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

Yes, precisely - it is a disservice to those with anxiety, who would appreciate counselling, to lump them in with those who don't and wouldn't.

And if any request for a CS is seen as a marker for anxiety (implication: irrational or troubling levels of) then the premise is clearly that women SHOULD want a VB and are problematic if they desire otherwise.

Which is why I think so many times on these threads you read about intelligent, articulate, grown-up women being reduced to quivering or sobbing figures in these meetings. Because we are treated as troublesome children who must become submissive to those who know best - if we know what's good for us...

And if any request for a CS is seen as a marker for anxiety (implication: irrational or troubling levels of) then the premise is clearly that women SHOULD want a VB and are problematic if they desire otherwise.

I do differ in my opinion on that. I think it should be regarded as a red flag because research has suggested that there are patterns in women requesting an ELCS having common traits - some of which do mean that women have some underlying problem.

Think of it like treating a physical symptom though. Lots of people have lumps. But not all lumps mean you have cancer. And not all cancers can be treated with the same treatment. You have a range of treatments based on circumstance. But you should investigate a lump in case it is cancer. And even if you did have terminal cancer it doesn't mean you should be forced to have chemotherapy, radiotherapy, surgery and god knows what else to prolong your life. You have a free choice to refuse treatment and die on your own terms if you want.

That's where things are failing though. With the assumption that all women with a lump must have their right leg removed regardless of whether its cancerous or not without critically looking at the situation and doctors/patient deciding together upon the most appropriate course of action for that individual, regardless of what the doctor would do if put in the same situation themselves.

Anxiety about the quality of care you receive whilst labouring is hardly irrational.

I had a homebirth but refused to transfer for anything other than a c/s. My traumatic birth was MLU based. Things were going very wrong due to mismanagement and inexperienced MW but the attached CLU was full. Doctor who came from CLU was delayed, harassed and assaulted me brutely.

Redtoothbrush, yes, we differ on this point - although I should say that I respect your opinion hugely on this topic, having read, as a longtime lurker, your comments on many of these threads. I am sure the research does show that, and HCPs should clearly be aware of the possible implications of any request, but I think it has to be 'possible' implications rather than a blanket approach to treat all requests for CS as indicative of underlying problems.

This, I think, is slightly dangerous, as it validates the views that are general in our culture, as well as deeply ingrained in the minds, seemingly, of many HCPs, that there is something 'wrong' with women who want a CS. The use of the language around these requests is a good example: the desire to label vaginal birth as 'normal birth' which clearly stigmatises those of us who actively desire the 'abnormal' as a positive choice.

So in terms of your analogy, I don't think anxiety is always a lump at all, benign or not. As Starlight says, it can be an entirely rational response to the prospect of both no matter your birth preferences, and pregnant women are all, presumably, somewhere on this continuum (not to diminish the experience of those at the tokophobic end of this continuum).

If you want to reduce c/s rates, then allow all maternal requests but invest in VBs to improve experience and confidence.

redtoothbrush thank you for the information. Sorry for the delay Im only catching up with this thread now. I had a BFP this morning!!! So this information is more important than ever.

Off to read the NICE guidelines in preparation for my first appointment!!!

I've recently had an ELCS at PRUH for 'non-medical' reasons, after a low risk pregnancy with my first baby.

I requested one at my booking appointment and the midwife basically laughed in my face, told me a vaginal birth is always best and, when I mentioned NICE guidelines, told me to stop reading stuff as it would only make me anxious! She also compared me with Victoria Beckham and implied only celebrities or frivolous people have elective c sections! Needless to say I was beyond upset as I always knew I wanted a c-section. She did in the end refer me to the Head of Midwives at PRUH, but I also went back to my GP to ask for a referral as I couldn't trust her.

The appointment with the head of midwives went really well, was able to have a proper conversation about the different types of delivery and she actually listened to my concerns. She also apologised for the lack of professionalism and care showed by the first midwife. After our appointment she wrote a letter to my consultant, advising that there might be some emotional/psychological reasons for an ELCS.

After the 20 week scan I met with the obstetrician who didn't feel I had good enough reasons to be granted an ELCS on mental health grounds, but she acknowledged that I was very well educated about risks/benefits and I made an informed choice. So she basically approved it, with the caveat that I still needed to see another consultant at 34 weeks in case I changed my mind. The second consultant didn't really try to persuade me against having the ELCS but still went through all the risks of a c section. So 6 months after I initially requested an elective caesarean I finally got it approved.

All in all, it was an uphill battle, with the majority of medical professionals trying to emphasise the risks of a caesarean and the benefits of a vaginal birth, but not the other way around. But I had done tons of reading about this and could reference the NICE guidelines and various other research when talking to the consultants. The fact that I work in clinical research was probably in my favour, as they acknowledged I knew what I was talking about. I had a straightforward pregnancy that I enjoyed for the most part, the only source of stress and anxiety being the uncertainty regarding my c-section.

As I said at the beginning of my post, I've had my caesarean a few weeks ago, everything went as planned, I'm recovering well and I'm really happy with the choice I made.

Thanks medeea15 , that's really helpful. Glad it went well for you and that you persisted with what you believed to be right for you.
I spoke to my mum last night - first time we'd really talked about what happened during my first birth. She has a medical background and is fully supportive a nd understanding of my reasons for leaning towards an ELCS. I feel a lot better now.
Athousandtrees congrats!