Unreasonable to request ELCS? *warning sensitive nature relating to pregnancy loss*

[Bearberry]

Hi, this is the first thread I've ever started - please be gentle.

I'm wondering really whether I have reasonable grounds to request a ELCS. I'm currently 15 weeks pregnant, with consultant led care and recent threads relating to C-sections suggest perhaps I should be having a conversation with my consultant about this soon-ish.

Back story is, earlier this year (April) we lost our first baby at 20 weeks. The pregnancy was eventful, with rather a lot of bleeding and placental lakes. We were not under a consultant until it was too late. In a nutshell after two days of contractions and two trips to A&E we were I was sent away with 'stretching pains' only for baby to arrive shortly afterwards. The whole situation was traumatic, we were at home, alone and completely terrified.

Although this is my only experience of delivery I completely appreciate that it's very different to have deliver at 20 weeks to full term. That said I feel completely terrified of a natural labour. I don't feel I could presently handle that psychologically. I feel quite traumatised by the experience both at home and A&E afterwards (to deliver placenta and for recovery.) I feel I presently have many intrusive thoughts relating to the whole experience and that even the feel of contractions would send me over the edge. I'm also feeling generally anxious about the pregnancy and feel a c-section would be more controlled (in reality this may be wrong I know) and there would be less opportunity for problems to occur.

In an ideal world I would really love to resolve these fears and issues however I'm not sure how possible that will be in the time frame and feel overwhelmed by my fears relating to labour as it is. I've been referred and then assessed by counselling services who have suggested both bereavement counselling and CBT for the potential trauma. They have referred me urgently but of course I'm currently sat in a waiting list.

I'm rambling big time, sorry. I guess I want to know if you think that these would be valid reasons for a ELCS. I'm not sure if I'm being pathetic and need to suck it up, or if this is my best option given the timescale and circumstance.

Thank you for reading.

[Mumberjack]

First, I'm so sorry for your loss and hope you manage to access counselling soon.
Second your circumstance is more than worthy of an elcs and you shouldn't need to put up a fight.
When my first baby was stillborn and I found myself pregnant again shortly after, the consultant was very clear that they would accommodate my needs both for the physical health of my baby and my own mental health.
I originally requested induction at 38wks but on finding that my baby was breech, I changed it to an elcs. She decided to arrive the night before the date so it turned into technically an emergency CS but throughout it all everyone gave me and my DH the care and attention we needed based on my previous experience.

[3littlebadgers]

Hi bear I'm so sorry for your loss, I'd say your reasons are completely valid my lovely. Did they give you any indication when the cbt would begin? I lost my daughter at 40+5 in March I am 26 weeks now and seeing the psycologist for the maternity dept and it is really helping. My next session she will be taking my down to the delivery suit and working with me there. My consultant has said she'd rather I have an induction at 38 weeks but she is willing to consider me for c section but at 39 weeks. I'm not sure I can hold on that long, but I completely understand what you mean about wanting the birth to be different. The anxiety is such hard work my lovely but we have no choice but to get through it. There is a thread www.mumsnet.com/Talk/antenatal_clubs/2366571-Angels-and-Rainbows-remembering-our-angels-and-praying-for-our-rainbows? which is for mums like us, a safe place where we can talk about our pregnancies after loss if it helps you to have a place to air your anxieties.
I wish you well my lovely, I hope your pregnancy goes well without worry and you get the birth that you would like and more importantly your tiny baby to hold and love

[April2013]

Oh you poor thing :( I had a miscarriage last summer with V heavy bleeding and emergency ERPC to stop the bleeding then 3 months to recover physically which left me with major fear of pregnancy and bleeding and A and E in general, so it was a whole year after the miscarriage that I dared TTC again and I had CBT from about 2 months after the miscarriage. It is great you have not let this hold you back and are pregnant :) i was so fearful for too long and it was stopping me live my life. My experience very different to yours as was much earlier, but i can totally understand how something like this can make someone very afraid and anxious and traumatised. I think if you get a good counsellor you will probably, hopefully, be in a different place when it comes to the birth, I swapped to a new counsellor because I didn't seem to work well with the first which apparently is fairly common. It was a revelation and really helped me to learn how to manage my anxiety so I am so glad I swapped and stuck it out. Does your hospital have a specialist mental health midwife also? How long have they said the waiting list for CBT is? Are you under a consultant now? I am for asthma and anxiety - been offered extra scans and appointments with consultant and midwives, perhaps they would give you a weekly midwife appointment to listen to heart beat? With my 1st pregnancy I had OCD which had never been treated and midwives were dismissive but now I am pregnant again having had a load of CBT midwives seem very supportive - I think now you have been assessed and are on a waiting list your midwife \consultant will be very keen to take this seriously and help you as much as they can - sounds like a c section might really help you, but also it might be that after CBT you will feel differently, I guess you can always change your mind later on either way. If there is a mental health specialist midwife maybe she will be your day to day contact? Im not sure if it will help but there may be written resources the CBT people could recommend you read whilst you wait, also do they do group therapy sessions that you could go to whilst you wait to get an introduction to it? Congratulations on your pregnancy :)

[Brummiegirl15]

I'm so sorry for your loss.

But I totally understand where you are coming from. I had 3 losses in a row before this pregnancy and I'm currently 27 weeks on my 4th attempt. And I'm terrified. Terrified of still birth , damage to me or the baby during delivery, everything. I have absolutely no confidence in my body. My feeling is that recurrent mc is do rare, yet it happened to me so therefore what makes this pregnacy any different?

As a result I've requested an elcs and my consultant and midwife couldn't be more supportive. I've got to go in at 32 weeks and demonstrate I understand the risks of a c section but the consultant said he will fully support my decision.

So I wanted to say you are not alone in feeling like this

[Smilelikeyoufeelit]

Not unreasonable at all. I was similar to you, sent away as an "over anxious first time timer" only to deliver my 18 week old baby hours later. I wish I had pushed for an elective section in my next pregnancy but instead went overdue, had a long labour ending in an emergency section and have a child with additional needs due to lack of oxygen.
In answer to your question, I think your reasons are totally valid. You have to show that you understand the risks but I understand the need for some control over the situation.
Wishing you a happy and healthy pregnancy and the birth that you want.

[Bearberry]

Thank you all so much for your kind words, I'm so sorry to hear of all of your losses

I certainly feel validated that if I do choose to go for an ELCS I have decent reasons to argue my stance, thank you.

My DH and DM are both very keen for me to have a natural birth if at all possible and feels I should be pushing for help to hopefully feel able to do this. They do appreciate my perspective though and say they will ultimately support my decision.

The woman who assessed me for the counselling and CBT was hugely supportive and seemed to really understand my need for support during the pregnancy and said several times that I would be listed as 'urgent'. This was less the 2 months ago so I feel it's expected that I'm still waiting. I work within mental health myself, under the same health board in which I live and understand (as with everywhere) it's stretched. Where I live is also pretty rural so services are more limited. My worry is that in 5 months time ill be in the same situation as I am at present, and currently feel an ELCS is my only option. I suppose it just feels like everyone around me views an ELCS as unnecessary surgery and something to be avoided at all costs. This just adds more pressure to me, as I feel I have to some how embrace and resolve all my fears unaided and be able to undertake this ideal birth. I'm struggling enough with being pregnant.

I think I will speak to my midwife and perhaps through her to a bereavement midwife and see what support I can perhaps access this way. I did have a lovely bereavement midwife at the hospital after we had DD, so I know at least one exists within an hours journey.

[bugista]

Hi Bearberry, firstly I'm really sorry for your loss. Secondly - I think your decision to have/not have an ELCS is something you should talk through with an obstetrician so that your worries and fears are being taken into account and you can make a fully informed decision that's right for you. You do have a right to request an ELCS and they must take it seriously, according to NICE guidelines. I've copied the full recommendations below so hopefully you'll feel comfortable opening up this dialogue.

All the best for whatever you decide, the most important thing is that YOU feel comfortable with the decision that you make - everyone else should support that.

1.2.9 Maternal request for CS

1.2.9.1 When a woman requests a CS explore, discuss and record the specific reasons for the request. [new 2011]

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. [new 2011]

1.2.9.3 When a woman requests a CS because she has anxiety about childbirth, offer referral to a healthcare professional with expertise in providing perinatal mental health support to help her address her anxiety in a supportive manner. [new 2011]

1.2.9.4 Ensure the healthcare professional providing perinatal mental health support has access to the planned place of birth during the antenatal period in order to provide care. [new 2011]

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. [new 2011]

1.2.9.6 An obstetrician unwilling to perform a CS should refer the woman to an obstetrician who will carry out the CS. [new 2011]

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

[Quodlibet]

Bearberry, firstly, I'm so sorry for your loss. As others have said, your wish for an ELCS seems entirely reasonable. And it seems like for your own mental health, you need to know now that this option is available to you and that you won't have to go into a natural birth if you still don't feel able to cope with it.

That said, you might find that the CBT helps you to make a lot of progress quite rapidly in terms of moving past your anxieties, once it starts. You might be (hopefully will be) in a different head space at 9 months pregnant when you have to make the decision about how to deliver.

Is private CBT an option for you at all?

It sounds like it would be helpful for your DH and mother to try to understand where you are coming from, as it sounds a little like their pressure is contributing to you feeling a bit backed into a corner. At the end of the day, it will be your delivery, your body, your choice, and they need to support that choice fully.