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Debbie

Age at interview: 31
Age at diagnosis: 29
Brief Outline: Debbie was expecting her second child, after her first daughter was delivered by emergency caesarian. She hoped for a vaginal birth after caesarian (VBAC). But during labour she felt a searing pain. Her uterus had ruptured and her daughter had to be delivered as an emergency.
Background: Debbie is a teacher, married with two children. White British.

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This was Debbie’s second baby, after having a haemorrhage and an emergency c-section with her first daughter’s birth. After an uneventful pregnancy she had a manual sweep and went into labour, hoping for a vaginal birth after delivery (VBAC). However the labour did not progress quickly and medical staff put in an epidural and started a syntocinon drip.
 
After a few hours she felt a really bad pain high up in her abdomen, like a pressure on her abdomen. Although the doctors said it was just contractions, she felt that something was not right, especially as she was able to feel it through the epidural. An internal examination led to the doctor shouting “code 1 caesarian” and she was rushed through for a general anaesthetic, and remembers nothing else. She had had a complete uterine rupture and the baby was outside the uterus, in the abdominal cavity. The baby was fine once they had resuscitated her. She was 18 months old at the time of the interview.
 
She spent a couple of days on the labour ward, and was then transferred to the maternity ward, where she felt there was a lack of understanding there as to the severity of what she had been through. She stayed in hospital for four days, desperate to get home. She insisted on being discharged earlier than her consultant wanted as she felt would be better supported at home. She was very debilitated when she got home, and it took 8-9 weeks before she could walk normally or do “reasonably normal things”. She had a debrief session at the hospital which she found very helpful.
 
While for 3 months she was just grateful that she and her daughter were both alive, she then started to dwell on the dramatic birth, and what that would mean for having any more children. She was now much more anxious about her health, worried that she might rupture again and extremely worried that she might fall pregnant. Her doctor picked up that she was still feeling traumatised by what she had been through and suggested a psychological assessment 6 months after the birth. The psychologist has put her on a waiting list for cognitive behavioural therapy (CBT).
 
While she and her husband do not actively want more children now, she felt very sad that she had had that choice taken away from her. In the early days she would speak to her husband about it, to help her piece things together, but she now tried not to, as it upsets her and him. She found it helpful chatting with people online about her experiences.
 
 

Debbie had a uterine rupture (a tear opening the womb directly into the abdominal cavity) during...

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And every time they time to lean me back to do the internal examination I couldn’t breathe. It was like pressure on my diaphragm. So eventually they either, they somehow managed to lie me down. It obviously happened in a very short space of time, but it felt like a lot longer. And when she did the internal examination, she, I just remember lights put on, buzzers put on and everyone said, “Code One Caesarean. Emergency Caesarean. Everyone to theatre.” And they all rushed me out and [Husband], my husband was just sort of standing. Didn’t know what was going on.
 
So they wheeled me through and I just, I think I remember shouting at the poor woman and grabbing hold of her, “Please, Help. Help.” And I didn’t know what was going to happen. And then obviously they gave me the, the mask for the general anaesthetic. And then obviously everything’s a blur.
 
And I woke up well I think it was the same evening, I think a couple of hours after [second daughter] had been born. They didn’t say much at the time about it, they just said, “Things have been complicated.” And I assumed it was similar to [first daughter]’s. So I think it was probably the following morning that I realised the full extent of it. He said it was a complete uterine rupture, so [second daughter] was completely out-with the womb. She was bobbing about in the abdominal cavity, which is just horrific to think about really. But they’d had to resuscitate her. I think her APGAR score was zero, initially, but she picked up very quickly within a couple of minutes. So she didn’t go to special care. She was there when I woke up which was great.
 
I’d had, they said the pain I’d felt in my upper abdomen was to do with the blood from the womb gushing up and that was what the pain was, it was kind of pressing down on everything. So that explained it all. And they had to fit a drain in my tummy to take all the blood and goodness knows what else. So apart from that I was quite upbeat. Because I felt like its fine. We’re both here. That’s the main thing. We’ve survived. 
 
 

After her uterine rupture (a tear opening the womb directly into the abdominal cavity), Debbie...

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I spent a couple of days on the labour ward and then went up to maternity, which was a difficult transition, because labour, they did everything for me. I wasn’t allowed to get out of bed, I still had a catheter in for a good few days. I wasn’t allowed to eat for two days in case, I think it’s something to do with the bowel. There can be complications because obviously everything’s put back in awkwardly, so they felt there could be a complication with the bowel, so I couldn’t eat and I could only have sips of water. 
 
So they were fantastic, but when I eventually moved up to labour ward, and one of the midwives, and it’s a very unusual case because I remember her saying to me, “They’ve asked me not to take your catheter out. But I don’t understand. You just want to be a normal mummy. Let’s get you up and get you going.” And so she left me to get on with everything at that point. But I remember saying to my husband, “I think they think I’ve just an emergency Caesarean, but it’s been so much more than that. And it’s going to take a long time to get over.” 
 
So I begged to get out as soon as possible. I think they wanted to keep me in a week, but I was only in from the Friday to the Monday. And they let me home on the Monday night, because I felt at home I had my Mum and my husband there staying with me and my other daughter to help me far more than they could in hospital. I was sort of a drain on their resources. 
 
 

Debbie had a debrief after the birth of her daughter. Hearing more about what happened was...

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I speak to the, I went for a debrief after both births actually. But it was very upsetting after [second daughter] because a lot of it didn’t make sense to me. I didn’t know the timescale of it all. So they took me through it, and they were fantastic. It was step by step, each minute what happened. How many minutes to took to get her out from when they realised there was something not quite right. 
 
Apparently when the doctor was doing the internal she felt [second daughter]’s head and then the head just disappeared out of her hands, so she knew that something had gone wrong and obviously that’s when she was kind of pulled out of the womb. So that’s when her heartbeat dropped and that’s when they took me through. So obviously without the debrief I wouldn’t have known that had happened, so it was really good to see, and they explained to me how quickly they’d acted and if they hadn’t been so quick, then things would have been very different, for both of us I think.
 
So that was really helpful having that. Very upsetting, but really positive, and I spoke to the lady there, who actually debriefed me on my first birth experience too. I spoke to her about having a support for women who’d gone through traumatic births, just generally, anyone whose had that trauma. And she said there was just no funding for it. Hospitals don’t have it. You would have to do it really off your own back. You’d have to work a way down to find mums to go to the group, and it just. It’s something I’d love to do, but it was just a bit impossible to do on my own. And particularly at that point in time I wasn’t ready for something like that. To go along and join in conversation is one thing, but to help organise that, I don’t think I could have done. But I know at some point that the hospital would have been interested in that. But unfortunately they just, they don’t have the money to do it. Which is really sad, because a lot of people go through difficult experiences with child birth.
 
 

Debbie was advised during a debrief with a midwife that she needed to seek psychological help as...

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And I remember getting really upset, the poor woman, and asking for a tissue, and she said, “I think you need to speak to somebody. It’s been a while, and then you should go and have a chat with your GP and see.” She said, “Because you’ve gone through trauma.” And she actually said, “If you’re in a car crash nobody expects you just to get up on your feet again and carry on as normal, as soon as you’re physically healed, you know, there’s issues you need to talk about and fears.” And she said, “There’s no difference here with you. You’ve gone something very traumatic, and you should speak to somebody about it, if you’re not quite ready to move on.” So she was super and I feel all the staff at the hospital were really supportive of us, and then she really did prompt me to get in touch and it was a very quick referral for a psychological assessment because she did that, which was very helpful.

 

Debbie had a uterine rupture during the birth of her second daughter. She feels that although...

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And what about your relationship with your husband?
 
I think we’ve gone through just about everything really we could. I think we’re stronger than ever because of it probably. You know, he was so strong throughout it all and he had a lot to deal with as well. I mean I hadn’t realised half of it, until afterwards when we talked about it and he said, “Obviously when I was wheeled away.” With [first daughter] it was far calmer that was taken into the theatre. He was waiting outside, but then they brought him [first daughter] without me and said, “There’ve been complications.” And this was our first baby and we just didn’t expect that and he had to meet his family and my family in the wee corridor and let them see [first daughter] while I was still in theatre being patched up after the haemorrhage which he hadn’t known about at the time. So he had quite a traumatic experience the first time round, and I think I didn’t really give him credit for that because I was very focused on how I felt and how I wasn’t bonding with our baby, and but he bonded with her fantastic and he kind of pulled me through that, thank goodness. But he had a really big scare.
 
So the second time was important for him too, because he wanted things to be okay. He wanted to have a positive experience and he wanted me to have a positive experience and I think when it went so horribly wrong, it took a lot for him to get… I think he felt even stronger the second time. I don’t know again if it’s because we’d been through something awful before, it was quicker to get back up on our feet the second time emotionally, initially at least and not in the longer term for me, but initially it was for [husband]. But he was, he’s just always been so supportive with the whole thing. 
 
He’s accepting not having any more children quite easily, and he kind of jokes about it, “Well we don’t want more than two anyway, they’re a handful.”[Laughs]. And I think, well he doesn’t really talk about it upsetting him, and I don’t think it does particularly. I think he’s okay with that. Whereas I still have the, but what if you know if we ever wanted to. But we’re very strong thank goodness. We seen it all hopefully together.
 
 
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Debbie feels that her experiences (she had a uterine rupture during the birth of her second...

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I think it’s made us closer and I’ve always been very close to my Mum and my sister, but I think after the fright we had with both, and certainly my Mum. I know when I was pregnant with [second daughter], my Mum was terrified the whole way through that something would go wrong, especially after the miscarriage. A lot of our family was on holiday when we lost the baby, but my Mum was the only one, my husband’s family was away and my sister was away. My Mum was the only one who was here and she was at every step and she was obviously really upset because again it was surgery and it was very difficult. So I think she was so frightened when we fell pregnant with [second daughter] that things were going to go wrong, and she tried not to show it, but ever since we’ve had [second daughter], she’s made a point of every now and again saying, “But you’ll never do that again. You can’t, you know you can’t do it again.” And I understand that. And I feel the same which is a good thing. 
 
So I think it’s put a lot of fear in them. You know, my Mum when I was pregnant with [first daughter] the first time, said to me, “Oh you’ll be fine. You’ll be the same as me.” She had my sister and I, natural deliveries, no pain relief, I think she had gas and air if that. You know no stitches. Everything was fine, and I remember her saying that through my pregnancy. “Oh you’ll be the same. You’ll be fine.” And I think after we had [first daughter] she thought goodness, it can go so badly wrong. And she hadn’t been aware of that, and then obviously with [second daughter] it went even worse. So I think yes, it has had an effect on them, and how they look at the girls and how close we are a family.
 
 

Debbie suffered a uterine rupture (a tear opening the womb directly into the abdominal cavity)...

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So I mean I think for the first few months, unlike my first daughter’s birth, where I was overwhelmed with what had happened and it was really traumatic and I couldn’t deal with it. With [second daughter] I think was so thankful we were okay that I didn’t have any concerns. There was nothing else worrying me at that point. But after about three months I suddenly started to think. Hm. Bit more about the birth experience, but more of why it happened to me, and also one of the implications is we can’t really have any more children. Which to be honest, I mean we probably wouldn’t have, because we’re happy with the two anyway, but we’d always said, we had friends, who very early doors after their second son was born decided to have, the husband had a vasectomy. And we said, “Goodness, you’re all so young, why did we do that?” We would always wait and get and get time in, and of course we’ve been put in a position where we really can’t have any more. The doctors have said we could think about it, but there would be a lot of implications and they’d have to deliver the baby at least four weeks early and I’d be in hospital on bed rest for a chunk of time, and with two children I couldn’t do that. So I’m trying to deal with that now as well and it’s quite a lot to take on, so I think there is a bit of post traumatic stress there too. 
 
I think for ladies who don’t, if we didn’t have our two girls, if we’d lost our first child to rupture, which some women apparently do, on an unscarred uterus, then I would may be think about it, but not when I already do have my two girls. I just wouldn’t want to risk that.
 
I remember being pregnant with [second daughter]. And because [first daughter]’s birth was so traumatic I had a lot of worries towards the end of the pregnancy. Although it was a perfectly healthy pregnancy, but I kept thinking, goodness what if I didn’t survive this time? Because with [first daughter], one of the midwives said, “It’s still touch and go.” When I came round after the general anaesthetic. And I thought goodness what, what if I’m doing this and I’m not going to be here for [first daughter] when she grows up. So to do that again with the two of them and know how much risk it is, this time, I just couldn’t put him through that or the family really. It’s too much.
 
So, and I have the fear of falling pregnant again, which is terrifying. I’ve had that conversation with my GP many a time, tons of things, you know, birth control, unless its 100% safe which doesn’t exist, because we’re, we’re terrified of falling of pregnant again. So, we’re, you know, there’s a possibility of a vasectomy or something for my husband but then that’s sad too, because we’re so young. 
 
And so there’s a lot of other issues which people wouldn’t think were major or upsetting but actually do really upset me, because its, its choices that we have to make that we shouldn’t have to at this stage in our lives surely. But then we’re so much better than other people and I keep thinking that, you know, we are very lucky.
 
 

Debbie had a uterine rupture during the birth of her second daughter. She would have liked more...

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I think the vast majority of information I had, I did gather myself. I think from the midwife I got a little pamphlet that opened up, about this size and it had very general stuff about how you’re far more likely to heal better and quicker recovery and promoting all the benefits of general birth which is absolutely how it should be. There was a tiny paragraph about rupture, but I think from my point of view and I know some of the other people I was speaking to haven’t research it as well themselves, even though I did research it, I don’t think there’s a lot of information.
 
Probably some of it’s for a good reason, not to frighten people. But there’s not an awful lot of information about just how deadly it is. Just how badly things can go wrong. Yes, I knew I could rupture, but it actually said, I’m sure, on the leaflet, on the pamphlet, that was a chance in two hundred chance of rupture, but when noticed early enough there would be no further complications from this. So it made it sound like, and I can understand why, because they want to promote vaginal birth after caesarian. It’s silly and then it’s a good thing. But it made it sound like well you know, this can happen but its okay we can fix it. Whereas actually, you know, a lot of the time they can’t fix it. Because things can get so bad, and it can happen so quickly and they don’t recognise the signs very quickly. I think in a lot of cases. I was fortunate and I think it was just circumstances. They were doing an internal at the time, [second daughter], I think, came out of the womb. So they knew something was badly wrong, but I think for a lot of women, from reading their experiences, that’s not been the case. They’ve had these pains. One lady I heard of, it was at home and they don’t recognize the symptoms often enough, early enough, because they don’t know enough about it. It’s so rare and I guess that’s the same with a lot of situations, a lot of different difficulties during childbirth. So I don’t know. I feel awkward about that. There are a lot of ladies who’ve gone through rupture who’ve I’ve spoken to who are absolutely 100% against VBACs and, ‘Oh you know, really shouldn’t allow them. Once a Caesarean, always a Caesarean.’ Kind of thing and I’m not like that, because I’ve heard of people going on to have really positive vaginal births and I think that’s great thing. 
 
But there is a part of me thinks may be there should a bit more information about how dangerous rupture is. And certainly if I’d known how risky it was, I would still have gone with the VBAC I think but I wouldn’t have had the Syntocinon. Knowing what I do now, and I certainly didn’t know about that when I researched things beforehand. Knowing, that although they say to you, it increases your chance, they kind of say along with that that but it’s very rare. But its okay, but we’ll monitor it, we’ll have it on a low dose. But from what we’re hearing in America they take a very dim view. Well in certain parts of America of using Syntocinon at all during a VBAC attempt. And so I certainly wouldn’t have gone down that road. I think I probably would have gone with the Caesarean at the point where they gave us the option. But hindsight’s a great thing and there’s not much we can do now. But I do wonder about that, should they give everyone information about had bad things can be with a rupture or would that just frighten people and then we’re going to have the rates of Caesarean Sections going up, because people are frightened to try. So I don’t know.
 
 

After her uterine rupture, Debbie spent a couple of days on the labour ward. When she was...

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I spent a couple of days on the labour ward and then went up to maternity, which was a difficult transition, because labour, they did everything for me. I wasn’t allowed to get out of bed, I still had a catheter in for a good few days. I wasn’t allowed to eat for two days in case, I think it’s something to do with the bowel. There can be complications because obviously everything’s put back in awkwardly, so they felt there could be a complication with the bowel, so I couldn’t eat and I could only have sips of water. 
 
So they were fantastic, but when I eventually moved up to labour ward, and one of the midwives, and it’s a very unusual case because I remember her saying to me, “They’ve asked me not to take your catheter out. But I don’t understand. You just want to be a normal mummy. Let’s get you up and get you going.” And so she left me to get on with everything at that point. But I remember saying to my husband, “I think they think I’ve just an emergency Caesarean, but it’s been so much more than that. And it’s going to take a long time to get over.” 
 
So I begged to get out as soon as possible. I think they wanted to keep me in a week, but I was only in from the Friday to the Monday. And they let me home on the Monday night, because I felt at home I had my Mum and my husband there staying with me and my other daughter to help me far more than they could in hospital. I was sort of a drain on their resources. 
 
Looking back are there any areas of the care that you received that could have been improved?
 
I was really grateful for everything the midwives did and even after the birth, when I got home they were fantastic. I think the only difficult really was, I don’t even know if it was the communication between the labour ward and the maternity ward. But certainly when I was transferred up there they, I don’t think they understood what had happened. My husband was very upset with the whole thing because he found me in tears. I was only actually there for one night thankfully and that’s part of the reason I begged to get home. And some of them were lovely, but occasionally I had the odd person, who just seemed to assume, it was actually an ordinary emergency Caesarean, why aren’t you not walking about, why aren’t you just up feeding your baby? When I’d been told in the labour ward to take things very easily and not really to get up and down too much at all. I obviously had to exercise my legs to stop any sort of blood clots and things but certainly to take very easy and they in no way wanted the catheter taken out at that point. And I think when she did that, that made me think, and the way she, things were said to me, “You want to be a normal Mum.” You know, after what I’d gone through I want nothing more than that. Why do you think I wanted a normal labour, you know, to go through the whole normal thing if you like. So that was the only thing that was really difficult. I think they may be didn’t understand, but there again that probably comes down to it being so rare and they probably read that in you know, uterine rupture ended in emergency Caesarean. Oh well, you know, you’re with the Caesarean ladies on the ward, that’s fine. They didn’t know how complicated it was, but the staff everywhere else on the labour ward were fantastic with me. They joked as they took the drain out and they were just superb, really supportive, yes.

 

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