Make my decision for me. Please!

[redllamayellowllama]

Sorry, it's a long one.

Am currently 33 weeks pregnant with DC2. I've been posting in this section on and off for the last few months with my procrastinations, so apologies if I'm getting boring!

DS EMCS following long latent phase, long 1st stage, back-to-back labour, brow presentation etc. Born with a large haemotoma on his forehead which is still there. Bad experiences with VE's, communication between medical staff and me and lead to a mini-breakdown in my relationship with DH (on my part; found the idea of sex very traumatic, he was understanding but inevitably lead to drifting apart). Definitely suffered in the early months and can only know talk about it without crying.

I've been for a de-brief, which I found very hard and don't feel like I came away from it feeling exonerated (that's the wrong word entirely, but hopefully you get the gist).

Hospital definitely pushing for a VBAC and I understand all the reasons why, but I'm still filled with fear. My consultant is good and will listen to me should I decide to push for an ELCS. Pros and cons as I see them below, what do you reckon?

VBAC:

-Quicker recovery, able to look after 22 month old DS.
-Baby arrives when ready.
-Less risks associated with.

But:
-Massively afraid and know that fear will hold me back (reading lots of Ina May, doing lots of VBAC Hypnobirthing and still filled with dread).
-Very VE-phobic following first birth.
-Worry about how negatively affected DH will be.
-Will be very medicalised anyway - constant foetal monitoring a must (apparently at St T's this is non-negotiable).

ELCS:

-I can control the situation (obviously within reason - I understand the many risks).
-There will be no need for VE's.
-For some reason there is no fear attached to this option for me.

But:
-Slower to recover.
-Harder for me to be physical with DS.
-Baby arriving when not necessarily ready.

I know only I can really answer this, but some other experiences would be helpful!

TIA.

Can you go to another hospital where they dont manage VBACsso aggressively?

You have every right to refuse ALL VEs and CFM but you will need a supportive birth partner to advocate your views. What about geting a doula?

tribunalgoer - you are right, I do feel like I need a decision to be able to sleep more easily and enjoy the remainder of my pregnancy. I'm due to see my consultant in 3 weeks, which feels like a long way away, but will give me time to further strengthen my resolve and talk things through with DH. I've tried to get something earlier, but there is nothing available. As I said, my consultant has been lovely previously (saw me through first pregnancy and at points during my last labour) and when I mentioned a VBAC at 12 weeks, she asked my husband how he felt and then said, "lets wait and see how you feel at 36 weeks".

I'm hanging on to this and am hoping that I won't have any kind of battle. I have written down a few things on paper and think writing a letter is a very good idea - more of one outlining my thought processes and underlying worries. Were she to then say she felt it best to go for a VBAC, I would call on DH to adopt a more hardline approach.

If no-one minds, I may post the letter here once I write it and get some feedback from you.

Thanks for all the warmth and support you've given me here,

Right, now this is a really long one. I'm posting below the very unrefined draft of a letter I would like to give to my consultant. Your unadulterated thoughts please.

Before DS?s birth, I felt I had prepared myself in every possible way to labour and give birth optimally. I had been to ante-natal classes, read various books on childbirth, practised breathing exercises and so on, Nothing prepared me for the physical pain I felt, how out of control and isolated I felt during labour (despite my husband?s unconditional and unwavering support) and the sense of panic and anxiety that became the pervading feeling during labour.

Following DS?s delivery by Emergency Casearean, I felt a huge sense of guilt towards him (however much my rational side told me this was ridiculous) and found it very hard to bond with him in the early weeks and even months. The constant questions and comments about his haemotoma brought memories of his labour back and reduced me to tears frequently. I still struggle to look at pictures of him as a newborn and can?t look upon those days with much fondness.

Whilst in labour, many vaginal examinations were carried out, some I believe, unnecessarily. These, combined with the scraping (not the medical term, I?m sure) of DS?s head, left me feeling violated and vulnerable. I believe this had a profound impact on my sense of self-worth and self-esteem. I have found any vaginal examinations that have taken place since DS?s birth hugely distressing and the intimate side of my relationship with my husband has suffered, almost irretrievably.

As I look to the impending birth of my second child, I am filled with fear and dread at the prospect of having to have a vaginal delivery. Following my de-brief with a consultant midwife, I felt no sense of closure about Isaac?s birth but was only reminded of the feelings surrounding his birth, which has added to my rising sense of panic.

I have researched VBAC?s thoroughly, have been reading books by Ina May Gaskin and have undertaken a course of hypnotherapy designed specifically for women preparing for a VBAC. Despite all this, the nearer my due date looms, the more panic consumes me and the more frightened I feel.

If I feel like this now, my concern is how on earth will I cope when contractions begin? I feel like the conditions I would have a VBAC in would not be conducive to me labouring optimally: constant fetal monitoring, being in the same ward where I experienced so much trauma two years previously and the inevitability of vaginal examinations. At the moment I feel like a vessel that this is all happening to ? I have no sense of ownership or control over my body. When I think about going into labour, I can?t stop myself from crying and I cannot get over the fear of everything that happened during DS?s birth taking place again. My frame of mind is not going to increase my chances of things going smoothly.

I know that an elective caesarean is no walk in the park, I have researched and am fully aware of all the potential risks. I feel like I can reclaim some control over my state of mind and my body by having an elective caesarean. I know that I can?t cope psychologically with having a VBAC, either ante-natally or during labour.

I don?t feel like my concerns about the delivery of this child and the strength of the emotions surrounding Isaac?s birth have been thoroughly listened to. I feel like I?ve been pushed into a position where it feels impossible to say that I don?t want to undertake a VBAC. I have reached a point now where I know that I would be having a VBAC against my wishes and I don?t wish to go into labour fighting myself.

Hi Red, I think thats a great letter and I would definitely take it with you to your next appointment.

However, by the sounds of it, your consultant is understanding and hasn't actually been the one to say that you cant have a ELCS? After I made my decision I did go in there yesterday with a whole load of "arguments" ready and I just didn't need to use them. I had already on previous meetings stated that I had fully researched both scenarios, as have you, and they put all this in my notes so this is how it went yesterday:

consultant: so lets just have a bit of a chat today
me: I need to make a decision today on mode of delivery?
cons: no you don't, you take as much time as you need, we can just talk about it
me: (bursts into tears) I want a ELCS, Im really sorry but I just don't think I can do a VBAC, I have thought of nothing else to this point, and I want to enjoy the rest of my pregnancy without worrying about this.
cons: thats absolutely fine, you have no need to apologise you clearly know whats best for you and I support that
me: (still crying) thank you!
consultant: lets book a date!

It was SOOOOOO much easier than I expected it to be, but I think thats because (again, like you) I had expressed most of my concerns, talked about what Id read, how I felt etc prior to the actual decision making meeting that they knew this had been niggling me for a long long time and it wasn't just a "oh I cant be arsed to try a vbac" decision.

Consultants dont have a huge amount of time unfortunately so if I were you, I would go in there and just say Im sorry but I don't want to go for a VBAC, I feel that a ELCS is the absolute best option for me, and Im fully aware of all the risks etc and see how she responds. If you THEN don't feel like she's listening or doesn't get it, give her the letter. I really really hope you don't have to fight too much, it does only make it worse but like I say, you may well be very surprised by her response.
Its totally not in their interests to make someone go through labour who is already emotionally distressed as they well know that you are more than likely going to end up in theatre anyway as you're state of mind really will interfere with your progress in labour.
Be strong and stand your ground, you have a very very good case and I can see no reason why you should be granted a ELCS X

I agree with kity (congrats on your ELCS, btw) that you should only bring out your brilliant letter if a simple conversation with the consultant doesn't give you the result you want. Anybody reading it would have to be a heartless idiot to deny you an ELCS this time round.

Good luck with your appointment. You will come back and let us know what the consultant says?

Thanks for the feedback. I shall follow your advice and go in armed with the letter as back-up, but not waving it about. I had toyed with putting it into my notes for her to read before I went in, but if that's going a bit heavy from the off, I shall refrain.

The appointment is not for another 2 weeks, but I'll be back to let you know how I get on.

Fingers crossed!

Red, just to say thank you for such an interesting and useful thread. I'm in a similar-ish position (at 31 weeks) and have been facing many of the same questions and anxieties, and it has been really valuable to read this. Good luck and I really hope this goes well for you.

I attempted a Vbac in may but ended up with a section (didn't progress like last time).My recovery was SO much quicker than the last one,maybe because I was in labour for only 15hrs as opposed to a couple of days!
Then next morning I was up and about with hardly any pain at all,the first time I was bent over for quite a while and found it very painful.

I'm glad I gave it ago but the actual section was a really calm and magical experience.

i also dont buy the ELCS longer recovery thing. I had ventouse and stitches and it took me a while to get back on my feet again

if you can get a ELCS, then go for it. you will have peace of mind and a pain-free birth

if you cant, then try and get the pain relief you want, stay calm (!!!) and remember this time is so likely to be easier

I was so excited when at 36 weeks she thought baby was breach, yay a ELCS I thought! But no.....head down, its coming out old school style!!!!

red, I just wanted to add that sometimes it can seem like things are non-negotiable. When I read the info from the hospital re: VBAC, it sounded like it was very medicalized. But when I actually met with the consultant mw, she was far more flexible - would not need cannula, would not need cfm and can labour in the birthing pool (as long as I get out from time to time for monitoring).

I didn't have a great experience last time either, but it sounds like you have been more deeply traumatized by your experience, plus it's not really that long ago for you, will be almost 4 years for me. I guess one of the things that keeps me going towards a VBAC is the euphoria that women have after having "done it", and the fact that I do want to try to actually push my baby out. Whether this will happen or not, is another matter, but I want to try. But if you don't feel this desire and your fear is greater, then you are right, you will be fighting your own body and that's not the right start for a natural birth.

It sounds like your consultant is very understanding, so at least you won't have to fight for c-section. I think where I am I would have to really fight to get one anyway, so it makes the decision easier in some way. Good luck.

As promised - an update.

Had my appointment with my consultant today who was absolutely brilliant. She talked through all of my fears and really probed on some of the issues (in an understanding, necessary way). It was hard to do, but beneficial, I think. She's agreed to an elective section on the grounds of tokophobia, so I have exactly 4 weeks to get myself ready. She's also referred me for psycho-sexual counselling, has apologised for the points at which I was badly dealt with and has promised me she will personally deliver the baby. I think I love her.

Thanks for all of your support and warm wishes - you've been so helpful in getting me to see what it is i wanted/needed.

Was wondering how you were getting on. SO PLEASED for you! Good luck!!!

Great great news red, so very pleased for you.
You'll at least be able to relax a bit for the next few weeks. Im 10days off my ELCS. Eeeek!
Best of luck X

Thank you both - I do feel both relieved (although still have a little guilt - is it the right thing by the baby etc) and a little nervous.

Kity, good luck for 10 days time - amazing how quickly pregnancy flies by, hey?! A bit of a selfish request (as I imagine you won't be busy at all after having an ELCS) - if anything pops up that you think I should know - i.e. anything you find really helpful to have in hospital - please pass it on! DH and I currently debating whether it's acceptable for me to ask for the screen to be lowered to see DC arrive (he says no, I say yes)

C section, go for it. Hospital are only pushing VBAC cos it's cheaper. Consultant wouldn't agree without a decent reason anyway.

Didn't read all of it

Goodies! An ELCS is less traumatic for a baby than being laboured and then having to have EmCS or instrumental delivery.

I am so pleased that it went well for you. You sound a lot more in control.

I am not pregnant with my second yet (or planning to be tbh) but have had a very similar experience to you. I attempted a homebirth and due to dd's position (transverse and asynclitic), transferred. I had a ventouse, manual rotation, episiotomy etc but nowt worked so had an em cs.

I remember well the feelings of indignity, the shame, the fear, the confusion, the anxiety. I do not look back at the birth or the first days of dd's life with anything but guilt and sadness. She had tears, cuts and bruises and some muscle damage. I see it as my fault.

I was referred to see a consultant after having a v bad time a few months ago. He was wonderful. Open, honest, kind. He promised me faithfully that if I ever have another, he will personally do the delivery, vbac or cs.

Your story so far has given me such hope that you can have another baby and feel happy about it. Please come back and tell us about the delivery.

Hi Red,
Of course I will pop back with a de-brief! Theres been so many threads on here that have really helped me through the whole decision making process and also what to expect etc. So least I can do is throw my experience into the pot!

Im now in the strange limbo land of thinking Oooo what if I go into labour? that will be weird. They've just told me to come straight in and they'll do me asap.
Im with you on the screen lowering thing? you absolutely wouldn't be able to see anything gory or bloody cos your tummy, covers etc will still be covering it, so I think I will ask if I can see them lifting the baby out.

I think if I had to pick a niggle, my only worry at the moment is that it will feel "special" if you know what I mean? Don't get me wrong I really wouldn't swap it for a VBAC. But the thought of knowing the date of your childs birth and walking in that morning knowing by the end of the day babs will be here will be a little strange?
So so excited that the end is almost near.
Will be back with news!
X

Yes - strangely I almost want to go into labour as then I would know baby was 'ready'. Ideally labour on the day elective booked for (the consultant asked me during my appointment whether I had issues with control..!).

I know what you mean about the special bit too - we're trying to avoid telling anyone apart from those who really need to know (i.e. people looking after DS) so that we still have something to announce.

I'm really looking forward to being able to enjoy all of the post-birth loveliness. Last time DH rushed off as he was in such a state and I was so spaced out and overwhelmed I can't remember any of those first cuddles.

I hope everything goes well for you - 10 days is going to fly! x

red, so glad you got your plan sorted and the consultant sounds brilliant.

I found the whole elcs experience actually very special. I knew DS was a DS (sonographer was pretty sure but I wasn't totally convinced), and the date he would arrive on (if he didn't kick off early!) but it was still incredible. After a traumatic first birth I loved going into theatre without pain, the surreal nature of it all, DH back in scrubs but calmly this time - and then, cries of a newborn!

I also wanted the screen lowered after such a detached first birth, was told it wasn't done and in the end I didn't push it with them. By the time the day arrived I wasn't so bothered for some reason, as long as DS got safely out I could wait a second or two to see him. Good job in my case as the 'screen' was a green theatre sheet masking taped to two iv poles They would have had to cut it off to show me what was happening!

As DS came out crying the midwife whipped him straight round the sheet to see DH and I for a moment or two, then checked him over and handed him to DH to hold next to me while I was sewn up. He stopped crying when I spoke to him and I touched him with one hand. In no time I was being wheeled to recovery and he was put naked on my chest before we left theatre. I was so happy he was safely out I really didn't mind about the things I had earlier been so emotional about - the screen lowered, skin to skin immediately etc.

So - push for anything you think is important for you but don't be surprised if details get overtaken by excitement nearer the time!

Oh my god Red the consultant asked me if I was the kind of person who liked to be in control too!! She said a lot of women want to control the uncontrollable and unfortunately birth is one of those uncontrollable things!! ha ha. I absolutely didn't take it personally but I could see her point, maybe I am a bit of a control freak?!?!? But in these circumstances when you have lost all control and dignity etc and everyone else around you is doing things to you (all for your own and babies safety) I think its enough to push anyone to think actually I'd like a bit more say in that next time?!?!

Lovethesea thanks for the heads up on the screen thing, I remember with DS they did whip him round very very quickly and no one said what he was, the midwife just said "look what you've got" which was a nice moment for both of us. they also cleaned him and dealt with him very closely to where we were, so I didn't lose sight of him for a minute. Now this may be totally due to the layout of the room but it helped me as I could watch and it took my mind off what was going on in the bottom half of my body! And like you by the time we were in recovery DS was on my chest for skin to skin so I don't ever really feel like I missed out on those first moments.

God, Im so nervous now! My sickness has come back and I really cant even attempt to sleep in anything other than a sitting up position, spd getting worse and I am permanently attached to a bottle of Gaviscon! Im so so desperate to meet this baby now 9days just seems too far away, am hoping that decorating the bathroom next week will either make the week go faster OR make me go into labour to I meet little one sooner rather than later!
Will keep you posted X

red got to the end of the thread and are pleased to see you've got your answer and everything under congtrol .

FWIW I had an EMCS with DS and a planned CS with DD and second time around it was much easier to recover from. I did stick to the no driving rule for 6 weeks, did bugger all housework, DS watched non-stop cbeebies and we ate lots of ready meals in that time (mmm, Dominos pizza) but it was a small price to pay for making sure I could recover safely.

With regards to the screen being lowered, personally I was happy to see my DC's whipped out (although I was almost as mesmerised by the sight of my insides and my stomach flapped up) but P was really freaked out by it for a long time. He said he could see more than me and there was a lot of blood and he wasn't exactly prepared to see the gory parts that surgeons spend years getting used to.

Glad this turned out so positively in the end. It astounds me that some hospitals give women such a hard time in situations like this. After an EMCS with DD I had already decided I wanted an ELCS for DC2. I was prepared for a battle but at my 12 week appointment I saw my consultant and the conversation took approximately 30 seconds:
Consultant - oh so you had an EMCS last time, so it's really up to you this time
me - ELCS plese
Consultant - right, let's book you in.

Good luck with your ELCSs and for what it is worth, I recovered from my EMCS really quickly so fingers crossed for this time.

Just a little update...

My beautiful daughter was born on Friday by elective caesarean and it was a fantastic experience.

We had lovely, meaningful (to us) music playing and a very calm and relaxed atmosphere. It could not have gone better. Recovery has been great so far - apart from the getting straight into a hot shower following 24 hours in bed and have a big faint number that I pulled. But I only have myself to blame for that one!

So thank you for all of your support and advice. I definitely made the right decision!