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!

Trixie, if a verbal conversation is not your thing, you can always write it in your notes (and copy them in case you need them).

When I asked for an elective when I was about 16 weeks pregnant with DS, the registrar told me it was "way too early to be having this conversation". And I think I replied that it was never too early to plan. I was clear about my preference for a section. She convinced me that I needed to wait until 36 weeks to schedule it. When I got my notes back she had written that I wanted to talk about method of delivery but I was happy to wait until 36 weeks to decide whether or not I wanted a VBAC.

I was and and I wrote my own recollection of the conversation in the notes. At my next consultant registrar appointment (at 36 weeks) I casually mention that I had copied the notes. I also showed up with a copy of the Nice guidelines (which I didn't need to use). It was clear at this point I wasn't backing down. And it was all in writing so he booked me in for section. However, they had made me wait so long that guess what... the schedule was pretty much all booked up. He wanted to schedule me for 40 weeks. I lived quite far from the hospital and was absolutely not prepared to ris going to my local (shit) hospital. So I argued for 38 weeks (was actually only one day before 39 weeks). AFter much persuasion, he agreed. Now, of course, if they had scheduled the section the first time instead of telling me it was too early to have the conversation DS would have been born in the 39th week and we would all have been happy.

So, don't let them bully you out of an early conversation.

As it happens, I am now pregnant with DC3. I went to talk to the consultant (and actually saw the consultant! ) at about 24 weeks. I asked for a section. He agreed almost immediately and turned his screen toward me and asked me to pick a date. So, I have had the luxury of peace of mind throughout the pregnancy. This is how it should be. .

I don't actually think the 'suing' thing is so ridiculous, though I wouldn't phrase it in quite that way.

Both VB and CS carry their own set of risks, and it should be up to each woman to decide what risks she is willing to undertake. If she declares clearly that she is not willing to take the risks posed by a second VB, and is forced into it by the hospital, and then sufferes the after-effects she was worried about, she does have very good grounds for feeling that the hospital is responsible.

Instead of mentioning suing, the way I would handle this is by saying some version of 'so you're willing to put in my notes that you understand I'm very worried about the risk of rupture/second episode of PND etc, and would prefer to take the risks inherent in CS, but you're forcing me to go ahead with a VB anyway'. I think most consultants would take her more seriously at this point.

I had an ELCS because I requested one.

DS was a failed induction due to PE followed by a EMCS after 28 hours of stop/start labour and agony. I was told many times that I should have a VBAC. One consultant even laughed at me when I mentioned a ELCS but I had a sympathetic midwife and kept asking and I got my date in the end.

If the midwife is uhelpful go straight to the doctor. If the doctor is unhelpful go straight to the consultant. Don't let them bully you or sweep your concerns aside.

again, STRIX, thanks so much, there are some great ideas there and I will act on them. The different interpretation of conversation has already happened actually- I saw the consultant, who I don't like, and told him that I didn't want to be induced. A few days later I got a copy of a letter he'd sent to my GP saying "I met this lovely lady" (patronizing git) and last time she was induced and had an EMCS which she wants to avoid, no reason for not VBACing - which is NOT what I said, he's just added on the last bit all by himself. Its not so much that I can't do the face to face thing, I'll just end up crying during it which is embarrassing and makes you look less sure, convincing etc. Good point about the dates getting booked up too.

Stark I am sure I have misread / misinterpreted your post but it seems to suggest that if you are educated and informed you will go down the natural route and I really don't think that's always or even mostly the case. There are a million reasons why someone may make the informed decision to have an ELCS from physical issues to past experiences to genuine concern about some of the things that can and do go wrong in natural births, especially when intervention like forceps is required.
Not at all looking to start a fight here, just wanted to clarify the post. I am a bit touchy about it because I do feel like I am being treated by the HCPs as though if I just knew more I would make a different decision and that isn't the issue.

Don't do the face to face thing first then - they will take you pretty seriously if you put it in writing. [Dear GP - I understand that my consultant advised you in a letter dated xx that... however I would like to clarify that my position is that I would much rather ELCS than to attempt a VBAC ... I will not consent to being induced to labour early, nor will I consent to... I also want to avoid having another EMCS, particularly as I understand the risks both to myself and the baby are greater with EMCS than they are with ELCS. " - that kind of thing

CC the consultant. Then have the conversation, you should be more confident of being taken seriously. Don't let them have the upper hand by being the only ones who get to put anything in writing.

They ought to be worried about having that kind of letter on file if they ignore your requests and you or your baby come to any harm as a result.

I would respond to that letter and say "I met this lovely doctor... But it appears he misunderstood the jist of the conversation. Perhaps I was not clear. I would therefore like to clarify that my strongly preferred method of delivery is a planned caesarian."

And I'd go on to say I'm not comfortable waiting and would like a scheduled date as soon as possible.

Every consultant letter I have ever read starts with "I met this lovely lady..." It reminds me of PMQ when they say "My right honourable friend..." and then forge into a viscious verbal attack on his character.

Different scenario but when I couldn't see a consultant via the MW I went to my GP and requested that she sort it instead - which she did.

I thought that if you have had a previous section that they won't induce you due to increased risk of rupture?

I am expecting DC2 in March, and there is no bloody way I am trying for a VBAC. First consultant appointment is on the 1st December, I shall be putting my opinion very strongly!!

I was told it was fine to induce me again. They would just put me on constant monitoring!!

I cried. Lots. I was petrified of going through it all again

I am, absolutely terrified. And I can't see how that can possibly lead to a successful natural labour.

Neither could I. I think that's what convinced the consultant in the end too. I just burst into tear whenever anyone mentioned the birth or DS's birth. I just could not cope with the thought of doing it again.

My ELCS was wonderful

Trixie123,

I've been in a similar situation to you as my hospital is pro-VBAC, and I was fairly terrified of being forced to VBAC with a lot of restrictions on my labour which I didn't think would improve my chances of getting DC2 out successfully (CFM, no food etc). I'm 28 weeks and I've just booked my ELCS with a consultant with no problems at all, just a discussion to understand my reasons for my decision.

Two thoughts:

1. If you think you will find it difficult to be assertive enough, would your DH/DP/any well-informed friend be able to attend with you and help to be assertive on your behalf? Like you, I need to be assertive at work and this isn't a problem, but felt a lot more confident in this situation bringing DH with me, although I didn't need him (helps that he works in the NHS and is full of insights as to how to Get Things Done!).

1. You are entitled to see a consultant. You are entitled to a second opinion if you don't like the first opinion. Maternal wishes are a factor to be taken into account when deciding the mode of birth after CS, according to NICE. NICE guidelines can be downloaded from here (and of course you should mention it if the hospital doesn't appear to be following them).

Good luck with getting the birth you want.

thank you everyone for your constructive advice, I really appreciate it. Also apologies to the OP as I seem to have slightly hijacked this thread! Here's to everyone getting the birth they want!

trixie No actually, I was making the same point as you. Obviously quite badly.

What I was trying to say was that those who are pro-natural can sometimes be a bit evangelical about it. They call themselves pro-choice because there is a culture currently where women are often railroaded into interventions and their rights to say no, or have any input can be overlooked by HCPs.

They can get a bit hung up on this and forget that pro-choice also means supporting a womans choice for a c/section of FOR intervention.

I have come across the same attitude as you, and it is a subject that I am close to for personal as well as hopefully soon, professional reasons.

It is certainly true in our current culture that women really aren't informed enough about the nature of childbirth and a strong push for the natural approach is needed for better outcomes for women and their babies. There is a lot of ignorance about what 'normal' looks like.

However, I also see that some pro-natural women sometimes get a bit lost in their own campaigns and imply it should be women's choice how they give birth, and once educated will choose to do so naturally, and if they don't it is simply that they aren't educated enough yet.

I think there is an element of truth in this if I'm honest, but it is not a good enough reason to dismiss a woman's request for a c/section. A woman should never be refused imo. She should perhaps be offered an 'education' IF appropriate. Far more useful than councelling in most cases. But ultimately it should be her choice.

I also think it should be dealt with in early or pre-pregnancy so that she doesn't have the stress not knowing if she is going to 'perform' adequately to get a desperately wanted c/section and have it hanging over her and her growing baby.

'are a million reasons why someone may make the informed decision to have an ELCS from physical issues to past experiences to genuine concern about some of the things that can and do go wrong in natural births, especially when intervention like forceps is required.'

Ah now you see, some of us pro-natural birthers think that things like forceps are never required or at least very VERY rarely and nothing like in the numbers that have this experience.

Reikizen etc - obviously saying that you are going to sue is over the top and that midwife probably wont be at the birth, however I was just trying to emphasize not to take no for an answer. I was told time and time again that I would be fine to have a vbac and that was that. It never felt like MY decision and all because I didn't speak up. And that was that. I had this enforced natural labour with tearing and suturing without pain relief even though I had a history of failure of epidural and unfortunately I seem to be hyper sensitive to pain.

Anyway, glad to see I have opened a bit of a debate, and I apologise if I have appalled anyone !

I had absolutely zero expectation of getting an ELCS on the NHS (ok, and the NHS hospitals scare me too) so we forked out a small fortune for a private ELCS. One thing I didn't have to deal with was being railroaded by a lay midwife (sorry, don't mean to be derogatory, but I find the fact that they generally aren't even qualified nurses astonishing) or a patronising consultant. I really feel for any woman who isn't in the financial position to have the kind of birth she wants. Women shouldn't be forced, either actively or passively, into a birth experience they don't want.

scarabeetle, I'm sorry but I take excpetion to your judgemental post about mws. They are highly qualified specialists in childbirth. I would not want a nurse delivering my baby unless she was the only HCP within miles.

Childbirth is not a medical 'problem' and doesn't require 'treatment'. It is a very delicate and specialist process.

Midwives are not 'lay'. They are overworked, expected to follow ridiculous protocols, forced to work with agency ad hoc colleagues and some of them quite narky because of it but the practice of midwifery requires skill that untrained nurses do not have.

at Scarabeetle.

I've had 3 HBs and have nothing but praise for the MWs who attended me, highly skilled and felt very safe in their hands. If you saw the amount of equipment that they come with and the scenarios that they could potentially but aksed to deal with I'm pretty sure you wouldn't describe them as 'lay'. Oh and for what it is worth you need a degree/diploma (like nurses) to become a MW and many do a top up year after completing a nursing course.

Granted, a degree is required and no, I wouldn't want a nurse delivering my baby either... but it's naive to ignore the potential for serious medical problems occurring during childbirth - problems which a midwife is not medically qualified to deal with. That's my point.

I think anyone having a homebirth in 2010 is foolhardy. You are just plain lucky that things haven't gone very wrong. What's with all the bravura about having the least interventionist birth possible? Why not concentrate on having a safe birth?

Women in the UK are conditioned to expect very little attention from actual medical doctors during pregnancy and birth. They expect to see a different midwife each time they have a check-up, two scans and perhaps a night in an MRSA ridden hospital (is the UK still the worst in Europe for MRSA rates?). Perhaps that's why you prefer to give birth at home.

'Why not concentrate on having a safe birth?'

Recent research and emerging research suggests that the safest place to have a baby if you are low risk is at home.

Opting for a home birth IS the safest for mother and baby for many women.

And what problems are likely to happen in birth that a midwife isn't qualified to deal with that a nurse is?

I would recommend taking someone with you to appointments who can speak on your behalf if you feel unable/too emotional to do so. I doubt I would ever have got an NHS ELCS for my first child without my husband forcefully but politely taking on the consultant. Walked out of that office with a date.

Had a date agreed for my second by 16 weeks pregnant - think they realised there was no point trying to talk to me about VBAC!

MWs are experts in childbirth.

to call them 'lay' people is not just derogatory, it's ignorant.

a lay midwife, would be one who was not formally qualified, but was an experienced birthing partner

a MW spends 3 years getting her degree, getting experience on AN, pn and delivery wards. there is mentoring and supervision and ongoing training and accountability

thre are also consultant midwives, so you know, calling one of them a lay midwife would be beyond ridicolous

midwives are trained in the care of women and their babies pre, intra and post birth. to refer to them as 'lay' people is patronising, something you say about doctors

each woman should be able to make an informed decision about where and how to give birth, be it at home or in hospital for a c.section

but informed choice starts with correct knowledge, and a basic undersatnding of what caregivers do in childbirth

In my experience here in the UK, some midwives are quite good and strike as me as very knowledgable. Others are... well... not exactly well informed.

I am currently going to C&W for antenatal (planned section mid December). I have met three midwives and one consultant. First midwife was great. She was thorough, well informed, and very pleasant to talk to. The second one was well informed and able to answer the questions I asked. The third was a moron, and appeared not to be very nice to work with. Another midwife asked her for a simple favour and she nearly nit her head off and I sat there thinking hmmm I think I will try not to upset you. The consultant was fantabulous. He was unsurprisingly the only one who could engage in an intelligent medical conversation with me.

I do think that the childbirth experts are obstetricians rather than midwives. But, some midwives are very helpful with non-medical queries (breastfeeding, for example).