Could you have coped with a 5 hour car journey 3 days post C-section?

[Daya]

I have a ELCS booked at a London hospital, I have for long and complicated reasons got to move to the North of England and have being told this morning that the hospital I am transferring to in the North will not give me a ELCS!

They do not do them on 'maternal request' and was advised that my only choice was to either not transfer my care from London and go to London for the ELCS or have a natural delivery at the new hospital.

I feel totally shaken up by this, really upset, I wouldn't be driving myself but would obviously have a new baby in the car with me. This is my first birth and don't know what to do?

Could you have coped sitting / laying in the back of the car for 5 hours post CS? Is it really unrealistic to plan this - at the moment I feel like I can't face having a natural birth now i've planned a CS for so long.

That's just how I feel Lunarlyte like I can't get my head around how I'm now at 36 wks facing a VB.

I've got a letter being faxed by a psychologist I saw for a few sessions re the birth anxiety to my GP and am waiting to hear from my consultant.

I am going to speak with another consultant at the hospital in the North East and really try and say what HmmThinkingAboutIt listed in her last post (thanks again for your encouragement to challenge them). Then try and contact another hospital and see if they are anymore sympathetic though time is running out!

I do get the risk JustFab , and honestly how I feel right now I'd rather only have one child and a CS than a natural delivery and more children. I know that sounds irrational but right now that's how I feel.

Actually I don't think it does sound irrational. It makes me feel sad that you are so worried about this. Please talk to someone.

Daya, people like you need and deserve all the support they can get to challenge decisions like this as they are just wrong especially given the circumstances you seem to be facing.

At 36 weeks after having being granted a request, to reverse that, to me seems to be dangerously close to opening the himself and the hospital up to medical neglect and is certainly showing a complete lack of awareness of medical issues surrounding tokophobia. Especially since you now say that you also saw a psychologist as part of this process! Even the most pro-ELCS consultants don't just dish them out as even with the NICE guidance they have to justify the decision and be able to say that the patient was fully aware of the risks.

People need educating on the subject as much as possible, and women like you need reassuring that they are not being in any way unreasonable and they have medical needs here that should be on a par with any other concerns during pregnancy and are not in any way shape or form "lesser reasons". They are part of the whole process and shouldn't be neglected. NICE recognise this. There is no excuse for hospitals not to do this.

It seems you have a really strong case to be answered here.

You have a right to be listened to and respected and any sudden changes to your care need better handling, explanation and support than you have been given - completely regardless of whether you do end up with an ELCS or not. You aren't being difficult or awkward in anyway, so don't feel you are being. Be a great big pain in the ass to them, as they deserve it. I fear it might be a bit of a battle, but don't loose sight of the what you have in your favour and what the issues are here.

The consultant you saw, under the circumstances, should be fighting any hospital policy with you instead of being an obstacle to you. Your health should be his number one priority, not the hospitals policy. Instead this consultant has left you in a position where you are seriously considering actions that you would not consider unless you were distressed and desperate, and which in a worse case scenario, could be potentially dangerous or put you or your baby at risk in some way. That means imho, at some point by the way he has handled your case, failed in his duty of care to you.

There are some awesome people who understand and are very supportive on this forum of birth fears (and risks and the politics of Maternal Request ELCS). I really wish you the best of luck, and hope everything gets resolved in a way you feel comfortable and happy with one way or another - preferably an ELCS at your local hospital.

Don't let the bastards get you down.

Respectfully JustFab, there are risks with any CS, but from what I have read from your post, yours was an EMCS which carries higher risks than ELCS. Remember that are also risks with any VB. I'm just wondering whether your experience was an emergency/crash CS and then a straightforward VB?

JustFab, it sounds like she has. And honestly, talking to people isn't the solution for everyone as I'm sure a lot of people on this forum will tell you.

If the OP has a phobia its more than a fear, and its not necessarily something you can just 'fix' through talking, especially since she's only got about 4 weeks left and she's already emotionally built herself up to having the CS she felt she needed because of her concerns which were supported as being completely valid by her previous medical team.

I find your comments a bit patronising in that respect and a little bit ignorant of the extent to which it can affect some people and why it effects people. Especially in view of the fact she's said she's seen a psychologist for several sessions and was granted a request by a previous doctor.

The problem is not that she doesn't somehow understand risks in this case. The problem is precisely because the consultant didn't talk to her and listen to issues already raised and were being dealt with and isn't giving her proper support. She's already made all these decisions. She shouldn't be having to deal with it all over again.

And by straightforward, I mean an unassisted birth with no intervention.

I couldn't have done so. My terminally ill friends wedding was 3 days after my elcs (my second one) and I had to make the heartbreaking decision that I wasn't physically able to travel for 5 hours there and back. It broke my heart not to be there but I just couldnt do it and i didnt want to put my DD2 through it either. I really hope you can figure out another way round this OP. Best of luck.

I am certainly not meaning to be patronising. I am trying to help her. I am left with the results of a c section I had no choice over so of course I am going to try and encourage someone to seek all alternatives. My emergency section with dc1 was actually a problem when I came to have dc3 and means I can't have any more. I can only post what I have experienced.

I will leave the thread now as I am clearly not helping or welcome.

I wish you all the best Daya.

Try Wansbeck, depending on which side of the river you're on. The RVI is very good and is where you'll want to be if your baby needs special care or you neede an emergency c-section. Do you know which local authority area you'll be in?

Regardless of whether youcould manage it, a newborn shouldn't be in a car seat for long. Is there someone you could stay with in London?

Daya - Have they told you that you are likely to be out at day 3?

My hospital doesn't like people to go home until after their stitches are out on day 5.

I had an elective c-section - although I had no choice about it really as the consultant thought it wouldn't be safe for me to go into labour at all.

There is no way I could have travelled even an hour let alone for 5. I was in hospital until 7 days and that was with no physical complications. Your milk can come in late after a c-section so mine didn't come in until day 5. It is a major operation so rest is so, so important.

I had a vaginal birth for my second child and felt quite different afterwards.

If it does turn out that you go down the natural birth route, have you considered hypnotherapy or EFT etc? Both are very good for phobias.

Whatever happens, I wish you the best of luck and good health.

I'm in North Tyneside MainlyMaynie. The problem is that in London it's self referral to whichever hospital you choose, here it goes first through the GP who refused to give me an urgent referral when I first moved back as I had no medical case for an ELCS.

I will look at the Wansbeck and also Darlington has been suggested to me too so these two I will try if I realistically have the time to get an appointment etc.

Seeker unfortunately I don't have any good friends I could stay with in London after the CS with a new baby.

Thanks hmm for your encouragement, I'm not giving up yet. I am reading some old threads on here now about elcs and birth fear so can hopefully argue my case better next week.

I only saw the psychologist twice because basically was told it's ok you can have ELCS, she will be faxing a letter to the GP in support of the ELCS though she said it may hold no sway with the hospital as she isn't medically trained and to not get my hopes up.

I did mention NICE guidelines today to the new consultant but was told elcs are not done when the pregnancy has been healthy etc and that London was a different population with different needs and expectations and things are different there...

Thanks again for everyones advice re the hospital and the car journey which does sound like it will be hell on earth and not a good start for the baby or for breastfeeding which I do plan to do.

I was told 2 to 3 days by the consultant ColinFirthsGirth so I was going on that advice but if I was in longer I could get a lift on the day we were released.

An ELCS is completely different to an EMCS and carried different risks and different problems. This is part of the problem with the taboos and research surrounding Maternal Request ELCS, which is why it is so important to make the point Lunarlyte did, JustFab. For the most part, the two are actually largely more incomparible than they are comparible despite effectively being the same procedure.

There needs to be a lot more education on the subject of maternal requests and the reasons behind them in general. There is a lot of ignorance amongst doctors, policy makers, politicians and the press that need to be tackled as it is having a great influence on the way in which women are being treated professionally and personally.

Sadly in this country our cultural belief in the 'too posh to push' myth is hindering research. Other countries are light years ahead of us and recommendations that have been made by parliament in 2003 have wilfully and conveniently been swept under the carpet making our understand of the entire subject a lot less than it should be.

The more research I see on the subject, the more it becomes apparently that our treatment of birth fears is woefully inadequate and that any request for a ELCS should be taken very seriously as there are patterns to what type of women ask for them and why. A significantly high percentage are vulnerable women perhaps with a history of mental health issues (such as depression, anorexia, or anxiety), a history of sexual abuse or rape, a previous birth trauma or several other groups. It should be regarded as a red flag, for someone who potentially needs extra support and understanding in childbirth and throughout their pregnancy.

Women who are primary tokophobics often develop it in early adolescence and tend to put off having a family - so it can be very deep seated. It isn't uncommon for women who have a family history of bad births to tokophobics, and even when they know that birth experience is in no way hereditary and research disproves a link with close family members experiences, its very difficult to simply talk about and resolve. This is especially true because childbirth is so closely linked with a sense of worth as a woman and various cultural beliefs about rites of passage. It is a taboo subject that is linked to self worth.

I could go on...

This is not about driving anyone from this thread. It is about education and trying to protect the OP to a degree from having to justify herself or her understanding of risks of an ELCS in anyway shape or form.

I'll PM you!

"I did mention NICE guidelines today to the new consultant but was told elcs are not done when the pregnancy has been healthy etc and that London was a different population with different needs and expectations and things are different there... "

Lets just separate the bollocks out from that.
So doctors in London only perform MR ELCS on what grounds exactly?
Because they are older and have more health risks? Because culturally there are more people from countries where CS are considered preferable? Or because the Londoners are more diva like celebrity copying demanding types?

Shall we completely ignore the fact that a doctor treats you and assesses your needs as an individual and the fact that tokophobia is a medically recognised condition for which you can be diagnosed in other parts of the country.

This guy is taking out of his big fat hairy backside and is also spewing dated stereotypes and ignorance into the picture.

Things might be done differently in London. I'm suspecting its because they have more modern and up to date attitudes to childbirth than in the NE if that doctor is anything to go by.

Patronising and ignorant. Thats exactly the type of stuff I'm referring to.

"Could you have coped sitting / laying in the back of the car for 5 hours post CS?"

Definitely not. I was in hospital for two nights after the birth of DS, so came home at approximately the three-day mark. I felt like my insides were about to fall out for the whole of the 5 minute drive home and could barely manage the walk from the front door to the bedroom.

Applauds hmm

Daya stand your ground. I have found that letters to the chief exec of the trust responsible for the hospital, which are sent recorded delivery can work wonders
As can letters to your new MP!

Be very very obvious that you aren't going to accept the hospital fobbing you off or ignoring the guidelines...

Best of luck and don't let them get you down!

no way could i have managed - i had a good cs, healed really well and have been up and about v quickly, but 30mins in the car 3days after cs had me tired and uncomfortable, was about my limit! it sort of, pulls you about, the movement. not to mention all the stops for feeding.

Sorry to hear that you have been so badly treated by the new gp/hospital

The consultant that told you that london patients had different needs/expectations etc - could you try telling him that you are a london patient - that you have exactly the same needs and expectations as you did for the first 36 weeks of your pregnancy in London, they haven't changed and just because you have had the misfortune to move up to where they haven't heard about tokophobia etc moved up north, that hasn't changed. And as a result you need the same treatment.

Would contacting PALS be able to help? What happens if you contact NICE to ask them why you are being refused something they have in their standards?

I would also ask them, if they carry on refusing you like this, to write on your notes that by refusing you the ELCS for your tokophobia as specified by NICE guidelines, then they are taking on liability for anything that goes wrong with the birth and any consequences for you or the child - whether that means having a vb and having problems (mental or physical) or because you are forced to go back down to london and then have to travel a long distance a short time after the birth and any consequences as a result of that. (I won't relist all the potential consequences here). Also ask for a guarantee of a safe and un-problematic birth given the significant familial problems experienced by your family (do you know about your gran/great gran just to add any weight to that argument?). And if they don't write it on your notes - then say that you are writing it on them and will be writing a letter to them and the hospital, hospital lawyers, PALS, local newspaper, MP etc just for good measure to say that by refusing you the ELCS for no good medical reason you will be holding them liable for everything that happens as a result of that decision.

Sometimes - unfortunately - making somebody sign up to be liable for all sorts of everything before they have happened - has a way of concentrating their mind and maybe making them slightly more amenable to your way of thinking...

good luck and hope you get the birth you want, where you want it...

Hurrah Hmm you took the words right out my mouth! Or iPhone keypad, anyway.

The term prophylactic choice is one that is not adequately represented regarding maternal request CS: that is, choosing one set of risks so as to avoid another. I chose my CS not because I'm too posh to push (such an easy pejorative term to throw at women) but because I wasn't happy with the idea that I could worsen a back condition that I'd developed as the result of a long pushing phase last time. I'm frustrated that my OB didn't take me seriously, despite contrary evidence from a physiotherapist and chiropractor. I don't know how my tailbone would have taken another VB, when it never fully recovered from my eldest daughter's birth in 2009.

It is unfair the way that worst-case CS outcomes are presented against the best-case VB outcomes to women requesting CS. CS shouldn't be taken lightly - it isn't the 'easy' option. But then, as another wise Mumsnetter once said, there's no easy way to have a baby.

There is no way I would have coped with a 5 hr car journey after my c.section, I was in hospital for 3 nights anyway and I hate to break this to you but having a c.s is not the easy option!! It is really sore for a good few days/weeks afterwards, I wanted a vb but due to my dd being in distress had a emcs.

If I had another child I would opt for a vb but specify that I would definately want an epidural!!

If you do end up having to go to London could you maybe ask your consultant there to allow you to stay an extra couple of nights in hospital given the way you've been treated and the risks of the journey? And maybe you could break up the trip back with an overnight stop or two in hotels along the way if the budget could stretch to it? Don't know how easy that would be either with a newborn but you would have your mums help.

By the way, although you can't of course know in advance how fast you'll recover and 5 hours after 3 days does seem to be pushing it, bear in mind that most of those who've commented haven't said if theirs was an ELCS or EMCS. People tend to assume that recovery is the same and give advice on that basis but, in general, there's a big difference between recovering from an often long and difficult labour + recovering from an often more rushed and rougher operation on a contracting uterus vs recovering from a planned caesarean prior to labour.

mine was elcs and perfect recovery - still v uncomfortable in car after 3days!

Lots of good advice and points made from hmm here -

I had a planned CS for tokophobia for my 1st DC (CS was great, btw - easy, fast recovery, DS breastfed no problem), and was quite able to walk/sit down/stanbd up after 2 days, if I took it slowly - I wouldn't have wanted to do a 5 hour journey, I'd rather have been in bed watching telly. i would have been worried about the effect of sudden braking or any pressure of a seatbelt over my CS incision if I'd had to make a long car journey.

But more than that, no way would my newborn have been ok in a carseat for 5 hours. It's not recommended anyway, but he needed feeding every 15 mins or so at 3 days old. A five hour journey would have been a 15 hour journey if we'd stopped everytime he needed feeding.

It's APPALLING and just utterly stupid that you have been left in this position this late in pregnancy. It just highlights what a lottery maternal healthcare and birth is.

If you can, I would be hurling all my energy at contacting as many people in antenatal care in your new hospital at the same time - a campaign, effectively. The Head Midwife, Consultants, Peri-natal Mental Health, management at the hospital - making it clear you are documenting each meeting and will remember any views expressed or decisions made.

But all that takes time and energy at a point when you really may not feel like it. You should be entitled to more humane treatment whether or not you have 'lawyerly' skills. It's just an awful situation.

I really hope your new hospital HCPs pull their heads out of their arses and listen to people who have already been dealing with you. Good luck.