Elective caesarean after difficult birth?

[nomoreminibreaks]

DS is 9 months old and I'm still recovering. He showed up big on scans and I had high BP so was induced - pessary, waters broken, epidural, 4 hours pushing, ventouse, episiotomy, forceps, stitches, lots of bleeding (nearly had a transfusion) and lots of swelling. He was 9lb 11oz. Because of pushing for such a long time I damaged my coccyx and still can't sit on a hard surface for long, despite physio.

A midwife said to me while I was in hospital that she'd rather have had a caesarean than that 'horrific' birth and a few people have said to me since that perhaps I should ask for a caesarean next time as they tend to get bigger (I know that's not always the case).

I just wondered if anyone else had experience of this and what they did?

Have you had any counselling or any debrief on birth? Not saying Elc may not be way to go but your birth experience sounds so traumatic that might help to talk .

I agree with Gigondas about counselling or debrief, the Birth Crisis helpline is supposed to be very good and it might help to talk about it with someone who isn't necessarily a midwife.

You don't say but I'm assuming you are not pregnant just now, only considering the future? It's still early days so your coccyx may heal. Also, if you do decide to go for a vaginal birth next time around, an upright position will take the pressure off your sacrum - standing, kneeling etc.

Ultimately, its your body and you need to do whatever is comfortable and best for you. A caesarean is a birth and is still a special moment.

Hth

My friend asked for an elective after her first birth involving use of forceps damaged a nerve in her dc's neck and permanently affected her dc's arm mobility. Her request was granted - and in fact it was her mw who suggested it to her to do this. Her subsequent child was born by elective caesarean with no problems. So yes I think your request might be granted, as it affected you personally and caused a bad injury to you. I mean in my friend's case, it affected her dc not her and she still got her request approved. If an elective is what you are seeking this time round, give it a try, ask your consultant. They might say yes. Also would second the above posters' suggestions to seek some form of counselling especially if you still feel traumatised by what happened. PTSD can happen to mothers with really bad births.

Thanks for the responses.

I should have said that I'm not pregnant, just thinking of the future!

I have been asked by people if I feel traumatised by the birth and I have to say I don't think so - it wasn't pleasant but DS and I both came out of it intact so in my book that's a positive birth experience. I just worry if it would be worse next time hence my question.

That said I did have PND - nothing too bad but coupled with DS having colic for the best part of 5 months (and being pretty weak for a while) it meant some pretty dark days at the beginning. I think that was a far worse experience than the birth so in comparison the birth didn't look so bad!

I'm just not sure if what happened was 'bad enough' to warrant any special treatment in terms of a caesarean. Are they 'given out' easily or do you need to put your case forward and convince your midwife/consultant?

I probably sound like an idiot. It's just I have no concept of where my experience lies in comparison to others. I know it could have been worse but also could have been better!

Sorry for the long posts!

I think it depends on the consultant. Electives are definitely not given out easily in this country. All I'm saying is that it does seem to me that if your last birth went badly resulting in some kind of long term damage or injury and you put forward your request for an elective based on that, the consultant might say yes. Depending on his/her judgment. Its very hard to say for sure what you have to do to convince them. I know my friend didn't have to try very hard to convince her consultant, but then again she never made a complaint or anything after what happened to her DC... It might be a case of protecting their own backs by saying yes to her request, I don't know. I don't really know why they agreed to it iyswim.

As tiger says, it will depend on your hospital/consultant. Some places offer or agree to caesareans much more readily than others.

NICE have recently changed their guidance and you can now request an elective Caesarian and it CANNOT be refused on economic grounds. So thankfully gone are the days when women felt they had to beg for one. There are checks and balances in place to ensure it's an informed choice, but the emphasis is on choice, not earning the right to one. X x

I had an ELCS 3 weeks ago, after a traumatic previous birth. On paper this was not physically traumatic at all, but for various reasons I found it extremely distressing, and therefore was very concerned about going through the same thing again.
I had to go through two different consultants to get an agreement but I had the back up of two different midwives, and I didn't give up.
It was all a very positive experience for me and the best decision this time round.

How awful for you, I'm so sorry you went through that

To answer your query, yes, I have been through something very similar. My first birth was not induced but involved failed epidural, ventouse, forceps. My baby was also 9 pounds 11 and I was very scared of delivering another huge baby.

I found a sympathetic consultant and basically said, I want an ELCS and I am not prepared to consider a natural birth at this time because I don't trust midwives after what happened to me last time.

My consultant agreed to an ELCS and it was a really brilliant experience. My second DC was 'only' 7 pounds 14 so it doesn't always follow that they are bigger, but had I have known she was going to be that much smaller I still would have wanted an ELCS.

I had a similar experience with my first delivery including the damage coxcyx and also some fecal incontinence and requested and had a planned section with my second. I spoke to my midwife about this at my initial (booking in) appointment explaining everything that had happened and she was very supportive and referred my to a consultant. When I saw him the first time I had already done some research into risks of C-Section and asked him about risks of a vaginal birth for me, was there any way they could quantify the risk of similar issues this time on coxcyx and on continence etc. He stressed the risks of C-Section but then advised me to go away and think about it and then he would support my decision if I decided to proceed with a C-Section, which is exactly what happened.
I wasn't pushing 4 hours but did go through the whole dilation stage of my first labour on my own on a ward (DH sent home when visiting hours finished in the middle of my induction!) and for me this was probably as tramatic as the following birth experience.
The C-Section itself was great and I found both bonding and getting breastfeed established easier, as I wasn't so exhausted and shocked (and I knew to push for skin to skin asap and try to feed asap also). The recovery was hard, I wasn't one of those - off pain relief in 2 days, driving in a week types. I was walking like an old lady for a few weeks, and on pain relief for 2-3 week, but it was nothing like as bad mentally or physically as my recovery from the natural birth.

Amongst other things, I sustained damage to my coccyx and pelvis when I gave birth. I was referred to an orthopaedic surgeon who did an MRI and standing x-ray to determine the extent of the damage and to check that I hadn't fractured my coccyx. I was very at this last suggestion, but it can happen! No fracture, but the coccyx was out of alignment and had the trauma had healed with scar tissue. He did some manipulation under anaesthesia (not possible in a physio session) and injected some cortico-steriods. I may need more injections, but I have been so much better since he did it. Might be something to think about. Pilates and strengthening your core might also help. In the meantime, do you have a coccyx cushion? This a wedge shaped cushion with a semi circle cut out at the back, where your coccyx is. Makes sitting possible!

And as for your question re ELCS, if you've weighed up the pros and cons to YOU (not to the 'average' woman, whoever she may be, but to you, with your experiences and with your life), and ELCS is what you want, then go for it. Bagofholly is quite right.

OP, just to be clear - BagofHolly's post isn't entirely correct - NICE have indeed amended their guidelines so that women no longer have to beg for caesarians or pray to the whim of a consultant. however - there is no legal obligation for hospitals to follow NICE guidelines. That's why they are called guidelines.

these threads normally become a divisive debate between women who want you to have a 'healing' vb for dc2, and women who think you would be better off with a cs. None of us have a crystal ball, so who knows. I hope women who are/have been in your position respond.

So my cards are on the table - I had an ELCS for psychological reasons for my 1st DC. It was a wonderful birth, I recovered well and have no ongoing problems or weaknesses. DS was also bf-ed until he was 18 months old, never had any formula. I know there are no guarantees but subsequent DCs will also be CS born.

Good luck with your decision.

FWIW I had a difficult first birth - second stage went on for over 2 hours, before an ambulance was called (it was an attempted homebirth), then failed ventouse, prep for ECS but given a one-off chance to push with forceps, and eventually delivered 10lb 2oz DS with 3rd degree tears, cuts and general bruising that took months to recover from, including a period of incontinence (wee and poo - lovely!)

DC2 born at home in about 4 hours, 8lb 1oz, 2nd degree tears but pretty unstressful. Personally, despite the horror of first birth, I was not keen on having major abdominal surgery by choice. Although second stage had been gruelling first time, the first stage had been relatively quick (about 6 hours) and I thought that if the 2nd birth was statistically more likely to be quicker that I would be more stressed at the idea of transferring to a hospital and leaving DS1 at home with a neighbour.

If you had asked me 9mths after DS1's birth whether I could do it again - I would have said no. But sometime in the 2nd year I thought I could face it again. If you're not pregnant, don't stress over this now. Concentrate on getting your strength up, mentally and physically, and enjoying your LO.

There's a legal obligation for trusts to fulfill a new Rechnology Appraisal within 3 months, but there's always the ability to make a clinical decision on an individual basis. Here's a document that makes it easier to understand.

www.nice.org.uk/media/654/22/AccessingTreatmentRecommendedByNICEEngland.pdf

Thanks so much for sharing your stories, it's been really useful. To be honest I can't bear the thought of getting pregnant again right now but the intention is there in the future and it's been playing on my mind.

I think that before we try to get pregnant again I'll have a chat with a doctor or midwife to see how things work at that time where I live. I'm still not sure if a CS is the way to go for me but perhaps if I am lucky enough to get pregnant again they can keep an eye on the size of the baby to see if we have another beast on our hands and make a decision then!

If you had a significant amount of bleeding you may be medically advised that a CS actually carries a higher risk of PPH. I had massive PPH, amongst other complications, & was assuming I'd be offered a CS automatically (not that I was decided whether I definitely wanted one) but was surprised to find that was not the case. Something to do with there being incision sites that can contribute to post-delivery bleeding & the treatment options to stop bleeding are reduced if they have to consider the incisions.

That's interesting idle - I hadn't heard of that. I'll make sure I bring it up. I'm guessing that if I almost had a transfusion then it was a lot to lose. They said I lost 1.5 litres, which sounds a lot to me!