First time Birth & having an elective c-section

[SASASI]

Hi folks.

I am booked in for a c-section on Monday for maternal health reasons.

It took us 2 years to get pregnant & it happened after an HSG end of last year (the dye test to check Fallopian tubes). Unfortunately everything that could have went wrong during this minor procedure did & I was left extremely traumatised. I lodged an official complaint & the SHO carrying out the procedure had never done so before unsupervised. So basically I was treated like a experiment with severe consequences to my mental health & confidence. He blamed his inability on the gel on his hand - yes that's why you rammed the equipment so hard into me that I screamed & cried until I was near sick! He blamed my cervix for being tilted. Eventually he gave up & went got a more senior doctor to carry out the procedure. The nurses were wonderful & told me I didn't have to let a 2nd attempt happen but I knew I needed the results before infertility clinic app so somehow I managed to let it happen, albeit with numbing gel etc. all clear.

A couple of weeks after the procedure, I underwent 2 plastic surgery operations for malignant melanoma skin cancer. Whilst being diagnosed with cancer was horrendous (and indeed primary infertility on the same day) & I was extremely nervous being on another operating table, the surgery itself turned out managable as did the post op recovery - I have wonderful support around me. My placenta needs tested after birth to see if the cancer passed through.

Somehow inbetween these times I forced myself to Dtd with OH as I was told fertility was increased after an HSG, despite the pain, trauma & absolute terror of anything in there again. Low & behold, our much awaited positive pregnancy test.

The trauma of the HSG has never left me. My consultant is being very supportive, thinks I have post traumatic stress syndrome & agrees a c-section is in my & the baby best interests. Problem is I rarely see her but her registrars etc are not in favour & try to terrify me from a c-section to a vagina birth trial. It upsets me everytime I have to repeat my history & reasons to a new face & I end up hysterical. It's like because there is no physical reason, my mental health doesn't matter? And the fact that it's men everytime who try to steer me away is laughable - they will never have to squeeze a watermelon out the end of their penis?!!

Basically to me the HSG is similar to birth whereas the c-section will be similar to my plastic surgery. I can't help but make this link & the thought of anything medical going near my vagina freaks me out & terrifies me - I don't know how I'll ever manage another smear test let alone attempt a natural birth. A lot of medical professionals have said 'just get an epidural early' but that's only masking my problems if that makes sense? I Am totally against assisted & instrumental delivery & the thought of any internals, interventions to my vagina is just a big fat no for me.

Has anyone any similar reasons to going for a c-section? I know no one can make the decision other than me but I would appreciate any constructive advice or positivity - I certainly don't need any more doom & gloom added to my current mental state.

[Gennz]

Yikes Sas I'm having an ELCS (just booked it today in fact) and I haven't had any of the issues you've had! I've had a very straight forward pregnancy so far - I just looked at the risks of each mode if delivery and thought I felt most comfortable with going for the ELCS. Like you I was more concerned about the prospect of instrumental vaginal delivery and ELCS is the only surefire way to avoid it! (Assuming that I don't go into labour before my ELCS date!)

Of course it's not the easy option but none of them are as far as I can tell! The main thing is feeling comfortable with your choice I think - and it's really no one's business but your's.

[Gennz]

To be clear, there's no medical reason (inuding amy mental health reason) for me to have an ELCS, it was purely preference. I know some people will take a dim view of that but bugger them.

[SASASI]

Thanks Gem. This time last year I may have has the same strong attitude as you but I just feel like I am a former shell of myself.
Internet is easy but I can't be bothered meeting people, ringing people. It has all just destroyed my confidence which doesn't help my fear / terror of thinking neither me or my baby could make it through a vaginal birth unscathed. The comments from the medical team are really playing on my mind & messing with me. I have my pre-op assessment today & couldn't sleep last night. If I get one more swarmy comment I will just flip!

[Gennz]

You poor thing. Hopefully this time next week you'll be holding your baby recovering from a very straight forward section!! It really doesn't matter how they get here, what matters is that they arrive safely and that you feel okay as well!!

[SASASI]

I know I need to keep my eye on the prize don't I? There is way too much emphasise on 'as long as baby is ok that's all that matters' - I want to be a mum more than anything & I'm important too! They are going to monitor me closely for PND.
Hope all goes well for you too! :)

[BlackbirdOnTheWire]

You're actually booked in for a CS though? So it doesn't matter what the registrars say. If anyone else makes any comments you ask "have you read my notes in full?" and if they carry on, you say "please put in writing your reasons for disagreeing with the consultant, so that I can consider them". If they don't shut up at that point, you ask them for their name and position, and carefully write it down in front of them, checking the spelling.

I had one MW during pregnancy with DC2 who kept advising VBAC. As soon as I asked her to put in writing why she disagreed with the consultant, she got extremely flustered and it was never mentioned again (as it happened, I would have liked a VBAC after an extremely traumatic EMCS - but the consultants were horrified by the idea! So the MW clearly hadn't read the notes).

You don't need to justify or explain anything, the consultant has made the decision. They can argue with the consultant if they like... Good luck.

[RedToothBrush]

I am having an ELCS for my first baby due to mental health reasons (anxiety related which are quite complicated, but revolve around a mistrust of doctors). I sought out help before I got pregnant and found a hospital which had staff who had an interest in the area and had experience in dealing with similar cases.

As a result unlike you, I have had an extremely supportive team and this has made the world of difference to me. One of my fears was exactly people trying to persuade me to change my mind and not taking me seriously. They have all seen me hysterical and have realised that I need them to listen to me and respect how I feel. The general approach at my hospital for women in similar situations is to work on building trust with them and support them in whatever decision they ultimately make, which sadly seems to be completely the opposite to what has happened with you.

Its my understanding that there are very few places in the UK which are like this unfortunately, as understanding of the subject is extremely limited. There are a lot of HCPs who really do not know how to handle the situation, and have their own ideas about what is 'best' for women who request and ELCS. Much of it is tied to ideological beliefs that a VB is always best and a CS is a 'bad' thing (which is backed up by political and financial concerns). They are often under pressure to reduce CS rates.

The reality is this: NICE realised that there was a problem, and changed their guidelines to reflect the latest evidence about women who request an ELCS. Previously mental health was an overlooked area with many HCPs failing to recognise it as a valid reason to have an ELCS leading to a massive disparity of care across the country. The guidelines were supposed to stop this - but this has had mixed results in improving the situation. The guidelines have been controversial, but have been slowly changing these attitudes and breaking through ignorance on the subject, though sadly not universally or quickly enough.

The guidelines compared planned VBs (which include assisted VB and EMCS which are a result of attempting a VB) and a planned CS. Their conclusion was there was very little difference between the two in terms of risk for the mother and there was only a slight difference for babies (slight increased risk of being admitted to SCBU for ELCS babies). But they felt that on balance, when you took into account the potential risks to mental health from denying access to an ELCS, that women who wanted one, should be allowed one. The conclusions of the guidelines are however flawed in so much as they only look at first time mothers, and don't consider the knock on effects for subsequent births.

So if you consider this as the 'official line', unless you have other medical complications or are considering more children (which from your story sounds like it is unlikely) what the registrars are doing in trying to scare you, is both factually incorrect and damaging to your trust in them. They are just wrong in both their words and deeds.

My consultant has been brilliant in stressing that my request for an ELCS is based on medical NEED just as much as any physical need for an CS rather than just being a choice which has massively helped my confidence on the subject. Attitudes that don't see mental health reasons / maternal requests based on mental health as being 'as valid' are common and the whole area is still steeped in dated stigma and ignorance. In fact the evidence shows that women who choose are more likely to need support than the average woman. Constantly have to defend or justify their position is actually the last thing they need. Put it this way too: you would not get many registrars challenging a consultants decision about an ELCS for physical reasons... It says a lot about their own beliefs and lack of knowledge that they think it is ok to do so under these circumstances.

Please, try and focus on the fact that your consultant HAS been supportive and DOES seem to understand where you are coming from. There ARE people out there that do 'get it'.

I don't have any other advice or gems of wisdom with which I can try and reassure you with, other than to say, that if you feel this is right for you, then it probably is. You seem to lack confidence in trying for a VB so if you did and things went wrong, you'd struggle to cope. With an ELCS you are at least mentally prepared for it at this stage. Those who have studied the area, support how you feel and do not think it is unsafe based on the research available especially when taking into consideration your mental health.

I am booked in for a few weeks time, so I can't give you my views/experience about the end result unfortunately. I can only wish you good luck and hope that the experience is kind to you and heals a few wounds.

[SASASI]

Thanks blackbird, I will say that if they get antsy with me.

Red - that's more helpful that you will ever know, thank you so so much for all that information. Hopefully I remember some of that this afternoon if I get my questioning !!

I'm deflated because last wk my consultant was so wonderful about it all & I left feeling relatively positive so it get a different registrar on Monday & for him to a) lack understanding & knowledge about me & b) try to convince me to get for a vaginal birth has really upset me & rocked my boat so to speak.

[RedToothBrush]

Sasasi, please be aware that the guidelines are only guidelines - they don't have to be followed (many places aren't) - and may not be appropriate to all patients, but they do carry a lot of weight and influence. If nothing else, they are helping a lot of women, who feel like they need to justify how they feel.

I hope in time that they will be taken more seriously than they currently are. There is still a lot more research needed in the area that needs to be done - the guidelines have helped to start that process as there was so little done in the UK prior to the changes and I am aware of a few studies that have been started since their publication.

We do seem to be behind several countries (Finland, Norway and Sweden) in our approach to the subject, but we are finally starting to make some progress.

[KnittedJimmyChoos]

Its a new time really for women and birth and so on, we are making strides forward although it also feels like ten steps back too at times.

The people who have been odd are only showing how out of date and touch they are.

Please ignore them. My doctor kept asking me in the most incredulous voice why I had an ELC, what was the need. i was able to take what he said with a pinch of salt, having had wonderful care during the whole thing.

It really is a lottery I cant stress this enough. My consultant was amazing, however I could have easily got the other one, known to be a dragon to put it not so nicely. The dragon came round before the op, barking at us all, and I panicked thinking she was going to do me also...thankfully NO. but its just luck. I was however the same person with the same needs no matter who had dealt with me...

As long as you get the section you want ignore them. Its a lovely way to have a baby, possibly the best way to many women, relax and enjoy.

[KnittedJimmyChoos]

If he has upset you could always call Pals and see what they say?

[Gennz]

I love your response Blackbird writing down people's names always makes them wind their necks in quite swiftly doesn't it?

I feel v v lucky to have had a consultant who has been completely open to the choices we've made around this pregnancy. We've paid to go private but DH and I were just saying yesterday how we felt it's been worth every penny - he's very factual and I've never felt pressured to go either way (the only hint of his bias was when he said "look, you having a c-section obviously works for me as it means I get to deliver you at a civilised hour but it's your call.") There's been no touchy-feely handholding or wonderment at the joy of new life - if I ask a question I get the risks, the likelihood and the stats but that suits me down to the ground. I can't imagine how stressful it must be to be battling pre-conceived thinking or ideology from your medical advisers.

[Gennz]

How did your recovery go Knitted? (sorry to hijack your thread OP). I've been umming and ahhing for ages about whether to go ELCS for the birth and researching to the nth degree, and having finally made a decision (which I feel really good about, which is always a good sign) my new research project is how to approach the ELCS and the recovery.

[SASASI]

Thank you all so much for responding. It was a midwife & she was great & didn't care I was going down elective route - she maybe actually read my notes!!

I'm still terrified & part of me thinks I'm mental going straight for surgery & not attempting a vaginal birth but the bigger part of me knows for my mental health I need a positive experience & an elective c-section gives me the best chance for that. It's no easy option & my lazy daisy birthing teacher texted me to tell me that I'm being really brave - sounds like tripe but she has made me feel better about things!

Scared about having to inject anti clotting jab into my stomach myself on Sunday, particularly given I've carpel tunnel in both hands but with the amount of needles that will come to me on Monday that's really the least of it isn't it?!

Would be interested in hearing about recovery too Gem so no worries. :)