What do you need to do/ have to get an elcs?

[soppypreggyloon]

My friend is due dc2 same time as me. She's in a right pickle at the minute as she was told by the mw at her booking in appointment that she couldn't have an elcs.

First time round she had 2nd degree tear which didn't heal well at all and got infected. Took her at least 6months to heal and she says it's still not right.
She also suffered from pnd- not enough o require treatment but it's only looking back she realises how bad she was. She thinks that's because of the mess the episiotomy and tearing made.

So could she get an elcs?
How does she persuade someone?

Thanks on her behalf!

Hi,

You may find some useful info for your friend on here.

Hope she has a better experience this time round.

Cheers birdy!

Ive only just started that thread but it seems like everyone had managed to see a consultant about their options.
My friend was only seen by mw and told no.
How does she get a consultant appointment?

Seems you can't have any chance of elcs without a consultant and you need a mw to refer you if you haven't had the automatic reason of a previous emcs.
Bit of a catch 22

A midwife doesn't (or shouldn't) have the power to tell your friend that. It should be up to the consultant to look at her notes and previous experience to see if s/he thinks that mentally/physically she and the baby would benefit better from a c-section, or at least counsel her to reassure her about the birth. I would demand to see her consultant - call the ante-natal department directly at the hospital if necessary and just make an appointment (they never asked me why I needed to make an appointment throughout my 3 pregnancies).

At least then she'llhave it from the horse's mouth.

Good luck to your friend.

Forgot to say that if she wants or can only go through the midwife I would say OK you are not taking me or my birth seriously, please put it in my notes that I have requested to see my consultant and that you have refused and the reason why and I am going to make a copy of those notes and if anything happens during or after the birth I shall sue you.

It's too important to let go. I went with the flow with my second - a vbac and had a harsh experience. Baby all OK, but epidural wouldn't work and had to have stitches fixed without pain relief 7 hours after and it took ages to feel OK 'down there'. My recovery from emcs was so much quicker.

With my third I managed to get an elcs and it was the best experience ever.

As DefNot says, an ELCS is a consultant conversation - it's not the MW who agrees it. Of course she can offer professional thoughts and advice, but it's really not on to say 'you can't.' It's not up to her.

Your friend can request to go via the consultant lead care path, not the MW led route if she wants. MW might well pressure or encourage her to stay MW-led, but she is absolutely entitled to see a consultant.

If she has an unsympathetic or obstructive MW, she can ask for another one. It might also be worth seeing a GP and explaining the situation - it can help to have another HCP 'onside', especially if your friend finds it hard to be assertive about this. The fact that she feels last time round contributed to her PND is a good reason to see a GP.

I would ask for a consultant appointment pronto. And if he/she says no, I would initiate a change of hospital through my GP.

Defnotyummymummy, I think your advice about threatening to sue is absolutely appaling. Think about that for one minute and you'll see how shockingly ignorant and aggressive a thing that is to say. If someone said that to me I would think they needed a psychiatric referral not a section! Can we just remind ourselves this is a third hand conversation and we have no idea what the midwife actually said to this friend.

Does your friends hospital have a consultant midwife that she could talk to?

I saw mine this morning about an elective and she has referred my to the OB to get is sorted.

She let me talk and explain why I want an elective and I fell listened to and respected.

Good luck to her.

I think it's perfectly fine to threaten to sue. The midwife is being obstructive for no good reason. Thinking about being sued may just concentrate her mind or what is and what is not her job.

I don't think defnotyummymummy's advice is appauling. In fact, I agree with it to some extent. But I would not make those remarks until I had exhausted a few more civil requests.

Tell your friend to:

1. Edit anything in the notes with which she does not agree.

1. Go around her and make a consultant appointment first.

1. If consultant is not agreeable, write down her reasons why she wants a section and make it very clear that she wants a section and don't leave any room for anyone to say she was undecided.

1. Write the results of any conversation in the maternity notes -- again making it very clear the section is her clear preference.

1. COPY THE NOTES EVERY TIME THEY ARE UPDATED!

She doesn't need to come out and threaten to sue. Once she makes formal written requests, she will have their attention.

I would do all of this quite quickly so she still has time to change hospitals if the consultant does not agree.

I would absolutley not let them put me off and schedule the consultant for 3rd trimester. It is never too early to plan and don't let tell you (or her) otherwise.

Just ask - well not quite!! But tell your friend she needs to express a clear opinion of why she wants a elc and not a regular birth. I know people who have argued with thier consultant and were given elc. In America is your choice of what you want to do!! MW will never agree with her- she needs to speak with consultant!!

However, be aware it is not easier than vb. The aftercare is excruciating and she better do a good research about c-sec.

Of course she is perfectly entitled to see a consultant. I echo the advice of getting her GP onside if her midwife is being obstructive. I'm in a slightly different situation as I did have an emcs first time round, but I also intially met a consultant midwife to discuss birth options (who was lovely and didn't pressure me at all to have a VBAC, just referred me on to a consultant ob who could authorise the elcs). If your friend does talk to a sympathetic consultant midwife, this might also be an opportunity to find out which ob is most elcs-friendly and get referred to him/her.

Thanks ladies!

I'll pass on all the suggestions but may go withthe slightly more routine requests/ reasons before getting to the serious stuff.

'if anything happens during or after the birth I will sue you'. What on earth does that mean? Do you mean anything you didn't expect/plan for/didn't like? Do you speak to your children's teacher like that? 'If my child doesn't get 10 A grade GCSE's I will sue you' Do you go to a restaurant exclaiming 'I warn you, if I don't like this pasta or get indigestion tonight I will sue you'.
That midwife probably won't be present at the birth of your baby so cannot possibly be held responsible for what happens then.
You cannot hold a midwife responsible for PND, nor can you be sure a section will prevent PND (quite the opposite in fact). Would you sue the consultant who performed the op if you do? Would you sue them if the wound breaks down like the tear did? Especially as it will be a wound on the uterus, not on a superficial area of skin. How about the increased risks of bleeding, DVT etc. Will you threaten to sue them if they say no, or is it just midwives who deserve this type of aggression?

It is not up to the midwife. She needs to demand tosee a consultant and have that conversation with him/her.

I think the NICE guidelines do say maternal request is an indicator for CS

i would say that based on the fact she has a bad time last time, she has grounds to request an el c.s

the MW should refer her, if not she can see the supervisor of midwives and ask her to intercede

threats to sue are ridicolous

and agree with reikizen, your friend needs to be aware of the pros and cons of a c.s , it is major surgery with its own inherent risks

for me, a c.s triggered v bad PND. it is something that needs careful and informed consideration

I'm in the middle of my infected episiotomy/restitch experience, so not at the DC2 stage, but I have been told by the gynecologist who is fixing me (not an obstetrician) that she thinks that all of the obstetricians she works with would give me the choice of ELCS or VB. My GP has said that there is no way that she would risk another VB if she were me and would refer me to someone sympathetic next time. I have heard the you'll probsbly be fine next time line from about 5 MW and I don't think I would go near MW led care again. MW don't see the 6 months of pain or the women too scared to have another child.

Your friend needs to get to see a consultant and not be fobbed off if the first one she sees doesn't agree - second opinions are a reasonable thing to request. She should get a GP referral, the GP who saw the mess she was in last time might be particularly sympathetic.

both my ELCS were maternal request (NHS) - was hard work getting agreement but best thing for me.

I am in reading all this with interest - after a EMCS last time due to failure to progress I am being very much directed to a VBAC by the hospital because "they like to keep their CS figures down" (they actually said this). I think I would prefer an ELCS but am a bit unclear about my rights to insist on one. I also think it is terrible that it depends so much on the individual personalities of the MW / consultant/ mother as to whether or not you get the birth you want. Lots of people on here have said they got an ELCS because they stood their ground and fought for one but that might be very difficult if not impossible for someone who is shy / lacking confidence / bad at confrontation etc or or if the HCPs are personally not very sympathetic. I keep being told I have choices but when I voice one (such as I DO NOT want to be induced after a horrendous last experience) I immediately get told why I should just do as I am told.

"I also think it is terrible that it depends so much on the individual personalities of the MW / consultant/ mother as to whether or not you get the birth you want. Lots of people on here have said they got an ELCS because they stood their ground and fought for one but that might be very difficult if not impossible for someone who is shy / lacking confidence / bad at confrontation etc or or if the HCPs are personally not very sympathetic."

Totally agree, trixie123. It's very unfair.

Trixie, if I were you, I would request a section loud and clear and make sure it's in writing. If you change you mind and decide you do want a vaginal birth, I'm sure they'll accommodate the change. But, you will have establishe your desire loud and clear wo they can't say you were undecided.

thanks Strix. I think it might be a CS by default because I had a GTT today and tested myself as well. Am fairly sure I have GD again which will mean they will want to induce me early and as I am absolutely going to refuse that they'll have to give me a CS if they don't want me to go over due date (assuming DC doesn't come early all by itself). Ironic thing about what I said in the earlier post is that as a teacher I can happily face down a class of 16 year olds but face anyone in some sort of authority and I go to pieces!! Very annoying.

I had an ELCS last time and will probably be requesting one this time. The consultant has said we will discuss again at 36 weeks but I'll be telling her at my next appointment my decision, cause at the end of the day that's what it is. I don't want the be induced early because of GD and then end up with an EMCS or, worse still, rupturing.

You must insist on talking to a consultant.

I agree with reikizen that the suing thing is OTT and agressive, but I for one do understand the sheer panic and distress that can lead to that kind of agression feeling like the only way out.

For someone who has made up their mind that they can only give birth via c/section to be made to wait and wait with the level of stress that can cause for someone who with a stroke of a pen can put them out of their misery is barbaric. Let's face it, by the time they go into labour they're hardly going to do it well are they and will most likely have an emergency c/section anyway.

Sometimes I think we pro-naturals forget that womens choice should be womens educated choice and that is what it should mean. Not, women are free to make a choice as long it is the one that most educated women will make.

Perhaps an alternative to threatening to sue is just to say "If you don't [do xyz] then I will take it further".

It's better than coming straight out and saying you're off to court!