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Planning an elec c-section before pregnancy. Worth a try?

(34 Posts)
1001questions Sun 10-Apr-16 17:42:45

Hi all

I joined up a few weeks ago after I unfortunately miscarried. Since then my partner and I have talked about trying again (it was an accident) and this is hugely exciting, however I have a problem: I have a serious phobia about childbirth. The pregnancy only served to worsen my fear, as the whole time I knew I was pregnant I was freaking out about the birth even though it would have been months off. So I no know that I won't magically stop worrying about it once the hormones kick in.

My fear has not come on suddenly, however: I've been this way all my life, particularly since watching a video of a lady giving birth at sex ed in school (ugh). While all the other girls were cooing over babies, I was just absolutely repulsed, and resolute in my assertion that I would never put myself through that. I thought that childbirth was absolutely horrific, and I have not changed this opinion one bit. It's why I've left having children rather late in life, but it's not changed my overall desire to be a mother.

However, I'm not quite as afraid of surgery, so I've decided that the best option for me would be a cesarian. I like the fact that I'd have a degree of control, that I would know more or less exactly what was going to happen, how long it would take and what order things would happen in. I also wouldn't have the worry of putting my baby's life at risk because I'm unable to follow instructions or control my panic response when in pain.

I don't have any reason to think my view on this will change any time soon, and knowing a bit more about my issues (I've been treated for anxiety more than once since my teens) I think it would be completely inappropriate for me to attempt a 'natural' birth. However I'm aware that the NHS takes a rather unhelpful stance on this issue and frankly this scares me. My partner and I could probably stump up the funds to pay for it ourselves, so I'd be interested in hearing what people here have paid - but this would be a last resort.

Is there anything I can do BEFORE I get pregnant again to make sure I've got the best chance of having the procedure as possible? I am wondering about seeing my GP and explaining all of this so that he'll write it on my notes, and I'll have this to refer to when I'm inevitably called upon to defend my decision. I don't want it to look like someone who's just decided they want an easy ride. I'm quite aware that there are post-op issues with this route, but the fact that I am willing to suffer them should be testament enough to my certainty of what I want.

But I don't really know how the GP will react to this - I'm worried that he'll just laugh at me or worse, tell my I'm a time waster.

Can anyone help? I have quite a lot resting on this sad

RedToothBrush Sun 10-Apr-16 18:21:59

I did it.

I have a beautiful 18 month toddler currently emptying the bottles out of the drinks cabinet into a pile in the middle of our front room much to our amusment.

I won't lie and say it was easy. I tried to write direct to someone at the hospital but the letter went AWOL (I was told they would have seen me if they had received the letter) and I was lucky that I had a GP who pretty much said 'tell me who you want to be referred to, and I'll support you" despite the care pathways for women who have not had a previous child being non-existent or unclear.

My case boiled down to me being able to consent appropriately due to panic attacks and anxiety around childbirth and doctors - it sounds very similar to you.

I spend a number of year stewing over it and finding the best hospital locally to go to which had mental health services available - many trusts do not have any specialist maternal mental health services. I did not go to my local hospital but went to one slightly further away.

The Maternal Mental Health Alliance published a map a couple of years ago, which gave details of which trusts at the time had services and which did not.

It is here - everyonesbusiness.org.uk/?page_id=349

The good news is the Maternal Review last month had a strong emphasis on mental health awareness, promotion and extending services and is something of the hot topic at the moment. Particularly the disparity and lack of services.

In my case, I simply got lucky and found the right people. It could have worked out very differently. But the point is it IS possible. I was treated with respect at all times. My consultant made a point of saying that despite it being on my notes as maternal request, my request was a clinical NEED due to mental health. He also said I was not the first case like this, he had come across and that I would not be the last, even though it was rare.

I can't guarantee you will have the same positive experience and outcome as me, but since I have done it, do not assume that it can't be done.

We had also looked into going private but as we do not live in the South East we quickly realised that there was pretty much not options to go private here. Its not just about the birth part - you need a plan and care throughout your pregnancy so the logistics of going to the South East for all that were not viable even if we could have found the money.

At the end of the day, you really don't have anything to loose by approaching your GP. If they say no, you are in no worse position. In fact you have it on record that you have asked - so if you do pursue it later, it shows you have given it thought and are trying to get the most appropriate care for your personal circumstances. Take any potential set backs like this, as a step along the road rather than a road block.

Good luck! I hope you find a way forward you feel you can cope with.

1001questions Sun 10-Apr-16 18:41:25

Thanks so much - it's always encouraging to hear success stories although unfortunately at the moment I seem to hear negative ones, including from a friend of mine who has the exact same issues as me, yet was refused a c-section and (even more unthinkable and my absolute worst nightmare) - induced. I can't quite reconcile what I read about the Maternal Review with what happened to my friend, which in my opinion was a violation of her human rights. I should add that she is super happy as a Mum now which is great - but she did suffer PTSD after what happened.

Another concern is that although I live in London which you'd think might work out 'better' for getting decent care, I'm in a deprived borough which I fear will have an impact on this. Or is it more down to larger 'hospital level' catchment areas rather than the very local services?

As I'm new to this I actually don't know what choice you have in terms of hospital etc - so I guess I will need to look into this which is another reason why I'd like to see a health professional now - not when I'm pregnant, hormonal and viewed as a captive audience who will forget all about it once my bundle of joy arrives.

However, I guess that being in the SouthEast I'd at least have the option of going private. That's also helpful to know...but bloody annoying if we had to do it.

I really wish I didn't have to think like this when I should be happy and excited that it finally (biology permitting) might be happening! But thanks again, you've reminded me it's worth fighting for.

ispymincepie Sun 10-Apr-16 19:27:41

Firstly, I do not wish to undermine the impact of mental health issues and I'm sure if nearer the birth you still felt the same you would be granted an elcs on those grounds. However, you say you are prepared to suffer any post-op complications etc.... but please be aware elcs carries risk for your baby too. Not saying that to be patronising but so you can be make sure you are making an informed choice. This is why many obstetricians will not grant one without much discussion. I know this won't help but birth IS a natural event and it certainly wouldn't hurt to read up as much as you can to try to re-educate yourself on the matter. Good luck with ttc.

RedToothBrush Sun 10-Apr-16 19:42:24

You can choose which hospital to go to in maternity. You can choose to go out of area of the one you live. The only area in the NHS you do have this free choice.

Having read a lot of threads on maternal requests there does seem to anecdotally be more refusals in London. HOWEVER it also seems it can be down to particular consultants in the same hospital. Care is patchy from one hospital to the next and seems to be down to budgets and policy rather than any thing to do with deprivation. The experience your friend seems to have had is NOT reflective of the huge number I've read. I've heard of a lot of refusals but when challenged women nothing do get what they feel they need. I've seen a handful of cases over the last few years where they have been 'forced into a vb'.

Remember you don't have a right to an ELCS but you DO have a right to the most appropriate care for your personal circumstances and this is what you need to keep in mind. Learn to ask the right questions. If you fear you can not consent under the pressure of childbirth, how do the hospital intend to enable and support you to do so for example?

Your approach rather than what you are requesting can make all the difference to how you are treated.

As you are not pregnant you also have time on your side. You can do some research, seek out help from a few different places if you are refused initially.

FWIW from what you have posted so far you seem very typical of someone with primary tokophobia. I can't say for sure if you are but you do seem to fit the profile. Getting a diagnosis of this would be helpful. Noting here that there is a medical condition you fit the description of, rather than you just being demanding or weak or too posh to push or any of the other derogatory comments on the subject.

Make sure you are well read on the NICE guidelines to CS.

RedToothBrush Sun 10-Apr-16 19:52:32

ispymincepie I am glad I never came across anyone like you whilst pregnant who took the view that I needed 'reeducating'. Utter utter harmful bollocks contrary to the current medical advice on the subject.

Fortunately I happened to see a consultant midwife with a specialism in birth fear who didn't come up with such clap trap and was experienced in treating women with similar problems.

His professional opinion was to grant ELCS immediately and then work with women to build up a relationship of trust with them. In this environment many did actually change their minds but having the safety net of the ELCS from the word go was crucial to this bond of trust. Without this many of them would have terminated or tried to give birth away from medical supervision out of fear. He recognised the dangers in this.

The increased risks to the baby via ELCS are there - but remain small. NICE concluded that ELCS are generally safe for both mothers and babies in the UK. Hence why they felt it ok to say that ELCS should be available in these cases as the act of restricting access to one was potentially far more harmful to both parties due to the mental health of the mother being an important factor to the baby too.

I hope you go away and re-educate yourself on the subject. There is a lot on the health economics in the NICE guidelines if you want a starting point. Around page 100 if memory serves...

ispymincepie Sun 10-Apr-16 20:18:12

Perhaps 're-educate' was not the best choice of words. The reasons that some women are terrified of childbirth while others are not is a very complex tapestry of things they will have seen/heard throughout their lives as op mentioned about the sex ed video. I just mean that by exposing yourself to more positives influences it is possible to adjust your mindset somewhat. I'm not claiming it would 'fix' op's fear but I stand by the fact that hearing positive birth stories, reading extensively on natural birth, attending positive birth groups cannot hurt but potentially be very beneficial. I do not think it should be a 'human right' to demand elcs for the simple fact it is a hugely costly procedure and that we are lucky to receive one when we need it. I'm sure op would be granted one on mental health grounds if necessary at the time, I've known consultants carry them out for much less valid reasons.

RedToothBrush Sun 10-Apr-16 20:48:06

Yes re-educate is definitely the wrong word. Its inflammatory.

Let me also just clarify the fallacy on cost too. NICE said that the cost economics were such that an ELCS was an affordable treatment, and when taking into consideration long term complications such as incontinence alone, then actually ELCS were barely different in cost. They couldn't put a price on all the costs (so I don't know how you judge an ELCS to be 'hugely costly' and more expensive than a vb, if they can't). There are cost associated with counselling too...

The thing is that granting an ELCS on principle is very different to actually performing an ELCS. You need to support from the word go. Once you are 'in the system' so to speak then assistance with anxiety should be part of your antenatal care if you are getting adequate care. You do not get given an ELCS on mental health grounds and then dumped!

I find your comments very naïve and patronising tbh. A deep seated phobia which might come from sex ed classes or a combination of things is not just being a 'little bit scared'. Its a clinical fear. You know like being clinically miserable is depression - that might need a bit more than a few counselling sessions. Lots of people with anxiety and depression have to also have medical intervention in addition to counselling to deal with their problems. Given you can't 'pop a pill' to give birth, what do you think medical intervention constitutes?

The OP is taking her problem seriously by asking if she is right in seeking medical help to deal with her problem. That in itself is a bit step. Especially when she fears ridicule and not being taken seriously. Counselling and support needs to be part of the process, not a gateway to an ELCS, whereby you have to first prove that other approaches are ineffective. Respecting how someone feels and not belittling it as somehow being a childish hangover from sex ed lessons.

Let me also repeat, there is no human right to an ELCS. But everyone DOES have the right to the most appropriate treatment for their case to protect both their physical and mental health. The two can sometimes be the same thing though...

Annie105 Sun 10-Apr-16 20:52:27

Hi there I was... AM! Exactly the same. With the help and support and advice from women on this board, mostly red tooth brush, I've been able to persuade my hospital that's it's in mine and my baby's best interest to have an ELCS agreed. I also live in London.

I tried very hard pre pregnancy (I had to go through a lot of fertility treatment) to overcome my fear I've had since I was very young. And also in my early weeks of pregnancy. It wasn't and never will go away no matter how many positive birth stories I read, hynobirthing sessions or how much counselling I continue to have.

Going into a vaginal birth with a positive mental attitude doesn't guarantee an easy nor straightforward non intervention style birth. I've had friends suffer badly after being so convinced by hypnobirthing classes that they were the answer and feel like massive failures post birth after forceps, every drug going and EMCS. I do not want to go through that.

I feel hugely relieved and most importantly my anxiety levels have decreased significantly since I agreed my ELCS. I know nature could take its course and this plan could go a little bit awry (although if I go early they will carry out an EMCS) so I'll continue to prep in case it does but at least I've prepared for my worst fear and just hope I won't have to realise it!!

Anyway my point being don't give up and start the ground works now

X

Junosmum Sun 10-Apr-16 21:51:28

I had a similar fear and got talked in to a natural birth. It was absolutely horrific and everything I didn't want to happen happened. I now have nerve damage, PTSD, incontinence and rectal, vaginal and bladder prolapses and sex is so painful it's impossible.

I really wish I'd stick to my guns and not been talked round or "reeducated". I'm now terrified of having more children, can barely leave the house due to the effects of the incontinence and prolapses and feel dirty all the time. This, combined with the pain has removed all intimacy from my relationship and with me also refusing to have further children has put an indescribable strain on my relationship.

Birth may be 'natural' and for some people it may be wonderful but for me, it was the worst experience of my life and has serious repercussions on the rest of my life.

I'm also costing the NHS more than double the cost of an elective to 'fix' me.

1001questions Sun 10-Apr-16 22:00:57

ispymincepie> I'm afraid that simply isn't true. I've read extensively on the subject and the fairly clear conclusion I've reached is that while a c-section can present certain risks to the physical health of the mother (comparable to any similar type of surgery), it is almost universally acknowledged that it's an easier birth for the baby, therefore far less likely to result in complications.

There's some stuff about immune development that I'm aware is being bandied around at the moment which may be what you're referring to, but having looked at the available evidence, I don't consider it to be of sufficient significance to consider against my own mental health. Whether or not there is truth in it, which I doubt.

A big part of why I'd want to do it this way is to protect my baby's health anyway, as I am fairly convinced I'd need a c-section physically even without the psychological necessity: I'm very slight and short, with hips that are on the abnormal side of narrow. And my honest opinion of maternity care in this country is that despite all of the above, I'd still not be offered a c-section unless I insisted upon it, because of the obsession we have with 'natural' birth.

I hope this demonstrates to you and anyone else reading that I'm well informed on the subject.

1001questions Sun 10-Apr-16 22:09:40

Junosmum> that is absolutely terrible and I think you should be compensated heavily for such an experience. I will remember what you've said if I ever have any moments of weakness. And I'm sorry sad

RedToothBrush Sun 10-Apr-16 22:18:08

I've read extensively on the subject and the fairly clear conclusion I've reached is that while a c-section can present certain risks to the physical health of the mother (comparable to any similar type of surgery), it is almost universally acknowledged that it's an easier birth for the baby, therefore far less likely to result in complications.

I've also read on it. And had an ELCS after making an informed decision.

What you say is also incorrect though.

NICE compared the quality of all these studies and did not say an ELCS was safer for the baby. They said it was less safe. Marginally. The issue being breathing difficulties at birth and admission to SCBU as a result. This is the information that doctors are supposed to be giving to women asking for an ELCS. Otherwise there are risks associated with both - they are different risks and the key point is accepting which risks are more palatable to you as an individual should the worst happen.

Therefore I would be careful if you were to state what you've just said above, because you might not look as informed as you think. Indeed it could look like you've been reading up all the bad stuff and have filtered out accurate / reliable / good quality research which is at odds with your fear. This could be intentional or unwitting bias. Either way, its inaccurate.

1001questions Sun 10-Apr-16 22:42:10

Oh, right. I did hear a doctor make the claim about it being safer but perhaps it was based more on their experience than on statistics. And it does ring true that when you hear of bad stuff happening to newborns it isn't usually after a c section, it's usually related to getting stuck.

I did know a bit about the risk you mention around breathing difficulties and that would definitely scare me. But I would assume that it's something staff are trained to look out for and are well used to treating. I've personally never heard of a tragedy happening for this reason but I probably should have another look at the stats.

I probably have done a bit of filtering, but it I didnt of world probably go mad.

Junosmum Sun 10-Apr-16 23:08:44

1001- have you researched 'gentle sections' they can counter many of the 'risks' to baby, specifically the breathing and feeding difficulties. They are becoming more common in the UK.

ispymincepie Mon 11-Apr-16 07:46:39

I also was referring to breathing difficulties, not something I would easily overlook for any reason. I know elcs is very straightforward for a lot of women but having worked in an obstetric theatre I have seen first hand many complications for mother and baby. I realise vb is not without risk either but most complications tend to arise from unnecessary intervention in the first place, just read some of the other threads on here-sweeps at or before term, inductions before 42 weeks etc....It is also from first hand experience that I refer to cost. I'm sure elcs can be cost effective for some where medical support in some way is inevitable but the cost of the anaesthetist, ODP, surgeon, assistant, runner, midwife x2 for the duration, the cost of running the theatre (lights, suction, diathermy) all the drugs, sutures, swabs, cleaning materials, sterilisation services, heck even the laundry services are huge (they put the cost of all these things on everything to remind us to use them sparingly)

1001questions Mon 11-Apr-16 08:23:14

Thanks. If what you're saying if that there are risks to both options then to me it still seems a straightforward case of a scenting being better because the risks in that case seem more predictable. As I mentioned above I'm tiny (five foot tall and size six hips).

Im hoping that this might even mean c section would be recommended for me on physical grounds but the seems to happen so rarely these days that I wouldn't want to rely on that alone.

So I think I would want to see a full statistical breakdown of complications arising from non-emergency sections, as my understanding was that this was the safest birth type for the baby but that figures were modern blurred by the fact that they get limped in with emergency situations which are far riskier.

As for interventions I would never ever consent to an induction at any stage.

1001questions Mon 11-Apr-16 09:21:49

The info on the NHS page about breathing difficulties is actually quite reassuring. Seems like unless for some reason you schedule it too early, there is no major reason for concern,which is kind of why I didn't see it as a significant factor before anyone mentioned it here.

RedToothBrush Mon 11-Apr-16 09:36:06

ispy you are only talking about the upfront costs. You won't see the downstream costs as that's obviously not what you would deal with as they happen later. There is a lack of joining the dots in cost between departments and long term care which NICE did take the time to look at. (There is an issue here between how budgets are drawn up and divided. Currently since many ELCS on mental health grounds are recorded as maternal request they do not receive additional funding and therefore are a 'burden' on departments. The maternal health review seeks to make sure that maternity is better funded by creating a second pot of money dedicated to mental health. After the discussion on MN with Baroness Cumberledge, I think there is still a problem with this, as even though my ELCS was very clearly on mental health grounds and everyone dealing with my case was at pains to stress this, it was still recorded as maternal request as there simply isn't a different classification for ELCS for mental health which is wrong. This potentially leaves a gap in Baroness Cumberledge's proposals. This is something I have been at pains to draw attention to. It is important to start recording how many ELCS are being carried out for mental health reasons as well as ensuring there is appropriate funding.

1001questions, I am a similar build. I am led to believe that whilst there is a slightly increased risk for every inch you are under 5'4" for complications, this risk is also minimal and not regarded as statistically enough to make recommendations on. Plenty of women of a similar build are capable and able to give birth without problem hence the risks associated with interventions are not enough to justify a reason for an ELCS. The problem would be that women who didn't need an ELCS would get one and we have no way of telling which women would have an issue and which wouldn't. It could end up doing more harm than good. Which probably offers no comfort to you.

NICE did their comparisons on birth type based on the real world scenario of planned vb (including instrumental deliveries and EMCS as these were outcomes from a planned vb) versus a planned ELCS. Very few studies have compared like this when really this methodology should be the rule rather than the exception (there are exceptions where it should be done differently though)

The information they say should be given to women asking for a ELCS is as follows:

Planned caesarean section may reduce the risk of the following in women:
•pain in the area between the vagina and anus (perineum) and in the abdomen (tummy) during birth and 3 days afterwards
•injury to the vagina
•heavy bleeding soon after birth
•shock caused by loss of blood.

Planned caesarean section may increase the risk of the following in babies:
•intensive care unit admission.

Planned caesarean section may increase the risk of the following in women:
•longer hospital stay
•bleeding after the birth that needs a hysterectomy (removal of the womb)
•heart attack

There is an important flaw with the NICE guidance though. It is based on data for first time mothers only. It does not look at the risks for women who have already had one child or for women who might want more than one child. This is important and a major failing of the document. The risks for planned vbs for a subsequent child (if you had a vb first time round) decrease. The risks for a planned CS increase.

So how many children you want is a very important consideration. (Though the data supports the fact that women who suffer from primary tokophobia have children later and plan to have fewer so this actually is less of an issue for many anyway).

I did hear a doctor make the claim about it being safer but perhaps it was based more on their experience than on statistics.

I would be very wary of anything that isn't evidence based. If you focus on evidence rather than anecdote you will cope better all round. Making sure that you force yourself to read things that challenge your preconceptions and look at the flaws and methodology of studies to work out their quality. There is so much evidence out there you can get swamped in it, and end up just reading what you want.

There is no right way to go ahead with this tbh. There are things that might help and there are women that may feel more confident in a vb with the right support. I personally was surprised at the end of my pregnancy how my feelings had changed about some things purely from good care that listened to how I felt. It didn't mean that I would have considered a vb in my case, but I did get to a point where I felt that another woman in a similar situation might feel able to change her mind and might get a positive outcome from that even if things didn't go to plan. At its heart is trust and the ability to feel confident in handing control to someone else as they understand you and have your best interests as their focus. I know that other women did have an induction as part of that - but they were not just 'left to it' but had a robust birth plan which defined parameters they felt comfortable with and a early 'emergency' CS was on the table as part of that.
My point here being that all inductions and indeed all vb are not equal and that a good hospital will make exceptions to their normal protocol if you have severe anxiety and they feel that doing so is in your mutual best interests.

I think the key thing for me was getting an ELCS in principal removed a lot of the pressure and allowed me to be a bit more open and trusting to those caring for me. It was absolutely essential. I would not have got pregnant without it.

Sorry I'm starting to ramble. Its just that there is such a lack of awareness and knowledge about this amongst women and HCPs that I tend to get carried away in sharing what I know and what my experience of it all was.

1001questions Mon 11-Apr-16 11:51:23

Thanks again, this is really helpful as although I have done a lot of reading up on this I do find it very hard to take seriously anything I feel is anti cs and because of the current fashion away from them, quite a lot of material would fall into that category for me. It would be good to get a better idea of what the most trustworthy source for this type of info.

Like you i think that having the option in principle is all I would need, and even being as strongly on favour of cs as I am, would in theory be open onto other ideas if I had certain assurances in place. The issue I think I'd probably come up against is the unpredictability, which may be where you landed with is, too.

My final (physical) trick in the book for this one is that I'm on thyroid medication for life which I think would mean I would at least be under consultant led care by default, which while perhaps not significant in itself I hope would potentially cut out some of the red tape.

Oh, and I have absolutely no concern regarding future pregnancy as I will be way too old to consider that a realistic scenario anyway...

No worries re rambling, I am doing the same. But this has made me feel a lot better about speaking to my GP and the approach I should take. I now have an appointment booked to discuss this and while I'm nervous about how it will go, I'm telling myself that if this one is unsympathetic I will simply speak to another, if only to get it on my notes.

RedToothBrush Mon 11-Apr-16 13:06:27

Write things down before the appointment! I found that I struggled to articulate things or forgot important points, plus writing it down was a good way to actively demonstrate the thought I'd given everything rather this being some kind of flight of fancy.

It also helps you to think of responses they might come up with, including tactless ones, so you can prepare yourself in case it doesn't go how you hoped.

My approach would be to stress the following:

You desperately would like to ttc but your anxiety over childbirth is proving an obstacle and you need help with over coming it.
Whilst you understand that an ELCS is a serious operation and you do not have a right to one, you would like to explore this as a way to deal with your anxiety over becoming pregnant as you feel that you could cope with it better.
You are worried about panic attacks inhibiting your ability to consent so would like to give birth in a way that is as controlled as possible, understanding that at times things can and do go wrong for all types of birth.
You want to take action now as you are aware of your age being an issue now and that you have not got time to go through years of counselling on the subject.
You are open minded about counselling and see that as part of the process even if you do get an ELCS agreed in principle.
One of your fears is about not being taken seriously and not been treated with respect as a result of your fears.
That the process of getting an ELCS agreed only after you are pregnant is too much for you to cope with. You could not go through with a pregnancy under those circumstances.

My understanding is there have been slight changes to NICE guidelines relating to mental health since I went through this a couple of years ago which are relevant to your position.

The recommend that any women who is considering becoming pregnant has the opportunity to discuss this with HCP if she has mental health issues. I believe its supposed to cover women primarily who are taking medication or have severe problems but its not explicit in this, and does therefore apply to any woman who might have severe anxiety over childbirth. If you have a history of anxiety problems this might work to your favour too. They should listen as, unfortunately, if you have mental health issues before pregnancy you are more likely to have problems like PND after so they are beginning to take requests for help more seriously as it can help reduce problems and it gets you into the system as a vulnerable person in need of extra support regardless of how you eventually give birth (despite this being at times frightening or just a pain in the bum, on the whole its a good thing. Midwives are more likely to spend that couple of extra minutes with you because you need it).

The services that do exist for women ask for an ELCS tend to be geared up more for women who have previously had a traumatic birth. Women who haven't given birth, do find it harder to prove they have a legitimate problem that needs help and support, but as I say things are beginning to change and I was able to do it.

This does mean that as a none pregnant woman without kids you are at the bottom of the pile for a referral as you are not considered a priority (tbh, this is quite right) and demand for services does out strip supply, so you might have to wait. But it doesn't mean you don't have a legitimate need for those services either.

You might find they will only refer you to counselling initially. You might have to go along with that as part of the process to demonstrate that you have explored whether this will help. Personally I have a few issue with this need to prove your case, but I also can see why its there too. And actually with the benefit of hindsight, I recognise that I did need emotional support in my pregnancy about my wider anxiety (unrelated to actually giving birth) and having some help with that.

If you go in with the attitude that this is about getting mental health support and you feel an ELCS would be a useful tool in achieving that rather than merely demanding an ELCS, you should get a better response.

If you understand what the system is setting out to achieve and why they have the system there is in place, it does help to navigate through the ignorance and prejudices that do still exist around the subject - even from those who work in maternity. Things have come a long way in the last 5 years or so though since the current guidelines were drawn up and there was a recognition of the problem by NICE.

You still might have a negative response; please just see it as a setback and part of the journey. Equally your journey is about having a healthy mum and baby at the end of it, not just having an ELCS. Mental health is a legitimate health concern. This is a legitimate reason to discuss pregnancy and childbirth with someone who can help you with your mental health during that period. Don't let anyone tell you, or make you feel its not legitimate as it is.

You have just completed step one of the journey though - recognising that this is a problem that you need help with and are seeking out that help. It takes more guts than people realise to admit that. You are brave despite your fears in trying to find a way to overcome them.

There are a number of women on MN who have been through it, like me and like Annie is currently going through. It can be hard to talk about in real life. But MN is generally a safe space for support with it.

1001questions Mon 11-Apr-16 18:17:47

Thanks Red toothbrush, this last post has been invaluable. I now know exactly what I want to say, and will hopefully come across a lot more convincingly than I otherwise might have. I do have some serious anxiety issues that go way beyond the birth thing (I'm actually still struggling a lot feelings of guilt and confusion after my recent MC), so I think I probably need some help with those anyway so fingers crossed it'll be a positive visit.

FuzzyOwl Mon 11-Apr-16 18:31:20

Sorry for your loss OP.

I would advise you to research the consultants nearby in the different hospitals to see if any have higher stats in agreeing to an ELCS. It just might make things easier for you if you see someone who is more prone to agree to them quite readily.

I think you are right that you would be consultant led due to your thyroid issues but also possibly due to your anxiety issues anyway.

You will probably have to discuss your concerns with people who will try to persuade you against an ELCS but just demonstrate you have taken on board what is said and you are still certain it is not for you.

Good luck.

1001questions Mon 11-Apr-16 18:55:21

Much appreciated, thank you. Do you mind me asking what you mean by research wrt consultants? I'm assuming that sort of information would not be readily available online, so how would I find out about how amenable individual docs are likely to be?

ispymincepie Mon 11-Apr-16 20:15:01

Some excellent information from RedToothBrush, you clearly know your stuff! Can I just ask from a practical standpoint and may help op to know, how the assurance of elcs actually works? I have never experienced the terror you ladies feel around childbirth but can certainly imagine the concept of an elcs being agreed in principle as essential (whether it happens or not) but as far as I'm aware any given consultant would only make a 'plan'. This isn't a guarantee that it would happen. Were you assigned an obstetrician pre-pregnancy who continued your care? What would have happened if you had had your care taken over by somebody else? OP with regards to checking individual doctors' agreement rates you may find its common knowledge in your area so ask around all you can. I know out of the consultants that work in our local hospital those who would grant an elcs at the drop of a hat and those who would be more thorough.

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