To be annoyed I’m having to fight so hard to have an elective caesarean?

[OutPinked]

Basically, after three 10lb babies, my uterus has understandably lost its tone. I am 28 weeks with my fourth and final baby but measuring 32 weeks. I’ve been referred for a growth scan which will be utterly pointless as they always are. They’ll confirm he’s a big baby then do nothing with that information because there’s not really much they can do. Passed GTT with flying colours and I’m not obese, it’s just genetics.

First delivery was shoulder dystocia with emergency forceps and an extended episiotomy. Stitches burst open and became infected, I was in agony for weeks. Second delivery was retained placenta and huge PPH, again I was rushed down to theatre then later given two blood transfusions. It still took me weeks to recover and feel human again. Third delivery went ok but I needed an injection to stem the bleed.

Last year I had medical management for a missed miscarriage. Had a massive haemmorhage, went into shock, fell unconscious and needed emergency surgery+ a blood transfusion. Again, it took me weeks to feel human and I was on iron tablets for months.

DP can’t face the trauma of seeing me nearly die again and I can’t face the trauma of doctors piling in from all angles, jumping on top of me and being rushed down to theatre either. We’ve both decided an elective caesarean is safest. There’s no risk to future pregnancies because there won’t be any. If I do start to haemorrhage again, at least I’m already in theatre surrounded by medics who will immediately be on top of it.
It just seems far more calm and controlled and to me, is an absolute no brainer.

However, I have now seen two consultants who have tried their upmost to deter me. I’ve had almost pointless risk factors thrown in my face (pointless because there’s more chance of dying in a car accident but that won’t stop me driving). I’ve been told that I may bleed more after a CS and when I’ve explained the fact its still safer than risking that blood loss after a ‘natural’ delivery they shoot me down by saying they will still be on hand if it happens after a natural delivery. They don’t seem to grasp that I don’t want them to have to rush in from all angles, I want them to just be there from the off. They also try to deter me by mentioning recovery time forgetting how long it took me to recover after my first and second deliveries as well as the MMC last year.

After yesterday’s consultant appointment, I now have to see an ‘expert midwife’ to ‘discuss birth options’ . Seems ridiculously patronising because my mind is evidently made up but it’s just another hoop to jump through... then I will have to see the consultant again if it’s still what I want (it will be). Argh! To me, it’s just another example of women not being trusted to make the right decision for their own body and I’m tired of it. It’s irritating they reserve so much energy to warn women of risk factors during a caesarean but never ever warn them of what can go wrong during a ‘natural delivery’ too.

To me, it’s just another example of women not being trusted to make the right decision for their own body and I’m tired of it

I agree with this 100%. While no surgery should be entered into lightly, it's clear that you are well-informed, have weighed up the risks and benefits and have given it a lot of thought. If men had the babies there would be far more emphasis on choice and less of this paternalistic "we know what's best for you" approach. No one would question their right to make informed choices about what happens to their body.

I had the same, two consultants (one who seemed moderately indifferent, one who was happy to support me) and then two consultant midwives. Both of whom were amazingly supportive.

The first then went on leave to be replaced by a second who literally stood guard over me during the procedure. He stopped the anaesthetists when I started having a panic attack, he made sure DH was in the right place, stopped them doing an unnecessary internal examination and basically that everything that went wrong with my first, didn’t with the second. He was amazing.

I know it seems like a long winded process but stick to your guns, don’t hesitate and I’m pretty certain given your history that you’ll get the ELCS.

Mind you, it can still go off plan. DC2 decided the timing of my ELCS was not acceptable and so started making her own way out early that morning. Still had bloody contractions and an up all night scenario! They just moved my slot to the first one and all was fine though. Could just have done without it.

Hi there. Just wanted ro chime in with my experience. Now im all for doing your own choice. I did. But i wish i knew the risks of c sections om later births before hand. My c sections almost killed me. It can happen after 1 or 2 or even d and cs any uterine surgury. My last baby number 3 implanted his cute self in my scar. I knew this at the start as i was hemorrhaging i went to the hospital and they said he is a scar ectopic. Previously rare as hens teeth but now due to the rise in sections its happening more and more. I had weekley scans up until 4 months with every week on edge at the chance of terminating under drs orders. I was cleared by miss diagnosis. I continued pregnacy and nothing was picked up in routine scans. Until 36 weeks. I got a call from my ob telling me to get my butt to the major hospital 2 hrs from me. This was 3 days before christmas. There it was confirmed my placenta had grown through the scar and into my bladder. I was rushed to have my baby in a total of 8 hrs surgery in 2 differnt theatres. Baby was taken to nicu and i was under the whole time. A team of 30 saved out lives. I hate a total abdominal hysterectomy. Im in australia and no one has died of placent percretta since 2011 here.. but in usa its a different story. Women die from this all the time. I am in disbelief about the difference in care. Anyway sorry to oprattle on. I just wanted to say if you have a desire ro have more children weigh your options. I totally understand your want for a section. I myself had 2 babies 9pd 11 and 10.pd 5 (he got stuck and emergency section ensued) i guess what im saying is if you have the section please pelase when and if you have more children have your placenta monitored closely as it can happen just after one. With regards to finding an ob who agrees with you not sure what country you are from but in Australia unless you go bbn private the public system wont give you one unless medically necessary or if you have had a previous one. A big baby isnt one reason they would say yes to. I wish you the best of luck

To me, it’s just another example of women not being trusted to make the right decision for their own body and I’m tired of it

Yes, I agree with this too.

I'm also fed up with people saying vaginal births are cheaper. Maybe they are but (a) dealing with complications costs the NHS money and (b) most pregnant women don't cost the NHS much in other ways eg being obese or smoking.

The number of hoops you're being forced to jump through is costing a huge amount of money, those senior staff don't come cheap! Stick to your guns and get what you want, I bet a lot of people have had C sections with far less cause than you.

I agree. Is there any scope to change consultants/hospital?

I had a failed induction (including a failed instrument delivery) which turned into an emergency c-section. My next pregnancies the (different) consultants said to me that they would recommend I had a planned section (I agreed - although it didn't turn out that way as they arrived very premature).

Stick to your guns on this.

I’m not always a fan of elective c sections, but in your case I can’t see why they’re being awkward. If I were you and I wanted one I’d keep pushing, I didn’t think - when it comes down to it - that they are allowed to say no?

Op start to kick up a fuss.

This is ridiculous. Utterly awful. Say to the mw yiu only want elc. Can you see any more consultants in the hospital start to get into pals.. Quite nice guidelines..

An elective cesarian section is a) more expensive and b) carries a much higher risk of maternal complications and death than a vaginal birth.

So, the consultants would not be doing their job if they didn’t try to explain those risks and encourage a vaginal delivery.

However, once they have done that, it’s thenyour right to choose. NICE guidelines state that if a consultant is unwilling to perform a c section for maternal choice then they have a responsibility to refer you on to someone who will (print them out and take them with you if you face opposition).

Speak to the midwife, really listen to the risks (I find it worrying that you are dismissing the risk factors they explain as pointless) then make a decision. If you want a section, that is fine, it’s your right and you will get one.

But no one has a right to a complex, expensive and risky medical procedure without first discussing it properly with the people who will have to perform that procedure and look after you.

The issue is I have discussed it twice now with two separate consultants so I am well aware of the risks. I completely understand they wouldn’t be doing their job without first warning me of the associated risks but I wonder why they’re not also stating the risks of a vaginal delivery?

If they were being completely neutral, they would list the pros and cons of both a ECS and also of a vaginal delivery. As it stands all they have done is go in depth into the risks of a CS but said nothing about a vaginal delivery. They’ve negated to tell me I have a 1 in 4 chance of haemorrhaging again for example and that the chance is higher still because this is undoubtedly another big baby. It pisses me off. I also agree that the senior staff I’m being shipped between won’t be cheap and I’ve already made up my mind so it’s surely more cost effective to let me have the CS.

I’m not dismissing the risks but they really are minimal especially since this is my last baby. They listed hysterectomy as a slight risk yesterday for example, that was also a risk during the ERPC’s I’ve now needed three times but I didn’t hesitate then because it saved my life. I don’t consider a 1 in 1000 chance of damaging my bladder particularly worrying and am willing to take my chances, vaginal deliveries aren’t risk free either.

They’re not allowed to say no anymore even if a woman simply wants one because she’s afraid of birth. They just make it really, really difficult to get one. I feel like I’m jumping through endless hoops.

"thank you, yes I've heard what you have to say and fully understand the risks as you've explained them to me. I would like to have my baby delivered by elective c-s for all the reasons I have explained" and repeat.

Don't waiver, be the squeaky wheel OP.

I agree with you completely - and I'm not usually a fan of elective C sections. Keep going and don't give up, hopefully the next midwife you see will sort this out for you.

I agree with you OP.. It is interesting to say the least they they spend so much time talking about the risks if CS, but very little about vaginal deliveries. I also wonder if the risks of elective CS are given seperately from emergency CS as they must be different. Id be inclined to ask why you need to see the expert midwife given you have spoken to two consultants.

An elective cesarian section is a) more expensive and b) carries a much higher risk of maternal complications and death than a vaginal birth

This is a massive oversimplification. It depends on the health and history of the individual mother, what complications have arisen in pregnancy etc. In some cases attempting a vaginal birth may be riskier.

@Cheby
Studies have proven that the difference in cost with an ELCS and vaginal birth are minimal when you account for the long term issues associated with both. Also the risk profile of ELCS Vs vaiginal birth are different but when you look at the risks for the mother AND child then it is impossible to definitively state which of the two is safer.

I have experienced trying to get an ELCS and it is a ridiculous process with bias and prejudice at every stage. I read all of the statistics and information regarding risks and was still treated as an idiot that was incapable of making an informed decision. Worst of all, I strongly believe they intentionally overemphasise the risks of a C-section and minimise those associated with a vaginal birth in order to mislead and manipulate women. This is one area of medicine where from bitter experience I would encourage all women to inform themselves of the facts and don't expect professionals to give you the best possible information.

Good luck OP and I hope they agree to it in the next appointment for you.

I had a CS with my first who was transverse, she was also 9.5lb. I requested an elective with my second. They insisted he wasn't too huge (about 9lb) and made me feel like I was being a princess about it, because I was convinced he was a beast and the idea of a VBAC terrified me. Well, he ended up being over 11lb, and the placenta was almost as big as him. The doctor who delivered him said that my uterus was so distended if I had started to contract it could have ruptured. I'm glad I trusted my instincts!

Threads like yours make me realise I didn’t have to fight too hard to get my elective section agreed, and that was “only” because I had a third degree tear. The consultant refused to acknowledge any of my concerns for my physical health (I was terrified of testing again and destroying my pelvic floor and my continence) but I was really firm that I was so terrified of having a natural birth, the fear would wreck my mental health for the remainder of the pregnancy. That worked. So if you need to play the mental health card, go for it.

I strongly believe they intentionally overemphasise the risks of a C-section and minimise those associated with a vaginal birth in order to mislead and manipulate women

Totally agree with you bumpity. This absolutely does happen across the board and it’s easy to figure out why. Vaginal/perineal injuries are considered commonplace and basically unimportant. Ditto prolapses and incontinence. You only need to look at the vaginal mesh scandal to see exactly how unimportant women’s health is to the medical profession as a whole.

cheby

The biggest cost to maternity section of NHS was, huge payouts o to children disabled in labour.. Usually starved of oxygen needing life long care.

Then as pp said factor in trauma both emotionally and physically from labour and botched births you can't call the difference.

Again stats on which one is safer... Elc in a calm environment is safer than vag delivery.

Op is abandoned big girl and has three large babies. She doesn't need to be repeatedly told about risks.

Once is enough.

Yy haworthier.

It's awful I feel this area has been left behind by feminists its barbaric to try and force women to vag Labour when they ate scared and don't want too for any reasons

Op mine was agreed in one small meeting with consultant. No issues at all. Nothing physical just emotional.

I've been there. The process sounds the same as the one I went through. You just have to stick to your guns. Replay your reasons over and over again like a stuck record. Make it clear you understand the risks and won't change your mind.

I'm surrounded by children so can't currently explain my thoughts on how wrong the current process is!

This must just depend on the individual hospital/consultant. My first birth was a 3 day induction ending in a severe shoulder dystocia, retained placenta and PPH. Recovery was bloody awful etc etc. I'm due next month and literally said at booking in 'I'm having an ELCS this time' and was referred and signed off on the basis of my last birth pretty quickly. However I had a birth debrief last time and got a report afterwards that states that future births should be ELCS which I photocopies for my notes this time.

The local midwife did try to send me to a Method of Birth clinic to discuss my options too, but I told them plainly I wasn't going, and contacted the consultant who delivered my daughter (and who wrote my report) directly. She agreed with me immediately and I got my ELCS date at 28 weeks. To be honest I've not even had anyone spell out the risks to me at all (although I am well aware of them, I've done my own research).

Stand firm OP. Don't be going to see these 'expert midwives' who can't authorise anything - ask for a referral to another consultant who can. It's not like you're asking because you can be arsed to push another baby out is it?! Ridiculous.

But it's their job to tell you the risks involved and make sure you appreciate them, even if they seem pointless to you.

I don’t consider a 1 in 1000 chance of damaging my bladder particularly worrying

No one does, until it happens to them, OP! But they'll be more on side with you if you tell them you appreciate these risks rather than saying you don't find them worrying. One shows more insight than the other.

Sending you to the Consultant Midwife is standard practice, it's worthwhile seeing them