Consultant did not say what i thought she was going to say!

[TwoTearsInABucket]

21 weeks pregnant with DC3, EMCS after pre-eclampsia, induction and fetal distress with DC1, VBAC on gas and air only, followed by 3rd degree tear sewn up in theatre with DC2. This then got infected and took about 5 weeks to clear up. Not the worst birthing stories in the world but I have pretty much decided I want an ELCS.
At my first consultant appointment today, she looked through my notes and said that given that I had laboured "beautifully" with the VBAC then the recommendation is a natural birth and an episiotomy (sp?) with DC3.

I am ashamed to say that I started crying and said that I want an ELCS. She advised to make an appointment with the consultant midwife, which I have done but its not till September.

I based my decision on wanting a controlled scar this time, likely to tear again after a 3rd degree tear and definitely don't want an episiotomy as I have read that they are more likely to get infected. I am working under a misapprehension about all that? Should I go with the advice even though I don't feel ready for it at all as I had it in my mind that I would have an ELCS?

Tell me what to do! I am crap at decisions

Hold on. Isn't it up to the woman now? You sound like you've thought it through, have completely excellent reasons and have decided what you want. I don't think you're crap at decisions, or at least, this one. You've made a sensible decision and a forceful and opinionated consultant has tried to make you doubt yourself.

Now, what the best next step is might take someone more informed than me, but I think you need to be insistent on what you want. As I understand it, you are allowed to choose an elcs.

I was surprised that the consultant said it, because with pregnancy no. 2 she gave me the choice and said that it was up to me what I did (same consultant). I think because I had what was essentially a successful VBAC the recommendations might change (maybe?). I plan on saying that I still want an ELCS though.

I feel a bit silly because with DC2, I went to the consultant midwife to insist that I didn't have continual monitoring and wanted to be allowed to move about etc. And now I am going back to her saying I don't want a natural birth. The consultant in this appointment said that I can't be pleased (in a jokey way). So I replied that I am very fussy. But just felt stupid.

Two tears I've posted on the other thread but you now have 2 valid medical reasons to have an elective CS (and that is before you even bring in the psychological/ woman's choice aspect).

Have a look at the Royal College Guidelines - section 12 is on future deliveries.

www.rcog.org.uk/womens-health/clinical-guidance/management-third-and-fourth-degree-perineal-tears-green-top-29

Whiteshoes no it's not 100% up to the woman to decide. It's a joint decision between the mother and consultant.

I had my 36 week appointment yesterday with my consultant, as I'm trying for a VBAC. We agreed that if I hadn't given birth naturally by 40+7 then I'm having a CS. Luckily for me +7 lands on a Sunday so they agreed 40+5.

Basically the consultant was very understanding of my fears etc, and said I could ask for CS at 40 weeks but then I would have to go in front of a board to discuss, put across my case and then they would decide. She said they do not have a problem booking CS at 40+7 without the board. Maybe go that route?

Ah, longfugu, i see. I was thinking about the media coverage about the change in guidelines, which made it seem very black and white. Plus at the time, a friend had an elective cs and she seemed to get her way very straightforwardly. But I guess that was her good fortune/ medical background.

Ask your consultant to record in your notes that she has recommended you have a VBAC against your express wishes. Also ask her to record your concerns and reasons for the ELCS request. If she doesn't do this type it up and append it to your notes yourself. I'd also start taking notes in any future meetings - I was more than a little peed off at the fantasy record of the meeting I had with the first consultant I saw and the one-sided bullshit reasons he fobbed me off with eg: telling me 2 women a year die from having CSs in London (WTF?!!) but no stats on the likelihood of death/damage for me or DD from a VB (that's balanced then!)

I feel I'm being pushed into a VBAC... I had a c section with dd (classed as elective due to breech presentation, I found out dd was breech when I went into labour but I'm not arguing with the classifications) I've asked for another c section as I have dd1 and 2 to.think of, plus, I've always gone over due and the consultant will only allow me to go to 40+3. Baby is also measuring big so they are concerned about my scar rupturing etc.

But yet, when ever I mention ELCS I get asked if I'd like to try a VBAC. My cs was now 9m ago, there will be 55 weeks between. Dd and this one so surely an ELCS is a safer bet...

Talk to the consultant mw and tell her your reasonings. If.she agrees then push to change consultants, its what I'm going to do if I don't 'get my way' as dh keeps saying.

I find that mw can be very dismissive at times, I find it helpful to write down what I need to say and to.then record her response. It's a difficult one but they should take into account your wishes.

I hope you get somewhere.

Can we have this hospital named and shamed?

Forcing you into VBAC with 3rd degree tear and only a 55 week gap?

The difference between a c/s and VBAC is £80.00. How much will a 'board' to consider your case cost?

I would write the hospital a strongly worded letter, copy it to the Chairman of the Trust, copy to the Clinical Commissioning Board and also to the campaigning group that Mumsnet supports called Birthrights www.birthrights.org.uk/

Good luck - hope you can make a stand and stop this kind of evil callous insensitive treatment

I have read extensively concerning elcs after being incorrectly informed on this very forum that I now had a right to choose one

You have a right to request elcs and onward referral if refused, but NO right to choose one outright. However, if you are able to make a good case for being granted one, I suspect you would get one, particularly if you can cite medical history. Reading your OP I would be astounded if you were not granted one.

My advice would be to research your particular circumstances and formulate an accurate, well reasoned argument. Incorrect information just makes the mum to be appear ill informed and have a limited understanding of what they are requesting, which will not strengthen your case. It's difficult to be calm and rational when it's such an emotive topic, but preparation will give you confidence.

If all else fails have a meltdown in your appointment and cry hysterically.... works a treat in other situations!

Good luck

cakebaby I totally agree in the case of maternal choice caesarean section - NICE says women should be referred on to consultant who will agree to c/s. Such is the ignorance of health service administrators that they believe that caesarean is vastly more expensive than vaginal birth when it actually isn't and put all sorts of obstacles in the way of maternal request.

However, the OP has risk factors - previous 3rd degree tear, traumatic birth and previous c/s. Declining a c/section in these circumstances would leave the trust wide open to a claim if anything went wrong - a rupture leading to cerebral palsy would put them in line for a colossal clinical negligence claim. The important thing for the OP is to ensure that she puts in writing (recorded delivery) that she does not consent to VBAC, the Trust is ignoring NICE guidance and she will hold the trust liable for any adverse outcomes.

I know what you mean about 'crying hysterically' (and I know you are right) but I think it is appalling that women are having to degrade themselves to get decent treatment.

Miaow glad it went well for you. I guess that's always the dilemma - it could go ok balanced against the risk of what might happen if it doesn't.

ushy totally agree with you, we should not have to resort to hysteria, but it just happens sometimes and is a genuine expression of feelings. Maybe I put it badly, but there's nothing wrong with it if it happens! OP I think you were insensitively advised by your consultant, but am confident you will get your elcs. Sometimes I wonder that we should have to give informed consent for a vaginal birth, rather than assuming it's all going to be fine and dandy!

cake you definitely didn't put it badly - I think you are completely right and I think the idea of giving consent for vaginal as well as caesarean birth would be a big step forward.

I would stand my ground and say I have had enough with tears and going through normal labour, this time round you want an ELC and who the hell is she to tell you differently. You are not a naive first timer after all.

I would also be v sceptical about meeting midwife.

As said - write very strongly worded letter. get it in writing.

Thanks for your replies. mouseymummy I hope that you do "get your own way", although its not about getting our own way is it? Its about trying to have the safest labour possible, safe for you and for the baby.

To be fair, the conversation wasn't really contentious I don't think, more that the consultant was informing me of current guidelines. However, I have since read the current NICE guidelines and it says that the mother should be informed that they are more likely to have a successful VBAC after another successful one than someone who has just had a caesarean. So, to me, that doesn't sound like they recommend VBAC as such, more that the mother should be informed. So the consultant didn't say that in those terms.

I really didn't want to cry, I just thought about my DC1's birth and that makes me teary anyway!

I did see the consultant midwife for my second birth as I wanted my own control of it, unlike the birth of DC1. I felt that I needed to experience natural birth. She was very good actually and at the labour itself I refused a cannula at the very start which they were ok about, they just made sure to record it in the notes that it was my wishes.

I would like to find information on subsequent tearing after a 3rd degree tear. I really do feel that I need a controlled scar this time because I cannot contemplate a worse tear than I had last time. However, as OH has pointed out, a CS cut is a very big one. I hate not being able to predict what is going to happen. Also, as the advice apparently is an episiotomy for this one, I think that might make things worse.

But, I don't have statistical information on that, and that is what I have to find out! Any ideas on where to look?

Two tears have you read the RCOG guidelines that I've linked to? I they'll be a good starting point though they are nearly 6 years old already.

Hi, I'm afraid I have no experience of CS or VBAC, but I think you asked a general question about episiotomies at the beginning of your post, which I do have experience of. I had one as part of a forceps delivery, and I have to say that it healed remarkably quickly and there was no infection etc. not particularly pleasant (goes without saying!) but in my experience it's not always horrific.

That said, i firmly believe that you should be entitled to the birth that you want and feel is best for you and your baby, so I agree to keep kicking up a stink