ELCS after EMCS - did you have to fight for it?

[WorrisomeHeart]

Currently 10 weeks with #2. My DS was born by EMCS following a v traumatic failed induction and was in NNU for 3 days. I ended up with PND, all in all a pretty horrible experience.
To try and ward against the same thing happening again (unlikely I know, but hard to be rational about) I want an ELCS this time round and wondered if some others who had been in my situation could share their experiences. Did you have to fight for the CS? I've had an initial read of the NICE guidelines but they all seem geared towards first time mothers. I have my booking in on Monday so will be raising it then, but am worried that they'll try and refuse and make me have a VBAC.

[Panzee]

I have had two CS, wasn't keen on the second one but went way over and didn't want induction.

There would have been no issue if I'd requested CS from the off. In fact when I went for my consultant appointment at around 20 weeks he had his diary open ready to schedule the section! He closed it again when I said I wanted to go vaginally (ha!)

[SignoraStronza]

No, not at all. And there was a five year gap between emcs and elcs.

I was being monitored for gestational diabetes but didn't actually have it (scored 0.1 above the threshold on a gtt and all hell broke loose, even though all subsequent blood tests and self monitoring was absolutely fine). Baby was head down though and no other health issues.

I really uhmmed and ahhed about vbac but wasn't willing to take the risk - and certainly wasn't prepared to be induced. When they told me I'd have to be continuously monitored and would not be allowed an attempt at a full rainbows and whalesong, drug-free natural waterbirth I decided to go straight for elcs.

3rd and final is extended breach atm (32 weeks) so a vba2c not even an option!

[feekerry]

nope. no fight at all. can't say i had an awful time first round medically or emotion so no medical reason why i i couldn't have tried a vbac but no pressure at all. saw a consultant who calmly explained both options and simply asked my preference.
when doing all my research before apt (went armed with nice guidelines etc) i got the impression it did vary from hospital to hospital but i certainly had no problems!

[theborrower]

I've just had a VBAC, but I was given a choice and was told that I could change my mind at any point. I was never pressured to VBAC, and was always under the impression that a CS was possible if I wanted. In fact, I had a CS booked in the event that I got to 41 weeks as I didn't want to be induced (well, I agreed to have waters broken that day if possible, but even then I was told I would be able to change my mind) but I had my vbac at 39+2.

Good luck, I'm sure it will be fine, and you're informed about the NICE guidelines should there be any pressure to VBAC.

[Mrsgrumble]

No problem. I asked. Granted there is only a year of a gap but I am booked in. Very happy.

[MillyMoo1113]

I did have a bit of a fight but won!

Ds was v long labour resulting in emcs for various reasons.

I said from outset when I was pregnant with dd that I wanted elcs but the junior doc I saw at hospital said that I should try vaginally despite my history and dd being breach. I insisted on seeing the consultant who agreed it without argument and I was very glad I stuck to my guns, the elcs was the right choice for me and for dd.

[Panzee]

The consultant (nearly) always says yes. Never bother with the underlings. ;)

[MillyMoo1113]

Underling looked about 12, tho maybe that's me showing my age! But the consultant was fab, my body doesn't do straight forward births!

[noblegiraffe]

No problem at all, they offered me the choice. They did give me a load of stuff about vbac but my mind was made up and that was fine.

[WorrisomeHeart]

Great, thanks so much for your posts. I will raise it at booking in and try and get an appt with consultant ASAP. I presume it's via the midwives, I didn't have to see one last time.

[dottytablecloth]

Well at my 12 week appointment the registrar was very adamant that I should have a vbac.

He very obviously compared a trouble free vbac with all the things that could go wrong with a second section- just be prepared for that.

I told him I wasn't prepared to take the risk of a rupture and he sniggered at me

When I see my consultant I shall be making it clear that I am very well informed of the pros and cons and I am not having a vbac.

It's not always a smile decision that is automatically granted. I will definitely be having a section, there is no doubt - I'm just not sure yet how hard I'll have to fight for it.

[dottytablecloth]

*simple

[BettyOff]

They have to tell you the risks and benefits of both, they'll push for VBAC as complications of 3/4/5th sections are on the rise and it's causing problems and costing a lot but you're well within your rights to have an elective section. There are risks of both for a second section and a VBAC and actually the risks are very equal. If you go in saying you know the risks, you're planning for your family to be complete after this baby, you feel the risk of uterine rupture is high at 0.5%, you feel traumatised after the previous delivery and that a VBAC sets you up for a fall as you have to go to hospital early, be continuously monitored and are less able to be mobile and therefore more likely to have an epidural and instrumental. If you know the risks and benefits and have a good reason for your decision they won't say no but they will have to go through all the risks of both sides before they'll book you in.

[Imsoontobemummyto2]

Panzee - I'm sure all the junior doctors who work their arses off in the NHS for surprisingly little money would find your comment very edifying.......

[Panzee]

Meh, it's the one who actually cuts who should decide. Most people on here have trouble getting a CS agreed until the consultant appointment.

[BettyOff]

Panzee it's very rarely the consultant who actually cuts. Registrars do the vast majority of both elective and emergency sections and do many more per year than consultants.

[RedToothBrush]

I've had an initial read of the NICE guidelines but they all seem geared towards first time mothers.

You need to read the right bit

There is a whole chapter (Chapter 11 Pregnancy and childbirth after caesarean section) dedicated solely to the subject of VBAC v ELCS.

In the chapter it does a breakdown of the pros and cons before making recommendations.

The key recommendation in that section for you is:
Recommendation 119
When advising about the mode of birth after a previous CS consider:
•maternal preferences and priorities
•the risks and benefits of repeat CS
•the risks and benefits of planned vaginal birth after CS, including the risk of unplanned CS. [new 2011]

To make it very clear: When discussing a VBAC v ELCS NICE recommend that your preferences and priorities are a key part of that decision making process and should be taken seriously.

NICE appear to have recently changed their website, otherwise I would link to the document (In the full version of the document recommendation 119 can be found on page 195 - but it will be in the abbreviated version somewhere).

Chapter 5 about Planned Caesarean section which includes 5.9 Maternal request for CS, might read as if its more geared up for first time mothers due to the data being looked at being solely for first time mothers, however the recommendations at the end are aimed mostly at women who are suffering from anxiety over childbirth rather than first time OR subsequent pregnancies. The focus for women who already have had children is on women who make requests due to previous traumatic births which you may well not identify with. (Primary and Secondary tokophobia are both discussed).

There are however elements of the recommendations in this section which are useful to you in that they also back up recommendation 119 in saying that any woman who wants a CS should be given one, and if you consultant refuses to perform it, they should refer you to someone who will. This is on the basis, that regardless of whether you are suffering from severe anxiety over a VB or just have a preference, forcing you to have one against your will could damage your mental health.

So the guidelines are in your favour; you just need to know how to use them.

That said, in most cases, if you have already had a CS, you will have less trouble getting someone to agree to one than if you never have. You might get some pressure to have a VBAC, but it tends to be an easier process as its judged to be about physical issues rather than trying to prove mental health ones.

Hope things go your way, but you should get want you want in the end (although you technically are not entitled to an ELCS).

[Zamboni]

Very easy for me and I saw a Registrar to confirm my decision - very much 2 choices explained and I was asked for my preference. Very straightforward .

[WorrisomeHeart]

Thanks Redtoothbrush that's really useful. I need to have a closer look, I think I was just reading re abbr version.

[Justfivemoreminutesplease]

I saw the consultant who talked me through the risks of a second CS and I nodded and agreed that I still wanted one please. Her diary was then produced & a date picked. I was expecting more of a fight to be honest but was glad that it felt like two adults having a conversation.

Fast forward to day of my section & they start the op and it turns out that my CS scar had ruptured - they could see the baby's head through the uterus membrane. I wasn't in any pain or discomfort.

Naturally I felt v relieved (& exceptionally smug) that evening and still think that you should always stick with your gut instinct no matter what.

[ATruthUniversallyAcknowledged]

V easy. I've actually opted for a middle ground (ELCS booked for 41 weeks but willing to try vbac of he comes of his own accord first) but consultant would have booked a section at 39 weeks if i'd wanted one.

He said there were three factors to consider:

• maternal preference
  
• how big a family you want (more sections = more risk so they're likely to push you towards vbac if you want a large family)
  
• reasons for section last time
  

In my experience, maternal preference was definitely given priority. Hope it works that way for you too.

[frankiebuns]

I had a emcs with ds after a non progressing labour him being oblique etc and my consultant this time told me elcs was far better than vbac for me as I have a anterior placenta and the risks were high I agreed but kinda felt a failure as I really wanted to do it properly this time, but glad sge made the decision. But I'm 37 + 3 and think my bodys got it this time! My braxton hicks have kicked in ugh