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.

@OutPinked if he's breech then you'll almost defo end up with a c section. I've had both, and I had to do the opposite - my baby was measuring small so I was told I would have to have her delivered at 36 weeks. Didn't help she was breech too and had to have a ELCS at 36 weeks. Wasn't happy with that because Dopplers etc were all fine and consultant wasn't listening to me so I got a second opinion and moved hospitals so I wouldn't be under that consultant. Maybe you should get a second opinion if your consultant is f listening and look to move hospitals within the same trust?

I think that’s my point exactly. The fact she has had a second opinion.

My consultant had a conversation with me and asked me what I wanted to happen. There wasn't some kind of textbook that could make the decision for them. Outcomes relating to the mental health of the mother must be particularly hard to weigh up - which is where actually listening to the patient is a good idea.

So what does it mean if the two consultants I saw for my two babies agreed to elcs without any arguments (just outlined potential risks of surgery) yet the OP's consultants say no? I had a medical reason but much less of one than the Op describes. Consultants will have personal views and also be very subject to the ethos of the hospital - have they been asked to bring down csection rates, for example?

londonerlove

@pickleup I agree but we are talking about the advice of two consultants, not one. The same consultants OP trusts to deliver her child but not trust their opinion.

I very much doubt she trusts them to deliver her child now. But the way NHS maternity services work, you don't get to pick your consultant and nor do you know in advance who will be doing your c-section.

And also, a second opinion is hardly a proper second opinion when given by Consultant B, a close colleague at the same hospital of Consultant A. If you want a second opinion in virtually any other branch of medicine, you go to a different hospital for it. But you don't get that option in maternity services.

So if you’re not happy with the service, then go private.

Also when consultant opinion will vary depending on which hospital you’re at, I think it becomes clear that personal choice is very important.
I agree that the recovery of vaginal birth is downplayed. Also that an emergency c-section recovery is in fact one of the possibilities of attempting a vb, and they can be much worse than elective.

@stickysticks actually you do have that option in maternity services.

So if you’re not happy with the service, then go private

You can't possibly be so ignorant as to think all women have this option available to them.

@minister no I don’t. But I also think if we respect our NHS then we should also trust them. If we don’t trust their opinion why should we trust them to perform surgery?
If we don’t trust their opinion then go private!

Someone may have suggested this but is private an option?

@Londonerlove: some of us have our doubts about the NHS and it practitioners - the trust is certainly damaged. If going private were an affordable option it would certainly be taken. But for most of us, the reality is a hobson's choice between using an NHS we don't trust, or giving birth unattended.

Wow, this thread completely blew up over night . Just had to read a few pages to try and catch up...

Going private isn’t really an option, I’m only a lowly FE teacher and my DP a civil engineer. Both public sector so contributing in that way and both paying taxes, if that helps. If we scrapped the NHS (since my cost for the NHS is clearly an issue), we would pay for private insurance and I’m sure it would be resolved that way. Fortunately though, I live in a country where the NHS exists so I pay my taxes and use it when needs be.

I don’t fully appreciate the choices I have made regarding my fertility being brought into question. It is kind of up to me how many DC I have and my thread wasn’t asking posters to bring that into question... It’s something I feel incredibly sensitive about following my experiences with loss last year too. This baby is something DP and I are incredibly grateful for and didn’t think we would ever have. Not that I’m not also grateful for my three healthy DC, we just wanted a fourth and final baby- is that ok?

As PP’s have staged, an ELCS costa £84 more on average but considering how traumatic my births have been I don’t think they saved the NHS anything. In fact, I think they cost more.

I feel like my life is being weighed up as a cost here, it’s making me feel very weird. My births didn’t get ‘easier as they went along’ londoner . No idea how you think a massive PPH and retained placenta is easier than shoulder dystocia, both were pretty traumatic actually.

My body does like pregnancy, I do fine with pregnancy and thankfully create healthy babies. It’s birth it doesn’t like, in particular the latter stages.

I ended up with endometriosis and adenomiosis and internal scarring that was so big it was mistaken for a polyp after my emergency c-section. It took nearly 2 months post c-section before I felt comfortable enough to leave the house. It took about 6 before I could comfortably lift moderately heavy things. It took a year before my abdomen didn’t feel very uncomfortable and about 2 years for it to feel just about normal. It was 1-2 years before I could comfortably wear jeans and waistbands that were anywhere near the scar. I still feel tightness nearly 6 years later around parts of the scar.
I didn’t realise just how long it took to recover from a c-section. None of that was made clear, but I didn’t have a choice because the midwife and doctor thought DD would get stuck because she was back to back with her head tilted and labour had already been 2 days.

@outpinked my retained placenta was one of the more minor issues I mentioned. I actually experienced something very similar to yours. Excessive bleeding, loss of heartbeat, extended episiotomy, which stopped my contractions as I was freaking out. Forceps, retained placenta with both. A cyst was which was 10x10cm filled with 750ml of fluid. Stitching fell out which was restitiched so tight that I couldn’t walk for 8 weeks. There is more, the list goes on. But all went well and your births do seem to be getting better.
I don’t think people should be commenting on your choice of having another child.
But I think your main problem is fear. Purely a guess. But I’m not a doctor and neither are you. You’ve had a second opinion but it’s still your choice.

I’m sorry to hear your experience green. EMCS’s are far riskier than ELCS’s, twice as much in fact.

I realise the risks, I really do. I haven’t completely disregarded them or the consultants opinions. I haven’t decided I want a CS flippantly. It’s not a case of watching OBEM and thinking they look really calm so I want one as one of the consultants suggested... I don’t even watch OBEM .

It’s mostly down to the MMC’s I had last year. I experienced the trauma similar to my second delivery with the first MMC and with the second, I chose the surgical option. It was far more controlled and safe, it made me realise this time how much safer an ELCS would be too. It’s a matter of being in a controlled environment surrounded by medics rather than having them flood into the room when it’s evident something is going wrong.

Maybe I am scared! Is that such a bad thing? To be scared of almost dying? .

I don’t have medical training but it is my vagina, if that helps? And I’d rather not lose half of the blood in my body from it again or need a consultant to literally stick their arm up it to obtain part of the placenta or have another consultant stick massive BBQ tongs up it after cutting into my butt cheek. I mean...

I’ll share a with you rastard.

Bitcat, if indeed you were putting your laundry 30 minutes after birthing baby #4, then I assume you had a home birth, and I would further assume you had a crap midwife. No MW wants any immediately post-partum woman to be doing non-essential stuff just after birth. It can make you bleed a lot more, faster, and is putting a lot of strain on a body that has just worked very hard.

I had a HB with my second child and my MW was extremely protective of me. Straight into bed with my baby, strict instructions to enjoy my time with my baby, feed him and not worry about the fucking housework. In fact I'm fairly sure both the MWs in attendance cleared up the shower curtain and old duvet I'd given birth over, stuck old towels in the wash and made cups of tea for all of us. They were superstars but I don't know a MW who wouldn't do that.

@outpinked not at all. I absolutely shat myself when preparing for my second birth, which was very similar to first, just slightly lower level. I don’t think fear should be a reason though. We become biased and will search for information we want to hear. Not necessarily looking for a fair argument on both sides. I think the first step should be to combat the fear. I can’t comment on having a c section but have had many tell me it was a great decision and others who tell me the opposite. But I think that decision should be influenced by a professional.

@outpinked that is what birth is about. It’s not supposed to be pleasant. It’s bloody hard and scary. It seems as though you need control. What’s so different from a consultant slicing your belly and sticking their arm inside your body. Then bed ridden for days? What you described above is similar to a c section but just under your control.

that is what birth is about. It’s not supposed to be pleasant. It’s bloody hard and scary.

I thought birth was about having a baby, personally.

The fear won’t be combatted because I am a human being who doesn’t wish to die.

I have weighed up risks of both sides. I know, for example, I have a 1 in 4 chance of another PPH which is something the consultants neglected to mention. That’s a pretty high risk. I have a risk of PPH following an ELCS too but my point is, I’ll be in a controlled setting surrounded by medics ready to resolve it from the off. It won’t be a case of lying down on a bed in a room with one or two midwives and hearing the red buzzer go then having ten doctors and midwives rush in from all angles to pounce on me. That’s the part I want to avoid.

I do have major anxiety surrounding that image, as does DP. We went through a lot last year and my MH really suffered including flashbacks etc. I have had counselling to help with that. We want this baby but not with an attached risk of my near death again.

Shock horror, woman wants to be in control of her own body .

But I think your main problem is fear.

Is that not enough?!

Technically, my ELCS was approved due to PTSD and PND following my first birth. So essentially it was my fear and anxiety that it would happen again.

Surely going into a birth with fear and anxiety won’t lead to good outcomes. Fair enough if it was someone fearful going into their first birth but the OP isn’t in that situation.

OP, for what it’s worth, I was told by a midwife that my PPH history was enough for them to be concerned about the subsequent births enough to consider an ELCS request without the additional mental health impact.

I honestly think that they will give it but that they have to follow the procedure (I.e. two consultants and two consultant midwives). Perhaps you could ask for the HA procedure when a patient asks for an ELCS so you can see how much more you have to go through? Or maybe the next step could just be to say that they clearly don’t want to do it and are causing you additional stress and anxiety which is unhealthy. Therefore could they please direct you to a consultant who will be willing to do it.

I don’t know why people have this idea that birth should be scary and painful.

No one says it about any other medical scenario.