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"?

Caff, I'm sure that they would want to discuss it with you as an option and possibly discuss what it is that makes you not want to have one but I would like to think that if you told them that you wanted an CS and the reasons why that they wouldn't harass you.

Muff, maybe 'recommendations' was the wrong word. 'Suggested rate' perhaps? Here WHO statement on CS in the panel on the right.

"Paula Briody, Sian Davidson and Anne Richley planned and implemented a Birth After Caesarean (BAC) clinic to help reduce the number of women wanting to have a caesarean section, which are potentially risky."

It's a VBAC clinic.

Thanks VitaminCrumpet. They don't call other clinics ambiguous and deliberately misleading things do they.

bumbleymummy, as we have discussed, I DID tell them that. They cancelled my appointment then.

It is a VBAC clinic. It aims to strong-arm women away from their favoured option, which they have chosen for many valid reasons.

Money saving and Austerity, anyone?

Well yes, they obviously felt that you had thought about the options and considered which one was best for you already so no need for the appointment. Was she trying to pressure you to change your mind on the phone? If not, why would you assume that that's what they would do if you went to the appointment? Sorry, but I do think you're being a bit UR to judge them and presume that they would have acted a certain way when you didn't even go.

I really really really don't object to the existence of VBAC clinics. I think they are a very valuable resource. I have no idea why THIS one (at Northampton General Hospital) is trying to fudge its agenda; other people's clinics appear to be happy to say what they are and their raison d'etre.

What I object to is an attempt to con me into coming to an appointment under false pretences, and only admit the purpose of the appointment when questioned at some length by a confused patient. And to admit that abruptly.

It says in the letter to discuss options around EITHER method of birth bumbleymummy. But she didn't want to discuss any options around ELCS she wanted to "change my mind" and cancelled my appointment when "it became clear they wouldn't change my mind".

And it took minutes of confused questioning from me and answers like "well it's to discuss it" and "it's to discuss the benefits" and "it's to discuss it again" until we got to "There's no point as we won't be able to change your mind".

If it had been a letter saying "This is an appointment to discuss VBAC" I'd have known what I was dealing with straight away wouldn't I?

As it is, in fact, a VBAC clinic. Not a clinic to discuss other options which is how it presents itself. Until you research it.

Bloody hell, you're like a dog with a bone. Leave it already! Just tear up the letter and forget about it.

You don't know for certain it would be hard sell on vbac, you've assumed that, because you've decided on a cs.
Having decided on one route, of COURSE the mw cancelled your appointment. She'd have done the same if you'd said you were adamant to have a vbac.

Cancelling the appt does not in itself prove its a vbac pushing exercise, just that you don't want to compare and contrast so other options can be taken off the table. In your case, the vbac.

It also makes sense that any birth options for cs veterans discussion will focus more on vbac than cs because the vb but is the part these women have no experience of. They already KNOW what a cs involves.

I can see why you're annoyed. I had a looooooooong labour which resulted in a section and I would NEVER consider a vaginal deliver ever again. If I'd received that letter is be phoning asking "what part of I never want to go down that road again did you not understand!!!!??"

No, it doesn't in itself prove it at all. It's the rest of the conversation, the ambiguous letter and the fact that she TOLD me that there was no point as they wouldn't change my mind. Implying there would be a point if they could change my mind, implying the whole point is to persuade people to try to have VBACs - which if you then research it on google, there's no need to infer anything as it TELLS you that the clinic's purpose is to encourage VBAC.

It is the dishonesty I object to. That's all. What proves it's a VBAC pushing exercise is that that is what the clinic was set up for!

www.northamptonchron.co.uk/news/local/midwives-from-ngh-who-reduce-caesarean-births-up-for-award-1-5822573

"Birth after a Caesarean (VBAC)

At Chelsea and Westminster Hospital we recommend that all women who have had one previous uncomplicated caesarean section should plan to have a Vaginal Birth After Caesarean (VBAC). In some cases this is not recommended and you will be referred to a consultant if necessary."

C&W appear to be more honest in their clinic title.

Jeez- have you actually read that article?

“We now run a regular clinic and workshops, and work in partnership with medical staff to help ensure that women and their partners have consistent evidence-based information to make their birth choices.

“Women in the BAC clinic expressed a desire to hold and cuddle their baby against their skin straight after a caesarean birth.

“We are delighted to say that we now encourage the women to have skin-to-skin cuddles with their baby in theatre with their baby placed inside their gown.”

So they provide birth choices, and have actually enabled women to have the c-section birth they want, with skin to skin.

Yep. Evil vaginal birth pushing agenda there. They are providing birth choices, so it's a bac clinic.

You spoke to one woman and judged the whole clinic on her response to your assumption they'd be pushing vbacs.

They do an excellent job from that article, for all types of birth. Give it a rest now.

I have read the article, Micah, honestly, I've also read my letter and had the conversation, and yes the clinic was set up specifically to encourage VBAC, which I still keep repeating is absolutely fine and great. But it's not what they imply from the letter and the conversation I had was pretty clear too - I do NOT think pushing VBAC is evil, and my original assumption from reading the letter was that it was to discuss issues surrounding EITHER choice, it was the clinic who made clear that that wasn't the point.

What on Earth would be wrong with Chelsea and Westminster's approach as posted by VitaminCrumpet above?

The other parts of the article about skin to skin after section etc are not in response to the clinic, as they have been part of the hospital's policy since before the clinic was set up. I had my own section at this hospital before this clinic was set up. Those things are things that the midwives encourage for people who've had sections, which is great, but not an outcome from the clinic in question.

I will, however, remake the appointment tomorrow, being perfectly upfront that I do not want a VBAC but would like to discuss the ELCS I do want with them.

I had a similar letter. It called it a "birth choices" appointment. Everyone referred to it as the VBAC appointment.

I had my consultant appointment first though, and he said to cancel it as "they'll just try to convince you to have a VBAC, and we dont want that".

In theory they're a good idea, but, well ...

I would really love to say I'm shocked by that, happylittlevegemites, but, well...

I went to a VBAC clinic. They persuaded me that my previous EMCS for non-progression, with complete notes as to how even on full whack syntocin at 41+weeks, for most of a day (abroad) I didn't ever dilate past 2cm was an aberration and I would likely be fine this time. They were so positive and sunny, they sounded so helpful and progressive.

Of course when I came along, twice in one week having been having regular contractions for days (and very little, very interrupted sleep obviously), wasn't dilated still, cried until they let me stay, didn't dilate any more over the next 2 days, much to everyone's frustration (and boy did the midwives let me know) none of that sunny positivity was in evidence, I had consultants, anaesthetists, and midwives trying to bully me into lying quiet on the bed with an epidural while they broke my waters (refused) and finally demanded no more mucking about, I was going to have a c-section.. not the experience they pitched at all.. and all totally predictable by my previous, copious (again, foreign - but in English) notes.. If you're sure. Stick to your guns. What they sell isn't what you get.

I've RTFT - over a couple of hours in a couple of shifts!! - and I'm still not sure. I read the news article too. I can totally see why OP is upset. But a few points/questions spring to mind. Was the woman on the phone definitely a MW, and was she on the team running this clinic? I suspect sending an apt to this clinic is automatic for any woman who had a prev CB and who is pregnant again. The OP has circumvented this by making her own arrangements to see the consultant, but the letter will have gone out routinely. Probably not sent by anyone who ever met the OP before or knows her personal history. The letter does talk of discussing options. If this truly happens then that is a good thing for most women. For the OP less so as she has already decided - and that is fine too. But the woman on the phone didn't know that and had to probe a little, and maybe she did it clumsily, but she had to reassure herself OP was not going to benefit from this clinic. Before she cancelled her appt. Some women will go to the clinic and get the chance to talk about the last birth/s, get information, some won't even be sure a VB is an option for them. In a big service like the NHS it IS very hard to give completely individualised care. And a clinic like this is probably useful to the majority of invitees. Some women will go along and have their mind changed - in either direction - by the information given and that will be a good thing. I'm not talking about bullying and hoodwinking, but the chance to ask questions and get answers from informed and interested HCPs.

I look back over my experiences of having babies - in the 1990s. How much it has changed. Or not! We have moved from a culture where VBAC, esp. after 2 or more caesareans, was almost unheard of and many midwives weren't au fait with the pros and cons - and women felt bullied and patronised and we had to go and seek the information and stats ourselves. Then we'd go to a normal clinic and try to discuss with a HCP who hadn't necessarily read the research (or our notes!) what OUR needs were, and how we felt one type of birth was better FOR US than the other. There was never enough time or expertise, and sometimes it was ghastly. Sometimes you'd have to get another appt because the MW did listen but you had to trail back up to the clinic with your bump and your toddler on a later date to see the right person. Having an umbrella clinic is probably the best way to deal with this. I know the OP has said she isn't against clinics for VBAC but in the way this one was described. And clearly she fell through the net here and she ahs the info she needs to make the right decision for her. But nothing in the information given says they necessarily do the hard sell. There will always be people who perceive it this way (I don't mean OP just generally) and it's true that you cannot keep everyone happy all of the time. Possibly a stretched service is just doing the best they can, and this is - for MOST women who are pregnant again after a previous caesarean - this is still the better way to do things.

But OP, this is how you feel and I think you might feel better if you told your MW that's how the approach from the NGH made you feel. And then do a ritual burning of the letter.

You might have wished to discuss other choices surrounding your birth. A lot of time is spent these days helping patients prepare for surgery. The clinic might have had more up to date info on that.

Don't forget, all choices are biased. Naturally you will base your choice on things that are important to you. It's irrelevant whether you are making an irrational choice or totally rational. For I would weight certain things above others and they would not be the same as you. Don't feel you need to justify!

choices are also swayed by experience. Midwives tend to see the normal going well labours....and Drs the most difficult ones. So a Drs view of birth will be different to midwives. Neither are wrong. Therefore Drs will say oh they all end up,in theatre because the ones she sees generally do!

Indeed bumbleymummy, recommendations was absolutely the wrong word. The WHO don't have a recommended section rate, for any country, and dropped that particular piece of poor science several years back. You will see from the FAQ in the link you posted that they reaffirmed the no recommendation stance quite recently.

www.who.int/reproductivehealth/topics/maternal_perinatal/faq-cs-section/en/

It's important we spell that out in this thread, as unfortunately a lot of people are still labouring (no pun intended) under the delusion that they do. Understandable in some ways as they made much less of a fanfare about withdrawing it than they did about introducing it. Politics politics.

There also isn't a 'suggested' WHO rate either, and nor should there be. The link you supply doesn't include a suggested rate. There is, I grant you, a fair amount of scaremongering and an attempt to overstate the evidence they have: you will see that when they mention the evidence they used, some of it isn't cited (always fishy) and some of it refers to research about the safety of sections in Africa and Latin America. Naturally, the safety of sections varies hugely according to the wealth of the country they're being performed in. As such, any attempt to suggest research based on lower income countries is globally applicable needs to be taken with a very large pinch of salt. But even when they're attempting to push something of an agenda by exaggerating the available evidence, the WHO does not have a 'suggested' section rate for countries.

And OP, you are still NBU.

That's fine Muff. My point was simply that other countries are making efforts to reduce their CS rate in response to a PP suggesting it was only happening in the UK. :)

Apologies for any confusion my choice of words caused.