Stressful process to have ELCS after EMCS

[DancingHat]

I'm 27 weeks pregnant and had an emergency c section for my DD after lots of different interventions including epidural, augmentation, ventouse. Despite the fairly drawn out labour I am happy with the outcome of the c section and I recovered well. I'm now jumping through hoops trying to get an elective c section rather than a VBAC because I don't want all the long drawn out labour process which ended up in a CS anyway. I'd rather have a postive birthing experience this time as it will be my last. Except because there's no clinical reason I'm having to have multiple psychologist appointments to get one and quite frankly the one I saw for the first appointment made me feel attacked and was totally unsympathetic. I've had hyperemesis since 6 weeks and continue to take medication. I've not had the smoothest of pregnancies so far and despite feeling slightly better now I do still feel sick and all this battling is making me feel negatively about the rest of the pregnancy. At least with my Dd and the sickness there I didn't have all this battling to do. My next appointment is next week and I've been tasked with looking at the risks, which I had already done but didn't have all the facts and figures at my fingertips when she was challenging me. I have a research background so am able to interpret journal or academic articles.

My first question is does anyone have any links to research findings I could read to prepare myself with sufficient facts and figures of the ELCS vs VBAC risks please? I've looked at NICE guidelines, NHS and RCOG so far. The second is does anyone have any advice as to how I can articulate my position in such a way that I can put an end to this stressful battle and enjoy the last few weeks of my pregancy as much as possible? Thank you for your help.

I was 'talked into' a vbac after emcs by the consultant at 32 weeks. I clearly stated no intervention. And if I went passed due date a cs. All was agreed. One week overdue and my visit to the consultant to book my cs. Arrived, waited two hours, felt dreadful and sick. New consultant, she asked me to lie on couch. I did and she put on gloves. I said why did she need gloves to feel my tummy she said she was doing an internal to start me off! I said no. She said why not as every other women does it. I said not me after emcs of four years ago. She said what did I want. I said a cs and she booked me I. For two days later. I was so angry and upset. I don't know if that helps but be firm and stick to your guns x

Well the saga continues!

Despite now being 30 weeks I'm still being denied a guaranteed c-section. I cancelled the psychologist appointment and asked the consultant if I had to see her again. He said no not if you see me at your 34 week appointment but you may get someone else (2 consultant appointments so far. Not seen the same one twice) So that leaves me hanging on. He asked how I was feeling and I said I still feel sick all day every day and he absentmindedly said 'good, good' So he's clearly not listening!

Then I receive a letter from the psychologist who's put stuff in writing to the VBAC midwife who referred me and my GP who's supported my hyperemesis which confirms she's a bitch! Her précis of our meeting sums up exactly how low she regards my reasons and even ends it by saying I cancelled the appointment due to work (true I had a meeting) & that the purpose of the appointment would have been how she could help me psychologically to prepare for a natural birth. I DON'T WANT A NATURAL BIRTH! Why on earth would I want to attend an appointment with that as its purpose??

Her wording of things is downright shit and in no way supportive. It riled me so much I've contacted the hospital complaints service who will hopefully be able to intervene and help me speak to someone more helpful. The psychologist said I didn't find the birth traumatic which is not true I said I'd come to terms with what happened. As a previous poster said, being too proactive and dealing with it appears to have worked against me. Goodmum1234 you experienced a clear case of not being listened to and I'm feeling like that sort of thing could easily happen to me. More than anything I am fed up of battling and wasting my time and really not enjoying my last pregnancy. So I'll wait to hear from the complaints service and prepare myself for the battle at 34 weeks

"Having had an EMCS last time I am not prepared to consider anything other than an ELCS"

"A VBAC you say?" "Certainly not! Please refer me to someone who will accommodate my ELCS"

Repeat, repeat and repeat.

I got my ELCS second time around but I had to make it it v clear to everyone that under no circumstances would I consider a VBAC. You must not show any signs of wavering or doubt over your wish for an ELCS, in my opinion.

I can't believe the way you are being treated. I have had 1 vaginal delivery with bad 2nd degree tear etc. & was so secretly pleased to have a breech baby next as I got an elective section without any fight. This time round I was pleasantly surprised to be told it was up to me if I wanted VBAC or elective section. The midwives have strongly encouraged a VBAC as my 'body has proved it can deliver' but the consultant said since I have had a 'previous c section' it is up to me to decide and he'll book me in at 34 weeks! I recovered much much more quickly from the c section than my vaginal delivery and with less complications! I was so relieved when I realised the choice was mine and I really feel for you that you are being forced to hotmail through this at this stage of your pregnancy!

OP - I am sorry about the hard time you are getting. I had this in my last pregnancy and I know how undermining and disruptive it can be.

You have to remember that they are making you jump through hoops. I felt, like you, that I might need to "qualify" under psychological criteria, but actually, in the end my trust had a waiting list that was too long for me to receive the psychological counselling before the birth.

I think this was a red herring though, and if I were in your position now I would be challenging why I had been referred for psychological counselling.

The approach I ended up taking was to say that I was open to hearing all arguments (which included some highly dodgy research on cs and childhood obesity and a reassurance that forceps just "got a bad press"). I smiled and nodded, then reiterated that I had weighed up all the pros and cons and was not prepared to accept the risk that came with VBAC. You do not consent to a VBAC because you are not prepared to accept the risk, and you are willing to accept the risk that comes with ELCS.

FWIW my ELCS did not go well for me, but like RedToothBrush I felt more comfortable with those risks than the risks of a vaginal birth in my circumstances.

Dancinghat - are you based in the South East? I'm just wondering if you might be with the same hospital I was at.

The psychologist said I didn't find the birth traumatic which is not true I said I'd come to terms with what happened.

What is birth trauma

READ - its important.

NO ONE else can tell you, you haven't been traumatised. NO ONE. Regardless of their qualifications.

The link has a very lovely quote:
Birth trauma is in the eye of the beholder
Cheryl Beck (Nursing Research January/February 2004 Vol 53, No.1)

The BTA also state the following.
When we talk of birth trauma, we mean Post Traumatic Stress Disorder (PTSD) that occurs after childbirth. We also include those women who may not meet the clinical criteria for PTSD but who have some of the symptoms of the disorder.

And then go on to say:
Characteristic features of PTSD include:
•An experience involving the threat of death or serious injury to an individual or another person close to them (e.g. their baby).
•A response of intense fear, helplessness or horror to that experience.
•The persistent re-experiencing of the event by way of recurrent intrusive memories, flashbacks and nightmares. The individual will usually feel distressed, anxious or panicky when exposed to things which remind them of the event.
•Avoidance of anything that reminds them of the trauma. This can include talking about it, although sometimes women may go through a stage of talking of their traumatic experience a lot so that it obsesses them at times.
•Bad memories and the need to avoid any reminders of the trauma, will often result in difficulties with sleeping and concentrating. Sufferers may also feel angry, irritable and be hyper vigilant (feel jumpy or on their guard all the time)

I'd say that going to great lengths to get an ELCS because you are obsessing over avoiding another similar experience ticks a couple of boxes. Whether or not you have 'come to terms with it' is actually beside the point.

This is precisely why NICE changed the guidelines to stop this bollocks of subjective diagnosis (and that's all it comes down to. Someone deciding in their opinion you don't tick enough of the right boxes. Even in physical illnesses few people display ALL characteristics of a diagnosis which is why it gets frustrating with mental health).

Is this psychologist a birth trauma specialist or just a general psychologist? (FWIW there are very few midwifes and psychologists with a specialist interest in this area so I'd be surprised if they were).

yetanotherchangename* not South East so it must be a widespread shit policy. You make my exact point of saying I won't accept the VBAC risks but will accept the c-section risks. The psychologist argued I was misinterpreting the information because vaginal birth is 'normal'/'the norm' so I shouldn't be thinking in terms of risks for that. Her logic only works if all vaginal births are consequence free apart from the pain. Except I'm not sure I know of any mums who have given birth without at least one episiotomy. I would rather deal with c-section stitches than vaginal ones. Especially as I'm likely to have a big headed baby thus an episiotomy is likely.

RedToothBrush once again you've been really helpful and have summed it up perfectly with supporting evidence.

This can include talking about it, although sometimes women may go through a stage of talking of their traumatic experience a lot so that it obsesses them at times.

I think I may be at this extreme because I feel compelled to explain what I went through to remind myself it was rubbish and that I don't want to do it again. I want to cuddle my baby straight away not be paralysed from the neck down from the epidural. I want to do skin to skin and feed immediately not be so exhausted I can barely keep my eyes open.

GlitteringJasper REPEAT REPEAT is exactly what it's like. Banging my head against a brick wall!

Cailinrua because I recovered so well from the c-section I am prepared to do that again. Because I did push for 2 hours and had the ventouse up there it took me 6 months to have sex and even longer to use tampons. My recovery from the surgery was half that time.

^