Consultant app this Friday - the CS argument

[moogdroog]

Hi everyone,
I've got a 32 week appointment with the consultant (or registrar) this Friday, mainly to come to a decision on mode of delivery. I've been thinking long and hard, and have decided I am dead set on a C Section this time around.
Had a horrible labour ending in EMCS two years ago, and am still struggling to deal with the psychological fallout from the whole thing.
I realise there are cons to the CS, but I'd at least feel that it was in my control.
Anyway, after a bit of advice on what I'm imagining will be a battle to get my own way, and to have some counter-arguments ready. My midwife just advised that I take an 'assertiveness tablet' beforehand.
Any pearls of wisdom?

"Having considered my options, I'd like a cs". The end.

I saw a consultant to deal with birth trauma from dd's birth and not even pregnant he agreed to be my named cons in the event of another baby and said it was my choice, either way. If your consultant isn't from the same school of thought, calmly repeat that you've chosen a cs and if s/he still doesn't listen then ask to be switched to a different consultant.

I would simply say that I want a c-section, that I am well aware of the risks of having one and that they are more paletable to me than those of a VBAC. If this is likely to be your last baby, throw that into the pot too (a problem with cs being that it increases risks for later pregnancies).

It might not be such a battle: I was offered a cs at every hospital appointment I had (although I wanted a VBAC).

Good luck, hope you get what you want.

I didn't have a battle on my hands at all, and to be honest there was very little discussion. I simply stated that I had read the RCOG guidelines on birth after caesarean (read them if you haven't, they are very informative), had assessed the risks, and was comfortable that ELCS was the right decision for me.

Consultant did not ask any questions at all, simply said "fine" and booked me in. If you look at the NICE guidelines, I don't think a consultant can actually refuse you a repeat c-section, although some may try hard to push you towards a VBAC.

They will also ask what you want to do if you go into labour before your ELCS date - be prepared to discuss this too. I have agreed that I will give it a shot if all progresses smoothly but would want an EMCS in preference to augmentation.

Good luck!

Hi
Just wanted to say good luck for Friday's appointment and that I had mine today (at 18 weeks) to discuss birth options. I was so anxious before the meeting, and actually crying as I waited in the room for the consultant. But she was lovely, very kind and started talking through my options very clearly(I'd already been to the hospital's birth options clinic read the NICE guidelines and talked at length to two friends who are obstetricians so knew what she wanted to tell me). Once she realised I was well informed, she asked me what I wanted to do and agreed right away. I was so relieved. She also agreed to book a date in and that she will do the section herself or arrange a meeting with the obstetrician who will beforehand (I've got lots of anxiety about this as DD was tiny and was nearly stillborn and the registrar panicked and started crying during the section!).

No real pearls of wisdom, but I just wanted to share a positive story. The things that helped me were:
-Be really, really well informed (NICE guidelines, any research studies/metaanalyses to support your view)
-Have your midwife and GP on your side. If possible, go to the VBAC clinic beforehand or talk to a senior midwife, otherwise they may want you to go there before making a choice.
-Be very clear about what you want (e.g. an EMCS if you go into labour before 39 weeks) and ask for it assertively.
-Make a note of everything the doctor says and their name ask them to say is again or confirm if you are not clear
-Remember, you are entitled to a second opinion and don't let them rush you.

Very best of luck. I hope it all goes well for you.

Thank you all for your lovely good luck messages and pearls of wisdom and advice.
Think I may be gearing myself up for more of a fight than might be necessary, but it's best to be prepared. Will diligently swat up on all relevant guidelines (thanks for the pointers and suggestions) and any studies I can lay my hands on.
Taking along my super assertive, nursing background mum in case I crumble and need some back up! She's quite used to not taking any shit from doctors :o
Will let you know how I get on...

My consultant was quite happy to book my section date straight away when I discussed the options with him - As I explained that my choice was based on RCOG and NICE guidelines rather than "I've read some internet forums" and we've happily discussed various stats of risks for either mode of birth he was satisfied that I indeed had made an informed decision. I think that's all they want - that patients know what they want and have looked at all the choices.

Good luck moogdroog - v good advice here.

I'd say, do make sure that you are aware of the NICE guidlines, which include the relative physical risks of a C section - they do need to make you aware of the physical risks otherwise they aren't doing their job, so it will help you if they can see you have made yourself aware.

That said, you are requesting a CS on psychological grounds. Standard patient info doesn't cover that, so you will need to be very clear that's your concern, and that given your previous birth experience and the mental health consequences for you, that is why you feel a CS is the right option for you this time.

I say that only because you don't really want to get trapped in a to and fro debate about theoretical physical risks (unless there is something in your personal circumstances that merits it) when you're actually requesting a CS on psychological grounds.

Also, if you get an unsympathetic consultant who keeps stressing how much easier an straightforward VB will be for you in terms of recovery, point out that they cannot guarantee that's what you will have, and you are not prepared to risk another traumatic labour.

Hope that makes sense. Just make sure too that as this is a 32 week appointment, and you are totally sure you want a CS confirmed, that they don't try to leave it up in the air until nearer your due date. There's no need for you to go through the stress of 2 odd months of anxiety and uncertainty when you would feel happier with a CS confirmed at this appt.

Just a personal thing - it's fine to be assertive, but as others have pointed out, you may not have a battle on your hands if you get a sympathetic consultant. You can go down the 'I want a CS and that's that' route if you want - but you can calmly state (or write down, if that's easier) your feelings about your last birth, and how traumatic you find the idea of attempting a VB.

I very much dislike like the idea that women have to go crying and begging for a CS to show how distressed they are (and extreme distress doesn't always manifest itself like that in any case). But if you think it might help, you can prepare a phrase or paragraphs beforehand to describe clearly how you feel so you aren't left floundering to describe painful experiences in the meeting.

Good luck.

Hi everyone,

Just got back from my appointment, so thought I would let you know how it went.
Thanks to your invaluable advice I've got the outcome that I wanted. The registrar started by saying that I had two options, but ultimately the choice was mine, but he had to make me aware of the risks. I was able to say that I'd studied the RCOG and NICE guidelines, felt myself to be well informed and that my decision had been made on that basis. He pretty much gave up talking through the risks at that point.
I was hoping to get a date booked in at this appointment, but I will need to go back in 4 weeks for this (I did try and push, but to no avail). However he did say that if I went into labour beforehand I would have an ELCS as he'd written it in my notes.
I just want to say thanks again for taking the time to reply, you really did help me.

Hi Moogdroog - I've been watching with interest, although have not been in your position so couldn't advise.

Thats great news though - must feel really relieved. I have an ELCS booked for a week Tuesday, but because my baby is breech.

Hope the rest of the pregnancy goes well for you.

Hi iloveholidays,

Thanks for your good wishes. Best of luck for your ELCS - everything I'm hearing is telling me that electives are worlds apart from a scary emergency CS.

Wishing you and baby all the best for a week Tues!

Glad that it went well for you, must be a weight off your mind. Hope you enjoy the rest of your pregnancy. :)

Very pleased for you, moogdroog - well done.

FWIW, my ELCS was great. Absolutely what I wanted, and I BF-ed successfully without being knackered to start with as well. You will find all sorts of tips to help with recovery (peppermint oil capsules for trapped wind, a big V shaped cushion for propping yourself up afterwards, and a large sports cap refillable water bottle so you always have a drink within reach are my top three!).

Well done moogdroog - just popped on to see how you got on. I've had my ELCS booked for a few weeks now and am really looking forward to it, it's nice to have a plan if your last experience wasn't good. Hope it all goes smoothly for you.

well done. im currently 32 weeks and after an ELCS with my second child (traumatic birth with first and SPD) i said at my first consultant appointment at 12 weeks that i wanted a cs again and it was written in my notes then! i am due to get my date for CS on 5th April!