ELCS after EMCS

[MalibuSeafood]

Hi everyone, I'm pregnant with baby number 2 and looking for some advice ahead of a 'feedback' meeting with my hospital to discuss delivery options following a previous EMCS.

Sorry for the long post! I had an EMCS 2 years ago as my DD was suffering from a decelerated heart rate (bradycardia) during contractions even during the very early stages of labour. Essentially, even though my DD was not coping with the early contractions, the hospital insisted trying the hormone drip to 'speed things up' and see if I would somehow progress enough that way in a couple of hours (which they admitted was unlikely). I was very concerned as I had understood that the drip would actually make the contractions stronger but the consultants refused to consider any other options, saying that they didn't perform c-sections unless it was a life or death case as it would reflect badly on their stats and everyone would want one. Lo and behold, my DD did not fare well on the drip and after numerous frightening heart rate decelerations, I ended up with an EMCS and DD was in hospital for 2 weeks following delivery although made a full recovery.

Having spoken to various midwives about the care I received, I understand that whilst the hospital was following a policy, they should have given weight to my personal circumstances (2 weeks overdue) and choices, which they did not.

Fast forward 2 years and I am expecting a baby at the same hospital and have a 'feedback meeting to discuss delivery options. The hospital seems to be pro VBAC but I have huge reservations about the approach taken previously to my delivery, as the hospital seemed to put policy ahead of safety to a degree. Can I insist on an ELCS? Would I need to be able to argue some kind of medical grounds for this, or would it be sufficient that this is my preference following my previous care?

Thanks in advance for any advice.

[ThermoScan]

You CAN insist on ELCS.Maternal request is a valid reason.Ask midwife to refer you to a consultant.Once you have got that apointment you are through the door and they will do it after talking you through the pros and cons.At my local hopspital ELCS is one route of the pathway after previous c-section,VBAC is another but the choice is made by the patient.

[MalibuSeafood]

Thanks for the reply ThermoScan, that's helpful to know.

If you went into spontaneous labour with a planned ELCS, does the hospital still have to honour the choice? I suppose it might depend on circumstances again?

[DuggeeHugs]

I'm also trying to get an ELCS after EMCS at a pro-VBAC hospital. My first consultant appointment was at 13 weeks and I was pushed hard for a VBAC although it was finally noted that I expressed a preference for ELCS.

I'm now 19 weeks and still don't have agreement about ELCS and no constant appointment until 30 weeks. It is the single biggest concern I have despite other risks in this pregnancy.

Other posters here have advised me to get the stats and facts before my next meeting so I go in well armed and to contact the supervisor of midwives, or PALS, for support. This I will also be doing.

I'm posting this so you know that it isn't always straightforward, whatever the guidelines say, and you don't end up as stressed and upset as I did if the first meeting goes contrary to everything you've been led to expect.

Good luck, I hope they listen and you soon have everything signed off

[ThermoScan]

Malibu yes,if you do go into labour and are booked for ELCS they will do it as long as it is safe to do so.

[mimiholls]

They cannot refuse you a c section if you've already had one though they may try very hard. Read the pros and cons in the blue box in this document:
<a class="break-all" href="https://www.google.co.uk/url?sa=t&source=web&rct=j&url=www.rcog.org.uk/globalassets/documents/guidelines/gtg_45.pdf&ved=0ahUKEwj7kPDDhLXSAhWnI8AKHcJaDrYQFggaMAA&usg=AFQjCNFs5sxYSOqQePlgn28JiIy7tHTuTg" rel="nofollow noindex" target="_blank">www.google.co.uk/url?sa=t&source=web&rct=j&url=www.rcog.org.uk/globalassets/documents/guidelines/gtg_45.pdf&ved=0ahUKEwj7kPDDhLXSAhWnI8AKHcJaDrYQFggaMAA&usg=AFQjCNFs5sxYSOqQePlgn28JiIy7tHTuTg

Make clear you know all the risks of both options but you are not prepared to attempt a vbac and would prefer to accept risks of c section.
The document states that by far the most risky outcome is emcs after failed vbac and you have at least a 25% chance of this according to the same document. The risk of uterine rupture with vbac is 1/200 and the outcomes of that can be catastrophic. State you are not prepared to accept those odds and would favour the risks associated with c section. Stick to your guns and they cannot refuse.

[Chathamhouserules]

Yes you can insist. I had a Elcs after an emcs. They did try to persuade me, and I'm not that assertive but I just sort of blocked out their arguments and kept saying 'yes I see, but I still want an elcs'. They were trying to promise me close attention from dr's and midwives, but I said "how can you know how busy you're going to be? Unfortunately you can't make those guarantees." And they did have to listen.

[MalibuSeafood]

Thank you all for sharing your experiences and the helpful statistics. I'm sorry to hear these things are not always straightforward.

I think my main concern is that I was pushed into what I felt was inappropriate treatment in my first delivery (and my concerns were well-founded) because the hospital was completely against the idea of a C-section, even though this was sadly the only viable option and they admitted as much at the time. I will ensure I have done my reading ahead of the meeting. Thanks again for your comments.

[TinyTear]

I did have a ELCS after a EMCS.

At every single appointment I asked for it. The midwife refered me to the 'birth options' clinic where they read out all the pros and cons and I stuck my ground.

At every meeting and appointment I asked and mentioned the ELCS...

I did get it and booked earlyish - but i had other issues like being hypothyroid and having Gestational Diabetes so I had my section at 38 weeks

Just keep insisting and talk to every single person you meet about it. Ask the midwife is there is a 'birth options' clinic you can go to...

In my case it was the perfect choice as during my ELCS the consultant said there were lots of adhesions left from the EMCS - bladder stuck to the womb, etc... took them ages to put everything back in and get me closed up hearing them say "i think this fits in here" isn't want you want to hear when you are lying down there

[ShanghaiDiva]

I had exactly the same experience as you with birth number one and requested an ELCS with number two. I also said the same thing - am aware of the risks and opt for surgery. I had mine 10 days before due date and so much better than delivery number one which was under GA.
Good Luck!

[Laquila]

I was in a similar situation - I think I always knew after my EMCS that I'd have an ELCS if I got pregnant again. I went along to a meeting with the consultant (after having done a lot of research) and made it clear that although I was carefully considering both choices, that I was leaning towards a section. They were pretty supportive of that. Then they sent me to meet the Supervisor of Midwives, and in recounting my previous birth experience I got emotional, started crying and wailed that I'd honestly looked into it but I just wanted a caesarean! She was very supportive and could see that I'd informed myself and hadn't come to the decision lightly. And basically that was that.

I do remember someone (a doctor or anaesthetist) asking me when I went in on the morning of the section why I was having a second one. I just said "because that was what I wanted" and stared him out - I was very proud of myself!! To be air, he wasn't being arsey about it - they've got to try and encourage VBACs but the reality is that they are absolutely not the right choice for everyone. My advice would be to show, at every step, that you're making an informed choice, and stick to your guns. Good luck!

[SpookyPotato]

I had no problems asking for section after my first one, no-one tried to persuade me otherwise despite not having a medical reason.. infact the most anyone did was give me a leaflet with the options and said "have a read of that". Two weeks ago my waters broke (a week before planned section) On the phone they asked if I wanted to progress naturally but I just said no, went to hospital and they brought section forward to next morning. If I'd have gone into labour they would have done it as an emergency but I didn't have any contractions after waters broke and had section as planned the next morning.