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Childbirth

Anyone asked for ELCS for first baby?

52 replies

PixieCake · 27/04/2010 10:41

Hi there,

I have been reading a lot about those of you asking for ELCS after a first traumatic birth. Is there anyone out there who has asked for one for their first baby, for non-medical reasons?

My reasons are mainly psychological (fear) although my mother did have terrible labours (don't know if that counts?)

I have done all my research, fully understand the risks and believe I have made an informed decision.
Unfortunately, when I told the MW at my booking appointment she was not impressed. I said I want to discuss it with a consultant and she said I should wait until I am over 30 weeks.

I am only 10 weeks pregnant but finding this very stressful and do not want this hanging over me until the late stages of pregnancy. Plus, if I am refused, I need time to investigate other options.

Can anyone share any advice?

Anyone know a sympathetic consultant at Kingston who I could ask? I have been given Al-Shabibi - anyone had experiences with her?

Many thanks!

OP posts:
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barkfox · 27/04/2010 12:09

Hi Pixiecake -

I am having an ELCS because of primary tokophobia, so have gone down this route. I can share what I have learnt, and I'll try and do it in as 'unbiased' a way as I can. I certainly don't want to influence you at all in any direction.

It's worth saying at the start that CS's are not granted on the NHS for 'maternal request', as in, you won't get one just because you ask. However, they can be agreed on psychological grounds, which do count as 'medical reasons' (obviously 'medical' doesn't just mean 'physical' - no one says depression isn't a medical condition, for example).

It won't count that your mother had bad labours, as far as I am aware. If you are arguing that you have a birth phobia, then I think (as with other psychological or psychiatric conditions), it's not that realistic to diagnose yourself, IYSWIM - you may need to be diagnosed. There is a difference (as with all phobias) between a 'reasonable' level of anxiety, and something which is much more serious and psychologically disabling.

I talked to my GP and my midwife when I saw them about my fears - it would have been obvious I was very distressed, as even talking about it is very hard, and luckily they were sympathetic.

I was referred after my 12 week booking-in appt to the Head Midwife at my local hospital, who referred me to the pre-natal pyschiatric team. I had another appointment with a psychiatrist, and they recommended me for a C-section on psychological grounds. The C-section itself has been agreed by a consultant, they are ultimately the ones who have to okay it - but by that stage, it wasn't a case of just me asking for it, I had the support of my midwife, Head Midwife and a psychiatrist.

That sounds like a lot of appointments now I write it down. But it's been a positive process, albeit pretty uncomfortable and upsetting at times just because of the territory and having to talk about my past. But the head midwife explained when she was referring me to the psychiatric team that they were concerned with giving me the best care, whatever that turned out to be. Given that I've a history of sexual abuse and depression, there are other pregnancy and postnatal care issues as well as birth that they wanted to be sensitive about. I found that very reassuring, and have viewed the medical entourage as supportive. I'm currently 27 weeks pregnant btw, so this has all happened prior to now.

I'm aware that other women in similar situations have had less sympathetic responses from the MWs/HCPs, and I'm sure that care in this area varies as much throughout the NHS as other pregnancy/birth care. So I can't argue that my experience is 'the norm'.

However, I would recommend that you go and see your GP asap, and be open to the idea of a psychiatric referral. The earlier you start the process and flag up your issues, the better. They might offer you counselling - up to you whether you want to go down that road, but I wouldn't rule it out. It is not the magic wand that some people seem to think it is, and with pregnancy as a 'ticking clock', the circumstances may not be ideal, but it can be successful for some people. There may be other options they want you to explore. It wasn't appropriate for me, but other women have found things like hypno-birthing really helpful, for example.

I'd just be aware that 'demanding' something from a doctor or HCP can sometimes rub them up the wrong way. I absolutely believe that in my position I needed to be assertive about my problems, and was determined to be taken seriously - but I didn't go in with a self diagnosed problem and a solution which I simply wanted someone to 'sign off' for me. IME, HCPs respond much better if they feel you are asking for their professional help, not treating them like a consumer service.

Just a quick 'heads up' to end this very long post. There is a huge lack of understanding about birth phobia, and other people's reactions can be very ignorant - sometimes inadvertently hurtful, and occasionally downright vicious, for some reason. It's hugely emotive territory, and tbh I'm still picking my way through it. Now, I'm not even saying you have a birth phobia, I don't know you or your situation beyond what you've said here, and I'm no more qualified than anyone else on this forum to 'diagnose' you. I'm just trying to answer your question (knowing that others will, like I did, look desperately for info about this subject). I'm just warning you that you might get some very hostile answers for some reason, and if you do, do try not to take them personally. It just comes from ignorance.

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Chynah · 27/04/2010 17:04

I requested an ElCS for birth of first as find the thought of a VB horrific and have absolutely no desire to ever experioence that. Was not easy and first consultant refused so needed to get second opinion who agreed to do it. I did not have to have a phsychiatric asessment but my secion was not agreed til 37 weeks which was very stressful. You need to research all the pros & cons and have your reasons clear - helps to take someone to back you up or speak for you if it gets a bit too emotional (DH was great). Now have DC2 also ELCS and it's much easier to get them to agree second time! Good luck.

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mosschops30 · 27/04/2010 17:09

Hi pixie from the other side of the fence from me im afraid.
I had 2 normal deliveries, painful yes, but normal with minimal intervention, few stitches and quick recovery.
With no.3 I had an EMCS, the pain I suffered after was unimaginable, I couldnt pick up my baby, carry him round the house, do anything 'normal'. After 5 days I suffered a complete wound dehiscence, my abdomen burst open and I was left holding my bowel in my hands. I was rushed back to hospital by ambulance, re-stitched and then followed a long recovery.
I have been left with an unsightly scar, a c-section 'overhang', ongoing health problems and PTSD. I will not be able to have any more children

I would rather have 100 babies vginally than one by c-section.

I am sure you have looked into all the pros and cons of both and there are women on here who have had dreadful vaginal births, but its is possible for a c-section to go horribly wrong to. I am a nurse but never realised just how bad the pain would be and how slow recovery would be.

I hope you make the best decision for you and your baby

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LilyBolero · 27/04/2010 17:10

Bear in mind that recovery from a CS is much more prolonged than from a VB (in general). For example, you are not insured to drive for 6 weeks, I know that friends who have had CS have found feeding more uncomfortable, and have found simply picking the baby up to be difficult. One friend who has had both said that with VB you 'feel rubbish beforehand but afterwards great', but that with CS you 'feel fine beforehand but afterwards feel crap'.

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Chynah · 27/04/2010 17:30

Recovery from CS is (alledgedly) slower than from an absolutely perfect VB (but who can guarantee one of those?). You can drive when you feel ready (your insurance comapany are unlikely to be bothered and if they are it usually only requires a quick doctors check to reassure them) I waited til 2 weeks first time but drove at 8 days this time. Never had a problem lifting my babies and this time lift my 15 month old toddler as well (sometimes at the same time - from 2 weeks post section). Feeding not been a problem either and I was back out running 5 weeks after #1.

I know Mosschops had an horrific experience but hers is thankfully not the norm any more than some of the awful incontinence stories are the VB norm - both can go horriby wrong.

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Poppet45 · 27/04/2010 17:45

How keen are you to breastfeed. I had an em C section and we only, only just got DS bfing after I had a huge bleed and ended up in high dependency (the most common side effect of a section) - it took a midwife blowing in his ear everytime I fed him as he was soooo tired, and was shutting down to conserve his energy as didn't manage to feed for 12+ hours. Birth is just one day... but the side effects of a c-section can affect you and your baby for much longer.
I'm so looking forward to another labour, but while I'm so glad I live in an age where I could have one, I wouldn't wish a c-section on anyone.

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ArthurPewty · 27/04/2010 17:49

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barkfox · 27/04/2010 18:04

Sorry, I forgot to say in my earlier post (which was long enough as it was, I know) -

That a key factor in granting a CS on psychological grounds is psychological risk. This tends to get left out of VB versus CS discussions here, which concentrate more on the physical/practical side of things.

Which are hugely important. There's never any shortage of people pointing out that a CS is a 'major operation', and it is.*

However, for tokophobics and people traumatised by initial VB experiences, then the mental health risks of going through a VB are a key consideration, and have to sit alongside issues like increased risk of bleeding/longer average hospital stay etc. These psychological risks include things like depression, dissociation, PTSD, psychotic episodes, depersonalisation, etc etc. All potentially very serious, esp in terms of a mother bonding with her new baby.

I think a lot of people find it very difficult to understand birth phobia, and so tend not to take the psychological risks into consideration (or dismiss them too lightly - 'everyone gets scared!' I've been told, among other things. Which is as helpful as telling an acute depressive 'everyone gets a bit down in the dumps!'). Luckily, NICE and the NHS do take mental health into consideration in their guidelines, even if they don't make it that obvious.

*it's worth adding, the big difficulty with all CS stats, which you see used in comparison with VB, is that they don't distinguish between an emergency CS, and a planned one. NICE admit this in the small print when they say "It is not clear whether the increased risk of these problems [listed in 'Summary of the effects of caesarian section on women's health'] is a result of a caesarian section or because of the reasons for needing a CS." E.g. there is an increased risk of maternal death with a CS compared to a VB. But then a lot of women will be having CS's precisely because they have health problems that make them higher risk in the first place. So it's not a very 'honest' comparison. BUT, still worth being as informed as you can be, IMO.

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withorwithoutyou · 27/04/2010 18:10

"with VB you 'feel rubbish beforehand but afterwards great', but that with CS you 'feel fine beforehand but afterwards feel crap'."

Afterwards great??? Not always!!!!

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scoutliam · 27/04/2010 18:17

I did, for reasons I never discuss because I always feel judged.

I had a very understanding NHS consultant who said it was my body my choice.

He made sure I was aware of the risks and asked me to speak to the consultant midwife who also discussed risks.

I had my section on a Monday afternoon and was discharged Wed afternoon, no complications, (was up and out of bed changing my sheets Monday eve)

People tell me I was "lucky", I dunno, I think most planned c sections go very well.

It's not the easy option but it is an option you should be entitled to.

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scoutliam · 27/04/2010 18:18

Oh and I breast fed from day one, and continue to do so 27 weeks after.

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barkfox · 27/04/2010 18:23

PPS - STILL forgot, and I'm going to try and shut up after this!

OP, I meant to say at the end of the last post - planned CS's and emergency CS's are very different experiences, and emergency CS's seem to be more traumatic by far (which is kind of obvious if you think about it). My MW has been very clear about the differences at the same time as making me aware of the risks, esp in terms of recovery time (with an ELCS, you aren't exhausted, you haven't gone through any of the emergency problems that necessitate a crash CS, you can think ahead a bit more about what sort of support you will need when you get home and be more prepared, etc).

None of this is to encourage or discourage you from asking for a CS, btw! Just saying it's a problem with the whole 'field' of CS info.

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ItalyLovingMummy · 27/04/2010 18:25

LilyBolero has summed things up perfectly. I wanted a VB, but had an EMCS and at the hospital felt ok, but believe me, once the epidural wears off its not nice. I was in tears in the car on the way home (I felt every bump and corner), I couldn't pick
DS up without any pain and breastfeeding was hard. However, I have heard that an ELCS changes things considerably - for starters you know what to expect. At the end of the day you have to do what is right for you and MWs should not make you wait so long to give the 'yay or nay', it should be your choice.

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DoulaKate · 27/04/2010 18:27

Excellent posts Barkfox, I wish you all the best with your pregnancy. x

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OTTMummA · 27/04/2010 19:41

yes, excellent Barkfox, couldn't agree more.

I find it infuriating that dispite the OP stating "I have done all my research, fully understand the risks and believe I have made an informed decision."

That people still feel the need to patronise her with stories of emcs!
they are not the same as an elective, not in any way, and to the OP, after having 20 weeks of SPD and ending up on crutches, i definately felt better AFTER my section than before, infact DS's section date was brought forward because of the pain.
I also recovered better and quicker than all bar one of my antenatel mates who all bar one, had complications and interventions.

I have a family member who has since been diagnosed with tokopohbia, but for her 1st child she wanted a section, asked for it, and after they refused she asked for an abortion because she couldn't mentaly cope with the idea of giving birth, and then they finaly gave her a section date.

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ArthurPewty · 27/04/2010 20:18

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HeadFairy · 27/04/2010 20:29

op... you haven't said if you want more children? It's one of the things to consider. I've had 2 sections, ds was footling breech so I had no choice, dd was 10 days overdue and showing signs of placental failure, so I did in theory have a choice but I opted for an elcs which was the right choice for me.

First cs recover was like a dream... really quick and easy, no pain, on my feet after 24 hours and after a little stiffness I was fine. Second time round was very different. I nearly passed out with pain the first time I stood up, I'm not sure if that's because I was in a different hospital and they'd given me different pain meds. It took me a good three days before I could stand up straight and I'd say about 6 weeks before I was pain free at the scar site. That said physically I was able to do everything I wanted to, I was carrying ds to bed 4 days after the section, but it was a hard recovery. I have been told that recovery after every section gets harder.

Mind you they did a lovely job tidying up my scar this time, it was really ugly after the first section

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ArthurPewty · 28/04/2010 07:49

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Oblomov · 28/04/2010 08:38

I've had 2 cs's. My consultant always supported me right from the beginning. But the second was an EMCS. No problems at all. Good recovery. Just saying. And don't be put off. Don't leave it till the last minute. Don't demand. Just be firm. Insist and ask to be refered now.

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Oblomov · 28/04/2010 08:40

I too bf both my boys.

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first1 · 28/04/2010 08:55

I've got Al-Shabibi at Kingston and I find her really unsupportive to be honest. I'm 37+2 weeks and have asked - begged - twice for early induction for my own medical reasons, and she's pretty much said "tough, deal with it" or in so many words. I have an appointment on Friday with my respiratory consultant who is much more understanding and am hoping that she will be able to push me for one.

My mum has also seen Al-Shabibi for gynae reasons and didn't get on with her at all.
I hope you have a more positive experience with her OP

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HandsOffMyDrum · 28/04/2010 09:03

I chose to have a CS with my first birth.

DO NOT BELIEVE THE HORROR STORIES!

My CS was a wonderful experience. I breastfed immediately and was walking around later that day. I was only in hospital 48 hours.

There is a world of difference between elective section and emergency section.

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Lindy · 28/04/2010 09:08

I asked for a CS due to my mature years (!) and fear - I was told that I was a big, healthy girl (!) and to 'get on with it'. I ended up having an EMCS - absolutely no problems at all afterwards - I can't see a scar, no pain. It was slightly difficult to establish bf - which I was only told afterwards can be due to the medication but was fine by the time I got home. My car insurers told me that it did not mean I couldn't drive. No discomfort at all. I only ever intended to have one child so can't comment on future pregnancies.

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missismac · 28/04/2010 09:54

You can ask, and if you really have good medical grounds then you'll get one. But don't forget that each Caesarean costs the NHS a lot more money than VB, even accounting for any complications that may follow. For this reason you will need to have very good grounds for being granted an ELCS, its not just 'your choice' (as someone else suggested), the NHS is responsible to us all for the allocation of its resources, asking for extra funding just because you're pregnant but don't fancy a VB won't go down well. There are sound reasons why ELCS aren't given just by request.

It's good you've done your research & checked out the pro's & cons for your baby & you. If you truly are tokophobic then I really hope you can get your CS.

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mosschops30 · 28/04/2010 10:08

am slightly and about the 'dont believe the horror stories' position handsoff

its inappropriate and disrespectful to those of us who have had problems following c sections. I wouldnt dream of saying 'dont believe the horror stories' about people who've had bad VB's just because both of mine were good experiences.

The fact is that there can be problems with both VB's and CS's and as long as the OP can weigh them up and make an informed choice then thats all we can hope for

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