ELCS: what are my rights?

[HenriettaTurkey]

I have a DS, nearly 2 and the time has come for DH and I to start considering TTC. We both want another child and, conception permitting, it could happen fairly soon.

Here's the thing. I had a horrible first pregnancy. Hyperemesis till 20 weeks, then a slow recovery, followed by outrageous PUPPS from 38 weeks and finally preeclampsia, which took a while to be confirmed, but which led to induction at 40+8.

Labour itself was SWIFT (35 min first stage) but DS had the cord around his neck.

I only had 2 stitches but sex was painful for a year afterwards - even though I was examined pre-smear (at my request) and all was apparently rosy.

Due to all this is I am very anxious about TTC DC 2, especially the final few weeks, and I am seriously considering asking for an ELCS.

Can I do this, and what would you lovely MNers advise?

Oh - I'm also approaching 37, so no spring chicken!

Hi there, sounds like you had an awful time poor love! Don't worry at all, you are well within ur rights for an elective section, just let them know right from the start. They may try and persuade you to go natural but it's your choice and I think they appreciate someone knowing their own mind. I had emergency section with DS1 and got talked into trying naturally for Ds2, didn't work but I know it does for lots! Know one would have minded or judged me if I had opted for section. You know what is best for your body and your mental health..Good luck X

*no one.. Apologies! Must be tired!

being brutally honest... given that your actual birth was ok I'm not sure you could cite your previous pregnancy as reason for a c-section

the issues you describe are mainly pregnancy issues and not related to how you give birth. Having an elective c-section won't stop you getting hyperemesis or PUPPS for example.

again, a lot of babies have the cord round their neck, that in itself isn't reason for a c-section.

I've maybe just misunderstood your post though, can you go into more detail about why you think a c-section would be better for the birth?>

You ask for a section, they try to put you off, you get refered to a consultant who will then agree to one after a bit of pushing.
You will be asked if you have changed your mind all the way up until you are sitting in the theatre. Which can become draining, mine was technically medical grounds and I'm glad I did it.

Thank you all for your comments!

Bundaberg, I know the hyperemesis is not something I can avoid, if it decides to strike. My point was that, having dealt with that, my stamina was already rock bottom when I reached week 38, which I believe is when most caesareans happen. It was after week 38 that I had PUPPS & preeclampsia. It was then that the hospital stays kicked in, along with the anxiety and other general hideousness. With that in mind, I will approach the end of pregnancy with utter trepidation and would be far calmer throughout if I could plan for an ELCS. I've had significant surgery before (bone fusion) and would be much more relaxed than having to 'let nature take its course'.

And then there's the sex issue I mentioned. This was significant, and a direct result of a speedy vaginal delivery. DH is very understanding but this was hugely stressful for both of us.

By the way, does anyone know what the chances are I'd have PE again?

Thank you Chunderella!

Ok, here's the lowdown.

You don't have a RIGHT to an ELCS despite what anyone might tell you or quote to you about the NICE guidelines. However the guidelines are on your side and even though some Trusts are trying to ignore them, it does make it more difficult for them to do so. NICE actually advise you should be allowed to have an ELCS for any reason - including where it is not medically indicted. The guidelines mainly focus on maternal request on the grounds of anxiety but they extend to all circumstances. I should also point out that an ELCS on the grounds of anxiety is a medical indication, and that may be where you fall given what you have said above.

The whole thing is hugely political though and it really does depend on where you live as to how hard it is to get an ELCS. Some places are much easier than others.

If you are not pregnant but thinking about it, it is possible to start to make enquiries and even get an ELCS agreed in principle prior to getting pregnant if it is bothering you so much that it is affecting you. I know, because I have done this myself. Its not easy and not everywhere seems to allow it due to their policies. Despite the intention of the NICE guidelines to make care and access to ELCS across the country more consistent the opposite has actually happened. I am extremely lucky; there are some Trusts who refuse to allow an ELCS until very late in pregnancy and others still who are clamping down so hard they are outright banning them.

Unfortunately getting an ELCS agreed prior to TTC seems to be especially difficult because you do fail outside most care pathways but it should be slightly easier in your case as you already have a child and can go down the road of being traumatised by it so it is giving you considerable anxiety now (you don't have to have a bad birth by the text book to feel like that, you could have the 'perfect' birth and still end up feeling the same way btw. You just have to demonstrate to them, that the thought of going through another birth is causing you anxiety because of how you - not them - perceived it last time).

I think its clear from what you say, that you will probably need extra support emotionally, during your pregnancy due to your medical history. Add your anxiety to this and you have good grounds to be pushing for that, even if there is resistance to the idea of an ELCS at any point.

You can either go to your GP and get referred from there or contact your hospital direct. It may be easier to find out the name of a consultant who perhaps has a special interest or is pro-choice if you can find that out and ask to be referred to them by the GP. They might refer you to some sort of birth reflections course or meeting as part of it. The good new is that, even though you have proved you are capable of giving birth, your age should count for you, as you are statistically more likely to have complications on that basis alone without taking your own personal medical history into account.

I think the thing to keep in mind is that if you are serious about wanting an ELCS is that it could be really straightforward, like it has been for me (after I'd done some homework on the policy/staff at local hospitals) but equally you might find you have a fight on your hands. I would say its worth trying to find out now how the lay of the land is in your area, so you can equip yourself to know what you are up against or have that reassurance that it won't be an issue immediately. In the vast majority of cases I've seen discussed on MN if an ELCS really is the thing you want, then thats what you will ultimately end up with, if you fight hard enough and long enough.

Good luck.

You didn't ask for advice about hyperemis (sp?) but I want to say - if you have had it before then at the first signs get really pushy with your Dr. My first PG I really suffered and lost over 10% of my body weight in 12 weeks. I didn't get much support from the Dr and took a long time to get over it. This time I was started on Ondansetron at 6 weeks after 2 days of vomiting 20 times a day! Much better - was sick loads less, only lost 10lbs and am totally over it and well at 14 weeks, stopped taking the pills last week. I really believe that early intervention with the serious drugs helped make it less severe - my dr is a big fan of this approach luckily for me

ahh ok, I see where you're coming from.

I would book a nice long appointment so you can discuss it all with your midwife.
Do as much possible research as you can on ALL options, because bear in mind a c-section comes with its own set of risks and downsides so won't necessarily be easier on you than a vaginal delivery.

You've had great advice on here though if you do decide to go down the ELCS route, so hopefully it'll all turn out good :)

I do think you need to fully consider the negatives/risks of a ELCS alongside what you see as the benefits for you. You definitely need to talk it through with someone so you can come to the right decision for you and your circumstances.

Good luck :)

Some great advice here, thank you all. And it's good to know more about the rights I do & don't have.

Leftover, you are definitely right. In finding out about my rights it's vital I find out about the process of ELCS. I don't love the ideas of being shaved, catheter, abdominal surgery, etc. I am also almost phobic about vaginal exams. Still, as I did labour so quickly it may seem strange that I'm looking into it. I definitely need more info.

I'm just aware that I may meet resistance. I'd need to feel pretty confident that if the issues that arose last time reappeared next time that they would be dealt with better than they were before!

And great advice about the hyperemesis too, Annie. I'll definitely flag my history at the first sign of nausea. Actually even before that.

There's a part of me that thinks it can't be so bad again - but then it's the same body: just a few years older & more knackered. And there's a whole list of issues I was mercifully free from that others suffer from terribly: spd, bleeding, breech, heartburn.

Maybe I should just worry less.

Henrietta, in terms of your rights - you have a right to refuse ANY examination or medical treatment. Ask on here about women who have vbs without vaginal examination; ask your doctor/midwife too. It is possible.

I believe that it is possible to have a CS without a catheter - I think I've seen a few women on here say they have. My understanding is its generally uncommon and not always advised, but I haven't really looked into it in depth so don't quote me on it.

Again in terms of rights, whilst you don't have a right to ELCS you do have a right to appropriate mental health support and treatment. That does mean if you have anxiety about anything related to birth or pregnancy and is causing you distress/anxiety to the point that is affecting your life you have a right to get support. Of course, in theory, if the appropriate treatment is to have an ELCS you would therefore have the right to an ELCS ;) (daft and as contradictory as it may seem, I'm pretty sure you could make a good case here)

In terms of 'just worrying less'... if that were possible then we'd all do that! Its natural to worry and you shouldn't criticise yourself for doing so. You just need more reassurance than the next person and there is absolutely nothing wrong with that! Don't beat yourself up, because someone else has had 'far worse' happen to her. The point is she may be more able to cope with that than you are able to cope with what happened/s to you. Because you are different people with different life experience, different bodies and different brain chemistry. Its ok to be a worry wart!

The medical advice I've been given is great; everyone sits somewhere on a spectrum of anxiety. There are fewer people at either end of the spectrum in terms of how fearful they are of birth and people categorise those at those ends as somehow being abnormal and perhaps in need of 'correction', but they aren't really. Its just that people want to put labels on others and confine them to boxes rather than properly explore why there is a wide difference and what else we can do to stop problems and support women.

I really do get the impression from what you've said that the best thing for you would be to get an ELCS agreed in principle now, but know that you don't have to commit to it and can change your mind further down the line if you wish. (Which tbh, is really what the principles behind the NICE guidance are but are really being misunderstood). My gut feeling is that with the right support and reassurance along the way, you probably wouldn't be adverse to a vb. Its just that you didn't feel you had that last time and your experience was made more distressing because of it and you don't really trust that you would get that the support you feel you need when it came to the crunch.

I could be wrong here, so please correct me if I am. I'm just getting certain vibes here from what you've said. If I am right, I think you definitely need to be talking it through with someone at length, over the months ahead. The good thing is, that because you aren't pregnant yet, you do have a little more time to consider everything and decide whats best for you. Thats what its all about - how you feel - not anyone else. And that includes outside pressures about how you think you should feel (eg other women have had it worse, therefore I have no reason to complain type self beatings up). However you feel is 'right' and 'ok' no matter what.

RedToothBrush, you have hit the nail on the head.

Thank you for that great, and incredibly understanding post: you're very intuitive.