Calling obstetricians/midwives - confusing consultant appt

[Outflewtheweb]

After an appt with a consultant yesterday I'm not sure whether or not I'm right to be feeling aggrieved. I'm certainly feeling a bit railroaded and would love to hear of others' experiences.

I'm 37 weeks with my second baby and due to a messy first birth with a large baby (induced, tear, episiotomy, forceps, 1750ml PPH, subsequent anaemia and don't even mention the awful piles...), I was given this appt to discuss the previous PPH/birth plan. I sat down and said that I would like an elcs. Seen first by a Dr who flatly refused, saying that this hospital doesn't do elective sections. I was then faced with her boss, who turned out to be the consultant named for my appointment, who told me an elcs would be unnecessary for me.

The tone of the appointment was all quite teacher/silly school girl but with a jolly sing-song voice designed to put me back in my box (it seemed to me). I was told that any damage done during my first birth was done and wouldn't get any worse with a second vaginal birth, and that she is hearing about some new and awful risks from c sections (but wouldn't share details 'in case she scared me'). She told me I'd get an 'apron' scar and that statistically I wouldn't need forceps again and that everything would go smoothly.

I then shared my fears about this baby being even bigger and that I wasn't prepared to go through a similar birth experience. She said she'd induce me at 38 weeks, though in the subsequent minutes that translated as she'll check the favourability of my cervix at 38 weeks then induce a few days later. When I asked what would happen if that failed to progress (quite early to be induced, I thought), she said 'we'll talk about that' and that was pretty much the response to most of my questions as she stood halfway out of the room, apparently keen to leave.

I think a successful early induction without any further intervention would be ok, but I can see me ending up with a section anyway if I refuse forceps etc. To cap it all I've also got strep b, so once my waters go I'll be put on the drip and it'll all be full on like last time.

In a nutshell I came away feeling really fobbed off and stonewalled. Both Dr and consultant were totally dismissive of my wishes and there was a definite air of triumph as they swept out of the room. I think they played a good game. I was told enough about the bad side of c section and nothing about the risks and complications of early induction.

What does everyone think? I'm not sure it's worth the stress of fighting for a c section, but equally I'm not convinced by the picture they painted of the perfect vaginal birth and concerned that none of the risks of early induction were mentioned.

Well done if you made it to the end of that! What does everyone think?

I would speak to your midwife and ask to be referred to the supervisor of midwives. Ask for a referral to a different consultant and swot up on the nice guidelines. If need be take an assertive companion ( be that DH, a family member or a friend ) to the next appointment to back you up.

Out of interest what was the scaremongering about? The new c-section risks. Obviously all surgery carries a degree of risk but unless she gave you cold hard facts and statistics how can you make an informed decision?

I found that a bit fishy. She said she'd been to a conference this week where some new risks had been discussed but she immediately said she wouldn't say what.

I smelled bullshit.

The problem is I want to be able to trust these people and really don't feel I can.

Thanks for the advice, btw, I know I banged on a bit.

Sorry just realised you were after ob/ midwives. I am neither just got a bit het up for you reading your post. Watching either interest though as I had a first birth which sounds remarkably similar to yours and am now ttc #2 x

All views welcome! All the best with ttc :)

Shedding the Dr mentioned we could do a growth scan before she pulled her boss in, but later in the conversation the consultant said there was absolutely no point doing one at this stage as they're too unreliable.

Incidentally I had a private scan at 31 weeks that put the baby on the 50th centile, but my midwife stated that she'd be very surprised if he turned out to be smaller then my first.

I know none of this comes with any guarantees but I just don't know what to think.

I don't think there's any research which backs up Induction for a large baby unless mum is diabetic.

Why do you need to be on the drip with group b strep? Do you mean a syntocinon drip as you say it'll be full on? The only thing you should need is IV antibiotics every 4 hours.

Definitely talk to a supervisor if you're wanting a section. But be aware that some hospitals are being really strict now about not doing elective sections unless there's a medical reason.
Sadly previous traumatic births, maternal wish, etc are often not counted as a valid reason.

There was someone on MN recently who got nowhere even with supervisor help and changed hospitals.

Thanks Viva. If I knew a vaginal birth would be straightforward I'd be happy with that. I'm just scared it won't be - that this one will be another big one and end up in a load of intervention I don't want.

With my son I was hooked up to the oxytocin as soon as my waters broke (different hospital, mind). As I recall they wanted to get the antibiotics in and get things progressing. The thing with a lot of this stuff is that you don't question it because you trust these people know best. I'm a bit wiser this time, but still I lack confidence in the face of a pushy consultant.

Perhaps she has no intention of inducing me at 38 weeks - she may be intending to string me along until he either shows up naturally or we get to 40 weeks. I will admit I'm keen not to go overdue, however the baby is born.

Again, not a midwife etc but your experience hit a nerve with me. I had a similar experience first time round and was adamant I wanted an ELCS this time. I did my research on how to go about it and got my midwife to refer me to the hospital's most amenable consultant and it was all agreed by the time I was 11 weeks. Just shows how variable NHS experiences can be!

There was a thread in pregnancy around the time I was making my plans that was very helpful, called something like "ELCS for medical or non-medical reasons". People on there had very differing levels of success in getting their sections, but one thing I remember is that NICE guidelines state that if one consultant refuses you an ELCS you can insist on being referred to another. In your shoes I would be insisting on that ASAP as you haven't got long to play with. I wish you the very best of luck.

I can't see there's any need or reason for getting things moving just because you have GBS. As long as you're getting the antibiotics that should suffice.

There is certainly a lot to be said for the reasoning that just because you had a tear, epis, forceps last time doesn't mean you will this time. But I agree that your wishes should be taken into consideration.

I'm in a very similar situation. I'm 37 weeks with my second after a very long back to back labour, failure to progress and an emcs with my first. My last consultant appointment lasted 4 minutes. I was basically told I didn't need an elcs. I was Given very vague reassurances that I wouldn't be left for more than 12 hours in established labour and that I wouldn't be induced. I felt that my fears were all dismissed.

Missmidden thanks for dropping in - I'm glad you got what you wanted. Agree that if I'm serious about an elcs I need to get my skates on. Doesn't help that my midwife is not familiar with the hospital I'm booked in at, but I do have a friend who works there who may be able to help identify a more sympathetic consultant.

Viva what I'm struggling with is not knowing how it'll all turn out, which I know nobody can tell me. The idea of an elcs appeals because (touch wood) it gives me some control over what happens to my body.

Oh, for a crystal ball.

Op I'm not a midwife but I honestly could have written your birth history as mine
I too wanted an elcs 2nd time. Heard all the same arguments as you even got offered early induction at same time. I'm actually wondering if its the same hospital.
I searched online to see which hospitals near me had the highest elcs rates and switched to that hospital. I dont think its too late for you if you can get urgent GP referral or speak to supervisor of midwives at another better hospital
Also resesrch nice guidelines and take them with you.
I had to pretty much demand a c section.
Its basically hospitals covering their own backs bullshit incase something goes wrong during c section. They make you demand one document in your notes its your choice and think they're ok then
Scar tissue doesn't stretch which.was a worry gor me as you need stretch to get the baby out.
Also I had pph with 1st delivery approx 3000mls. This was put down to tears I then had pph with second baby unrecordable amount. I had undiagnosed von Willebrands disease a simple blood test would show this I'm not trying to worry you im only mentioning because you still have time to get tested for that if you are concerned about bleeding.

And that's what is never taken into account.

For some people the risk that things may not go text book perfect is too big a risk for them personally even if statistically its only a small risk.

I'm really sorry you've had this treatment. I've just been booked my ELCS (first baby) but it's for 42 weeks as I'm happy if I have baby naturally first. They vaguely tried to put me off but I never felt I had to fight at all. I had a midwife at the appointment with the doctor- I didn't ask for her I think it's just standard, but she was excellent. Wonder if you could have a midwife attend an appointment with you?
Did your first birth lead to PND?

I am not a MW/Obst. either but I had a 3litre PPH with DC1 and was advised that the risk for bleeding with a CS is actually higher although it seems counter-intuitive. Something to do with the body's own mechanisms for preventing blood loss not being activated. Second babies are supposed to be easier because of the cervix having been previously dilated and pelvic area f**ked stretched so there's a slightly lower chance you would need all the assistance you had first time round, especially if the baby is in the optimum position.

No, no PND, luckily. I was told a first baby would've been more likely to have been granted the elcs, but because everything is now stretched there's no point.

Sounds like you had a really rough time Scarlett. Hopefully all is well now. Thanks for the tip, too. Nobody can tell me what the PPH was all about, which is frustrating.

I wonder if I can call the hospital and request a different consultant myself...Annoyingly I was booked in to see one who is a lot more favourable towards elcs, but I had to rearrange the appt and ended up with the charmer.

Btw, the hospital in question is in Surrey!

I was amazed to get mine as my hospital has been in press for doing too many CS's. I have the supervisor of midwives number stapled in my notes- yours might be too - maybe give them a ring tomorrow?

Thanks for all the advice - I called the hospital earlier and will be speaking to a midwife manager on Monday.

All I want is a reasoned discussion of my options, and that's where the consultant failed quite miserably.

Will update in case anyone else finds this thread helpful!

All I want is a reasoned discussion of my options, and that's where the consultant failed quite miserably.

Blimey I wonder if we're booked into the same hospital. I'm 30 weeks with my first and having exactly the same problem.

I have a mix of physical and MH issues and wanted a proper discussion with the consultant about CS vs. vaginal birth last week. Had a senior midwife in the appointment with me.

It didn't stop the consultant talking to me like a not very bright child until she reduced me to tears and seemed satisfied that she'd won.

It was honestly the worst medical appointment of my life.

I cried, too and was very cross with myself. It's just such an emotive topic and I felt like I wasn't being listened to at all.

Definitely complain - you've got time on your side :)

Hi.
I had a massive pph with my first and an elective section with my second due to fear, anxiety and managing it. I did have another bleed in theatre and it was under control very quickly. My consultant told me that induction was a definite no following a previous pph and that I shouldn't go over due. I decided on a c section as it would have happened had I not gone into labour on my due date. I really would push for what you want. They said afterwards a c section was definitely the right thing as my uterus is vascular and the could manage the bleed easier.

I had a similar experience when requesting my elcs. I was expecting (and wanting) a frank discussion about the pros and cons of c sections vs. vaginal births and instead had a talking-to downplaying the cons of vaginal birth and overstating the cons of c sections. The consultant was patronising and dismissive. He referred to my concerns as "things I had read on the internet"... as though I had read about them in Heat magazine. I am a lawyer and had read extensively on c sections vs. vaginal births including the NICE guidelines.

Anyway, what nobody tells you is that under the NICE guidelines you are effectively entitled to a c section if you want one. You may have to go through a process of further consultation (e.g. with a consultant midwife / psychologist) but ultimately your consultant either has to agree to your CS request or refer you to someone else who will agree to do it. If you Google it you can read it for yourself - NICE Clinical Guidelines on Caesarean Sections (CG132), it's paragraph 1.2.9.5 in relation to maternal request c sections / a bit later in relation to VBAC vs. c section scenario.

My consultant tried to fob me off. If I hadn't known about the position under the NICE guidelines I would have walked away thinking I couldn't have the c section I wanted. If you want a CS you should go back to your consultant and tell him / her that a VBAC isn't an acceptable option for you. Be firm and refer to the guidelines. Ask that if he / she isn't happy to sanction a section that he / she refers you to someone who will. They bank on you giving up. Don't.

I find stories like yours really outrageous (hence the essay). NICE have determined that women should get the c sections they want if they have been adequately counselled. Why do the medical professionals hide this from us? And why do they think that patronising us is the best way to get their point across?