Getting an elective section on psychological grounds

[MarianaTrench]

I am 28 weeks pregnant (4th pregnancy) and have started to worry about giving birth. I have carried one baby full term and her birth was traumatic but not unusual (labour failed, fetal distress, so induced resulting in epidural and forceps.)
Since that birth I have lost two further babies in the second trimester that I have had to deliver. These experiences were very distressing. As a result I suffer from depression, acute anxiety and PTSD. I have had counselling, CBT and lots of support from my GP. I am also to be referred to mental health midwives at my next appointment.
To me giving birth is synonymous with terror, uncertainty and dead babies. I do not want to risk going through a natural birth with this baby as I am terrified that something will go wrong and I'll lose the baby.
I am fully aware of all the risks of a section and would far prefer the controlled, non emergency aspect of having one, regardless of the longer recovery time and post operative risks for me and the slight risks to the baby.
I raised it at my last ante natal appointment (I am consultant led due to my history). The junior doctor I saw brushed me off with 'not clinically necessary in this case' and didn't seem to think my history justified it. I am now waiting to see my actual consultant about it.
What I am interested in is if anyone here has successfully got an elective section on similar psychological grounds and what is my best strategy for convincing the consultant? I intend to be honest and try to be assertive, but my mental health problems mean I am not as tough as I would like to be.

I'm so sorry about your babies.

I don't have any experience but my advise would be to make sure you take someone with you for support, make some notes to take with you and that your actual consultant is normally more receptive to anything than the ones that report into them.

Will you see the mw before the consultant? Her support will help.

OP I'm sure someone will be along soon to fill you in on the NICE guidelines. The next step I would take is to request a second opinion from a different consultant. I am very sorry for what you have been through. I had a difficult labour ending in EMCS, currently TTC DC2 and I will be requesting ELCS when the time comes (and will do what I have to do to make sure I get it).

i did. 3 years ago. my first birth now 6 years ago was very traumatic and resulted in an EMcaesarian, i then went on to get pnd. I was classed as high risk because of this and when had my 20 week appointment i said that i would prefer another caesarian, they discussed cons and cons! i went on to have a booked caesarian and it was stressfree (my son was breech anyway!)
my main worry was what if i went into labour before my booked date- but thankfully i didnt.

Thanks. I don't see any midwives at all, just my consultant or one of her underlings. When I was going through all the dreadful stuff this time (amnio and scans) I only saw my actual consultant. Now my pregnancy has been declared clinically normal I see her junior. My consultant has always been very understanding but I'm scared she'll not support me on this.

Goosey - I've studied the NICE guidelines so I can recite them but my fear is that I don't have the assertiveness to stand up for myself, I tend to start crying and be unable to stop. I have written some notes though and will take them. It's hard to take my husband with me to appointments as he has to have our daughter, I have no other sources of support.

Poor you what a horrible time you have had. My friend had serious concerns about a vaginal birth due to her family history and had to fight to get an ELCS but did after getting a second opinion and a midwife on board and said it was stress free and lovely. Good luck

A friend of mine recently had planned section. Her previous pregnancy was twins however she found out at 36 week scan that one had died. Had section that day to make sure surviving twin was ok (he was fine). 3 years on, next pregnancy super anxious about losing this baby too. Had long discussions with Consultant and was given elective section at 39 weeks. Massively reduced her anxiety about the birth, and all went well. So it is possible. Good luck.

I've also read all the research I can find comparing methods of delivery and feel that for me, the risks of an elective section are far more acceptable than the uncertainties and risks of a vaginal delivery. It feels like most of the risks of a section are for me rather than the baby and most of the risks of a vaginal delivery are for the baby rather than me. I would do anything for this baby to be born healthy and will happily take on extra known risks for me to ensure this.

Dizzy, the poor girl. I'm so glad her other twin was ok. That sounds like a similarish situation though and is reassuring. My problem is that the causes of death if my previous babies have been ruled out in this pregnancy so that is why they are saying it's all normal now. The straw I cling to is that my consultant said previously that women who have been through what I have can never have normal pregnancies as their trauma and anxiety is too great. I hope this means she is more sympathetic and perhaps the juniors are instructed to brush off all requests for electives.

I have a medical reason for needing a CS but I still had to "fight" to get it first time round.

It turns out when I was saying I don't think I should take the risk the consultant was hearing I would like to give birth naturally but I'm a bit scared.

Eventually at 36 weeks got the go ahead for ELCS after I very clearly and firmly said I want a caesaerian. His response "are you sure this time, you don't want to phone a friend" My response was "No you bearded twat I want to kill you for making me so stressed through my pregnancy rather than allowing me to enjoy it you fathead. Alas my response only took place in my head.

Moral of the tale... leave no room for doubt
, you're not asking for a CS you're telling them that's how your baby will be delivered. I'm sure I read/heard that it's a lot harder to labour when fear is involved and delivery takes longer adding to risks check that one out and use that as ammunition if needs be.

Good luck and stand firm

I'm just not assertive enough to 'tell' them! My consultant is generally ok but I have no idea on her stance on elective sections.

If when you get to ANC you request to see the consultant rather than the registrar/SHO they'll always let you (just might have to wait a bit longer). It doesn't matter if you cry or turn into a complete blubbering wreck, just make sure you tell her your thoughts and fears and that you understand the risks and benefits either way. If she's not happy to say yes at this point then you will need to see your counsellor/psychologist and ask them to write to the obstetric team explaining the nature of your PTSD and that they feel planning for a vaginal delivery would have a significant effect on your mental health and if there's still a problem you need to get the opinion of a second consultant. It's rare for it to get to this in a situation like this. Most of the time in this situation people are asking for a CS when there's no medical indication but in your case there certainly is a medical indication because of the effect on your mental health and the fact you have diagnosed psychiatric conditions secondary to the effects of childbirth.

A tip would be to speak to your midwife about this before hand and ask her who she would recommend for a second opinion just in case. In every unit the consultant will all have different views on elective sections with some very willing and some very ante. The midwives in the area will know this information or be able to find out from one of the midwives in clinic! Make sure your second opinion isn't someone who is anti sections.

By the sounds of it though I'm sure your first consultant will be willing to talk this through fully with you as you have strong grounds for your request.

Have you tried the 'tell me a positive birth story' service?

A friend was terrified (ridiculously over the top for no reason scared) of giving birth and having a few chats with a local mum who'd had great local births really helped.

Apparently believing it can be positive is one of the bets things you can do.

If you make me give birth vaginally against my wishes when I have informed you that my level of fear is such that it will interfere in my ability to give birth safely and my ability to care for my newborn afterwards, then I will hold you responsible. I am willing to attend counselling of any other intervention that you think I should try but you can be assured that unless I know in advance that a c/s is guaranteed should I not be persuaded to change my mind, I will be unable to engage in any in intervention due to my extreme stress, not due to being unwilling.

could you talk to your gp? i did get a cpn who helped me during my 2nd pregnancy just talking about fears and anxieties-maybe it was her involvement that made my elective caesarian so easy?

I'm so sorry for your lost babies.

One locum consultant took me to one side and told me nobody could MAKE me have a vb and if I didn't like my consultant (nudge nudge) to ask for a different one next time.

Young ones are IMO often the most ideological.

Thanks all, this is very reassuring. I genuinely know that I cannot enter into a natural delivery situation without becoming a hysterical wreck, a planned section is the only way I can have this baby and keep what tattered remains of sanity I still have!
My consultant is not that old but the doctor I saw the last time was distinctly younger and clearly didn't have the authority. I am happy to go through whatever processes they want regarding my mental health but nothing will change as far as my feelings are concerned. Medical staff have been generally sympathetic so far due to my history, so I hope that my consultant recognises how important this is to me and that I am not making a hasty or ill considered decision. I have had to make decisions based on risk throughout all four pregnancies of mine she has supervised and she has seen me weigh up what I'm prepared to accept and so on. She knows I'm not stupid and that I do my own research.
In a separate issue I am experiencing disapproval from family for wanting a section so I am having to rehearse my arguments already with them. Great.

I had ptsd after a traumatic delivery. I found emdr therapy very helpful and recovered after just six sessions compared to 18 months of trad counsellinf which btw i was told can make ptsd worse. I think you shd have a cs if you want one but wd also be ood tobe free of ptsd.

Well, your family are right (whatever your right to choose, VB is the best option for both you and baby from a physical stand point) and they probably care. As, to some lesser extent, do the medical professionals.

You had two traumatic deliveries, neither of which will be repeated as your baby this time is clear of what they had. And you had one that resulted in your daughter.

You created and brought into this world a new human being. That is pretty amazing.

You've had some really tough times since.

But your experience of birth also did something spectacular.

So, you have a choice how you view it.

OMG - the emoticon was so not what I wanted - phone emoticons are not the same as laptop ones. :(

Mariana Please ignore gingerjule - it's either some uncaring happy-clappy, lentil-eating lunatic, or it's an interfering member of your family. VB is not safer for the baby - ask anyone whose child has cerebal palsy.

My first birth was emcs, my second was elcs - transpired my elcs would've ended up a very nasty emcs anyway and I dread to think the damage that would've been done whilst I waited for the call to be made. :( I am thankful every single day for my live, healthy children and I would take any type of surgery or damage to myself to ensure that my children live.

I presented my consultant with a variety of reasons I was not suitable for VB using the guidelines and information found at www.rcog.org.uk/.

Fwiw, I've always felt that having to birth a dead baby is barbaric, although I have read that some find it a carthartic process - I would most definitely be in your camp!

Is there a birth afterthoughts / bereavement midwife at the hospital? I had a traumatic birth and when I went to see them I was tols that if i have another baby I could contact them and they would attend my appointments with me to act as my advocate if I wasn't being listened to. Could that be worth investigating? It might be really useful to have a professional who is there for you and can argue the points you want to make.

So sorry for your losses.

Gingerjulep, you actually are my sister aren't you? I will say to you again that IF you had had the same experiences as I have (which I thank God you haven't,) and IF you had any understanding that it is not a choice how I view birth as, erm that's the 'disorder' part of PTSD then you might have an opinion I think is worth listening too. As it is, save your evangelism for someone who doesn't know any different.