C section or VBaC 11 months after EMCS

[Savannahrose]

Right, I need advice and support from you lovely ladies.....
I'm currently 21 weeks due April 2012.
I had my DD in may this year by EMCS prematurely at 34 weeks. I went to the hospital 2 weeks ago and they told me I HAVE to have a VBAC despite the risks of my scar reopening and uterine rupturing :(
I asked for a ELCS but she refused and said I would have to have a VBAC and see what happens if anything goes wrong it will be another EMCS which I said I didnt want as it traumatised me last time. She wasn't very nice at all.
I am now panicking and instead of looking forward to giving birth to my baby I'm dreading it, and to top it off I keep having nightmares about SERIOUS things happening to me during labour.
My DH isn't very understanding, he is saying oh you will fine but it's not him going through it. I know from ladt time the recovery wasn't great and took a while and have been told recovery after a VBAC is quickly but I'm just bothered about mine and the baby's safety.....
Can anyone help? Please.....
Xxx

Plus with DD coming early what are the chances of this one being early??
X

I thought NICE had updated their guidelines yet again this week/month with a "if you want one, you get one" policy?

Did they give you a reason for VBAC?

I spoke to my consultant yesterday who wants me to VBAC if the baby is before 37 weeks. I'm happy to go along with that if my body and my baby are "ready" - although in reality it seems unlikely this will happen.

Savannahrose, if you are having nightmares over this THERE IS AN ISSUE HERE that needs to be resolved one way or another. You are have psychological needs that need to be supported - either to help you with a VBAC and give you reassurance OR to let you go forward with a ELCS. Whoever refused you is being a bitch by being unsupportive, regardless of them refusing you an ELCS - they are ignoring your mental health needs here.

The NICE guidelines out today are in your favour HOWEVER they only mean so much. Hospitals are completely free to ignore them as they are only guidelines.

What they do cover though is the fact that if you are making a request for a c-section, this usually suggests that the woman concerned needs extra support. They recommend counselling. They also recommend that if you are refused by one consultant that they refer you to a second. (In the document the advice is that after counselling, if a VB is still not acceptable, then you should be allowed a ELCS - this is not as straightforward and in reality is unlikely to happen.)

My advice would be a) if this is bothering you this much get a second opinion. Do not be put off by negative reactions.
b) You should not ignore your mental health needs - push this - if you are having nightmares there is a problem.
c) There is no guarantee you will be able to get a ELCS, but the NICE document is pushing for counselling, extra support and to take into consideration psychological reasons for requests for an ELCS.
d) Write down exactly what your fears are and what your concerns are in order to understand them better and be better prepared to ask questions and get the reassurance and help suitable for you - whether it be for an ELCS or an VBAC.

There are several women on the forum at the moment who had a refusal, and have since been able to get a consultant agree to an ELCS.

speak to a local midwife and ask if she can refer you to a different consultant. In my experience they all have different rules and regulations even if they work at the same hospital

I would say 11mths is too close to have another cs. I personally would have an elcs.

sorry, I meant 11mths is too close to have a vbac. Woops

Wow so many responses, thanks ladies!

Well I am at the hospital tomorrow for a scan having to be scanned every month until my due date now.
LadyMetroland I would rather have a cS too but it's just getting there.....hopefully when I go next to clinic I will see another consultant and tell her my fears and how it's effecting me and she may sympathise? Or is that wishful thinking....?
Did I mention the last consultant told me it costs the NHS £1000 per c section which made me feel like that was her only reason and that my baby wasn't worth this!!
Who cares how much it costs? I pay national insurance, what for??
I'm beginning to wonder.....
My scan is tomorrow and I am excited but it also hurts when they push down with the ultrasound on my scar I told her last time but she didn't listen....sometimes I feel like we would all do better if they only employed staff who have had children etc so they know how were feeling!
Ok rant over :)

I wanted an ELCS for second baby after a crash section under GA with first baby and was refused. Consultant was utterly vile. You can ask for a second opinion.

What I did - went into labour and didn't progress. Asked for a CS. They wanted to break my waters and give me an epidural. I adamantly refused and said no I'll have the section now, thankyou. They did a section.

Previous CS is still a good reason for ELCS if you want one. VBAC is also pretty safe, but if you don't want it then they shouldn't try to force you, IMHO.

I would ask for referral to another consultant, lots of them are still happy to do CS.

Savannah - if they bring the cost up again, you could ask i) what the price difference is between an elcs and an "out of hours" emcs? and ii) how much would it cost to have a recteole (?) repair surgery 9 months post-partum? You could also ask who will be financially responsible for any birth trauma to your child? I'm not saying these are the "right" answers - but they are logical questions when faced with a barrage of numbers!

I had an emcs last time at a small(ish) hospital - the team was scrambled in as they'd mostly gone home... this was I feel the inevitable result of an induction at 36 weeks, would've been much cheaper to have booked me in for an emcs at 9am surely?

Well you really have just proved your consultant is an utter bitch with her comments about cost. Incidently, if she bothers to read the new NICE guidelines on the subject, NICE looks at the health economics and concluded (this is editted version):
The analysis considered the costs of birth and 'downstream' costs associated with the outcomes reported in the clinical review and found that a planned vaginal birth was approximately £700 cheaper than a maternal request CS. However, there may be other outcomes, such as urinary incontinence, which were not reported in the studies that were included in the clinical review which make the findings reported above more uncertain. Sensitivity analysis suggested that this could, under certain assumptions, produce a different cost effectiveness result.

DO NOT LET ANYONE MAKE YOU FEEL GUILTY ABOUT THE COST ASPECT OF REQUESTING AN ELCS if thats what you think is going to be the best thing for you and your baby. Guilt trips make me angry and are extremely destructive and coercive. Doctors should not do it. If they think that a VBAC is better for you, they should reassure you about your fears and make you feel comfortable about that route, and not bully you into it. Its heartless and cruel and has no place in medicine.