Second ELCS - can you help me word my request? Not good at 'demanding'

[Pinkflipflop]

First off I'm not yet pregnant but I would like to get this 'sorted' in my mind iykwim?

My first baby turned breech very late on in my pregnancy so I had a CS. This was the best possible thing for me and I couldn't have wished for a better birth experience.

Looking back I was so full of anxiety during my pregnancy about the prospect of natural birth but I didn't think there was an alternative.

I waited 10 years to get pregnant and a large part of this was due to my fear of childbirth. I have never mentioned this to my doctor, as I'm really embarrassed about it. I don't know anyone who feels like this, most people just get in with it. I didn't feel comfortable talking about it with any of the midwives during my antenatal appointments as firstly I never saw the same person twice and secondly appointments at my hospital are very rushed due to the intense pressure on the staff and how busy they are.

I know that I want a sibling for my dc and I dread having to go through the months of anxiety worrying about the birth.

I read about women who say they demanded a CS, but I don't think I could do that; I get very tearful and embarrassed when I think about my reasons for fearing natural birth.

Is there any way I can be guaranteed a CS right from early on in pregnancy. How do I go about ensuring this? I absolutely wouldn't have another baby unless I could have a CS.

Is it relevant that I know I only want 2 children? Wouldn't be a drain on nhs resources etc?

Thanks if you have read this far. Sorry for the ramble.

[tethersend]

Depending on where you are, you might not need to do anything other than tell them you're having one- I didn't, but I was at UCH. It was no problem to get a second one.

VBaC carries a slightly increased risk of uterine rupture, and afaik, they cannot make you take that risk.

Can you say where you are in case someone has experience of a particular hospital?

[DolomitesDonkey]

Hello. I'm not very good at confrontation either, but one thing you say stands out when you say you waited 10 years, how old are you now?

I had my second at 38 by elcs and I showed my consultant the statistics from her own hospital indicating that due to my age and other factors - I had less than a 25% chance of avoiding emcs/forceps.

She was my third consultant. The first wanted me to vbac, her locum said "swap and ask someone else". On the day it was the same woman who did number 1, she is now well versed with my uterus.

I think I didn't get it agreed until I was nearly 28 weeks if I remember right - but nobody can FORCE you. Had needs be I'd have rocked up to the Portland...

[DolomitesDonkey]

I also printed out stats from rcog which also indicated I had a low chance of a vbac. Use their science against them.

[Pinkflipflop]

I'm in Northern Ireland, I think sometimes they are less inclined to agree to csections here.

I'm 33 so not sure if my age is a factor.

Thanks for replies so far.

[DolomitesDonkey]

I wasn't even in the UK but I still presented rcog stats!

[Pinkflipflop]

donkey just what you said that nobody can force you; do you think if I kept repeating over and over that I wanted a section they would give me one?

At what stage do you raise this issue?

[DolomitesDonkey]

I said at 12 weeks. I think as far as repeating yourself goes, some will understand that you're an adult who understands the implications others will require you to prove that you're virtually capable of performing the operation yourself. The only advice I can give is what that junior locum told me - keep trying different consultants until you find one you "click" with.

Fwiw, when I had my elcs there were some complications came to light which showed I'd have been a very messy vbac indeed...

[DolomitesDonkey]

And when I say messy vbac I mean horrendous labour and then emcs with or without incontinence.

[MyDarlingClementine]

its probably a good thing that you get tearful and embarrassed! its a good thing to show some emotion.

agree with DD if you meet one who you don't feel is listening to you, go to another. Dont put yourself through the stress.

[Choccybaby]

I've had no problem asking for a second CS, the consultant just asked what I wanted.
You shouldn't have to argue hard as the rcog stats show maternal mortality is lower with a cs than vbac as well as small reduced risk of still birth and anoxic brain injury

[breatheslowly]

I suggest having a pre conception appointment with a consultant. It may be that your GP could refer you on the NHS due to your anxiety, but if they are not willing to then you could, if you can afford it, pay for a private consultation. Which ever way, ask your GP for the name of the consultant who they think is most likely to listen and follow your request and make sure that they work in obstetrics in your local/chosen hospital. The advantage of a private consultation is that you will definitely see the named consultant, not just the member of their team doing the appointments that day and if you see a consultant then they are the top of the tree in terms of decision making, otherwise you may be fobbed off by someone who is not the decision maker. Also everyone on their team will know who they are. Explain your concerns and they will probably be fine with your decision. Then ask them to write a letter to be kept by you in your pregnancy notes explaining your discussion and their conclusion. Everytime someone caring for you attempts to discuss delivery method, just say "I'll be having an ELCS as agreed with X, here is a letter that explains it" and if they attempt to discuss it further just repeat your statement and ask not to continue to discuss it.

This is my plan - only time will see if it works for me!

[PeaceAndHope]

VBAC has a 4-11 times higher risk of perinatal mortality. Tell them that if they force you into it, you want them to take full responsibility for anything that happens to your baby.

Nobody can force you to VBAC.

[RedToothBrush]

I read about women who say they demanded a CS, but I don't think I could do that; I get very tearful and embarrassed when I think about my reasons for fearing natural birth.

Right to start with you need to know this. Fear of a natural birth is not unusual. Its far more common than you think but extremely taboo. Several bits of research put the number of women who have severe fear at somewhere between 1 in 6 and 1 in 10 women. Thats extremely high.

So why are we all so embarrassed to talk about this and freely admit it?

The simple truth is probably to do with how closely giving birth is associated with 'being a woman'. To reject this is perceived as weak and unfeminine and going against 'the most natural thing in the world'.

Forgetting of course that the most natural thing in the world without the aid of modern day intervention, kills thousands of woman on a daily basis and throughout history has killed million.

When you think about it, it should actually be considered more weird to not be afraid! So please, please try and stop feeling guilty for having a reaction which is perfectly normal. If it upsets you that much, allow yourself to express it rather than bottling it up or pretending its not affecting you.

If you were in England or Wales, I'd be quoting the recent update to the NICE guidance about CS at you here, but because you are in Northern Ireland you have a bit more of a complex situation as NICE doesn't strictly apply to you. HOWEVER the good news is that the DHSSPS has recently endorsed NICE's recommendations (despite the efforts of the delightful Edwin Poots) Trouble is that how this is going to be implemented is yet to be seen as since the situation in England, where NICE applies, is still so shocking I wouldn't hold my breathe. However if you do come across obstacles or people saying that they don't this in NI, then you can quote that and say that NI should be doing the same as England and Wales.

In terms of getting a CS agreed in principle before getting pregnant - You may/may not be able to do this. I've seen a couple of women on here say they've managed it. I'm trying to, but... yeah well... my GP isn't exactly being helpful to say the very least (I'm in England).

So as it stands the only way you can guarantee a CS is to go private and pay for it. Which is decidedly unhelpful for anyone who lives outside London due to the lack of private maternity facilities.

Your age at 33, probably won't work in your favour for this. Its only after age 35, that the rates of intervention and CS start to increase and thats more the case for women who, unlike you, haven't had a child before.

The big thing for you though, is the fact you have previously had a CS. This alone gives you a bloody good case for a repeat CS as they should be discussing the risks of a VBAC with you. Which puts you in a good position to say you are unhappy with this risk and then therefore request a CS. You can't force them to give you a CS, but you do have a 'legitimate' case for a ELCS.

And finally for what its worth, despite whats been said about ELCS costing more than VBs (yes Mr Poots you arrogant fuckwit I'm looking at you), the truth is that NICE actually found that when they tried to do a cost analysis that when they started adding in the costs of complications they concluded that cost alone could not be used as an argument against a CS as the difference was small and impossible to accurately calculate. They basically felt it was a cost effective treatment from all the information they had available to them. So again don't feel guilty.

There is no need to justify how you feel. Just feel it, and try and deal with it in the best way you feel you can.

[Pinkflipflop]

Thank you for the replies on this question and the helpful advice. It is greatly appreciated.

[Jollyb]

I had an EMCS with DD and am now 24 weeks pregnant. I want an elective section this time and haven't faced any opposition. As a formality I do have to attend a birth options clinic to go through the risk/benefits of VBAC vs section but have been told that I will be able to have a section.

[MarianaTrench]

I was all geared up for confrontation and having to demand a section when in the event my consultant agreed almost immediately. I had a traumatic delivery with DD and since then have lost two babies late on and had to deliver them which was traumatic in a different way. My consultant did say that her knowing I didn't plan any more children was a big factor in her agreeing. The other thing was that she didn't really agree it until I was 32 weeks, she just said we'd wait and see how I felt nearer the time. It doesn't always have to be a battle though, I was extremely surprised and relieved how sympathetic she was.

[PeaceAndHope]

Isn't it a bit cruel to make someone wait until 32 weeks?

[MarianaTrench]

I got the impression that was policy and I didn't push it at the time but asked her to record that I'd requested it, which she did.

[PeaceAndHope]

As long as you were happy to wait. :) I just think that perhaps for someone with tokophobia or an anxiety about childbirth, it may be too much to wait until 32 weeks.

[tethersend]

I was granted one at 14 weeks.

[MarianaTrench]

I suspect if I'd made more of a fuss earlier she would have agreed. I think someone with tokophobia would get agreement earlier.

[PeaceAndHope]

That's reassuring to hear. I think it would also largely depend on the hospital and consultant. Some refuse the request outright, some make you wait, others agree in time. Lottery system that's the NHS.