Appt to discuss ELCS imminently -- nervous and in need of advice?

[wrapsuperstar]

Will try to keep this brief

I had a very traumatic birth with my DD, now 2 years old. It was a long induced labour, three hour pushing stage and ended in EMCS due to her being in what I am told is a rather rare position (brow presentation). I then suffered a 2.5l PPH, went into shock on operating table, nearly died, missed out on proper skin to skin, ad nauseam. Suffered PND and PTSD as a result.

Was told by midwife shortly after the birth that an ELCS would be 'no problem, a dead cert' for me if I were ever to have another child. Two years later, we've relocated, now with a different hospital trust and am finding them completely lacking in compassion and being utterly obstructive with regard to my desire to have an ELCS.

Am now 27 weeks and will be 29 at my mandated appointment with consultant midwife to 'discuss my options'. I am determined to leave this appointment with my ELCS agreed firmly and, ideally, a date booked for the section too. I know this is perfectly possible from the research I have done and threads I have read on here, but my midwife (one of many -- I have had zero continuity of care but that's another story) refuses to accept this.

I really want to go to this appointment armed with all the information possible to ensure the best outcome for me and my baby. I am satisfied, 100% that a VBAC is not right for me, so please, if anyone can advise on 'negotiating' my ELCS it would be so so helpful.

As an aside, I have also experienced what might be serious failings with the care given to me during this pregnancy. I was supposed to be consultant-led due to the birth trauma and previous RMC but have heard nothing. Might this also be relevant?

Many thanks to anyone who can lend their knowledge and experience.

hello

There are wonderful people who come to these threads with all the facts at their finger tips, so hopefully you can get one, or google past threads...all the info is there.

I am aghast that you are being denied one after your birth.

look at birth trauma website, call them email them and see if you can glean some good terms from them.

I dont know why your meeting a consultant MW to be honest i would have thought a normal consultant who may do the op would be better...

I was put forward by community MW and I met with consultant who said YES, but just to be sure said i should meet head MW.
The head MW was useful in going through my past notes and first labour, however she was as mad as a hatter when it came to discussing what was best for me as a person.

so i am not convinced they are the best people to meet.

be prepared to get tough, ask them how they can guarantee the same things wont happen or different bad things ( of course they cant) what redress is there, if you have been begging for ELC and denied it and something goes wrong ( i get the impression from other threads, legally this shakes them up), PALS, to complain too and of course kick up a massive stink, say you are utterly terrified of labour again, that you have been though it once and know what it entails and it was horrific you have been left afraid and traumatised and now, you would like to have this baby the calm and more controlled way...

yes of course your lack of consultant led pregancy will be helpful.

to be honest, depending on what happens when you meet this MW i would get onto PALS and tell them...

Nice guidelines!!! Look up elective c section and take a copy of the guidelines with you and write to the head midwife. (I know this as I just had my elcs confirmed after a bit of a battle)

I had a similar appointment with the consultant midwife to "discuss birth options" and was expecting a chat with a meeting with consultant to follow, so wasn't prepared for the argument that followed, and didn't take anyone along which would have been useful. I discovered that in my hospital the consultant MW can book a date for the section (she went to see the consultant and got it signed off), this happened after about 1/2 hour of trying to dissuade me. My advice would be to take along the NICE report 2013, the page with the statistics comparing ELCS vs VBAC (in the full version of the report). She couldn't argue with the statistics so tried lots of emotional arguments / blackmail. I got the feeling that basically they can't refuse (something to do with litigation if things go wrong). After she went to get my date she was all sweetness! Good luck OP, just stick to your guns and say you won't change your mind.

I've just had my consultant app and had no problem requesting another section.
My first was 3yrs ago. Breech baby and low lying placenta. I fully expected to fight at the app.

I didn't even meet with the consultant, met with a lovely lady on his behalf. She listened to my reasons and agreed. She did try and talk about the benefits of a vbac and I assured her that I had thought long and hard about this and that I had done my research.

I'm booked in for 2days before my due date because the consultant wasn't happy doing it early as there's no medical reason. Just stay calm. Tell them your reasons.

I had no problem getting my ELCS 2nd time round, after a 3rd degree tear first time. Have a think beforehand what you want to say, but don't assume it will be a battle, it may well not be.

In my experience the midwives I saw throughout my pregnancy were a little dismissive of my request for a CS but once I saw the registrar/ consultant the tone of the conversation was very different and supportive of my right to choose.

Hopefully it will be easily sorted out today, if not ask to be booked in to see the consultant obstetrician.

Hi, I have no knowledge of the ELCS procedure, sorry, but what stood out for me from your post is that you are getting a total lack of care in this pregnancy.

You are 27 weeks and still haven't seen the consultant despite the fact that you are supposed to be having consultant led care, is that right??? That is absolutely disgraceful.

I think you need to either complain massively now ie letter to head of trust copying in head of midwifery and head of medicine asking what the hell is going on and giving them a very specific list of things they need to do to satisfy you now (ie consultant appointment, case loading midwife, serious review of your care etc)

OR move hospitals right now if there is somewhere better you can get to.

I spent a lot of time at a really poor hospital not complaining, not wanting to be a problem etc when I should have upped sticks and left. Proper care should happen automatically, not be something you are trying to wheedle out of them. I am now at a different hospital and the difference in how they operate is just staggering.

Unfortunately experiences vary massively between hospitals. A sympathetic MW or consultant can make a big difference. FWIW, here's what helped me to get an ELCS:

• as others have said, try to get an appt to see the consultant. Whilst the MWs were sympathetic, they didn't seem to have the authority needed to push things forward. The conversation is very different with the consultant.

• be honest about your concerns (which are very valid given what you've been through). I told the consultant I wasn't sleeping, was having nightmares, was constantly anxious and didn't feel I could cope with labour. I was visibly very upset. Be prepared to quote the NICE guidelines etc but also let them see how anxious you are. I found the consultants very sympathetic.

• Be prepared to jump through the hoops, that's just the processes some hospitals have to go through. In total I saw three separate consultants and a specialist MW. Whilst all did try (to some degree) to convince me have a VBAC, they were also very honest about the benefits of an ELCS and the (minimal) risks.

I hope all gets sorted for you.

Wow, thank you, thank you to everybody who has taken the time to read my post and reply with such excellent food for thought.

It's very reassuring to hear from those of you who have been treated with at least a degree of compassion and respect for your birth choices. I will take heart from that and hope that despite the treatment I have had so far, I might be more fortunate at the next appointment. I don't want to treat this as a battle by any means, I just feel very disheartened by the progress so far.

One problem for me is I have severe hospital anxiety following my previous birth experience. I also don't particularly enjoy the company of midwives. For me, getting the ELCS agreed and booked as soon as possible, without further hoops to jump through and anxiety-inducing appointments to attend, is the only bearable outcome I can think of. I just need to think of a way of putting this diplomatically so I don't run the risk of pissing off alienating the very people who have the power to make decisions for me.

One thing I have taken from your replies is that my absolute lack of consultant-led care is totally unacceptable. This is something I will start to tackle immediately, perhaps my poor treatment up to now might even work in my favour when it comes to negotiating my ongoing care.

Many thanks again for all your input.

• I don't want to treat this as a battle by any means, I just feel very disheartened by the progress so far

You must treat it as a battle and be as prepared as you can! Better to go in armed to the teeth in arguments and facts not need them than be sat flummoxed and out foxed by the MW.

No one has the power to make decisions for you expect you! Take the reigns and control for yourself, who on this earth has the right to make you go through labour again? The very thought of it is utterly barbaric.

Who is being obstructive? Your community midwife? I would be surprised if your obstetric team would try to force you to have a VBAC with your history.

You might find these guidelines helpful

www.rcog.org.uk/files/rcog-corp/GTG4511022011.pdf they look at specifically at birth options post cesarean - and basically they say that the mother should be counselled on relative risks of VBAC versus repeat section. They talk about increased risk of haemorrhage with VBAC which is of course very relevant for you and perhaps something you could mention at your next visit.

I agree that you should try to book an appointment to see your consultant as soon as possible. Don't worry that you haven't seen them yet. I had CLC for similar reasons and was only seen at 23 weeks and 36 weeks.

Good luck.

I don't think it's necessarily unacceptable that you've not seen the consultant yet. I was consultant led but didn't see mine until 35 weeks- if your pregnancy is otherwise going ok and it's just the delivery that needs consultant input the MWs can look after you until then (although it doesn't sound like you feel looked after! I had no continuity of care either and I know it's v frustrating)

I would have liked to see my consultant earlier to discuss delivery but they didn't want to book me in sooner- I think because it's better to discuss delivery options knowing about any problems throughout the pregnancy, baby's current position etc. However, if you're so anxious it's really affecting you I think they should have seen you earlier to put your mind at rest.

Best of luck with it. Be polite but firm and make sure you get across how troubled you are by it. They'll want to discuss it with you rather than just immediately say yes because they need to make sure you're fully informed- it's obviously a bit different to an EMCS where they have to act immediately to protect mother and baby. I'd be surprised if they didn't agree after that though.

Thanks all.

Jollyb, that link is very interesting, particularly the mention of the risk of transfusion being higher with VBAC versus ELCS. When I have mentioned my fears of haemorrhage to the midwives, I have been brushed off with 'well, major abdominal surgery might not be a great idea then' sort of comments. Ridiculous especially given my bleed was due to uterine atony thanks to a long, fruitless labour and protracted pushing stage. So many many thanks for that.

Thanks to you and ImNotCute for sharing your experiences with consultant-led care. I suppose what concerns me is that, apart from being told I would be consultant-led on booking in, I haven't heard any mention of it. Am now 28 weeks. My reasons for being under CLC were the complications of my DD's birth but also my history of miscarriage, which I was under CLC for my last pregnancy too. So I would really have hoped to hear from them by now.

Have printed out some good documents though still on the hunt for the exact NICE guidelines I think I need. Starting to feel more prepared now, which is great.

Full guideline is here:
www.nice.org.uk/nicemedia/live/13620/57162/57162.pdf

Page 96 (particularly around p100) for maternal request ELCS.
Page 180 for VBAC versus ELCS.

Please be aware that the stats for maternal requests only reflect studies on women who have had their first child, so the data and findings is slightly skewed and perhaps look better than they are for women who have already had one child. It is limited in its scope. However it is helpful in terms of debating the psychological aspect of wanting and requesting an ELCS.

The information in the other second gives you more appropriate comparison of risks - which may/may not change your mind but is worth considering as they may use this to try and talk you out of an ELCS.

Recommendation 119 is the key one with regard to VBAC v ELCS.
When advising about the mode of birth after a previous CS consider:
• maternal preferences and priorities
• the risks and benefits of repeat CS
• the risks and benefits of planned vaginal birth after CS, including the risk of unplanned CS. [new 2011]

Basically that your preferences and priorities should be given significant consideration.

In combination with the recommendations of considerations for maternal request, this provides a clear guideline that any concerns you have should be taken seriously, treated with respect and not dismissed.

Of course, they don't have to follow the guideline

(and it is possible that both you and the midwife are correct. You can get an ELCS agreed early but its dependent on the trust involved and some have a policy where you simply can't unfortunately).

Just checking back in. Had my appointment today and the outcome was, ultimately, pretty good. I have had my section signed off and will be getting a letter with a date on by the end of the week.

As anticipated, the VBAC angle was very strong. I was firm about having done my own research on risks vs benefits and, I think, convinced the consultant midwife that I knew what I was on about! As part of my desire for ELCS was due to birth trauma/anxiety, she did push the idea of me exploring counselling and even hypnotherapy. I said I was happy to consider counselling as part of a bigger mental health picture, but it wouldn't change what I wanted for this delivery especially with only 10 weeks to go. Strangely, and I think pretty poorly actually, I think the fact that this will be my second and most definitely last baby helped swing it somewhat. The tone of the appointment changed slightly when I said that my DP had recently had the snip and that I felt so strongly I would consider sterilisation too, just to be sure.

She also tried to overwhelm me with risks to the baby. I was prepared for this, had the NICE stats and also had done some research on 'natural' caesarians which can help mitigate the small chance of respiratory difficulties in newborns delivered this way. Think that was my opportunity to have her on the back foot a bit actually.

All in all, she was very nice and understanding. It wasn't the battle I thought it would be and I felt like my views were treated with respect and compassion. I hope this will help any others going into this situation. Thanks again for all your support.

Congratulations OP on getting your section signed off.

I do think that it's sad that women have to "battle" with HCP to get the birth they want.

Good luck