Wednesday, July 13, 2011

Was Posh pushing it to have a fourth Caesarean?

By Julia Lawrence

Jayne Hughes struggled to look her obstetrician in the eye as she faced him across the consulting table, feeling sheepish and embarrassed after confessing she was pregnant again.

Jayne was expecting her fourth baby. Significantly, if this pregnancy were to progress, it would mean her going through a fourth Caesarean.

After the birth of her third child, Benjamin, three years earlier, doctors had strongly advised Jayne not to have any more children because by that point she had been through three Caesareans already — which is regarded as the accepted ‘safe’ upper limit.

Family fortune: Jayne Hughes, pictured with three of her four children, Jonathan, 11, Ben, 10 and Laure, seven, says she feels lucky her fourth pregnancy ended safely

Since she and her husband Mark already had two boys and a girl, who is severely disabled with a debilitating premature ageing disorder, they had been more than happy to follow the medical advice they’d been given.

‘Mark was going to have a vasectomy but we kept putting it off,’ says Jayne.

‘To be honest, we were so exhausted most of the time that the risk of me becoming pregnant again seemed very slight indeed.’

But one rare amorous evening, and an accident with a contraceptive, later, and Jayne, 45, and Mark, 38, found themselves back at Liverpool Women’s Hospital ‘feeling like a couple of idiots who really should have known better’.

Jayne, who runs a charity, and Mark, a food safety consultant, had been warned there was a serious risk that she could die if she didn’t terminate the pregnancy.

Her three previous Caesareans had left her womb with so much scar tissue there was a big risk it could rupture, either before or after delivery, resulting in Jayne bleeding to death.

There was also the risk of the baby being starved of oxygen, leaving it severely disabled.

‘I was strongly advised by doctors not to go ahead with the pregnancy,’ says Jayne, from Wallasey on the Wirral.

‘But I was already 17 weeks pregnant at that stage, and had seen the baby kicking healthily on the scan, in which it actually looked as though it was waving at me.

‘I couldn’t abort a healthy baby. Mark and I talked it through and decided that, although there was a huge risk, it was one we had to take.’

Jayne’s predicament bears a close resemblance to that of Victoria Beckham, who gave birth to her fourth child at the weekend — a daughter named Harper Seven — by Caesarean section.

She had already gone under the knife for the births of her three boys, Brooklyn, 12, Romeo, eight, and six-year-old Cruz, reportedly all on doctors’ orders.

And 37-year-old Victoria reportedly opted for a fourth C-section when she had her daughter at a California maternity clinic.

The Beckhams, pictured with sons (from left to right) Brooklyn, Cruz and Romeo, have said Harper will be their last baby

Much has been made of Victoria’s numerous Caesareans, which, she has always insisted, were not due to her being ‘too posh to push’ but were rather the result of an unspecified medical issue.

With a six-year gap following the birth of her youngest son, most people assumed she had followed the accepted unwritten rule that three C-sections were enough.

So was Victoria, like Jayne, taking an enormous risk and putting her health on the line in her quest for a much-wanted daughter?

According to consultant obstetrician and gynaecologist Clive Spence-Jones, a fourth Caesarean — or even a fifth or sixth — is not the automatic health disaster many people assume it to be, although risks do exist.

Currently, 23 per cent of births in the UK are carried out by C-section, but many hospitals have much higher rates.

For example, at London’s Portland private maternity hospital, where Mrs Beckham had her previous babies, the rate is around 52 per cent — 36 per cent of them planned and 16 per cent unplanned.

Although it isn’t impossible for a woman to give birth naturally after a previous Caesarean, few do — usually on the advice of their obstetrician, due to the risk of old scar tissue rupturing
during labour. ‘The main worry is that the placenta will implant on a section of the uterus wall in which there is scar tissue from the previous operation,’ Mr Spence-Jones explains.

‘This will not separate as easily after delivery, leading to a greater risk of haemorrhaging.

‘Also, the effect is cumulative. The more operations a woman has, the more scar tissue is produced, increasing the risk of the uterus becoming stuck to either the bladder or the bowel, again leading to greater risk of complications and further surgery.

‘There is the risk, albeit very slight, that old scar tissue, which is not as elastic as skin, could rupture during pregnancy or childbirth if a woman opts for a natural delivery following a Caesarean. In this case, the risk is said to be one in 200.’

Babies born naturally are understood to have a much lower risk of respiratory problems, and are also exposed to protective bacteria as they pass through the birth canal, helping their immune system to develop.

That said, Mr Spence-Jones says he has known women who have safely given birth in the UK to as many as seven or eight healthy babies, all by Caesarean section.

Jayne's predicament bears a close resemblance to that of Victoria Beckham, pictured, who gave birth to her fourth child at the weekend - a daughter named Harper Seven - by Caesarean section

Four years ago, Debra Hicks, from Taunton, Somerset, gave birth to her eighth — and last — baby by Caesarean. She was still three babies short of the world record, however, which is held by Kristina House, from the U.S., who, according to the Guinness World Records, had 11 Caesareans between 1979 and 1998.

‘The important thing is to differentiate between planned and emergency Caesareans,’ says Mr Spence-Jones.

‘There is no reason why a healthy woman, with the right medical supervision, cannot have four Caesareans perfectly safely.’

Jayne’s medical team took no chances with her. She was hospitalised, with complete bed rest, for the last four months of her pregnancy.

She’d had no such supervision during her three previous deliveries with Amy, 19, Jonathan, 11 and Benjamin, ten.

‘Amy was delivered early, as there were fears that she was not developing properly,’ says Jayne.

‘It later turned out she had the congenital disorder Cockayne Syndrome.

‘I had elective Caesareans with my two subsequent pregnancies, as I was told there was a risk of my uterus rupturing. Having already been through hell with Amy, it wasn’t something I was prepared to risk.

‘I was checked four times a day, and I wasn’t even allowed out of bed to stretch my legs or visit the bathroom. My life consisted of reading magazines and waiting.’

When Laura was born, weighing a healthy 5lb 6oz, on August 14, 2003, Mark and Jayne’s relief was enormous.

Like the Beckhams, who have said Harper will be their last baby, the Hughes decided to eradicate the risk of any more accidental pregnancies.

‘I was sterilised there and then,’ says Jayne.

‘We love Laura to bits, but I think we’ve pushed our luck as far as we want to.’


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