ELCS appointment with consultant

[Flangipan]

I am 33 weeks pregnant with my first child and I am due to have a meeting with a consultant next week to discuss an ELCS. I have a history of epilepsy that is brought on by pain / discomfort / illness although I have been fit free for 7 years, however during that time I was on medication. I came off the medication in January 2014 in order to prepare for pregnancy. Luckily I haven’t had a fit, although there has been occasions when I felt very poorly and thought that a fit might be brought on but it didn’t develop.

I was supposed to see the consultant at 12 weeks but ended up seeing a trainee doctor who wasn’t much help, couldn’t make decisions and basically just booked me in for another meeting nearer my due date (i.e. next week). What I’d like help with is how to approach the conversation. I know that due to my history the intense pain of labour will bring on a fit, according to my notes I’m classed as ‘low risk’ but I just know full well I will not be able to withstand the pain and will fit at least once if not numerous times. I can see myself having to have an EMCS if this happens. The very first consultant I saw when I was diagnosed with epilepsy said there was no way I’d be able to cope with a natural birth. Obviously this scares the life out of me, my fits are tonic clonic so can be quite bad and the more severe the pain in the past, the more severe my fit has been. I just do not want to put myself or my baby through the stress.

All the midwives and doctors I have seen have been quite dismissive of my concerns simply because I haven’t had a fit for so long, but ultimately I haven’t been in a position to have one – either through sheer luck or just being very careful about not putting myself in situations where I risk hurting myself and therefore feel pain.

I understand that a c section is major abdominal surgery and both options are not without risk, however to me the greater risk lies with what could happen during a VBAC.

Are there any words of wisdom out there from people who may have gone through the same thing? I’m starting to feel very anxious about the meeting, I’ve done my homework and I feel well researched but I want to come across as eloquent as possible. My husband is coming with me and he is very much of the opinion that it’s elective, the NICE guidelines are in our favour so why should there be a problem but I want to plan for a negative / anti-section consultant just in case. Any advice is greatly appreciated.

Thanks in advance.

I'm preparing for the same argument for diffent reasons, I had a section with my last because she was breech and really want the same this time round. I have had 1 appointment with a lovely doctor who basicly said its your choice, gave me some pro and con lists to read and said well go though them next time and I can make my final decision. I think it's just a case of being lucky with who you see. Midwives tend to look down there nose when you say you want an elective. One even had the cheek to tell me I was trying to take the easy option last time! I've decided to just not discuss it with anyone except for the doctor who will help me make the decision, I'm fed up of trying to justify myself to nurses/midwives who have no say in the final decision.
Last time round I did lots of research and made an informed choice that I thought was best for my situation and stuck to my guns. If your mind is made up don't be put off by them midwife telling you horror stories and risks, 1 in particular was very rude and determined with me .

Thank you for that. I'm seeing my midwife tomorrow and I wasn't sure whether to really go into detail with her seeing as she won't be involved in the decision. I'm preparing myself for a bit of a fight with the consultant but don't want to just melt into a teary mess like I seem to when I talk about it!!!

It's hard to know what to do but I've found that nurses/midwives just try to put you off and are quite stuck up and judgemental about it. I've actually stoped going to my midwife because she was very dismissive about everything I asked her and treated me like an idiot. So I'm only seeing the midwife at the consultants appointments and its never the same person twice so I just end up going over and over the same things every visit half the time they dont even read my notes properly. I haven't been particularly firm with what I want so far because I'm waiting for a scan next week to see if I have placenta previa and need a section anyway. But I'm planning on saying I've decided and that's it , I'm not disscusing it.

I don't think you should have a fight on your hands. Explain that you are not comfortable with the risk of natural birth with your condition, that you have considered it but you are not prepared to put yourself or your baby at that risk.

You'll also need to think through what the risks might be with a c section and show that you've understood them.

Good luck with it.

I've got a big folder full of all the research I've done so I'm going to take that with me to prove I've looked at all angles!!

I would hope you don't have to fight. If your epilepsy consultant feels a section is less risky then the obstetrician should respect that, not being an expert in epilepsy. If you do encounter resistance, can you get your epilepsy consultant to write a letter advising he/she is concerned about the effects of a vaginal birth? You may well find the consultant is a lot more reasonable and less dogmatic than the midwife in any case.

The research is a good idea, as it will show you're not naive about the risks and effects of ELCS, and have thought carefully about it. Don't worry too much if tears happen. If anything, it will show you're anxious about vaginal birth and that this is further grounds for ELCS.

Good luck!

Thank you - the problem is that I haven't seen the epilepsy consultant for a number of years due to it being under control. However I will make a point of explaining those comments to the person I see next week. I think the likelihood is that I will cry but like you say not necessarily a bad thing!!

I don't necessarily agree that crying and showing fear of childbirth is a good think. Although it would be ok to say that you want this agreed as soon as possible because emotional stress is a trigger for epilepsy.

I would just stick to the line that you don't accept the risks that come with you having a seizure in labour.

I agree that Flangipan should be able to have her concerns about her epilepsy taken seriously, without having to push the anxiety angle. It's just that she said she is getting teary when she talks about it already. I think this is perfectly understandable given what is at stake, i.e a possible relapse in her epilepsy after such a long period of it being under control. Those who don't suffer from chronic health problems are often unable to fully understand what they are like to live with, and the terror of facing a relapse. Her consultant may fall into that camp. Also, it may not be possible for her to speak about the subject without getting upset, and in my opinion she should not beat herself up if that happens.

Agree - OP don't beat yourself up if you do get upset.

Thank you so much for all your advice. I saw the midwife today and she was really positive and supportive, she said I came across as very level headed and is carefully weighed up the risks, she doesn't see me encountering a problem. I feel a lot more confident about next week now. I did find myself getting a little bit choked up but I was able to control it. She also said that baby is measuring quite big so that would be another plus in my favour xx

Well done , I hope it goes as smoothly for me on Monday

Yes good luck...let me know how you get on and I will post my experience after my appt too xx

I had my ELCS for different reasons to you, but I had no trouble getting it signed off. And I don't think having a few tears is a problem, giving birth and being pregnant are emotional things and emotional times. It's not like you're weighing up whether to invest in share x or y.

Hope it all goes well!

Hi everyone, I just wanted to pop back and update about what happened yesterday...it didn't go really to plan!!

So after a two and a half hour wait I was called in to see....not the consultant but the same doctor I saw at 12 weeks!!! So I was obviously quite annoyed that this wasn't going to be the meeting I had been anxiously preparing for. After having a feel of my bump and hearing the baby's heart beat on the doppler, she asked what I would like to discuss. So I went on to explain that I thought this was meant to be a meeting with my consultant because I would like to opt for an elective c section. To which she said she wasn't able to make a decision as mine was a maternal request not an obstetric reason. Which I didn't quite understand as obviously my medical history is a huge part of my issue with labour.

Anyway after explaining my reasons for a c section she said it would be my choice but I would still have to come back and see the consultant next week. My DH then stepped in and said that why have we waited all morning for an exact repeat of the meeting we had at 12 weeks? She then said that the consultant was on the labour ward and she would go up and have a chat with him...half an hour later she came back and said he is happy to authorise the section.

So even though the 'meeting' wasn't what I expected it did have the right outcome. I am so relieved as the thought of having to wait another week was very upsetting and stressful. So in the end I didn't even have to meet the consultant at all!!

Good luck to anyone else going through a similar experience.

xxx

I am so pleased that you got the outcome you wanted and well done to your DH for insisting that you got a decision today. That is brilliant news and must be a weight off your mind.

BTW I was maternal request when I had twins, one of whom was breech and with a 100 centile head. It's crap but it just means that it would be technically possible for you to give birth vaginally, rather than I guess transverse triplets.

Thank you xxx

I had a planned section but because I went into labour earlier than the booked date I was still in labour for nine hours before I had an emergency c section. So if you go into labour before the section date this will be something to consider. Booking a section doesn't mean you can avoid labour if baby comes earlier.

Thanks Heels, I did ask this question and at the first sign of anything I'm to go straight to the hospital and I will still have a c section but will be classed as emergency - hopefully if it does happen it'll be a lot quicker than 9 hours!!! Why did you have to wait so long?

I was classed as an emergency. Went straight to hospital. These things all take longer than you expect! I never expected to be in labour as c section booked. But with childbirth, expect the unexpected! I was having twins so high risk pg anyway. Waters broke at home before date of c section. Straight to hospital. Transferred in labour to another hospital. 9 hours after waters broke had c section.
Good luck!