Am I crazy to want a c section?

(17 Posts)
xxx28xxx Mon 22-Jun-15 20:03:54

Just that really! Am pregnant with my second and am anxious about birth, my first labour was pretty bad. A very painful induction followed by forceps delivery and narrowly missing an emergency section.

Recovery was painful and after a nearly 30hr labour I felt like I'd been hit by a train. I had both a big, nearly 10lbs, and long baby so I'm sure this contributed to the forceps delivery.

Anyway I just don't want to possibly go through all that again. I had an apt with an obstetrician today and I feel like they completely dismissed my concerns as my first birth was apparently completely normal!

I was given lots of negative facts about sections and was told there was a chance I could die! I understand that can happen in rare cases but surely the same can happen in natural childbirth?!

I was also told that pretty much all sections involve forceps so I can't avoid them, that second babies being bigger was a complete myth and that recovery is much worse. Is this all true? I appreciate recovery may be harder because I wouldn't be able to lift and that it is major surgery but I just feel like the consultant was throwing everything at me to put me off.

Can anyone advise? Also can I insist on a section if I decide I want one? I thought I could and the consultant was quite vague and kept changing the subject. I'm only 20 wks so appreciate a lot can happen before I'm due but I would like to make an informed decision rather than feel rail roaded again!

Thanks in advance smile

LashesandLipstick Mon 22-Jun-15 20:31:30

You're not crazy. I'm having a cesarean because I have a higher chance of needing an assisted delivery and an EMCS, and also have bad anxiety. I told them that in that case I'd rather just have the cesarean.

Some people love to play up the risks of a cesarean and downplay the risks of natural birth, it's very annoying. Ask for a second opinion

FlumptyDumpty Mon 22-Jun-15 20:39:20

It's very unprofessional of them to highlight only the risks of the section, and not the risks of a vaginal birth. Both have different pros and cons. Medical ethics demand that the patient is given enough information to give informed consent. If you are only given half the information you are not able to give informed consent.

ELCS appears to be less risky overall than a forceps birth. You are not crazy to consider a section, especially given past experience. Though of course, a second birth could be easier... But no guarantees of that.

If you are unsure I would ask for another meeting, as Lashes said.

If you really want a section and they dig their heels in, you might need to go down the route of saying you are too anxious to try for a vaginal birth.

Good luck.

SaulGood Mon 22-Jun-15 20:42:21

They do have to tell you the risks as you have to be considered informed before consenting to elective surgery. Of course there are many risks with vaginal birth but you don't need to consent to a vaginal delivery, only to interventions as they crop up.

I've had two emcs. Second was an attempted vbac. It was a positive, wonderful experience and I suffered no pain, took no painkillers and was up and about within a couple of hours. I was back running at 9 weeks. It isn't necessarily a terrible experience.

You should be able to request a CS and you should request that you discuss this again. If your consultant is not amenable to discussing it appropriately, then you need to see somebody else. A large/long baby isn't necessarily the reason for forceps. Head circumference and position make the most difference to delivery and I had a 7lber and a 6lber who got very, very stuck because of their positions. Have you ever had a debrief and gone through your notes with a professional? It's worth making sure you are aware of what actually happened in terms of clinical reasoning and use this information to make a decision about what is right for next time. It should be a dialogue based on what happened last time and what your concerns are for next time. You shouldn't feel dismissed or ignored. If a CS is indeed right for you, then that's what should be happening.

Good luck with it all!

Tequilashotfor1 Mon 22-Jun-15 20:45:54

No not at all and I'll be doing the same!

I had a ten pound baby which ended up in a ECS. It got s bit manic towards the end and im not going through that again.

I was ok after my section, you just need plenty of help

HappyIdiot Mon 22-Jun-15 22:29:29

Just to add, you can avoid forceps if you refuse to consent to them. My baby was in an undeliverable position. They tried a ventouse to turn her, which didn't work. I kept saying that I didn't want forceps and they didn't use them and went straight to an emcs.
But obviously you would have to pay attention to what the doctors were saying during your delivery, if the baby was in distress for instance. I felt confident to refuse forceps because dd was being monitored and was ok, if she was distressed I would have probably consented if it would have made a difference to her.

BlinkAndMiss Tue 23-Jun-15 05:47:06

I was in a very similar position with my 1st labour with the exception that DS was relatively small. When I fell pregnant with DS2 I did everything I could in the beginning to be considered for a C-section because I was terrified. The consultant I saw was adamant I wasn't having one, she went through my notes and showed me how normal my 1st labour actually was. She also said that there was a 95% chance my next labour would be straightforward because 2nd babies usually are. At the time I felt completely ignored and abandoned by the people who were supposed to help me.

The one thing that changed for me was that DS2 turned from back to back to the right way around, this gave me more confidence and I stopped pushing for a section. Looking back I should have been stronger rather than giving in but I did feel like I was meeting brick walls in every direction.

As it turned out, DS2 was out naturally within 6 hours of my first twinge. I was expecting a large baby as he was my 2nd and because of the pattern within my family but he was smaller than my first. Everything was very straight forward and so much easier than the first time round. It actually gave me some closure for my first labour and the horrible experience I had.

I know that it can't be guaranteed but in my case the statistics were true. It's more than likely that your 2nd labour will be completely different to your first and although it's hard to believe, your 2nd won't necessarily be large. A vaginal birth might actually be the 'easier' option. So please try not to dread it if you are refused a c-section. You could request a growth scan, I'm not sure how accurate they are though.

However, if you aren't wanting to take the chance (and it is a chance) then you absolutely must stick to your guns. I didn't focus on the mental health side of things when speaking to the professionals but I know people who have and they tend to be taken more seriously. I was lulled into feeling more secure but looking back, I shouldn't have allowed myself to be because it took away my option of having a section. What I'm trying to say is that they will try to convince you that a section is not an actual 'option' and if, like me, you believe them then it absolutely won't happen. They really do focus on keeping their section rates down when there is no specific medical need for a woman to have one.

Whatever you end up doing you must have confidence in your choice, otherwise the stress of it all will hinder your experience. 1st babies are notoriously difficult, it might not be the case with your second. This has turned into an essay, but hopefully there'll be some useful info in here some there.

Best of luck OP.

icklekid Tue 23-Jun-15 05:55:24

Just wanted to say thank you so much blink for your post. Like others here my first birth was traumatic and am about to have debrief and counselling for post traumatic stress. And yet I can't help but want another baby and I guess my hope is for closure like you have found. Thank you

seaoflove Tue 23-Jun-15 05:57:11

I was also told that pretty much all sections involve forceps so I can't avoid them

What a silly thing to say. I mean yes, they use forceps to help deliver the baby's head, but at least they aren't being shoved up your vagina confused

As for recovery being worse, I had an ELCS recently and recovery was a piece of cake. Of course I had pain, but it wasn't nearly as bad as I was anticipating and I stopped taking painkillers entirely by day 6.

My VB (and third degree tear) took much, much longer. I felt awful, physically and mentally, for months.

xxx28xxx Tue 23-Jun-15 06:33:44

Thank you all so much for your responses. You have given me confidence to pursue this further!

I'm having an apt with a birth trauma midwife and then hopefully seeing the consultant again around 34weeks to see how I feel. In the meantime I will research this further so I can confidently argue my case if I still feel this way closer to the birth.

It's really helpful to hear real life experiences rather than just horrible stats. I know things can go wrong but that is the risk with any surgery and my argument is they can't guarantee me a safe vaginal birth so I don't want to take the chance of having an either worse experience.

Anyway lots to think about smile

SaulGood Tue 23-Jun-15 07:53:05

My second labour was a very healing experience too. It might reassure you to know, however, that it wasn't healing because it was the magical, straightforward natural labour I'd wanted with both babies. DC1's birth was pretty traumatic (31hrs of labour, 8hr second stage, 2 attempted ventouse, 1 attempted manual rotation, cat 1 emcs). When I had my second, I struggled with what to do with regards to the birth. I didn't want another cs, I didn't want to risk a traumatic vaginal delivery. I didn't actually want to give birth. I had some counselling, I had a bloody brilliant consultant who told me everything was my choice and he would support me whatever happened. He told me that I was around 80% likely to have a normal delivery, that second labours are quicker, easier etc. He also told me how clinical decisions would be made in the second instance, what would and wouldn't be allowed to happen and when they'd consider intervention. Having that knowledge made all the difference.

I did try for a vbac and ds (though smaller) was in exactly the same position as his sister, labour was longer at 38 hours and I needed another emergency caesarean. However, it was uplifting, positive and just beautiful. This wasn't because of the specifics of delivery but because I felt supported and in control. I found out first time round in the harshest possible way that you have no control whatsoever where labour and delivery is concerned. Not in terms of progression of labour. It's luck. I also had my heart absolutely set on a natural, home water birth. When none of that happened, I felt like a failure. Because second time round I knew what could happen, I'd researched my options and I felt supported by my health care professionals, I made controlled, confident decisions with the hand fate dealt me. This was a world away from the blind hope of the first delivery and the panic when it went wrong.

I truly believe that what makes the difference in the end is you feeling supported and empowered to make the decisions that are right for you in that moment. That might be taking the decision to have an elcs or attempting a normal delivery and making decisions as labour progresses. There only ever is what's right for that moment, not the vague what ifs of what may happen in the future. That's why if it's important for you to choose an elcs, you should be listened to and you should feel confident that you are doing what's best for you, not fighting against your own fears of history repeating itself.

RedToothBrush Tue 23-Jun-15 16:27:22

Ok, information as unbiased as I can it and to the best of my knowledge:

Am pregnant with my second and am anxious about birth, my first labour was pretty bad.
Anxiety is a health consideration in its own right. Which ever route you go down, if you are anxious enough to consider requesting an ELCS its a pretty big clue that your anxiety is significant enough to merit support and taking seriously. An ELCS is currently being pushed in a lot of circles as the solution, however I really don't believe this is correct.

The issue should be more about addressing concerns by examining them in detail. This may enable some women to resolve issues with extra support, options being given to them, good communication and listening to what the problem is. It may well be that some find a home birth a way of dealing with things, for others a detailed and robust birth plan which the hospital, knows, understands and respects, for others it might be breaking a normal hospital 'rule' or two to accommodate needs. Basically individualising and tailoring care to suit the needs of a woman. If done well it can help women face a VB despite their fears. For others who continue down the ELCS route, it is still a crucial part of tackling the under lying anxiety.

Its good that you clearly have been referred, but it does should like instead of listening, the consultant has done more talking at you.

Generally at the heart of a request for an ELCS is the desire and need to be more in control of the situation. Ultimately an ELCS might not necessarily offer that to an individual for various reasons depending on what they feel they need to control. The key is to find ways to empower women and give them back the control they feel they need regardless of how they eventually end up giving birth.

For this reason there are women that find subsequent VBs a healing process having initially requested an ELCS.

Recovery was painful and after a nearly 30hr labour I felt like I'd been hit by a train
I had an ELCS for anxiety. A text book ELCS. If I am honest, I think it was more painful than I'd expected, and I did feel very out of it for some time. I don't feel my experience was reflected by comments I've seen online about an ELCS being a breeze. Don't automatically assume it will be easy or less painful.

I had both a big, nearly 10lbs, and long baby so I'm sure this contributed to the forceps delivery.
Quite probably. However the question you now need to ask is about this birth and how likely it is you will need forceps again. Just because you had them previously, doesn't mean you will again even with a 10lb baby. Most damage is done during your first vb. Having done it once your body is more likely to be able to stretch without the need of forceps. Equally second and subsequent babies tend to arrive quicker. Unfortunately no one can give you a crystal ball and tell you this definitively. They can only give you statistics on the likelihood of this.

Anyway I just don't want to possibly go through all that again. I had an apt with an obstetrician today and I feel like they completely dismissed my concerns as my first birth was apparently completely normal!

This is more of an issue. The Birth Trauma Associate make it very clear that Birth Trauma is COMPLETELY in the eyes of the beholder. That is, even a 'text book' VB can be traumatic to someone going through it, and that thoughts and feelings should never be dismissed just because everything 'went right'. Equally someone who had a very difficult birth ending up in lots of complications, may not necessarily be traumatised by the experience. Its more about how different individuals react with different situations and they ability to cope with that. It is crucial that women are listened to and their feelings given value otherwise if they have been traumatised they are liable to become more anxious.

I was given lots of negative facts about sections and was told there was a chance I could die! I understand that can happen in rare cases but surely the same can happen in natural childbirth?!

Yes this is true. For both. Deaths from CS in the Uk are exceptionally rare. They majority happen with unscheduled surgery not ELCS though. There however is a huge problem with data and how that data is being presented. An EMCS is a consequence of a planned VB so when researching and presenting the risks of a VB the risks of an EMCS should be included. However the methodology of a huge number of studies is flawed and compares VBs with ALL CS's, rather than looking at data for planned ELCS separately. The effect distorts information and is misleading.

One of the things you should be aware of though, is the physical risks to the mother and baby are different for first time mothers compared to mothers having their second child. Once you have had a VB the risks drop, whereas if you had a CS first time round they actually increase. This does mean that statistically, if you have had a successful generally uncomplicated VB first time around that you are safer to have another than go for an ELCS. Especially if you are considering another child in the future. Like I say, though that's the physical risk. I think that the psychological risk should also be considered too, and its poor to completely ignore this factor. Its about balancing risks across the board.

I was also told that pretty much all sections involve forceps so I can't avoid them
That's an arse of an consultant using his medical knowledge to beat you with. Yes the use of forceps is common in CS. DS was delivered with forceps via an ELCS. However the mechanics are completely different and the consultant will know this. If it reflects anything it reflects an attitude that your well being is unimportant and secondary to the baby, when both are important.

that second babies being bigger was a complete myth
There is some limited evidence to support the fact that second babies are bigger, but it depends on a lot of factors including the gender and isn't always the case. I don't think its significant enough to assume that you will definitely have another 10lb baby. Its possible, but having given birth to a 10lb baby previously, they are likely to keep an eye on this (though scans for size are notoriously inaccurate).

and that recovery is much worse. Is this all true?
It depends. A bad VB could be worse than a straightforward ELCS. An EMCS is likely to be much harder than an ELCS because you've laboured first but its a consequence of attempting a VB. Again crystal ball time.

I appreciate recovery may be harder because I wouldn't be able to lift and that it is major surgery but I just feel like the consultant was throwing everything at me to put me off.
I suspect they were. However I was surprised at just how hard my straightforward perfect ELCS was.

Also can I insist on a section if I decide I want one?
Technically no. The NICE guidelines advise that anyone who wants one should have one, and if a consultant refuses they you should be referred to one who will. UNFORTUNATELY, not all hospitals agree with the guidelines and don't follow them. You do not have a right to an ELCS.

However, mental health is a legitimate HEALTH reason for an ELCS. Though not recognised by all Trusts yet due to exception ignorance and a lack of political will to do so, despite NICE's considered recommendation and acknowledgement that it is a health issue.

Ultimately it depends on the individual consultant you come across and the policy of the hospital you are at. It shouldn't be the case but it is. There is a wide disparity of care between hospitals. At some you will find it very easy, at others a massive battle. Many consultants are under considerable pressure to reduce CS so try and put off as many women as possible at least initially. (Interesting, some consultants seem to be less obstructive at subsequent appointments having 'got the message across that its a big deal' at the first. Though some are still just utter twats).

My advice is this:
Examine you fear. Pull it apart. Write down every single thing no matter how small that bothers you. If you can understand what exactly is driving your fear, you might be able to find ways to tackle those elements rather than going as far as an ELCS. The theory of eating the elephant bit by bit rather than eating it whole. Go into your birth trauma appointment with it. Look for alternative ways to deal with your anxiety. It does not mean that this closes the door to an ELCS. It merely gives you other options to consider which you might not be aware of.

No two people are the same. This is about you and your needs. There is not 'right' or 'magic' solution. Just one that's right for you.

Go to appointments with your partner if you possibly can. You are more likely to get a more positive response judging by similar threads on the subject. It seems that its easier to be dismissed if you don't have back up. Rightly or wrongly.

Be prepared. Do some homework yourself. Read up on the NICE guidelines. That way you are a bit more empowered and less likely to feel 'railroaded'

Don't be afraid of crying if that's how you feel. It is NOT a sign of weakness but reflection of the extent to which is it affecting you.

Good Luck what ever route you decide.

xxx28xxx Tue 23-Jun-15 17:17:41

Redtooth, thank you very much for taking the time to write your post. Along with the other posts it is incredibly useful and it has given me some excellent pointers.

I think the issue with my apt yesterday was they didn't give me all the facts but just focussed on the negatives so if anything they haven't put me off a section, more just made me feel like I can't make an informed choice. I plan to raise this with both my mw at my next apt as well as the trauma mw.

I think you hit the nail on the head when you mentioned control and feeling empowered and with my last birth I didn't have that, partly because of my body but in part due to the whole delivery experience. I don't feel like I could have ever said no to what they suggested yet with hindsight I think I could have been more vocal, or perhaps even should have!

I will certainly go armed with my facts and I think sitting down and writing down my fears will really help, both in terms of addressing what I'm worried about and also being able to express it to the consultant properly.

Thank you again for an interesting post about your experience!

nutelladipper Wed 24-Jun-15 18:24:44

Hi,
I'm in a similar position but on baby 3 and I'm 31 weeks. I had a horrible 36hr labour with ventouse and tears and episiotomy with my first and I was filled with problems and stress. I felt anxious about my 2nd but believed if I tried to be positive and take more control id have a more positive experience. I didn't it was a very quick 3hr labour which resulted in forceps more tears and another episiotomy. The fact it was quick really didn't help my mindset.

So this time round as soon as I found out I was pregnant I was getting flash backs and generally found the idea of a VB upsetting and I was very anxious.

I saw a consultant at 24 wks to request a c section but as soon as she started asking me questions about my previous birth so started crying like a baby and just could not form a sentence so I was referred to trauma midwife to discuss my births. The consultant said she'd consider my request but felt it was only right that I get a debrief as i couldn't remember lots as I'd obviously chosen to blank a few things out.she wanted my decision to be based on facts not my fears which I think was right of her to honest.
So I met with the midwife at 27 ish weeks and it was useful in terms of I felt less to blame for the issues that I experienced with previous births but I hadn't made me feel any less anxious for this birth. I feel calm at the thought of a c section (taking the risks into account) and feel very anxious, nervous, shaky at the thought of VB which the midwife says speaks volumes as to my decision.

So I see the consultant again in 3 weeks and assuming I can control the tears I'll request a c section.

The NICE guidelines say you have the right to have one even on non medical grounds and if the consultant won't agree he/she is to refer you to one who will.

Mine would be on the grounds of mental health and not medical which may mean I'll have to see a mental health nurse but realistically I'll only have 4 ish weeks from seeing consultant to delivery so I'd be surprised if that appointment happens based on how slow all the others have been!

Sorry massive response but happy to keep you posted!

X

Booboostoo Wed 24-Jun-15 19:33:12

What an arse of a consultant! I would ask to see someone else and get some proper information.

Your choice is between ELCS and VB so you should be given an analysis of risks and benefits for both. Telling you only the risks of CS does not inform you fully so you cannot make a decision. Highlighting grave but exceptionally rare complications without telling you that they are exceptionally rare is very misleading.

Risks vary in different situations, some apply more to certain individuals, and some options carry more risks for the mother than the baby and vice versa. In general an uncomplicated VB is the less risky option for both mum and baby. However, a complicated VB carried he greatest risks for both with grave risks for the baby such as neurological damage and hypoxia. Complicated VBs are not the norm but no one can guarantee you an uncomplicated VB. If you have these types of concerns an ELCS may be for you. The main risk are to the mother, blood loss and infection. Recovery may be more difficult but again depends from person to person. I had two, lovely ELCSs with very easy recoveries. Neither time where forceps needed but I don't know the likelihood of this being necessary during a CS.

xxx28xxx Wed 24-Jun-15 20:57:56

I agree boo, the consultant was a complete arse. The more I read people's responses the more I realise that she was incredibly patronising and hasn't done her job correctly. I plan to raise both these issues with my mw and the trauma mw, I might also see if my mw will refer me to a different consultant!

I just want to feel that I'm in a position to make a fully informed decision but right now I can't do that until I have the proper facts from the consultant. It's frustrating and making me more stressed confused

RedToothBrush Wed 24-Jun-15 21:29:47

Mine would be on the grounds of mental health and not medical which may mean I'll have to see a mental health nurse but realistically I'll only have 4 ish weeks from seeing consultant to delivery so I'd be surprised if that appointment happens based on how slow all the others have been!

I had an ELCS on the grounds of anxiety. The consultant midwife went to great lengths to stress that my ELCS was MEDICALLY indicated and was a MEDICAL need. Need not want. It wasn't a flight of fancy nor a whim.

The clue is the health bit in mental health. Its a misconception to regard an ELCS for this reason as non medical. Yet people many medics persist in suggesting its not a medical reason for an ELCS which I don't think helps anyone considering going down this route as they are marginalised and made to feel like its not a problem that the NHS should give you help and support with. Instead by suggesting its non medical you are made to feel like you are making a fuss over nothing or you have no grounds to have an ELCS which is simply not true.

The trouble is that by doing this, women who might be fine with a VB with the right support don't get it, because the whole system is dismissive of women requesting an ELCS rather than treating it as a red flag and actually helping them. And probably pushes more women down the ELCS than need be and the system adds to their anxiety rather than addressing it.

I do think recognising birth trauma more widely and treating it as a condition that deserves understanding not contempt and encouraging women to come forward and talk about would do a huge number of women a massive service especially when unfortunately that trauma is all too often caused by poor practice which women accept as being normal and don't question.

But then, perhaps there in lies the issue. The NHS has no stomach for stirring than can of worms.

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