appoint to see consultant to discuss ELCS / VB after probs at first birth

[workatemylife]

I've posted a couple of times in this section, but coming up to crunch time now! I have an appointment to see a consultant to discuss birth options for DC2. I'm pregnant at the moment, and have a toddler-aged DC1. First birth experience was, at least from my point of view, thoroughly unpleasant. It took a long time to get anywhere, even once labour was established progress was slow, baby was back-to-back which probably didn't help. Concerns over slow progress and potential fetal distress led to forceps delivery. Baby was fine, but I had an episiotomy, which extended, a third degree year, and a PPH. Now that I'm pregant again, my midwife says nothing here is exceptional, and a homebirth might be the best option to reduce anxiety, ensure 1-1 care etc. But other professionals - HV, physio after DC1, consultant after DC1 suggested discussing birth plan with consultant early in next PG, and whether ELCS would be a better option. Current MW not keen, but she and GP agreed to refer to consultant, and 'the letter' arrived this week.

I'm not sure what to say when we meet. I've seen a few threads on here on a similar topic, and got some useful advice. I have a list of things that I think it would be worth saying / asking, but I don't know if this is appropriate, or if there are other things to think about. I HOPE that the consultant will lead the discussion, but I've been in positions in the past where GPs have expected information to be forthcoming but without doing much to solicit it. Can you cast your eyes over my 'list' and advise if there are things not worth mentioning, or other things to think about? Many thanks!

1. I've read the NICE and RCOG guidelines, so I'm familiar with the risks of ELCS, and also with the potential problems caused by bad tears / repeat tears. I also have my notes from last birth.
2. I worry that I'll get stressed by the whole thing and make it worse for myself
3. I don't think I really dealt with the first birth mentally. I didn't bond for a long time with the baby (feel really bad about that now). I used to wake up a few times a week with nightmares / flashbacks, which did get better, butd now that I'm PG again, it has all started again. It sounds feeble, and I know lots of women have problems with tearing and deal with it, but this is how it is for me.
4. I've wimped out of smear tests (I know, I know!), and just can't imagine letting anyone rootle about up there for any purpose. I almost cancelled the consultant appointment through fear that he would want to have a look
5. The tear scar and episiotomy healed eventually, but it was a four month wait, in discomfort
6. It was about 5-6 months before I felt I could walk for more than ten minutes. I had major problems with (bowel) continence for the first few weeks. Much better now, but I still experience some 'urgency', and I think things have got a little but worse since I got PG again. Bladder seems in better shape; I have a cystocele, but day to day continence is fine. I've had to give up aerobics / any pretensions that it is appropriate to bounce on a trampoline though. Great reason not to get one for the garden

7.I also don't have much sensation 'down there'. Trying to conceive #2 was complicated by the fact that I can only feel what is going on when it was causing pain. For the most part, DH could have been reverse parking an oil tanker and I wouldn't have noticed.

Anything else? This all seems very negative, in a 'why did you TTC again if you were this worried' kind of way. Are there some more positive things to bring to the discussion? I'm terrified that I just blub my way through it all and get nowhere. Any advice much appreciated!

I will be having a similar convo next week, though in my case it is an ELCS or VBAC. The only thing I would add to your list (though it isn't exactly scientific) is that the recovery from a CS need not be any worse and can be much quicker and easier than a bad vaginal delivery. A friend of mine had a not dissimilar experience to you and took 7 months to get back to "normal". The first 2 weeks or so I was quite careful with how I moved but pain was not a problem and I felt normal again by about 3-4 weeks. Best of luck - let us know how you get on.

workatemylife, I'm sorry you had a traumatic experience the first time round.

You've clearly done a lot of research. The only thing I think is missing from your list is what your instinctive preference is. You don't have to have one, but some women in a similar position might feel that they really want another VB - others feel very strongly that an ELCS will avoid any repeat trauma. I think it's really worth paying attention to your instincts, especially as you are well informed and are letting that information guide your decision making. It's your life, your body, your birth and your DC after all.

You will find good and bad stories about every kind of birth here, I know - but I second what trixie123 says, in that recovery from a CS, especially a planned one, which is a very different kettle of fish from an EMCS, can be easier than a non straightforward VB.

I had an ELCS with my 1st, and was surprised to be mobile and painfree much more quickly than friends who had forceps deliveries. And actually, than friends who had non instrumental births, but who tore and needed stitching.

I think as a general rule, pelvic floor damage and genital trauma simply isn't taken seriously enough by HCPs, but that's an aside.

And I don't think you sound negative at all, just worried - I wish I could give you a crystal ball.

Hey there.

Rotten luck. And certainly with high forceps your outcome doesn't seem (sadly) unique either. I haven't experienced them, but recently have come to terms that I may have actually got off quite "lightly" with my emergency caesarean (which I'm also really unhappy about). Anyhow. Enough of me! These are the 5 areas I'd look into I think:

OFP
Ok, so back to back for first time mums is a often a really long and uncomfortable labour (mine certainly was) and the longer you spend labouring the higher, certainly in a medical environment, the risk of intervention and instrumental delivery becomes. A positive step this time might be to try your damnedist to assist your baby into settling into a more convenient position. I didn't know how important OFP was until after my first, and this time round, I'll do anything to avoid a back to back labour! Of course, it doesn't always work, but there seems to be plenty of evidence and stories out there to inspire positive thinking through positive actions.

Forceps/c-section
Maybe you should consider not consenting to high forceps again, and requesting a c-section if baby gets into distress instead? Just a thought.

Home V hospital
I would certainly advocate labouring in an environment familiar to you if you are worried about the labour stalling/taking a long time again. When placed into an unfamiliar environment the "flight or fight" hormones kick in and this literally fights off the oxytocyn, slowing and sometimes stopping progress. Some people are more affected than others by this, and sometimes the reverse is true too (in a "thank God, I'm safe at hospital now, let's have this baby now" kind of a way).

Debrief and requesting notes
This helped me enormously in understanding and coming to terms with what happened to me and my labour experience. I'd definitely vouch it's benefits. And wouldn't just go in for the debrief, but also get a copy of the notes to go through in your own time at home. I was empowered by small choice remarks left by a particularly supportive midwife and enlightened to realise that I had been mislead by another. Hugely beneficial.

Doulas and Independent Midwives
Have you considered hiring an advocate? Doulas and IM's get to know you properly and understand your fears and will absolutely speak out for you when you can't. IMs of course also have the added advantage of not having to work withing NHS guidelines. We decided to find the money for one this time and am certain that whatever the outcome, it will be a much more positive experience all round. Doulas are cheaper, and some are ex-midwives too with a wealth of experience in their pockets.

Sorry for hugely long message. i wrote it in stages and now I guess highly likely that somebody else will have posted a much more concise post!

Best of luck!

And oh look, they have.... Agree Trixie- bad vaginal birth experience and recovery can certainly be worse than a c/s. Good luck with choosing whatever's right for you.

Thank you for all the replies - and no worries about the length, carlyvita, given that I wrote an essay in the first place.

I'm not sure where my preference lies. At the beginning, certainly an ELCS, but I worry about the CS / toddler combination. Gloyw, Good to know that it is possible to bounce back more quickly than from a difficult VB though. I think there were people with the same experience that I met in mums & baby groups; DCs the same age as mine, but without the pelvic floor baggage (saggage??) that had made the first few months harder. Trixie, your experience sounds great. And it is encouraging to know that other people are having the same kind of conversations. A crystal ball would be great!

Carlyvita, thank you for the detailed advice. I think I would be more relaxed about the VB idea if I knew it would not end with forceps again, so the idea of trying for a VB but missing out the operative delivery VB route is quite attractive. I'll look into OFP - like you, I knew the deal first time around but not how important it was. Plus the poor positioning seemed to start during labour. Perverse as it sounds, the 'I'm safe in hospital' mentalilty seems the more likely, despite hating the place!
I have my notes from the first birth, and hope to talk them through with the consultant and / or my midwife. I've read some positive stuff about doulas too. DH seems to be of the view that I should talk to as many people as I want to until I feel I'm getting appropriate answers and advice, so I'll bear that in mind.

Mumsnet is great for this kind of thing! Not stuff I talk to RL friends about (although why the heck not?!)

I'll let you know how it all goes......