ELCS after horrible first birth

[goldenegg]

Advice needed please - sorry for long post! With my first baby I ended up with pre-eclampsia, 3 weeks in hospital on heavy drugs then induced at 37 wks (which took 4 days!) - waters manually broken, then syntocynin drip plus magnesium sulphate to control crazily high blood pressure, pushing for 1.5 hours then dragged out by forceps plus episiotomy! So not at all a fun experience. Recovery was quite tough, I never got to breast-feed as baby went into special care for a few days with feeding tube, and pelvic floor shot to pieces! So needless to say a bit of a traumatic experience, but thankfully a healthy baby in the end. Am now 15 wks pregnant with baby number 2 - and have already met with consultant because of pre-eclampsia history which i'm heading for again by the way. I discussed the terrible birth and asked what options were for next birth. I do not want an instrumental birth again - firstly its scary, and secondly I worry about further damage/episiotomy and pelvic floor which hasn't fully recovered from first birth. Consultant did a lot of sympathetic head tilts but basically said that he can't guarantee it won't be another forceps delivery, or that I won't have further pelvic floor damage, and that they would look to do any corrective ops after the event! I asked about ELCS but it was flatly denied stating no particular reason to warrant one. I left it at that but came away feeling disappointed that I don't seem to have a choice on this one. I don't want to spend my entire pregnancy fighting against consultants -but nor do I want a repeat run of the first birth either. It's my body and I feel I should have some say in the matter. MW insists that 2nd birth will be much much easier (how do they know?) So should I insist (perhaps going via my GP) - or leave it as is and hope for a better second birth? For the record, I don't think ELCS is an easy option by any means and understand about recovery but simply that I think it would be better overall than re-run of first birth.

Insist. Change hospitals if necessary. Good luck.

I left it at that but came away feeling disappointed that I don't seem to have a choice on this one

Of course you have a choice its your body, you just have to navigate your way round the stupid system to get your way,.

Talk to PALS at hospital, ask if another consultant to speak too, google some other names see what comes up.

I would simply the first birth left you traumatised emotionally and physically and you do not want to risk a repeat and therefore you would like to have an ELC.

Look at your differnet hosptials too, ask around about them.

I had normal, straight forward birth with dc 1, I say straight forward but horrific for me emotionally and I was given - an ELC with no arguing second time round.

It was the best desion, and perfect for me.

You have the right to choose an ELC. On the NHS. Look at the NICE guidelines. They'll have to go through the process of having a psychological assessment and making sure you know all the risks but you can insist on one. Good luck!

I did not have a psycological assesment!

Lucky you! If there is no medical reason (which in itself can be subjective), hospitals should follow 1.2.9 of the guidelines - providing perinatal mental health support. But they are 'guidelines' and doctors decide if they consider you have a medical reason. If you stick to your guns and really want a c section though, they have to give it to you - following 1.2.9.

Put it in writing and attach it to your notes. It can't be so easily dismissed when it's there in black and white. State clearly it is your wish and that you are having your express wish declined.

State that if you sustain any trauma from a 2nd birth which they have forced you to have vaginally and you will consider legal action.

Ask them to guarantee that the second birth will be easier. Fact is that they can't. You could roll the dice and be unlucky again.

Make friends with a midwife that will support your view. After one breaking down in tears episode (me) one of mine was moved to accelerate my 2nd opinion appointment (and change it for a consultant known to be more pro ELCS).

Poor you. Second opinion definitely. I'm having an ELCS in 5 weeks after a traumatic forceps delivery and subsequent damage. Consultant was tough but sympathetic, discussed risks reasonably and fairly and accepted my decision. Fight for this - it's your right.

Of course you have the right to insist on ELCS if that's what you want. (My sister had an amazing CS, and her recovery was miraculous btw...).

However, I do believe second births are generally much much easier. Everyone who I have spoken to who's had a traumatizing first birth has had an easy second birth. We live close to a shit hospital and virtually everyone I know who's been there have had horrible, horrible first births.

I haven't spoken to anyone who's second birth wasn't completely different. One woman I spoke to last week had her 10.5 lb baby stuck for ages in an extremely traumatic first delivery. The second popped out in 20 minutes (from the first contraction) with no pain! When I was in recovery after my first traumatizing delivery, a doctor came and told me there was no way my second would be like this. I thought she was crazy to think I'd even consider a second pregnancy. But her words meant a lot, and here I am expecting my second next month. I truly believe it'll be totally different...

Keep on with asking for further discussion for an ELCS...you do not have to just accept the opinion of one consultant if you feel that ELCS is the right thing for you.

Yes bear in mind that it seems to be the case that 'most' second births are much easier.

However, at the end of it all, it's you who will have to cope with the aftermath to your vagina and pelvic floor. Nobody else.

No health professional can really predict how 'easy' the birth will be, a lot of it is down to the luck of the draw.

Good luck, you have plenty of time on your side to get things done

Fallacy number 1
Of course you have the right to insist on ELCS if that's what you want.

Unfortunately this statement is untrue in the UK. A lot of people now believe this because of poor reporting of the changes to the NICE guidelines on caesareans but its just not true. You do not have a 'right' to an ELCS. However you do have the right to the most appropriate care for you which may well be an ELCS.

I think you have to really think about what it is that is that bothers you about giving birth - there may be alternatives to going straight to an ELCS, that you haven't explored. Unfortunately these options are not often discussed. I know that the hospital I was at did a lot of work with women who requested ELCS and getting to the bottom of what their anxieties were - particularly with women who had a previous traumatic experience. They didn't refuse ELCS, but were keen to give women who wanted one proper support as are usually in extra need of this. Many actually decide to go ahead with a VB in the end as they were given reassurance and rebuilt the trust they had with midwives that they lost during their first experience.

If you are worried about further damage to your pelvic floor, I think you need to bare in mind that its not just the method of giving birth which can result in problems, but also the actual pregnancy itself. If you already have weakened muscles from a previous VB then you may well be more susceptible to further damage regardless of whether you have a VB or a CS as the majority of damage is done during your first birth. A CS as a prophylactic choice for subsequent births I believe only has physical benefits for some women.

Fallacy number 2
Look at the NICE guidelines. They'll have to go through the process of having a psychological assessment and making sure you know all the risks but you can insist on one.

The NICE guidelines focus on - but are not restricted to - the psychology of choosing an elective, but the fallacy is that you will have to go through a psychological assessment. The NICE guidelines suggest that you should be offered counselling not that this is compulsory. The problem is more than many hospitals have interpreted the guidelines in this way, and do pretty much insist on you going through some sort of process which looks at how this affects you mentally. I do think there is some merit in this, as many women - perhaps the majority - who ask for an ELCS do so because there is some sort of trauma or history that means a VB is a prospect which gives them anxiety. However this is not true of all women, and there are reasons which are a 'lot more rational' and logical in their reasoning for the benefits of their overall health and for whom psychological assessment is completely inappropriate.

The truth is though, that there is no consistency in how you will be treated if you request an ELCS. Its very much up to individual consultants/midwives and the policy of the Trust which you are at. Unfortunately it can be near impossible in finding out where you stand with this before you embark on pursuing getting an ELCS. It can be a real battle, but equally it can be very easy. Its complete pot luck.

Fallacy number 3
If there is no medical reason (which in itself can be subjective), hospitals should follow 1.2.9 of the guidelines - providing perinatal mental health support.

Mental health reasons ARE a health reason. Diagnosis as being a mental health reason can be subjective but mental health is as valid a reason to have an ELCS as physical ones.

As I mentioned above, it can be useful to go down this route as often women who want an ELCS do have underlying issues that are yet to be resolved and need help to address these issues.

In this particular case, it does seem that the OP does have unresolved issues with a previous traumatic experience, so it would strike me as relevant to her to explore this with the mentality that if she is suffering from anxiety she has the right to the most appropriate care to deal with that - which might mean she has medical need for an ELCS.

In the OPs situation, I think pushing for appropriate support and an ELCS would be the way to go at this stage; this means she gets the help she needs and may give herself the option further down the line regarding an ELCS - if she doesn't pursue she doesn't have the luxury of being in this situation. There is no obligation to have an ELCS even if one is granted; you can change your mind at any time.