Think I want an elective CS for DC2, any advice please?

[twinklespeciallyforlittlegirls]

Hello

Sorry, this is long.

I planned a homebirth with DC1 who is now 16m. All was going fine until I was sent in to hospital (due to lazy midwife spurious concerns about my BP, which was fine when I got there...oh well!). My nearest delivery suite was shut so had to go to the other one, they were also on the point of closing and I was left in a cubicle on an assessment unit for seven hours until they realised I wasn't "making a fuss" and was actually fully dilated.

It was horrible, I had no privacy whatsoever and was labouring with horrible pain (the classic back to back pelvis being sawn through thing) with about 10 other women and their partners on the other side of a cotton curtain. They told me off for making a noise (I was very distressed that I was involuntarily noisy, I stayed as quiet as I could but the pain was just too much and I apologised in between), they wouldn't give me any G&A for ages even though I was certainly dilated enough to justify it, I could go on but I won't!

Once I finally got onto delivery suite things were much better and I had a wonderful midwife, but after a 4 hour second stage with augmentation nothing was happening and I was consented for theatre. Anaethetist was great, theatre team were great and the actual birth was a nice calm event.

Almost a year later I decided enough was enough and that I was fed up of nightmares about the 7 hours on the AU, crying if I saw anyone giving birth on tv, etc, and arranged to talk through my notes with the lead mw for the delivery suite. She was great, apologised to me and DP, took our concerns seriously and was all round great.

She couldn't say why I'd been unable to deliver naturally but baby's head never ever engaged and apparently the consultant wrote in my notes that when she pushed on baby's head she shot away from her, so she STILL wasn't down in the pelvis after all that. Baby was not huge, I am not tiny.

Lead MW said that given that history I would certainly be able to choose whether I wanted ELCS or to try a VBAC, and that she thought a VBAC should have the caveat that they should progress to CS quickly if nothing was happening. She also said that in our (huge) trust the CS rate is low so there is no desire to "reduce" it.

I am now (just!) pg with DC2 and terrified! That's why I'm up at 4.30 writing this. I have read so much recently about ELCS being refused on cost grounds, etc. and I am very scared. I am scared that I'll be refused a CS and will have the same sort of experience as last time.

It's not the VBAC I'm scared of, it's a repeat of no pain relief, no privacy, being told off for being in pain, being left alone and ignored despite telling them I wanted to push, being terrified for my baby as they only checked the foetal heart when they admitted me and then not til delivery suite. I'm scared this DC will be injured, my daughter had a big scab on her head where she'd been banging into my pelvis for hours.

My DP is also very keen for me to have a CS, he was amazing last time and if it weren't for him I would probably still be in labour in that cubicle!

I've read the RCOG guidelines on CS and I do have a background in healthcare so am happy that ELCS is right for me. I just want to know how I should approach it from the off - I don't want the mw at my booking appointment fobbing me off, I don't want fobbing off by an SHO at consultant appointment, and I certainly don't want to stress about it til 36 weeks as I know many are left to do.
I also don't want to be booked in for ELCS at 41 weeks as I am reading about just now - I went into labour on my due date with DC1 so have no reason to think I will get that far (I know that's the idea!)

If I could afford an independent MW (ha!) I would be happy to try for VBAC but that's a pipe dream, and no disrespect to doulas but I know the NHS and that's not the answer for me (did consider one for DC1 homebirth though, I'm not anti-doula).

My main fear is that they will make me try for a VBAC, I will go through hours of cx, then 4 hours of pushing and end up with another EMCS (labour with DC1 was 49hrs total so even allowing for faster with DC2 I would probably still be very tired).

Sorry about the essay. If you've made it this far thanks for reading and I will be so grateful for any advice. I know my experience doesn't sound like the worst in the world but it was bad enough and has had lasting effects on me which I am keen to avoid a repeat of.

Hi, I think it may depend on the hospital - I'm due in December and the hospital say they will let me have an ELCS. It won't be booked until 34/36 weeks and they have been trying to persuade me to VBAC but have said that the choice is mine.
You should be referred to consultant led care by your community midwife ask for an appointment with the consultant as soon as possible as they may make you see him/her a couple of times before agreeing or, you may have to talk to a consultant midwife. They are very keen on making sure you have all the facta and figures which is good but a little scary!
Be honest about how you feel as they do seem to take your mental health into account - I get upset every time I explain DD's birth and it has been noted that I'm very emotional about it.

I'm watching with interest as I had a similar birth experience, except I laboured for almost double the time you did before finally seeing a Dr who noted my DD would never have got out via the traditional route.

Do you have your GP on side? I spoke to my GP very quickly after the birth of DD and she was very supportive and said she would be happy to help me insist on a CS.

OP although my labour wasn't as long as yours my experience wasn't dissimilar and I have opted for an ELCS this time, a very big part of that decision being that I simply don't trust the staff at our maternity unit to get me through labour. It's awful, but unfortunately that's the way it is.

So, I said from my booking apt that I wanted another section. I was asked why, I explained, and was told this should be fine. All the way through I've maintained this is what I want. I had an apt with an SHO at about 22 weeks, said the same, and was told this should be fine. Next saw a doc at 36 weeks, and was booked in. I'm now 37+5 and am due to have my ELCS at 39+4.

I've been very lucky, noone has really questioned my decision or tried to persuade me that VBAC would be a good route to take. As far as I've seen noone has sat down and gone through my previous notes in detail, all the info has come from me. I was very adamant from the start and I'm sure it was clear that I was unlikely to change my mind anyway. My initial midwife just said it was good that I knew what I wanted. I was on the ward last week and told the sister there why I'd made my decision. She said she didn't blame me and thought it was the right choice.

So if you are firm, and make them see that you are fully aware of the risks then hopefully you will get what you want. I think it's incredibly sad that we've had to chose what we have, but there we are. Good luck

Thanks for the responses, it's nice to know I'm not alone but a shame that mine wasn't an isolated experience.

I haven't seen a GP since before I was pregnant, didn't even get a six week check. There is a really nice doctor in the practice who I might see if the mw isn't sympathetic (if he hasn't retired!)

I'm hoping that they will let me have the choice. I was certainly given that assurance a few months ago by a very senior mw (who has now retired! fgs) and I think the community mw I had last time would have supported me but she's retired! My friend is a mw in the same team though and says her replacement is really nice (she also says she would recommend someone with my presentation for ELCS if they wanted it).

I did have a referral to an obstetrician last time due to possible hereditry thing on DPs side and the reg was really good, so hopefully they will be the same about this!

If they could promise me the sort of care I got on delivery suite for the whole admission I could be persuaded to try a VBAC, but I don't want to take the risk of being left alone for hours again.

I had a similar situation but did have dd1 natuarally - she came in 2 hours 5 mins but mws kept telling me I had at least 12 hours etc so got no pain relief until 15 mins before dd1 was born and I truly blame the panic that occured once dh asked for a 2nd opinion and the registrar realised I was 10cm for the terrible tears I suffered.

The tearing was part of my reason for requesting a cs but it was more the care and lack of being listened to that I couldn't face a second time. We went and saw an nhs consultant in November last year and he agreed and apologised for my care - which helped a lot. I got pg in December and liked the fact I had a cs as an option but was keeping an open mind.

As it happened the pg was twins and both were breech so were born by cs 5 weeks ago so the decision was made for me. FWIW the cs was a lovely experience and my emotional recovery has been much quicker than the vb.

Good luck whatever you choose x

I had bad birth with ds1 and emcs. Saw consultant mw after re vbac for ds2 and was useful - opted for that and tbh it was a bit chaotic as was left in reception for an hour being told to be quiet but when I did get in I had mw throughout. I again saw consultant mw for ds3 and was assured that they had improved admissions and it would be better - it honestly was and I got the royal treatment - it completely restored my faith. Ds4 in 2 weeks and hoping for the same. They will not let you go more than 12 hours with about 1 hr of pushing on a vbac - you will probably not be left to labour alone as you are high risk. I honestly think you'll find a vbac different and your body has labourered before. First births are generally shit in my view.

But I am sure if you do want a section you will get it - I honestly don't think they can make you have a vbac.

"the care and lack of being listened to that I couldn't face a second time" - this is exactly it! My CS was lovely, really calm and peaceful.

Lollystix, that's a good point about increased risk and one I shall be making! Though the being left in reception being told to be quiet sounds all too familiar...I actually work in the trust so I'm hoping that might help, they don't want their own staff complaining to the local paper.

The problem seems to be getting the baby's head into the pelvis I wouldn't mind so much if I didn't have "childbearing hips"!

I just had an elcs after horrible instrumental birth. There was no argument. Friends at same hospital who had emcs last time are being offered a straight choice of vbac or elcs. They were really understanding of my psychological concerns. I had appt at 14ish wks and at 34. I was so worried until 34, but in the end was able to block or it would have ruined the pregnancy experience.

Elcs was v calm and civilised. I enjoyed it and loved the recovery room time where we had 3 hrs of skin to skin undisturbed. Of course that could have been the morphine! Good luck

I had the exact same problems with my first birth ( not with the horrible having to labour in EU thing though.) DD back to back never came into the pelvis= EMCS
I tried for a VBAC with DS 2 years later thinking it must have been just the awkward way DD had been lying, but he was exactly the same, back to back head never descended. Ending up in another CS.
There are people who go on to have a VBAC after a previous back to back labour but I wasnt one of them.
I am now 27 weeks and have opted for an ELCS this time, although part of me is hoping I will go into labour before it, get examined and told this baby is normal position and I will be able to give birth naturally. The thought of recovering from another CS and the subsequent days in hospital is giving me nightmares!

I hope you do get your cs. I had a failed vbac that went really wrong (complete rupture). I can't fault the care I was given though and thanks to great drs DD is fine with no damage. Other thing to bear in mind with vbac is that they are reluctant to give an epidural as you may not feel danger signs of rupture (pain on scar). One tip though if it comes to it and you do labour they will take you pretty seriously if you say you have pain on the scar. So not exactly the best thing to do, but it might get you into theatre. I hope it won't come to that though. My trust (north bristol) said I could change my mind at any time, even in labour and request elcs. Good luck, its a scary time I know.

I remortgaged my house to pay for an IM with dc2 because of incompetent nhs care with dc1.

It was worth every penny.

If I didn't have a house to mortgage I would have sold things/taken an unsecured loan or borrowed the money from family.

Sorry to sound like I'm questioning your financial circumstances but I know that I started off thinking 'I can't afford it' it was a situation not of not being able to get my hands on some cash but thinking 'that's a lot of money when we have no savings, haven't had a holiday in years and I'm buying all my clothes in charity shops'. It's never something I would have considered before.

Ah thank you!

SkiBumMum as far as I am aware that HAS been the situation here but I'm a bit worried they'll be "costcutting" a bit more now - though it's the same financial year as my debrief so maybe not. Seeing my mw friend next week so will have a word with her about it as she will know what the current situation is.

Wormshuffler that's really interesting - were yours restless in utero? My dd was rolling about right up til I went into labour, I was even sent for a scan at 39+4 to see if I needed a CS because the day before two mws thought she was breech. She was an odd "lie" the whole time, I had a very experienced community mw who used to remark on the interesting positions she was in at each appointment. I wonder if the movement was because she couldn't get her head down? That's another reason I would like a CS actually, I was worried about cord strangulation with all the huge movements. Sorry you've found recovery from CS rough, I was lucky last time and recovered well. Hope you get your VBAC in that case!

Zoonose, I will bear that in mind, I didn't have an epidural last time (until theatre) so reckon I'd be okay to do 12 hours/1 hour without, and I think that if I have a similar presentation there's no way I'd manage a VBAC with an epidural - my contractions weren't pushing the baby down so it was all a bit hopeless, but at least I could tell them that. Glad you and your DD are fine, that must have been very very scary.

shagmundfreud, I appreciate what you're saying but we really can't afford it! Remortgaging is not an option and we don't have family with that kind of money either.

No neither of them were shufflers to be honest, the consultant said when I asked why they were both in exactly the same position, that I must have "a queer shape" where they get super cumfy and not move. I do have an arched back not sure if that's anything to do with it.
I say I am hoping for a vbac but not so much that I'm willing to opt for one!

Arched back? As in your bum sticks out a lot further than the small of your back/very curvy spine? That's what mine is like...

Yes that's it, think it is also reffered to as a ducks arse! Coincidence? Or have we found the reason why !

:) yep definitely a touch of the duck! I think it does make a difference, my sister is configured similarly and though she had a normal birth my niece was back to back....