Your experience asking for planned section?

[eaiand2]

DH and I are just starting to think about TTC again after having our DD just about 15 months ago. My main worry is about delivery..

I had a spontaneous labour and vaginal delivery first time around, but DD was large (9lb8), had a third degree tear, then uterine atony resulting in 3 LITRES (well, 2.8l, but near enough to) of blood loss. It was an emergency situation immediately after she was born and it was very frightening. My husband thought I was dying. They patched me up, I had several transfusions over a few days and then when I finally did get to go home I was on 'bed rest' for a couple weeks and took iron supplements for 8 weeks.

When I met with the obstetrician at 6 weeks post birth for my check she told me that blood loss like I had is one of those things that can just happen and risk factors include large baby and long labour, but it could just be random, and when I asked if it could happen again she told me it's more likely now that I've already had a big PPH.

Sorry, essay! Anyways, because of the horrendous time I had the last time around and that I'm likely to have another big baby and subsequent bleed, I'd like to ask for a section next time. That way if my uterus doesn't contract I'll already be in theatre with doctors here working on me and I wouldn't face the same stressful situation I had before. Has anyone else felt the same and successfully requested a section? Blood loss aside, a 3rd degree tear is not something I ever want to experience again

I asked for one. First baby, no previous pregnancies, but the idea of a vaginal birth terrifies me.

I had no trouble at all, no one argued with me and my section is agreed. I was expecting a battle on my hands but no, everyone was fine.

I just remember my notes last time around had written in big bold letters something along the lines of THIS TRUST WILL NOT PERFORM AN ELECTIVE CAESARIAN SECTION FOR NON MEDICAL REASONS.

Mental health IS a medical reason, tell them how anxious the thought of a natural birth makes you. In my experience I was having panic attacks and nightmares about it. They were very understanding. You should get your section

THIS TRUST WILL NOT PERFORM AN ELECTIVE CAESARIAN SECTION FOR NON MEDICAL REASONS

I'm really shocked by the bullying tactics some Trusts/consultants use on frightened and vulnerable pregnant women. It's abhorrent. Anyone would think that vaginal births are totally risk free, which, as you know, isn't the case.

I asked for an ELCS with baby #2 because I'd had a third degree tear and was terrified of it happening again. I also had a lot of concerns about another vaginal birth weakening my already damaged pelvic floor.

I was very firm and unapologetic when I saw the consultant. He totally dismissed all my concerns about my pelvic floor and tearing again, but agreed on mental health grounds. I couldn't have cared less about what was written on my notes, so I was fine with that.

He tried to talk me out of it at 36 weeks, listing all the potential risks and complications, but I just nodded and signed the consent forms Everything went without a hitch and I don't regret it one bit. It was so great not having to spend the pregnancy scared of the birth

I remember reading that and thinking 'well, I wasn't planning on it, but you'd better damn well give me an epidural when I ask for one!'

I hadn't realised mental health could be medical grounds. I assumed they would just send me to talk to someone about my anxiety and still make me have a vaginal birth.

We haven't even started ttc yet because I'm so anxious about it!

It is although some people are not very good about it, so you have to make sure you don't get bullied into something you don't want. They probably will send you to counselling, I have to but I was told it's a requirement and if I still want a section it's fine. They shouldn't bully you into a vaginal birth

Also remember to research the risks of vaginal birth and if anyone tries to talk you out of your choice, explain calmly you're trying to avoid x,y and z

Thank you!

I am having emcs on Wednesday after traumatic emcs. Not too difficult actually to persuade them. Both the senior midwife and cons listened to me and we're great. They explained risks and benefits of both options and then after I said that a 30 per cent chance of emcs was too high a risk for.me they agreed that elcs was the right choice for me and DH and booked me in for 39+0

If you keep bombarding them with paperwork, i.e. your reasons, your request, what you are worried about etc, sent recorded delivery, they cannot easily refuse.

The evidence of the strength of your feeling is not something they will want to justify ignoring in a courtroom.

The physiology of birth requires the mother to be calm and working with her body for an optimal outcome. A woman scared half to death, and angry, with adrenaline flowing through her body is not conducive for this.
One can argue that a frightened woman flooding her womb with adrenaline in the lead up to the birth is also not good for her baby, so you would like the agreement in writing asap so that you can concentrate on your and the baby's health.

Having said ALL of that, do you have any idea what actually caused the PPH. I had a PPH and a traumatic birth and blamed the hospital staff for a mismanaged birth, insisting next time on a homebirth against their advice (history of PPH iyswim).

My personal experience is that I asked for one, was refused a big healthy girl (I was 43) like you doesn't need a CS and ended up with an ELCS - I was delighted, but it must have cost the NHS £100s more than a planned CS.

It depends on your trust. I'm me has the big bold letters thing as well and are currently putting up barriers to an ELCS. I had an emcs last time but they are pushing VBAC.
So far I've had to go on a VBAC course and see a birth choices midwife. I've now got to see a psychologist and won't see the consultant until 34 weeks. If they say no I don't know what I'll do.
Saying this I've had friends have theirs signed off very easily with no bother at other hospitals

Starlight, I asked about the cause of the PPH when I met with the OB at the hospital for the follow up 6 weeks later to check healing of the 3rd degree tear. She looked at me and asked if I dyed my hair, I said no, so her response was 'redheads are bleeders.' I was incredulous, I'd never heard that before, and actually looked it up when I got home and it appears to be a myth, so I'm a bit bemused that she said it.

Otherwise she said it was just caused by an atonic uterus. No retained placenta, it wasn't from the tear, it was just because my uterus would not contract, even after double the syntocinon shots and I ended up on the drip, but by the time it started to work I'd already lost enough blood to land me in the high dependency unit for a few days having a couple transfusions (they didn't give enough blood the first time). I looked up uterine atony and two risks are long labour and big baby, both of which I had- 20 hours in latent labour (wtf it still HURT!), 10 hours in active labour, then 2-1\2 hours pushing and a 9lb8 baby!

Starlight, I asked the OB when I had my 6 week check and she told me redheads just bleed, which I'd never heard before and having since looked it up online it appears to be a load of woo. She said the PPH was caused purely by my atonic uterus. Uterine atony is usually down to long labour and big baby (20 hours latent, 10 hours active, followed by 2-1/2 hours pushing my behemoth 9lb8 DD out). Obviously second labours tend to be shorter, but there's no guarantee, and babies tend to get bigger if anything, so I expect any other children I have will be huge, too.

I don't blame the hospital at all, they were all wonderful, my birth plan was followed, my wishes were respected, they didn't do anything that might have caused my PPH (no mismanagement of third phase, for example), I really do believe it was just one of those unexpected things that happens.

Abbey, that's exactly the kind of thing I'm fearing.

I might make an appointment to go over my last birth with the head of midwives at the hospital and bring it up then to test the waters...

Sorry for the double post, I thought mn had eaten the first one!!

My dc1 birth sounds exactly the same as yours, including the few nights on HDU but I had a terribly mismanaged labour. I knew for dc2 that I wanted an elective c-section. Read and printed out all the info from the royal college and NICE and generally worked myself into a state. after all that, the consultant asked my previous birth history and basically suggested that I have a c-section. In fact his words were "of course if you really want a vb we will support you but a c-section may be better".

I'm always shocked reading on here how obstructive medical staff are. It must really depend on your area (my midwives too were great about my choice). Whereabouts do you live?

i saw the consultant in a flat panic. The baby was on course to be 11 lbs and my maternal grandmother had died in childbirth. Also my mother had nearly died. So, I felt the odds were stacked against me.

The consultant took a look at me and decided the same and offered me a ELCS.

Having the choice made me calm down. Then I made the mistake of listening to the NCT and trying for a vaginal birth. however, after 36 hours of full-on labour, it was obvious that there was no way that DS was going to come out intact unless he was cut out. So I ended up with an emergency caesarian.

So, that's how to do it. Make the consultant believe that you cannot mentally cope with a normal birth and have a big baby for good measure.

I suggest you see your GP and ask to be referred to your consultant for a gynae appointment to discuss future births due to your anxiety about this. Hopefully you can then get written reassurance that you will be having an ELCS for all future deliveries. You have several reasons to make this a valid request.

IME as a midwife you wouldn't need to be too pushy to be accepted but others above seem to have had unfortunate experiences. It is often first timers who ask for ELCS that get a hard time but in your case there is plenty of medical evidence to support your choice.

Be pleasant and firm that until you have this assurance you cannot contemplate another pregnancy. Mentioning stress incontinence won't hurt either.

Lots of good reasons for wanting c-sections on this thread, and I'm not judging, but just wanted to introduce a note of caution for anyone who is not planning for this to be their last pregnancy and something to consider when weighing up the pros and cons:

I was left infertile by a c-section in my first pregnancy. I was not told that there was a risk of this when I gave my consent - which was given reluctantly in any event. I was left with adhesions in my fallopian tubes, one of which was twisted right around my uterus, pulling it out of alignment. Nobody flagged this as a risk and it wasn't diagnosed (and subsequently fixed) until 5 years later, by which time I was too old to conceive naturally.

I'm so glad you posted this eaiand2
I had a traumatic first birth with DS1 and am petrified of getting pregnant again, but I really want another baby.

I'm in Northern Ireland and am unsure of the protocol in relation to planned CS. I was gonna make an appointment with my gp to discuss before TTC but am not sure how sympathetic he'd be.

I had my Lo nearly 4 years ago and was truly terrified at the thought of giving birth so asked for ELCS. My GP agreed that it would be best for me too, but the consultants at the hospital said no and sent me for counselling which was awful. (I was only about 20 weeks at this point)

Then a few days later NICE had new guidelines published saying that if you ask for a ELCS and have good grounds for one then they have to seriously consider your request and have good reasoning for not performing it, my GP sent a letter to my consultant telling him this. All of a sudden my consultant said it was fine and I was booked in! thank you NICE and thank you to my gp.

As it happens my LO was footling breech so it was non negotiable for an ELCS. I still remember when the consultant came round the next day and said to me "just because you have had a section, don't think you will get one next time" I did have pleasure in telling him to do one.

Good luck, I do think with the NICE guidelines and getting your GP on board you will be fine.

I had an EMCS with my first child after 36 hours of labour and foetal distress. At my 6 week check, my consultant told me it was extremely unlikely I would be able to give birth naturally and that I should elect for a section if I had any other children. Cue pregnancy 2. The district midwife (who was very good in all other respects) refused to note the request down. When I got my hospital appointment, I saw the registrar who also refused to book me in and just quoted that VBAC statistics were good. I, however, had read the NICE guidelines from cover to cover and they stated that, having had a previous CS I was entitled to an ELCS. I finally saw my actual consultant 6 weeks before my due date. He was the only member of the medical team to look at my previous notes and his response to his registrars note about VBAC was "Well, I think that's overly optimistic. When would you like to come in?". I think the default position is to refuse and discourage but if you stand firm and state your reasons they will do as you ask.

My first delivery was forceps, thanks to DS being just under 11lb. I suffered a third degree tear and was almost rectally incontinent (very little warning, maybe about 20 seconds before I needed to go. How I escaped having an accident, I don't know) for a good few months after. I also suffered from granulated scar tissue and ended up needing everything to be completely refashioned after trying silver nitrate treatment and dilators, which didn't help.

I'm expecting DS2 in October and was all geared up for a fight. I armed myself with the NICE guidelines before I saw my consultant. In the end it went something like this:

Consultant: 'I've seen your medical history, have you thought about how you'd like to give birth?'
Me: 'I want a c-section please.'
Consultant: 'No problem, I can arrange that for you.'

All I'd heard was how hard women find it when they want an ELCS. I was flabbergasted!

Has the 3rd degree tear left any lasting issues? I had a 3rd degree which went from the edge (don't want to get too graphic) in very deep and required 50 stitches and reconstructive surgery on my vagina, no blood transfusion. My consultant stated the tear may well come open if I had a vaginal delivery and the risk was too great and therefore strongly advised an elective section, which I had. Then 8 years later I had another baby, they suggested a vaginal delivery but my dh said he refused as the previous birth had been so traumatic and they agreed. I did go into labour and they asked again if I wanted to try a vaginal delivery as we the baby would be small (prem labour) but my dh said no we have agreed a section (so, so glad he was there as they may have talked me into it). If your consultant says no for the reasons you have highlighted ask for a second opinion.