did you have an elective section, what were your reasons?

[chocoraisin]

Hi all,

I'm having a bit of a palaver over my birth plan. I've relocated into a different PCT (marriage breakdown means I've had to move in with parents with my toddler) and here, no-body knows me. I was booked in with a specialist birth trauma midwife where I lived previously, who supported an ELCS due to my previous emergency delivery, my problems in pregnancy (SPD very severe) and general stress over the situation.

It was meant to be discussed and booked in here, but the consultant is pushing me to have a 'natural' delivery. She's suggesting I use stong opiate painkillers at a level that my baby would require withdrawal management from, to control my SPD. She says going through withdrawal is better for my baby than having a planned section. I disagree. I would rather grit my teeth through the pain, even though I'll be very, very tired, and have a planned section. I don't understand why the doctors are pushing me to have a 'natural' delivery when it means lots of drugs, total exhaustion and the likelihood that I'll need another instrumental delivery if I am too tired to get baby out. Last time I had emergency forceps in theatre, and took 10 months to recover from my pelvic problems :(

The main argument seems to be that a c-section takes 6 weeks to recover from. I don't really give a damn when I know that my last delivery/pregnancy took roughly the best part of a year to recover from. And I DO NOT WANT to take high doses of morphine for the next 18 weeks or so just to 'perform' as a woman :(

How do I get them to listen to me? Am I being unreasonable about this? Can someone more experienced come along and tell me why the doctors plan is better than mine? Feel very upset and pressured about the whole thing.

In your position, I would ask to see a different consultant and push for section.

I had a planned c-section for SPD, the consultant thought it was for the best, I was on painkillers while pregnant which I was told were safe and the doctors prescribed and then he ended up having drug withdrawal from it (luckily only mild). I cant believe someone wants you to take a drug KNOWN to make the baby have drug wthdrawals - can you see someone else at the hospital?

I've been referred to the pain clinic (who have precribed codeine, with a possible step up to fentenyl patches) and they are unwilling to take responsibility for the 'obstetric' decisions as they don't think the pain control offered is safe for pregnancy. I know other women have used the patches, I don't want to though. My DS had withdrawal symptoms from the codeine last time and that was upsetting enough. I've also been asked to speak to a clinical psychologist to discuss the 'anxiety' problems the consultant thinks I have I do not have an anxiety problem. I am justifiably anxious about what I feel is a bad clinical decision, that me and baby will have to live with. I feel crap about the hoop jumping they are expecting me to do :( and there is no guarantee that this doctor will listen. She suggested she write my birth plan for me!! Um, thanks, but no? It's my birth, my plan - you can't just TELL me what to do!!

Third degree tear in first delivery and baby breech (although when scanned on the morning of section she had turned). C section was wonderful and whilst I didn't drive until six weeks, a week after section u was in a hell of a lot better shape than a week after delivery that gave me a third degree tear. I was pushed to have a natural delivery, I told them i would have one if they could guarantee no tearing/pelvic damage and if I or the baby were injured I would sue. They got the diary out and asked which day suited me best for the section.

I had one due to 4th degree tear tear during first delivery, following forceps in theatre, like you. It did not take 6 weeks to recover from the CS, why do people keep banging on about this magic 6 week point? Everyones different. For me it was a million times better than the first experience. Having another elcs in 10 days. See a different consultant or dig your heels in. Sounds horrendous for the poor baby, last thing he/she needs.

thank you - I will keep fighting. I just feel like they are treating me as stupid, selfish and lazy right now! I am mentally competent and want to make an informed choice. I hate the god complex some doctors seem to have when it comes to telling you what your 'best' option is. I also had bad internal tears last time which I was being referred for a possible Fenton's proceedure for, when I conceived DC2. Not at all happy about the idea of forceps as an 'option' ever, ever again.

Macrosomia.

I was fine way before 6weeks, except for driving a manual car. I tried at about 5 weeks (on advice of gp) and although possible, I could feel pulling in my abdomen. Ok for normal driving around, but wouldn't have liked to be in a situation where I needed to brake hard and fast iykwim.

All fine.

I had two vbacs, one of which ended with me needing extensive rehab on undercarriage, and the other a brain damaged baby, so I'm now not allowed to vb even if I beg.

I had an ELCS for my 1st DC due to severe birth phobia. I had to see a perinatal psychiatrist who recommended to a consultant I have an ELCS.

If you've seen a specialist birth trauma MW, it sounds as if you might have had some counselling/debrief anyway? It might not be such a bad idea to agree to talk to a psychologist about 'anxiety' issues, although if you feel it's been offered in a patronising way, I can see why you wouldn't want to. You might want to be clear that you will meet them to see if you feel they will offer you help/support - but let your consultant know, in writing if necessary, that you feel you are raising legitimate clinical physical concerns which are being dismissed as anxiety problems, and you don't feel this is a fair or helpful approach.

As others have said, I would ask to see another consultant, and also ask to see the Head MW at the hospital you are at. I think you could do with some people fighting your corner for you. If you were being considered for an ELCS in a different PCT, and had seen a specialist birth trauma MW, then it's worth saying, in writing, that you don't feel you are getting the same level of care in your current PCT. And by all means let them know if that is causing you 'anxiety'!

I keep banging on about 'putting it in writing' - it doesn't have to been legalistic or threatening etc, but I do think that it's often only at the point when patients record their concerns and objections in writing, so that it can be part of their file, that they are taken seriously. It can be very difficult when you have several 'one to one' chats with consultants etc to get a sense of progression - it's easy to keep having the same conversation over and again - written notes which amount to a polite but firm version of 'you said this and I disagree/think you are not taking into account x' are often useful in moving things forward.

Having one in July after EMCS with first dc five years ago. Post traumatic Stress Disorder and depression helps to persuade them! Ask for midwife and GP support.

PS CS recovery times vary so much - I don't know where this '6 weeks' thing comes from. Some women recover much faster, others take longer - you obviously took a very long time last time to recover from your VB.

Also, if you have a toddler but are living with your parents atm - wouldn't that mean you would have some help with your toddler while you were recovering? If the consultant's concern is to do with your recovery time, they should be taking into account your life circumstances and available support.

I had big blood loss last time, felt fairly crappy for about 2 weeks but was driving at 3 weeks and fairly back to normal so I dont think recovery time is a valid argument from consultant. I'd hope with a planned CS recovery time would be even quicker.

I did, with ds2. He was breech, and despite being blessed with 'child bearing hips', my pelvic opening is actually not that big. Ds1 got stuck and was unceremoniously hoiked out in an emergency section in the end. Obviously I couldn't risk delivering a body and failing to get the head out so there was no way I would have opted for a natural delivery, and my consultant wouldn't have allowed it anyway - too risky.

My recovery was so much better 2nd time round. I was fitter, but the fact I hadn't had to labour for 30+ hours first definitely had a bearing. I was driving within 4 weeks.

Hi Chocoraisin, I am currently 33 weeks pregnant with my second baby and am persuing an ELCS due to developing coccydynia (severe tailbone pain) during labour/delivery with DD1 3 years ago.

It's a long story that you might be interested in reading, in terms of where I'm at now regarding ELCS being the 'best' option, despite some very heavy-handed attempts to inform -frighten- to the contrary by obstetric staff - if you're interested, you can read the details on my thread www.mumsnet.com/Talk/childbirth/1401146-Coccydynia-and-second-delivery-what-to-do

I don't have any practical advice whatsoever - but I did just want to offer my sympathy in what sounds like a v upsetting situation. You poor old thing. I don't know how you go about transferring to another consultant but hope someone can come on and tell you how to do so as your current one sounds AWFUL. Good luck and keep fighting!

I had ElCS with 2nd baby because he would be bigger than 1st baby (whose birth & recovery were veritable nightmares) with a huge head, SPD, and frankly, because I couldn't face the thought of having another VB. It took a bit of crying to the maternity psychologist. HTH.

Re recovery from ElCS - I hurt on 1st day, pain wasn't bad on 2nd day, and I felt FINE on 3rd day. Seriously. Of course I was being careful with the scar, but I could care for DS, I was laughing, enjoying the first days of my lovely little baby. Compare & contrast to the nightmare 3 WEEKS I had after DD's "normal" VB where I was crying and squirming on the bed and basically couldn't care for (nor about) her, I know which one I would recommend.

Ask to be transferred to a different consultant who will, with reference to current NICE guidlines, perform your ELCS.

I had an ELCS for both of my DCs. Was up and about within hours, driving at 2 weeks, running at 4 weeks.

ELCS with both mine - scared of birth. Never saw a counsellor but my NHS consultant just accepted that it was the only way that I wanted to have my baby. First one I felt "normal" within a couple of days second it was more like a week (but I had had a severe haemorrage due to my placenta growing into the uterine wall and was in the HDU for 24hrs after birth).

I had an emergency (crash) section with dd1, which was such a rare type that the hospital with dd2 wouldn't beleive me. Once they got my notes through (after the point where dd1 was born) they booked me in.

ELCS after previous EMCS and post partum infection. Quoted the RCOG green top guidelines at the consultant, made clear that I've researched risks and benefits and he was quite happy for me to have an ELCS then. In fact once I mentioned the ppi, he even put in my notes that I shouldn't have TOIL if going into labour before booked date.

Was out of the hospital 2 days after section.

I had one following an EMCS for my first DC. My cervix was broken so there was no way a baby was coming out of it.

Personally I would say to bear in mind the 6 week recovery period. It's not a race and the last thing you want to do it mess up your insides when they are healing. But I was back at the gym at 12 weeks after both CS's. Planned CS's are fine really . Just rest and let your body recover.

I'm having one at the end of may due to a previous section, failed keillands forceps and a PPH. I've also had post mc/surgery complications.

I thought I would have to fight my corner but the consultant just said 'have you read the leaflets?' 'what do you fancy?' and 'fine, come back at 36w and we'll book you in.'

Where abouts are you? Is there another hospital you can swap to? If not I'd do whatever you can to get another consultant.

Good luck, you've been through enough shite without all this stress too!

Wow I am surprised they are being so stubborn, I was asked what route I wanted to follow when pg with my second after an emcs with my first. I told the reg elcs and he said that usually he would try to nudge towards vbac, but because the baby was measuring large with +++ fluid, he wouldn't bother.

As it turns out he was the only one who would have had a chance of coming out the trapdoor, third baby elcs because of previous 2 sections, plus transverse and gd.

Have never had any problems with recovery (lucky), made a bit of a perfomance with my first was when they wanted me to get up . Was fine with 2 and 3 because I knew it was best to be up and about asap, obviously keeping the painkillers up for a few days.

I would certainly stick your heels in, if they are really not listening then transfer to a different consultant or even hospital.

Good luck.

I have had ELCS for both my children by choice (no medical reason just really don't fancy the thought of a VB).

Both were quick recoveries - driving by 2 weeks (8 days with 2nd) and back out running at 5 weeks.

thank you so much for your replies and advice. It's confirmed to me completely that I really do need to push for this and will go to the psychologist armed with info (NICE guidelines et al) so that I can show I am clued up and am making an informed decision. Good luck to all of you about to deliver!! I hope you have wonderful stress free deliveries and enjoy your beautiful little babies :)

I'll let you know how I get on x