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.

Absolutely, it’s 100% individual. Hence why all the conversations and referral to specialist midwife are intended to make sure the individual gets the best care for them - which is different to just saying yes straight away.

Also, I recovered great from my caesareans. I was out shopping within 5 days and back into my jeans (albeit still sore!) within a month. I thought it was all pretty fantastic - it was during my second caesarean 5 years later that it was flagged how badly the scar tissue and adhesions were, and probably a couple of years after that until the real problems kicked in.

That’s like me, I was pushing the pram in my normal clothes a week later. We will see when I have my twins whether I have extensive scar tissue.

I suspect I do because I have pelvic pain since my cesarean, and I’ve been told it may be an adhesion.

I think though, that it was worth it. I only want 3DC, so once these two are born they can do whatever they need to to repair or fix or remove anything, without fear of damaging or limiting my family options.

I do think it should be discussed but I think they should make it clear thay she can definitely have one if after everything she still wants one.

Ahh Mumsnet... you start a thread to discuss being refused the birth you want and in turn have two posters recommend you have your tubes tied because you were stupid to have a fourth child. Wonderful.

Thank you to all of the many, many supportive posters on here though . You have seriously given me lots of much needed support and advice I have taken on board and will use at the next appointment(s) whenever they may be.

Just wanted to clarify that I wasn’t attempting to ‘rubbish’ the advice of two highly qualified medical professionals. I’m complaining about the fact I was offered no balanced dialogue in the slightest. They were forceful and biased, that is what I believe was wrong.

Also to londoner, you cherry picked the fact my third birth was easier negating to mention the missed miscarriage I had last year where I was also expected to ‘push’ the baby out except it wouldn’t come out. Instead I lost four pints of blood, went into shock and was close to dying. I was rushed into theatre to save my life. DP and I were traumatised and required counselling. My births didn’t quite have the same effect on me at the time, although looking back they were horrific. It is mostly the experience I had last year that has terrified me and because I chose the surgical route during the second MMC, I realised how much safer and controlled that was.

Also wanted to say that if you believe the NHS will put another baby at risk because I chose to have an ELCS you’re frankly deluded. EMCS always have priority, I’m not going to kill a baby in danger because of my ‘selfish’ ELCS .

Also wanted to add that if having children is ‘risky behaviour’, I must lead the most boring life imaginable. I also better inform my life insurance company that I am involved in ‘risky behaviour’.

No, I don’t ride a motorcycle or smoke 50 a day or shoot up heroin, I have children. Party, party.

Best of luck OP - I’m sure you will get the caesarean and I’m sure it will most likely be fine with no issues as most peoples are.

Over three pregnancies I’ve met some lovely consultants and some total twats who obviously had their own opinions etc but I stuck to my guns in every appointment (from the very first midwife appointment at 6 weeks!) and in the end, after many conversations, I got it.

My point is that those conversations, however frustrating and difficult when faced with less pleasant consultants, are necessary because the side effects from caesareans can be really horrible too and some women should be dissuaded (just not necessarily you!)

*Ahh Mumsnet... you start a thread to discuss being refused the birth you want and in turn have two posters recommend you have your tubes tied because you were stupid to have a fourth child. Wonderful.+

I got told I should call social services about my kids because I decided to have another baby while having an anxiety disorder and someone said I was selfish for having another child when DC1 has SN. Aren’t people nice.

Ignore it OP, and I hope you get your cesarean.

Stick to your guns op and don’t waiver. I had an elective caesarean after a 3rd degree tear with my 1st dd. I was under consultant care and she tried to talk me out of the c section every time I saw her and it pissed me off, she even changed my c section date at the last minute in the hope that I’d go in to labour naturally. Just be firm in your response.

Apologies for not reading the whole thread - some of this may have been covered. First, one shoulder dystocia birth puts you at risk of another one, so that’s a good medical reason to have a caesarean. Second, Nice guidelines state that trusts should agree to maternal request caesarean. Third, in broad terms, caesareans are riskier for the mother but safer for the baby. Elective caesareans are much safer than emergency ones. If you want good advice on making your case, go to caesareanbirth.org, which is full of excellent tips.

www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-shoulder-dystocia.pdf
I am sure that you have seen this but there is a 1 in 10 chance of reoccurrence of shoulder distocia if you have had it before. The Royal College of Obstetrics and Gynaecology reccomend that the mother should be given a choice whether to have a vaginal or caesarean birth in these circumstances.
I am frankly amazed that you are having to put up so much of a fight for this.

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.

Their job also isn't to present a one sided discussion of the risks. That is simply not defensible. Based on OPs account there is no way has been counselled appropriately at this point. And that matters, because she could quite easily and reasonably have made a decision to go for a VB based on the one sided, incomplete, failing in legal duty information she says she's had so far. It's not enough for patients to be able to get a section if they're informed enough to realise when they're not being given the full picture and confident enough to insist on better.

I got them to stop measuring at "46 weeks" (actually only 35 by my calculations and 37 by theirs). My baby got totally stuck and I had to have a c-section as an emergency at 39 weeks (37 by mine). It is major surgery and I don't seem to be able to carry babies anymore but I'm glad I didn't have to endure what you've been through more than once. I did discuss elective but there was a real determination for me to have a vag birth. It sounds odd, but talk to someone not involved in the pregnancy process, such as your GP about the psychological aspects to your health, and the mental trauma of everything that's happened, so they can recommend a section for your mental health. It would possibly be better for your physical health but I suspect the best arguments lie in your state of mind and not the state of your under section.

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.

Their role should be:

To review the patient’s history, and current status in order to get as accurate a picture as possible of the patient’s clinical status and needs
To discuss with the patient the risks AND benefits of each method of birth, in general and as it applies to them specifically, given their history and current clinical status
To answer any questions and concerns the patient has and to reach a consensus together with the patient on what is best for them. That may be VBAC or it may be CS.

There will be times when a woman say wants one thing and it’s absolutely contraindicated for them. That’s fairly rare. In all other cases the woman’s wishes should be taken into account. It should t just be a box ticking excercise either way. It HAS to be a genuine conversation with ALL risks and benefits explored and the final method of birth one that’s agreed on.

What’s key is informed consent. Nobody should be railroaded Into anything without understanding and consent. That’s what’s causing distress here.

There is no blanket ‘this way is better than that.’ There is however often a very clear clinical or maternal preference for one method over another and that should be respected. Where clinical need and maternal preference clash (which isn’t that common) then consent is truly vital.

So in this case OP had a clear preference. She feels that this isn’t being taken into account. She’s right. She’s not been given correct risk/benefit analysis. She’s not being listened to. Her wish for a cs should be accommodated unless there is an overwhelming clinical case not to do one. If there is an overwhelming case to avoid cs, which there doesn’t seem to be from the information given, then she should be made aware of this and given full information as to why

In this case, good clinical practice is not being followed. Op should get her cs.

I really hope you get the birth you want as I strongly believe in the right to choice. I just wanted to point out, so that you can be prepared for it, you are also very likely to have a PPH during ELCS, in fact more likely as the uterus is less likely to contact with a scar on it. If this happens, even though the room is full with people, they will still pull the emergency buzzer and people will still come running into the room as many of the people in the theatre are not trained to deal with PPH and they need as many people helping as possible, especially with the level of blood loss you’ve had previously.