Advice re C Section please- feel like I'm being given the run around!

[lotsofthingstolearn]

Ok so potted history

As a result of a car accident am left with Chronic back pain, unable to stand, walk or sit for long periods of time without increase in pain (no more than about 15 minutes). Sure you'll appreciate pregnancy certainly hasn't been easy but as people keep saying it will be worth it! But I am determined that I won't moan about it there are lots of people in far worse situations that I am.

Anyway, I have been consultant led and so far can't complain at all about the care and attention I've received but this is my first pregnancy and have nothing to compare it to.

Getting to that stage where they're talking about birth BUT I can't help remember one of the first things my midwife said at 8 weeks that I am likely to be brought forwards by maybe a couple of weeks with a C section as I may not be able to labour naturally. BUT when I've seen the consultant (who was quite dismissive) said that "oh lots of people cope ok with an epidural and labour naturally!" I am not sure if he appreciates just how painful this is- sorry for TMI but it's painful to even push a poo out and (under dr's orders) I have to use glycerine suppositories to help things along! At the moment, all I know is that an appointment has been made for with an anesthetist 6 weeks before due date.

I'm trying not to get anxious but I really don't want to get to a situation where I labour naturally and then have to have an emergency C section. I completely appreciate the risks both for and against. Friends (who also work in the medical profession) say that it will be a nightmare for me and I should be pushing for a planned C Section. I don't want to cause a fuss and be seen as an "pushy patient"

Any advice on what I should do as I feel that I'm getting really conflicting information from the medical experts?

[Biggem]

Maybe chat with your gp and see if he/she can help get u a more lockdown plan?
Can't understand why the midwife isn't being a bit more helpful tho?

[wheresmespecs]

Research the risks etc of C sections thoroughly - also try and get specialist advice (from physio? anyone who has seen you for previous injuries) about the likely problems for a VB.

You can request a CS - but realistically, you are very unlikely to get one, esp for a first baby, without being very pushy and persistent - effectively mounting a campaign.

If you have already seen a consultant who has refused you a CS, you will need to ask for another one.

Re: whether or not a CS is the answer for you - you don't say how expert your friends are, but in any case, it is common for consultants to disagree over whether a CS is the best plan or not. Some are very pro VB, some are more amenable to CS - some hospitals are very anti ELCS (most, I would say) - others more flexible.

Either way, the 'default' setting is a VB. If you really want a CS, you will have to work hard to get one' and get some medical professionals onside on on the record. If someone appropriately qualified can say on record that a VB might damage your back, that will help. If it boils down to you saying you want a cs because you have back pain, then i don't think it will carry much weight, sorry.

[lotsofthingstolearn]

I thought that too Biggem but the GP basically said that they can't do anything and has no real sway on it and to speak to consultant and midwife! So frustrating!

[mellen]

If you have back pain a CS might not be the best option - I found that I has terrible back pain after my CS, I think it was the disruption to my abdominal muscles that then left my back less supported.

Are you due to see the consultant again? Or is there a helpful midwife that you could talk over your options with? What the best option is for you will depend on what your priorities are.

[TheAngelshavetheOod]

What's the consultant saying?

[lotsofthingstolearn]

I'm not pushing for one or the other as I'm trying to listen to the experts but they're all disagreeing.

My pain management consultant says it could be very very difficult but he has to go with the consultant
Physio says that some women labour perfectly well with an epidural an it's a matter almost of trial and error.
Midwive is the one saying that natural labour likely to be not possible but seems to be "shot down" by consultant.
Consultant seems to be saying let's just see how we go and use an epidural but I am so weak I don't think I'll be able to do it and no one has really done anything to reassure me
Perhaps I ask to see another consultant?

Like I say really don't want to cause a fuss

[mellen]

It isn't necessarily about you causing a fuss or being pushy, you are entitled to be given the information in a format that you can understand and feel confident in (even if that is only feeling confident that there is genuine uncertainty, IYSWIM), and it doesn't sound like this has happened yet.

[LivingThings]

You need to get a consultant appointment. Do your research so you can argue your case (or get DH/DP to go with you and do it for you whilst you sob and wail!) Do not be fobbed off and if the consultant wont agree to your request ask for a second opinion and change consultants.

I got an ELCS on the NHS for my first baby and had no medical issues at all - its not easy but it is possible. Do not take no for an answer. Good luck.

[lotsofthingstolearn]

Thanks everyone- I really appreciate your comments.

I'm prepared to have a natural labour but no one seems to be giving me the confidence that it will be ok- and the last thing I want to try and avoid is having an emercency C section.

If there is a higher % that all will be ok with VB- I'd do that. If not I'd have the CS . The consultant gives me the distinct impression that he'll try VB first and an epidural is the asnwer to all my problems. He doesn't seems to be considering if I will be able to push baby out as I am so weak- I've mentioned a couple of times and he just says dismissively lots of people manage ok and so let's see how we go.

These people are supposed to be the experts and I want to be able to trust and feel confident about what they are saying- perhaps I am asking for the impossible.

[SoYo]

The chance of having a successful vaginal delivery for any first time mum is around 80%. Probably less for you but from what you've said it's very likely to be greater than 50%. Elective section would definitely avoid emergency section and problems in labour but the recovery period could be significantly worst, could make your longstanding problems worst and would definitely leave you higher risk for future deliveries. At the hospital I work in we wouldn't offer someone elective CS for chronic back problems unless there was a structural abnormality likely to stop them being able to deliver vaginally.

The main problem with labour in general is that there are no guarantees and no way of knowing if things will be ok, there is plenty that can go wrong and plenty of reasons for emergency section but as long as the likelihood of this less than that of vaginal delivery then the risk/benefit analysis swings in that direction. They will never be able to give you the answer you want if that answer is that you will definitely not have an emergency section!

I know people are telling you to fight your corner and argue your case but to me it doesn't sound like you want to fight for one, you just want as much information as possible about the pros/cons either way. If you're really not sure you're getting enough information then I would ask the MWs in clinic to refer you to another consultants clinic just to get their take on it too and some more information, 2 heads are often better than one!

Also, as much as I love my midwifery colleagues and the good ones are worth their weight in gold, unless your midwife understands the anatomy and physiology of your condition and the potential implications for labour (which is unlikely as it falls outside of their remit of normal low-risk care) then I would try not to put too much weight behind their opinion. It may not be based on much fact! (Sure I'll get shot down for that bit!!!!)

Hope that's in some way helpful.

xxx

[ShhhhhGoBackToSleep]

If I were in your position I would go for an elective c-section, definitely. And I say this as a NCT lentil weavery hyponobirthing type.

When SoYo says a first time mum has a 80% chance of a successful vaginal birth, she means an average first time mum has a 20% chance of having to have an EMCS. There is also a large proportion who will need to have forceps/ventouse, who will sustain tears etc etc. if you have issues with pushing already I would be be very conscious of the fact you could dilate fine with an epidural in place, then not be able to push the baby out and end up with forceps, guaranteeing yourself at least a second degree tear (an episiotomy being automatically 2nd degree, plus much higher risk of tearing with epidural/forceps).

In my experience doctors tend to see a successful birth as mum alive, baby alive, and not cs (which is of course important) but they don't see what comes in the weeks and months and years afterwards. The negative experiences which can't be measured such as labouring for days then having a cs, tears that don't heal well, continence issues later in life just don't matter to them, as it won't be them that has to deal with it.

My thinking was that if I knew all the probabilities I would prefer in order -
Natural birth
Elective section
Assisted birth
Emergency section

And in your situation the probability of having forceps would make me go straight for a ELCS.

I would guess that your midwife has seen the "yay! Look a successful birth! Just like we said!" from doctors in hospital but has also then visited the women at home for two weeks and seen the aftermath of long hard labours with no sleep, nasty tears and traumatised women and has a more realistic view of the overall position.

Either way, enjoy your gorgeous snuggly newborn

[WillowB]

I would agree with the people who are encouraging you to think beyond the birth when making your decision. I had a c section & didn't realise now much I relied on my abs till they were gone (well damaged!) never had previous back problems but I've started to experience backache since as I don't have much core strength anymore.
You would probably spend a night or two in hosp where the midwives will help you lift your baby, but even getting out of bed is a major effort. In the following weeks you would probably need considerable help at home. Hoovering, carrying washing, lifting baby in car seat & driving would all be out of the question.
Just something to think about.

[lotsofthingstolearn]

Thanks everyone- I've been honest with midwife today about my concerns and she has agreed I need to get a second opinion so lets see what they say. She was brilliant! I'll go with what they say as I've said these folks are the experts and I am certainly in no position to judge!

The points about the invasiveness re CS i get completely but hoovering, carrying, washing etc even before pregnancy was a no no as I am so physically weak with little strength

She more or less said that medical intervention of some sort is likely so let's just make sure that all options are considered

So I feel a whole heap better and thought I'd just drop you a little update

[elizaregina]

your consultant seems in capable of understanding your physical problem.

he is probably a very busy man - with a quota of sections to keep down adn those that he can get away with pushing to VB he will, without much thought to your particular circs.

he is also probably a man being paid - very very very well to deal with stress and a busy hospital situation.

he is of course being paid for via our NI contributions.

so he is being paid for partly by you = to look after you.

i am not an expert on this but having read many threads about sections I get the impression that ladies like you with a specific problem - probably need to talk to someone in that field - ie your back - an expert to give you an idea of what the injury can sustain....

someone was on here a while ago with a specfic tail bone problem, her consultant had no idea what implications vb or section would mean for her - and dismissed her fears - UNTIL she got an expert in tail bones to say - if a VB does go wrong which we dont know if it will or wont - IF it does - it could mean long term serious problems....so...best not to risk it.

however - you dont know - and the next consiltant may not know - so i would be rining round people who know about your back problem - then going back to consulant.

re not making a fuss - i am not quite sure why you are so worried about making a fuss - if someone is trying to fob you off - and making a huge descion about your physical well being without themselves being bothered about being armed with info - how much fuss wuold you have to live with should you be phsyically impaired for life becasue a sloppy wrong desion was made.

another theme on threads of this nature has been, remeber each hospital dept has a budget, if your damaged in labour and need physio - it wont be maternity that pays for it - so not thier concern. sometimes it seems not matter how dangerous for the woman - if they can get you in and out - as cheaply and quickly as possible....

[mellen]

Consultants dont have a C Section quota.

[happierhigherstrongerwheezing]

You need to make a fuss if it's important to you, don't be fobbed off.
Write down your once runs and take it with you to your consultant.

If not happy ask for a referral.

[Lambzig]

Its great you are getting a second opinion as I think you need more info and understanding of your options.

When I had DD my consultant said that she leant towards an ELCS (due to age and other complications), but was happy to support me if I wanted a natural labour. She suggested I speak to some midwives and go to NCT classes to make up my mind. It was going to NCT classes and understanding the interventions and emergency CS situation that made me choose the ELCS. I am completely convinced that this is so much better than an emergency CS in terms of recovery and I had a fast recovery, so different from friends who had the emergency version.

I echo others saying don't be afraid to make a fuss - its really important that you go into whatever labour plans feeling confident, happy with what is planned and that you have the right information.

Good luck.

[Beanypip]

I also suffer from a back condition which causes lots of pain and was always told I'd need a CS so never thought anything of it until I got pregnant with DD. I mentioned it to the midwife who referred me to the consultant they said I was fine to give birth normally but said they wouldn't let me go over due as the pressure of a full term baby would be a lot for me to manage. Fast forward to 39 weeks and they decide I'm fine to go over due I decided to bring my concerns about the pain up and asked for a CS again. They kept seeing me and said I would be fine so was induced at 40+11. To be fair after the epidural went in I didn't feel any pain in my back but the pressure at the bottom of it was agony (which I know can happen to anyone) I felt I was too weak to push to much and it turned out I was ended up rushed to theatre for forceps where with the help of a spinal (and a very hot doctor) they managed to get her out. She wasn't breathing and ended up in Special care for 3 weeks. I wish I'd pushed for a CS from the start like I had wanted I just went along with the fact the Doctors know best. But they don't know your pain and your limitations only you know that. If you really don't think you can push the baby out without forceps help then I would explain your concerns and make them listen and like others have said if you can get your pain management consultant to help then do. (When I saw mine after the birth he said he could of sorted it for me! )
Don't be afraid to stand up to them at the end of the day all that matters is a healthy baby and a healthy mammy and if your going to constantly be worried about it while in labour it won't be good for either of you!

(I haven't written this to scare you!)

Hope you get everything sorted x