How to get an ELCS after EMCS?

[AbbeyRoadCrossing]

Sorry if this is long, but I want to give all the information in one go

With my 1st pregnancy I had placenta praevia and ended up with an EMCS at 36 weeks due to a large bleed. I'm now 18 weeks with DC2 and have had conversations with the midwives about giving birth next time.
They are very keen on me having a VBAC, whereas I'd rather an ELCS.

My reasons are:
I'm worried about rupture. I know it's rare but I've read it's more common if you were sewn up small (as I still had a month to go) as there is extra stretching on the scar.
I'm also worried about an unsuccessful VBAC that turns into an emcs. I really don't want another EMCS. I understand my chances of success are lower because I've never had a labour.
I had postnatal PTSD after my EMCS. Probably a multitude of causes but I have flashbacks to it, I really fear another one. If they could guarantee a successful vaginal birth I'd do it, but of course no one can.

The midwife said I have no medical reason for a c section (although we don't know this yet, as I haven't had my 20 week scan) and if there's no reason I will have to have VBAC. Yet I read about others on here who've been granted sections for various reasons, maternal preference being one of them. I thought my previous emergency was a medical reason, am I wrong?

I'm seeing the consultant midwife after my scan and am getting very worried about being turned down. Has anyone got any stats or anything that can be used to back my argument up? I can't find much on what's safest.

[comeagainforbigfudge]

Oft that sounds like a traumatic time indeed. Have you had counselling for PTSD?

Aside from that, you may not have any percieved physical issues stopping you from having a vbac, you do however have some mental health needs that shouldn't be ignored. I would discuss that with the consultant. Don't leave anything out. Write it down if needs be.

I'm sure someone will come along with the relevant evidence but as a starting point I would go on to NICE for their guidance on c-section. I'm sure it is a valid option for you, in that they can not absolutely refuse you one. Particularly if it's detrimental to your mental health

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


Section. 1.2.9.5 is probably most relevant.

[Jemimapuddleduk]

Hi I had an emcs and then an elcs. I was under consultant care and made my decision at around 28 weeks - ish. I just gave my reasons and was granted one. Was easier than I expected!

[shattered77]

Yeah, but consultant just said, Ok. It wasn't a problem at all.

[meglet]

Hopefully the posters who know all the ins and outs will be along shortly.

Fwiw, after having an EMCS it turned out I had a medical reason I couldn't give birth (broken cervix). At my booking in apt with dc2 the midwife was sniffy when I said I would need to sort out my planned cs with the consultant, she had no interest when I mentioned my broken cervix. As soon as I saw my consultant he confirmed my planned cs.

Ignore your midwife and push to see a consultant. Personally I don't blame you for wanting to guarantee avoiding an EMCS.

[shattered77]

Sorry, keyboard issues. Consultant said that all surgery has risks, and gave me some vbac info, but there was no pressure. They can see from your notes the previous birth hell.

[fustybritches]

Consultant was dismissive to me but I just had to keep insisting. It felt rubbish having to argue for a choice over what happens to my body, but I had to swallow my instinct to just go along with what the person with a stethoscope said. Good luck OP

[Steph1502]

Sorry to hear this Abbey. From the sounds of it, your previous experience was seriously traumatic and it obviously took a lot to get over that. I'm sorry I don't have any advice to give but it would seem to me that what happened at your precious birth would definitely be cause for ELCS. As comeagain said: write everything down and all your concerns and fears etc and exactly why you want an ELCS. If they are still going down the route of VBAC then I'd ask for a second opinion. You're obviously anxious about this and you're not yet halfway through your pregnancy. It's not fair to put undue pressure and stress onto you. Pregnancy along with having precious children is stressful enough. I hope you get this sorted and someone can put your mind at ease xx

[Steph1502]

*previous.... Although they are precious too x

[AbbeyRoadCrossing]

Thanks all. Unfortunately they don't have my notes from last time - different hospital and they have been lost, but they have basic details in my current notes.
Hopefully the consultant will be more understanding than the midwife it seems
I'd go for VBAC if it would work, but it sounds like they'd be quick to turn it into an emcs, so there's no guarantees

[Chiefbumwiper]

But don't forget the very real risks associated with a Caesarian section too, I've seen Women die following elective section, don't underestimate why they are recommending a vbac as the safest option.

[Strictlyison]

I was also 'encouraged' to go for a vbac, and at all the appointments I said I wanted to keep an open mind about. When I got to around 7 months, I asked for them to book me for a elcs, and they did. I went into labour before the elcs date, so I ended up with an emcs, but all calm and trouble free.

[Panzee]

My consultant had his diary open and his pen ready when I went to see him. :)

[Strictlyison]

Chief, I am not sure your message is appropriate... very patronising and scary. A bit of sensitivity please.

[Steph1502]

There are risks associated with all types of childbirth and it's already been the case that OPs only option was EMCS....

[AbbeyRoadCrossing]

The thing is they haven't said VBAC is the safest option at all. I've asked and the midwife has been pretty non committal about which is safest. She said VBAC is usually safer but when asked about the previous preterm possibly complicating it she didn't know.
She was also a complete arse about my previous section. Although I'm not sure what I was supposed to have done about that seeing as my placenta covered the usual exit and I lost 2 litres of blood in less than an hour. A vaginal birth would've been deadly - the section had to be performed almost straight away. Anyway, her bring an arse about that is a different matter but it did give me the impression her medical knowledge might be lacking somewhat!

[Thepurplegiraffe]

I had an elcs last time due to dd1 being breech and have been told this time it is my choice what to do. At 34 weeks I still haven't made up my mind but I don't have as many good reasons to have an elcs as you do.
I was expecting pressure to go for vbac from the consultant midwife when I saw her but there was none at all. I am expecting it from the consultant when I see him at 37 weeks as I know he is pro vbac but as I said before I have been told at the end of the day it is my choice.
May be worth seeking a second opinion?

[puddleduck27]

I had emcs. and am looking to get booked in for my elcs for this pregnancy. in fact after getting ready to fight my.corner I only really said I think a csection and they would have booked me in there and then.

[AbbeyRoadCrossing]

Thanks all. It sounds like the consultant is likely to listen more than the midwife from all your posts, which is reassuring.
I'm going on the VBAC course soon so hopefully that will cover some of my questions.

[Thepurplegiraffe]

I was told by the consultant midwife that as long as I has been on the vbac course and been to all appointments the choice was mine as it would in theory be an informed choice. Good luck!

[WhirlpoolGalaxyM51]

I had an emcs and was offered a straight choice for my next birth, this was 5 years ago.

AFAIK ( and the NICE link in first post might help) they have to give you the option?

Midwife sounds awful, you can ask for a different one, you can round here anyway. If you don't like / trust her then it's in your interests to see someone else & they might have a more reasonable approach to elcs.

IIRC (do check this!) a vbac is slightly riskier for the baby than elcs, elcs is slightly riskier for the mother. Or something what I DO remember was it wasn't s straight this is better all round, one was better for one and the other the other.

FWIW i don't regret going for a elcs second time one bit, and so don't let anyone persuade you into doing something you fundamentally don't want to do (and they may push vbac HARD).

Good luck

[WhirlpoolGalaxyM51]

Oh the risks thing there was because when they are trying to persuade you, they can't outright say "vbac is safer" as it isn't. So if you find out the numbers round that you can say hold on a minute what about xyz.

[AbbeyRoadCrossing]

Thanks Whirlpool I had a look at a research article on Royal College of Obs and Gyn website (I'm trying to use reputable sources and not Google!) and it seemed to agree with what you say regarding risk to baby / mother.
I couldn't get a figure on my % chance of success with VBAC. It said 70% chance of success overall but lower if there's a small age gap, never got far in labour / never went into labour, preterm c section, age of mother. So I don't know by how much but it seems my chance of success would be a lower than 70%. Hopefully I can get some figures on the course as that's the way my brain works (I work in stats). I don't want to be going into a situation that's 50/50 chance of working out, or less possibly
I never saw the same midwife twice in my 1st pregnancy, but I've moved now so not sure how it works here, so it never crossed my mind I might see her again. I'm seeing the consultant before my next midwife appointment so hopefully it'll be decided by then

[WhirlpoolGalaxyM51]

Have a read of the NICE guidelines as well I think they may help (I am lazy and haven't ).

If I were you I would not hold back when talking about the trauma of the first birth and how you just do not want to even consider trying for a VB, tell them about your PND, flashbacks and so on. It may go against your rational decision side to use this to plead your case BUT they are supposed to take things like that into account and they are very good reasons for you to want a ELCS.

I'm sure it'll be fine

[Thepurplegiraffe]

That's interesting Whirlpool and Abbey. I have been told by the pro vbac consultant that vbac is better for both mother and baby and that I have a 75% chance of success. I have also never had a contraction. Maybe I should do some of my own research...

[AbbeyRoadCrossing]

www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg45/
This is the article I read. It was around 75% success overall I think (I need to reread the article) but there are various factors that make success more or less likely