Can I request a CS whilst in labour?

(22 Posts)
Julietee Sun 23-Feb-14 20:52:29

I have diagnosed anxiety / OCD that has just been hideous at times during my pregnancy. Honestly, I'm angry about how my mental health has been handled. The midwife who took my booking didn't ask me the question that would have led to me being referred to a consultant (have I ever been under the care of a psychiatrist. I have, but she didn't ask and marked it down as a 'no'). I did explain to her about my anxiety but she was pretty dismissive in a nice way, if that makes sense. I feel it wasn't her call to make how bad my mental health is/ could be, and she's effectively barred me from a lot of help that would have saved my sanity the first 20 something weeks when my anxiety was crazy high.

Anyway... rant over.

I'm 40 weeks today and I'm feeling such despair on and off about what's coming. Not only about labour which I am terrified of, but about being capable of caring for a newborn when I can barely care for my husband and me, and recovery if things go badly. I'm not suicidal, but I have caught myself thinking 'this would all be so much easier if I could just, you know, be dead, then I wouldn't have to go through all this'. I'm pretty sure that's an anxiety response to my various fears, though, rather than something to be horribly concerned about, as I don't feel it right now at all.

I just read on another thread in here that anxiety is something that can warrant an ELCS. Obviously it's too late for me to be going through that process now, though maybe I would have been told that if I'd had consultant care.
So, can I request a CS during labour if I can't cope? My fear is that I'll start panicking and won't be able to stop. I've already been told they don't do anti anxiety drugs in labour, so no safety net there.

I have a doula and a supportive husband, and I don't want a CS if I don't get incredibly anxious, I just want the option to be there, if you see what I mean?

fuckwittery Sun 23-Feb-14 20:57:10

Its not necessarily too late, can you request an urgent meeting with a supervisor of midwives.

Julietee Sun 23-Feb-14 21:05:40

I guess I could ring tomorrow. Half of me feels like I'm kicking up a fuss over nothing.

plentyofsoap Sun 23-Feb-14 21:34:35

I requested one half way through my labour and got it.
It was going to be arranged but I went into prem labour. It was my second section though. To answer your question, I managed it but be prepared to be talked out of it.

MyDarlingClementine Sun 23-Feb-14 22:14:52

I think 99% you wouldnt get it, the likely hood of someone in a life and death situation, booked sections that are running late and so on.

the mw would simply smile at you and pat you on the head and tell you you are doing well.

its down to you to manage your care, and it sounds like your mw had no deeper understanding of your fears or indeed was able to understand them.
even now you dont seem sure of what you want. i had anxiety and did loads of research, spoke to consultant and got an elc, I also changed and complained about my mw.

I guess the point is, its not very likely you will be granted one in labour, women can barely get epidurals!

do your research decide what you want nad try and argue your case.

PenguinsEatSpinach Mon 24-Feb-14 12:51:08

I would agree with Clementine.

During labour you will be below the emergency sections for maternal/baby problems like foetal distress and may even be below planned sections given that it doesn't sound like you've talked it through with them previously so it is likely to be considered 'normal' first labour panic.

I think you urgently need an appointment to discuss it all. It may be that you decide you still want to labour naturally but have more detailed information in your notes regarding your mental diagnosis and it you aren't coping, for example.

Good luck.

VivaLeBeaver Mon 24-Feb-14 12:54:39

I think you need to ring and talk to a Supervisor urgently today. I think in the event of a real panic attack/major anxiety it should be and could be an option. However you run the risk of a midwife not taking you seriously enough so the more support you get now, stuff in your notes, etc, plan in place, the better.

But yes your priority in such a case would come below those with medical need for a section. So even with all the support and a plan in place you will always run the risk of it not been a possibility on the day depending how busy the ward is.

Anonymai Mon 24-Feb-14 12:58:44

I agree with pp. Try and fight for an elcs now before you go into labour. I was in a similar situation and only found out after I'd had a vag birth that my MH issues would have guaranteed me a caesarean. I still feel quite angry about it because the last few weeks, I was petrified of labour and actually could have enjoyed it rather than worrying.

It might be worth finding out if you have a perinatal mental health team in your area and contacting them. That's who I would have gone through had anyone told me it was an option.

Julietee Mon 24-Feb-14 16:02:05

Sounds like my situation is similar, Anonymai.

I know I should force myself to face this, but I don't think I'm up to it now. Will discuss with husband and doula tonight.
Thanks very much for all the advice.

rightsaidfred Mon 24-Feb-14 17:03:58

Breathe
Sorry to go against other posters- but this seems to be a classic avoidance strategy- which if you have had any past treatment for anxiety you will know that avoiding ultimately makes the anxiety worse. Surely you need a plan to manage the anxiety rather than a C Section? Plus- you would be awake during a C Section and for most people that is more anxiety provoking.

Have you had CBT in the past? Can you revise a few old techniques? Do you have a CPN who could go through this with you? Are you know to your local crisis team? Or can you contact your old psychiatrist or CMHT for an urgent appointment? They might be able to offer some short term support/ strategies that your doula and partner could help you with on the day. Do you have any relaxation/ breathing exercises or cds that you could use?
It is a real shame that you haven't had decent mental health support during your pregnancy- it sounds like you have been badly let down..... but you can do this. Please try to talk to someone in MH services- they will be able to help
Good luck x

Anonymai Mon 24-Feb-14 17:12:24

Plus- you would be awake during a C Section and for most people that is more anxiety provoking

She would be awake during labour too? confused

Planning for the anxiety and relying on that might not be the best idea. OP doesn't know how she will feel during labour and it's very hard to implement cbt methods when your anxiety has reached a certain point. I don't really see how cbt would work here anyway. She can't push a baby out multiple times to lower her anxiety about giving birth can she?

rightsaidfred Mon 24-Feb-14 17:28:17

Anonymai - Yes.Of course she would be awake during labour!!!!
You are thinking of ;systematic desensitisation' which would be used for a phobia- no obviously that would work in labour and isn't appropriate treatment for the anxiety the OP described.

The CBT techniques of challenging the intrusive thoughts eg 'I can't do this' coupled with the behavioural elements of breathing exercises are what is needed here- and what the perinatal team would likely advocate- but it doesn't need to be someone as specialist as a perinatal MH practitioner to implement this - a crisis team or CMHT would be able to respond much quicker for some last minute birth prep...... this should have been done months ago but it is not too late

Anonymai Mon 24-Feb-14 17:37:57

How does the cbt work in this example then? Genuinely curious because the two years of cbt I've had involved repeated exposure to prevent certain responses (ERP). Repeated exposure to learn that the anxiety eventually goes away. Which obviously wouldn't work for childbirth.

Wondering now if I've been treated incorrectly?

Anonymai Mon 24-Feb-14 17:41:29

And this:

* Yes.Of course she would be awake during labour!!!*

Is unnecessary. I was pointing out that your reasoning that she would be more anxious in a caesarean as she'd be awake is a bit daft considering she's anxious about labour which she would also be awake in.

rightsaidfred Mon 24-Feb-14 18:46:21

Anonymai- I am slightly perplexed as to why you are so upset by my post and are attacking me.

The OP expressed the opinion that mental health team involvement would help her and this is something she wanted- and that she was considering a CS out of despair. This was her opinion- not mine. I was attempting to suggest ways that she could access the care she wants/needs. As others have said upthread it is unlikely that a CS will be offered at that late stage and likely to be fobbed off by midwives. This was intended to be helpful to the OP and was addressed to the OP. In no way was I intending to be offensive to you

Julietee Mon 24-Feb-14 18:53:12

Rightsaidfred
I see where you're coming from, thank you.
Yes, I've had CBT in the past and have actually seen my old private psych a handful of times in the last 3 months because of the anxiety. He's not really a breathing technique guy, but we've definitely done the 'I can't do this' thought challenge stuff. I actually think he would support me having the possibility of a CS as an anxiety prevention tool.

Anonymai Mon 24-Feb-14 19:06:07

I think you've misread tone in my post that isn't there. I'm genuinely asking you how cbt is applied in this example as I'm worried that the treatment I've been having isn't right. That's why I said "genuinely curious" as I'm panicking a bit. My treatment hasn't worked so I'm wondering if it hasn't been done in the best way which is why I asked how it would be applied in this situation. No upset and no attack. Just a genuine request for an explanation.

Julietee Mon 24-Feb-14 20:06:19

Anonymai
I think different practitioners latch onto different techniques that they use/ overuse sometimes. That might be the case with your psych, or it might be that s/he considers exposure therapy to be the most useful thing for your issues.

With my guy, he concentrates a lot on challenging thoughts. We often use (overuse) worksheets where you write down the initial thought and through a few steps work towards changing that initial thought to a more useful one.

I don't know if you have OCD or other anxiety issues, but you might find it useful to see what people with similar issues have had, treatment wise, on more specific forums. I always really liked the forums at ocduk.org.

Might be that strategies other than exposure would work for you better at this point. I got to a stage with my psych where I found generally talking through the issues more help than going through yet another worksheet (I had CBT initially for 4 years because my OCD was awful).

Anonymai Mon 24-Feb-14 20:13:35

That sounds really useful, thank you for explaining! I think I will ask about trying that approach and hopefully it might help. I've always found ERP a bit confusing because it seemed more about getting used to something over time but then the things I was meant to be getting used to change every time so it never feels the same if that makes sense? I'll check out those forums too thank you grin

Julietee Mon 24-Feb-14 20:24:51

NP! Uh, yeah, that doesn't sound terribly helpful and yes that does make sense. One of the main sheets we used was called an ABC worksheet. Can't find the exact one online but it's a good example of thought restructuring.

randdom Mon 24-Feb-14 20:26:10

I think that regardless of whether a CS is possible at this stage or not it would be worth urgently highlighting your concerns to someone. They might be able to put a plan in place to help you cope better with labour. Some units for example with have a policy of putting an experience midwife with women who have significant mental health problems. Your first point of call should probably be your midwife and see how that goes.

Julietee Mon 24-Feb-14 21:27:47

Thanks randdom. I have a mw appt tomorrow and will bring it up.

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