"2 Emergency C-Sections"

I've given birth twice - both emergency C-sections for breech babies, but whilst I found the birth of my first child at a RIE to be traumatic and disempowering, the arrival of my second was one of the most beautiful experiences of my life. I owe that in large part to the staff at St Johns. Specifically midwives Abbie and Lindsay, obstetrician Dr Viner and anaesthetist Dr Crawford, all of whom demonstrated the very highest levels of care, compassion and clinical excellence. They embody the very best of the NHS and St Johns is incredibly lucky to have them.

When I met anaesthetist Dr Crawford, I had reached the point of considering a general anaesthetic to avoid another traumatic C-section. When I explained the severity of my fears, she empathised and went above and beyond to address not only the anaesthetics issues I had last time, but also took practical steps to address my fears about the upcoming birth. I left our consultation hopeful for the first time, and I will be forever grateful that I met her.

On our arrival, two wonderful midwives, Abbie and Lindsay, quickly put me and my partner at ease. I started going through my history but they had already read my notes and knew what they needed to. They created a safe, supportive and relaxed environment for me to labour in during the hours before theatre was free. From getting a speaker so we could play music, to giving encouragement, to providing excellent chat, as well as analgesia, they thought of it all without us asking. When you know you need a C-section, labouring can seem like pain without gain, but Abbie and Lindsay somehow made labour a happy memory which I never thought I'd say!

Likewise, Dr Viner was friendly, empathetic, reassuring and had a great sense of humour. By the time we met, she had read my birth plan, embraced the vast majority of what I wanted and explained very reasonably why one thing wasn't possible. She took her time explaining the practical elements of the procedure (using a doll to explain what a breech C-section would look like was great!) She did an excellent job surgically, with a neat scar and minimal blood loss, but what was important to me was that she made sure it was my birth, not just her operation. When I listen to the playlist I had in theatre I feel a rush of happiness as I remember seeing him come into the world and feeling his skin on mine as we snuggled for the rest of the operation. I'll never be able to thank Dr Viner enough for ensuring I have one of the happiest memories of my life.

The broader team in theatre also explained what was happening at every step, kept checking in to make sure I was ok and asked for permission rather than just doing things. It was a very relaxed, happy atmosphere. This was very different to my first C-section at RIE, where I felt like an inconvenient lump of meat that had things done to it.

Whilst my birth was a beautiful experience, I didn't have confidence it would be until I arrived at St Johns. Women are given a choice about where to have their baby, but choice is meaningless without information about the options. So much of having a C-section comes down to the preferences of the surgeon - for instance some will happily drop the screen whilst others refuse. When these things are simply about the preference of the surgeon, rather than evidence based practice, it is very stressful to try and get yourself under the care of someone whose preferences are not aligned with your own.

For instance, as my second birth was to be another C-section, I attempted to put simple things in place to make this a better birth experience. The main points were dropping the screen so I could see my baby born, keeping baby in the room with me if there was no medical need for the Resuscitaire and immediate skin-to-skin contact. I feel these are reasonable requests that lots of obstetricians are amenable to. However, my allocated Consultant at RIE advised that they didn't like to drop drapes as they felt my maternal instinct would cause me to reach over and contaminate the surgical field. This felt, not only deeply paternalistic, but ran counter to the fact that for 17 years NICE guidance has said "Accommodate a woman's preferences for her caesarean birth whenever possible, such as, music playing in theatre, lowering the screen to see the baby born..." Likewise NHS Lothian's own planned C-section leaflet from May 2021 says "We place a screen in front of you but if you wish we may be able to lower this when your baby is born." They also advised that babies always go the Resuscitaire and if I was in the theatre without a Resuscitaire in the room, my baby would be taken away from me initially no matter their condition. This approach was massively stressful and hugely detracted from my enjoyment of my pregnancy.

I decided to go to St Johns, based on the balance of positive and negative encounters at St Johns vs RIE, but without being able to establish if my allocated surgeon for my elective date would be amenable to my requests. Whilst I'd encourage every hospital to offer and enable things like immediate skin-to-skin to aid bonding and breastfeeding, as a minimum it would be helpful to guide women having elective sections to surgeons who are ok with such things. Of course unexpected things happen but at least give us the best shot at having the birth we want.

Thankfully, through Abbie, Lindsay, Dr Viner, Dr Crawford and the theatre team at St Johns, I got the beautiful birth I lost out on with my first baby. I said thank you at the time, but I hope this will be shared with them and that they'll get some of the celebrating they deserve from management too.