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 just kind of told them what I wanted. I think as long as you're calm and rational in presenting your reasons why, you should have less of a fight about it. Like some PPs, my midwife was a bit 'ooh well we really push for VBAC here, you'll need to see the consultant to discuss that' (DD1 was EMCS). I just said okay, saw the consultant (who actually agreed with my reasoning) and that was that. Good luck, stick to your guns and don't be intimidated if you encounter some resistance. Remember if one consultant refuses to do it, you can always ask to be referred to a different consultant.

I had a 4th degree tear after an induced forceps delivery almost 5 years ago with dd. I was very lucky that I remaind in control of my bladder and bowel but ended up with pnd due to the birth and after effects. Was very sore dtd so much so that we ruled out having any more kids
Until last year so took 4 or 5 months to conceive.
At booking appointment midwife went over everything from previous and said
Right then we having a section this time ?
I thought I'd have to fight tooth and nail but my consultant agrees there's less risk to me, my baby and my mental health with a section so I'm booked in for aug 24

Keep calm explain your reasoning and stick to ur guns

Sadly I found it does totally depend on the attitude of your nhs trust. If you live in an anti-elcs area as I did,be prepared to fight as they can be pro 'natural' birth at seemingly any cost.

Get in touch with your hospital's Supervisor of Midwives. She can kick serious arse on your behalf and as I understand it is equal to a consultant in the hierachy so will be listened to. Mine accompanied me to consultants meetings and put my case forwards as I was always a sobbing wreck by then. She got my elcs agreed for me in a trust with one of the lowest levels of elcs in the country.

Good luck,you have a right to request one and with the right support on board you can get one.

I told the MW my birth story (similar to you, vvv late, long induced labour, big baby, shoulder dystocia, PPH, blood transfusions), and by the end was hysterically laughing and said something like "so I won't be doing that ever again". She said - yes - second babies are often bigger so I don't think the consultant will have a problem with ELCS.

Saw the consultant - told her the same story, she said well I do need to tell you the options, early inductino... to which I said no way. She said - I jsut need to mention it. We'll book you in for 39 weeks ELCS. No other worries.

:)

The 3rd degree tear was horrific for a while, I had to book it to the loo when the need hit, like oldblood above. It has left sex painful as well at times, but it's more the fear of it tearing again.

It's nice to hear so many stories of women actually being listened to!

My hospital is princess royal university hospital in bromley, btw. Anyone with experience there specifically? Bit of a big ask ????

I had an emergency CS with DD1, when I got pregnant with DD2 - I kept having bleeds, she was fine it was obviously my body. I was given the option of a VBAC (I was 42) but decided on an elective CS. Rose in Cambridge, they agreed because of my age and problem pregnancy. Good luck - a third degree tear should surely be a very good reason indeed!

Sorry to hear you had such a traumatic time first time round.
As others have said, how easily you will get a section depends on your Trust. I requested an elective with first child due to a scoliosis in my lumbar spine - obstetrician (Kings, London) tried to scare/bully me into a natural birth (risk of perforating bowel, bladder, hysterectomy etc).
Eventually I got the orthopaedic surgeon whose books I was on (different hospital) to write a letter of support - he said Kings were notorious for being 'right on' about natural birth. I was also supported by my amazing obstetric physio, who opted for an elective with her baby because 'I spend 90% of my time repairing the damage done by natural birth'.
I'm just about to have baby no.2 and obstetrician tried to scare/bully me into a VBAC (success rate nationwide is only 33%!!) I was polite but firm and said I had no interest in attempting it - they booked me in without any fuss.

So - here's what you need to do:

read the NICE guidelines and go armed with them. Here's the link:
www.nice.org.uk/guidance/cg132/chapter/1-recommendations
the bit you need states that even after the woman has been told of the risks of a CS, if they still want one, they should be granted it:
'1.2.9.5 For women requesting a CS, if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned CS. [new 2011]'
just remain polite and firm at every appointment (midwife, obstetrician etc) and say 'I want an elective and I am not prepared to consider another natural delivery'. If they get arsey, then hit them with the NICE guidelines - they can't refuse.
remember that while there are risks inherent in a CS, they are vastly smaller (1 in 500 or greater) than the risk of a 3rd/4th degree tear and/or an episiotomy with a natural birth, which happens - as far as I can make out - to just about every woman who gives birth naturally, bar the what? 1 in 20? 1 in 30? who pop the baby out after 8 hours in the birthing pool on half a paracetamol with two stitches.

I hope this gives you some reassurance. All the best.

Athousandtrees: 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.

Sorry to hijack the thread a little bit, but my understanding of the situation in NI is a bit more complex. There is more political hostility towards ELCS than in England and Wales unfortunately with the previous NI health minister the 'delightful' Edwin Poots coming out in opposition to the NICE guidelines when they were published in 2011. And it does not appear to be the only politician openly and clearly stating their opinion on the subject in NI.

However the DHSSPS did endorse the NICE guidance in November 2012. A
brief explanation of this can be found here. This isn't to say you won't face opposition or even be told that NICE guidelines don't apply in NI (which isn't true as they have been endorsed - the problem is that hospitals are as free as English and Wales ones to simply ignore the guidance if they so choose).

The issue you will probably face is more about whether the HCPs you come across are sympathetic and supportive, and unfortunately it does seem that NI is still a few years behind England and Wales in its opinions on the subject (and there is still a lot to be desired in vast corners of England and Wales) But in theory the protocol in NI SHOULD be the same as the other side of the Irish Sea.

Hedgehopper, I didn't know Kings had that reputation, the PRUH, is in Kings College Hospital NHS Trust!

I'll do a bit of reading of the NICE stuff, and write out what I want to say before hand. You guys are really helpful

I paid for mine....

I had an emergency section following 4 days of heavy contractions (failure to progress) with DS, I also have a chronic medical condition.
With my last pregnancy (unfortunately ended in miscarriage) at my first appointment with my consultant I was all ready to ask for a planned section but the consultant beat me to it and said "I hope that a section will be all right", she was worried I'd want a natural birth which she didn't recommend.

I had an EMCS last time, not an especially traumatic one, but the reasons behind it were enough to make me not want to attempt a natural birth. This time, at my booking in appointment, the midwife mentioned the previous EMCS, I said that I'd thought about it a lot over the last few years, and had decided that I would want an ELCS. She said that at that hospital, the consultants tend to go along with what women want, particularly if a previous birth has been difficult, and that they'd arrange for me to see a consultant at 30+ weeks. I think it's luck and which hospital you're signed up with does make a big difference. Good luck.

Redtowel - if you don't mind me asking, how much did it cost (assuming you weren't at the Lindo Wing?) One of my colleagues is considering going down this route.

I had one after two assisted vaginal births, which didn't themselves cause major damage. However, I needed surgery between 2nd and 3rd pregnancies which meant I was reluctant to push out another beast. Consultant agreed very reluctantly that if I went a week over, I could have one.

Baby duly went overdue, I did get a c-section. I can't say it was preferable to a vaginal delivery, and I would have loved another vaginal delivery, but the risks of the c-section were better than having a massive tear.

My nearest hospital (where I ended up having the c-section) does not do so-called elective c-sections, but another big hospital that's not too far away does and I could have requested to be referred there. So if you have an issue, try another hospital, assuming it's not really far away.

I had an ELCs with DD1 due to her being breech.

Second time around, I was open to VBAC but my blood pressure was climbing in the last few weeks and they started saying if I went into labour I would be closely monitored because of the BP, have a trace on at all times, not be able to move around freely, so that wasn't great.

The by 39 weeks I showed no sign of early labour and they talked me through the process of induction as a post-CS mother - much slower than for mothers who hadn't had a CS before, lots of hanging around and being sent back home if things didn't progress. This just wasn't practical when we had a DC at home already, and PILs on call to look after her, to have us bouncing in and out of hospital for several days waiting for labour to start. And of course more chance of further interventions and an EMCs after starting an induction.

So as my blood pressure climbed , they asked if I wanted to be booked in for a CS just before 40 wks. I was glad to say yes!

First child, NHS, no particular medical history. Just asked the surgeon if we could have an elective C Section and listened to his talk about dangers, etc but then reconfirmed we wanted one and he said no problem. Easy to organise and even easier at the time. Went into hospital on Friday at 9am, into surgery at 9am, DD born at 9.10am and out on Monday morning. Careful not to drive etc for a while but was back riding horse within 2 months. I think the fact that we know friends who had had them done at same hospital meant it would be hard to refuse us.

I was all geared up for a battle when I had DS2 (had EMCS previously). However the conversation went:

Consultant: Have you thought about delivery options?
Me: I really would like to have another section... (steels self for discussion of why)
Consultant: Well, I think that's a perfectly reasonable decision. Let me see when's free...

And that was it! I was fully prepared to explain how I was aware of all the risks, but I was also aware of the risks of a trial of labour, and the likelihood it would end in a repeat section, and how my mental health would be affected just by worrying about it all let alone going through it. But in the end that was totally unnecessary.

Good job too, as I was told afterwards that my uterine scar was on the verge of rupturing as it was so thin, and I shouldn't ever have a VBAC in future.

3rd degree tear with ds1 (9lb 3) . When I was being sutured the consultant said I might want to consider ELCS if I had another baby. I decided that I didn't. That was a mistake. Dd 9lb 15 back to back cord, around neck . Mismanaged episiotomy and arrogant consultant and his evil secretary and failure to follow guidelines etc. I had counselling. And changed hospitals
Ds2 Booked for ELCS. I Knew that I would be able to have ELCS but it has to be a consultant that signs it off. I was told that I would see a consultant at 20 weeks after my scan. Consultant wasn't in that day and the registrar was lovely but told me that she wasn't allowed to sign me for ELCS as it had to be a consultant. So I then had to have another appointment to see a consultant a week later. Quickest appointment ever. Authorised ELCS .
Then my waters broke a few days before I was booked. I was asked if I wanted to try for a natural delivery when I arrived at the hospital, the look of panic on my face and a quick read of my notes and I had an EMCS. He was 9lb 15 as well. You should get ELCS no problem. Don't make the mistake that I did though. It was a different hospital and due to child care etc my husband didn't come for the tour and we were sorting out child care when I went to hospital after my waters broke and he followed after. 5 in the morning and he couldn't find anyone to ask where the delivery suite was as it was in a different building to the antenatal unit. He did make it in time for the EMCS but only just!

I'm generally of the opinion that most people who ask for an elcs cannot really be aware of all the risks and think they are given way too freely however in your situation I think I'd ask for one too! I can't imagine you'd have any trouble getting one. Good Luck

I think every woman should have the right to choose. ELCS is major surgery and I am sure no woman would choose it without good reason.

I had 2 natural births but had a 3rd degree tear with the 2nd. A lovely midwife told me she had been left incontinent after a bad tear and if I had another child she would advise a section.

Anyway it turned out after a terrible 3rd pregnancy I needed an emergency section so the decision was out of my hands. For children 4 and 5 I requested a section and it was not a problem. Now booked in for 4th section for DC6!

Good luck OP x

I don't think they are given freely at my trust!
Last pregnancy ended up as a premature emcs, I had PTSD afterwards. This pregnancy I've read on websites such as RCOG that my small age gap and previous premature section not long ago makes rupture more likely and VBAC less likely to succeed. I have about a 60% chance of it working out, so 40% chance of another emcs which I do not want for my mental health. Never having had a labour before also lowers my success rate for VBAC.
So far I've had all the usual appointments, plus VBAC course, consultant midwife, supervisor midwife, and I've got a series of psychologist appointments and then the consultant right at the end, pretty much at the same gestation as I delivered DS. All of the appointments so far have been pushing VBAC hard - the 'birth choices' (more like birth no-choice) appointment was nearly 2 hours of pressuring but luckily I was prepared with studies and RCOG's recommendations on VBAC / ELCS.

It seems to vary massively between trusts though.

If anyone wants ELCS (or any other birth choice e.g.VBAC) I'd advise doing your research, take a look at RCOG and NICE websites, highlight the relevant studies and guidelines and bring it with you. I'm still going through the process but have got through quite a few difficult hoops so far to see the consultant. If I'd been unprepared I don't think I'd have got that appointment.

The NICE guidelines recommend a C section for births following a 3rd degree tear if there are any symptoms remaining. There is a list of symptoms given, which it sounds like you may have. I had no problem at all requesting a subsequent section. Be calm and clear and adamant of what you want!

I think every woman should have the right to choose.

I think that the risks of ELCS are over-emphasised and over-publicised; the risks of VB to mother and baby are under-emphasied, under-explained and under-published.

See for example this NHS advice forceps

"With a contraction and your pushing, an obstetrician gently pulls to help deliver your baby."

...I'd like to know what % of women have that experience! GENTLY!!! The consultant had his foot up against the table and pulled with all his might. It was the antithesis of gentle and that was clear from the damage to my body and my baby's face.

The statistics in that link also state that if you have forceps you have:
12% chance of 3rd-4th degree tear
30% chance of urinary incontinence
25% chance of anal (faecal) incontinence

At least it’s being publicised now. That info was not widely available (and certainly not offered) when I gave birth in 2009.

Unfortunately at the point at which you are being advised that forceps are needed your other birthing options (and your ability to make any choices) are greatly reduced.