, you wonder why this is happening and the Mother’s complaining of abdominal pains, you know, it’s really so obvious, you know, that its likely to be something to do with her that’s causing this, this problem. Don’t view the baby and the Mother in isolation and don’t forget about the Mum when there are problems with the baby, because if she’s complaining of, you know, she needs to be listened to as well.
 
I think it’s really important for midwives not to assume that if someone is complaining of pain, it’s because they’re, they’re weak or their pain threshold is low and I hope I, it’s obviously that my pain threshold’s not significantly lower than others because I had a pain free delivery. So if I’m complaining about pain, that needs to be listened to. So I think there’s a sort of tendency to think that someone’s a bit of a whinger if they’re complaining about pain before, during or after and just assuming that, that’s par for the course with childbirth, but actually listen to what they’re saying and put it in context. If they’re just delivered without pain relief then, and then are asking for morphine, surely the alarm bells should be ringing. Yes. 
 
 

While she was in hospital with septicaemia (blood poisoning) after her second daughter was born,...

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I think I was so focused on [first daughter] and my own situation, at that point that he was sort of carrying me along. I didn’t really ever, I didn’t have time to think about how he was feeling until afterwards and I reflected back on it. He seemed to be very strong to me at the time, but my Mum saw him, she saw the cracks when he wasn’t with me. And when he phoned my parents to tell them, each night when he left the hospital, he took that week off work, he would phone them with update and she saw a different side to him. She saw someone very anxious and traumatised by what I was going through and he’s not easily made anxious or traumatised. He’s a very laid back, optimistic person who he’s very strong, he’s, he’s been through difficult situations and sort of weathered the storm very well. His Mother died when he was 19, his brother died when he was 14. He’s been through a lot, he’s a very strong man and he kept that façade up but I think probably was really struggling underneath it all and my Mum certainly feels that it was a very difficult time for him, yes.

 
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Ciara had a uterine infection and was in hospital after her first daughter was born. She recently...

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Right, Mum and Dad have definitely been around an awful lot more as I think they probably are worried about my ability to, to cope with two certainly, which is difficult anyway. But they probably saw me struggling with [first daughter]. They saw an anxious Mum who, isn’t prone to being anxious for no reason at all, yes, I can be anxious, but you know, there needs to be a good reason for it. So the early days of motherhood for me, were just full of, of sort of feelings of anxiety and… probably a very mild case of post natal depression. I think it would have been mild. I think I was reasonably resilient to it. I know others who have suffered from it. I don’t think I had it badly, but I think it was definitely there to a degree or there was a risk of it getting worse, had I not had the support that I did have. So, I think that, yes, that’s affected the sort of family life. 
 
I suppose, I think probably my husband, I don’t know what he would have been like if it had been different, but he is a very hands on Dad and is very supportive of me, always. But he might have been like that anyway. I don’t know if that’s got anything to do with it. 
 
I think, yes, I don’t, it’s very difficult to know if it would have been different. I think it’s strengthened us in a sense. It’s strengthened our relationship in, in a sense, because I saw what, and he, he was really rock solid during that period, from my perspective. And that, that was really important to me. I suppose it made me feel more secure about everything.
 
Yes, so in some ways it has strengthened the links and made them all sort of create support around me, which would have been there, but may be not to the same extent otherwise.
 
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