Consultant pushing me to VBAC without listening first(38 Posts)
I gave birth to DC1 18 months ago via EMCS (very calm - an excellent experience) following a failed induction (an awful experience).
This time my midwife referred me straight to the consultant at my booking in appointment because of all the complications first time around - she mentioned that an ELCS was probably best. DH and I had also come to that conclusion and were happy that we all seemed to agree.
I saw the consultant at 13 weeks and came away very upset and scared. They refused to accept that I'd done any reading up on the subject, continually pushed at me that ELCS was more dangerous and told me to consider VBAC. I kept trying to point out why - based on the literature she'd just given me - I'm not a good fit for VBAC, but the consultant didn't appear to be aware of the details of my first birth, which didn't help. Instead they kept saying 'try a VBAC then go to CS - at least you'll have tried'. I'm not sure what prize you get for trying but I don't see the point in tiring yourself out before a CS.
Since our appointment last month I've been very tearful and have realised that the other reason I don't want a VBAC is that I do not trust the hospital staff. The day before DC1 was born I had yet another internal exam. It was excruciating and I begged the doctor to stop. He refused and instead left his hand in my vagina until I gave in and let him continue. The midwife in the cubicle did nothing to help. I was so upset I nearly discharged myself there and then - it was only the fact that DC was at risk that I stayed. Fast forward 13 months and I finally plucked up the courage to have my very overdue smear test. The practice nurse was completely baffled when I broke down as she explained the procedure. When I was able to explain what had happened she told me it was assault and should have been reported. Weirdly I felt a lot better because I wasn't overreacting and something had been wrong. It was too late to report and I didn't want to dig it up so tried to forget it.
The problem for me now is that, having spoken to the consultant, I'm terrified that I'll be forced to VBAC and if there's one thing I'm certain of it is that I will not be giving permission for any internal examinations at any point.
I'm sorry, I don't even know where I'm going with this any more, I'm just terrified and need advice/reassurance that I'm not crazy to feel this way, that there is a chance it'll all work out and advice on how to make that happen.
If I could afford to go private I'd do it in a heartbeat but we don't have that kind of money.
TLDR; bad (and very long) induction experience prior to lovely EMCS. Not a good fit for VBAC but consultant refusing to listen to my concerns, just quoting some very selective stats at me.
It isn't too late to report what happened - it's never too late.
I have had two VBACs (entirely my own choice, never any pressure on me whatsoever - and I was a good fit for a VBAC due to the reasons for my Csection) and I didn't have a single internal examination during either labour. It is possible to avoid them if that is what you want.
If you want a csection this time, there are lots of threads on here with great advice from women who have been through this process - have a browse through the Childbirth threads or do a search. Don't panic. It will be okay. You're not crazy and lots of other women have trodden this path, many of them are on here and will be able to give you more specific advice.
Thank you emsyj37 I didn't realise you could go through VB without internal exams - they were very insistent last time and I think I was very naive.
I've been reading the VBAC and decision threads and can see that a lot of people have positive experiences. I'm aware that my view is probably quite skewed after last time. I'll look up some of the ELCS specific threads too
This happened to me, I had to contact PALS which changed the way the conversations went. The consultant at the ELCS agreed that if I'd ended up with another EMCS it could have been very very bad in terms of outcomes. I am glad I did my research and stuck to my guns. A section was statistically the most likely outcome for me given various factors, and the first consultant I saw who insisted on a VBAC had no interest in listening to that. I think you know your circumstances and the risks you are prepared to take. Go with what you want to do. RCOG guidelines are great for balanced pros and cons if you haven't found them yet. Good luck!
Firstly I would ask for your care to be transferred to a different Consultant, or for a second opinion from another Consultant re your birth plan. Different Obstetricians have different experiences/ opinions on vbacs and elcs, and also different degrees of communication skills. If you have a midwife appt soon perhaps ask which Consultant would be sympathetic to an elcs. I'm not sure what the procedure for changing Consultant would be, but you absolutely have the right to this.
On the Childbirth thread there have been quite a few posts about requesting elcs, do search.
I completely understand why you want elcs and I would do the same in your shoes.
Im pretty sure they have to offer you elcs if that is your wish as you've have a previous cs. So don't panic. If it's an elcs u want u can and will still get it if you stand firm. I'm towards the end of the this vbac vs. Elcs process and what I've noticed is that each appointment is very much dependent on the personality and opinion of the consultant. I've had some who have left me feeling very teary and made me want a home-birth just so
I don't have to see them again and others who I felt really safe and relaxed with. I expect u have unfortunately met one of the former. can u call your midwife and tell her how anxious the appointment has made you? and ask if there is another person you can speak to? I did this and my midwife was great. My midwife wrote in my notes how upset I was after one of my appointments and then next consultant I saw was much more sensitive and understanding with me.
Whatever you choose, vbac or cs, really important that you understand that they cannot do (and that doctor shouldn't have done) anything without your consent. That includes vaginal exams. It is illegal to force medical procedures onto an unconsenting adult. Birth is a sensitive time anyway and if the people around you are behaving like that it can be completely traumatic. I'm not surprised you were upset and now don't trust the hospital staff.
Have u thought about getting a doula? they can come to appointments (and the birth too if u wish) to advocate for you too and make sure people are listening to you. Or do you have a friend or relative or DP who would be able to do similar for you?
I started a 'vbac support thread' on here and there's people on there who are going for cs or vbac or who r still undecided. Feel free to ask any questions on there. Quite a few of us are due soon and have been through most of the process so others may be able to offer further advice.
Sorry to hear your upset I don't usually post but felt I had to. I was advised by my midwife who was a supervisor of midwives (senior) to go home go online to NICE website ( Google) have a good read which advises your right to request basically . print off the NICE guidelines (60 pages!) and go back and quote this to the consultant and she / he has to offer you one . Turns out I didn't have to get my 60 pages out but they knew I was aware of my rights. Hope this helps you I don't see how they can refuse you . Take care
Hi just adding a message of support. I know the feeling or terror when a consultant seems not to have heard a word you say or your wishes. Keep calm in the consultation, state clearly what you want (isn't it in the NICE guidelines now that you have the choice?) and ask to see someone else or involve PALS if necessary .
Oh God love, I hear you.
I broke down two weeks ago and finally had my smear done today (and dildo cam ultrasound). This is three years after a traumatic birth and brutal handling.
Fortunately my gynae is a love and was so so kind today. I promised him I was going to try not to cry and he was exemplary. So punch the air, have got it all done.
I second the advice to change consultant and fight for what you want. I have also had a female midwife do an internal that was excruciating. God knows what she was doing up there, trying to break waters? Do a sweep? I just know that I felt like a glove puppet and lost all trust in her.
All the best OP and in getting the birth that you want. X
Thank you all for taking the time to reply
chchch I hadn't thought of PALS but will definitely get their contact details. I'll look up the RCOG guidelines before I see the midwife this week. I'm sorry you had to fight for your ELCS and hope the birth was smooth
Hopeless Fortunately I have my 16 week check in a few days and I will definitely raise this with my midwife. I had assumed there wasn't a choice of consultants because we were with the same chap until I was admitted last time. I trusted him implicitly but sadly he's now retired and the new one is cut from a very different cloth
Fabuloso I've been following your thread with interest these last few days! I almost posted yesterday but didn't want to derail things for anyone as I'm a bit negative at the moment. The incident happened during my fifth day of induction, I was sleep deprived and the midwife gave an almost reasonable explanation of what happened when she saw me later. I was afraid that if I made a fuss then things would get even worse and all I wanted was to give birth safely and get home again. I feel like such a pushover now though. There are no doula services in our area unfortunately, but I'm hoping this time things will be much quicker and DH will be able to be with me the whole time - it took 6 days to get to the EMCS and DH couldn't be there for all of it
Claret and mum I haven't been to the NICE website yet, but will definitely download the guidance and attend my next consultant appointment armed with it (highlighted, so I don't get put off by overbearing medical staff!)
Bof for you and well done - it takes a lot to walk into that room knowing what's going to happen. I hope you've treated yourself to some tonight.
As for the midwife I'm not surprised you lost trust in her - it's an awful experience.
Good luck , they HAVE to offer you one - end of. please try and stop worrying and enjoy your pregnancy as best as you can
Thank you Claret Starting this thread was partly about finding a way to be less worried and it seems to be working - you've all given me great advice and places to look for the information I need! I was flailing a bit because, after speaking to my midwife, I really hadn't expected there to be any objection to the ELCS.
Going to go now and look at those lovely 12 week scan pictures before getting some sleep
I'm sorry you're going through all this. Have zero experience of c-section but for what it's worth my understanding of requesting ELCS is that healthcare professionals want to be sure you're making a positive choice. This means they don't want to hear "I don't want vbac or I don't want forceps or I don't want EMCS or x y z. What they want to hear is" the risks of ELCS are x y z and yes, this is what I want". They want to be sure you understand issues for future pregnancies, issues around bleeding and infection, issues around baby's breathing etc.
Also yes, you can ALWAYS ask for a second opinion. Ask the supervisor of midwives or maybe PALS on how to proceed.
Good luck 🍀
Thank you ping. Although I see an ELCS as a very positive choice for me, I suspect this didn't come across to the consultant as I was getting increasingly frustrated that they weren't listening.
Before my first CS I had 'the talk' from the supervisor of midwives that I shouldn't feel I'd failed at giving birth. My view has always been that a successful birth is anything that gets your foetus out of your womb and into your arms without harming either or both of you in the interim.
Unfortunately, this consultant also seems to be of the opinion that not having a VB is some sort of failure, whereas I've read everything available and have concluded this is the highest risk option for me.
A second opinion could well be the way forward, but I will also write down why I think this is the positive choice for me, despite the risks - perhaps it will help me explain myself more clearly next time
I'm pretty sure that once you've had an EMCS you can't be refused another CS. At my hospital the midwives are also very keen on VBAC, but there are quite a few things you can cite in your favour if you want to avoid one. e.g. unadjusted risk of scar rupture is supposed to be 1/200, but the risk for particular women may be much higher. My obstetrician said that if the baby is over 4kg, the risk is more like 3-4/100. I would actually like a VBAC, but I think that risk is too high for me. My last baby was big and so they're doing extra growth scans. If it turns out that this one is/appears to be too, I am going to play it safe and have an ELCS. Many hospitals will also refuse to induce for a VBAC. So if you go 12 days past dates you may end up with a CS anyway.
Can you ask for more data? E.g. what percentage of VBACs at your hospital end in EMCS? What about in women who 'look' like you? (Age, medical history, reasons for precious EMCS etc) As another poster said, I think try to keep conversations as unemotional and simple as possible -- if you say "the risk of x" is unacceptably high to me, and on those grounds I am requesting a CS, then I don't think they can / will force you to undergo the risk (for legal reasons)...
But in general the further 'up' the chain you go, the more flexible they seem to get. Was it actually the consultant that you saw, or a junior doctor working underneath her/him? If it was the consultant I would ask to be transferred to a different consultant. Absolutely true that different consultants have different opinions -- e.g. one of the ones at my hospital will induce a 'scarred uterus' but the others will only break your waters to get labour started in prolonged pregnancy.
I think you are in a very solid position (would be different if this was your first baby, or if you hadn't had a previous section). You can definitely get an ELCS on the NHS.
Thank you hops you make a good point about the stats. I've started compiling them but need a few more; big baby being a key one (DC was >4kg). Hospital VBAC success rate without any interventions is 53%.
Unfortunately, it was the consultant I saw, so I'll talk to the midwife tomorrow about my options to change. The consultant did say that induction would not be allowed for a VBAC, so that was a small reassurance.
Sorry, meant to say 53% regardless of interventions
I had a planned c-section with my first. Not for any physical health reason but for my own mental health. It was my decision and the consultant wasn't too happy but he knew I wouldn't back down and my midwife was supportive (not to mention my psychiatrist and other doctor). This time I was so so determined to have a natural birth (which I did), and they told me that as I had a c-section before, I could choose to have a planned one again this time. My natural labour went smoothly, physically at least, but that's another story. If you are this traumatised over your previous experiences (and I don't blame you!) you should stick your heels in and and leave no room for discussion. It is your choice! Do not let them make an already incredibly difficult experience, any harder for you. I hope everything goes well and you get your c-section!
Hi, you should be offered elective cesarean as your first was c-section. If you don't wish vbac, they can't force you. It really is your choice at the end.
I was consultant led and had 2 birth options appointments. On the first appointment midwife spoke to me about my options, chances and risks, at the second appointment few weeks later the agreed date for elective cesarean was booked even though I decided to go for a vbac. Still I was booked an elective just in case.
They really can't force you.
The vbac which I wished for ended up with emergency crash cesarean and placental abrusion. Very scary traumatic experience. I wish I had just gone for elective cesarean. I know there are women who had good vbac experience so I I'm not trying to convince you for elective but just sharing my experience.
Oh and my planned c-section was such a calm experience. The medical staff were beyond amazing and made me feel so secure and safe and very peaceful. It's the recovery that's a bitch!
Thanks Mama I'm glad you got the births you wanted - I think that's the key, isn't it? Trusting the staff to give you the best chance.
Mum it sounds terrifying - I hope all is well now. The consultant said there was no point in the choices appointments as they would only give me the same stats again. I'm going to ask my midwife to book me an appointment anyway, on the off-chance they'll be more receptive.
I've noticed in the hospital literature that there's no guarantee you'll get a CS of you begin labour spontaneously. Has anyone else come across this?
Duggeehugs, were you overdue last time? Or did they induce for some other reason?
I completely see your point about not wanting to go into labour, having no one available to do the c-section, and ending up with a vaginal birth. But perhaps the chance of you going into labour spontaneously before 40+10, or whatever their cut off date is, is quite low? My dates have been moved forward by more than a week in this pregnancy already, and I hadn't gone in to labour (or anywhere near) at nearly 42 weeks last time. (In fact this seems to be a family trait on both sides.) So in my own case, although I would actually like a VBAC, I think the chances of ending up with one are small -- just because I would have to go into labour within 40 weeks of my LMP date, which I don't think will happen! So effectively I see my options as being a c-section before the due date (38 + some by my dates), or a c-section 2 1/2 weeks later.
In a way this is irrelevant though, because you ought to be able to elect a c-section at 39 weeks if that is what you prefer. Which hospital are you at? I assume there are other consultants? (Maybe Googling will tell you something about yours -- e.g. if they are unusually hardline about c-sections etc.) I am at a big hospital in London so there are a lot here. Maybe in worst case scenario it is possible to switch hospital? Would be annoying for antenatal appointments, but if you are going to have an elective c-section anyway you needn't worry about being too close when you go into labour (probably).
Thanks hops. I was induced at 39+2 due to severely high blood pressure so I don't know what my chances of spontaneous labour are. Given the lack of progress with induction I think it's possible the chances are low, but my consultant says it's different every time depending on you and baby. Hopefully this is good news for you though if you're hoping for a VBAC!
I'm currently listed with our nearest hospital which is 20 minutes away. The next nearest options are 30 minutes plus away. This isn't ideal as we will have a child under 2 to consider. We live in the midlands so don't have a lot of choices. I'm seeing the midwife later and the alternative consultant question is top of my list.
I went for VBAC after my first (also failed induction at 41+weeks and EMCS - also a perfectly fine experience). In hindsight it was completely the wrong decision - my first baby didn't descend at all, I didn't dilate past 2cm even after I'd been on syntocin for hours (in another country)
I think that someone should have read my file, and realised that I was a poor candidate - because exactly the same happened with the second baby - still no descent or dilation (although I refused any induction this time. A consultant did do a stretch/sweep despite my explicitly telling him not to though).
Stand firm. They were very enthusiastic about VBAC, but the VBAC midwife's description of their maternity provision was an outright lie. I wish I'd taken the experienced community midwife's advice and gone straight to ELCS rather than the manager-style VBAC midwife's 'I'm sure it'll be different this time' perkiness.
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