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As with all health-related issues, please seek advice from a RL health professional if you're worried about anything.

CS scar reconstruction question & any recommendations

(11 Posts)
Eastie77 Tue 15-Sep-15 15:28:24

Posted in childbirth with 0 responses so reposting here...

I am 31 weeks pg with DC2. I had an EMCS with DD1 and the resulting scar is pretty horrendous. My current consultant said it one of the worst he has seen and the the way it has healed is 'highly unusual'.

It is very, very uncomfortable (keloid) and I am in pain every single day. Pregnancy has not helped.

Anyway, I am due to have an ELCS next month. This was recommended by the consultant who delivered DC1 who stated that I would be very unlikely to successfully have a vg birth due to various issues. If the ELCS happens obviously I will get the scar redone and hopefully see an improvement.

However my current consultant has informed me that he disagrees with the previous consultant's opinion and insisted if I go into labour before the date of my ELCS I should attempt a VBAC. He has written that I should undergo 'trial by scar' on my notes. There has been a lot of disagreement / back and forth between him, the other consultant and midwives who have all weighed in with their opinions. All quite exhausting.

Anyway if that happens and I don't end up with an ELCS I assume I will need to get my scar revision done privately as it is considered a cosmetic operation. Although the pain is pretty bad I'm guessing it will not be a priority case on the NHS and going private will just be the quickest option.

Couple of questions-
In the event I have a VBAC, does anyone know how long I'd have to wait before making an appointment to get the scar redone? I'm quite desperate as the pain, discomfort and appearance is really getting me down.

Does anyone have any recommendations for the best place to go? I am based in London but can travel.


TreadSoftlyOnMyDreams Tue 15-Sep-15 15:47:45

That's shit. I had an EMCS in London and it was entirely my choice what I did the second time around. I would be raising holy hell right now.

I honestly don't know about the "cosmetic" surgery but I would be inclined in the first instance to speak to a private obstetrician in case there is more to it than cosmetic refinishing so to speak? St Thomas's and the Portland have both got private practices.

This would be the alternative I guess? So you should look for a registered accredited practictioner

Eastie77 Tue 15-Sep-15 19:26:19

Thanks v much for the links! I'm also in London (UCH). I have argued my case as think it highly likely I'll end up having another EMCS if I attempt a VBAC based on what happened with first pregnancy as well as the opinion and extensive notes of Consultant no.1. Current Consultant has said I mustn't be so 'negative' but reluctantly agreed to the ELCS. However his caveat about the trial by scar if I go into labour before date of ELCS concerned me. Presumably I can ask for this to be ignored since it goes against my wishes..

Thelushinthepub Tue 15-Sep-15 19:29:05

I'm afraid I don't know anything helpful but am so angry at the way you've been treated! Hope you can get this sorted to your satisfaction soon

TreadSoftlyOnMyDreams Wed 16-Sep-15 09:57:41

Keep pushing with your midwives for a date for 39 weeks and a pre-op appointment to be scheduled. Once all of that is in place all your birth notes will point towards an ELCS.
If you do go into spontaneous labour before that date, based on personal experience of an unplanned vbac and you definitely want an ELCS my advice is to:
1) get to the hospital as early as possible [particularly on a weekend] so that barring emergencies you are first in the queue for theatre.
2) don't assume for a second that the labour will be as slow as your first so have your bags packed and ready to go.
3) make it very clear from the outset that you are booked in for an ELCS on X date and will only consider an ELCS today.
4) when you are told that you are progressing nicely, are "nearly there now" and generally lots of encouraging noises are being made; don't diverge from your mantra about when the theatre will be free.

Be very clear and make sure your husband understands what you will accept in terms of intervention if theatre is not free and your labour is progressing quickly. Make sure that eg: no forceps delivery is on your birth notes if that's what you want.

Read up on and understand the possible complications of an instrumental CS birth where the baby is in the birth canal. You may hit a point of no return from a personal perspective where a vbac is inescapable.

All of this sounds really dire and there will be lots of folk on next to tell you that a vbac is fine yada yada. Been there and it is fine. Recovery was much much longer than my CS though and I ended up with an instrumental forceps delivery. All my notes from my first EMCS pointed towards likely issues the second time around. Consensus is that only my second child was v small and early, she would have gotten stuck too.

If you want an ELCS, you will need to stick to your guns and appear at least to be extremely inflexible on this point.

Eastie77 Tue 22-Sep-15 17:32:57

Thanks for your candid advice! I have a date for the ELCS and a pre-op appointment scheduled. There was actually no issue getting this arranged with the midwife and my notes were updated with the relevant information. I was just thrown a curve ball when I met this new consultant for the first time who has decided he does not accept the opinion of Consultant no.1

I'm a bit baffled as this latest consultant has not actually stated why he disagrees. He just has a 'feeling' I will be fine if I attempt a VBAC confused He made some comment about women who have EMCS descending into a negative spiral of thoughts in subsequent pregnancies and convincing themselves they cannot give birth naturally. Funnily enough his daughter is my GP. I went to see her not long after I gave birth as I was really concerned about my c-scar. She told me quite dismissively that it was healing fine which unfortunately was really not the case.

Hospital bag is almost fully packed. In theory I have 4 weeks to go but I am conscious that anything is possible and spontaneous labour fully possible. I will stick to my mantra re. the ELCS (DP not shy about voicing his opinions so am sure he will more than able to argue the toss with anyone trying to steer me away from that route!) but my concern is that UCH is so busy that if theaters are occupied before the date of my op I will somehow end up having to attempt that VBAC and then it escalating to a EMCS. I've already been told that my scar might not withstand a VBAC (it really is quite awful and every medic who has examined me has commented on it) so that is a concern for me as well but I guess there is little point in worrying about 'what ifs' before anything actually happens.


TreadSoftlyOnMyDreams Thu 24-Sep-15 10:30:13

They sound like a lovely pair.

I saw three obstetricians prior to my decision to go for an ELCS. I had been referred to a consultant after my birth review and each time I went to hospital to see her, she'd taken the day off/was unavailable etc. So I saw three registrars. The first [male] was v informative and open minded, the second [a woman] basically told me to man up and have a VBAC, and the third [male] was back to making it my choice.
I consulted with a relative who is an obstetrician in another country and when he told me that a second CS and even a third is considered routine surgery, [a consultant would be operating after then] I was v reassured.

I hope it goes well for you and your second surgeon does a better job of sorting out your scar.

Eastie77 Thu 22-Oct-15 00:15:30

Thank you! Currently cuddling DS, born this afternoon via ELCSsmile It was such a calm experience compared to the EMCS. Had a lovely surgeon who was very honest and said he had done his very best re. the scar but could not guarantee it would not become Keloid again. I have ordered a scar dressing/bandage recommended by the midwives which may also help.

AnyoneButAndre Thu 22-Oct-15 00:22:04

Oh that's good news, I do love it when worried posters come back with a happy ending.

Congratulations OP, and good luck with the scar with or without medical help.

poocatcherchampion Mon 26-Oct-15 18:55:16

Great news op!

Just to say that I had a manky scar from the first time and thry cut it out the second time and it was hugely improved afterwards.

I've just had dc3 so no idea what it will look like now

Eastie77 Tue 01-Dec-15 11:13:05

DS is now 6 weeks old and my 'new' scar is basically invisible. The difference between this scar and the first one is like night and day.

I am really relieved I did not end up going down the VBAC route (nothing against VBAC at all but I don't think it would have worked for me) and I no longer have a scar that causes me searing pain every day.

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