AIBU about "Birth after Caesarean" clinic.

[Caff2]

I had an elective section for my second child after previous traumatic birth. At booking in appointment for current pregnancy, I asked the community midwife about elective section this time, and she said she would refer me to consultant again, and did, to same consultant I had last time, and I got an appointment letter through to see said consultant in September.

Today, I had a letter from the "Birth after Caesarean" team giving me an appointment in August to "discuss options for women considering vaginal births aftersection or planned sections". I was confused as to what this clinic was, as I already have an appointment to see the consultant to discuss this. So I rang up to enquire. The hospital midwife I spoke to was quite cagey about what the appointment was for and said it was to "discuss it". So I said "Well, I already have an appointment to discuss the elective section I want with Mrs X (consultant) in September - won't she go through it all with me again?". At which the midwife said "Well, I'll cancel this appointment then, as it's clear to me that we won't be able to change your mind, so there's no point"!!

AIBU to be a bit upset about this and think that they should be more honest about what this clinic is for, as it is plainly to try and talk people out of having planned sections, and not to discuss "Options for women considering vaginal birth after section OR PLANNED SECTIONS"?

The name of the clinic would make it precisely obvious to me what it was for. (shrug)

The same thing happened to me, I was invited to a "birth after c-section clinic" even though I had already made up my mind and said from the beginning that I wanted an ELCS. They made me jump through hoops to get it, and tried all sorts of bullying to get me to VBAC. I had read so much about VBAC I knew more than the midwife running the clinic. My hospital had also won some sort of praise for bringing repeat c-section rates down. I too felt deceived by the letter OP, and talked to like a child. The consultant midwife said "but statistics don't tell the full story, do they" (when I showed her the official stats showing that ELCS are safer after a previous one) and also "I'm disappointed you are not even going to try", and "let's make a deal, if things are not going well and you need an instrumental delivery we'll go straight to a c-section" (yeah, right). It's so wrong but I have no idea what can be done to stop it?

Sorry - I missed some posts - thank you to all who can see that I am not anti VBAC or discussing it at all (except for myself, obviously!). I think that's great.

I, too, like some others have said though, do think this is actually really important - being dishonest with women about this issue is damaging in my view, and really doesn't foster a trusting relationship between women and their medical advisors. It's upset me and made me feel anxious anyway, where a simple, honest letter about a VBAC clinic (what this is) wouldn't have.

It makes my blood pressure rise when I read comments about MW being "disappointed" if someone doesn't try a VBAC. Fuck off with your disappointment.

YeOldeTrout - I don't think it's good that the name of the clinic would have made it obvious (shows an acceptance that this hidden agenda is likely) and also, the main body of the letter (as I've said) really doesn't make it obvious, and neither for quite a long time did my actual conversation on the phone with a midwife at the clinic.

Caff, this is from one of the articles that came up when I googled what you said upthread:

"All women who have had a previous caesarean section are referred to the BAC clinic at 16 weeks and then 36 weeks of pregnancy. A specialist midwife reviews with them their records and discusses the advantages and disadvantages of each type of birth."

It seems like the clinic is there to discuss options, not just VBAC so that's probably why they don't call themselves a VBAC clinic. Another poster upthread has said that she went to one of these clinics and didn't feel pressured so perhaps it isn't what you think it is.

Hmmm. I really do get why you're upset, caff2, but sleep on it for a couple of days & see if it still matters (whilst singing "let it go", obviously )

As a devils advocate, I wonder if you just got the receptionist on a bad day, or were so clear on what your agenda was that she just didn't see the point of doing anything other than cancelling, or there is some other element of miscommunication.

I can't tell if this clinic is being mis-sold/advertised; or if it's actually fab and run by a group of dedicated, caring midwives. To some extent, it doesn't really matter... For you, it matters that you get the best care for you...

That's one of the articles bumbleymummy (I have spent too much time googling this clinic )

The article about the award makes the agenda and purpose of the clinic clear as did my phone call (midwife, not just receptionist, she introduced herself as such).

I think it probably is a good clinic run by dedicated midwives, AcademicOwl (and I am really trying to channel Frozen to an extent ) for women who wish to discuss VBAC and be reassured that VBAC is the way forward.

I may actually re make the appointment to find out exactly how that appointment pans out. That would be a definitive solution to the question, I suppose, and would be great if they do want to discuss my new ELCS and not just VBAC.

I had to fight tooth and nail for a VBAC despite no containdications. My consultant was all for repeat caesarians as he said they 'mostly finish up that way , anyway'. When I went in to labour they still diodn't let up with it!! The baby's heart slowed just for a bit and they were trying to wheel me out of the door.the midwife in the end stood up for me against teh doctor and said lets see lie her on her side and give her oxygen and see if it resolves, and it did!

i am invited to attend one also after I have requested a section because of my third degree tear. I will not be attending. I have no interest in speaking to midwives who are evqngelical about vaginal births and under pressure to get section numbers down. I shall discuss with my consultant of course will hopefully not be so biased.
It only seems to be the UK that is so obsessed with vbacs. Can't be anything to do with money.....

They can't be too transparent or they would con fewer people than they do.

It is all about saving money, I would guess. That and meeting targets, box ticking etc.

Maybe remaking the appointment is the way to find out.

Not at all Bodicea - the US are trying to decrease CS rates as well Other countries are also trying to come in line with the WHO recommendations.

Which WHO recommendations?

What do you honestly think would happen bumbleymummy if I remade the appointment and went along to see what they had to say? Do you HONESTLY think that they wouldn't try and encourage me to attempt a VBAC?

I also wonder how many of the benefits of ELCS they'd chat to me about unprompted.

Bodicea - that's a huge leap that all m/w are evangelical about vaginal births. How do you know your consultant isn't evangelical about c-sections. Each case is individual, and both sets of hp should examine the case and help the patient make the decision that's right for her.

Read my posts. The m/w I saw was extremely knowledgeable, and unbiased. A vbac clinic is about accessing information. It increases vaginal births not because they're pushy, but because women are given choices.

I agree with you wholeheartedly. When I left hospital after my 3rd section, there was a letter in my discharge pack saying that in any subsequent pregnancy I would be referred to the VBAC clinic - the midwife and I exchanged a bit of a look about it, obviously it was nonsense for me and just went out automatically. I was also sent a questionnaire from the VBAC midwife asking for negative experiences from my sections. I refused to fill it out and told them why - I wanted no part in bullying women into VBAC. Luckily for me all of this started just as I had my final dc, so I was able to make my own, informed choices without any pressure. I think that when it comes to VBAC vs repeat section the feelings of the woman are the most important thing to consider - many women choose VBAC without a second thought, others prefer the more controlled environment of a planned section after a difficult previous birth - the VBAC clinic has its place, but only for women who are not sure and need more time and information to consider. It should absolutely not to be used to bully women into VBAC.

Thank God, Micah! You finally call this what it is and is pretending not to be! A VBAC CLINIC!!

Caff they did with me.

Very thorough. Previous birth, progression, outcome. Risks of vbac, benefits. Risks of c-section, benefits. I got given researched, referenced reading material (and as a PhD scientist it takes a lot to impress me!) to take away.

I came out confident in my decision, with a lot of info about c-sections and how to prepare- no need to shave, the showering protocol with hibiscrub, everything.

It has everything to do with money, putting pressure on women in an already vulnerable state to agree to the generally cheaper options.

I wouldn't remake the appointment. They will very likely pressurise you. I'd steer well clear.

If it's just what to call it you want to argue and shout about I'll shut up.

Call it what you want. Assume it's a biased attempt to force you to vbac.

There's no way on God's Earth I'd personally consider a VBAC, TopseyT

Micah - my whole AIBU was whether it was unreasonable that this clinic, which is actually a VBAC clinic to encourage people to have VBACs should be upfront about what it is.

Can we agree that it is a VBAC clinic?

And that it does have an agenda as evidenced by the conversation I had with a member of staff about changing my mind?