Elective c section reasons

[nutelladipper]

Hi what reasons did anyone have for elective c section other than having previously had one? Did you have to really fight for it too?

Cheers

[LollieLoves]

It does sound as though the consultant is not well informed about mental health/is dismissive of it. Some doctors are, sadly, though they should really know better. I wonder if the hospital is under pressure to get their caesarean rates down. Good luck Matilda30 !

[woodsies1975]

It's a good few years ago now but after my fourth degree tears and PPH with DD, I didn't want to have another baby but Mother Nature had other ideas and at 6 weeks I found myself in shock and in tears at my booking in appointment. My midwife was very supportive. I had consultant led care and she came with me to support me in my request for a planned section. The consultant was fine about it, explained all the risks etc, but ultimately agreed. For my mental health as much as anything it was very important and I don't think that should be underestimated by the health professionals.

[Matilda30]

Thanks LollieLoves for the advice. It's very early so I'll see how it goes with the MH midwife. Think I need to be more confident in my decision as previous posters have said. Not sure about moving hospitals, hope it doesn't come to that. Fingers crossed.

[LollieLoves]

I don't get what they mean that it's "not an option". It is an option, a valid one, and the NICE guidelines state very clearly that this is the case. I think their attitude to peri-natal mental health is in the dark ages if they think a quick chat with a MH midwife will magically resolve your anxiety. Severe anxiety is a serious mental health condition, that needs to be taken seriously and treated. It will do no good to you or your baby if the anxiety is untreated. Anxiety can also lead to depression if left for long enough. And in any case, the risks from an elective c section are comparable to a vaginal birth, and for the baby are slightly lower. The only scenario where this may not be the case is if you are planning a large family. I would push on with stating your case, though be prepared for a fight. You can ask to be referred to another consultant for a second opinion. If you get no traction with the hospital, you could consider, if funds allow, getting an appointment with a private psychiatrist and asking them to assess you for anxiety and then write to your maternity hospital explaining that a c s will be in your best interest from a mental health point of view. Which hospital are you with? I know some are worse with this than others. Could you change hospital if this one continues denying you your rights?

[Matilda30]

Just had my first midwife appt and mentioned elcs as I suffer with severe anxiety. I was point blank refused, and told it wasn't an option but after I got visibly upset, I've been referred to a MH midwife. I'm dreading this as I can see it being a fight the whole way. I anticipated resistance but having read the NICE guidelines, I didn't expect point blank refusal. Feeling crappy :(

[nutelladipper]

Thanks very much and thanks for all the info booboo.

[hazeyjane]

I had a 3rd degree tear, followed by a 2nd degree tear, and had some double incontinence as a result. I had to fight for and ELCS.

Unfortunately my ELCS was probably the worst of the 3 births, with a long recovery time, I don't think there are any guarantees with any sort of birth unfortunately!

Good luck with whatever birth you have.

[Booboostoo]

I had two ELCSs because of a personal assessment of the risks of VB vs CS. For me it was better to accept the risks of CS than the Risks of VB. I had to move countries for both births as France does not offer ELCS.

[RedToothBrush]

In terms of recommended reading, it is difficult to suggest much other than trawling the internet and learning how to read and understand the quality of what you are reading.

www.amazon.co.uk/Choosing-Cesarean-Natural-Birth-Plan/dp/1616145110?tag=mumsnet&ascsubtag=mnforum-21

Best book on the subject. HOWEVER I do caution the fact by saying it IS very biased in favour of CS and falls foul of its own valid criticisms of studies being biased. If you get the idea of why they are biased from the book you can be critical of the book itself though. Its biggest strength is teaching you principles of reading data rather than simply its point of view. It is easy just to read it on face value so I stress its about understanding why we shouldn't automatically believe the pro-VB rhetoric out there, but rather should try and look at circumstances and how bias (on both sides) is making it very difficult to get a picture of 'whats best' before doing what is best for us as individuals.

I try and be as unbiased on the subject as I can, though I do have a personal point of view so I try and point out information that you need to consider as much to be devils advocate. I don't believe an ELCS is for everyone and I think that often they are being pushed rather than properly understanding a woman's reasons for requesting an ELCS and offering her more appropriate support for her personal situation. I'm not pro-ELCS rather I'm pro-getting it right for woman as individuals. Whats right for me, isn't right for the next person.

So as such as you have already had two vbs be mindful of just how much of a preventative effect a CS will have for you; most damage is done by pregnancy itself and your first birth. In the majority of cases, it will make little difference to women having their third baby by vb.

In terms of safety, generally if you've successfully had a vb, its safer to have another - this tends not to be brought up in most literature on the subject and certainly does not appear in the NICE guidance which is one of its major criticisms.

However in your case because you have had a baby with shoulder dystocia this rather changes the odds and risks to you and your baby. I'm not terribly familiar with the statistics regarding this, but I'd definitely look into it as your focal point in your case as it does change the situation somewhat from what my failing memory serves to tell me.

Its not a straightforward subject by any means, and you can drive yourself half crazy with it.

My gut feeling is that you probably have a good argument that is more accepted and readily valued by HCPs and with luck may not have quite the same battle that others have as a result. (This doesn't mean your case is more valid or 'better' more than its in line with more old fashioned thinking within the profession). I hope that, if you decide an ELCS really is the thing for you, that's the case.

[nutelladipper]

MrsN can you recommend any reading! I've read so much now I'm not taking it in so will stop and read again closer to meeting with consultant.

[MrsN1984]

Meant to say terrified of any injuries down there that would affect the sphincter muscle

[MrsN1984]

I suffer from IBS and am terrified of tearing / needing an episiotomy and forceps.
I decided that I would rather take the Known risks of an ELCS than the unknown of a VB.
It's my body and I have to live with any damage after.
After a long battle (and I mean battle) I was finally booked in for an ELCS
Today.
I done a lot of research and demonstrated to the consultant that I am making an informed decision.
I found the process exhausting and they don't make it easy but if that's what you want, don't take no for an answer.

[onthematleavecountdown]

I am having an elcs. First baby. Ivf. I want to eliminate as many risks as I can and for me the best option is an elcs. I mentioned it from my booking appt and have had support all the way from mw and consultants. I think what has helped has been staying calm and collected during discussions, being armed with knowledge, stating RCOG stats at them def helped :) and most of all being super aware of the risks to me, the baby and to any future pregnancies. Good luck.

[nutelladipper]

Thanks redtoothbrush. She is referring me to consultant automatically due to shoulder dystocia and due to another issue i have with my eye which means I'm being seen by an oncology team. So didn't need to go into detail about my thoughts she said to chat with consultant about it.

X

[RedToothBrush]

nutella, a couple of things for you to think about before your appointment today.

The next two questions that come from what you say are

why is a positive experience so important to you

and

why do you think an ELCS will give you that positive experience

also be prepared to think of other ways a vb could be managed in someway to make sure your experience was more positive as part of the second question - there may be no way it think it could be - but its about looking closely at what parts of your previous experience made it a negative experience.

TBH at your booking in appointment, I would suspect that the conversation on the subject will be quite limited. So be prepared for that too.

[nutelladipper]

Thanks everyone I really appreciate your experiences.
I have my booking in appointment today - so yes still early days but I'm keen to have the conversation from the start.
My main reasons for considering a c section are:

1. Daughter shoulder stuck, forcep delivery with episiotomy and tears. Fear of another. DS was also assisted so two horrible births.
   
2. fear that if I end up on my back it'll put pressure on my prolapse disc.
   3)this is last baby and I'm desperate for a positive experience.
   
   I'll let you know how the first conversation goes.
   
   Thanks again

[scratchandsniff]

I've got an appt booked with consultant at 36 weeks to book in elcs if that's what I still want. I had an emcs after failure to progress after induction. It felt like they let me go on and on to the point of sheer exhaustion for me and baby. He was never going to come on his own, the consultant that took over and examined me said he was in awkward position and big baby and I'd been left for long enough. I felt I couldn't risk that happening again. I'd rather have a planned emcs and be in control. I don't feel its the easy option as it is painful and difficult after, but for me it's better than going into the 'unknown'.

[RedToothBrush]

A previous shoulder dystocia is potentially a very good reason alone for asking for an ELCS. It immediately suggests you had a traumatic delivery and would give a good reason to back up any anxieties you are having. Anxiety being your second reason for an ELCS.

[flanjabelle]

Mine was on mental health grounds. I was raped a few years ago and felt that a natural birth would be very triggering for me. I wanted a positive experience and so asked for a c section. I didn't have to fight for it, but I went prepared for the questions they asked and made my points clearly. They accepted my wishes and that was that.

[nutelladipper]

What tests did you have? I had my shoulder dystocia with my last. X

[Feathers1981]

My 1st, an assisted delivery, had shoulder dystortia. After some tests I have a 3% chance of the same this time. If it happens again, best case they release the baby quickly as they did my 1st, worst case it dies (1 in 1000 chance of a 3% risk). Very low risk but I said it was too high for me and consultant said "that's fine we'll book you in now an no we don't think your crazy, what date suits you"

[cuphat]

I am due to have a baby in May after having an ELCS for a breech baby. I went into my consultant appointment with a list a reasons in my head, ready to argue for a repeat ELCS (after reading threads on here) but the consultant asked me if I'd thought about how I want to give birth and agreed to a repeat elcs straight away! He'd read my previous notes and must have decided that it would be best for me anyway.

Things in my favour:
My ELCS was only 19 months ago.
DD was 9lb 10oz and that was a week early
Her head was on the 99th percentile
As previous section was an ELCS I didn't go into labour so this one would be much like a first labour.

I just need to go back at 36 weeks to pick my date (the earliest they book ELCSs at my hospital).

[RedToothBrush]

Just to make the point that severe anxiety - which covers having a traumatic previous delivery which has resulted in PTSD - IS a medical reason to have a CS.

Its a popular misconception to dismiss mental health reasons as not being a sufficient clinical reason to justify an ELCS - this includes a misconception from HCP who really should know better. They are as valid as any physical reason, and this is recognised by NICE.

The trouble is that a lot of hospitals are refusing to acknowledge mental health and its relationship with childbirth. And in doing so are actually costing the NHS and the taxpayer a small fortune in the process rather than saving money. Something that has been shown up in an independent report on the subject which showed the gaps and inequality of provision across the UK.

I can rant rather a lot on the subject...

In my case I had an ELCS on this basis. My approach was to seek help before getting pregnant and to find a hospital with peri-natal mental health provision (a task that is easier said than done). I had an ELCS agreed in principle prior to pregnancy and faced no problems whilst pregnant. My understanding is this is the exception rather than the rule though.

My biggest piece of advise is to actually to ask what your reason for wanting an ELCS is. I read a lot of threads like this and when you explore women's fears an ELCS isn't always the solution for every woman. One of the reasons I liked the hospital I went to was that there approach was to look at this, and to work with the woman and address the individual fears she had and how to tackle them. Many women they deal with have ended up with a vb despite requesting an elcs because the issues and concerns they had were properly dealt with, and they were given more options and/or control. If you do this, and still want an ELCS, it will give you a much better argument as you'll be able to articulate your case better.

Also, its a misconception that you have to have counselling if you have anxiety. You don't. Its advised you should be offered it. I personality didn't take up the offer for various reasons. It depends on your circumstances. I felt strongly it wasn't appropriate in my case and this was respected.

[plentyofshoes]

I requested one after my first. Many reasons, I just felt that it was the right decision. I had very complicated pregnancies and went into labour rapidly at 33 weeks (again) The pain was awful and they would not make a decision. They ended up ringing my consultant at home who authorised it. My uterus had started to tear so it was the right choice.

[nutelladipper]

Thanks MrsNec. I have got a prolapse disc but haven't even considered that that would help my "case"!
Thanks