Advice needed: seeing consultant and want CS (V.V.LONG, sorry!)

[herethereandeverywhere]

I'm 11w and had my booking in appt last week. The midwife was lovely and picked up on how stressed I am about the birth (already!) given my first birth. She made me an appointment with the consultant to discuss my concerns - neither of us mentioned CS but its what I really want.

Background is:

• Induction
• Hyperstimulation (7 in 10 instead of 4 in 10) so no gaps between cx at all
• Drug to try to treat hyperstimulation caused tachiacardia
• Baby was back to back
• Was induced just before midnight so went through all of this through the night which meant I didn't get any sleep
• The pain was horrific. It was torture, so much so it literally demented me, I was smacking myself on the head to try to knock myself out
• after 7 hours of this they did an internal, ZERO centimetres dilated.
• They agreed to give me an epidural. It took 4 hours of them constantly checking and putting more stuff down it before it eventually worked. That bit was blissful. I got almost 2 hours sleep.
• Waters broke at 5cm, was fully dilated 4 hours later.
• Couldn't push her out, couldn't push her anywhere. I let the epidural wear off because I heard it was better for pushing. Still had no urge to push, it was just horrifically painful

-Went to theatre for Keillands forceps, turns out she was in deep transverse arrest. -Huge episiotomy (about the length of my finger) but they got her out

• Cut to DD's face which has scarred, still very visible now, she's 23 months.
• Aftercare was awful, asked for help getting out of bed (has been sitting in a pool of blood all night) and was told they didn't do that (so I asked could someone pull the curtain so that when I bled all over the floor the rest of the ward didn't have to watch) managed to escape that hell after 24 hours
• DD too sleepy to feed and was vomming up anything she took due to all this "gunge", developed jaundice, was getting dehydrated.
• DD readmitted to hospital via A&E 2 days later due to these problems. Despite me trying to breastfeed my milk didn't actually come in until day 6 so she was tube fed formula for 24 hours then we managed to get discharged even though she was still losing weight
• No home visits from midwives. DH spent the whole of his pat. leave driving me all over Sth London to available midwives at health centres (to monitor DD's birth weight as she'd lost 15% nd to get me checked.)
• all but about 2 of the stitches in my epi came undone. The pain of sitting on that open wound, (for hours to breastfeed) even on my full dose of diclofenac was like hell, for weeks on end, the thought of it still makes me feel sick. DD was too much of a fussy feeder to feed her lying down.
• wound ended up healing through granulation tissue, was still partially open 8 weeks later.
• had some faecal incontinence for the first 8 weeks or so. Still get pain from the epi site today.

So, I just want a calm ELCS and to be cared for afterwards. No pressure to breastfeed, I'll try it but alongside formula so I don't end up with my baby wasting away like last time.

Given the desire to reduce the CS rate at all costs (the day after the birth a midwife was championing the consultant who dragged DD out of me as "the man who keeps our CS rate down!") I expect I'll be told to try it again and see what happens or somesuch. I'm not sleeping well at the moment and find every time I'm not occupied my thoughts are turning to the birth and what happened last time.

So mnetters, what do I do/say/ask for and what should I expect? My heart is racing just from typing this. Thank you.

I also had a hideous first birth (won't go into details, but hideous) and a week in hospital including high-dependency unit.

Second time, I was having an elcs come what may. I told the mw at the booking in appointment. She said she could see my point, but couldn't authorise anything. I told the Registrar who did the 12-week scan (or maybe it was the 20-week scan - not sure which). He said I would not be allowed a cs, and that if I had one, it would be my fault if the baby or I died.

I wrote to the consultant explaining what the Reg. had said, and asking him for a meeting. He met me the following week and said he would not recommend a second vaginal birth in a million years after my experiences, and asked me whether **date would be suitable for the elcs.

So: it is possible. Make sure everyone knows that it's what you want, and if someone doesn't agree, ask for another opinion. Take your DH if it's too upsetting to talk about it rationally. Good luck!

Thank you whiffofbath. I know it's long, but any other experiences that people could share?

Thanks

Bloody hell herethereandeverywhere, no wonder you are anxious already, I am suprised/impressed(?) you feel able to have another pregnancy at all!!!!

I haven't had your experience, and in the nicest possible way with one week to go I kinda wish I hadn't clicked on your thread but agree with the other poster. You need to ask for this to be refered upwards. I can't imagaine that any one would try and say no. Only people who can't authorise won't say yes btw, they can't cause they will get in trouble. Don't take no for an answer.

Oh and massive congrats!

Hi herethere,

Sorry you had such a horrible experience. I had similar experiences to you (though without the trauma to my son). With my second pregnancy I was sure I wanted a CS, and that's what I got.

With the consultant, I would suggest making it clear that you understand the risks of a CS, list your reasons for prefering this to a vb, tell them the stress it is causing you now and have all these things written down in case you get flustered with the emotion of it all.

There is a website that outlines the risks of CS vs VBs but I'm afraid I can't remember it - I'll try and remember, but hopefully somebody will be along who does know (I heard about it on Mumsnet).

I would imagine that your incontinence issues post-birth would be a large factor in having a CS, as they were for me, and that yuo won't have too many problems. However, if you do, ask for second opinions and make a fuss.

As for the CS - lovely. The pain immediately after the operation was bad, but other than that, the recovery time was shorter, the general pain was better, and not having had a lengthy exhausting labour was a big help. I did need some help with my toddler for a couple of weeks after but not all the time. Breastfeeding was no problem, and compared the the vb it was an amazing experience.

Good Luck and let us know how you get on.

NorthLondonDoulas, I agree that there's no guarantee of a subsequent birth being the same as a first one. However, I think you're perhaps not quite understanding the sheer horror of the OP's experience (or mine). The experience I had was utterly, unspeakably horrific (it was supposed to be a drug-free home birth, so it was particularly bad. I am completely convinced by raspberry tea and all the rest of it - but when you are at death's door, that's a different matter).

The OP wants a cs, and she needs to be listened to.

OP: my elcs was relatively blissful. After-care was still rubbish, but at least I was only in hellhole-hospital for two days (rather than a week after vb). It hurt a lot, but not a patch on granular tissue, burst stitches, reconstructed vagina etc etc etc etc. And not a single incontinence problem (I was incontinent following vb).

Insist!

Your story is very similar to mine herethere. I'm really sorry you had such a horrible time. I am seeing a consultant to talk about CS on Monday, after I explained what had happened to me to my GP at the booking appointment. I am just in the process of collecting all the information I can about CS, and making a lot of notes. I want to be prepared for the conversation. I'm also very likely to be a nervous wreck on Monday so I know I will need to have notes to refer to to stop me freezing up or disintegrating into tears. Even at the GP booking appointment I was shaking nerves just knowing I was 'back on the rollercoaster' again and when he took my BP it had shot up.

Can you get a referral from either your own GP, or a nice one that you know at your local practice? I never see my own GP but ask for whoever is around that I know and trust. I am just hoping to be as calm as I can, do my homework and firmly focus on getting an outcome that I want and that will enable me to look forward to this next arrival. Hope you get what you want, it's so important to feel back in control I think.

OP - you could be me. Not an induction, but pretty much all the rest, and like some others here, a long healing process from my 'natural' delivery (forceps). I asked the MW about CS at my first appointment, because after months of postnatal physio I was told this should be an option if we got pregnant again. MW refused, and said that a natural VB was the best option, despite the shattered state of my perineum (apparently it would stretch very easily second time around).So I went to my GP, who referred me to a lovely consultant. She discussed the pros and cons of VB and CS with me, and my continence issues, recovery after first birth etc. Her strong advice was to go for ELCS, on the basis that after a third degree tear that had not healed that well, I was in danger of losing 'control' completely if there was more tearing second time around. She said I could think about it and make a later appointment to see her, but I signed on the dotted line there and then.

ELCS was enough to make me broody - much better recovery, much less blood loss (no PPH), less mental trauma, and no continence issues. Feeding was a breeze (first time around I had your experience, with major weight loss), and the scar has healed up really well. I know that this is not the case for everyone, and that yes, it is major surgery, but the whole experience was so controlled and calm that I have only positive memories of it.

If you see your consultant, go in with an open mind. I was happy enough to hear the benefits of a VB, and agree that they were worth thinking about, but with me, for both of us, it was the continence issue that was the decisive factor. Ask him / her about that specifically if you are concerned.

I've contacted the Consultant Midwife at my hospital as we've not ruled out DC3 but I wanted to know that I could have an ELCS. I wrote down all my points for why I would want one and emailed it to her.

Obviously she has come back with all the stats etc about succesful VBAC's but has agreed that should I have another pregnancy I could have an ELCS. I would highly suggest you find out who your consultant midwife is and contact her straight away.

herethereandeverywhere, I had a planned CS for my 1st DC, after a diagnosis of severe tokophobia.

Apologies, I have read your post very quickly, as this is exactly the kind of story that horrifies me -

My thoughts, FWIW - your aftercare and your baby's weightloss and feeding problems won't be something they take into account when you ask for a CS. They just don't generally see it as their 'business' or problem. They will probably just tell you you werte unlucky and it will all be different this time. So it's not a good thing to use in arguing your case, although you can certainly see how it all added to your trauma.

In fact, a lot of your experience they can argue is unlikely to happen again, or can be avoided through better management.

Whatever. I hear in your post that you aren't interested in going down the road of 'suck it and see' with a VB, but want a CS.

In which case, your best arguments are foecal incontinence, and they will be most concerned if this is still an issue in any way - and mental health. If you are going to suffer a huge amount of stress during the pregnancy, and are worried you might get panic attacks/extreme anxiety, insomnia or depression, or already are experiencing this, they should take you more seriously. If they worry you might get PND or have/will suffer PTSD episodes, it should sway your case. It will be helpful if you can get HCPs onside in this respect - so it's not just you telling a consultant you are worried, IYSWIM.

So you could ask for a referral to someone on the perinatal psych team, or get your GP both to record in your notes that you are under extreme mental pressure, and you'd like urgent referral to psychiatric services or a counsellor.

I've also had the impression from other women's stories that sometimes the well organised woman worried about 'making a scene' has gone in to consultant's meetings with a dossier of arguments to hand, a rehearsed speech or two, and come across more like a barrister than someone with genuine emotional and mental distress. Now, I'm of the opinion that women should be listened to, full stop. But it often seems that unless a consultant or MW sees that someone is in genuine misery, they don't take it seriously. So if you are adamant that you don't want anyone to see you in tears etc, that's fine, but can you write down your feelings honestly and in full and let your consultant or MW or whoever read them. (and ask that they remain on your notes - they can be sealed so the world and his wife don't read them if you want).

I'm sorry you've had such an awful experience. It sounds like you have had a positive MW so far (mine was wonderful), and so that's helpful, at least.

I had a third degree tear (3c) delivering my first, now 7mnths. The consultant midwife told me during a follow-up appointment that nobody would stand in my way if I wanted a c-section next time. I had an epi too and seem to have torn further down that line. Sounds like you had third degree too or at least tearing which has produced the same effect. Agree that it's worth highlighting the faecal incontinence and concern that it hasn't healed all that well. Really think you shouldn't be refused.

OP, I had what I felt was a traumatic first birth - but not even close to what you're describing - and when I got pregnant the second time around I spontaneously burst into tears when telling my GP as my episiotomy scar still hurt 18 months on, and sex was painful. Without any prompting he said, "you're obviously psychosexually traumatised, just have an elective this time round". This went down on my records, the consultant obstetrician was very understanding and agreed to it. Subsequent HV and consultants tried to talk me out of it with sensitive statements like "why on earth are you having a c-section, surgery is really dangerous you know", but I stuck to my guns and repeated the tears every time, and got what I wanted in the end - a lovely pain-free birth, very little pain following it (better drugs, and no weeks on end of being in agony whilst sitting down as you describe). Stick to your guns, you can do it! Also based in South London btw. Good luck.

Thanks to everyone for their helpful responses and for sharing your experiences. I know I'm going to be faced with "it might not be so bad this time" but I listened to the received wisdom about childbirth last time and I was in no way prepared for the hell on earth I went through.

I will need to play up the continence and mental health angles (I actually had a breakdown in work earlier this year and the 1st psych therapist who assessed me said i had unresolved issues with the birth of DD).

I actually managed to miss one other bad bit off my story. I supposedly lost 400ml blood (not too bad) and as a result noone checked my iron levels (I heard the midwives discussing it and agreeing they wouldn't bother). However, the midwife who saw me on my only home visist pointed out I had blue lips and the pads of my fingers were completely white (not blood in there at all!) She revcommeded I see the GP but with everything else that went on my heklth just got sidelined.

Regardless of CS/VB (I really don't want it to be the latter!), how do I end up being cared for this time? Last time I was treated as though I'd popped DD out with no more than a graze. I felt so bad that I actually had no feelings for several weeks and when they came back my confidence was shot to pieces. I can remember crying because DH was back to work and I had to do the trip to the mdwfe/bf counsellor by public transport on my own.

Your advice has been great, the appointment isn't until 14th but I'll let you know how I get on.

I had a similar (but not as bad) experience to yours. My GP (who has experience in obstetrics) said she wouldn't have another VB if she was me. The consultant who did my restitch said that I would be given the choice and another consultant has written into my notes that she recommends a CS if I have any more DC. Given that my experience wasn't as bad as yours I can't imagine that you will have any problems getting a CS. I would get your GP to refer you to a named consultant (not the one who delivered your DD and preferably one that your GP recommends). If you can afford it you might be able to get a private referral so that you can avoid being seen by a registrar who can't actually make any decision. Once the consultant has agreed, I would then avoid discussing it with other HCP as I think that it is a bit futile to have random MW telling you that you have made the wrong decision.

I had a birth debrief and the MW said that it is worth planning with the consultant about what to do if you go into labour as there is a small chance that you would get too far to have a CS, but I am assuming that if I needed an induction for my DD being overdue that there is little chance of going into spontaneous labour before a CS date.

Are you planning on going back to the same hospital?

herethere, my heart goes out to you. After my frightful vb, I was in the high dependency unit. They asked me to stand up so they could remove blood-sodden sheets; I couldn't. It took me about 30 minutes to move from bed to chair. I felt in physical agony, and utterly numb. I couldn't even speak straight for about two days.

The after-care was a mixed bag. Some MWs were fantastically sympathetic once they read the notes; others were brisk. The thing that stands out for me, though, was one of them talking about me to another. I was struggling to bf as my breasts were so engorged; the one MW was laughing to the other outside the cubicle about 'that Whiff who thinks she's going to be able to bf - have you seen the size of her nipples ha ha ha?' Bf didn't go any better than the birth.

I am still traumatised by the sound of ambulance sirens now, nine and a half years on (I was an emergency transfer to hospital).

ELCS after-care was indifferent. I left after two days with painkillers and no trauma either physically or psychologically. I felt calm and relaxed, and I found it much easier to bond with DD than I had done with DS. After DS, I was in no fit state to look after myself, never mind a baby.

Do press for it. You need it.

Saw consultant today and I'm gutted. Outright flat refusal. He'd already decided my problem was the sintocin drip (I never had one) and my labour was traumatic because it was long (it wasn't long). He kept saying that on balance a CS was safer and I could only have one if there was placenta previa or breech. I simply cannot let myself or my new baby go through what me and my daughter went through. I haven't slept more than 5 hours straight for weeks because of this. The best he could do was tell me every birth is different. Well on that analysis it could easily be worse. Shoulder dystocia, distress, oxygen starvation, brain damage (baby) and permanent incontinence for me. Not to mention the HELL on earth before and after the birth. I swing between wanting to kill someone and wanting to die. I cannot look forward to this baby knowing I have to get it out of my body.

If you have been seen in DGH ask for referral to tertiary obstetric unit. Get a second opinion there.

I am no advocate of "oooh, I think I fancy a section and it's my right to have one" but you sound to warrant one.

Please please bear in mind the advice already offered though, by several sources that every birth IS different. Even if the "mode" of delivery is the same.

I was in a similar place, and it was actually being offered a CS that calmed me down enough to accept the help of my lovely, lovely midwife and GP to support me to another (and so, so much more straightforward) vaginal delivery.

Oh no,I am surprised at this. I don't know what happens now but someone who is wiser than me will be able to advise you.
I don't know which hospital you are based at but perhaps you can ask for a 2nd opinion.
And failing that ..........a private c section.

With your pelvic floor injury I think it is very likely you will find someone else who will grant an ELCS, honestly.

Ask your GP to refer you to another Cons. Ask around if you know any midwives, see which Cons are more happy to offer CS and ask to be referred to that one.

It's true, every birth is different. But you have already experienced a really shit birth and don't need to risk doing it again. I would insist on a CS too in your position.

This is not acceptable. You must get a second opinion. Stand up for yourself, make a fuss and ask your mw or gp to refer you to a more sympathetic consultant. Perhaps to a female consultant, even pay to see a private obs consultant.

Ask to see another consultant immediately. You have a right to do this under NICE guidelines. Go to your GP and tell them about your anxiety and current mental/emotional state. Write it down if necessary and in as strong and clear a way as you have talked about it here. Ask to see someone on the perinatal mental health team asap. I think you need to press all these buttons at once, and pursue it while you are getting an appt with a second consultant.

It sounds as if the consultant has talked about purely physical issues - it is not up to him to tell you what was traumatising about your birth. If he has made basic errors in your case like telling you part of the problem was the syntocin drip when you never had one, this is shocking, and you must bring it to someone's attention. I suggest the Head or Consultant MW for a start.

You absolutely have to go for a second opinion. I'm having an ELCS this time after an EMCS last time and this hasn't been quibbled (so far, though I am 34+4 so it's a bit late now....) and although I felt my experience was hell of earth, it was nowhere near the hell of yours.

You need to to keep shouting loudly, get back up from your psych, any notes / documentation that backs you up.

Good luck

herethereandeverywhere, I feel for you. Had some of the issues you had ( including PPH, traumatic forceps birth and baby readmitted through A&E) and now, newly pregnant with no.2, like you I cannot sleep with the fear of another vaginal birth. Am still seeing a physio for postnatal issues and broke down in front of her after a gynae had told me another VB, instrumental if necessary, would be preferable to CS. Physio said I should be offered CS to avoid further perineal and mental trauma, so will follow the excellent advice given above and fight for it.
Which hospital were and are you at? PM me if you prefer: am asking because I too am in South London...

Thanks all. He said I could have a second opinion from his colleague at 28 weeks. That's too long to feel like this and I got the feeling his colleague would just back him up. He also said I could see a counsellor. Whilst I think that talking might lessen the memory of the trauma it's not going to affect my next birth. My experience was terrible, you can change my perception but you cannot change the facts of what happened to me and DD.

DH and I are contemplating going private but it would cost about £10k and we really do have better things to put money like that towards.

Also I'm supposed to be getting a referral to the damaged perenium team (the MW was going to make that one) and I'm hoping that they'll establish more evidence of the physical consequences of last time.

I should go and see my GP but I've had so many medical appointments lately.