Midwife trying to put me off C-Section

[pinkribbonbon]

Had an appointment recently (28 week one) and told midwife that I’d like a C-Section. I’ve had two natural births and nearly died both times for various reasons and complications. So I’m very high risk for birth. I’ve researched a lot and decided on a C-Section even though I know it’s still high risk (either way is). The midwife started going on about lots of c section related things and said ‘ I don’t have the facts and figures, but it’s definitely linked to an increased likelihood of obesity and asthma for the baby’, without the evidence to support that, how it’s going to change my body forever and if I need another operation in that region it makes it much more complicated, how the surgeon could accidentally cut the babies face, how it’s not good for baby’s lungs and immunity. The thing that’s annoyed me is that none of her advice was specific to my circumstances, and she kept saying how its not a walk in the park- of course it’s not and I’m aware that recovery can be a lot harder, but the fact is I nearly died twice naturally anyway and I’m traumatised. But she kept going on about how it’s not a good idea to have one ever unless absolutely necessary. AIBU to be annoyed? Especially as she said things that were scientific but said that she doesn’t know the facts and figures, I don’t see how that’s helpful. Also, to reiterate, none of the stuff she said was tailored to my circumstances or risks.

I’m not sure if this is relevant or not, but with my second, one of the midwives said to the other ‘do you think that placenta looks complete’ and the other one said ‘yeah that’s fine’. Guess what? Wasn’t fine, left some placenta in which got very infected and I was very unwell. It’s highly unlikely (although possible) that the surgeon will leave some of my placenta in and this is something I’m worried about happening if I went natural. That’s just one thing of many that went wrong though.

Just insist on a section

' I am aware of the risks, I want a cesearean'

I might have been a little oblivious about the risks as my c section was an emergency but it was great, over in minutes an recovery was so quick, walking the next day, pain was managed so well I hardly noticed it. I’ll be doing an elective if pregnant again.

YABU I appreciate she was telling you things you didn't want to hear but women really do need to be made aware of the many serious risks of major abdominal surgery.

I nearly died during my c-section, and I was left in chronic pain for several years afterwards and then needed another operation to correct the damage done by the c-section.

I had a VBAC with my next child, and whilst that wasn't without issues, I had to transfer into hospital to have my placenta removed in theatre, and a nasty tear stitched, the physical and psychological healing was much quicker than with the c-section.

My SIL also had a terrible time after her planned c-section.

You know what went wrong in the previous births, they can be prepared for those things happening again. I'd certainly be taking that over the associated risks of c-sections.

But of course, it's your choice, as long as you know the risks, you can firmly tell her you've made your choice and accept the risks.

If this is true, I hope to god they are getting women's consent for this.

If it’s what you want, stick to your guns. Ask to firm up the plan with the consultant. They do try to push natural delivery quite hard. Mine asked me as I was in the pre-op room if I wanted to reconsider/have another scan in case the baby had moved (breech baby). I’ve had one natural, one c section, massively preferred the c section recovery. Wish I’d done it for both. Everyone has a different experience, but given your history your choice is very logical. Good luck!

Sorry to hear of your prior experiences. I think some midwives are just like this, when I floated the idea of a c-section to the midwife I got exactly the same conversation from her - even the line about the baby being cut accidentally. They obviously do need to make sure you are aware of the risks, but I think for some of them they don’t deliver the conversation very well and have a bias whilst they’re saying it all. If you absolutely are 100% on it, then when they say things like “there’s no need to decide just yet” just be really firm and say “no, I’m absolutely opting for a c-section and would like it recorded now please” it is your absolute right to have one, and if you want one you will get one, so there’s no point joining in on their dance, just be blunt. Maybe unconsciously it makes them feel better if they know they outlined every possibility, but like you said the information wasn’t personal to you, it’s a script essentially. But you know your story, and you know what you need.

I’ve had 2 planned sections with 2 high risk pregnancies. Never regretted either. Easy recoveries both times.
Here’s a leaflet from RCOG which is factual and helped me make my decision. www.rcog.org.uk/media/41jdfprf/considering-a-caesarean-birth-patient-information-leaflet.pdf

Caesarian does promote an increased risk of asthma,
https://pmc.ncbi.nlm.nih.gov/articles/PMC7067498/

the Midwife was just doing her job, she is required to outline all the risks associated with a CS, which are recommended only where medically necessary.

i would ask your midwife (I see she was a stand in) to review your medical notes from your previous births, her job is to advise based on your previous history, she will still have to outline all the risks associated though.

I’ve had three c sections -

First one everything they said could go wrong did - bladder damage, 7 litre blood loss, my heart stopped and I needed resuscitation and then a lovely bout of sepsis - we spent a month in hospital after.

My second planned one was a dream but they did cut the baby’s face - but it was super small and healed with no scar.

My third in November was somewhere in between the two.

It is really important to be aware of the risks and not brush them off. However; the statistics of things occurring include both planned and emergency c sections - so some things, like heavy blood loss are more likely with an emergency C-section as you’re more likely to have uterus atony after being in labour beforehand.

The facts are the facts, you need to do your research before you make the decision. Although I had to have a C-section with my third (11lb baby, previous c sections and a kidney issue) I still really struggled to get a date due to the amount of people electively choosing them (I’m in Essex, I’m sure it differs accords the country) and I didn’t get my date until 48 hours before!!

I had a LGA baby (4.5kg) who was footling breech at 37 weeks, and also I had severe polyhydramnios (too much water) meaning I wasn’t allowed to even go into labour naturally and it would’ve been induced / involved specialists in breech births and a doctor. A senior birth consultant told me I must have a section for baby’s safety and that I hit every risk factor.

I still had midwives telling me I could and should try for a natural birth.

Ignore their nonsense and best of luck.

My baby sadly did have trouble breathing and never managed to latch and breastfeed even though everything was planned and she was born at 38 weeks. She needed some time (3 days) in NICU but was then totally fine. Her lungs just weren’t ready. Still, I’d rather have had that than a dead baby.

I healed completely fine and quickly.

A C-section is serious surgery. If you are going to choose it, you should be able to sit through the downsides of that choice for both you and the baby.

it’s ultimately your decision. That doesn’t mean you should be told that it’s going to be a wonderful experience.

Btw, the surgeon cutting the baby isn’t scaremongering. I have a lovely scar running the length of my back from where the surgeon cut me open during my birth. The only real trouble it causes is itching or occasionally hurting just a little, but that is annoying after 50+ years.

This, sounds like a midwife who was letting her views colour her comments. Impart the facts yes, keep personal views out of it.

I’m a midwife. She wasn’t doing her job. the one thing she should have done which is make a referral to a consultant it doesn’t sound like she did.

She’s supposed to give unbiased information and only discuss risks which are statistically significant unless specifically asked. And actually it’s the consultant at a birth option appointment who needs to be discussing risks as they’re the ones who will be getting formal consent. We need to be very careful that we don’t present information which will brow beat women into choices which we want them to make.

and when it comes to the possibility of increased asthma risk she’s presenting unbalanced information. It’s not statistically significant. While the risk is increased, it is important to note that the absolute difference in risk is relatively small. This means that C-section should not be a major factor in individual delivery decisions, and should not discourage parents from choosing a C-section

plus if someone was concerned about asthma they could do vaginal seeding

its poor practice to talk about increased risk. People should use actual stats. Ie a baby born vaginally has a 1 in 800 chance of having asthma and a baby born by lscs has a 1 in 700 chance.

That’s very poor behaviour on her part and worth considering providing feedback on.

Any advice on risks and benefits should take your individual situation into context and not include scare mongering.

i felt my midwife was trying to steer me towards c-section as opposed to induction. I understood her logic but in the end I did what was right for me, which was induction. Glad I listened to my feelings, all went smoothly, albeit painfully

I have had every birth you can, spontaneous labour, induced labour and a c-section, I had 2 spontaneous labour's which were fine but with my induction it was traumatising, with my 4th baby I had gestational diabetes and they wanted to induce me at 39 weeks I said no and I will have an elective c-section instead, the consultant said fine and booked it for me, the birth was good and the recovery was also fine I was back doing school runs a week later, ask to see a consultant and tell them you want a c-section, midwives like to push natural births as they are trained to deal with those, you need a consultant for a c-section and you can request to see one and get a c-section date

I had an awful first birth, induced, episotomy, forceps, v long labour. I requested a C-section for my second. The consultant tried to talk me out of it but I stuck to my guns. The second consultant I saw was more understanding. Planned C-section was a lovely experience. My vagina birth child has allergies and asthma, my C-section child doesn't. Sounds like your midwife has no understanding or empathy for your previous trauma.

This is just my personal experience, but many midwives can be obsessed with natural births and no pain relief. My first labour was horrendous and mismanaged and ended in the c - section I had been begging the mid wives for and my baby nearly died. Consultants called far too late by midwives who think they know child birth better.

For my second, I had a planned c section and it was a wonderful experience. Went smoothly and recovery time was so much faster. No problem with breastfeeding and baby scores 9 on the scale they score them at, can’t remember what they call it now.

Personally I know more people who have struggled to recover after birth than a c section. I am c section all the way!

Things might have changed over the last 10 years but based on your previous births, do you not have an appointment with a consultant?
That is where I was able to discuss the arrangements for my second child. I was actually surprised that I didn't have to fight for anything. I explained I wanted a CS after the trauma of first child and the delivery, and they basically just said ok that's fine,it's 50:50 and then outlined the risks and I think I might have signed some papers. I can't remember but a date might have even been set at this appointment. The specifics were not organised by a midwife and they just did the routine checks at appointments.

Smile and ask to see consultant. It will be granted. They normally give you an appointment to go through the procedure/risks. Then another for form signing and to book you in for the date (think it was around 36 weeks).

Good luck with your c section. I had one elective and the second was an emergency one. With the emergency one, I was already a single parent to a 2 year old and the recovery wasn’t bad at all. I was doing the food shop a few days after it.

hi OP, you’re not being oversensitive. Some midwives do see it as their job to gatekeep C sections and see it as a personal slight if you don’t have a natural birth. It’s fine to read out the risks of course, but I do think, especially when it comes to damage to baby, that this is one of those areas in which there is massive bias and overreach in giving you one side of the equation but not the other. Yes c sections do go wrong and are associated with slightly higher risks of asthma etc, but natural births go wrong and are associated with a higher risk of oxygen deprivation and brain damage. In terms of getting a live, undamaged baby, elective c section is the safest method of delivery, but you don’t get the micro biome benefits and it is major surgery (though, better than having a very serious tear). How does one balance those risks for the individual case? Some parts of the NHS don’t like to help women balance their particular risks by giving impartial information. They also read you statistics that include emergency c sections and c sections for medical reasons due to maternal or baby ill health (which might have a higher risk profile).

I had a bad first birth that ended in a crash section and so had an elective and had to change my midwife for being very negative. Every session, she tried to change my mind on c section and it got very wearing. Next midwife didn’t try. I just asked to have an appointment on a different day going forward.

I also had a birth choices appointment with a junior doctor in which they gave me the risks (fine), and then proceeded to tell me that 2/3 women in my trust who choose a VBAC have one successfully. When I said to her “ok, so 1/3 don’t. Which do you think is likely for me?”, she said “I can’t advise on that, I haven’t read your notes”. Utterly pointless and I complained to the trust that it was basically just a way of being obstructive rather than giving advice and got an acknowledgement that this meeting was a waste of time (had already had an appointment with the midwife who had read me all the risks and was very supportive of choice, had to sign many forms on the day of the elective, truly, the NHS were covered!).

can you request a change of midwife?

My elective c section went beautifully - the hardest part was getting my fetal medicine consultant to actually give me a date!! And she didn’t right up to the day she admitted me for c section the next day and for 2 doses of steroids in the meantime!!

I had been adamant from the start I wanted a section due to being an older mum, pregnant with twins and was told it was a sensible choice but I could try for natural labour if I wanted to (that was at 12 weeks appointment). Then found I had low lying placenta at 20 week scan and advised I would be wise to avoid trial vaginal delivery if that was my preferred choice unless placenta moved higher - in fact, it went lower and I was diagnosed at 26 weeks as having partial placenta praevia and vaginal delivery was completely withdrawn as an option.

Finally, at 33+6 I was told my dopplers were not looking great and time had come to get me in for c section - up till then, consultant who had been scanning me every 2 weeks from 20 to 30 weeks then weekly to monitor twins growth and blood flow through placentas, had been saying she wouldn’t give me a date as she didn’t want me to think I’d get that far into the pregnancy!!

Recovery was great, up the next day, able to pick up both babies, get in and out of bed by myself, walk around unit and (probably most unexpected) was able to sneeze without pain - unlike some other c section mums on the same ward!! I did get an infection in my wound but it was identified quickly with a swab then antibiotics prescribed (had I been at home it would have been days before anyone could look at it so could have got worse).

People do need to be told the risks of c section delivery but, trying to scare someone off it when they’ve had 2 traumatic experiences previously, is not going to instil confidence in the midwife for that mother and will potentially damage the relationship for the remaining time pf the pregnancy.

@pinkribbonbon I hope that you get an appointment with a consultant soon to discuss your choice and reasons behind it and are listened to - and heard and that it’s arranged for you!!

C section stats in this country are warped by the fact they don’t separate maternal request sections from planned sections for medical reasons, which means C section outcomes are lumped together for both methods. This obviously isn’t ideal as a mum/baby having a planned section for medical reasons are obviously far likelier to have health issues.

A study done looking at maternal request sections found they had better outcomes than vaginal births, which shocked the researchers, but there is now evidence that says a purely maternal request section is perhaps the safest way to give birth. It’s very interesting.

https://www.theguardian.com/lifeandstyle/2022/feb/13/caesareans-or-vaginal-births-should-mothers-or-medics-have-the-final-say

The research and link to it is included here. It’s worth reading. I think women are being done a real disservice when being dissuaded from c sections with data that doesn’t actually apply to them.

FWIW I’ve had two sections, one emergency, one elective. The emergency was okay, recovery wasn’t bad, but the elective was an absolute breeze. I was back driving 10 days PP, pretty much no pain. I’d have another one tomorrow, I’ve got no lasting issues from either other than the scar, and my low-cut bikini days ended quite some years ago anyway.

Oh and I also had one conversation with the unsupportive community midwife before the change that went

“one of the reasons why I had an emergency section last time was because my baby was very big, back to back and malpositioned and I have a small frame and they let me go far too long before realising that baby just wasn’t descending. If I went into spontaneous labour before 39 weeks, I would give it another go, but I do think it’s likely I’ll have another big baby and I can’t really risk another 5 day stay in hospital during Covid with my husband and child unable to visit”

”having one big baby doesn’t actually mean anything. Babies are the size they are - it’s random”

Reader, this is not an accurate statement - the biggest predictor of baby size in multiparous women is the size
of the other babies. This is scientifically confirmed in many studies. When I said that I had read papers on this, she said that it wasn’t true “in her experience”.

I don’t think that midwives get training on the proper use or misuse of statistics.