Any advice re 16 week consultant appointment?

[GlitteryFluff]

This is my second pregnancy.

I have a consultant appointment in a few weeks booked for when I'd be 16 weeks (although dates now will make me 14 weeks) I believe this is because I am high risk this time around - due to first DC being over 4.5kg, having a section and pph- I also have a bmi of over 30. I believe the consultant is who can or won't grant a section for this pregnancy. I assume this will be discussed at this appointment?

First pregnancy was fine until i was induced at 12 days past due date. The induction didn't work, I didn't dilate, didn't have any proper contractions and after a few days (with thanks to posters helping me on a thread I posted on here under an old name) I asked for a section. They originally didn't want to do this, wanted to try the whole induction process again but I was so sore from the examinations, so tired from hardly sleeping in hospital and also worried as the further this was going on the risk of still birth/placenta failing was increasing. I explained they were having me induced as they wanted baby out, how long would this go on for, I wanted baby out safely and that my bishops score was only a 3 so an induction isn't likely to work. Section was then granted ( due to failed induction) and I had finally had DS in the evening of the 15th day overdue. So almost 4 whole days of induction.

He was undiagnosed breech and also 11lb 7. I lost 1000ml of blood. The section was so amazing after 4 days of hell. All whilst in hospital being induced I had midwives telling me I was massive, baby was going to be big. Midwives telling me baby didn't feel like it was head down, but then didn't do anything about it. I had no scans for either position or size. Just continued to try to make he induction work. So I felt a little let down, if that's the right word? I felt like some of this could have been avoided if someone did something about the feeling they had about this big baby/his position. But anyway, I'm just so glad I had the section as i'd have never got a breech 11lb7oz baby out safely (both him out safely and me being ok too).

So this time around I would like to have a planned section. I know this time around the baby could be smaller and not breech. I know they'll probably give me scans to check the baby's size (but I also know how unreliable weight scans can be after reading up) and a scan for position if necessary nearer the time. But I really want a positive experience this time around. I know things can go wrong but I feel like after weighing up the pros and cons the section feels safer for me, and the baby. 

I'm absolutely terrified of being made to labour and end up being rushed for an emergency section due to another massive baby or undiagnosed breech or a complication due to previous section (scar rupturing etc). Or actually managing to give birth and doing serious damage to either myself or the baby.

What can I say to convince the consultant that a section is right for me? Is what I've said here enough? Do you think they will grant me a section?

Does anyone have any facts or figures that would go in my favour? 

Sorry it's so long, and thank you for reading it all! Any advice or opinions would be much appreciated.

[AbbeyRoadCrossing]

Have a look on the RCOG website as there are papers on there about repeat cesarean section vs vbac and the various risk factors for both. I printed it out and highlighted relevant bits for my case although my NHS trust were 'natural birth policy' so I had a bit of a fight to get an elcs.
You'll probably discuss it at this meeting but it's often signed off much later in the pregnancy. I'd definitely bring it up though as it's what you'd prefer.

[JohnLapsleyParlabane]

As above. I hope you get an understanding consultant. I declined pharmaceutical induction and ended up having to say 'I do not consent to this' on several occasions as the medical staff sort of went into automatic mode.

[GlitteryFluff]

Thank you both for replying.

On the front page of my notes it says 'we promote natural childbirth'. So I reckon I'll have a fight :( am I right in thinking of the consultant refuses the induction I can ask to see another? I'm also worried about them saying we'll discuss at 36 weeks and I'll spend my whole pregnancy worrying about what their final decision will be. How likely is it that I can get a decision much sooner? Either at this appointment or another appointment (with another consultant) much sooner than 36 weeks?

I've had a look at that website and can see it says vbac's are more successful if you have had a vaginal birth, bmi less than 30 and labour starts naturally. Well I haven't had a vaginal birth, bmi over 30, and so far haven't laboured so assuming I don't go into labour again this time it's not looking favourable.

I also categorically refuse to be induced in any way. Never again. I couldn't talk about my induction for months afterwards as would get so upset thinking about it all.

If I refuse an induction and haven't naturally gone into labour by induction date then it would default to a section again wouldn't it?

[PenelopeParmesan]

They wouldn't usually induce you after a cs anyway because it greatly increases the risk of rupture of the uterine scar

[Lj8893]

Generally If you have had a section before they will be very accepting of an elective section this time round, they will do all the pros and cons etc but I would be surprised if they didn't offer you the choice of elective.

[PenelopeParmesan]

If the first consultant declines to offer you a cs you can ask to be referred to a different consultant.

I was refused an elective cs after my first was a cat 1 emcs under general.

Ended up with another emcs after failing to progress. That was nice

[Topsyloulou]

When I had my 16 week consultant appointment I left it feeling deflated. I was induced, got to 9cm but then developed possible sepsis, both our heart rates kept dropping, on examination in theatre it was confirmed DS was back to back & in poor position for vaginal delivery. He was 9lb9 & his head was over 100th centile, consultant said there was no way he was coming out on his own. From what the midwife had poorly told me I expected to get a decision on elcs there & then. He did listen to my reasons and felt they were valid but wanted me to meet with the birth options midwife to ensure I was aware of everything both options entailed to see if we could find a medium ground. I have my appointment for a decision at 36 weeks. I'm going to continue to push for elcs & my mw can't see any reason why not based on DS birth.

[EdgarAllenPoe]

I recently had my 16 week appointment with a consultant after a very similar birth experience. I was induced as my waters went but no labour ensued. It didn't work (well I had loads of contractions but never got beyond 3cm), couple of days later emcs and 4.5kg baby, (and I am small) and badly positioned (but not breech).

My consultant had no problem agreeing to an elective c-section this time. She mentioned VBAC, but I explained my reasons for wanting a cs and she said it was obvious I had really thought about it and done my research. CS agreed. I'm 20 weeks now, and a lot more relaxed!

Points I made:

History of big babies in my family (even though no diabetes etc).
I wanted to avoid an emergency situation as 2nd c-sections often take longer.
Recovery is often easier compared to an emergency section too as no labour to recover from. I was so exhausted last time we never got breastfeeding established.
I found constant fetal monitoring very difficult to handle, which is a necessity for a VBAC.
I would not consent to an induction. Adamant on this as inductions increase the risk of uterine rupture, especially for bigger babies.
I was getting anxious about the thought of VBAC, and I am not normally an anxious person.
I just did not want a repeat of last time. I didn't even get close.
Find out the % of successful VBACS for your hospital and decide if you're happy with that. Mine was about 70%. I didn't want to put myself through it with still a 30% chance of needing a section. I told her that, I think that convinced her I'd really thought about it.

Hope that helps. I was really stressed before my app. Just know, you have a right to request another consultant if you're not happy.

[GlitteryFluff]

Thank you so much everyone for your opinions and sharing your experiences.

I'm so worried about having an even worse experience than before. DS is speech delayed and is being assessed for ASD and I always worry the induction/birth/just being massive, breech and squished had some effect on that. It probably didn't but I worry what if this time baby was damaged trying to come out vaginally, what if I have to have an emergency and it goes wrong. Reading up iirc there's a higher chance of learning difficulties with vbac vs elcs- will need to double check that.

I also don't want to have the stress and worry until 36 weeks when they might decide no and then I'm running out of time to find a consultant who agrees with me. Pregnancy can be stressful enough worrying about every little thing, to know they have ok'd it early on means it's once less thing playing on my mind.

Does anyone know how I'd find out info about my specific hospital ie %of successful vbac's at my hospital? I'm off to have a look on my hospitals website but not sure I've seen anything on there when looking before.

[DoctorMonty]

Hi GlitteryFluff,

Any consultant recommending VBAC for you would need their head examining. You tick all of the wrong boxes in terms of likelihood for successful VBAC.

I fully expect them to breathe a sigh of relief when they hear you are not desperate to attempt VBAC - you should have no problems whatsoever getting an elective CS.

Hope that eases your fears

[thereallochnessmonster]

Penelope - you are certainly induced after a previous CS. I was.

Op, in your case I would advise asking for a CS. And I think you have good grounds for one. (You poor love. Not an ideal birth.)

But remember that a CS can have problems too - I lost a litre of blood and have to have a transfusion after my planned CS, but had a subsequent vbac which went much better.

Al hospitals have to promote natural childbirth - their motto can't be 'we promote CSs', can it? It has NICE figures to think about too.

Good luck with your consultant appt.

[GlitteryFluff]

I really hope you're right doctormonty!
Are you actually a doctor? A surgeon? Fancy doing a cs me? Haha

[GlitteryFluff]

sorry cross posted with you monster
I totally get that a section isn't risk free. I just feel that the risks of a planned section are better for me and baby than the uncertainty of the risks that could happen with vbac (or emcs)
I was absolutely petrified before my section with DS. I thought I was going to die, or he was. I was very scared and will be again this time. I just really feel that weighing everything up a planned section is much better for us.
I lost that amount of blood with my section, I need to check figures for vbac but I believe you have a higher chance of pph with vbac although actually eventually lose slightly more with a section. I need to double check that though.

[GlitteryFluff]

Have just double checked both the learning difficulties and blood loss and i didn't word it quite right but:

The risk of stillbirth or brain injury are higher with vbac than a planned section.
There's a higher risk of blood transfusion needed with a vbac rather than a planned section.

I also can't find stats on my hospital anywhere? Have googled and also checked on the hospitals page.

[MadameJosephine]

In my experience the 16 week appointment will be to go through why you had the CS last time and to discuss relative risks and benefits of VBAC v repeat CS and then the consultant will arrange to see you again later in the pregnancy to discuss your final decision. At the end of the day though the decision is YOURS and if you want another CS you should get one. If your consultant does not want to perform it (highly unlikely given the circumstances) they have a duty of care to refer you to another consultant who will.