Why was ELCS was 'only safe option' last time and now VBAC is being pushed ?

[Babieseverywhere]

Last time I wanted VBAC and was told at every consultant appointment that VBAC's were dangerous, me and the baby would die. Had very crap and scary but non lethal VBAC.

Now I requested the bloody ELCS which they kept pushing on me last time, as the safest best option. Oh no, I can't/shouldn't have ELCS, VBAC is much safer cheaper and better for our csection figures for you and baby.

Plus they have my dates out by at least 10 days but won't change it even through I know when I am due. So even if I get an ELCS, they do them at 38 weeks, which will be 36.5 weeks or earlier for this baby.

Meh, they wonder why I have problems with hospitals. But I have chocolate so all is now right with the world. :)

what made you have a vbac the first time round?

if ou feel it's right to have a elcs, keep pushing and keep taking it further

They do elcs at 39 weeks these days, not 38.

Plus, it can be scheduled for later than 39 weeks. I had my elcs with ds2 at 39 + 5 after previous c-section.

Guidelines have changed these days and if you want a c-section you are entitled to have one.

But hex guidelines are guidelines, not law. Believe me, as someone who is currently pushing for an elcs, you are not entitled to a c section when hospitals have targets to meet. They will go out of their way to refuse. The new guidelines give women a false sense of choice.

Where are you? Can you change hospital or consultant.

I had an ELCS at 40+7. Was 6 yrs ago, prev EMCS. Up to 40wks they were still saying VBAC poss, then consultant said no way baby coming out on her own. With babies, it can all change right up to last minute, v stressful for you tho' hope you can get your mind put at rest one way or another.

they always do this. But even before the guidelines changed if you'd had a c-section, they had to give you another if you requested it. When I had my second, they tried to push VBAC on me (twas the registrar rather than the consultant) despitemy 36 hour labour, EMCS and being told it was unlikely I could have a natural birth. I just left, went to the reception and demanded to see my consultant. He checked my previous records and booked me straight in. Stick to your guns and you will get your c-section. For the record I'm not pro or anti vbac, CS or any other form of birth. I just believe that if we tell women they have a choice in childbirth then it should include all options not just the option the hospital or anybody else wants you to choose. And CS are not bad, they are good - they save lives!!

OP why dont you just go all hysterical on them and say you are so scared of a VBAC you are worried you wont push hard enough / will be traumatised etc? I wanted an ELCS after a 3rd/bordering 4th degree tear. I saw 2 consultants, one who suppported me and the other who tried his best to get me to have a normal birth. It was only when I made the point that I am so scared of tearing that badly, or worse, that it wil be on my mind and then I might not push hard enough that he finally agreed with the first consultant.

Is is possible that your record of having a 'successful' VBAC (even if crap/scary), has shifted the balance of risks in your case so that a elective CS would not now be justified?

Are you sure that your hospital do elective CS at 38 weeks, that would be unusual? That shouldnt happen to you though, because you say that they dont want you to have a CS in any event, so if that is the case then if they do agree to do a CS they should be happy enough, unless there are other medical issues, to book you in later.

I think the new guidelines are not to do an ELC before 39 weeks if possible. I think this is quite a recent thing. I had placenta previa and I had to wait until 39 weeks, I so wanted it to be over but my OB said no way, this was in Canada though.

I might of misheard the 38/39 week bit. I was a tad emotional.

Ironical I don't even want a csection but couldn't go against all the emotional pressure I had last time to have one IYSWIM.

They refuse to support me at home and have a long list of rules they WILL do if I am in hospital which make that experience an unmitigated disaster again. Through to be fair the worse part of hospital last time was the failed epidural, enough to stop me moving but allowing me to feel all the pain of a back to back inducement on my back, lovely.

Yes, I know you can force midwives to come home to you, they simply turn up and transfer you to hospital (like last time) and I am not crazy enough to go ahead with no medical support. So that is a no go.

I also understand in theory you can refuse stuff in hospital but I am not strong enough to object when in so much pain and they are pushing all the emotional buttons about you having to have x, y, z or it could cause harm to baby, how can you refuse, sigh. They don't listen. I have no support just endless pain. I am soft, after the first 30/40 hours of pain I can't cope any more, how people deal with chronic pain every day of their life is beyond me. Poor people.

DH and I had discussed prior to consultant visit, what needed to happen to get this baby out safely and decided in light of my crappy failure to birth times three, we decided that we would go with the consultants ELCS suggestion pressure from last time.

I nearly laughed out loud in a hysterical way (but then I cried a lot instead aren't hormones lovely) when they had a 100% turnaround this time around. I had got myself to a safe space thinking major surgery whilst being awake is a nightmare and something I don't want but it is Hobson's choice, baby would be safe and at least I'll skip the 30 hours of pointless failing labour before it this time. But it seems not.

I know I can get a section, I'm pushy. But I don't want to have one several weeks early, surely it is better for baby to be term and as baby might had HDN, every week the baby is early increases the risk of needing blood transfusion due to extreme jaundice, something I want to avoid if possible.

Had a good sleep last night and have decided on the following.

Limit time at all hospital appointments, DH will take over speaking I have had enough, he is more tactful than me at times. We'll say whatever means I get out of appointments asap. Agree with anything they say, it doesn't matter what I say they ignore me, so become nodding dog agreeing with any stupid thing they say, breath deeply and enjoy chocolate.

Wait until my official incorrect due date, baby won't arrive (as they have the dates wrong) Wait another 2/3 weeks until they are pushing a csection on me again, like they did last time. Accept. The End.

I think your plan now you've had a think sounds ideal. DD was meant to be a VBAC, ended up as a RC/S at 42+6 in the end!!!!! DC3 will be a RC/S at 40wks.

What does the R mean as in RC/S...rush c section ?!

If you have delivered a baby vaginally before then your chances of an easy delivery are much higher this time around, you are not doomed to a prolonged horrible experience this time just because thats what happened the last time.

I had three bad 'births', two vaginal with forceps, one emcs. All three babies were malpositioned and being forced to lie on back once transferred to hospital, I had zero chance of helping them switch position, hence I am indeed doomed to a prolonged horrible experience again...might pinch that phrase of you.

I will never have an easy birth. Partly because of bad luck with babies positions, coupled with the rules forced upon me by the hospital preventing any hope of such a thing happening. The best I can hope for is a unwanted but needed cs. But I am very lucky to have three healthy babies and have to do what I can to have a fourth healthy baby.

That said I do reckon I'll get an elcs or emcs nearer the time, hopefully NOT involving 30 hours of pain first. Guess I'll have to wait and see what happens.

Well, I met up with my lovely community midwife earlier in the week and she was utterly gutted for us both and can not understand how or why, the hospital would refuse my reasonable request, especially with my medical history. Glad to hear it is not just me who was shocked at the hospital's 100% turnaround in policy and attitude from last time.

She has asked a senior hospital midwife to advocate for us with the consultant in the next hospital appointment. I did thanked her, though as the consultant can not deviate from their guidelines, I am unsure how a senior midwife could help this situation but if the senior midwife wishes to try, good for her :)

Community midwife is also going to think about any other possible solutions, which is very sweet of her.

I have been thinking of how I can try to reduce my pain levels and encourage the hospital to give me an EMCS, if I go into labour prior to 42 weeks (by their dates).

I have decided to refuse their inevitable kind demands offers of inducement drips & breaking my waters etc, which have featured in previous labours.

As these interventions in my previous labours makes my pain levels unbearable and does nothing to help my badly positioned babies to move. If they feel labour is going nowhere I want to move straight to CS.

I think restricting the level of unnecessary pain is an reasonable goal, as I am prevented by their guidelines from accessing any effective pain relief.

The best pain relief which actually works for me, is simply moving around sitting, standing stretching and being in water work very well too. I got to being fully dilated at home, due to being able to move and my lovely water pool, shame DC2 moved sideways and had to be an transfer and EMCS in hospital at the end.

But hospital forbids both of these options for me. i.e. I am not allowed to move at all, not even an inch off my back (as it affects their monitors) Or have access to water/bath/shower (ditto monitors).

The injections of various pain relief don't work for me (tried different types in two different labours), gas and air doesn't help pain wise but gives me something to bite down on I guess, epidural failed on me.

They have nothing else to offer me.

Therefore the spinal offered with ELCS was starting to sound wonderful.

Sigh, It is a shame that in 2012 in a first world country, I am denied effective pain relief but never mind at least they can be happy that despite how much pain I am in cursing the writers of hospital policies, at least they are following their guidelines.

But as 3/3 pregnancies have gone to 42 weeks minimum I would be surprised if this one starts earlier, I'll have to wait and try not to think about it too much.

Open to hear about any other pain relief option which works on back to back labours (2/3 labours) with malpositioned babies (3/3 labours) and can be accessed from a bed requiring no moving (3/3 labours). I await suggestions.

There are other posters who will be much better at offering advice, but I wanted to respond as you sound so despairing in your posts. I think it's possible to monitor the baby with a clip on its head, which has the advantage of allowing you to move around? Also, could you afford a doula or a trainee doula, as she would be an advocate for you in labour. You do not have to have continuous monitoring, the midwife can listen in with a doppler every 15 mins - but I agree it can be very hard to argue with midwives/doctors, this is where a doula could help.

I'd be tempted to play hell with the medical director of maternity services, quoting the new (niv2011) guidelines, expressing the reasons for your request and asking to see TWO consultants for their opinion in line with that guidance. You might have to fight but you'll get one if you're prepared to ask in the right way.

Zimbah, TBH I feel fairly calm this time around. I fought tooth and nail to get support the last three pregnancies but it is not to be. I have finally accepted that I have no control or choice over anything and just have to endure. I know in theory I can reject continuous monitoring, I did last time, they ignored me and put it on me, telling me I was endangering my baby by objecting.

BagofHolly Thanks, I do agree if I push it I can force them to do an ELCS, however I can not influence the date of the section and I can not let them take the baby at 36 or 37 weeks in real terms, due to their policy and inaccurate due date. It is too risky for baby if he/she develops HDN (50% chance) every week early gives higher risk of severe jaundice (last time it was just light treatment, baby just avoided blood transfusion for a 43 week baby)

I have to say that although you may feel sure of your dates, scanning and dating is incredibly accurate. And you can absolutely influence the date of the section - what makes you think you can't? In any event most trusts won't do ELCS before 39 weeks, sometimes more, in which case even if your dates were spot on, that only takes you to say, 37+x. Again I'm sure if you explained all this at booking you could reach a compromise. Fwiw if they're keen for you to have a vbac anyway, they'll be more minded to book a late section in the hope/possibility that you go into labour and deliver naturally. I think you just need to be v upfront - no one cam make you do anything and they're there to get the best outcome for you and your baby.

I know we can't influence the elcs date, as that is what the consultant said to us during booking.

Consultant said even if she did agreed for us to have an elcs (which she hasn't yet) the date is fixed in line with hospital policy that all elcs are done at a set week (which I am guessing was 39 not 38 like I thought)

The scan dates are not necessary accurate, they were at least 3 weeks out with my DC3. She was meant to be three weeks overdue by their dates when she arrived. Yet she was covered in verdix and light hair, certainly not an overdue baby in any way.

Problem is all calculations for due dates for our hospital are done to a standard 28 day cycle, yet I have 32 day cycles, a difference of 30 ish days over an entire pregnancy. Consulant was very nice and explained her hands were tied, she had to go off their due date and their policy for elcs, regardless of what we said. She said there was no movement in dates at all, something which really surprised my community midwife.

No matter, it just means we wait out to the end and see what happens. After all I am very early yet and anything could happen with my regular RH blood tests or baby position could turn breech etc, loads of things might effect things.

Going to try and relax and chill a bit and not worry about things I can't control.

I think the fixed date is nearly 40 weeks. I was booked for 38 with twins and type 1 diabetes both of which take a week off what they'd do normal women.

Thanks Tigger, I hope everything went well with your new arrivals. :)

isn't it frustrating how policy varies from hospital to hospital. I had a elcs with dd after an elcs for ds as he was a footling breech. I was really sceptical about my chances for a vbac as dd was transverse the entire pregnancy. They kept telling me she'd turn (she didn't until the very very last minute) but in my discussion with the cons, I asked if for peace of mind I could book a post dates elcs so if we got to that point I could fall back on that, and not have what would be classed as an emcs.

They duly booked me in for one at 40+15, they were quite happy to do this. I decided if I felt uncomfortable with the idea of a vbac I'd refuse an induction. As it turned out, on 40+12 after 4 sweeps they'd decided I'd been through enough. The fourth sweep did nothing, cervix was still very high and closed (I think that's what they said) and my placenta was looking ropey, so they said if I wanted an induction it had to be started there and then so they could give me the required 2 days before going for the cs.

I did turn down the induction and had the cs I'd booked in at 25 weeks!

Could you ask them to book you in for a similar post dates cs "just as a precaution" so you're in their list, and then when you get to that point, if you're booked in I think they're happier to let you go for the cs.