To expect everything to be considered equally by my midwife and doctors?

[FrostyPopThePenguinLord]

Apologies for the long post, I'm stuck at home bored with too much time on my hands!

I'm having my first official midwife appointment on Friday, I say official because it's been a mission just getting to 9 weeks, I've been under the care of EPAC unit since week 4 due to various bleeds and extreme extreme stomach cramps and huge amounts of vomiting. I've been signed off work till the end of the first trimester as my doctor does not think it's worth the stress to my body as the smells trigger the excessive vomiting and I'm in enough pain without adding more vomiting.

It's my third pregnancy this year, I've had an ectopic and miscarriage so far so as you can imagine I'm a bit on edge.
I've been looking into it for a while and I'm fairly certain I want a C section, for anxiety reasons amongst other things. I've looked it up and apparently I can have one at maternal request, I just have to show I understand the risks etc.

I'm concerned however by a number of things I have seen that make me think I won't be taken seriously, numerous stories of midwives being offended and not referring you or waiting until you have no choice but to give birth vaginally.

The pregnancy pack I got given has a bunch of little leaflets in it on various things, there is nothing about Csection, not even as an emergency but there is a lovely colourful one advocating home birth, as in it's all positive....none of the bad things that can happen are put on there, it just makes it sound like it's the best thing ever (I'm sure for most it is, but I want allllllll the medical attention I can get!)

This worries me as it makes me feel like I'm going to be pressured into having a paddling pool in my front room with someone telling me to imagine my cervix opening like a rose or some bullshit like that.

Each to their own, I do not judge anyone for their choices, but I know very clearly what I want and I am prepared to be educated by midwives as to the benefits and other issues concerning other modes of birth. However I'm very concerned that it will be presented to me very differently than an educational information session, rather natural/home birth propaganda.

Im having enough trouble relaxing in this pregnancy with my various issues without feeling like I can't count on the medical professionals who are supposed to support me.
My husband thinks I'm being crazy and I just need to stand my ground but I can't do 30 weeks of stress, it's going to send me insane.
I'm sure my midwife will be incredible, but I've heard so many horror stories I have to ask.

Does anyone have any advice about having to deal with this?
AIBU to want my very carefully reasoned and researched birth choices taken as seriously as any other maternal choice?
I just don't want to get irritated or anxious and then come across as someone who is not sensible enough to be taken seriously.

You're only 9 weeks. I really wouldn't worry about planning a c section just yet.
I would focus on getting help with the anxiety and then see how you feel. Wait to meet your MW and see how things progress.
I'm sorry it's been such a stressful time.

Have a look at the NICE guidelines on c sections. If you want to have a c section you're entitled to, though your midwife and consultant may refer you to a specialist midwife to discuss your reasons for wanting a c section.

Congratulations on your pregnancy and I hope the pain and vomiting resolve soon. Most people I know have found the second trimester easier so hopefully you will too.

They really won't discuss a cs with you at 9 weeks... This is just your booking in appointment. Good luck with the pregnancy.

The midwives give you the advice they think is best for you and your child. For most people, natural, vaginal births are best and so of course their advice is going to swing towards that. C sections have a lot more risks and longer recovery time: it's a major surgery. If that's what you want that's fine but don't be surprised that the midwives automatically advise a vaginal birth. Re natural/home birth propaganda it's not propaganda as it is true: natural is best if you can possibly do it that way. The stuff they tell you isn't false information; but be prepared to tell them what you want to do. I'm a huge advocate for home births as well so I do agree with the midwives on that. Ultimately you must decide what's best for you as an individual but don't expect them to not advise you another way. They are professionals in what they do.

Don't borrow trouble. You're only nine weeks, they won't be ready to discuss anything like that with you yet. Given your history you may well have consultant-led care anyway and you're as likely as not to end up with people who support your choices. I was never given any leaflets about home birth, but I had one anyway and no one questioned it. Then for my second no one gave me any information about c sections, as it was assumed I'd have another easy labour, but I ended up with a c section anyway! You've got a long way to go, don't assume you'll have unsupportive people around you!

Oh I'm fully aware I won't even be considered right now, I might not even make it to 12 weeks for the first scan! but given how many horror stories I've heard, I just wanted to register my intentions early on, I thought the booking appointment would be ideal to start as it's supposed to be the longest appointment you have with lots of time for questions etc.
I've been told some hospitals have dragged it out right to the last moment, I can't imagine how stressful people must find that in a pregnancy without any issues, let alone a more complicated one.
I'm not expecting a date or anything like that, just more of a reassurance that I'll be taken seriously and considered with the same amount of seriousness as a woman who wants to give birth at home.
I've been told to relax so many times it's unreal, it's like, asking a depressed person to cheer up...
I've been hospitalised 4 times this month because the pain is so unbearable, it's made me vomit and pass out, and obviously being worried makes it worse, if I can't cope with that, I'm never going to get through X hours of labour conscious.

Just to add, maternal anxiety is a valid reason for a c section. That's completely different to maternal request, which would be someone requesting a c section with no medical indication. Maternal anxiety is (in some cases) a medical indication for a c section. Your midwife and consultant may refer you to a specialist midwife or other professional to discuss your anxiety and see if you might decide you'd prefer to try a "normal" birth if you receive proper support. But if your anxiety is severe enough that only a c section is going to allow you to cope with the anxiety and enjoy your pregnancy then you should be able to have one.

They won't discuss delivery at all just yet. You could mention it if there's anything you want to find out that you think they might be able to tell you. In my experience they'll only discuss delivery when you're in your 3rd trimester.

I would suggest perhaps getting your anxiety professionally documented as otherwise they may just say "well, everyone has a few nerves" and then "well, no time to be anxious now, you just have to get on with it".

I speak as someone who was pre-booked for a c-section due to breech baby in a position that wasn't going to come out, with "C-SECTION" written across everything, who was still initially left for hours to "give me a chance" of doing it on my own when I went into labour a few days earlier than the planned date.

You really do need to focus on getting help with the anxiety. It's clearly been a stressful time for you but panicking about labour when 9 weeks pg is really not a good sign.
Explain you are very anxious. Maybe a separate GP appointment.

I've been told to relax so many times it's unreal, it's like, asking a depressed person to cheer up.

Ugh, I remember comments like that too. I had pretty severe anxiety during my pregnancy. I was lucky to have a specialist midwife and consultant taking care of me, but the attitudes of non-specialist staff were awful. They seemed not to understand the difference between someone who was just a bit worried about birth (which practically everyone is!) and someone with severe anxiety who was receiving specialist treatment for it. The comparison with telling a person with depression to cheer up is very true.

As a slight voice of dissension although PPs are right that there will be no detailed discussion of delivery plans I have been asked at all three booking appts where I planned to deliver. I was asked if I was considering a home birth and when I snorted and said "no chance, it's a totally bonkers idea as far as I'm concerned" that was totally accepted and I had the hospital birth box ticked with no further discussion.

So while you won't get anywhere trying to pin down a ELCS you can make it clear a home birth is out of the question

Sorry to keep posting, but at your booking appointment make sure you ask if they have a specialist midwife who supports women with anxiety or other issues. My experience was that this specialist support made a big difference.

I have so much admiration for women who can do it vaginally , it's not that I'm against it at all, I just think I'm never going to be able to get to a point where I'm going to be able to go through it without losing my mind with pain and anxiety, the last thing I want is to stress my baby out.
I know they think it's best and the only reason I said propaganda is because I'm concerned there isn't enough fairness being put into the information process. I'm worried I won't be told in as much detail about the risks of 3rd degree tears and the baby not getting enough oxygen etc as there will be about the risks of surgery. I'm not expecting to be told a C section fairytale but I want all the choices equally represented to me rather than glossing over any unpleasantness C section or vaginally.
I've had surgery before, it's a familiar process and I know what to expect (to a certain degree obviously) the pain and recovery for that is much less anxiety provoking, childbirth is an unknown that fills me with horror, it was almost enough for me to decide not to have children at all until I was told there was another choice.
Now it's just getting that choice.

I was in a totally different situation to you - low risk after straightforward vaginal deliveries, wanted a home birth. Ideal candidate, except, even with all the NHS retoric on homebirths, it appeared that they don't believe in them round these parts.

They did indeed drag it out to 36 weeks with repeated consultant and midwife appointments trying to convince me to change my mind, with much alarmist talk involved. Also threats on the day a midwife might not come and maybe I should go in to hospital just to be sure. Very stressful, and a homebirth ultimately doesn't even rely on their cooperation like a CS does as I could have chosen to freebirth.

I'm sorry I don't want to add to your stress but I would expect difficulties tbh. Have you considered hiring a doula? They will have the time to talk through your emotional state with you, and if experienced they will know who you need to talk to in hospital to gain a sympathetic ear. They aren't all anti-intervention hippies lol, I'm sure you can find one who will understand and support you. I'd highly recommend it.

Yanbu at all to get your anxiety documented early and to at least mention this.

Yabu to post judgy inaccurate bollocksy stereotypes about home births. No roses or paddling pools required, thanks, and I am sure you would be offended if I started wheeling out equally offensive generalisations like too posh to push.

You have the right to choose the birth you want. That's non negotiable and if you want a c section you can have one. If a doctor is unwilling to provide one they have a duty to refer you on to a doctor who will.

However, id keep an open mind if you can.
There are a lot of things you posted above which are misconceptions about vaginal birth, pain etc, and your understanding of the risks of the two sounds a bit skewed. It's a fact to say that c sections carry more serious risk than vaginal birth, it is major surgery and is by no means an easy option. I'd listen and discuss properly with your midwives and doctors and make a decision once you have the full facts.

Yes, with a VB you will most likely experience some sort of pain during the birth, and with a section you won't (other than putting cannulae in etc). But the recoveries are so dramatically different; I've had a c section and a VB, I was up and in the shower straight after my VB, I was confined to a bed for 24 hours after my section, catheterised and unable to pick up my baby by myself. I guess I'm suggesting you think about the whole experience including recovery, and not just the birth itself.

Congrats on your pregnancy OP, o hope all goes well for you.

I'm sorry you've been so ill and I'm wishing you the best for a healthy pregnancy.

I understand where you're coming from with wanting a CS and feeling anxious about securing one. I almost wouldn't start TTC until I had reassurance that I could have a CS, but then I realized nobody would speak to me about it until I was pregnant.

I'm not in the UK so my experience was a bit different. But, I am having an ELCS. I didn't have to fight for it in the end, but I was prepared to. I brought it up at all initial appointments, to make sure it was in my notes. I agree with the PP who said that if you have a way to get your anxiety documented, do it. Another thing that I did, which I went back and forth on, was I decided that I would be absolutely firm with all providers about my wish for a CS and not appear to be "open" to other options. That meant I never really got to talk through the idea, but in the end my OB was completely supportive and felt it was the right path for me, so I did actually feel like I'd gotten professional opinion on it too.

I also get frustrated with how vaginal birth is presented. There's very little information about the risks. I've read that this is because it's considered the "natural outcome" of pregnancy, whereas a CS isn't, so they don't have to outline the risks. But I don't think there'd be harm in at least preparing women for what could happen. I have a friend who is an OB who strongly feels that women should be given a choice. Sometimes I wonder how this would all look if it was men who gave birth...

Anyway, I'm rambling a bit. Good luck. You can fight for what's right for you, and I also second the PPs who recommend getting some support with your anxiety, as this could be a long road and pregnancy is pretty anxiety provoking in general.

I would bring it up early and be very prepared with your argument - get Husband/partner in there backing you up too. Only a consultant can decide (not midwife) so you need a referral to one first and be prepared to change if first refuses - all this takes time. I belive they sometimes suggest counselling (I didn't have to) so that also adds time and until you get the date booked in it's adding stress to you at a time you don't need it. I had ELCSs with both mine by 'maternal request' before the Guidelines changed - don't know if things have changed for better or worse since. Good luck.

I do object to the idea that women who want a CS think it's an "easy option." For many of us, there are reasons - physical or emotional - that having a planned birth with a fairly clear set of possible outcomes, risks included - is a better option that a more unpredictable vaginal birth. Not an easier option, just a better one.

@FrostyPopThePenguinLord
I completely understand where you are coming from as I have severe anxiety about childbirth and was very fearful that I'll be forced into a natural birth (I'm due at the end of the year). It's not rational but nothing anyone says helps. I also noticed all literature fails to mention c sections but there were 10 pages on home births!

This was raised in my booking appointment and I don't think that's too early. They asked if I suffer from anxiety (and I don't apart from about childbirth) but when I mentioned it they took it seriously and said they won't make me do anything I don't want to. I'm seeing a consultant midwife in a couple of weeks (I'll be about 19 weeks) to discuss it.

The most recent guidelines recommend that women should have a choice but from what I've heard they're not applied uniformly and it really depends on your hospital how hard you have to push for it.

I completely sympathise with you. It must be awful dealing with such severe anxiety amongst the stress of what appears to be a pretty horrid pregnancy so far. But I think the reason they're not going to ram pro c-section info down your throat is because it comes down to money. A c-section costs the NHS a lot, so if they can veer the majority of people to natural births or even better home births it saves a lot of money.
I personally agree that advice needs to be well rounded and non-bias, I got quite nearly with my NCT leader when she kept harping on about c-sections giving a higher risk of PND, especially as two of our group were having planned sections for health reasons.

I really think you need to seek some kind of professional help for your anxiety though, it's not going to be much fun for you over he next few months if you aren't able to get it under control. Good luck, hope things work out positively for you

I don't give a flying flip about being told I'm too posh to push, mainly because I'm not and also because other people's opinions are the one thing that are not causing me anxiety in this pregnancy. The medical professionals I have to rely on, their opinions do stress me out as they have all the power.

I got the paddling pool and rose scenario from a relative who is a midwife and almost militantly pro home birth. I'm avoiding her like the plague, I'm sure she will have plenty to say about it.
I am not judging home birth/vaginal hospital birth, I've already said I admire it immensely. I just don't think it's for me and I want to be taken seriously, not forced into something that stresses me out more.

I've asked for help with anxiety, all the people at EPAC and my GP have said so far is that they can't give me anything to relax in pregnancy.....I'm not asking for medication! 😂

You absolutely do discuss this with the midwife at "booking in" that's the whole point of the appointment as it is to assess where you are mentally, socially etc as much as physically. Good luck. Early pregnancy is such a strange and anxious time at the best of times.

You can have CBT. You can be referred for help.
It is absolutely your decision if you wish to ask for a c section. And I wouldn't for one instance think anyone who wished for surgery was doing it because they were "posh".
I do though think your anxiety is something you need help with or it will mar your whole pg. Be honest about the extent of your fears. Ask for help. Good luck.