Advice needed: seeing consultant and want CS (V.V.LONG, sorry!)

[herethereandeverywhere]

I'm 11w and had my booking in appt last week. The midwife was lovely and picked up on how stressed I am about the birth (already!) given my first birth. She made me an appointment with the consultant to discuss my concerns - neither of us mentioned CS but its what I really want.

Background is:

• Induction
• Hyperstimulation (7 in 10 instead of 4 in 10) so no gaps between cx at all
• Drug to try to treat hyperstimulation caused tachiacardia
• Baby was back to back
• Was induced just before midnight so went through all of this through the night which meant I didn't get any sleep
• The pain was horrific. It was torture, so much so it literally demented me, I was smacking myself on the head to try to knock myself out
• after 7 hours of this they did an internal, ZERO centimetres dilated.
• They agreed to give me an epidural. It took 4 hours of them constantly checking and putting more stuff down it before it eventually worked. That bit was blissful. I got almost 2 hours sleep.
• Waters broke at 5cm, was fully dilated 4 hours later.
• Couldn't push her out, couldn't push her anywhere. I let the epidural wear off because I heard it was better for pushing. Still had no urge to push, it was just horrifically painful

-Went to theatre for Keillands forceps, turns out she was in deep transverse arrest. -Huge episiotomy (about the length of my finger) but they got her out

• Cut to DD's face which has scarred, still very visible now, she's 23 months.
• Aftercare was awful, asked for help getting out of bed (has been sitting in a pool of blood all night) and was told they didn't do that (so I asked could someone pull the curtain so that when I bled all over the floor the rest of the ward didn't have to watch) managed to escape that hell after 24 hours
• DD too sleepy to feed and was vomming up anything she took due to all this "gunge", developed jaundice, was getting dehydrated.
• DD readmitted to hospital via A&E 2 days later due to these problems. Despite me trying to breastfeed my milk didn't actually come in until day 6 so she was tube fed formula for 24 hours then we managed to get discharged even though she was still losing weight
• No home visits from midwives. DH spent the whole of his pat. leave driving me all over Sth London to available midwives at health centres (to monitor DD's birth weight as she'd lost 15% nd to get me checked.)
• all but about 2 of the stitches in my epi came undone. The pain of sitting on that open wound, (for hours to breastfeed) even on my full dose of diclofenac was like hell, for weeks on end, the thought of it still makes me feel sick. DD was too much of a fussy feeder to feed her lying down.
• wound ended up healing through granulation tissue, was still partially open 8 weeks later.
• had some faecal incontinence for the first 8 weeks or so. Still get pain from the epi site today.

So, I just want a calm ELCS and to be cared for afterwards. No pressure to breastfeed, I'll try it but alongside formula so I don't end up with my baby wasting away like last time.

Given the desire to reduce the CS rate at all costs (the day after the birth a midwife was championing the consultant who dragged DD out of me as "the man who keeps our CS rate down!") I expect I'll be told to try it again and see what happens or somesuch. I'm not sleeping well at the moment and find every time I'm not occupied my thoughts are turning to the birth and what happened last time.

So mnetters, what do I do/say/ask for and what should I expect? My heart is racing just from typing this. Thank you.

You need to see a GP for another referral because you do not need to see only his colleague. Also you can chase up the referral to the clinic.

It might help to print out your OP and use it as a list for when you go to the GP.

Your mental health alone is reasonable grounds for ELCS.

The website mentioned earlier in the thread is this one
[http://www.csections.org/]

I didn't get an NHS ELCS but paid privately (but in NHS hospital) - £6000 3 years ago. My second was NHS and was agreed as an ELCS - however the registrar tried to bully me into VBAC.

I'd also print off the NICE guidelines, study them and take them with you. I think they may have been changed fairly recently so you can request CS. Agree to printing out your OP - it's a good bullet point summary of your reasons for requesting ELCS.

Hi -

You don't need to wait until 26 weeks to see another consultant, and you certainly don't need to see another consultant that is recommended by or who is a colleague of the first one you saw.

Most women see a second consultant because they are very unhappy with the first one, and want an independent second opinion - again, I'd recommend talking to either your GP or head MW about who else you can contact.

I would take up the offer to see a counsellor asap. If they can see you are in a state of extreme anxiety about a VB, they can recommend you have a CS. I saw a psychiatrist before my CS was granted, and she wrote to my consultant recommending I have one, given my level of fear about a VB, and as I was pregnant already, they could not guarantee any counselling or therapy would lessen my fear to a degree where a 'forced' VB felt reasonable, from a mental health POV.

I hate to say it again... and it varies from area to area... but playing up your physical damage from last time is a much weaker strategy than bringing mental health into it. Basically, they can always argue that what happened last time is unlikely to happen again with a 2nd VB. Even with lasting perineal damage, they can, if they are resolutely anti-CS, play it down and argue it probably won't get any worse.

But if you are saying you are in a state of extreme anxiety, and that this is severely affecting your mental and emotional health, I really do think that's the thing to flag up. Unfortunately, if you don't see counsellors/psych team/GP about this, they probably won't take you seriously.

I want to be more reassuring - and I think you will get your CS in the end, btw - I just think it's insane to make someone like you jump through hoops and suffer all this anxiety to get to where you need to be.

I'm so sorry. I had an extremely similar experience. Deep transverse arrest, back to back contractions and unrelenting agony. Episiotomy/rotation/ventouse didn't work though, dd born by emcs. I was offered an elcs without question. A good cons and trusting relationship is a must. I had severe ptsd and pnd and it took over 4 years but my crappy one-handed typing is due to bfing 12 day old ds. I actually chose to attempt a vbac but no trauma this time round. I give all credit for this to my consultant who listened, understood and acted.

So sorry to hear your experience. I have just been through something similar which might help - after a fairly traumatic birth last time (prem baby, forceps, tearing no pain relief etc) I had severe PND and PTSD. At my 6 week check last time the consultant said to me that my delivery was partly so bad because of my pelvis shape, and that I could attempt a vb if I got pregnant again, and that it might be easier, but that I could request a CS if I wanted one. Fast forward three years - am currently 37 weeks pregnant. Mentioned that I wanted CS at my consultant appt at 28 weeks (no idea why I waited so long - expected it to be mentioned to me I suppose) and I broke down in tears as I described my last birth. The consultant said ok, but not for physical reasons (she completely belittled the previous consultant's opinion!) but because I was obviously traumatised. She said we could confirm my choice at the next appointment. When I went for that appt, she was away and I saw a different consultant who refused to agree to CS, wrote in my notes that there was absolutely no need for one, accused me of lying when I talked about my last birth and was very condescending and patronising. I sobbed for hours when I got home. I did not have the strength to do anything about it myself (felt utterly rubbish and like a lesser woman for not wanting a vb) but my husband rang the antenatal clinic on my behalf and complained about the state I'd been sent home in and demanded to see another consultant who would take 'his wife's concerns and mental health seriously' - we got an appointment the next week with the original consultant and he came with me and they agreed I could have one. But only for the mental health reasons. I think it helped that I sobbed every time I talked about labour and that my husband was there to be the rational one whilst I blubbed and emphasised that we had both read all about the risks, NICE guidelines etc.

As soon as it was agreed I felt much better, and even had a week or two when I thought hard about attempting a vb again. I am now in the situation of hoping nothing happens before the date I've been given for the CS, as apparently if you go into labour naturally before the planned CS date, it can be very tricky to get them to do a CS as you are not an emergency case and by the time they have space for you in theatre, you may be too far along (and progressing too well) for them to agree to attempt it. My friendly midwife at the gp surgery advised me to stress my poor mental state in that situation as well and to be the most annoying patient to get what you want.

Good luck - I hope you manage to get another consultant on side - sadly it seems the best way to do this is to appear mentally distraught (or rather make sure they can see how mentally distraught you are instead of trying to be strong) or get your husband to complain vigorously on your behalf.

I cannot believe women are bullied and belittled like this!

Hi,
Haven't read all thread, but got this by email today - info on new 2011 NICE guidelines on CS. Might help:

"Maternal request for CS
36 When a woman requests a CS because she has anxiety about
childbirth, offer referral to a healthcare professional with expertise
in providing perinatal mental health support to help her address her
anxiety in a supportive manner. [new 2011]
5.9
38 For all women requesting a CS, if after discussion and offer of
support (including perinatal mental health support for women with
anxiety about childbirth), a vaginal birth is still not an acceptable
option, offer a planned CS. [new 2011]
5.9
39 An obstetrician has the right to decline a woman‟s request for a CS.
If this happens, they should refer the woman to an NHS obstetrician
in the same unit who will carry out the CS. [new 2011]"

Thanks everyone so much for your support and your excellent advice. I will see my GP and hope she backs me (or I'll be seeing a different GP too!) I did try to express my mental trauma to the consultant. I was sobbing and saying I hadn't slept more than 5 hours straight for weeks. He looked up from whatever he was writing and said (I kid you not) "Is there anything in your life that is worrying you at the moment?" If it wasn't so truly awful I might have laughed.

Oh someone wanted to know which hospital I'm at. It's St Georges Tooting. I don't know the name of the consultant, he introduced himself but it was an unusual Asian name so I didn't catch it.

Got the referral re: the perenium damage today. It's not until early November so will definitely see the GP before then. I have no idea if the consultant will be true to his word about the counselling so I'll get her to chase that up too.

Those NICE guidelines are really useful, thanks tittybangbang. Although I was induced at midnight last time, which is contrary to NICE guidelines which says it should happen during the working day (I think) so I know hospitals do freely breach them.

Just want to point out - the guidelines Tittybangbang posted are only Draft guidelines. NICE publish a draft for comment and discussion, and may change them as a result, although I hope not.

In any case, as noted on these boards, NICE guidelines are only guidelines, and while they can be helpful to have as support in a meeting (if you are arguing for something the guidelines say you should have, for example) hospitals do not have to follow them.

I think you have been very unlucky to get this unsympathetic consultant. If you feel you were clearly expressing your anxieties about birth trauma in that meeting, and he just wasn't listening, it might be worth seeing what he wrote in your notes. If he hasn't recorded your concerns adequately, or at all, then you can raise this with the Head MW or your next consultant.

It might be worth pursuing the Head MW and your GP at the same time. They will have different ways of accessing things like psychiatric support/counselling etc. And putting it bluntly, the more noise you make and the more HCPs you have onside, who understand what you are going through, the better position you are in to request a CS.

OP: it was I who asked which hospital you were at. I too was at St G and i wonder if we've seen the same consultant. Mine too had a strange name that I did not catch and was totally uncaring- working through the notes after delivering his shattering one-liner with no thought whatsoever for how I felt. Had already decided to give birth elsewhere but that horrible appointment sealed it: I cannot bear the thought of coming across that insensitive man again. What fills me with dread is that I was there for advice on how best to manage my current issues during pregnancy but he wanted to operate and once he'd heard I was pregnant he lost all interest and said there was nothing they could do, but have a VB birth, instrumental if needed. No questions at all about how I felt or what I wanted. He then examined me and was already asking for thing to implant leave in situ (sorry, don't want to give more details as this is my usual username) without explaining why. I had to stop him, ask for pros and cons (all this while on the examination table) and then refused the procedure. But the shock of his procedeeing with not a thought for my wishes ( or my consent) is what shocked and terrified me. If this is how things work in an elective non-urgent situation, what are the chances of the patient's point view being taken into account during birth?
Sorry to add to your worries- but if I were you I'd make sure your GP is clear in her referral about what happened so that people understand why you do not want to see that man again. I too have a referral to the perineal team for late Nov and will ask my GP how to go about obtaining the same result: I cannot and do not want the stress and anxiety of going through something similar again.

OP, I'm almost in tears reading this hoping you get the outcome you are looking for. :(

I'm just under 5 weeks post fucking horrific traumatic birth. The actual birth part really is almost the same as yours. Induced, pessaries caused my whole genital area to feel like it was on fire and was swollen, eventually got put on drip which made me have 7 in 10 hyperstimulated contractions, failed epidural, ended in forceps and episiotomy which by this point i was literally begging for I was too exhausted and in so much pain I couldn't push even though I tried my hardest, hemmoraged as well, got put in stirrups even though it said in my notes no stirrups because I have hypermobility and had SPD.

When people say you forget the pain it's a load of bollocks, it was nothing I could ever imagine I was literally begging my partner to kill me or knock me out, the MW was shouting at me when I wasn't taking the G+A or when I even took it out of my mouth! The stuff made me throw up so badly but looking back on it I think it may have been transition.
I needed to push and told her that and was told that I wasn't to be checked for another 2 hours and that nothing would be happening and it would still be a good while! I had to beg her to check me and after her finally giving in she discovered I was fully dilated and she could apparently feel an ear, I then got told to hold off pushing for an hour as they like to wait an hour after you are fully dilated! Is that even fucking possible?!

After the birth the hospital was horrendous, first they wouldn't take my catheter out even though I had tugged it and I was telling them it was agony, when I did eventually get it out (someone came over and was wondering why the hell I still had it in) I went to go have a shower and was passing out with every second I was on my feet (no one had bothered to check if my iron levels were low even after losing over a litre of blood ).
I tried to tell people there was something wrong with my stitches, had them checked and was told they were just a bit bruised after I got home I discovered all the stitches had ruptured and by the next day it was infected so ended up on antibiotics and holy hell the pain! I couldn't even lie on my back, I had to spend all my time in some strange side position or in a salty bath. Mines also healed through granulated tissue and isn't yet healed properly.

If I could go back and do it again I would have went as overdue as DS wanted, I wouldn't get induced and there is no way I would have had a hospital birth. Failing all that I would need a CS.

My DS was in special care as well for 2 days after he was born and no one noticed he was jaundiced until we were leaving.

I really hope everything is okay for you in the end, I really do.

Feck that was a long comment!
Apologies about the essay, this is the first time I have talked about it since it happened. I guess I needed to vent.

I really do hope it works out for you.

Thanks SchrodinersMew, it's good to vent, I wish I'd started to process it all at 5 weeks.

I'm just so sad that so many women (and men) won't try to understand what we've been through and (with reference to the news about NICE recommending greater choice over cs) why we might choose a cs to preserve whats left of our dignity/sanity.

Similar first birth here: induced, back-to-back, pain like nothing on earth, no pain relief, PPH of 3litres, retained placenta, intensive care, left with some degree of prolapse. The only thing that kept me going was the miracle that somehow bf-ing worked out well.

Am currently 7mths with DC2 & obstretician actually said to me (in the 5mins I've seen him all pregnancy & without him even having seen my previous notes) something along the lines of, with all the hard work you put in with the first birth, this birth will be much easier & straightforward....wtf! patronising git I thought, how the hell does he know? & if it's going to be so easy why do I have to go to a special teaching hospital 45mins away instead of the regular hospital 15mins away? I'm in Australia & there is no such thing as NICE guidelines, the public health system is so backwards & PTSD after birth is only just being recognised here. Sometimes I think the whole maternity care thing is just institutionalised misogny on a grand scale.

I agree with those who have said it's the psychological angle you've got to play on. I'd do what I could to make them see me as a litigation risk, including taking any counselling or therapy that I was offered and writing them a letter to put them on notice of the affect it was all having on my mental health, and the additional risk to my mental health if I was forced to undergo a vb. As a last port of call, if all else fails (which it won't), you could instruct a clinical negligence solicitor to write them a slightly stronger letter.

herethereandeverywhere

I've only just read your story here as I was reading back through THAT thread...

Its utterly dreadful to hear you have been refused. And it makes my blood boil after reading Cathy Warwick's blog (chief exec of RCMs) on the subject of ELCS on request today. I thought that some of what she said was out of touch with the reality on the ground...

www.huffingtonpost.co.uk/cathy-warwick/caesareans-nhs-women-choices_b_1067710.html

In it she say:
"The guidelines essentially reflect what is already happening in maternity services. It is not a case that they are recommending that a woman should walk into a meeting with an obstetrician and say 'I want a caesarean' and the obstetrician should say, 'ok no problem'. What should follow now and is recommended for the future is that there is an on-going discussion between the obstetrician, midwives and the woman about the pros and cons of the different types of birth.

If a woman, for whatever reason, feels she is psychologically unable to face the prospect of a normal delivery then I have yet to meet a clinician who would currently deny her that choice and I agree with the NICE suggestion that 'if after proper counselling' a 'vaginal birth is still not acceptable' then the option of caesarean section should still be possible."

I've heard various arguments about why the guidelines shouldn't be changed as they already apparently cover situations like yours. Clearly they don't.

If anyone wants a good example why we need these new guidelines - then you are it. An obsession with C-S rates is a disgrace if it is at the expense of women who NEED one.

I hope it works out for you in the end...

I thought I would do an update for those who are interested. I had my second consultants appointment today - rearranged by a kind midwife who took pity on me when I broke down at a routine appointment.

I've been granted my c-section. I'm having some counselling with a midwife and assessment of perineal damage so I'm still seeking to "repair" the damage but knowing I won't have to give birth is such a relief, it's like someone has switched the lights back on.

The second appointment was so much less like I was on trial - a simple explanation of the risks - it IS major surgery and I am aware of the possible complications but it's right for me and my unborn baby - and I've made the decision, being re-granted that control has been so important.

Thank you all so much for all your great advice and kind words of wisdom. I hope to support others on here in the way you've supported me.

herethereandeverywhere What a relief that must be for you. I'm so pleased that someone has understood your concerns :) Enjoy the rest of your pregnancy!

That's excellent news herethereandeverywhere - I'm really, really pleased for you (and cross that you were put through the wringer emotionally just to get that decision - it just SHOULDN'T be that hard).

You must feel like a weight has lifted. I hope you can enjoy the rest of your pregnanc now.

I have been so completely shocked by your experience and very sorry or you. I clearly have been very very fortunate in my births (3 out of 4 at home with no probs) and I was going to write and say ight your corner you should definitely have an ECS - I am so delighted or you, it must be like a great weight lifted off your shoulders. Now you can relax and enjoy the rest of your pregnancy knowing you will not have to go through that again.

Well done for fighting your corner and the very best of luck sweetheart x

Well done Herethere! You deserve to relax now, enjoy your pregnancy and try not to worry any more about the birth.

I have been granted a CS also this time by the consultant who did my operation after VB damage. I went into that appointment expecting to have a hard time and found her very understanding, so I was really shocked when you had such a totally different response. It still makes me truly angry to think that some consultants are still able to continue being so utterly indifferent to the legitimate concerns of women who come to them for professional help.

Make sure you have something in writing in your notes so that any possible change in consultant/midwife etc can see it in black and white. After my last appointment with my consultant I had to see a GP who started trotting out the 'considering the possibility of a vb' line and I immediately shut the conversation down by pointing out the notes on why the decision was made. Subject closed as far as I'm concerned.

Thats awesome news herethereandeverywhere !

So pleased that you have the right thing for you. I hope that it turns out to be everything you want it to be and it goes some way to healing some mental scars from the past.

Apologies - haven't read all the thread.

Have you considered getting an independent midwife? Whether you have a vaginal birth or a planned c/s it would be worth your while.

I went without holidays for several years to pay for one after a bad forceps birth first time around. Worth EVERY penny.

I had a very difficult first delivery and poor care, followed by problems breastfeeding which I was still struggling with when I went back to work 5 weeks after dd's birth. Second baby was born after a diagnosis of gestational diabetes and after having been told baby was likely to be 10lbs + (he was 11lbs) .

I had him at home. Totally amazing experience. Breastfeeding was a breeze.