worried about going into natural labour before elcs

[Loonybun]

Is there a way to delay labour? (Yes I know its the opposite to what most people ask!)

I am 35 weeks with an elcs booked for 39 wks due to maternal request due to previous traumatic birth 8 years ago.

My consultant wasn't keen to book me for the elcs and I've had the entire world of midwives and consultants attempt to talk me out of it but I am adamant that this is what I want.

My biggest fear is that I will go into labour between now and the booking date and they won't fit me in for a c section as they have already told me they will try but obviously due to possible emergencies and the progress of my own labour it may not be possible.

This terrifies me. Esp as I have been having a lot of very strong braxtons every evening till bedtime and a coule during the night that are quite painful although they seem to go during the day. Is this a sign??

The consultant has said I could have an early epidural if I go into labour before the elcs but he doesn't seem to understand that this doesn't help me as I had en epidural reaction with dd which meant it paralysed me from the neck down for 48 hours and still left me in agony. So I won't be happy unless I have the elcs with spinal.

Really worried :(

I understand a bit where you are coming from - I had a failed epidural then a crash section under GA with my first baby. If you did go into labour before your section date I would go to hospital ASAP and insist on the CSection being brought forward. Someone who needed a section for an acute medical reason would be prioritised over you - a placenta praevia could not wait whereas it would probably not be dangerous for you to go into labour, IYKWIM.

You can't force them to do a CS but you can decline any other intervention except for a CS under spinal.

My second baby - I asked for an ELCS but was refused. I went into labour but had failure to progress. I started to get terrified that it would end up awful again. They wanted me to have an epidural, have my waters broken. I just kept saying no thanks, take me to theatre for a CS. In the end, they did But it is very hard to remain bolshy when you are feeling vulnerable ( I managed because I am very bolshy and a bitch and my only plan was not to have another crash section)

Perhaps a doula to support you might be helpful? Or train your partner up very thoroughly?

Thanks ... I totally understand that emergencies would have priority. That's how it should be. I suppose I'm just scared that by the time I get there I will be too far gone for them to do anything - but saying that dd took 70 hours so hence the birth trauma! Can't see this one flying out in a few hours but who knows....

You're right its hard to remain so strong in such a vunerable position. Dh is very supportive so whilst I can't afford and don't want a doula I know he will do his best...

I'm just really scared of not recognising the start of labour and getting there too late - dd was an induction via drip.

I'm also scared of going there and being examined (hate internals) and being told to go home again... Hospital is an hours drive away too!

I am very sorry you are in such a distressing situation - I hope the following helps.

If you do feel you may be going into labour, err on the side of extreme caution! and get to hospital asap. If you ring to let them know you are coming in, don't be put off or told have a hot bath and wait and see etc etc. Tell them that you have CS booked because of a previous traumatic birth, it's all in your notes (or should be), you are aware there may well be a wait for an available theatre and so you are coming in now.

This btw was the advice my (sympathetic) MW gave me when i had an ELCS booked for my 1st DC because of primary tokophobia. Don't hang around, get in there. If you turn up 8 cm dilated, then they have much less time to get you into theatre.

Your consultant is being a little disingenuous with you. Of course you may well have to wait to go to theatre because emergencies take priority - but this is also true of your planned CS date. The important thing to remember is that if you are there in very early labour, it's no big deal if it takes 6 hours before they get a gap. I know they like to do the scare story of 'oooh, but your labour may progress SOOOO fast, we won't be able to do it!' Well, some women do labour very fast. Most don't. If you didn't last time, chances are you won't this time. What you really don't want to do is have them tell you to wait at home, have labour progress, then turn up and have them say 'whoops, too late for a CS now!'

Btw, as it turned out, my waters went 10 days before my planned CS date. I followed my MWs advice (and refused an internal when I went to hospital, btw - they don't need to do them at all, they can put a trace on to see if you contracting. Or check pads to see if it's your waters). I was told to be ready at 8 in the morning, but because of emergencies, didn't get into theatre until after 5pm. I was very thirsty and hungry by then! but otherwise totally fine, as I was not in established labour. It was all ok because I had gone in as soon as 'something happened'.

I do feel you could do with some help from your healthcare professionals. Is there any way you can get a meeting with your head MW, or consultant MW, explain the situiation and ask for a few things to be put in your notes? This is what I had, and it did make life easier. Things like NO INTERNALS unless it was a medical emergency. Like that you are scheduled for an ELCS and if you go into labour earlier, you will come in asap to give everyone the best chance of getting you into theatre. If it is not too late, I would also try to get an urgent meeting with a perinatal psychiatrist (MWs should have a way of getting in touch with them). You really need someone on your side, and it doesn't sound as if they are taking your mental health and well being seriously. You also really need to clear up this issue of an 'early epidural' not being an option. This sounds as if your consultant simply isn't aware of your history. Again, can you get hold of a consultant MW and bring this to their attention? It's really not acceptable for your consultant to suggest a course of action which might be actively damaging for you.

I had an ELCS booked at 39+3 weeks. I had strong Braxton Hicks contractions about 10 days before the birth day and I did feel panicked. Like you, my CS was maternal request (albeit for different reasons to you). Regardless, consultants, midwives, etc, tried to talk me out of it so I was extra-worried about going into labour before the date.

However, you've got your date booked for 39 weeks, which is great :) You wouldn't want bub delivered before that, really, as each week increases the chance of baby needing help to breathe outside the womb.

Try not to stress as that might encourage an earlier labour! Be confident that your date is booked and enjoy the last 4 weeks of your pg.

Relax and good luck for your section x

Awesome advice, Fruity, just in case!!

Thank you for all the tips and advice.. In particular, thank you Fruity for your very informative post. :)

I think I'm just getting myself into a pickle as I don't remember having this many (if any!) braxtons with dd and I've convinced myself I'm going to pop early...

I really hope not!

I don't know why consultants and midwives feel they have the need to try and talk you out of a decision once it's been made and booked in, it's really undermining.

I have an appointment with my midwife on Tues this week so I may talk through this with her then and see if there is any other support I can have.

Thanks again.

FWIW, I didnt have any BH contractions in 1st pg either. 2n of was a different story!

Stick to your gun for your ELCS. My consultant let it slip that hospitals news to keep CS rates to 15% because of WHO recommendations. At the hospital where I delivered, their March 2012 CS rate alone was 34%. So I think women are pushed encouraged go for VB as it looks better for hospitals.

Meant to be '2nd pg'! Sorry, blaming iPhone keypad ...

Hello - thanks Lunar - you are right about the 39 weeks or post issue too, I forgot to mention that -

They do try and schedule CS's 'on the cusp' so babies are as cooked as they need to be! Which makes complete sense, but of course does cause anxiety about them arriving early.

FWIW, my DS was born at 37 weeks plus 1 day or 5, depending on how you calculate it - and he was totally fine. APGAR score of 9 at birth, and 10 five minutes later. We BF'd successfully and he never had any formula (would have fed it with no problems if he needed it, just saying that he didn't).

The WHO recommendations were dropped last year - BY THE WHO. Google it and check it out for details. They now say there is no 'limit' but that CS's should be carried out for 'clinical need.' No shit. And clinical need includes mental as well as physical health. If anyone disagrees with that, let's just remind ourselves that severely depressed people can kill themselves. No one should take mental health lightly.

it pisses me off no end that NHS hospitals started basing their CS rates on this nonsense WHO recommendation, which is now withdrawn. When people start arguing about cost, I just remember that at the weekends, over 70 percent of my local A&E dept intake is injured drunks. If they can expect and get free NHS treatment, then surely a traumatised woman can get an ELCS.

Applauds Fruity Well said! I think that attitudes to mental health in the UK are shocking, and this is reflected by antenatal care here. Your point about budgets too is very accurate as far as I'm concerned. I saw a chiropractor for advice regarding how my spine would fare during another labour and vaginal delivery (I damaged my tailbone during the protracted pushing stage of DD1) and she - strictly off the record - told me that I was much more likely to redamage my tailbone and possibly incur damage to my pelvic floor with another VB (tailbone is the 'anchor' of the pelvic floor muscles and has already taken one severe battering).

Okay, a CS means that there is now damage to my abdominals, but she said that these muscles are easier to repair/strengthen (due to the surgical technique of CS) than a ripped pelvic floor and tailbone.

The problem according to her is that my OB wouldn't be the one to fix my back if it (very probably) got damaged again. That would be her job. So I effect, it doesn't matter to him if I needed to be fixed at a later date. It's all about how it looks on paper for the hospital's records. That's so wrong, isn't it?!

I LOVE that comparison about the drunks!! I am going to remember that one

I agree that as a whole we don't take mental health seriously when it comes to childbirth. It seems to be a very mechanical attitude - almost like "you have a vagina, it works, push the baby out"... Well what if you're too scared, or something goes wrong, or any other host of reasons?? Just because a part of your body works in the basic sense doesn't mean you should be denied access to other means that might save your mental health. Drives me mad.

I'm feeling a lot calmer after speaking to everyone on here, strangely enough not had so many braxtons! So may be stress induced!

Thank you very much x

xxx

My consultant pushing me to go for a elcs due to "my previous pg history" - dd1 dying from gbs at 3 weeks having been born prematurely but vaginally. I have incompetent cervix and was stitched in this pg, but besides no reasons to consider cs. I deliberately searched for a high risk pregnancy specialist to look after me in this one and he has done his job brilliantly, but now I am worried that I am pushed into unnecessary cs or - if refuse - will not be left to birth without constant interventions. I am sure he does/the hospital do not care one moment about the stats...

Damned whichever way we turn, ah?

fruitybread

I am copying and pasting this thread as I also want an elc for " maternal request" and I know it will be a battle. If I get it I will also be scared of going into labour early.

I was shocked by an interview one of you posted with a midwife on radio, they didnt at all take into account the mental torture of labour.

i thought labour was tortrue plain and simple, at each stage i was terrfied that one of the things that happened to ALL of my friends would happen, I was the ONLY one who had a so called text book birth. There is no way I can mentally cope with going through that torture again.

You dont know how it will turn out or how it will end. Slicing me down below is not an option for me.

I hate that there is a general expectation that because you happend to be born a woman you must therefore just be able to give birth.

My husband is a complete woos, if I put him in a chair and tortured him - made him pass a melon, sliced and cut him, etc etc, there is no way he could stand it!!!!! And you dont know when its going to end!!!! he would be in therapy for years....

There are so many things wrong with hospitals at the momnt - low midwife numbers, horror stories from ladies at toddler groups from my local hospitals....

I love your point about the drunks in a and e.......I will remeber that when I am pushing for a section!!!!

I think a lot of the problem with consultants when battling with them to get an elective section is that if you have a vaginal birth that results in mental trauma then basically it doesn't matter to them - they're not the ones who will be treating you / counselling you / seeing you again. It doesn't come back on to them.

If, like my horrible birth, there's nothing majorly wrong in that baby is delivered healthy, mum makes a physical recovery etc then you can complain all you like to the hospital and they will send back a very nice "come and read your notes..we're so sorry..." sort of reply but that's as far as it goes. And the consultants have "done their job".

It's the women who go through PTSD and traumatic labours that understand WHY for so many an elcs is the only way to even consider having a second child.. I don't think a consultant who deals with the mechanics of a vagina can really comprehend that. (At least I have yet to find one, despite being granted my maternal request elcs- I had to argue with my consultant to the point of basically bashing him over the head into submission).

For the record I haven't gone into labour yet (thank god). Still feeling really sore down there and lots of braxtons but I guess that is par for the course..Hopefully baby will stay put for the next 4 weeks!!

Hiya-

First of all I'm really sorry that you're regarding this experience with such fear when it shoudl be a happy and wonderful time for you. Many women find natural birth empowering and wonderful, but many do not. Health professionals should be sensitive to women's needs as every woman is an individual with individual perceptions.

Most hospitals, if you turned up in labour, would attempt to accommodate you for immediate LSCS as you have one booked. As mentioned above this may not always happen- emergencies sometimes take precedence.

If you thought you were labouring before 37 weeks it might be wise to go to the hospital as soon as possible if you feel you're going in to labour as this is considered pre-term and there are certain implications with performing a caesarean section prematurely (the baby's lungs are at risk during an elective caesarean section anyway as the lack of contractions and descent through the birth canal does not remove the excess fluid- it is quite common for a baby to require extra care and attention for respiratory distress). This is particularly pronounced before 38 weeks (even though term is considered from 37 weeks onwards).

I know you say you ould prefer not to have a VE but in this case it might be wise to permit at least one internal examination if you feel you are labouring prematurely- there are other ways a professional can assess labour through touch and feel, assessment of behaviour and other observational signs (though a CTG monitor of the baby's heart-rate is not an accurate depiction of whether or not you are having contractions- you are the best person to tell them that) these are not always evident in early labour, and as you say you are afraid of progressing quickly.

An induced birth is very different to labouring spontaneously- it can progress faster as your body and baby have decided that now is the right time for the baby to arrive. You are not being forced by an artificial hormone. It may also not be as intense straight away- your body builds up natural painkillers in nomral labour that help you cope. I therefore agree with the advice above- if you believe you are labouring, it is a good idea to go to be assessed sooner rather than later, but it they may be reluctant to submit to your request fo LSCS without an examination first, particularly if you're classed as premature. In hospital environments doctors and midwives use internal examinations as a key feature of labour progress as this is a given in those having medically managed labour and births (as their behaviour is not always the same as those labouring physiologically).

Sorry, I feel I'm rambling a little!

It may be worth putting a birth plan together stating your choices and what you would prefer to happen in certain eventualities. Labour and birth is unpredictable, and it is better to approach it with fluid concepts, but at the same time if you are very anxious it would be nice to have something written to hand to your care-giver so you do not have to articulate all of your choices when you're trying to concentrate on keeping it together with contractions.

I know you are 35/36 weeks now but have you considered any alternative forms of relaxation for birth preparation- natal hypnotherapy or hypnobirthing? It is approached often with a lot of skepticism but the principles of hypnotherapy can really assist with anxiety. Hypnobirthing courses are not cheap but do involve partner training, but natal hypnotherapy do offer reasonably priced CD's/DVD's, including one on the experience of caesarean section, for you to listen to in your own time.

There will always be that element of unpredictability as your birth is effectively is someone else's hands- and those hands are often busy, short-staffed, and prioritising elsewhere. My advice would be to ring early, stay calm, and communicate your choices as clearly as you can.

I hope things go well for you, and that the birth of your new baby is as positive as possible xx