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 i do hope you get the birth you deserve and that they see sense and give you a bit less of a stressful time. I didnt mean any offence to anyone it was just my opinion. And yanbu at all..you absolutely make total sense. Best wishes

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

In regards to b), that's not what the stats say though, is it? Caesareans overall carry longer recovery times and higher rate of injury, but if you take out emergency Caesareans, elective Caesareans are actually safer statistically to both mother and baby than vaginal delivery.

I was tempted to have elective Caesarean, but I ended up going for a water birth. I was incredibly lucky - it was uncomplicated, short and I had an excellent recovery. I know two others who had an experience like mine. Every one else who had vaginal births :

• One ended up having an instrumental delivery that broke her pelvis, and was still having physio three years later.

• One had a retained placenta, and had to be rushed by ambulance from the maternity unit to the nearest hospital for a blood transfusion. She still has stress incontinence 15 years later, despite exercises.

*One ended up with sepsis, as did her baby (they both fully recovered).

*One had such severe injuries she's had to have three operations in two years to try and repair the damage.

I think the medical profession needs to be more honest about the risks of vaginal delivery - I only knew because of my friends' experiences, researching, and my private antenatal class.

And as well as being honest, they need to stop shrugging off women's injuries and the aftermath as 'just one of those things', and start coming up with proper treatment plans. Maybe vaginal delivery wouldn't be regarded as the cheap option if they factored in proper postnatal care.

It is offensive though, because you want to deny other women bodily autonomy

Thats my opinion BlairWaldorfsHeadband.
If its just because you dont want to give birth vaginally just because then why get pregnant in the first place..everyone knows how it works?
I dont make the decisions so my opinion doesnt count anyway...its not like anything i say will change what the powers that be decide.

I wonder if they factor in the potential of postnatal care when they state that vaginal deliveries are cheaper though? Or whether they even factor in the many possible complications. Or do they simply mean the straight forward deliveries that require one or two midwives to attend, only G&A for pain relief and possibly a few stitches.

My second delivery was like that. I had a second degree tear because she flew out of me so quickly but aside from that, the birth itself was great and fairly quick with only gas and air. Then the placenta retained and I was rushed to theatre and needed two transfusions so it sort of negated the previous complication free delivery. Baby was delivered fine, placenta was a bit of a bitch.

Haven’t read all the comments so apologies if I’m repeating what others have said.

It’s isnt much more expensive. NICE themselves have costed out that it’s £84 quid more on average for a c section when you look at long term follow up (a VBAC cohort vs elcs) due to a percentage of women needing emcs, and long term condition follow up and repair (prolapses etc.) since OP is having to jump through multiple appts with senior people, that 84 quid has been wiped out anyway.

Secondly - it’s your damn body and you should have autonomy over it. obviously there will be cases where what a woman wants isn’t medically advisable and so she has to go for a non preferred option, but where it’s a genuine choice, that choice MUST be with the woman. And that goes both ways - being able to choose MLU if no contraindications and being able to choose c section if no contraindications.

I had to fight like mad for mine - it’s scheduled next week. Four separate appointments, being outright lied to over statistics. Being told only risks of c sections and benefits of VBAC, refusal to look at risks of VBAC at all. Misleading stats when I pressed (lumping emergency sections with electives.) Refusal to consider individual risk factors. It was like a teaching excercise in Poor Clinical Practice.

OP, you need RCOG green top guideline 45 - that has the relevant data in. And you need to be a stuck record. And ask for any refusals/pushing IN WRITING and before you leave their office.

Be polite, always, but be pushy. Your body.

If its just because you dont want to give birth vaginally just because then why get pregnant in the first place..everyone knows how it works?

Because I want children? I get pregnant to have kids, not to give birth. The goal is the child surely?

I'm struggling to know what to say as I can't quite believe BITCATs position...I mean, giving birth is the tiniest part of having and raising a child but apparently you shouldn't have a child if you would just rather have a section. So irritated by all the pp saying that they 'aren't a fan of elcs,' well don't bloody have one then...but don't argue that others shouldn't, even if they have no reason! Good luck with it all OP.

If it’s helpful OP here is the costing reference.

OP I agree that you should definitely be allowed the choice without being questioned. Your body sounds like it struggles to birth (horribly morbid but you no doubt would have been one of those poor poor women 100 years ago who died in childbirth) and like you said, it is surely no cheaper to have a vaginal delivery with loads of intervention than a controlled c-section? At the same time though, if everyone could just tick a box and go for a c-section without consultants trying to dissuade them then it'd just be another back breaking cost for the NHS, so I do see why there are hoops to jump through.

Thank you so much yarn, that is enormously helpful and I’m going to use that to my advantage. I’m very glad you got your wishes in the end and all the best with your delivery . It’s a shame you had to leap through so many hoops to get there too. It will be the same for me, four different meetings before it’s (hopefully) accepted. I think one consultant appointment is enough.

I have insisted on a c-section when pregnant with twins. Hope you get what works for you.

metal midget

You have struck nail on head with your last comments about vaginally injury being the cheaper option, not if they factored in proper care.

One meeting is enough and should be enough.

OP, don't try to argue specific causes (anxiety, large baby, history of haemorrhage) as the reason for wanting ELCS. It makes it easier for consultants who oppose your decision to drag things out for longer in the hope of changing your mind - referral to antenatal MH for anxiety, repeated growth scans every 2 weeks for large babies, etc.

Just be polite, calm, and immovable: "I understand the overall risks and benefits of ELCS compared with VB. After discussions with XYZ (consultants, senior midwife, etc.), I am certain that a VB is not an acceptable option for me. If you are not willing to offer me an ELCS, please refer me to an obstetrician who will." Repeat ad nauseum.

It's very much a lottery of Trust and consultant how much you'll have to fight for it, but NICE guidelines are pretty clear that you should be offered one if the above is true.

I never wanted a CS, elective or otherwise. I've had three vaginal deliveries, two of them with ventouse, all of which I recovered well from. But a recent thread on here opened my eyes a bit about the pressure on some women in the NHS system to not go down the CS route, combined with what seems to be a real disregard for the women's experiences (and, secondarily, for the false economy it clearly often represents). I find it very troubling. I'm abroad and suspect/believe that if I had insisted on a CS at any point I would have got one. I didn't have perfect care - had some issues postnatally with dc1's breastfeeding, in particular - but the pre- and intrapartum care did all feel very led by my (and of course the baby's) interests. The accounts on here make it seem as if it's a very different story in the UK

It is after all an op and will take longer to recover from. After baby four i was up putting my washing on within 30 mins..you wouldnt be able to do that with a c section.

Recovery time depends on what happens, genetics and luck though. I was dancing with my 3 year old at Messy Church 2 days after my 2nd emcs. My SiL who had horrific tears with both her vaginal births, was still sat on a rubber ring crying at that point.

I think that geekaMaxima's advice is perfect. Just keep repeating it until they listen.

My first was a planned but non optional CS (placenta previa, so no choice.) I was recovered far, far quicker than 3 of the 4 women I knew who gave birth that month. They all had awful vaginal deliveries, forceps, third and fourth degree tears and in one case a badly broken coccyx. Two are still suffering now almost three years on. The fourth had a textbook vaginal and recovered really fast - that’s the point, you don’t get to choose what kind of vaginal birth you have. It can be fantastic or it can produce serious injury. A section is never going to be as easy to recover from as a straightforward VB but it does remove some risks entirely. Many pelvic injuries are not fixable with current surgical techniques.

Women should be given much more accurate and comprehensive information on both methods. Neither vbac or elcs is always the better option - what’s safest depends very much on your individual circumstances. And that’s what consultants should be using those appointments to talk about - ensuring women know the risks AND benefits of each method and exploring what’s right for them. It might be vbac and it might be cs.

If that’s not done, it cannot be an informed choice.

The costs itself of all the consultant appointments you'll have to go through is ridiculous ... I had an ELCS due to a breech baby (despite them forcing me into attempting to turn him - never do that !!!) and it was fine. Please stand your ground.

OP, were both the consultants you've seen men? If so, maybe ask to be referred to a woman, it could be that you get agreement very quickly. Unless, of course, she's like the pp who was up and about and doing the washing straight after a vaginal delivery - which I very much doubt somehow.

Thank you geek, that’s very sensible advice I’ll definitely be following through with at the next appointment. Stonewalling seems to be the best option rather than entering into a debate.

I saw one female and one male consultant. The man was actually kinder than the female but he was still vehemently against an ELCS. He stated he “wouldn’t put his wife through one unnecessarily so wasn’t willing to put me through one” . I’ll be back to the female one after seeing the consultant midwife... she basically dismissed a c-section as a stupid idea so that should be fun.

I was up and about straight after my third (non-ventouse) vaginal delivery, pretty much. Walked the ten minutes home 4 hours after the birth with dd in a sling. I had an induction, an extremely precipitous labour (2cm to birth in about 20 minutes) and a first-degree tear. But there's absolutely no reason to think that that should be the case for anyone else having a vaginal birth, nor that it's particularly desirable. It was fine for me - that's where it begins and ends.

I'm so sorry you're going through this it must be so stressful. It sounds like your previous births were really traumatic. Have you checked out the birth trauma association and the support they can offer? They have a private Facebook page full of lovely supportive people and I've found it so helpful talking to people on there. Hope it all goes well for you and you get the birth you want and need. It sounds like an ELCS is the safest and calmest option. xxxx

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

Links to sources on this statement please.

I long for the day when how a woman chooses to deliver is nobody else’s business except hers. All the ‘I don’t agree with elective C-section’ bleaters, wind your necks in! What business is it of yours how a woman delivers HER child.

Good for you BITCAT, you can barely write but you manage to put on a load of laundry 30 minutes after squeezing a baby from your vagina. A medal is on its way.

OP, insist and insist. It’s a disgrace you even have to.