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.

I understand but I think it’s different for each case.

In my situation, I had decided before pregnancy I wanted an elective. It was my first and I had no previous trauma, I simply found the risks and methods associated with vaginal births to be unacceptable to me personally.

I wasn’t under any illusions about what cesareans were or that they were risk free.

I think it’s for consultants to try and work out who is informed and who is perhaps unaware of the risks or alternatives. For example, someone asking for an ELCS due to horrific pain in a drug free birth should perhaps be told about epidurals and various methods of pain relief, before just giving them an ELCS.

I would’ve found the hoops patronising as I knew, for years, that I didn’t want to do it naturally. I think it’s a very individual thing.

I remember also finding the hoops patronising, and I think consultants should be schooled in how not to sound patronising, but I still think the drawn out conversations need to happen.

I was a huge fan of my elective caesareans, no problems with recovery etc. It has only been in the last two years when I’ve been shown images of how messed up my insides are directly due to the scar tissue and incisions that I’ve changed to a more moderate perspective - that it’s risky and I’m not sure that non medical people can fully understand the long term ramifications. It was hard to appreciate (or fully care) at 25 that in my 30/40/50s and onward my quality of life could be impacted because of surgery I chose to have.

Vaginal births have their own horror stories - none of its great to be honest but the hoops should be considered a burden of care not patronising.

Were the risks fully explained? And if you don’t mind me asking, are they fixable?

The issues I have are

1. plastic surgery is allowed, providing someone is of sound mind. Not on the NHS but it’s stilll perfectly legal to consent to surgery you don’t have a medical need for based on what you want

And

2. the risks of vaginal births aren’t explained and laid out the way the risks of a cesarean are.

For me, the risk of say, a hysterectomy is one I’m willing to take. I don’t want any more children after DC3 is born and my own mother had one at 35 and has been fine, therefore I’m far more okay with that than I am with the risk of shoulder dystocia.

I do think conversations need to happen but I don’t think it needs to be as complicated as it is.

But also some risks are more acceptable to some women than others

We are unique individuals and for two women in exactly the same situation with the same risks/history, they would want different births because the risks they are happy to take are different. That’s up to the woman as it’s her body, her life and her choice.

My caesareans were 5 and 10 years ago, I was very fixed in my view that they were necessary due to the ptsd. It’s probably still the decision I would make today - I had complex ptsd and still had flashbacks to the delivery at the time of my first caesarean.

What I couldn’t comprehend at the time is that it wasn’t simply a risk of hysterectomy. After a stillbirth I would have risked that every day of the week for a healthy baby. Instead it’s been years of problems, back and forth to the dr/hospital. Misdiagnosed a couple of times, pain, flooding, scans etc.

I have adenomyosis, with the scar area particularly involved. The scar is unstable and so my bladder is pocketing through into my uterus. My anemia was so bad at one point I was hospitalised.

I didn’t see any of this coming and I wouldn’t have listened! I’m otherwise fit and healthy. This is what I mean when I say I genuinely think 99% of consultants aren’t trying to be difficult on purpose by trying to dissuade from surgery, I’m sure they’re just trying to save women from future pain.

That sounds very tough and unpleasant.

However, vaginal births carry risks of awful prolapses, episiotomies gone wrong and long term issues too, so I don’t think it’s fair to paint a cesarean as the more risky option.

The risks are different with each

Yes there will be women who were approved an ELCS but ended up with bad side effects, and regret the decision

There will also be women who were denied an ELCS and end up with lifelong side effects from the birth they went on to have, whether an EMCS, forceps delivery or difficult VB.

For me, if I made the informed choice to have an ELCS then I would accept the responsibility that I CHOSE this method of birth and agreed to these potential risks, not say the consultants should not have agreed

Absolutely not saying the consultant shouldn’t have agreed. I’m through the other side now but my ptsd was bad and I’d probably make the same decision again. I’m merely saying that the hoops the OP is currently jumping through are there to inform and potentially dissuade some women from having electives and that’s not a bad thing in every case - there’s been an attitude on this thread that the consultants are being stupid/ill-informed or deliberately difficult and I just don’t think that’s the case.

I also don’t think caesareans are the risky option - I was fairly lucky physically after my vaginal delivery but it still wasn’t pleasant. There’s no easy or safe way to get a baby out - I know some people think birth is great but once it’s gone wrong for you the blinkers are off.

There’s no easy or safe way to get a baby out - I know some people think birth is great but once it’s gone wrong for you the blinkers are off.

Yeah I agree with this.

Oh, I see. Yes I agree it’s very important for a woman to have the risks explained to her (in a non-bias way with the risks of vaginal birth and emergency c-section laid out as well) and for the consultant to say what the hospital would recommend based on xyz.

Interestingly, there was a trial over by a hospital for women wanting maternal request c-sections. They saw these women early on in pregnancy (somewhere after the 12 week scan I think) instead of the later stages which is usually the case. The women were reassured from the start that if they ultimately wanted to choose an ELCS then the hospital would support this and carry one out, however their aim was to support them with their fears of vaginal birth and see if that would become a more appropriate choice (they did things such as make birth plans and show women they were free to decline forceps etc if they wished). 90% of the women asking for ELCS ended up opting for a VB- more successful than just trying to tell women no, refusing to talk about it until late on in pregnancy and trying to scare them. I just think a lot of people would hate and resent the fact they still ultimately had power and agency, a choice and say, even if hardly any chose a CS.

nellierose there is a lot of wisdom in your post.

I’m certain that it was the refusal by the obstetric consultant to have a sensible discussion with me that pushed me over the edge towards a CS.

All I could think was - this women can’t be near me if I’m in labour.

Fortunately she also wasn’t anywhere near me on the day of my planned CS but I suspect that was chance.

Stand firm.
My first baby was stillborn (not related to the labour/birth process) and for subsequent pregnancies I was given option of ELCS - And I ended up with them due to breech babies.
Seems that the mother almost dying (or being very ill) on more than one occasion, isn’t given as much credence which is so sad.
Having a clear plan of action through elcs was key to my precarious mental health whilst pregnant, surely the professionals can see this being a huge source of anxiety for you too?

I can't believe the difference in trusts. I had an ELCS with my first because he was measuring large, his head ewouldn't engage and the sitation didn't look like changing. the idea of an ELCS was mentioned by a consultant and seconded by another, I never even mentioned wanting one and was advised to have it - never regretted for a second, he was clearly too big for me to have any other way, although some midwives pulled their faces (the evening of his birthday!!) when they found out I'd had an ELCS because of his size
Now I'm pregnant with my second, any medical professional I've met so far has ASSUMED I'm having another C-section. I'm actually open to a VBAC if the baby doesn't seem another whopper....but if I say yes to another ELCS, it will literally be agreed immediately....fingers crossed for you op!!

I was a huge fan of my elective caesareans, no problems with recovery etc. It has only been in the last two years when I’ve been shown images of how messed up my insides are directly due to the scar tissue and incisions that I’ve changed to a more moderate perspective - that it’s risky and I’m not sure that non medical people can fully understand the long term ramifications. It was hard to appreciate (or fully care) at 25 that in my 30/40/50s and onward my quality of life could be impacted because of surgery I chose to have.

The same is also true of attempting vaginal birth though. Had you delivered vaginally, you would for example be facing a higher risk of prolapse now. You might also have ended up with one or more EMCS when attempting a VB, and thus been at greater risk of problems with scar tissue. Women can't and don't understand the long term ramifications of attempting vaginal birth either, because the NHS doesn't explain it. There is nothing in OPs posts to suggest the consultants she's seen have done so.

As for consultants having a broader view, well, they're supposed to. Ideally. But being human beings, some of them have their own agendas too. Not just against ELCS either.

I do completely agree that vaginal births can cause significant damage.

My stillborn son was a vaginal birth and he was 11lb so I do understand the ramifications of that.

My stance is simply that the ‘hoops’ and long drawn out conversations that the OP has encountered aren’t necessarily a bad thing or patronising. An elective caesarean means electing to potentially have further complications in the future. They may be the lesser of two evil but they should still be discussed at length - perhaps that means repeating yourself and it being a bit annoying or feeling patronised in some cases.

The hoops and long drawn out conversations are definitely a bad thing if they've failed to appraise OP of the risks of attempting a vaginal delivery. Which appears to be what has happened based on her posts. The problem isn't the discussion, it's the bias. Sorry to hear about your son btw

I’m all for informed choice. However, the long drawn out conversation that the OP has had to have were not actually conversations. There was no dialogue by the sounds of it. It was more a case of ‘you can manage a vaginal birth, don’t worry’. Maybe the OP can manage but it is not what she wants to manage.

With regards to birth injuries, I have recently been told by a 70 year old women about the problems she is experiencing now, 35 years after her last child was born. Apparently episiotomy scars can become absolute hell after menopause. It has affected her and number of others but at their age, a trip to the gynaecologist only happens as a private patient and the one that went private was told there really isn’t much they can do.

I, for one, would like to see more research into birth injuries not just in the short term but long term as well. Then we might be moving towards informed choice.

I was sent to specialist midwife after asking for selective Caesarian. Spoke to her, told her about my fears (it was my second preg) and the next time I saw my consultant, he simply whipped out the calendar and asked me to choose the date for my c-section.

The thing is, OPs aibu is that should she be annoyed about having to fight so hard for an elective...I’m simply saying that due to the complications that can arise from any abdominal surgery that, no, the consultants are right to question it all thoroughly, even if that means some frustration.

I didn’t get the go ahead for my caesarean until 32 or 34 weeks, I had different consultants saying no or wait and see for months, not to mention trips to midwives. I found it all really annoying at the time but I got the caesareans and I’m sure OP will too. But there are huge risks in choosing to have surgery (as her third birth was ok ish then this is a choice/lesser of two evils situation) so the consultants aren’t wrong not to just agree straight away.

OPs use of the term 'fight' isn't just about length and number of appointments though. It's also pretty obviously relating to the failure of the consultants to provide her with any kind of balanced picture. She appears to suspect she's encountered some of the providers who simply want to persuade her not to have a CS. It would be perfectly possible to have long appointments providing her with a balanced picture, as opposed to simply trying to talk her into one option, where she's not made to feel like she's fighting. And in fact if she were given accurate information and the trust complying with both their legal obligations and NICE guidance, that's what would happen.

I think it rather sounds like the OP is on track to get her caesarean. No, the consultants probably don’t think she should have one - she’s had some horrendous issues but the third delivery was managed ok and this one could be too...but she’s perfectly within her rights to request an elective so she’s been referred to a specialist midwife etc and then, according to many other posters accounts on here too, she’ll probably get the green light.

By taking the time to talk about the dangers of caesareans they are doing the right thing.

Drs are not super human or god like by any means but they absolutely do know more about female anatomy and risks of surgery than none medically trained people...they are the experts and threads like this are full of people saying not to listen to them or to get further opinions until the OP finds one who agrees with her. Their job isn’t just to agree immediately with what the patient wants if it’s going to hurt them long term - that’s the point of conversations.

I didn’t get the go ahead for my caesarean until 32 or 34 weeks, I had different consultants saying no or wait and see for months, not to mention trips to midwives. I found it all really annoying at the time

The issue I have with this is its crap for women with anxiety. Uncertainty really bothers me and not getting it agreed until later would’ve really upset me, because I’d have felt like it was hanging over me and I’d be in a constant state of nerves.

For me, I felt like a vaginal birth was walking to my execution. I know that’s extreme but I was convinced j would die during it, because several women in my family have had awful births and I was convinced the same would happen to me.

What they said to me was “it’ll be signed off later but you will definitely be allowed one.” which was fine

I totally get the anxiety thing - my caesarean was after my first baby was stillborn so I was a total mess throughout the next pregnancy to the point I was signed off work due to ptsd.

What was repeatedly said to me before and since my caesareans is that if a vaginal birth goes well or even just ok then recovery is quick. Even a good caesarean can leave you with problems later down the line because any surgery, particularly in your abdomen, results in scar tissue, adehesions and other issues. That’s not to say vaginal births can’t be totally awful too but it is different to choosing to have massive surgery.

Despite the fact I’ve been unlucky to have all the problems, further operations and I’ll probably have a hysterectomy in the next year or so because of caesareans I’d still make that same choice because of my situation. I’m sure the OP thinks it’s worth it too - however it’s no necessarily the best choice for a lot of women who initially request one.

That is true but it’s also true that different people recover differently from surgery. I recover scarily fast, something my son has inherited (he was attempting to walk out of recovery after his surgery and had to be held on the bed!).

I know others who heal really slowly and feel awful for a long time afterwards.

This is why I think it’s a deeply personal and individual thing.