Electing for Csec after Induction/EMC. How to convince a consultant. Help.

[LaCiccolina]

Hi,

2yrs ago I was induced a week before my due date on the pretext of my pregnancy diabetes figures going 'wildly' out of control. They honestly hadn't I know as I kept the book and the boundaries they used. They were slightly higher but it was December and id had a few more desserts than otherwise I had during the whole of the previous pregnancy. DD was born by emc after a hellish ordeal over 3 days. She was only 7lb 11. Hardly the mammoth baby I was told to expect. I had also only put on 1stone in the whole pregnancy.

Once xmas passed it was obvious that the hospital nearest to us that I went to were pretty much incompetent. They were nationally vilified in the press for killing off several mothers in labour. Many more complained of poor treatment. The hospital has been on the watch list ever since. It still is.

I am now due with baby2. Im bloody terrified. Had I any idea how terrified I would be quite honestly I wouldnt have gone through with this. I thought I was over it and it wouldnt be an issue but giving birth is now keeping me up at night in pure unadulterated fear.

I wish to elect for a csec. I know the hospital has a policy of election csec at the second time if requested. However after 2 consultant visits I am convinced they want me to go for vbac.

I am quite specific in my fear. I am not scared of vaginal if spontaneous and Im at practically full dilation immediately. I am terrified of any suggetion of induction again. Midwifes, consultants and registrars etc all now simply terrify me. Last time they didnt listen to me or my husband. They ignored us almost entirely until my DH got the ward manager involved. Its too long to go into details, mainly I wouldnt want to terrify others ether. If you have had a bad birth Im sure you can imagine it..... I do not want a home birth or anything. I just want another csec - one my hospital would let me have if no other health complications. This time I dont even have the diabetes as Ive done the test and its clear. Im watching my diet and have no other health issues. I do not wish to go to another hospital. Im told by my GP Im best here as I was treated here last time. Also quite honestly its all staff Im terrified of now. The location is completely irrelevant.

We explained our fears to the junior doctor under the consultant. She shot off to discuss with the consultant and we were told that it would be fine. 4 wks later at the second visit the SHO (why do consultants never actually see anyone?) hummed and haaaed. She listened to everything then said that the number of births last year exploded and it was big in 2010 also - 9k in 2011 in our area. The policy of how to handle inductions has not altered since we were last there. They are still struggling with equipment. I know they are under watch but Im really wondering whats improved. She also said no decision would be made until 36 wks at which point they would book us in for 39wks.

She then wrote in my notes I was happy with vbac! Bullpoo I was, as per described above is the ONLY way Im doing it. As thats not guarranteed its csec all the way!!! Again I feel unlistened to. They are doing what they want to me.

I have to go back at 36wks at which point apparently the consultant will actually see me - bets anyone??? - and decide if I get the csec I want. Im dreading it. Im terrified. Im in tears, I cant sleep, Im as near to panic attacks as Ive ever been.

36wks is NY Eve. Is there ANYTHING I can do before hand? I dont want to wait and miss some sort of boat just because I dont know it exists - does that make sense?

Can anyone help offer any thoughts? Which organisations give good stats on successful csecs? Ive googled a bit and want to go armed with information to argue with. What are PALS? Could they help????

I have no interest in giving birth naturally so if you are against csec please dont post and waste your time and mine.

I have no suggestions but lots of sympathy. Failed induction, EMCS here too. Horrible. Thought of it will put me off a second baby.

Hope someone can help.

I did hear of a friend of a friend being refused a CSEC and so opting for a homebirth. After a lot of bluster they caved in and gave her the elcs...could by urban myth though!

OP that sounds awful, and you sound very stressed.

I think you will get different advice from different people, but I think you need to complain now and get VERY assertive.

I think you need to complain, in writing, that someone has recorded you as being happy to attempt a VBAC when you are not, and you have not agreed to this. This is shocking and unprofessional. It also means that anyone you meet subsequently will, if they look at your notes, be expecting to meet someone happy to VBAC and will not be prepared for the conversation about ELCS you clearly want to have.

Complain to the Head MW or Consultant MW, whatever you have there - get the name of the consultant you are supposed to be seeing and cc the letter to them.

You don't have to wait until 36 weeks to see a consultant to get a c section agreed. This is a timescale based on those pregnancies where the mother may need a c section for purely physical reasons (placenta in a difficult place, breech positioning etc) as things can change physically and so they don't know what they are dealing with until late stages.

You need a meeting with a consultant because of the mental and emotional stress you are going through. You can get one if you ask and are DEFINITE about it. I am meeting my consultant to agree a c section next week - I will be 15 weeks pregnant.

It may help to get an emergency appt with your GP to describe your anxiety and ask for their help. You could ask for an urgent referral to the perinatal mental health team.

I am outraged on your behalf that you are being railroaded into a VBAC you do not want by a SHO lying in your notes. That is INCREDIBLY unprofessional. You must compain.

Good luck.

Yes, do make an official written complaint. It will help.

In the meantime, if you have your notes, write in CAPITAL LETTERS across the page where the SHO wrote you agreed to VBAC, that you did not agree to it and that it was written without your authorisation. Also on the next blank page if there is one, write across the top that you want an ELCS and you will not agree to induction.

I wrote across my notes in this way, and the notes were looked at with great interest by everyone who dealt with me. It certainly got my point across while waiting for them to deal with the complaint.

My situation was a bit different, but involved wrong info being written on my maternity notes by a doctor.

My situation was different to yours but there is an overall parallel so I will share it.

My second baby was 9lb 12oz, born in a birthing pool & had shoulder dystocia. Although he had no long term damage his birth left us feeling terrified.

When I became pregnant again we were both concerned that I would have a bigger baby & did not want to risk vb.

The mw referred me to the consultant. He belittled our fears, told us the mw at the previous birth had panicked & it wasn't shoulder dystocia. I cried, he said we'll do size scans. I went along but knowing that they are utterly unreliable. Went to see the consultant again who said I can tell you aren't having a big baby (from just looking at me) Anyway I was 36 wks by then & so so worried. We ended up sighting the NICE guidelines that a woman requesting elcs should be counselled but if she still wants a cs should be offered one or the consultant needs to arrange someone who will. The consultant didn't agree with my request but did back down & it was agreed I would have a elcs at 39 wks. We had to be utterly forthright in stating what we wanted. They patronised us, we rude & quite horrid actually but we were not swayed. I had my gorgeous dc3 by elcs at 39 wks & I can say it was the right decision for us.

If it is what you want remain strong, don't hide that you are terrified though as it is the honest truth & shows the emotional anguish you are going through.

Good luck, I know it is awful to have the decision left hanging open when you are so scared.

Just home from my much less distressing ELCS with my beautiful DD2. By no means am easy option, but stick to your guns! List what went wrong, your lack of faith, fear of failure again, get upset, show them how you feel. Its not am easy option, but it was the best option for me. Let the questioning become 'water off a ducks back' they were still asking me at the point just before I entered theatre. Yes, they do have to ask because you are requested major abdominal surgery, but you have to respond in kind.

In my case I had a previous breech which was undetected at the point of attempted vaginal delivery in mu first, and breech presentation in my second. They suspected the baby had turned at the last minute, which as it turned out she had, but I was very clear I would not attempt a vaginal birth, under any circumstances and we had our baby as planned. See it as what is going to happen and try to see the job of the medic as to play devils advocate and make sure you ae making the right choice.

You poor thing. If you just insist on a section, you should have a good chance of getting one. If you don't want to risk VBAC, make that very clear.

I have copied below a previous post I wrote when a Mumsnetter was asking for advice on how to get a section. Good luck - you have a stronger case than I did, and I managed it!

BTW the newspaper articles I have linked at the bottom the post to may be upsetting. I have included them specifically because I used them in my argument to get a c-sec. Don't read them if you will get upset.They are about birth injuries suffered by both babies and mothers.

Seoladair Thu 28-Jul-11 15:04:20S
I had an ELCS on the NHS.
I had a meeting with a registrar who went through everything with me re c-section. I told her I would prefer to have the measured risk of elective c-section than the unpredictability of natural birth, which could easily end up in forceps, or emergency or even crash caesarean.
Adam Rosenthal, Clinical Research Fellow at St. Bartholomew's Hospital in London cited a study at Queen Charlotte's which suggested that women over 35 only have a 49 % chance of delivery without intervention anyway. So if you're over 35 and opt for natural delivery, you're more likely than not to end up with a medicalised delivery anyway!

I found this website very helpful indeed - www.csections.org

BTW it advises that if you get turned down by your consultant, you are entitled to a second opinion - but you must check what the hospital's policy is on non-medically indicated c-sections, because it would be pointless to have a second opinion given by the same hospital. They should refer you to another hospital who will do elective c-sections.

Here are some excellent articles. I printed them out and took them along to my meeting. BTW it was in the news the other day that there were 17 avoidable deaths in 18 months in London hospitals, due to poor care. I don't imagine any of them were elective c-secs....

www.guardian.co.uk/lifeandstyle/2010/dec/10/torn-apart-by-childbirth

"The safest method of birth is by Caesarean" www.guardian.co.uk/society/2004/may/02/health.politics1

www.guardian.co.uk/lifeandstyle/2010/nov/20/elective-caesarean-tokophobia-childbirth-phobia/print

www.independent.co.uk/life-style/health-and-families/health-news/british-maternity-wards-in-crisis-2261403.html#

www.thisislondon.co.uk/standard/article-23927143-family-of-girl-paralysed-at-birth-win-pound-400000-payout.do

www.thisislondon.co.uk/lifestyle/article-23913235-writing-brought-my-baby-to-life.do

Good luck!!!! xx

This is wonderful. Thank you very much all! Thank u soeldair for the articles I will definately print and use.

So, today I am phoning the ante natal clinic to arrange an appointment with the consultant specifically as I wish to complain about her sho. Ill also be putting it in writing to them. I'm putting massive letters across my notes too - I do not agree to vbac!

It's their own messes so I hope they sort them out.

You could be me! EMCS at 38+4 with DS after failed induction for gestational diabetes. Lost significant amount of blood 14 hours active labour, 26 hours total. Was also told he'd be huge he was 7lb3 and had no clothes that fit!! Due to a number of things was in hospital days after, so totally the opposite of what I wanted.

Pg with number 2 due 5/1/13. I am electing and was concerned as 38 w is 22/12, and need to be home for xmas (was in hospital 4 days with DS) for DS.

I mentioned ELCS to the first consultant I saw pre diagnosis of GD this time (at about 16 weeks), and he fobbed me off... I said i wouldn't see the VBAC mw, he nodded at the time but wrote in notes "re address method of delivery 32/40"...
I then googled NICE guidelines on sections made a dossier of supporting info etc...basically got quite angry.

Then I was diagnosed with GD again, at 28 weeks, changed to my diabetic consultants, saw both yesterday, mentioned section (31+4 yesterday).... Mr consultant did the form there and then and mrs consultant sat there and said "we would never make you do anything you didn't want to, we understand how hard your labour was" etc, and now theatre will be calling me to arrange a date! He even said that give that 38 weeks is close to christmas it will be my discretion on date slightly before 38 or after xmas (depending on theatre space of course). He took the time to explain to me that I wouldn't be kept waiting (my induction was repeatedly delayed), what would happen if Labour starts naturally before section date etc.

He also said even if Id not had GD again a section would of still been an option.

I think the basic premise is if your consultant is being an arse about it, formally complain and change cons, as NICE guidelines are very clear, your body your choice!

Make an appointment to see another consultant, get your community MW to do it if possible.

When I read my notes after seeing the 1st consultant who rejected my CS request and discovered it was not a reflection of reality I amended them (not by deleting anything!)but by putting '' by the incorrect information and noting the reality in the margin eg: "No, my DD is permanently scarred NOT bruised". In the risks bit I added ' did not explore the negative effects on my mental health" and so on.

The second consultant granted the CS!

I have to say, I am really really disturbed and angry to read how misleading (and deliberately misleading) some of these medical notes are.

I accept that they will only ever be an imperfect record of a conversation - but apart from making patients' lives difficult on an individual level, by affecting care, the chances are that they will be used as data in recording a hospital's performance somewhere down the line.

Lying and saying a woman is happy to VBAC when she has clearly said she isn't - downgrading the degree of birth injury to a baby from 'scarring' to 'bruising' - this can't be acceptable. they are not mistakes caused by pressured staff and a big workload, this is just unprofessional.

When my ds was born I was surprised to see comments in my notes about all the breastfeeding support i got in hospital. I had none. At all. I mentioned this to my hv, who pulled a face and said 'yes, the hospital are trying to get recognition as a centre of excellence for bf-ing.... a lot of people are getting that on their notes.'

So basically the mw was out and out lying. I didn't complain about it at the time. I wish I had.

Its shocking to see how common place it is, whilst the first consultant for me didnt write happy to vbac, he implied I was open to change / further discussion, when I plainly wasn't. Its a disturbing trend as what if you were vulnerable/ weren't the type to stand up for yourself?!

I must admit in my discharge papers it said I was planning on "predominantly BF with some mixed feeding" Id categorically stated i was FF!! On the ward several MWs refused to deal with me when i gave up BF... All very damaging to a first time parent.

A le leche league woman reduced me to tears in the middle of the night... Yet hospitals wonder why many women are scared to remain in hospital?!

My birth plan literally says

ELCS - Do not bring any forceps anywhere near me in ANY circumstance, i rather have a tramps hand up there - discharge as fast as is humanly possible, with copious drugs. It has raised a few eyebrows!

It never occurred to me the first time round to write on my own notes. I understand that is not why they are there, but I will have no hesitation about doing so this time round if I see something that is just not true.

Can you name and shame this hospital?

If you go to NHS choices, you can post feedback. www.nhs.uk/services/hospitals/services/service/defaultview.aspx?id=8491

LA just to let you know, i got my date today only two days after they did the form, so your consultant really is being a dick! Needlessly!

Stick to your guns OP. I had a lengthy labour which ended in EMCS. We're about to start TTC DC2. Myself and DH have already decided by hook or by crook it will be ELCS next to time, no way I'm going through all that again only for it to end in another EMCS. The recovery is not fun but I would rather that than be physically and mentally traumatised by another bad labour experience. (And I couldn't have been better prepared... did all the yoga, hypno stuff... but once that syntocin drip goes in there are no prizes for bravery.. I could have kissed the anaesthetist that did my epidural!!)

How do you find out what your hospitals policy is on ELCS? I have been looking on the internet for my hospital (Hinchingbrooke in Huntingdon, Cambs) but can't find the info anywhere.

My DS1 was big 9lb 14oz and MWs have confirmed that this one is a big baby too. i'm up for a natural birth as long as it stays natural, but DO NOT want an induction. That led to an epidural and ventouse, with a long second stage with legs up etc. Having had SPD/pelvic girdle pain from early on in both pregnancies, this was exactly what shouldn't have happened. It was 18 months before I could walk at a decent pace without pain in my pelvis. (Note, that isn't a normal affect, it was only because i had SPD. Don't want to scare people!)

Tried to talk to a consultant who I know had SPD when she had her children .. but surprise surprise got fobbed off with some registrar type who was totally unsympathetic. I think in his book not being able to walk properly for 18months wasn't an immediate clinical need or medical reason for enquiring about an ELCS!!! Been trying acupuncture this week to get things going naturally as am due on Tues 13th, so 3 days. Still not sure whether to fight for a ELCS though. Think I will if things go overdue (DS1 induced at 8 days for no good reason, and against my wishes). Having read all the posts above, will write in my notes too, so thank you for that advice :-)

Does seem to be quite widespread, this ignoring the wishes of the mother .. grr makes my blood boil!

This is my first currently 34 weeks!

I asked to see a consultant at 19w for a c-section i got 'you can do it your young enough'

Apart from having serious fucked up knightmares and scared of labour itself. I finally got a consultant meeting last week.

I have to see a physiatrist next week, to talk through how i feel. If i still feel the same way at 37weeks!!! I am allowed a c-section. They do at c-section at 39w. 2 weeks before i will find out.

I would kick up major fuss!! You well within your rights!

The consultant asked why i left it so late, i told her why. She said they shouldnt brush you off, you have major issues with this.

her words not mine

good point, ilovemyoboe - individual hospital policy seems not to be a matter of public record anywhere, as far as I know (would welcome correction if this is not the case) -

From other posters' experiences, it seems to be quite an 'informal' internal thing. A consultant or mw saying 'oh, no, we don't do x here' in a meeting, for example. as far as elcs goes, attitudes can vary wildly from consultant to consultant within a hospital, in any case.

I think where a hospital policy differs from the NICE guidelines, they tend not to advertise the fact as well.

(it is, imo, a ridiculous lottery - if you run into problems, your best bet is to go in with the NICE guidelines and be very very assertive, just to get meetings and clear decisions. which of course for those women who are not assertive and not well informed, won't work and isn't fair)

To re iterate my own experience, which echoes the thought that it is a consultant / postcode lottery... With DS i was happy to try a natural (if induced) labour, however no one made me aware of the other options. This time I saw a non specialist consultant to begin with.. He was minimising my views and I believe had no intention of supporting a section. Having transferred to the specialist team I went in armed with NICE guidelines and didnt need them!! Weds i saw cons, mentioned i wanted an ELCS, he did the form there and then, theatre called fri. Which just goes to show it obviously doesn't need to be any more complicated than that, but it is and one can only assume that is because of consultants / hospital attitudes.

It's my understanding (after long labour/emcs and elcs) that its risky and poor clinical practice to induce someone only two years after an emcs due to the risk of uterine/scar rupture rising from 2% for a normal labour to 20% with an induction.

You can point this out to them now and insist on booking your elcs date now.

You are particularly high risk given you have a history of diabetes. They shouldn't even be considering you for a vbac. You are likely to suffer diabetes again and Apparently a larger baby increases the scar rupture risk during labour.

If you prefer a nice calm elcs and don't want a vbac, tell the hospital that and insist your date is booked now given your history and the above risks.