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

Another one here with the hideous 3rd degree tear after episiotomy, failed ventouse then Kielland forceps delivery. 9lbs 13.5oz baby delivered safely albeit battered and bruised and missing sections of scalp - Theatre for repair under GA for me.
Next baby - I saw consultant and asked for a ELCS, wish granted! 3rd baby - asked for ELCS, wish granted again! No messing. Be firm. It is your body and you who will be dealing with the after-effects or whichever way you choose to give birth. Make sure you get what you want!

I had an EMCS with DD, then was pregnant again 4.5 months' later. I had to go to VBAC clinic before I saw the consultant, but both the VBAC midwifecand consultant were happy for me to have an ELCS due to the small gap between babies and risk of rupture with a VBAC. (A VBAC would've been heavily monitored which my labour was with DD and I didn't want another labour like that.)

As it was, DS was an unstable oblique lie and wouldn't have exited vaginally anyway, so I was destined for an ELCS it seems (it just happened at 38 instead of 39 weeks as they deemed it safer against the risk of waters going / cord compression).

I had a third degree tear and forceps birth with DS. I think I was in theatre being stitched for about 40 minutes.

The next day the doctor came and saw me and he said I should never give birth naturally again because of the tear. I'm surprised ypu were not told something similar. When I had my check up at 8 months (which was longer than it should have been, I think they forgot me) they said I healed better than they thought and next time I would have the choice but if I did choose natural and the same thing happened again, the damage would be far worse. I did ha en the urgency thing which took a couple of years to sort itself but it's still not the same and I don't have huge amount of time before I need to go. I also suffer (sorry tmi) with fissures quite often so bleed from the back. They heal themselves so I just leave them.

I actually wanted a natural birth again , but DD had other ideas and was breech. I even had an ECV but she wouldn't turn so I had a section as there was no way I wanted a natural breech birth after the tear. I'm glad she was breech because I wouldn't have chosen the section, which after my first birth, was great!

Push for it. There is no way you should be forced to have a natural birth after that sort of damage. As I was told the damage would be greater should it happen again, I can't see why it would be different in your case so you should be able to ask for one on medical grounds even without saying about mental health.

I had one on maternal health grounds. I had an operation for malignant melanoma then a HSG 2 weeks later which went horrifically wrong. I then unexpectantly fell pregnant naturally.

My consultant believed this gave me PTSD. Basically I had been through enough shit & felt ELCS was the safest route for he both physically & mentally.

My female consultant was fine about it, pity about the 2 male registers I seen....

I don't regret it. Although as another poster has mentioned, it can cause infertility so I'm yet to see if that's the case.

I'm in NI.

I had a few months of 'urge' issues with #2s after having my son by forceps. Very long and augmented labour too. I'm keen on an elective section if I ever have another baby.(We've already have fertility issues and miscarriages so the infertility risk with a c-section goes over my head a bit.)

Urge issues needed many women's health physio appts to sort too!

Yes, eaiand2 I had 2 ELCS at the PRUH no bother. The 2nd one was after Kings took it over.

DC1 had to be delivered early and I refused consent for induction so got an ELCS. With DC2, the hospital's presumption was very much that I would have an ELCS. I saw a VBAC midwife who gave objective information and didn't try to push me one way or the other. I didn't have any trouble getting the delivery I wanted.

The consultant you want to speak to is Mr Steer.

DD was born by ELCS due to pre-eclampsia. The hospital felt my blood pressure was already too high to risk inducing me (so they said).

DS was later born by VBAC, which went well.

Crapbag, tbh I never discussed possible future births with anyone and no one I'd spoken to brought it up either, I'm just making the assumption that they will push for a vaginal birth next time.

Thanks, underthefloorboards!

This is the thread I started where others also share their experiences

www.mumsnet.com/Talk/childbirth/2336662-Stressful-process-to-have-ELCS-after-EMCS

I did eventually have one but only after jumping through more hoops than I ever imagined. I had one for 'non medical' reasons and it was a battle but if you quote the first NICE guideline at every appointment someone eventually has to listen!

I had a 4th degree tear with DS. 20 months later I was offered a c-section for DD. they didn't recommend a second natural birth.

This was 9 years ago but I had EMCS with Ds1, when I was pregnant with Ds2 I told the midwife at my booking in appointment I wanted a ELCS.

I had read everything I could on both VBAC and ELCS and I was decided.

I saw the consultant after my 20 week scan. She didn't just accept it, she told me of the risks of the surgery such as bladder problems etc. I told her I had done all my research and that surely this time round it would be a more calm and slower compared to them jogging me down to theatre and whipping Ds1 out.

I told her that I had no support network locally so if I went into labour spontaneously I wouldn't have any childcare for Ds1 and I didn't want to labour alone. I wanted Dh with me and for that to happen I had to have my Mum available which meant my sister had to juggle childcare because my Mum looked after her children. Plus they live some distance away. It was agreed there and then.

You have to show that you are informed and decided. Good luck.

Dancing, I'm glad it all turned out well for you in the end [:)]

I asked for one because one of my twins had a rare condition which lead to heart strain whilst in the womb and he was twin 2 so would have endured 2 labours, my obs agreed as did the Head of Obs and gynae but i went into spontaneous labour before my date and my obs was on holiday. The attending registrar, without even reading my notes suggested we could have a go at vaginal delivery - no way was i trusting the opinion of someone who knew nothing of me but seemed to quite fancy having a go at a twin delivery.
Cs did not go well, anaestetic didnt take, i was in agony and they didnt believe me - anaethetist did not want to give me a GA but after 20mins of me being in distress, he eventually gave in. My uterus contracted afterwards but in recovery just before i was about to be sent up to post natal i started to bleed - massively. They had to operate to save my womb - dh thought i was dying - not helped by the nurse who was in pieces after seeing what had happened. 9 pints of blood were needed to bring me back.
I'd still choose a cs again for the sake of ds but it wasn't a walk in the park.

I had an ELCS after an EMCS, and had to jump through hoops to get one, but did in the end. The toughest appt was with the consultant midwife, she tried to bully me into going for a VBAC. The consultant was fine with it. The argument I used in the end is that they would be going against my wishes if they refused to do a c-section, and I would hold them to account for any consequences to mine or my DDs health. They stopped arguing after that... Yes to taking the NICE report (full version) along, which has the statistics, to show that you are aware of the risks.

I've had 2, both on my Consultant's orders.

1st due to a standing breech.
Hosp had recently tried to turn (ECV) a similar baby and baby died so they were not messing with me (they didn't want to, and nor did I).
Child was born with cord round twice and blue after heart rate dips so I am glad they didn't make me have a 'trial of labour'.

2nd time I was very keen for VBAC but I had a transverse presentation and again the Consultant was not for taking any risks.

I would think you were well within reason to ask for one due to very realistic fear of huge blood loss / medical trauma etc again.

Take the NICE report along, stand your ground.
Only mention 'mental health' if you feel you have to.

I would concentrate on the physical issues with your last birth and comment on 'how expensive it can be when things go wrong'.

Good luck with it.x

BTW the guidance on maternal request is the one that everyone seems to know. However if you've previously had a CS then its worth knowing the following also applies:

1.8 Pregnancy and childbirth after CS
1.8.1 When advising about the mode of birth after a previous CS consider:
• maternal preferences and priorities
• the risks and benefits of repeat CS
• the risks and benefits of planned vaginal birth after CS, including the risk of unplanned CS.
1.8.2 Inform women who have had up to and including four CS that the risk of fever, bladder injuries and surgical injuries does not vary with planned mode of birth and that the risk of uterine rupture, although higher for planned vaginal birth, is rare.
1.8.3 Offer women planning a vaginal birth who have had a previous CS:
• electronic fetal monitoring during labour
• care during labour in a unit where there is immediate access to CS and on-site blood transfusion services.
1.8.4 During induction of labour, women who have had a previous CS should be monitored closely, with access to electronic fetal monitoring and with immediate access to CS, because they are at increased risk of uterine rupture.
1.8.5 Pregnant women with both previous CS and a previous vaginal birth should be informed that they have an increased likelihood of achieving a vaginal birth than women who have had a previous CS but no previous vaginal birth.

My point being that the very first point above is that the wishes of the women should be taken into account.

There is also a very large intro to the guidance that talks about woman centred care. Its another useful bit to throw at someone if you start to feel like you are being process rather than treated as a individual.

www.nice.org.uk/guidance/cg132/chapter/1-Guidance

Also if you have suffered from some sort of anxiety, trauma or have mental health concerns at all relating to childbirth or pregnancy this is covered by another set of guidelines: Antenatal and postnatal mental health: clinical management and service guidance.

These are useful to know as they include a new section about seeking help before getting pregnant. Whilst mainly aimed at those who have problems not relating to pregnancy they can be applied.

Considerations for women of childbearing potential
• Discuss with all women of childbearing potential who have a new, existing or past mental health problem:
? the use of contraception and any plans for a pregnancy
? how pregnancy and childbirth might affect a mental health problem, including the risk of relapse
? how a mental health problem and its treatment might affect the woman, the fetus and baby
? how a mental health problem and its treatment might affect parenting.

Coordinated care
• Develop an integrated care plan for a woman with a mental health problem in pregnancy and the postnatal period that sets out:
? the care and treatment for the mental health problem
? the roles of all healthcare professionals, including who is responsible for:
?coordinating the integrated care plan
?the schedule of monitoring
?providing the interventions and agreeing the outcomes with the woman.

Whilst this sounds extreme, it does give some women good grounds to get extra support and greater opportunities to discuss their choices and care rather than being pushed down a particular route which doesn't focus on this.

www.nice.org.uk/guidance/cg192/chapter/Key-priorities-for-implementation

Dopey, I'm sorry you didn't get the births you wanted, but so glad to hear all went well when otherwise it could have been so different! You mention saying how expensive it can be when a vaginal birth goes wrong. Isn't it a sad state of affairs when a doctor would take more notice of that than a patient's wishes

Redtooth, I remember reading through the intrapartum care nice guidelines leading up to birth of DD just to know what to expect in different instances really. There was definitely an air of 'listen to maternal preferences' to most parts of it, and yet I can think of so many ways in which I WAS treated as a cog in the processes they have to follow. I got on so well with my community midwives, but when I booked in at the hospital at the beginning of my pregnancy I remember saying my preference was for a hospital birth because I knew my mother had had a life great ending PPH and even though there isn't really a genetic connection just knowing the risks meant I didn't feel comfortable with MLU or home birth. Maybe it's because I'm foreign and hospital births are the norm for me. Anyways, the midwife then told me I was low risk and I shouldn't even consider hospital, my two choices were MLU or home! I again said I wanted hospital and why and the cheek of it she wrote down MLU on my bloody notes! And then when I was in labour the midwives I had were really lovely for the most part, and I had a student midwife who stayed with me through to DD's birth despite it being 2 hours after her shift ended as I was her first, bless her, but I could have THROTTLED her when, after hours of labouring and still only being 5cm, I asked for an epidural and she told me I didn't need one because I was doing so well and it might not even work and would probably stop my contractions (I was not doing well, it worked perfectly, and my contractions continued as they had done and intensified as they should!). HOW IS THAT HELPFUL?? ???? I can laugh now looking back, but at the time I could've killed her!

Thanks for the info about the counselling pre-pregnancy. I don't really have mental health issues, but I suppose traumatic birth and the anxiety it causes count!

*threatening, not 'great ending'... Thanks, autocorrect

I have a hip condition that means I couldn't have a vaginal birth. My first obstetrician didn't even ask any questions about this, he just accepted it, was reassuring, professional, answered my questions and was wonderful throughout.

We moved to York. I told the obstetrician about my condition. He asked questions about it, and when I answered them kept saying 'So it is like a...' and then naming things it was not like. In other words, he did not know about my condition (which is not common) but continued to speak about it, at length, demonstrating his lack of understanding, and eventually he said, 'But if I could tell you that I could give you a vaginal birth anyway, would you have one?'. Because I'd been a bit rattled by having to answer questions about my hip condition that didn't relate to my hip condition, that mislabelled it, I just said no. Because I already had lost confidence, and I was thinking, what if the crazy bastard tries to go ahead and something goes terribly wrong and my hip dislocates, I have to have major surgery, it isn't operable, mad things were going through my mind and I was starting to panic. So yes, I said no. At which point, he virtually (and call me paranoid if you like!) said, ha! I have caught you out you are just too posh to push.

Also he said my baby should come out at 28-30 weeks because she was growing badly.

I was terrified and talked to my dad, who was a GP, and he said if you don't have confidence in your obstetrician, you should probably look for a second opinion. So I did. I went to a different hospital to have my baby. I loved my obstetrician, he was wonderful. He knew my York obstetrician, in fact. I don't think they were great mates. My baby was born by c-section at 37 weeks. She is perfect.

I had a emcs first time, due to hospitals bodge and second time round they said because my first baby was huge 5kg and because of the risk of my womb tearing during labour after being opened for the first one, and having to have a cs anyway I should have one.

It was at 40 weeks and I was abroad as an expat. The surgeon did all the checks himself and I didn't see a midwife.

If I had been in the UK my dh was under instructions the moment I went into labour to drive as far away as possible from the original hospital that nearly killed me to any other random one.

Lavender, where abouts were you? I feel like if I was home in Canada I wouldn't have to fight for it like I may have to here..

I had my son at Kings, 8lb 4oz! Got bullied about sections early on even though I have a uterine abnormality. In the end, he stayed breech and I had high blood pressure issues so was scheduled for a section. I went into labour early and had an emergency section. My consultant in the high blood pressure clinic was lovely - much nicer than the lady I saw first time!

I had all sorts of issues following that section and needed a second op. When I fell pregnant with DD and had her at the PRUH in Bromley/Farnborough, I told them that I was having a section and they just signed it off. My daughter also stayed breech from about 20 weeks.

Don't be frightened to ask for a second opinion. I got myself so worked up about my second section (before it was agreed) I started looking at loans for the Portland!!

When I had a 3rd degree tear, with blood transfusion etc, not dissimilar to your situation I think, they told me at my post natal check that if I had another baby it should be an elective section. I am amazed you would even have to ask! As soon as I got pregnant again I was just booked in, no question.
Sorry haven't read the whole thread if this has been answered already. But you must insist on a section.