Please no flaming - how to word this to midwife.

[kiwifluff25]

Please no flaming or shouting down as I'm finding this difficult enough as it is, I know these topics are controversial.

I'm looking for some advice on how to tackle this. I'm currently 23 weeks with DC1 and I really strongly feel now (after a LOT of thinking since being pooh-poohed at 9 week appointment with prevous baby [MC] when I brought it up first) that I would like to try to pursue an ELCS.

There are a LOT of reasons I want this, and I'm definitely not ''too posh'' or mistakenly thinking it'll be an easy option in any way shape or form. But... for me and for the baby I think it'd be for the best.

Historical abuse brings up many issues and fears (these are currently being dealt with by CBT, but wont be magically fixed any time soon) the main one of these is being left with trauma injuries, particularly any relating to incontinence. I have a weird sort of phobia around continence, and basically have to plan my entire life around how quickly I'd be able to get to a toilet if I fell ill (very miserable!). It's totally understandable when you look at the causes (abusive mother- lots of shaming when I was little, making me show myself to people, infecting me with illnesses on purpose then shutting me somewhere with no access to sanitation/cutting off comforts like privacy, access to toilet, or a bed etc). I get an upset tummy/diarrhoea literally every time I have to leave the house because I get so worried about it. If I ended up incontinent (over 50% of VBs have urinary incontinence and up to 25% faecal incontinence for 6 months or longer) it'd completely ruin my life, I find it hard enough as it is being ''normal'' with just the psychological causes never mind physical ones.

My mum had long labours and EMCS/baby in NICU due to distress; my sister was induced with a 36+ hr labour, baby got stuck and was consequently left brain damaged, she almost died from blood loss and suffers from PTSD and double incontinence now which has totally destroyed her life; my other sister also had 30hr+ labour, bad tearing, PND and incontinence.

I have HSV1 (herpes virus, not the STD one, but it manifests literally all over my body, the virus was originally caught in a few years ago through dermatitis cuts on my hands when working with disadvantaged children ). Outbreaks tend to happen when I'm very stressed, and if I had one near due-date I'd have to have an EMCS anyway as it can be fatal if passed on to the baby.

I'd psyched myself up over the past 23 weeks towards a home birth to minimise intervention and so I can feel more relaxed, safe and secure, but all the women in my family have gone beyond 42 weeks (the cut off for home birth and mid-wife led unit) and I know that if I didn't ask for an ELCS now it'd be too late then and I'd be coerced into induction or risk harming the baby. I really have given it a chance, but I just feel like I'm fooling myself that it's even a good idea, given the reasons above.

I've also found out at my 20 week scan that I have an anterior placenta so my chances of a long labour and baby getting stuck due to being back to back are slightly higher still.

I'm really really scared of asking about it though, I find all the reasons listed above quite personal and intimate and I've been put off asking since I brought it up before. When I asked at my 9 week appointment, I merely said ''can we discuss electives as I....'' to be cut off with ''oh no, you don't want THAT, babies are unpredictable, that's just how it is''. I'm the sort of wallflower who will smile and say 'oh ho ho silly me! You're right'' then cry as soon as I've left the room.

Any practical advice on how to word this next time to the midwife? (or should I go to the GP?) Should I tell them everything? Would it even be enough or will I just be talked over again?

Please, please, no flaming. It's taken a lot of courage to work myself up to writing this down as the whole topic makes me want to cry.

[Chasethechaser]

Oh darling, you have every right to a ELCS, that's coming from a home birthing X 4 mother. Don't feel guilty or shit or anything else.

Could you show midwife your post?

[KimmySchmidtsSmile]

No flaming whatsoever sweetheart
Hopefully someone who can quote the guidelines and been there will be on in a minute.
I think you have every right to pursue the type of birth best for YOU. Please do not believe the posh to push nonsense.
I have done a natural birth after two ventouse ones, it is....overrated.

[ForeverBeingFobbedOff]

I think you should write it all down and show your GP (or show them this post) and ask them to write a recommendation that you should have a caesarean.
Hope you get what you need!

[LuckySantangelo1]

You need to request your midwife refers you to a consultant. There is no point bothering with your GP. Midwife has no right to say no to this request. The consultant is the one who will make the decision re whether you get approved for a CS. Good luck!

[lavenderdoilly]

All the very best. Mw not the boss of you or your body. Even if you didn't have the medical history you have got, it is what is right for you, that matters. Can someone on your side come with you to discuss it? Ask to see a consultant.

[CodyKing]

I'd agree to writing it down - that way you're not sidelined or go off topic you can say every think you need too in one go.

Give it to the midwife as soon as you can as they need a consultant to sign it off

Good luck - get it done so you can stop fretting

[MyKingdomForBrie]

You'll need to see a consultant to get an elective so it isn't up to the midwife - just tell them you need a consultant apt to discuss an ELCS for medical reasons and ignore any chuntering.

[LuckySantangelo1]

The NICE guidelines say every woman has a right to a CS but the problem is that not every hospital follows the guidelines! They don't have to, which seems a bit daft. I wouldn't even get into a dialogue with your MW about it as she may well try & put you off. Just request the referral and lay out all your issues with the consultant. They may make you jump through a few hoops (such as numerous appointment, counselling) but I don't think they have a right to turn you down if you stick to your guns.

[SpuriouserAndSpuriouser]

I second (third?) writing down the reasons why you want an ELCS, so basically what you have written above, and bringing that with you to your next appointment. You don't have to read it out, but if you get sidetracked you have a reminder there of everything you want to say. Is there anyone you trust that could come with you, to help you fight your corner?

And good luck, I really hope you get the ELCS and that the CBT you are having helps you overcome your past

[itslookingbright]

Your midwife has to refer you to a consultant if you ask, the consultant then decides if you can have one. Although my understanding is that anyone is allowed to have ELCS if requested, if you're adamant I don't think they can turn you down. This is from which.co.uk:

If you’re anxious about having a vaginal birth, you should be offered a referral to a health professional who can help you cope with your anxiety. If, after discussion and any support offered, you decide that you would like to have a caesarean then you should be offered a planned caesarean. If your doctor isn't willing to perform the caesarean, they should refer you to a doctor who will be.

So get a referral and do not take no for an answer. If you feel you are not able to hold your corner can you ask someone with you to the meeting? Your mum, partner, a close friend? Someone who could demand on your behalf? Don't feel embarrassed about your reasons but I don't think you need to explain them in detail to your midwife anyway, it's the consultant you have to convince. To your midwife I would possibly just say you have sone very personal reasons/trauma and you rather not discuss it unless with the consultant.
I had ELCS and my midwife didn't really go into too many details for my reasons and to be honest my consultant was happy with a very "clean" version of my story too, he didn't ask too many questions at all.

[liberatedwine]

Print out your post and hand it to your midwife. Your body, your baby, your choice.

[lavenderdoilly]

Mw can be wonderful and supportive. And occasionally box ticking bullies - they have targets on elcs and other aspects of maternity care. I now regret being a compliant wall flower with the ones I had now i have learnt that. Don't make the same mistake.

[ItsLikeRainOnYourWeddingDay]

Your entitled to an elcs. Bring it up asap with midwife and ask for referral to consultant. Go in armed with facts and be strong. Don't be a blubbering mess.

[Pinkheart5915]

Oh bless you
I can see why you'd want a c section, write down your reasons honestly and clear and take that along With you and talk to the midwife.
I've never asked for a c section so could be wrong but surely the midwife will have to refer you to a consultant and then they say yes or no.

[VinceNoirLovesHowardMoon]

Can I just say - you wouldn't have to have an elcs if you had a herpes outbreak, this only applies if it's your first outbreak. You can also safely take acyclovir over the period too which will suppress the virus.
That's not to say you shouldn't choose elcs but I don't want you or other people reading to be misinformed about herpes and birth.

[Frickle]

Bypass the midwife and get a consultant referral, and write down clearly everything you've said here. Don't let yourself be fobbed off, but it's perfectly possible you'll just get a straightforward ELCS recommendation. Best wishes.

[Lunar1]

Ask to be consultant led and write it all out for them. If they say no, ask for a different consultant.

[BadlyWrittenPoem]

I'm so sorry you've had such awful experiences. I would suggest that you ask for a referral to a consultant to discuss ELCS (as it would ultimately be decided by cons and not MW) and take in a statement explaining your reasons to the consultant so that you don't have to say it all and can get it all across.

Another option (which I'm only mentioning because you've stated that you were considering a home birth as on option and have rejected it due to fear of going to 42 weeks and being forced into hospital induction) might be to have independent MWs for a home birth as they will likely be okay with you going over 42 weeks.

A third option would be to ask consultant about the possibility of home birth with an ELCS is you get to 42 weeks.

Whatever birth option you go for I would recommend having a doula for support. I think a doula is always a good idea but in your circumstances where you are worried about birth and find yourself not standing up for yourself and regretting it afterwards I think it would be invaluable. From my own experience I would say ha is doula also helped me a lot while I was pregnant as it meant I had someone supportive to talk to who was reassuring and supportive of my choices and was never going to try to railroad me into anything that wasn't my choice. So even if you don't feel comfortable with having s doula at your birth I would recommend talking to one antenatally.

[ThatsIrrelephant]

Agree with above and nothing to add except that when you see the consultant bear in mind that they have to discuss risks and benefits of section with you - they won't be trying to put you off, it's in the NICE guidelines. These might be reassuring:

1.2.9.2
If a woman requests a CS when there is no other indication, discuss the overall risks and benefits of CS compared with vaginal birth and record that this discussion has taken place (see box A). Include a discussion with other members of the obstetric team (including the obstetrician, midwife and anaesthetist) if necessary to explore the reasons for the request, and ensure the woman has accurate information

1.2.9.5
For women requesting a CS, if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned CS

www.nice.org.uk/guidance/cg132/chapter/1-Guidance

[cavedescreux]

I absolutely agree you are entitled to a section. But I simply don't think some of your statistics can possibly be correct, and that will do you no favours - I mean the incontinence ones. They seem plainly wrong to me. Focus on why you need a section, what nice entitles you too, and not why vb is bad or dangerous. If you are anxious about incorrect information, they can correct it and (in their view) it should help your anxiety. You don't want to give them that chance. So focus on your personal needs/request and your case is stronger. Best of luck.

[cavedescreux]

Entitles you to, typo sorry

[DoYouLikeBirds]

I had two vaginal births, and decided with the 3rd I didn't want to do it again. My previous labours were fine, and I have never had any issues with incontinence, so I'm not entirely sure where you found your statistics or if they are even accurate.

The first step is to tell your midwife. They may probe into why, but should ultimately send you to a consultant. This is where things may be tricky.

I told my consultant on the first appointment that I wanted to avoid damage to my pelvic floor, but she refused to grant me a caesarean. Her argument to me was that pregnancy is what does the most damage - the weight and strain on its own - and that a vaginal birth was unlikely to make things worse. I had to push to see another consultant, and within 10 minutes of that appointment I had a date for my c section.

I am now on my 4th pregnancy and used the same argument this time and had no problems at all and was given a date straight away.

In my experience, if you have an anxiety or fear of childbirth you need to play on how it will effect your mental health. If you simply march in with statistics and your HSV1 status, you will probably find that they will dismiss your concerns. If hospital policy is against you, that will be another hurdle to jump over. Be persistent, write down what you want to say and bring it with you, and don't let them fob you off.

As a P.S I recovered from my first childbirth very easily, and found a c section infinitely more painful and the recovery much MUCH harder. I know that's not everyone's experience, but there is no certainty you will have a horrible birth simply because some people you know have. For me it's always been consecutive births and the potential damage that they do to the body, that made me not want to do it again.

[kiwifluff25]

I'm hardly going to be marching in anywhere, more likely crawling in with my tail between my legs. I am terrified of this and it's been a huge burden to even write this post.

The statistics were from a medical journal on the lack of information/reporting on faecal and urinary incontinence after VB, if I did take any stats to back up my case I'd print out the source for back up. The 'people I know' are all of my immediate female relatives, so surely this bears some weight on how my own birth could be (esp. considering anterior placenta)?

VinceNoir I was told that about the HSV by the doctor that diagnosed me he was a bit of an unprofessional dick though good to know it wont necessarily harm the baby, thanks.

[DougalTheCheshireCat]

OP would you consider looking into finding a doula to support you?

it sounds like some one on one support could really help you work out what you want for yourself through your ante and post natal treatment, and help you articulate that and stand your ground at appointments.

Our doula was fab for helping me work out what I wanted from the system, and how to get it. I know she has supported several women who had strong personal reasons for wanting an elective C-section, and helped them get past the 'Oh no, you don't want that' brush off to get their needs met.

I think as birth services are considered 'medical' far too many professionals within it look at the physical side of your pregnancy and ignore the emotional / psychological aspect, which is massive.

Doula's aren't free, although some of them do pro-bono work. And some of them have affordable rates (from a few hundred pounds for support through pregnancy and labour, which when you think about the hours they do, is well worth it).

This is very important to you. ANd the NHS system is medically not emotionally / psychologically focused, and rushed off its feet.

Get someone who will be on your side throughout.

Good luck

[MissWimpyDimple]

The two doctors that I am friends with both went for elective C sections. I think that says a lot.