How realistic is this a the fundamental of my birthplan?

[legallyblond]

I would like to say in my birth plan that, at the first sign of any trouble at all, I would like to go straight for a CS rather than "try" other options.

For instance, if I am not dilating very fast, perhaps due to the baby being back to back, I would like to request that, after a certain time of slow progressing labour, I would like to request a calm, "semi" emergency CS, rather than keep going, be exhaused for pushing and have a potentailly dangerous instrumental delivery.

I know this sounds totally illogical, but I would rather have a CS than a natural labour with pethidin and epidurual. I know a CS carries its own dangers, but I would so much rather have a very early anticipated CS than a long drawn out and difficult labour ending in high levels of medication and/or an instrumental delivery.

It seems that often, the mother (totally understandably) wants to keep going with the natural labour, meaning that, when problems arise, it is safer to have an instrumental delivery than a CS. Fine - but I would rather anticipate the possibility of a CS early, even if that possibility is remote, and go for the CS straight away.

Am I totally misinformed and unrealistic here? It is quite possible that I am! Is this an "option" I can state in my birth plan or is the hospital going to do everything to avoid a CS whatever I say!

Obviously, the best would be a nice back facing baby with a straightforward natural birth... I am just trying to think about what I would like if that isn't the case.

PLEASE feel free to come and tell me how wrong I am if that is the case!

I think a lot of us would rather have a CS than a dreadful vaginal delivery with forceps/big tear etc, but I think you are highly unlikely to be guaranteed this. If the baby has descended past a certain point then they will have to use forceps or a ventouse - they can't pull the baby back up and out through your abdomen. Plus, assuming you are in the UK and an NHS hospital, they will only give you a CS if you medically need one - they are very unlikely to have spare anaesthetists/theatres knocking around. Unless you can persuade them that you need an ELCS, then they will be trying to deliver you vaginally until that becomes dangerous/impossible.

Will be watching this to see what responses you get, I have similar written on my birthplan, but it is my second baby, after emergency CS first time round, so I think they will be quite pro going straight to CS anyway. I think they will take note to a CERTAIN extent but maybe not as much as you would like! For me first time round they knew i had been hoping for a homebirth so they were trying to give me every chance to have a natural birth when actually I was thinking "Look I can tell this isn't going to happen, just give me the CS!"

I do agree with emmaKate to a certain extent, but I do think it will make a difference having this on your birth plan. There will be a point where they would make a decision whether to give you a CS, and in my case they definitely extended this decision longer at the last minute (I had already signed consent forms and thought they were going to do it when they decided to try and take sample from DS's head to check he was ok - they failed to get the sample as I freaked out and kicked about three doctors in the head after they held me down for about 10 minutes - at this point they said, "OK - cs")

I think you are probably being a bit optimistic with "but I would rather anticipate the possibility of a CS early, even if that possibility is remote, and go for the CS straight away" - after all there is always a remote possibility of CS!

EmmaKate - this is what I suspect, but I just wonder whether there is an earlier point, before it becomes a question of the baby being too far down the birth canal for a CS, where, if I am vocal about wanting to go straight to a CS rather than try for 1 more hour etc etc, I will be allowed the semi-emergency CS that I imagine must be safest, albeit very conservative in terms of risk management..... I await responses!

I know that the NHS will not want to give me a CS unless I need one becasue of costs and staff etc, but I am hoping to push (no pun intended!) for one in the grey area when it starts to look like a natural birth is not going to plan but before it becomes a genuine panic emergency because it has become acutely dangerous for the baby to give birth naturally...

Wishful thinking?

Impossible to predict I think - will depend on the particular circumstances of your birth, the attitudes of staff on duty at the time, the number of other patients in labour, the number of other CS's going on, availability of anaesthetists etc. You may get lucky, or you may not. I just wouldn't count on it if I was you.

Hmm... that's what I thought. Still, probably no harm puttng it in my birthplan and getting my DH up to speed with what I want, right?

N0 - of course no harm. Just be aware that the prevailing view of NHS practice is against non-medically necessary CS - see numerous threads on MN re how to try and beg for a CS after a traumatic first birth, or for some other reason, so if the medical staff who attend to you at the time think they can deliver the baby with forceps etc, without the need to open you up in theatre, that is what they are likely to want to do, so you won't be pushing against an open door. good luck.

My case was a little different to yours, but after an instrumental delivery/tear/pph with dd following epidural and syntocinon, I discussed my birthplan with my mw, and she suggested that I said I didn't want any attempts to 'speed things up' with syntocinon. She explained that if things needed to happen quickly because baby was in distress I'd have a CS, so there was no need for artificial 'speeding up' which is where it all started to get out of control first time around. Ds was born naturally after quite a long labour (back to back, head high, not pressing on cervix effectively, anterior rim... or something) but we resisted all attempts from mw's to 'speed things up' and felt better for it. Still hurt, but didn't feel out of control, and didn't have pph, and ds was in better shape when he was finally born (9lb 13oz). I don't think its a bad idea to say that you'd prefer a CS to other means of trying to hurry baby along, whether thats syntocinon or ventouse/forceps etc. Good luck

If the baby gets too far down the birth canal, CS might not be a safe alternative to instruments and/or use of position changes.

Do be aware that it might not be an option and that even if it is, you might get a talk about the risks if medical opinion is not in favour.

Are you maybe worrying a bit too much about getting to the stage of having a forceps/ventouse delivery?

I had a Keillands Forceps delivery 7 weeks ago with episiotomy and I can honestly say it was calm, I even enjoyed it. All the staff were so chilled and professional that I felt completely safe. And the episiotomy site has never given me a minute's bother.

I would much rather have that than major abdominal surgery and long recovery period.

Foxy - quite possibly! What will be will be I guess!

unrealistic - it's also what I requested when the midwife suggested a VBAC with DS2. The midwife said that if I was in labour I would never get a CS nwhen I wanted it.

So I opted for a cool elec CS instead

You are not likely to get a cs because things are going a bit slower etc. Hospitals dont like doing them until they are absoloutely neccesary (I had an emcs last time, wanted a elcs this time and was told no! I am having one though as baby is transverse so they dont have a choice!)

However, often they will suggest a cs early on if it might be needed. I was given the consent forms to sign for the last baby within 30 mins of arriving at the labour ward just in case they were needed, though I was left to labour for several hours before they made the decision. Its worth adding to your birthplan though, just so your views are known. It cant hurt, but really dont get your hopes up.