Please share experiences/tips about consultant's appointment in second pregnancy following emcs in first- I'm feeling nervous!

[Helzapoppin]

Hello

I have an appointment with a consultant in March to discuss delivery options for my second baby due in August.

First baby was born by immediate emergency c-section before I was actually in established labour due to foetal distress picked up by my independent midwife who visited when I had a show.

I know that there is no reason why I cannot try for a vbac, but I am adament I want to go for elcs. There are sevaral reasons for this.
Firstly, my daughter's delivery was (although well managed) extremely frightening. It appears that she was in significant distress and the panic which ensued was traumatic for me. Also, I am very scared of going into established labour as I understand that if I had got to that stage with DD, owing to the nature of her distress, she would probably have died. Her distress would not have been picked up on, except for the fact that my independent midwife happened to come to my house before I was in labour.

Secondly, although I know that uterine rupture is very rare, I have worked closely (in my professional role in a child development clinic) with a child who has very severe disabilities because of this situation. I can't see past this child's experiences when I consider the (tiny) liklihood of this happening to us.

I've read the RCOG guidelines, but it would be really helpful to hear about what goes on in discussions with consultants about VBAC/ELCS choices.

My GP has been really supportive, saying 'a normal delivery just isn't worth the stress you'd be under'. However, I'm concerned that a consultant won't necessarily have the time or inclincation to have a discussion about my reasons for wanting ELCS and will try to pressure me into VBAC. I feel that I would never forgive myself if something went wrong, having agreed to a VBAC. Also I become very emotional when I talk about my previous birth, so she may just think that I'm a bit neurotic (which I'm generally not!). I considered writing it all down in a letter and asking her to read it, rather than having to explain. Is that a bit OTT?

Any thoughts and experiences would really help.

Thanks :)

Their job is to talk to you about this so don't worry about his / her time and inclination. I had sort of an EMCS though it wasn't a "crash" situation, just a failure to progress in an induced labour. I have now had to had the same conversation with about 5 different consultants because the regular one is on long term sick so its a succession of locums. I was worried beforehand because I tend to cry in any sort of confrontational situation but surprised myself by managing to stay in control and just explaining why I felt the way I did. It might help to write down your reasons in your notes and "practise" the convo. first with the midwife. Remember that you ARE entitled to a 2nd opinion if the first seems unsympathetic and you can get the guidelines for ELCS on the NICE website. Bear in mind also that your situation may change throughout the pregnancy and as you have a way to go yet, they may want to defer the decision. If they do, accept that and let it go for few months if you can - you'll only have to repeat the experience. Best of luck.

I had this situation (EMCS then consultant chat at start of 2nd pg to discuss the EMCS and future options). TBH she was pretty neutral. It wasn't a big interview or anything, she already had my notes from the pg and from the birth to hand and had obviously skimmed through them as she knew the basics.

Try to see it as an informal chat with a locum doctor ie one you don't normally see at the surgery rather than a big deal re whether or not you get an ELCS. I really wouldn't write the letter. She just asked me short questions and responded to that, that forms the basis of the meeting (even saying "meeting" makes it sound really formal and it really wasn't!)

The outcome was that she gave me neutral advice on VBAC and ELCS, neutral in that she didn't try to personally influence me. It was a case of "this is what VBAC involves, this is what ELCS involves". She told I was a suitable candidate for either VBAC or ELCS but would continue to monitor as nearer the time she might strongly recommend an ELCS over a VBAC. Or vice versa.

Nothing is set in stone, in actual fact the final decision is often made at 36 weeks so there's a long time yet. If you are sure you want ELCS then when the consultant asks what your initial thoughts are on type of birth simply say you want an ELCS - don't try to justify and get yourself in knots/all emotional! Just state it and see what they say.

Thanks so much for that very sensible advice. You both had some really helpful thoughts. Hopefully, I'll be able to keep it together in the meeting too!

Ok, I had an emcs with my DD in '06 and was adamant I wanted a vbac. I was worried about seeing the consultant as I was anxious he wouldn't support my preference. I got myself into a right state before the appt. When I got there, I was called in by the dr (who turned out to be a registrar not the consultant). He had no idea of the purpose of the appt, he said, "So you want to go for a vaginal delivery this time?" I said "Yes." He listened to the baby's heart for about 5 secs and said "We'll see you again nearer the time." That was it.

I then had to see a specialist mw. She was brilliant. She had read my notes, knew what had happened last time. I got really upset during the appt with her when talking about my first delivery - which she said was perfectly normal. If it makes you feel any better, she told me that she sees women who burst into tears the second the walk into the room. I wasn't as bad as that She also reassured me that my feelings and emotions about my first delivery were completely normal and that while people assume you've got over what happened, the reality is that you haven't.

So for me, the consultant appt offered me nothing, but the mw appt was fantastic. I felt that she understood me, she validated my concerns, we were able to talk about options for management during labour and we exploredmy preferences for what would happen if I didn't go into spontaneous labour. Good luck with your appointment.

Please don't worry about it, although I completely understand why you are - it is a tense time!

I had an EMCS with DS, and I too was adamant that I wanted to have an ELCS. I was worried that I would have to fight for it and that all the pressure would be to have a VBAC.
A very good friend of mine suffered uterine rupture attempting a VBAC recently, and that looms large in my mind.

In reality my consultant was lovely. She said straight away that if I wanted to have an ELCS then I could, she would have no problem with booking me in for that. We organised a repeat consultation with scan at 36 weeks.
She did ask me whether I would go and talk to the senior midwife about a VBAC, just to have all the info and be sure in my mind - and I was happy to do that.

In the end I haven't, because subsequently I've been diagnosed with Gestational Diabetes, felt it was all too much and just wanted to go ahead with the section.
I had to have an extra growth scan because of the GD, and also another Drs app, this time with the specialist registrar who did my EMCS. I had a really good talk with him about the pros and cons of each scenario - still no pressure to decide either way though and I have another scan and appointment booked at 34 weeks to make a decision.

As time goes on, I'm actually leaning towards attempting a VBAC. Mainly because the idea of having a much shorter recovery period post-birth appeals - I don't want to be unable to pick my toddler up for 6 weeks! But that is just my own thoughts, and I still haven't made up my mind.

Sorry to ramble on! Anyway, in short the hospital have been very supportive, have answered loads and loads of questions and have really left the entire decision in my hands.
Obviously there is a possibility that I won't have the option to VBAC - if the baby is breech or transverse at my next scan (which is likely because they are transverse atm and showing no signs of moving) then they will book a section date there and then.

Just go in there and be calm, maybe write down any questions that you have? Don't be embarrassed if you do get emotional, I started crying thinking back to DS' delivery and no-one was anything but totally supportive :)

Just wanted to add that in case it helps, she was so neutral she was almost bored (not in a bad way but in a consultant-ish kind of way. to us, it's a HUGELY personal experience and it's easy to think the consultant/MW feels as strongly as we do about our own case history and will argue with us re their own POV of our case notes, as passionately as we might....

TBH they really don't .

We are probably one in 10 women they have seen that day/50 that week/1000 that year or whatever. They will have come across it all before. I would be very surprised if they felt strongly about you having an ELCS and even if they did it's not down to one person, you would simply say you would be requesting further opinion and reiterate your wish for an ELCS. Please don't tie yourself up in knots about this til March! It's all be ok

Thanks so much for the posts, I feel much more reassured having heard of your experiences. althoug I'm still crying after having read themm which doesn't bode well for my meeting!).
My consultant won't have acces to my last set of birth notes, as DD was born at a different hospital. Should I request a copy of my notes?
It was helpful to hear that meeting with the midwife was useful for some people, I just assumed that they would think I was being daft and had resolved not to talk to them about my anxieties at all.

absolutely get hold of your notes. They are YOURS and just like all your medical noted should follow you if you move. Contact the old hospital immediately and get them to send them.

Yes, your notes should be sent just as if you changed doctors or dentists your notes should go the new surgery. It'd be nice to think there's some co-ordination going on between hospitals, but I wouldn't rely on it so a quick call to your old hosp should help speed it up

I know it's far far easier said than done and I can't imagine how frightened and worried you were during and after the first birth, but please try to remember that you have every chance of getting a professional, calm, pleasant consultant who would recommend you for a CS. Try not to presume you'll have any difficulties getting one not least because it'll make you all tense and that's not good for you .

In my (admittedly limited) experience and from what I've read on here, it has seemed to be MW who prefer VBACS and doctors/consultants who prefer CS!

All the best.

I found that my consultant was very sensible. I wanted a VBAC, she looked through my file and concluded there was no reason why I shouldn't try. I am positive that if I had wanted a cs that would have been fine too.

I should say that before I finally saw my cons (28 weeks?) I had seen umpteen members of her team/midwives etc. All of them had asked me what I wanted - I am certain it was entirely my decision. One doctor (twit) wrote in my notes that I wanted a cs, so I think she was the only one who wanted to push me one way or the other (i.e., she wrote down what she would do - a freudian slip sort of thing).

If there is a pro-VBAC policy at your hospital you may find that, if you see a more junior doctor, they may try to steer you in that direction,. But ask to see your consultant specifically and I suspect things will go your way. It is, at the end of the day, your decision. You have to live with the results of that decision. The doctors can merely advise you, but the final say must be yours.

At my appointment the registrar was so neutral I was surprised. I wanted a VBAC for various reasons, but had thought they would be pro it as a variety of factors from my first attempt (I won't bore you with irrelevant details) meant that in theory the chance of a successful VBAC would be higher.

The conversation went along the lines of "what do you want to do?" "Fine." I don't think that's cos I went for a VBAC either, my three friends went for elective sections and ahd similar responses.

Here they see you at 36 weeks too (I guess in case you are breech etc). The conversation was with a consultant and longer, but mainly cos we had lots of questions!

Good luck.