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Childbirth

All this talk of VBAC only policy....

29 replies

kblu · 19/09/2011 08:16

Hi ladies, I wonder what your views would be on my situation. I had a very traumatic birth 3 years ago resulting in an EMCS under a GA. I developed severe pre-eclampsia as I went into labour 10 days overdue (I had signs two weeks up to getting it but no protein in my urine so they didn't diagnose and wouldn't induce). The day I went into labour I felt physically fine and I had the usual "take a paracetamol and have a bath" routine when I rang the labour ward that morning but I was in so much paid that I decided to take myself into hospital. Good job I did because I had my baby half an hour later. I was extremely poorly and my baby suffered HIE as a result of oxygen starvation and I was told whilst in intensive care that my baby could possibly be brain damaged as a result. I also suffered severe bonding issues as I didn't meet my little boy for two days after he was born due to me being too ill etc. etc. All in all completely horrendous experience for me and my husband and we decided we'd not have any more children because of it. That is until now!

So obviously we've some major concerns this time round. First of all i'm now 38 which isn't old I suppose these days in baby terms but it's still a concern for me as I never intended on leaving it this late to have my second (and last) child. I'm other major concern is that they won't give me an ELCS. This is an absolute must as far as i'm concerned because i'm frightened of the fact my PE came on so suddenly and severely when I went into labour that it would happen again. I just wouldn't put myself in that position. The only way i'd be comfortable getting pregnant again is if I had a planned C section at say 39 weeks, that would give me a massive amount of peace of mind and I would be able to have a relatively stress free pregnancy. I've read up on VBACS and it's just not an option i'd feel comfortable with. I really don't want to end up in an another emergency situation putting my life and my babies at risk like last time. I realise I might not get PE next time but I had a text book pregnancy last time with no signs of PE until the last couple of weeks so this is my concern!

So with this in mind I made an appt with my GP for some pre-conception advice. Although very sympathetic his view was that it wasn't a guarantee i'd get one but I would have a very strong case. He spouted all the usual government guidelines have changed routine and they are encouraging VBACS now etc. etc. He did however telephone the local obstetrics for me and their advice was that their hands were tied and couldn't give me a definite yes (I suppose until i'm sat in their office with a baby in my tummy). Seems madness. I then decided to go for a birth de-brief at the hospital and found this very helpful. The midwife remembered me as she had dealt with me in the maternity assessment leading up to my birth. She said to me that 100% I would get an ELCS and I didn't need to speak to a consultant for her to give me this guarantee. She said my case was so horrendous that she more or less gave me her word. I've also spoken with a friend of a friend who was recently given an ELCS at the same hospital because she had a first traumatic birth (she never had an EMCS the first time).

So this is my dilemma. Would you be more inclined to go with the advice of your GP or the advice of the midwife at Birth Afterthoughts?

Your views ladies! I'm really scared I would have to fight my case with a consultant once I got pregnant.

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kblu · 19/09/2011 08:18

Just wanted to add that my little boy is now 3 and he is absolutely fine we think!

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verybusybear · 19/09/2011 13:50

I think that GPs (and actually in my experience even community midwives) have very little say and knowledge about what a hospital will decide to do with you.

Given the midwife you spoke to was at the hospital, I'd go with her advice definitely. However - not wanting to be too pessimistic - it is also my unfortunate experience that hospital policy can change part way through your pregnancy. But I do think that your case sounds like a much more 'extreme' case than mine, so even with a policy change they would probably do an ELCS for you. If you could get the midwife you saw to write in your notes that she would advise future births to be ELCS then I think that would help a great deal.

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kblu · 19/09/2011 14:18

Thanks, what was your case verybusybear if you don't mind me asking?

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QTPie · 19/09/2011 14:20

Hi

Where do you live and - if absolutely necessary - would getting a C Section privately be an option?

I can't help on your case, but at 37 myself (DS almost 20 months) and wanting another child (hoping to convince DH), I feel that having a second child is the most important thing (feel it would complete our family and, as an only child myself, don't want DS to be an only child...). I am sure that getting an ELCS must be achievable somehow (second opinions, begging, demanding, breaking down, begging/borrowing/stealing to go private....), that it would seem a shame to give up having another child because of the threat of not getting an ELCS.

Hope that has come across right... (probably not :( ). I think that there is always a "way" and hope that this works out for you.

QT

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LadyMary · 19/09/2011 14:26

I think you do need to see a consultant as soon as possible and ask what the score is. If they agree, they will sign it off in your notes there and then, book you in and you can stop worrying. You ave a very good case for not wanting to go for a vaginal birth again.

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kblu · 19/09/2011 14:30

I'm in Blackpool and I cant afford a private C section, wish I could!. My main concern is that I don't want me or my baby to die this time. Sounds dramatic but we were very lucky last time. I'd be horrified if they just left me to go over my due date again when my placenta was completely shot to pieces as it was last time which was the reason my baby suffered HIE I assume. I was really poorly last time and didn't actually realise how poorly until I had my recent de-brief. I just can't go through that again.

It just seems madness that i'm being sensible by taking pre-conception advice but they can't give me an answer even by looking at my notes from last time, i've even offered to pay privately but my GP says i'd be wasting my money. I assume they prefer to see how your pregnancy goes before giving you a final decision at 36 weeks or whatever. My concern is that my PE came on all of a sudden and so severely it was "off the scale".

I feel stuck between a rock and a hard place. In my heart i'd love another baby to complete my family and it's now or never due to my age but the thought of going through all that again or the possibilty of it just fills me with absolute dread.

Oh bugger me, decisions, decisions!

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babylily · 19/09/2011 14:39

Hi, I would also go with what the midwife has said to you. Obviously hospital policy is to encourage vbac, but in a case such as yours I would expect this to be more of a formality... I have had an elcs, followed by vbac and 2 weeks ago had another elcs. I did have to repeat my reasons for not having another vb pretty frequently at every obstetric appointment...and listen to the reasons why vbac was best more than a few times...but there was never a question of being refused a section. I live in Scotland, and my elcs was a calm and completely non-traumatic experience.
Don't let this prevent you having another child...as QTpie says there is always a way.

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kblu · 19/09/2011 14:49

Thanks babylily - well I thought that, more the midwife, she was very adamant and I remember saying to her two or three times "so I would definitely be able to have one then" and she said yes in your case 100%. Problem is more time I have to dwell on it and the more ladies I see on internet forums such as these having to fight for one the more doubt sets in!

My GP was very much sitting on the fence, almost like he didn't want to say too much, like he was scared to. He said the consultants are pretty much the same, their hands are tied, they would not be able to say to me that i'd definitely be able to have one because they would get hammered for it (his words). I would have thought they could give me the benefit of their advice though surely?

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Nevercan · 19/09/2011 15:12

I would go with the midwife. I was overdue with both my pregnancies and had EMCS with first as baby in distress due to induction - long story On second they asked if I wanted to be induced and I said no and opted for elective cs. My case was far less dramatic than yours and my consultant wanted me to do what was best for me and safest based on previous pregnancy. I can't see why they would refuse you based on your history.

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MooseCakey · 19/09/2011 17:51

I would always listen to the midwife over the GP for anything to do with pregnancy and birth. GPs have to know so much they can't know details of everything, the first GP I saw about my pregnancy gave me so much mis-information, all now contradicted by my midwife or another GP, that I prefer to avoid them!

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QTPie · 19/09/2011 17:57

I would go with it and fight tooth and nail if required (hopefully it won't be).

Good luck
QT

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kblu · 19/09/2011 17:58

Thanks ladies, that is kind of my thinking too, she was very adamant that I would get one taking my case on its own merits. I did say to her that I was worried about what i'd heard about VBAC being pushed nowadays but she agreed that it was but in my case I wouldn't have a problem. It still concerns me though!

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kblu · 19/09/2011 17:59

I am up for a fight if necessary I really would push for it but I didn't really want to have to. Pregnancy is hard enough isn't it?

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ohanotherone · 19/09/2011 18:03

Obviously the midwife, GP's are just GP's not specialists.

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VivaLeBeaver · 19/09/2011 18:17

I'd go with the midwife.

I'm a midwife and I know what our consultants opinions are on vbacs. I know some are more pro and some dead against them. So depending what a woman wants I know which consultant to ask to change to if she doesn't get the answer she wants from the first one. I know which consultant is happy to agree to lscs for maternal preference where there is no medical reason at all.

I would think this midwife knows what normally happenes where she works.

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verybusybear · 19/09/2011 22:42

Hi kblu. To answer your question from much earlier, I had what is the not too uncommon situation of going very overdue, (waters going by themselves though I will add), being induced on the drip and then ended up with emcs due officially to failure to progress-stuck at 2cm! There was fetal distress on and off as well although that wasn't why they did the section. But thank god they did as she looked awful when she came out and it took what felt like forever to get her breathing. That's what I can't face again really. I remember lying there really thinking I'd be going home without my baby.
To echo vivalebeaver's post my community midwife is optimistic that she can move me to a different consultant and hospital if necessary and that I will get an elcs somehow! A lot of worry for me in the meantime but I guess that I accepted this risk from the start.
Best wishes.

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kblu · 20/09/2011 07:12

oh no! Good luck verybusybear, how stressful for you ((hugs))

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Catsycat · 20/09/2011 13:41

DD1 is 4 now, she was 18 days overdue, born by EMCS after a 3 day failed induction. I only got to 2cm after 3 days, and wasn't having any convincing contractions. I wanted VBAC with DD2 (she is 20 months now), and had a very unconvincing chat with the VBAC mw at our nearest hospital - along the lines that I could try (but she clearly thought I would fail, and talked about induing me again!!!!!). I changed hospitals to get a more pro-VBAC response (among other reasons). After 6 membrane sweeps from 37 weeks onwards, I did go into labour, but again after about 3 days (and 15 days late) was at 2-3cm, and not progressing. I had another EMCS. I am very newly pg, and planning ELCS this time.

Despite talk of VBAC being encouraged, I know a lot of women who have had all their children by CS (for various different medical reasons) and none of them have ever been discouraged from having a second or third CS (and this is as recently as january). Even at the pro-VBAC hospital, it was a case of the mw keeping me away from discouraging consultants as much as possible!

I would also listen to the mw, not the GP, as vivalebeaver says. My mw was very clear that GPs have very little to do with anything obs or birth related. In fact, with DD1 I was booked for a homebirth originally, but when I first asked my GP about this, he said "we don't do homebirths here". Our local mws do loads of homebirths, and my mw's response was "well, he doesn't"!

Good luck.

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EasyFriedRice · 20/09/2011 13:55

Hi there,
Just be aware a new NICE guideline on Caesarean section is coming out in November see here.
The rumour is that they are going to advise allowing c-sections for maternal request, especially in the case of a previous traumatic birth. We'll have to wait and see though.
Keeping fingers crossed for you.
I have known people get a pre-conception appointment with an Obs Consultant and get an assurance they can have their section. One woman I know got a promise of a section after a normal vaginal birth but terrible PND afterwards. She felt she needed a section to feel in control. She got her section in the end but it was an EMCS because she went into labour before her ELCS date. She felt so happy with her decision.

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kblu · 20/09/2011 15:46

Thanks ladies for your kind responses, so helpful. I feel a lot more reassured now and i'm sure I will get one now after hearing all your opinions.

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FormbyDoula · 20/09/2011 17:39

The draft of the new NICE guidelines says that where there is a maternal request for a CS:

  • if it is because of fear of childbirth, refer to perinatal mental health support to help her address her fears
  • if after support a vaginal birth is still not acceptable, offer a planned CS
  • An OB can decline the request for CS but must refer the woman to an OB who will carry out the CS.


So even where a first-timer wants a CS, it seems NICE would still recommend she gets one (after counselling). So after a traumatic birth like yours, it is even more likely it will be granted.

FWIW the consultant OB at my local hospital told me ANY woman can have a CS if she wants one (he seemed quite proud of that).

Good luck!
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kblu · 20/09/2011 20:27

thank you FormbyDoula, I will look out for the new NICE guidelines.

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Catsycat · 20/09/2011 21:07

That's how I read the new guidelines too FormbyDoula. From previous experience, I'm sure the NHS bank balance will be very relieved to see me opt for a CS. And I noted they will now consider discharging you after 24 hours, which I thought was very interesting.

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Catsycat · 20/09/2011 21:07

Sorry, should have said draft guidelines!

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MrsHoolie · 20/09/2011 21:25

I had an emcs and when I got pregnant two years later I was given the choice of vbac or ELCS.
I didn't even have to see a consultant!
Wishing you the best of luck Grin

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