The C-Word

Cancer. What is it? Why are we so scared of it? And what can we do about it?

Cancer is basically the mutation of cells. Cells that divide beyond the normal growth rate for their type and that invade and kill neighbouring cells are loosely defined as cancerous, sometimes they also travel around the body via blood or lymph.

We hear alarming figures thrown around such as 1 in 3 women will contract a female cancer in their lifetime and that almost all of us can say that they have been in some way affected by cancer, either themselves directly or a loved one. It's no wonder that we are so scared of this disease. But is this accurate?

According to Cancer Research UK, there are now over 2 million cancer survivors in the UK, approximately 3.3% of the population and around 10% of those over 65 are cancer survivors. The number of diagnoses per year keeps increasing, but the so does the survival rate. The most common cancer is breast cancer, with about 550,000 current survivors in the UK today. In 2008 the mortality rate was 0.176% of the UK population. That doesn't sound so scary.

Why might cells mutate? 90-95% of cancers are caused by environmental or lifestyle factors, only 5-10% are genetic. Tobacco is the big one, we all know that, smoking is the cause of nearly 30% of all cancer deaths, 83-90% of lung cancer deaths and is also linked to cancers of the oesophagus, larynx, pharynx, oral cavity, pancreas, bladder, nasal cavity and sinuses, stomach, liver, kidney, cervix and myeloid leukaemia.

Other environmental factors that can increase the risk of cancer are UV exposure, weight, diet and infection.

But the one I really want to talk about is hormones, particularly female hormones and the "female" cancers; breast, cervical, uterine and ovarian.

Certain lifestyle choices are known to impact on our chances of contracting a female cancer. The combination oral contraceptive pill slightly increases the risk of breast and cervical cancer whilst taking the pill, but once no longer taking it the risk decreases again. However, there is a significant reduction in the risk of ovarian cancer for women who take the pill for five years, lasting for more than 20 years. And when I say significant, I really mean it: 50%. There is also a 40-60% reduction in instances of endometrial cancer (uterine cancer) for women who take the pill.

Having 7 or more children and having a first child before the age of 17 are known to double the risk of cervical cancer

The oestrogen only Hormone Replacement Therapy (HRT) has been shown to increase the risk of breast, uterine and ovarian cancers.

And last but by no means least, women are at 4% less risk of breast cancer for each year that they breastfeed and women who do not breastfeed at all are twice as likely to contract endometrial cancer and two thirds more likely to get ovarian cancer.

While all these figures are interesting, what I am most interested in is why. What no one seems to be saying is that cancer is thought to occur in cells that are over-stimulated, that's why the pill is so protective, it prevents ovulation and therefore gives the ovaries and uterus a rest from menstruation. Just like pregnancy and breastfeeding does. The pill basically replicates the consequences of reproduction, but in a more thorough and predictable way. It is my belief that the cells in any given part of the body are programmed to behave a certain way, according to their function and if they are not given the opportunity to perform their function as they expect then they are more likely to mutate and turn cancerous.

The ovaries expect to ovulate regularly until conception and then take a break of an average of 22 months (9 of pregnancy and 13 of breastfeeding, this is the average return of menstruation for women who breastfeed their children on demand). The breasts prepare themselves during pregnancy for lactation, regardless of the mother's intentions, the breast tissue fundamentally alters. What happens then if the mother does not breastfeed? Likewise, the cervix prepares itself for birthing a baby during late pregnancy and labour. So what are the implications for those who do not labour or who have a surgical delivery? I didn't find any statistics on that, but I'd love to know if caesarian sections carry an increased risk of cervical cancer. It certainly wasn't a risk listed on my consent form. Does some research need to be done on this?

Could we go back to a time before cancer became the single biggest health scare simply by living as our bodies expect us to?

The Recovery

At 6 days post partum it was found that I had an infection in my c-section wound. I was then on antibiotics for most of the next 7 weeks, and having my wound dressed by the district nurses at my local GP surgery every few days.

I developed post natal depression, had trouble breast feeding Jack and found it virtually impossible to participate in the basic care of my new baby. I couldn't bend or kneel to change his nappies, couldn't lift him from the floor or his bouncer, couldn't get out of bed in the night to fetch him to me for feeding, couldn't lift him in his infant carrier or push a pram and couldn't take him out anywhere without help. It was hell and seriously interfered with my ability to bond with him.

Luckily, Andy had over 3 weeks off work so was able to help a lot during the worst of it. My mum then took over, visiting every day to take me to the nurse and help look after Jack.

We had trouble with BFing, mainly, I believe, because of the surgery. I wasn't able to hold him for several hours afterwards, we didn't get our immediate skin-to-skin, in fact it wasn't until the next day that I got this. We were advised to use nipple shields to help him latch on, so we used these for a couple of weeks, but they were a pain to use, had to be sterilised and were generally unpleasant and interfered with normal feeding. At about 2 weeks we cracked it, we ditched the shields and Jack managed to latch on on his own and from there on I was able to feed him normally. We did give him a few bottles of formula in those early weeks, but stopped when Jack was about 5 weeks old. We've been exclusively BFing since, Jack will be 19 weeks old tomorrow!

When my physical recovery took off I was almost immediately better able to bond with Jack, I could do more with him and began to enjoy being a parent. But the events of his birth continued to haunt me and although I had felt ok with each decision at the time I began to look back with deep regrets about our decisions to call the MWs so soon, consent to ARM and hospital transfer and the cascade of interventions we were coerced into accepting. I have since learned of many women who had extremely long latent labours (days long), who had posterior babies etc who gave birth naturally at home. I applied for my hospital notes and on examining them we found that there had been more progress than we had taken in at the time (at one point I was 5-6cms) and Jack was posterior, not transverse as predicted. Transverse babies can become lodged in the pelvis, but women give birth to posterior babies all the time with little more difficulty than anterior babies.

I believe now that the NHS MWs did not try hard enough to help me have a normal birth, protocols and misguided use of interventions led to the c-section. We have an appointment with an independent MW next Monday to go over the notes with an impartial 3rd party and I am keen to know what she thinks about what happened and what she may have advised differently had she been in attendance.

I have agreed with Andy that the only way I would consider having another child in the future is if we can hire an IM and shun the NHS. He agrees with me. A dear friend asked me why it matters what happened and I had to tell him that I feel I failed as a woman, I did not give birth to Jack, he was surgically removed from me and the experience of giving birth that I was very much looking forward to was stolen from me. It also has implications for Jack's health (c/s babies are higher risk of asthma and diabetes) and makes a normal birth in the future less likely. Hiring an IM goes some way to increasing the chances of me being able to give birth next time and there is no way I will trust the NHS to have my best interests at heart in future, they will have their arses as their top priority.

The Birth

OK, so it was another four weeks after my post about normal birth that Jack finally decided to arrive. I wrote this birth story a few days after the events, it was still very raw but also written with some naivety... Jack was born on Saturday 28th March 2009, at 18.37, weighing 8lbs 7oz.

It's hard to say exactly when labour began! We thought it had got going on Sunday 22^nd March. I was having regular surges at five minute intervals and went into the trance-like state I had been practising for so many months. It was a euphoric experience, pain free and very intense. The MWs were called out and I agreed to an internal to see where we were at. It was fairly gloomy news, I had barely begun to dilate and my cervix was still high. The MWs left us to it and the surges almost immediately stopped. I then spent the next few days in an almost constant state of frustration waiting for things to start again but only ever had occasional irregular surges.

It wasn't until Friday 27^th that I knew things were starting for sure. I woke up at around 5am with surges accompanied by cramps. I got up and wandered about a bit, squatted by the bed and tried to put my breathing to good use. After almost an hour I woke Andy to tell him something was happening. I couldn't concentrate on my breathing, I was excited and restless and it did hurt a fair bit, so I was a bit frustrated too!

We kept an eye on the surges and after a while we were happy that they were coming five minutes apart. So my mum was called and we put some music on for me to try and get into my deep relaxation. I got half way there, was using the breathing techniques I'd learnt and it was all going pretty well. Soon the contractions moved up to every three minutes and we thought things were progressing quite quickly so called the MW.

My mum arrived and sat with me while Andy started getting the pool ready. Shortly after my MW arrived and I remember being so pleased that it would be my MW who I had seen antenatally who would attend the birth. She examined me and again it was not great news. Despite the frequency of the contractions I was barely 2cm dilated and my cervix was still high and posterior. She also said that it felt like the baby's head might be in an awkward position.

She agreed to leave us to it for a few hours and I sat on my birth ball by the bed, trying to breathe through the tightenings. They were getting very intense and I found it too hard to get into my relaxed state. It was very different to the previous Sunday.

We decided to try and keep busy so the three of us went into the front room and put a film on. I sat on the sofa with my birth ball in front of me and with each surge I moved to my knees on the floor and leaned on the ball. It was getting more painful and even harder to relax and I desperately wanted to get in the pool. We had to turn the film off half way through for me to go back to bed and put my relaxation CD on. Things improved a bit then and we called my MW back early afternoon but there had been no progress.

I was getting frustrated now and all attempts to get relaxed were failing. But I was still reasonably happy with the pain and it felt great to know that we would be meeting our little one soon. My MW called in the on-call MW for the evening so I could meet her before needing her in the night – everyone was still sure baby would arrive soon – my MW was going off duty so it wouldn't be her delivering our LO after all. So we met the new MW, she was young and seemed a bit nervous, but I was barely able to register that at that point. Both MWs left with the parting advice to give them about an hour's notice when I felt we would need them again as the second MW, who I had not yet met, had to come from Leeds and go to Bradford first.

It was only an hour or so later that the intensity really picked up and I felt desperate to get in the pool for the pain relief. So we called the MWs back and they arrived just over an hour later. I was told I was 3cm and could get in the pool. By now it was about 7pm and all I'd eaten all day was half a sandwich, but I just wasn't hungry.

Andy and I got in the pool and it was absolute bliss! The pain eased up but the contractions kept coming. But they weren't as regular as the MWs would like, and hadn't been for a number of hours. They would come in pairs with a bigger gap between each pair. But this didn't seem to be of much concern. I spent most of our time in the pool up on my knees leaning against the side of the pool, aware of being in a good position for the baby to descend.

The MWs and my mum sat in the living room chatting while Andy and I laboured in the pool for a number of hours. I was back to enjoying it now but soon the contractions became much more painful and I asked for the entonox. I didn't use it right away, I didn't want to feel sick or drunk, I'd always been wary of using the stuff but after a few more very intense contractions I relented and started sucking.

I told the MWs I felt like I needed to push and they came to sit with us, everyone was quite excited now. I'm not sure what time it was or how long it went on, but I was using the “J” breathing from hypnobirthing rather than trying to actively push. The MWs wanted me to get out of the pool to examine me, they had guidelines to examine me every four hours. I didn't want to get out, but I agreed and we went into the bedroom.

Here is where it all started to turn. I think it was about 3am, so I had been contracting at least every five minutes for 22 hours, I was exhausted. The MW examined me and found that I was still only 4cm, if that and I began to feel very disappointed. She said that she could feel the sac between baby's head and my cervix and she offered to break my waters as it might make the contractions more effective if the sac was no longer forming a cushion. I had heard of other women finding that they progressed after ARM so I agreed to it. She went ahead – it didn't hurt, much to my surprise – but her face said it all. She told me there was meconium present and that we should transfer to hospital.

I resisted at first, I remember saying a few times that I was post dates and that baby probably just had mature bowels. But she was concerned that the last few doppler readings had shown an elevated heart rate. I asked them to keep monitoring with the doppler for a while, which they did, they checked him about every five minutes for half an hour, while the lead MW talked to her supervisor on the phone regularly. His base line rate was up in the 160s consistently, whereas it had been around 140 earlier.

My mum and Andy were starting to really worry, Andy was even a bit tearful so I agreed to transfer. I was devastated and cried a bit, saying that I was going to end up with a c-section – I knew the hospital transfer story well - but felt we were doing the right thing. In the ambulance I really got stuck in to the entonox, I was becoming distressed and the pain was getting very intense. Once we got to hospital I had to stop a few times on the way in for contractions, I was holding onto my V-pillow for dear life and was barely aware of where I was.

We got taken into a room on the delivery unit and I was offered a bean bag rather than the bed, which I accepted. I was very woozy from the entonox and couldn't focus on any of the people coming in to the room to talk to me. I remember a woman offering me an epidural and telling me they were going to put a canula in my wrist. I shouted “No!” I didn't want a routine IV or anything and really didn't feel the need for an epidural. People came and went in a blur as I got more and more drunk on the entonox.

I remember my dad trying to tell me to stop taking it and someone said to only use it during a contraction, but the pain went on between contractions as well and I was finding it hard to tell where one ended and the next began.

I don't know how long I sat there, but I remember them putting me on a syntocin drip to try and get my contractions into a regular pattern and I dozed my way through several hours, sucking on the entonox.

A some point I moved to the bed and was examined again and there had still been no progress, I was stuck at 4cm. It was confirmed that the baby's head was transverse, so the widest part of the head was pushing down, basically preventing dilation. Breaking the waters hadn't helped, the contractions were still not regular enough to compensate for the position of the head and I had a premature pushing urge. I tried to fight it, but god that's hard! I remembered from our antenatal class a tip to lift your chin to resist pushing, which I kept doing but it just didn't help. I could feel fluid rushing out of me every time a contraction peaked and I was screaming the place down. It was the most horrific period of my life. I cried and screamed through each agonising contraction and couldn't stop myself pushing hard even though I knew I had to try.

The MW examined me again and found that my cervix had swollen and closed up. She strongly suggested an epidural to stop the pushing urge. I agreed and we were given four hours to get my cervix to unswell and start dilating before we would have to talk about a c-section. I remember the anaesthetist telling me to lay off the entonox and taking it away from me! Once the epi was flowing I didn't need it and I became properly lucid for the first time since about 5am.

The epidural was pure heaven. By this point it was about 11am, I'd been labouring without food or sleep for 30 hours. I was able to sleep and the pushing urge disappeared completely. Four hours later and my cervix had started to unswell but was still only 4cm. We talked at length with the MW, who I was finally able to focus on! She was wonderful and had been looking after me all morning, though I was oblivious. We asked for another two hours to try and get the baby into a better position. The consultant wasn't happy about it but he agreed as the baby's heart rate had settled down significantly since we arrived and was holding steady at just under 150.

I managed, with difficulty, to get onto my knees and lean on the head of the bed, I was desperate to get the head to turn so that I could still give birth to him. But we had very limited time now and I knew that it was going to do no good. I actually felt fine about it, I was reasonably cheerful in fact. The most important thing seemed to be that we had done everything we could and that we just wanted a good outcome. People kept telling me that my body just wasn't going to manage it and although I was upset and disappointed I felt we had taken the best decisions we could based on the information we had at the time.

I was checked again at about 5pm and had barely got to 5cm in 36 hours. So we agreed to the section. The anaesthetist came back to top up the epi, the consultant went through the consent form and got me to sign it and Andy was taken away to get into scrubs. When he came back I remember declaring to the room at large how sexy he looked! We had a giggle with the MW about Dr “McDreamy” Shepherd in Greys Anatomy and everything seemed quite cheerful, despite what was going on. The MW cleared the room to put the catheter in and shave me, concerned about preserving a little dignity for me, which was much appreciated. My mum went to meet my dad and wait for it to be over and we were wheeled into theatre.

It wasn't too bad, I still felt calm and reasonably content with what had happened, I had Andy right by me and the MW who had looked after me all day was there too. We insisted that Andy be allowed to announce the sex, it was the one part of our birth preferences that we could still have, so the MW made sure everyone knew to keep their mouths shut! The epi made me really shaky and I kept trying to breathe and relax to stop my arms from lashing out.

When they held him up for us to see there was really no mistaking him for a boy! Andy announced it anyway and I started to cry. He was taken away to be cleaned up and he needed a little help breathing as he had swallowed some meconium. But we soon heard him cry and the MW yelled that she'd been weed on - twice! He was handed to Andy all wrapped up and he sat with him by my head while they stitched me up. I tried to look at him and stroke his face but I had to crane my neck and it really hurt and I was still shaking uncontrollably. The stitching up seemed to take forever and I did ask at one point if everything was ok, as it was possible they had been busily stopping a haemorrhage or something without alerting us! There was a woman stood by my head on the other side to Andy, I'm not sure who she was, but she reassured me that I was fine.

When it was all over we were taken to recovery and the next hour or two is a blur, except that I kept on shaking and couldn't hold Jack yet as I was still being kept on my side. I remember someone manhandling me to put Jack to my breast and he sort of fed for a minute. My parents came in to see us and my MIL popped in just as they were tidying me up to take me to the ward! I actually had to ask for some privacy, I think they would have had everything on display to my MIL if I hadn't said something and then I was on the ward and Andy was saying a heart-wrenching goodnight to us both.

The three days in hospital passed slowly. Although Jack slept lots I couldn't and various midwives kept trying to help get him feeding, some of whom with very little regard for my personal space, getting very hands on without asking my permission. The MW who was on duty during the day for all three days was wonderful and I am very thankful to her for being very supportive. She wanted me to stay in longer to get the breastfeeding working, but I was desperate to go home. I couldn't stop crying and the nights were getting harder to be without Andy, so on the third day I insisted on going home and she told me she had every confidence we would persevere at home and crack it, which was a nice confidence boost.

It was good to get home, but the recovery was hell.