Requesting an ELCS due to previous traumatic delivery

[User24689]

Hi all

I'm 33 wks pregnant and have found myself struggling a lot with anxiety which has been intensifying for probably the past 10 weeks or so. I was referred to the antenatal mental health team at the hospital because on 3 occasions (twice at antenatal clinic and once with GP) I have become really choked up and broken into tears when discussing birth of this baby and it has been occupying my thoughts almost constantly.

This is my second baby, my first birth was very difficult. I saw a clin psych at the hospital on Monday and she said I have what is called 'Secondary Tokophobia' (fear of childbirth brought on by previous traumatic birth) and that I'm showing several symptoms of PTSD.

She asked me whether I had thought about a section and I said that I have thought about it in the sense that having one would definitely lessen my anxiety a great deal although I am nervous about coping with my 2 year old plus the baby while recovering from surgery and we don't have any family to help me other than DH (live overseas)

She put down in her notes that I was willing to have a vaginal delivery but that a psychological care plan will be drawn up which will state that I should be offered early pain relief, basically on presentation at hospital, and that I absolutely don't want to be given a syntocinon drip (being denied pain relief and having the drip contributed to the difficulties I had last time)

My DH is really keen for me to request a section. To be honest, I think he has a lot of anxiety about the birth himself that he isn't really admitting too (so as not to make me worse!). He was very upset during and following DD's birth and I don't think he wants to witness another one though he of course says it is completely my decision.

I've given it a lot of thought and I'm now wondering if a section would be the right thing for me. I'm concerned that I won't cope with anything other than a smooth delivery this time, which I know can't be guaranteed. I'm worried I will panic when contractions start. Looking at the photos of the delivery room in the information leaflet the midwife gave me makes me feel nauseous.

I'm just not sure I feel emotionally strong enough to push for a section and as I'm giving birth in a public hospital I know I'm going to have to really argue my case. I have a lot of shame and humiliation left over from my first birth because it was a thoroughly humiliating experience and I lost all control. I also received comments from a horrible midwife afterwards that have really stayed with me - she told me the staff in the delivery room had been "left traumatised by my screaming". I had been asked a couple of times to stop screaming and became even more distressed because I couldn't actually stop the sound coming out of my mouth with each contraction, as if it was a kind of reflex. I think that I feel weak asking for a section and like I've failed again, before I've even started.

Can anyone offer any advice based upon their own experiences? Does anyone have any knowledge of whether this would be a justifiable reason for a section or whether it would be something I'd have to really argue for? I'm actually in Australia giving birth in a public hospital but I imagine that the system is similar to an NHS hospital. Should maybe add that this was an unplanned second pregnancy and we will be looking into permanent contraception (vasectomy or tubes tied, still unsure which) after the birth.

Sorry for the length! Many thanks in advance.

[Lozmatoz]

You've articulated how you feel really well here, I would print this out so you don't have to argue you case, you can hand this over to doctors, midwife, psychologist etc. so they get a clear understanding of the severity of how you feel.

I haven't experienced a traumatic birth, but I did Hypnobirthing and I think it may be useful to you if you really practice it every day between now and the birth even if you have a section. You're gonna have to try and change your mindset and hopefully this will help you. I have always use this one (in the picture), you can pick up a copy on eBay easily enough. You can also download apps to listen to mantras to help you cope.

A birth plan may help too so you and your partner are clear on how you want things to go. he can speak to the midwife on your behalf while you're in labour. They will also be able to read it so they completely understand what you need. You need to take control of the situation!

I would also add that you came through last time, you did it, and you can do it again! You'll be surprised how easy or newborn is the second time compare to a two-year-old! Good luck, you can do it! X

[Lozmatoz]

Forgot to add that maybe you could request some childbirth counselling or post-traumatic stress counselling?

Also remind your OH that during labour it is his job to completely look after you and remain calm.

Weird tip I know, but I found breathing through my nose only helped keep me calm. As soon as I took a breath in my mouth I began to panic.

[Bisquick]

Also please be kind to yourself and stop blaming yourself. You grew your first baby and protected her from all harm and brought her into the world. You've done your job. The rest is just needless societal bullshit designed to just make women feel guilty. While vaginal delivery is more economical and there is some evidence this is better in some situations than a section, the way in which we fetishise it as "natural" is just ridiculous. And it leads to women feeling like they've let themselves and their babies down.
Your job is only to make informed good choices for your baby and for yourself and you did an excellent job of that last time. And whatever you choose you will do an excellent job of it this time too!
Fwiw I had a traumatic first delivery and am most likely going to opt for an ELCS at 38 weeks this time around.

[Thewinedidit]

Have you mentioned section to midwifes? I don't think you will have to push as hard as you think.

I have quite severe pelvic prolapse following first DC and was referred to consultant to discuss birth. Whilst they don't think further vaginal birth should worsen it they have said my birth choices will be respected and I can choose a section although they seem to prefer vaginal. I have yet to decide and go again in a few weeks to discuss. My DH very much wants the CS like yours bit I am nervous about it.

Hopefully your experience of asking for CS if you do opt for it will be positive.

[Downbutnotyetout]

Can you possibly afford to go private? I am in Aus as well and going private with DC2 because of similar traumatic previous experience. My OB is fabulous and offers C section for personal preference reasons. I chose to go private for 2 reasons 1) so I didn't have to go back to the public hospital where I had a bad experience and 2) so I didnt have to keen explaining what my issues were to whichever public dr / midwife was at a particular appointment. It's not super cheap (about $4-5k) but much cheaper than in the UK, especially if you have private health cover. Even without you can chose a private dr in a public hospital. Sorry if that's not an option for you, but it is my coping mechanism for a similar situation. I haven't decided if I want a CS yet but I wanted to keep the option open.

[User24689]

Thank you all so much for your replies. I must admit I was half expecting people to come on and tell me I have to get on with it so it is encouraging that nobody has said that!

Lozmatoz Thank you for all the info. I completely agree I need to take control and if I go for a vaginal delivery I need to go in with that mindset, absolutely. I did listen to some Hypnobirthing audiotapes last time and the visualisations really helped but only until the drip really ramped things up and I could no longer focus because the contractions ran into one another end to end. Thank you for all the tips. Giving the request in writing is a good idea too as I find it really difficult to speak about. This is one of the ways my anxiety seems to present itself - I have spoken to close friends and family about my birth experience without a problem but have found that every time I try to speak about it in a clinical setting my throat closes up and I become breathless and tearful. This reaction has really shocked me as I hadn't realised how affected I was by the experience. I think I just put it out of my mind.

Thewinedidit I haven't mentioned it to midwives. My last 2 antental appts have been with a doctor at the hospital as I had a minor anomaly on my anomaly scan (cyst). I'm due to see a midwife on Tuesday. I'm actually quite nervous speaking to midwives as I didn't have a good experience with the midwife team last time and I know they tend to really promote "natural" delivery. Thanks for letting me know of your experience though and I'm really glad you're being listened to.

Down I don't think that's an option for us but thanks. We don't have private health cover. I suppose if I'm refused the section and completely freak out about going through with the birth the money is there in savings so we could do it, but not sure how much notice we would need to book in etc. It seems like a big financial outlay.

Bisquick That is a really kind post thank you. I will take heed. Have you requested your ELCS already and was this respected?

[Bisquick]

Good luck upthewolves

We had quite different circumstances and eventually decided to go private. But both the NHS consultants we've spoken to and our private obgyn have said they'd offer an ELCS or an induction with continuous monitoring based on what we preferred closer to the date. As of now obgyn has recommended ELCS and we've pencilled in a date but I have 12 weeks to go still.

But as always you can never predict how these things will go so just trying to keep an open mind so that I don't freak out if circumstances mean I have to deliver vaginally etc. I found hypnobirthing helps with that too, although as you say in the extremes of stress all that often goes out the window!

[StellaHeyStella]

What Bisquick said, lovely wise words.

I had a awful traumatic first birth, second pregnancy went to see horrible uncaring bitch consultant to discuss delivery, I asked for an elective section due to previous trauma. She said 'No, there's no reason why you can't deliver this baby vaginally', I broke down in tears while DH calmly stood up to leave and informed her that in that case we would be seeking a second opinion.
Stand off.
Cue the nurse in the room clearly trying to keep her face straight.
Consultant gave us her best hard stare and then got busy with her diary booking me in for an elective section.
Discrete wink from nurse.
My HV later said she was very proud that we'd stood up to that particular consultant like we did. Apparently she had a rep for always refusing section requests. Something to do with cost and her statistics apparently.
My point is if you want a section under these circumstances and are denied it, don't argue, just ask for a second opinion.
All that matters is your baby is delivered safely and that you and your baby are well and happy, I don't believe there are any prizes for pushing.

[User24689]

Good luck to you as well Bisquick I'm definitely going to have some further counseling over the coming weeks and try to come to terms with what happened last time and prepare myself for a vaginal birth just in case this doesn't work out. I think I will see if my DH can come with me.

Idiot Thanks for that. I've had a look into an equivalent for Australia but can't find one actually :( The system isn't quite the same here as most people over a certain income have health cover and can therefore access the private system so public is seen as more of a 'choice'. If I was at a private hospital I could request a section with few questions asked (I think).

Stella thanks for sharing your experience. I will remember not to give up at the first no.

I think the first reaction at mention of a section seems to be a sort of defensiveness that vaginal birth is safer and that C sections are still painful/ aren't an easy option.

I am actually totally fine with being in pain afterwards and understand the risks... But I'm thinking a section would be a controlled, managed type of pain. It isn't really the pain im trying to avoid (although the pain was unbearable) but the fear and trauma. It was the scariest day of my life.

[HVB79]

Best of luck with getting the c section and counselling too. I don't know if they do this is Australia but in the U.K you can request a debrief on your birth with the supervisor of midwives, who sits with you and goes through the notes from your labour to help you understand what happened. I don't think my first was as traumatic but it was scary and upsetting - I had the debrief after a few months and it really helped me.

[AddictedToSausageRolls]

@upthewolves my first DD was a "traumatic" birth which ended being an EMCS. Because of this, and both mine and my DH's concerns about going through something similar, we opted for a planned CS second time around. I did have a pang of guilt that I wasn't even trying to give birth "natural" (whatever that is anyway!) but it really took away our anxieties and was a much more pleasant experience than the first time. Recovery was absolutely great - albeit after an painful first week - and looking after a 2 year old was fine, although I did have help so managed to avoid heavy lifting for many weeks. (But I know plenty of people who were lifting their toddlers within 2 weeks and had no issues.)

There is no "wrong" way to give birth and you don't need to feel guilty for your choices - whatever they are - particularly when you had such a traumatic experience and still have anxiety. I agree with a previous poster's advice to print out your OP (or write it down again) - then keep handing it over to the midwives/doctors/consultants if you don't feel strong enough to repeat it each time.

Good luck x

[notangelinajolie]

Good luck upthewolves. It sounds like you have seen the right health professionals and have a supportive partner.

I also had a difficult, traumatic first labour and still to this day believe I suffered from PTSD afterwards (right up to the birth of my second child). I am in the UK and it was over 20 years ago so the support network you describe wasn't available at that time. The consultant brushed off my request and I was denied an elective section for my second baby. In the end I had a very easy straight forward labour and it all turned out ok but I will never forget the worry and anxiety I had all throughout my pregnancy and if I was offered a section I would absolutely 100% have gone for it Delighted to know that women in Australia and the UK both now have the right to a c-section if they request one.

Hope it all goes well for you

[user1472377586]

I had traumatic first birth & requested (and got) c-section with 2nd and 3rd births.

My experience was similar to Stella. I got my first c-section by demanding it from consultant (in Australia). You just have to say that you are extremely anxious and not willing to go through it again. My consultant said to me "you could do it, you know". And I replied "No. I cannot." That was the end of discussion and it was booked for me.

Once you have had one c-section, you are offered it subsequently.

By the way - my recovery from c-section both times was easy.

[User24689]

Thank you all for your advice! Just thought I would update this thread for anyone interested/ anyone else in a similar situation in future.

I have decided that I am going to go ahead with pursuing the section as my anxiety around the birth is if anything increasing rather than lessening as time goes on. I'm also now having physical symptoms of anxiety such as digestive issues and feel like it would be best if I did something now that will allow me to relax a bit for the remainder of the pregnancy (about 6 weeks to go so a long time to feel under stress).


I had a midwife appointment yesterday and was really nervous as my experience of midwives so far has not been the best. I had actually decided not to raise the issue at that appointment but go through the counsellor as couldn't face a lecture about how I can give birth naturally, c sections aren't as safe etc.

I had the most compassionate midwife ever. She told me that she completely understood why I was feeling the way I was and that I was clearly more anxious than was normal or acceptable. She said that she would support me having the choice to birth via c section - she said she wasn't advocating making that choice but that she felt the choice should be mine and not be called into question. So she has made me an appointment on Tuesday next week to speak to a registrar at the hospital about birth options and that doctor would be able to sign off on it if they agreed. She told me that she felt it was unlikely it would be refused as my mental health is a clinical consideration. I'm feeling more optimistic.

The MW did say she would support me going into labour and then having the option of a section if I found myself in distress but I don't think that would help at all - I would not trust them to honour it and if I was refused at that moment by whoever was in charge on the day, I think I would cause me huge stress and upset.

I do feel like it is a huge decision and I do feel some guilt about it, like I'm opting out of confronting something I should be confronting. I'm also worried about recovery and about birthing the baby earlier than its due date. BUT a huge part of my anxiety is the feeling of being out of control and I think once this has been decided and locked in I will feel a huge sense of relief.

[Bisquick]

Glad to hear this update upthewolves. Good luck to you, hope you have a nice and peaceful birth and a happy healthy baby home with you soon.

[LumpySpaceCow]

Good to hear you have a supportive MW.
My first birth was traumatic and resulted in ptsd, pnd and it took 5 years for me to.even consider another birth! Just before getting pregnant again I had a debrief and felt empowered that the 2nd birth would be different - I even planned a home birth. Well, baby had other ideas and was a little breechling so I opted for a section just after 39 weeks (we had a gentle section).
The whole experience was incredibly empowering and positive for both myself and my DH and I actually found the recovery easier than I did after my vaginal birth.
I hope you have the positive birth experience you deserve and your anxiety lessens x

[bulldogmum]

Your update sounds so positive!

I'm in the same position as you but in the U.K. and have longer to go (18 weeks). I had an awful first birth that has left me petrified, we complained to our hospital as their care fell well short and they have apologised. As a result I told my midwife at 8 weeks that I was thinking ELCS was my preferred choice due to previous traumatic experience.
The hospital to be fair have been great, I had a reflections meeting where they go thru previous birth step by step and fully appreciated why I was so anxious. Since then my care has come under senior midwives and consultants rather than the standard route and as it stands I can make a decision either way up until the end but final consultant chat is booked in for 34 weeks. They are keen however to keep their c section stats low and have been telling me everything that should have been different and written all over my notes that I should have immediate pain relief on arrival. However they do also say it can't be guaranteed if there are emergencies etc at that time.
So I am like you and working myself up more and more with it. I'm sure it would be fine but it's the small chance that it won't be which stresses me beyond belief. So I'd be interested to hear how you get on. I'm also worried about caring for a toddler post c section. Good luck with your choices getting pushed through, and with the birth.x

[jitt3rbug]

Another elective C-sectionee here with another positive story. waves

Traumatic first birth following a long labour which finished with me being prepped for an emergency section but 'only' needing an episiotomy and forceps in theatre.

Severe PND (which I attribute in part to the birth), two miscarrages, and three years later, I was beside myself with fear during pregnancy number four. From the outset I decided on an elective section and made my feelings very clear on the matter. The risks associated with surgery were totally outweighed by the risk to my mental and physical health (the physical effects of stress and anxiety) if I went for a vaginal birth.

A planned section is a much calmer and sedate affair. You feel much more in control (well, as much as you can be!) which I found helped my anxiety hugely. Yes it is nerve wracking but birth - any which way - is.

I honestly had the BEST birth second time around. I bonded with my baby immediately and actually enjoyed the first few days in hospital, rather than feeling the horror, shock and detachment I had with my first. Recovery was also much easier with the section, very little pain and no infection, and I was driving within two weeks (with my GP's approval). I stayed in hospital for five days (from the day of the birth to discharge) which I think helped enormously both physically and mentally. This was my choice and the midwives were super supportive.

Just discovered I'm pregnant again and, if it sticks, I'll be requesting a section again without a doubt. I know that the NHS attitudes and services vary hugely region to region but the maternity services in my area (east midlands) are fabulous and I cannot praise the staff enough.

Whenever I searched MN for advice when I was pregnant, I always promised myself I'd post something about my experiences in case it could help others too.

Best of luck OP.

[User24689]

Hi all! Thanks for the replies, it really is so good to hear from others who understand. I find it really difficult to talk about this to anyone in RL as i feel so embarrassed by how much my first birth affected me. I don't know about you guys, but I find being pregnant seems to be an invitation for some people to regale me with horrendous birth stories in an almost jokey way, like isnt it funny that this is what woman have to deal with ha ha when in actual fact it is quite horrific. Jitterbug your previous birth sounds awful, you poor thing. Bulldog all the best to you. I do have an update, saw the doctor at the hospital this morning. I was very nervous but the section was agreed I actually didn't have to argue my case at all. She wanted to know that I was aware of all the risks but basically said that it was a common procedure, the chances of anything going wrong are rare and that it was up to me if that was what I thought was best. I couldn't believe it tbh. I have also requested a tubal ligation during the C section as we feel 2 DC is enough for us and I don't want to go through this stress again. That's approved too. I feel an enormous sense of relief! I hope everyone else reading this with the same issue is listened to and taken seriously like I was. I do feel a bit strange now it is organised - an odd sense of guilt that I'm having a baby in an "unnatural" way before he is ready... But what he and my DD need most is a calm, happy mum and this is the best way to make sure that happens!

[User24689]

Thank you Kitty! Yes I'm actually quite nervous about the remainder of my appts as feel like I'm going to have to continually defend the decision but I will breeze it out as you did. I am prepared for this baby to come naturally ahead of time too and seeing the clinic psych again next week to discuss that. The doc today did say that if I present at the hospital at any time ahead of the section date they can do a section then... I can imagine they will try to persuade me otherwise though so just hoping this baby stays put until week 39! It is great to hear a positive story of a second delivery though, thank you.

[NotesToSing]

Go for a c-section, I’d say. The recovery time is grand. As long as your DP takes his 2 weeks paternity leave (or even adds on a few weeks annual leave), you’ll have no problems. My recovery was fine.

[NotesToSing]

Oh, just saw your updates. Delighted for you! Well done, OP!

[AJPTaylor]

well done Op
you might find that having a better experience helps you lay to rest some of the trauma