Elective C-section after retained placenta

[Chelvis]

Hi, I'm expecting my second child (14 weeks now) and I am very worried about the birth.

I had a normal delivery with my daughter (well, complete agony and 2 2nd degree tears, but that seems normal!). However, i had a retained placenta, which they removed manually, using only gas and air. I was recovering from a mild chest infection so they wouldn't give me an epidural or spinal block during the removal, and the midwife was very negative about surgery - she kept telling me to calm down and not to scream 'because we'll end up in surgery, and that's the last thing you want - if you think this is painful, try surgery' etc etc.
It took little over an hour to remove, with the midwife and then a registrar in me with a scalpel. It was agony, especially because they kept taking the gas and air away from me (I was over using it apparently). I remember the edges of my vision going dark at times because of the pain. i thought I was going to die, the pain was worse than crowning.

Obviously, I never want to go through that again. I naively thought that women had a choice now of vaginal or c-section birth, but I went to my booking in appointment and was basically told, you have the right to ask, but there's no way we'll approve you for a c-section as you're healthy and a retained placenta would be dealt with differently next time. The midwife said they wouldn't attempt a removal like that (different hospital - she said my treatment was appalling), but would sent me straight to surgery.

My view is that if I have a vaginal birth then get sent to surgery, I get all of the negatives of each type of birth and none of the postives (i.e. I'll have the pain/tearing/risk of haemmorage of a vaginal birth, then all the risks of surgery). I pointed this out to the midwife, but she just kept reiterating that they wouldn't approve me for a c-section.

Sorry for the long story - what I need to know is whether I am beong reasonable and if so, how I can persuade them to give me the section. I am terrified of a vaginal birth now. Since my booking in appointment last week, I haven't managed to sleep through a night because of nightmares and worrying. I've gone from being excited about the birth to tearful and scared.

Sorry for the essay, I just don't know what the heck to do :(

You need to find out exactly what happened last time because what you are describing is bizarre. You can ask to speak to a Consultant or the Supervisor of Midwives to go through your notes. Use PALS if you need support to do this.

Having a chest infection is not a reason to rule out a spinal anaesthetic. A general anaesthetic might be better avoided but spinal is the anaesthetic of choice in obstetrics because of other risks.

Manual removal of placenta is not done with a scalpel and a MW would not be allowed to use one in this situation anyway. The placenta is peeled off the wall of the uterus by hand and sometimes a curette (a sort of spoon type instrument) is used to confirm the uterus is empty. A curette is a surgical instrument and I cannot imagine it being used outside of a theatre.

You obviously found the experience frightening and don't want it repeated but I think you need to know exactly what happened first, then move on to deciding how to have this baby. Although there is a chance the retained placenta could re-occur, as your MW said it should be managed differently. Especially if it is clearly documented in your notes what a horrible experience you had last time. You are more likely to have a completely normal birth without complications and no need of any surgery.

Once you have all the information from your last birth you can go through the pros and cons of aiming for a vaginal birth versus an elective CS. That is not a decision the MW makes, it's the Consultant you need to discuss it with.

I will ask about my old notes - I have a consultant referral, that's what I want to prepare for really, to ensure I know what to say then.

I thought it was a scalpel, but I might be wrong - it was definitely a metal instrument though - me and my husband both saw it. The midwife kept pulling the cord, then seemed to be ripping it out; it was the registrar who used the metal thing.

Sorry, forgot to say thanks - I will push more for my old notes and speak to PALS, thank you

www.mumsnet.com/Talk/childbirth/1557313-I-have-heard-about-tugging-on-placenta-before-leading-to-heomorage

hi have you seen this thread, as traffic said - find out what happend however you can - pals or whatever, push hard if needs be.

decide how you feel after, anyone would be horrified after what you went through, one cant imagine the pain.

you may not be able to push because of awful birth - ie placenta as they will say it wont neccasilry happen again but you can prob push for elc for the bloody trauma casused to you by this placenta business!!!

I had a troublesome VB, with 3rd deg, face first, and retained placenta. That was removed under spinal, took about an hour.
Then 10 days later had another d&c to get remains of the placenta they'd missed, all my lovely stitches which had healed cut open and restitched Again.

I had a section for my 2nd child, I warned the surgeon about the prev probs with the placenta, but it was fine.
Just because you suffer it once, you may not have it again.
You are much better prepared this time, you can warn your MWs and theyll manage it differently, you wont have a chest infection so you could have a spinal. better take the choice of a natural birth and cross the bridges if you need to, than opt for a section if there's no real need?
it's up to you though, and if you want a section, ask to speak to a consultant/ try and firmly declare you want one.

I had a partially retained placenta that was manually removed.

It was extremely uncomfortable although a lot less painful than the bastarding baby coming out.

No surgical instruments were used although there were about seventeen people and a miner's torch

Agree you need to ask for your notes.

No bugger offered me a section the next time either.

Chelvis, I'm sorry you had such a terrible experience.

It is a myth that you can now 'choose' between a CS and VB on the NHS. The NICE guidlines say that a woman should be granted a CS if after discussion and 'counselling' (patchy provision in the NHS) she still wants one. However, hospitals don't have to follow NICE guidelines - they can refuse for their own reasons, often budgetary.

If you want a CS you will have to argue your case forcefully, and convince them that your anxiety about a Vb is causing you mental and emotional stress. You may need to see a counsellor or perinatal psychiatrist as part of this process.

It isn't entirely clear if it is the thought of a VB itself is what is causing you distress (although you do say you are terrified of a vaginal birth), or the prospect of another retained placenta and manual removal.

If it is the latter, they will in all likelihood refuse to grant you a CS, because they can simply say 'but it probably won't happen again'.

if the trauma of manual removal of placenta in an operation that took over an hour, with no spinal or epidural anaesthesia, has left you so traumatised that you cannot contemplate the 'normal' or probably interventions during an uncomplicated VB (internals, stitching etc) then you need to be completely clear about that.

whatever you ultimately want to do, I would flag up NOW that you need mental health support, via your GP and a request to see a perinatal psychiatrist. If your anxiety about VB is so strong you cannot sleep at night, you need help. and if you start pinging their mental health radar now, it will help you if ultimately you decide you want a CS and are prepared to argue for it.

Good luck.

The recent change to NICE guidelines were widely misreported so everyone thinks you can just "choose" ELCS and, as you've already seen, that's not the case BUT if you want an ELCS you can press for one and may well get it with a bit of a fight.

I had a horrible 1st birth (have posted on here before if you want to search and read about it) and got an ELCS after a 2nd consultant opinion (1st flat refused me). My reasons were related to my mental health, I just could not let myself risk going through that trauma again. I had unequivocal support from every midwife I saw (and never saw the same one twice as is the way these days!) which really helped.

I think you need to decide whether you definitely want a CS and if so do your research so you know the risks. You also need to firm up your reasons for no wanting a VB 'I might end up with surgery anyway' isn't going to be persuasive enough I don't think. If you experience has caused such mental trauma that any aspect of VB is now unacceptable to you then you should be offered counselling and if after it an ELCS is still what you want, you should get it (according to NICE). Gt you, GP and midwife on your side. In reality dogged determination and a bit of a fight is the best chance to get one.

HTH Good luck.

X-posts with wheresmespecs !

damn x post - could just have put 'what herethereandeverywhere said' if I'd only waited!

Absolutely agree with what TrafficWarden said.

You really need a debrief, and to go through the notes with a Supervisor of Midwives or Consultant.