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request elcs due to birth history

(19 Posts)
keeponkeepinon Wed 29-Oct-14 09:47:42

I have brought up my concerns at practically every midwife appt and have always been fobbed off with its early to worry, hmm i see type responses. I am fed up of it and at last appt ended up at verge of tears and midwife booked me an appt with consultant. My first two labours were long and mins away from emcs. First ended up ventouse and epi (only because there was no room in theatre) and second i managed myself but both times were near emergencies because baby got stuck. Failed to progress and fully dilate. Doc had to manually move a lip on cervix out of way both times. It was all stressful both times and i am terrified of it happening again as the same thing has happened twice before and end up with emcs anyway after being knackered by being in labour for hours. This baby has been transverse for much of the pregnancy and i am still getting a lot of big movements and body parts clearly changing position. I guess i just have no idea what to expect from consultant appt and am looking for advicd from anyone who has experience. I dont want to get laughed out of the office - i think i have genuinely good reasons for a request but if i am going to be shot down in a ball of flames i would rather be prepared! Can anyone advise? Wish there was a place you could go to ask a midwife for advice without just being ummed and ahhed at! Every midwife i see agrees that i have not had straightforward deliveries! But never seems to do anything with a review of the history! Thanks in advance.

HaPPy8 Wed 29-Oct-14 10:05:52

The midwife cant really do anything other than refer you to a consultant because they generally don't have the 'power' to agree to a CS. I think you will need to wait until you see the doctor but maybe request the appointment is brought forward if it is causing you a lot of anxiety? How many weeks are you?

keeponkeepinon Wed 29-Oct-14 10:15:01

36 so getting close to dd!

SixerofthePixies Wed 29-Oct-14 10:22:43

Yes I have. Incredibly traumatic first birth, needed an op later to repair damage. Walked into my booking in appt second time and the midwife said hello please sit down, how are you? I replied fine thank you now i'll be having a section this time please. She asked me history, labelled me high risk, sent me to consultant who said yes absolutely. My c sec was the most wonderful experience in the world ever. Recovery was so much quicker, physically and especially mentally.

SixerofthePixies Wed 29-Oct-14 10:23:57

Just seen you are 36wks you need to get a consultant appt asap.

LizzieMint Wed 29-Oct-14 10:25:38

If your baby stays transverse, you'll likely be booked for a section anyway. This happened to my friend, she had to stay in for a couple of weeks beforehand just in case she went into labour then had a section at 39 weeks.

HaPPy8 Wed 29-Oct-14 10:27:19

I agree you need your appointment as asap - how far away is it?

keeponkeepinon Wed 29-Oct-14 10:32:13

I have appt booked later this week i just feel a little unsteady about getting my point across without getting flustered and missing half the relevant stuff out. And nervous of having a hard balls consultant who just tells me to get on with it. I wish the midwife at my booking would have listened to my worries properly instead of fobbing me off! I just have a feeling that maternal request even though its for historic reasons will be frowned upon and i will just get flustered and upset and not get my point across And they will say its not a legitimate reasoneven though i am really worried about another repeat performance. Really nervous . I am also shocked as it seems to me they dont do any looking at your previous birth notes. I thought this would be an important part of your care?

GhoulySpook Wed 29-Oct-14 10:42:00

Hi OP I don't have a lot of useful advice, but I do know that the medical staff have to take your wishes/emotional state into account when deciding whether to book you in for a CS. There was a thread a while ago offering advice to someone to prepare her about what to say to the consultant to get the point across that she was very very frightened of a VB due to previous experience. Sorry, not super helpful, but maybe search for that thread? Can others remember it?

SixerofthePixies Wed 29-Oct-14 10:43:52

Just go in and say I want a section please. Make it absolutely clear what you are after. Maybe write a short bullet point list of why you want it just in case your mind goes blank, be sure to include your mental health if you feel that it's relevant.

GhoulySpook Wed 29-Oct-14 10:48:15

The issue with emotional state being important is in the NICE guidelines. Add that to the bullet point list!

keeponkeepinon Wed 29-Oct-14 12:46:56

I think i am going to have to write it out on paper then just read it out!

Lottiedoubtie Wed 29-Oct-14 13:51:03

Absolutely write it down. I had to fight for my CS and I saw a consultant who was spectacularly rude and unhelpful.

BUT they will agree in the end- the NICE guidelines say if you want one you can have one.

I did get a bit of 'sniffing' about 'maternal request' and it was upsetting. Ultimately though I know it was the right thing to do and the CS itself/aftercare was fine smile

RedToothBrush Wed 29-Oct-14 22:47:42

Just to clarify quickly as i'm just off to bed and don't have time tonight to post more fully. Your mental health is a health issue. Anxiety is a health issue. It is every bit as legitimate as any physical indication for a CS. NICE clarify this clearly in their guidance though unfortunately a lot of hospitals still haven't grasped the concept.

I'll try and post a bit more in the morning if I can, but basically if they are doing their job correctly they shouldn't be fobbing you off in this situation regards of the outcome of your request. They should be giving you additional support and offering some sort of reassurance to deal with how you are feeling even if they don't like the idea of an ELCS.

The fact they currently don't appear to be says a lot, and you should be pushing things here as you are not adequately being looked after.

keeponkeepinon Wed 29-Oct-14 23:37:40

Thanks red, i do have anxiety about the outcome because i have had the same thing happen twice before so its due to more than just anxiety, i am hoping to convey my concerns that itwill be repeated, i will have to have epidural esp due to risk of lip having to be pushed back, dunno how i would cope with that without pain relief, they let me sit for hours both times at 9cm then declared emcs butlip was pushed back and baby delivered via traditional route. My concern is that there is something different about the shape of my cervix which is causing it and it may happen again, potentially ending in c section. An emergency though, after already being exhausted with hours of labour and in a more traumatic manner. Plus i would have to insist on epidural for reasons above and this cant always be guaranteed and the epidural and the tension i am already experiencing dont bode well for a productive labour, ie fear plus epidural slowing things down on top. I want them to understand that i feel a lot of anxiety, but the reasons behind the anxiety are physical and based on past experience. Does that make sense?

RedToothBrush Thu 30-Oct-14 10:02:04

Keepon, it makes PERFECT sense.

Many, many women are asking for ELCSs because of previous traumatic births. Its 'normal' in the sense that it is within the boundaries of how some women react. If you go through something bad, is it logical that you would want to face that again? Its technically recognised as a medical issue, the most extreme end being called tokophobia or fear of child birth. I am not suggesting that you are as bad as that, but anxiety over birth covers a spectrum of different levels. (Phobias and fears are a form of anxiety so I use the word anxiety to cover all bases). Clearly your previous experiences have left you traumatised to a certain degree and this is what you need to tackle and this is what your midwives technically have a duty of care to help address with you. This is not you being 'weak', 'pathetic' or otherwise 'not tough enough'. This is a medical need.

The trouble is that care and understanding of the problem is very patchy throughout the country. If you are suffering from anxiety about this to the degree that its dominating your thoughts or giving you nightmares, which it sounds like it is, really they should be referring you to peri-natal mental health support. Unfortunately not every hospital has this service. Its something that has been recently raised as a real issue to women's health by a report on the subject - its not pie in the sky wishful thinking or unrealistic expectations.

I think making you aware of the huge gaps in helping women needs to be done, for your own sanity to make you realise that actually you have a legitimate issue here and that unfortunately it may mean you need to be the driving force about getting support here, rather than let them take the lead. You are not being unreasonable or demanding in anyway by doing this. The key is to understand that your feelings need to be addressed professionally rather than being dismissed and you have a right to this. (You don't, by contrast, have a right to an ELCS unfortunately, but in addressing your anxieties an ELCS may be the appropriate course of action).

From what you just posted, I get the impression that you need a) a full explanation of what happened previously b) an honest conversation about how likely it is to occur again c) a discussion about various options including an ELCS d) to built more trust with your hospital e) to have your fears and anxieties properly acknowledged and taken seriously.

Reading between the lines here, and I could be wrong so please correct me if I'm barking up the wrong tree. I am getting the impression that under certain circumstances you would be able to cope with a VB (eg if an epidural could be guarenteed or if you were only allowed to labour for a certain length of time to see how quickly you progressed before going straight to a CS rather than allowing it to become prolonged). The impression I have is that you are seeing an ELCS as the best option in the face of not having your labour well managed and you being kept fully informed about whats happening and why. I personally had an ELCS on mental health grounds. But part of the reason I liked the approach of the hospital I was at, was because they recognised that a request for an ELCS often was more of a cry for help rather than a real desire. They had a track record of helping and supporting women have a vb under these circumstances under their own terms and with their full consent. I think this is great as it showed they were really listening to the problems of each woman as an individual.

I think your plan of action is to write everything down firstly - like you have above. You need to clarify your thoughts and understand exactly what your fear is, and thats the first step. You need to go into the meeting knowing what you want and need to get out of it. Ask what they can offer to support you; don't just ask for the ELCS. Make it clear you are not coping terribly well with the prospect of labour as it stands.

The NICE guidelines for maternal request CS were drawn up primarily (but not exclusively) for women who are suffering from anxiety - and its framed as medical need, not as a 'request' as such. The recommendations are worth understanding for that reason alone.

keeponkeepinon Thu 30-Oct-14 10:59:23

Red, thank you so much for your thoughtful response. I burst into tears at the first line because its such a relief to hear from somebody else that I am not just a jibbering idiot!

I don't think it is just that I am afraid of child birth, its that I am afraid that there is some physical reason why I did not get to full dilation and needed that intervention both times, and now I will have to go through it again. It was never explained afterwards and frankly, I suppose once I had my baby safely in my arms I wasn't in a frame of mind to ask.

I think you are right in that yes, I need a full explanation of what happened the last two times, and I definitely need an honest conversation about the likelihood of it happening again. In lots of ways, this is the most important bit - don't just umm and ahh and say yes, that was tricky wasn't it, hmm, I'm sure it'll be ok... I need to understand whats going on with my particular situation. And yes, to have these concerns addressed, rather than be told nothing at all.

And yes, if a VB would be genuinely the better route, I would take it, I am not about to stamp and shout over it, I just want the safest delivery. But can they guarantee it won't happen again? I don't even think its a cry for help, its a way of minimising the risks I encountered in the past. Its not about fear, its about a physical issue that stopped things moving both times. If it wasn't for that, I wouldn't even be thinking about a CS.

Thanks so much for your very well thought out response. Like I say though, its not a case of me just being afraid of birth, it is due to a repeat performance of a physical thing. And I need to know whether this would happen again.

RedToothBrush Thu 30-Oct-14 15:29:56

My situation was different, there are lots of women on MN who can emphasise perhaps better than I can, but the most helpful thing I found was simply knowing that I wasn't a loon and other people had similar issues and that the NHS was behind where it should be with helping women in the situation.

I understand when you say its not just about fear its about minimising risk. The two went hand in hand for me in the sense that there was a logical/rational part of my decision as well as a very emotional/fear driven part of it two.

Overall I think its hard to articulate everything in a way that others can appreciate its a multi-faceted thing. Its very personal to everyone and no one's situation is exactly the same which makes it harder. There is no 'right' solution in the end, just one that gives you the most peace at the end.

I hope you know how to approach the meeting a bit better and can get a positive response. I personally would make it crystal clear from the word go that you feel like you are being fobbed off and you aren't being taken seriously with a bit more confidence.

woodsies1975 Thu 30-Oct-14 15:39:56

You have had lots of sound advice already but I wanted to say that my experience is almost identical to Sixer's. I wasn't planning on having any more after my first baby's delivery was so traumatic and when Mother Nature had other ideas I was shell shocked. Anyway, like Sixer I basically told the midwife from my booking in that I would be having a section. Luckily, she was really supportive and considered my high levels of anxiety, and even wrote it all in my notes. My second pregnancy was under the consultant anyway due to problems I had with clotting after birth, and she agreed as well. As for the traumatic experience you had with your other deliveries, you can ask for someone to take you through all your notes. When DD was about 12 months old I decided I had to do something so I wrote to the hospital and they invited me in to go through my notes with the senior midwife. I can't tell you how helpful that was. It changed nothing, but it helped me to process and deal with it all.

Good luck x

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