Did anyone ask you why you were having an ELCS?

[DancingLady]

And if so, what did you tell them?

I am probably going to have an ELCS (on MH grounds).

I won't tell everyone I know, obviously, but family and in-laws will need to know (childcare for DC1 etc). I'm planning to tell anyone who is rude enough to ask asks that it's on health grounds, and leave it at that, as it's no one's business but mine and DH's.

Did you get people questioning your decision, and how did you respond? Any pointers gratefully received.

you get offered counselling

The problem with that is NOT that you get offered counselling, its the fact that the interpretation of the NICE guidelines is that you MUST HAVE counselling and women feel it is a hoop they have to jump through in order to get an ELCS even if their reasoning is purely by informed choice. The framing of counselling means that a lot of women, including those who would actually benefit from it, view it with suspicion and a way to 'brainwash' women and get them to change their minds by force with it wrong.

In truth, NICE's recommendation that all women who want an ELCS should get one stands. It should be without obstruction though, because the obstructions undermine confidence and trust. Often things that women who want an ELCS are short on and need measures to rebuild. And often confidence and trust in HCP is something that women who want an ELCS need MORE than counselling ironically.

I personally made this all very clear when going through the process and indicated that the process itself was part of my problem. Fortunately my consultant was someone with a special interest in the subject and respected everything. I was offered counselling with no strings but did refuse it. However I do think that a lot of women either feel they can't refuse it or are simply unable to refuse it because of protocol.

This is the thing. There is nothing wrong with offering counselling. I do think its actually good practice. The problem is actually the strings attached to counselling and the assumption that you MUST need counselling and you MUST have counselling in order to comply with procedure in order to have an ELCS. And the perceptions that these strings are then therefore creating.

I wasn't offered counselling, I think my consultant understood full well my reasons for an ELCS. I had been booked in for a VBAC appt (one of those standard things) and she offered to cancel it for me, since I wasn't goign to be a VBAC'er anyway and we had already talked through the risks/pros/cons etc.
So some consultants do get it. Getting to speak to your consultant, now that's another problem.

"The problem with that is NOT that you get offered counselling, its the fact that the interpretation of the NICE guidelines is that you MUST HAVE counselling and women feel it is a hoop they have to jump through in order to get an ELCS even if their reasoning is purely by informed choice. The framing of counselling means that a lot of women, including those who would actually benefit from it, view it with suspicion and a way to 'brainwash' women and get them to change their minds by force with it wrong. "

Absolutely right. I was told 'well the next step is you have counselling, and we have a 75% success rate!' It was only because I responded 'er, and what happens if I say no' (closely followed by 'and why is vaginal birth seen as a 'success' anyway, yadda yadda') that it became clear it was optional rather than compulsory.

As you say, it's the framing, which is disingenuous and proceeds from the same dubious ideological premises as the rest.

Your consultant sounds great, dildals. I was never 'allowed' to see one, only midwives, as there was nowt medically 'wrong' with me.

Anyway, all of this is germane to the point, which is that if you want to tell people you had a CS and that was a good result and you were happy with it, well, its difficult -- because the entire system conspires against women being able to feel like this.

Success is whether women feel satisfied with the care they have received and whether they feel like they were helped and respected with whatever issues they have.

You could therefore have counselling which should be about addressing your underlying issues and still have an ELCS and 'be a success' because the purpose of counselling is to address anxieties not to persuade you to comply with their preferred choice of birth plan.

Its quite troubling that doctors and midwives don't understand the purpose of counselling or worse still understand that, but put other priorities above those individual patients (who they have effectively sworn an oath to protect). It does highlight a massive conflict in interest with maternity.

The NHS only judges success based on physical outcomes. Targets have completely taken humanity out of the NHS. Hospitals are rated and in turn funded on the basis of this rating, with one of the criteria being CS rates.

So yes its ideological but its being driven by politics more than ideology as that traditional ideology has being challenged by the governing medical advisory body. The fact that NICE has made a clear definition but its been distorted at local level by decision makers who then in term put pressure of clinical staff is very clear as there were hospitals 'banning' ELCS on request before the guidelines were published to try and put women off them. Policies that were not drawn up by doctors but by managers.

So it is a success for the hospital if you have a successful vb (even if its with instruments) because they will end up with a better rating and better funding.

It needs doctors and midwives to blow the whistle on it all really as it is harming women.

I had emcs with dc1 and wanted elcs with dc2, which I felt was right due to wanting to avoid the mentally and physically agonising experience I had of attempted labour with dc1, the fact I'd had lots of previous surgery and this would be my last dc (infertility) as well as fear of damage from natural labour. The consultant was lovely and said I could have elcs, no questions asked and no counselling offered.

Various people have been very judgemental though, suggesting I'm a wimp for not trying natural labour again, wasting nhs resources by not having natural labour etc

Now I tell people the consultant recommended it, that stops their stupid comments.

Completely agree with RedToothBrush.

Yes, excellent post, Red.

Another poster agreeing with RedToothBrush. DC5's birth (attempted VBAC ending in EMCS) left me extremely traumatised. Different women have different ideas of what is a "successful" birth.

RedToothBrush - do you mind me asking if it was hard to get an ELCS based on your anxiety? I've been having counselling since October 2014 as I had to have my wisdom teeth out and am SO needlephobic and afraid of medical professionals (based on a very, very traumatic event when I was 4 years old) I couldn't cope - as it was, I had a full blown panic attack when they told me I couldn't be 'knocked out' before they put the cannuala in.

My partner and I are planning on trying for a baby next year and I've already had about 9-12 MONTHS of worrying about childbirth - I saw my sister give birth 2 years ago and it petrified me as she had a terrible time - massive blood loss, lots of tearing, 3 hours of stitches, double incontinence and she can't talk about the birth without crying - I was with her the whole way through and the thought of even the potential of having that happen to me is just too much to bear.

I've already started researching how to ensure I can have my wishes respected (and am not even planning on trying for another 6 months!) but I have to have as much control over things as possible, else I find it impossible to cope - the counselling is helping a lot, but the anxiety will never go.

I wouldn't care what was put on my forms 'Maternal request' , 'too posh to push' , even 'Wouldn't listen to reason'.. not bothered AT ALL, so long as I am able to have an ELCS - However I've heard that a lot of medical professionals aren't keen at all to do this?

apparently things have changed a lot in the past few years and now midwives/consultants are far more accepting of requests for ELCS. my midwife agreed to one immediately, based on anxiety relating to previous birth experience. you shouldn't be talked out of it or have your fears dismissed.

I really hope so. My sister asked for a birth debrief (Swindon hospital) 2 years ago and she went into a room with a Dr and a nurse - The Dr was really angry as to why my sister had asked for one and said 'For Gods sake, that's the problem with women nowadays, they don't realise, labour is HARD.... Yours was a perfect textbook birth, if gold stars were given out for births, you'd have one' (Yes, she really did say that)

My sister asked a few questions - It was known her daughter was HUGE, why wasn't a C section offered, why didn't they offer her more pain relief earlier when she asked, if she was to choose to have another child, could she have an ELCS?

The nurse apparently shook her head and said no, didn't she realise how risky C Sections are? My sister actually asked 'Are you referring to Emergency ones or elective ones?' and the nurse looked really taken aback and mumbled 'All of them' to which the Dr said 'No, we wouldn't want to offer you a C Section as it could be different next time around'.

.. My sister left in floods of tears, phoned me and I felt so guilty for suggesting she talk to them about it as the whole thing left her so, so upset.

I'd love to think things have moved on (and as I don't live in Swindon, I won't be going there) - I wasn't in the room when my sister was there so am not saying things verbatim, but she said that they were both really against offering or saying she could have a C-section for additional children and as such, she said she couldn't bear to take the chance so is sticking with one child.

Thankyou Dancing Lady (and apologise to the OP for de-railing slightly) It's nice to hear that you think I wouldn't have a massive fight to opt for one.

I always said that I was too posh to push

'Cos I is...well posh

They could never work out if I was joking of not and I didn't feel that it was anyone else's business

fluffy your poor sister, that's awful. It's not up to the dr to decide whether your sister is traumatised or not. If she found it traumatic then it was. Personally I found my almost elective EMCS traumatic and my crash section even more traumatic. Lots of people find VB traumatic and have great experiences of ELCS. It's very much an individual thing.

FluffyPersian, my advice would be to see if you can get referred to someone BEFORE trying to conceive.

I was very fortunate to have an understanding GP who was happy to refer me to anyone I thought could help. I managed to track down a consultant who had an interest in the subject in a nearby trust (not mine own) and my GP referred me to him. Its just under an hour from where we live.

Whilst unorthodox and usual I was not the first patient he had seen who wasn't yet pregnant. He agreed in principle that I could have an ELCS.

I believe this route isn't conventional, and isn't well supported but is possible. I think the trick is to find somewhere that is experienced with handling women with similar issues. Unfortunately maternal mental health services are crap to non-existant in the majority of places. This may illustrate the problem and help Campaign to improve services and map of level of services. Care is so patchy throughout the country its scandalous. Some places you will get help and support with relative ease, in others you'll come across HCP who frankly should be held to account for their damaging behaviour.

Given your situation, I don't think you have much to loose by exploring your options now especially if you feel the counselling is not helping. You may get nowhere, but that's no worse than where you currently are.

With regard to your sister. The doctor was completely unprofessional and ignorant of what birth trauma is. Being 'textbook' is completely irrelevant and the Birth Trauma Association - THE experts in the UK on the subject - categorically state this saying 'Birth trauma is in the eye of the beholder’. In other words, no doctor can tell you, you aren't traumatised because its how you perceive what happened not their interpretation that counts. Being treated without respect or with contempt could be traumatic to some women and actually in being dismissive of your sister the doctor has done exactly that, and is in fact potentially reinforcing her fears and damaging in its own right. A woman treated well but who has a physically more invasion or damaging birth can fair better than one who has been treated badly in terms of trauma for that reason. The BTA have a good description of what birth trauma is, if your sister is interested.

She has good grounds to complain.

I don't know if your sister will ever feel able to revisit this. I do think it important that she knows that the treatment she has had is not universal throughout the UK. She's been exceptionally unlucky. There are alternatives out there who do sympathise and support her. Its a question of finding them. (which can be easier said than done). Its also important that she understands that text book births CAN be traumatic, she did not waste anyone's time (as I say she in fact does have grounds to complain as I think its not only disrespectful but the doctor was negligent). There is hope if she can find the courage.

I was treated wonderfully by some amazing people. I didn't have a problem getting the help I needed but I did do a lot of research to find where locally was best option for several years before to try and avoid hostile and obstructive HCPs. I think that if I had just gone to my local trust my experience would have been very different. It shouldn't be like this but I do feel that a little knowledge helps navigate the system better on this issue.

That said I do feel its easier than it was even a couple of years ago but there is a lot of ignorance and politics going on, which you may have to find your way through.

Good luck.

RTB - Thank you so much for that thoughtful post. I've copied this entire thread into a text file to read again in a few months when we've moved house and my new job is more secure.

If I can have an agreement in principal before even starting to conceive, I'd be so much happier as I could plan / control more and also would know exactly (or as much as possible) what would happen to me from a medical perspective. I agree with you RE my sister, however she has told me she doesn't want to pursue / talk about it again and whilst I also think she should complain, I need to respect her wishes... she's bottling it up inside and that's her choice, even if I don't agree with it.

I definitely do research before anything - I did research for months before my minor op in January so it's nice to hear you did the same and it worked for you.

Thanks again