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.

Dolomitesdonkey, having to deliver a dead baby is absolutely barbaric but they won't consider anything else. They do let you have morphine so you're less aware, but it is still absolutely horrific. The only tiny crumb of comfort is that going through a natural delivery is less damaging to your overall fertility, as the overriding feeling I had both times was that I wanted to try again one last time. I know this is my last chance, which is why I'll take as few risks (as perceived by me) as possible.

Your attitude sounds very similar to mine though, I feel far less alone due to all these responses. Thank you all.

Some of these responses are pretty awful. If you have had to give birth to a dead baby, and I have, you would know that no 'positive attitude' or 'you choose how you feel about it' nonsense can make up for the overwhelming trauma this woman has suffered. You cannot choose how you feel about having given birth to a dead baby.

I felt like you op although thankfully I only went through one late loss. I did go on to have a vb with the next pregnancy, and I had a letter in my notes from bereavement midwife explaining how I felt. It is the absolute fear of the baby dying and flashback episodes from previous medical intervention that stops you from building that resistance to contractions that would normally happen..the terror just seemed to increase the pain for me. I had had a previous vb of healthy child before my late loss that was a totally different, much calmer experience.

Get the mental health midwives on side, they should advocate for you on this. A person with PTSD should be able to elect for C-section imho. Otherwise you could end up with PND on top of other problems.

I'm very sorry for your losses and awful experience.

I think the problem is that you are having to deal with this alone and as you know, it is hard to maintain a barrister like cool and assertiveness when you feel as you do.

I would get perinatal mental health services involved asap. Ring your mw or your gp and asked to be referred as a priority. You are being treated at the moment purely as a physical object in terms of your request for a cs, without your mental health being taken into account, and that is wrong. If you already have an appt with mental health mws, make sure you tell them this. Write everything down you want to say and tell them you can't talk to them until they have read it. Tell them too, in writing, that you feel you are under huge pressure trying to convince unsympathetic consultants to listen to you, and that they are not taking your mental health into consideration.

I do feel for you - you shouldn't have to do this, and I am already angry at your family for putting you under more pressure. I do think if you fling all you've got, so to speak, at the mental health mws - and PLEASE do it in writing - they could fight some of these battles for you.

The writing thing is important - if possible, ask for what you have written to be put in your notes. It can be sealed in an envelope if you don't want every passing hcp or family member to pick it up and read it. But it makes them pay attention to you, and means you are not relying on someone else's accounts of how you feel.

Thanks. I had a referral to perinatal mental health services but I was turned down as I am too 'high functioning'. The grounds for this were that I hold down a responsible job and I am 'not psychotic'. There does seem to a possible opportunity to get referred to the mental health midwives and the bereavement team though so I will pursue these avenues to add weight to my arguments.

My family are annoying as I have said over and over that an uncomplicated vaginal birth is an outcome, not a choice and if I could be guaranteed that then maybe I'd consider it. All I am doing is opting for what has the most predictable outcome and that carries the least risk (in my experience and opinion) for my baby.

If you're not good at being assertive can you script what you want to say? 'due to my previous birth experiences I have decided I want a c-section. I know the risks and am not budging, if you won't sign it off then I need an appointment with someone who will'. Or you could write it down and give it to them? Take someone with you to the appointment for support.

Oh, and don't feel you have to argue your case with your family, it's none of their business. Instead of rehearsing arguments, rehearse 'It's not up for discussion' and repeat.

Yes, I will be doing a fair amount of writing prior to my next appointment. I need to stress that this does not feel like a choice to me.

What is infuriating about the family situation is the veiled withdrawal of offers of support and help after the birth, because I will have brought it all on myself. I needed lots of help after my daughter was born due to my episiostomy but that was fine, because at least I'd had her dragged violently out of me, which it seems is totally acceptable.