Has anyone been "counselled" when trying to get ELCS without a medical need

[StrawberryRiceCake]

I have this appointment tomorrow. I have requested ELCS due to my last birth being very traumatic (distressed baby, long labour, intense pain, forceps, episiotomy, PPH, ongoing damage) and the protocol is that I have to be counselled by a consultant midwife before they will agree to it.

Due to admin problems at the hospital I have only just got this appointment at 35 weeks so I don't feel that I have many options if they won't agree at this late stage. I know it is to make sure that I understand the risks (I do) but the midwife I am seeing is a "natural birth enthusiast" according to her page on the hospital website. I can't go through another natural birth :(

Just wondering what others have experienced. Is it going to be a challenge to be listened to?

I am sorry I did not see this yesterday...

wonder if you are at your appt now....

first of all:

elective c/s is the right choice for some women, you are the main person who will know if this is right for you

counselling is good, even if you have already explored all options (emotional/practical ones) and you see it as an 'unneeded step', in this case you will just re-confirm you know what is right for you.

approach this appt open minded, try not to 'guess' what the midwife will want or not want, a good counsellor (and hopefully she is just that) only want to talk so that you naturally follow the path which is right for you, so in essence they are there to help you find that path, not to 'steer you'.

the midwife will give you options (many different ones), including trying for labour/birth with different plans in order to help you (and the el c/s)

just follow the flow and see how you get on, if after the talk you still feel that el cs is the way for you do tell her, do not just go away thinking she is 'fobbing you off' with a plan for labour/birth, read through the documentation she writes with her so that you are happy you understand what she wrote on your notes and that it is an 'accurate statement/summary' of your meeting which includes all the main points and your views/choices.

sometimes a second appt is needed, this is normal, do not worry, let her know how anxious you feel and that you would like this meeting to be by next week (so before you are 37/40), el cs mostly (but not always) are scheduled for when you are past 39/40 (more like 40/40 in most cases but not all).

the important bit is that everything from this meeting 'must' be written in your handheld notes (if there is any detail you wish to be confidential make it clear to her and agree on what to exclude and/how to approach it).

OP- how did your appointment go? Reading your post made me feel sick, it is exactly my experience. OH would like a second child but I will not go through the torture of a natural birth again.

blacknpurple Thanks for that. I saw your post as I was waiting for my appointment so it was very helpful.

I feel very confused now I've been to the appointment. The first half was great as it was a birth debrief and really helped me understand what happened with my DD. I didn't know that she was actually back to back and that's why the pain was so intense. She also moved around quite a bit after that and ended up transverse which is why the forceps were needed. My progress up to that point was good but then all that happened and she got distressed and I was traumatised.

Unfortunately the midwife then told me my body knew what to do and it would be easier and for that reason she was not going to support a section. I'm seeing the consultant next week for the final verdict but she is recommending against it. The only things she had to say about sections is that they might cut my bladder, some babies come out in "terrible condition" and I won't be able to look after my toddler DD properly after the surgery. I feel really stupid and selfish for wanting one now and I was so sure before :(

She also suggested I have a plan to go into natural labour and call to arrange an epidural before I go in. I told her I couldn't contemplate any of that again but she wasn't particularly sympathetic.

Ffs. I just want this sorted out :(

I've been following this as I've been considering child no 3. My first was emcs and second was a vbac via ventouse. I think I will request an elective having experienced both if they let me.

I'm sorry the midwife wasn't helpful or sympathetic. Such a shame when health professionals have an obvious agenda.
I had to see the vbac midwife last time and she listed all the miniscule risks if a c section but no mention of vbac risks apart from the scar splitting.
The truth is you might not get unbiased answers from the hpas.

Absolute bollocks on her part. Honestly, ask for journal references to back up what she is saying-there are none. Stick to your guns, refuse to accept no for an answer. Grrrrrrrr.

I had my youngest dc over 5 years ago so things may well have changed then but I elected to have a c section when I had her and took in a load of notes I'd made with me and reeled off points id got from some organisation (nhs/nct or something like that) which basically backed up my right to have a c section if I preferred. I had to sign a load of documents to say I knew nd understood the risks etc but I think she was impressed that I'd come prepared and done my research and knew exactly what I wanted and was willing to let me go ahead with my choice. I will try and remember which organisation I got my notes from so that you can have a look and see if any of it applies to you.

forceps, episiotomy, PPH, ongoing damage = medical need for a CS

Just keep repeating to them - I want a caesarean

Sorry you are having this hassle

I downloaded the nice guidelines. I took them along with me.

I know it's probably irrelevant but I've had 3 c sections and they were. First was emergency but the following two were planned. They were calm and we had skin to skin in recovery afterwards. I breastfed and wuth the third child I was at home approx 48 hours after section.

It's totally your decision. But remember you don't get a medal for a natural birth. It doesn't make you virtuous or 'better'just go wuth your instinct and good luck whatever you decide.

I am having an elcs in 2 weeks. It will be my second elcs. Dc1 was born naturally and I had a missed tear which has caused ongoing problems.

Both times round they have completely supported/ recommended the elcs as they wouldn't want to risk further damage. They also told me that they are trying to reduce the number of elcs but ongoing problems due to previous births is a reason they do
Agree to support elcs.

I have had friends in a similar position to you where they have been told no but continued to push for the elcs and got it in the end. It's bloody awful you need to go through this at a time when you are exhausted and hormonal (if you are like I am right now) but if you keep pushing I think you will get it.

Good luck.

Thanks everyone. I'm not giving up. So much crap going on at the moment and I could really do without this being a battle. I'll take the NICE guidelines and anything else I can find with me next week. I guess my main reasons are that I don't want more damage to my private parts, I want to avoid my baby being distressed, I don't want more pain like that and I want to feel in control. The part of my labour in theatre was the part that I finally felt safe. The thought of going into natural labour again terrifies me, especially if it is fast and there is no time to get any pain relief. The midwife kept saying that it was very possible that I would go into natural labour before an agreed section and she really wanted me to think hard about this and face my fear.

I saw a registrar at 20 weeks and that was the first time I mentioned the section. He dismissed me but then went to speak to a consultant. When he came back he said they can't force me to have a vaginal birth but I had to follow the protocol. Really hoping this still stands and the consultant will agree.

I had a first terrible birth (we lost the baby but not actually due to the birth) and then had a pretty terrible second birth. There was no way I was having a third natural birth as my anxiety during the third pregnancy was just horrific, especially when I had to go to hospital.

I also had a completely farcical meeting with a nurse specialising in ante-natal mental health when I requested my ELC. I am still furious when I think about it now as she completely ignored the fact that I lost my first baby even though I was very clear that I knew that this was the major contributing factor to my anxiety. Her ridiculous report never mentioned my loss and she seemed obsessed that a then undiagnosed neurological disorder must be a somatic disorder (she clearly knew more than my neurologist!) although this had nothing at all to do with my pregnancy/anxiety etc. and I was not there to discuss that.

My solution was to write an extremely detailed, clear and direct one page document detailing what I had been through, why I needed my ELCS and why I would refuse all and any interventions if there was any attempt to persuade me to have an induction etc. I also effectively (and very firmly) stated at the end that if the hospital did not agree to my ELCS I believed my subsequent mental health would suffer and I would hold them to account if this was the case.

I made everyone I then spoke to read this document as I was usually too tearful at meetings to explain myself. I was granted an ELCS very soon after this with no more challenges and I am quite certain that this document and it's absolute certainty was key.

I am also writing this really to balance blacknpurple's post which seem to have no breaking on my experience.

This is a good book to read which puts some of the risks of ELCS in perspective:

www.amazon.co.uk/Choosing-Cesarean-Natural-Birth-Plan/dp/1616145110

I would complain about the treatment you have received so far. I did, when I was told a Cs may cause bf issues and bonding issues. Absolute tosh designed to make you not want a Cs. I agreed to try a natural birth if I went into labour naturally but that was an agreed decision that I was comfortable with. I also insisted on a Cs if I laboured for more than five hours with no progression. Stick to your guns, honestly. Ignore the guilt tripping crap they will come out with.

That's so awful lucy. I find they don't take mental health seriously at all. I'm going through some mental health problems at the moment and my midwife offered to refer me to the mental health midwife. I declined at that point as I was coping but she said to call her if I changed my mind. I did end up calling her a few weeks later and she said that she was off on holiday for two weeks and didn't want to do it so to call her when she was back and she would try to do something then. I ended up finding a private counsellor as I couldn't wait. She also shrugs off every concern I have, symptoms of GD being one.

I feel my care has been one big cock up so far.

Haggis that is absolute tosh isn't it. Tbh I felt my appointment today was like a marketing pitch for natural birth. There was nothing about what could go wrong with that. I know people who have ended up with worse births the second time too.

Totally. I was referred to the mental health team for pregnancy anxiety but got an appointment after I had given birth! I even tried to book a private, payable appt but didn't even get a reply. Bloody awful. I got my elcs and it was fantastic and absolutely the right decision for me and my family.

My first birth was v similar to yours op, and I asked for a cs for my second. They weren't keen (as in their view I had a straightforward birth) but I did get it. I don't think they'll refuse, but you might have to be pretty assertive. Fwiw, my ecs was AMAZING. Good luck

I hate this. I had a cs for my third after my second child died as a result of labour complications. The consultant agreed to it unreservedly. I kept getting calls from the midwife saying I 'had' to come and discuss it with them. I went to my next consultant appointment and asked why I needed to get more time off work to tell yet another stranger about my baby dying and reliving it all over again. He agreed and got the midwife off my back for me.

Women just aren't trusted.

she told you to face your fear ? Fucker. That is so out of order.
You may be surprised by how much more positively the obstetricians view your request than the midwives. I think they are partly testing your resolve with all this protocol. Show you know the facts/risks of a elcs, that you have made your mind up and that you will be very distressed if they don't agree and very happy if they do. Cry if necessary. Don't give up. I felt such a weight off each time I got the form signed.

Sorry that happened to you Treats

Treats I'm so sorry that happened to you. I'm glad you were listened to by the consultant the third time but that is really awful about the midwife.

Well I dreamt about birth and have been crying since 5:30. I think that answers any doubts I was having. Will make sure I print the facts and make sure I know them before I go. I wouldn't be surprised if she has organised the consultant least likely to agree but I will question their ethics if they won't agree at this late stage when I will have no time to see someone else.

I did mention that it would seriously affect my mental health and she said "we will put that in the pot before we make a decision". I may be unreasonable but I find it pretty shitty that someone else makes the decision about what I do with my body. And I hate this "you were designed to do this" argument too. I wasn't designed, I evolved. Evolution doesn't always get it right.

Treats I am so sorry for you loss, it is so painful.

StrawberryRiceCake, you are doing a good job and you will get there. You just need to be incredibly persistent. You can always ask to see a different consultant if you get a no again (I changed to a fabulous one who was completely understanding). I also managed to get an amazing GP onside who wrote the hospital quite a stroppy letter which may have helped. Privately a couple of GP's (including one who had had a very traumatic birth) from my practise were very supportive.

I honestly believe that if they think that you are immoveable on that position and appear to be the kind of person who might cause a huge fuss if forced to have another natural birth that resulted in any problems they are unlikely to want to challenge you.

One other thought I had is that if you are having any MH problems now then it is a good idea to be prepared in case you have PND. I didn't after my son but did after the last pregnancy (I am quite sure I was grieving all over again as I had a girl and my first baby had been a girl). The great GP and I had discussed this and 5 days after the birth I started AD's (Sertraline which is one of the best for breastfeeding etc. from my research).

It makes me so,so angry that there seems to be this culture of almost bullying women when they are pretty vulnerable and often incredibly anxious..

OP, I am furious on your behalf!

my body knew what to do - clearly this is bullshit, otherwise no woman would ever need a CS or forceps.

It's inexcusable that a HCP should have an agenda, I can't believe she is allowed to peddle that bullshit on the hospital's website. Can you change midwife.

If I were you I'd be stating very strongly (difficult, I know, when you're frightened and vulnerable), that "we" aren't deciding anything, as you believe her personal crusade for vaginal births is inconflict with your needs.

The only things she had to say about sections is that they might cut my bladder, some babies come out in "terrible condition" and I won't be able to look after my toddler DD properly after the surgery. I feel really stupid and selfish for wanting one now and I was so sure before

Well this is absolute utter bollocks for a start.

NICE looked at the risk of bladder injury for a planned ELCS compared to the risk of bladder injury for a planned VB (which includes EMCS).

They concluded there was NO SIGNIFICANT DIFFERENCE though they did also say the quality of evidence was very low. So how this person can quote 'facts' that NICE can't, raises very big eyebrows for me.

(NICE's figures actually were ever so slightly better for an ELCS but not enough for it to be termed a significant difference)

The reason she is spouting this shit, is because people tend to lump all CS together. The actual risk of bladder injuries tends to be stacked up in EMCS, rather than ELCS.

If you have a straightforward VB then yes you are less likely to have a problem than if you have an ELCS as they obviously don't put a knife to you in the same way.

However in an emergency situation, because of time constraints and the fact that you might be having contractions it means its harder to ensure that accidental injury to the bladder does not occur. ELCS, because they are planned and you are not in labour don't have the same issue.

The key bit is though that since EMCS are a possible outcome from a planned VB, the risk of bladder injury from an EMCS should be part of the risk of a VB rather than the risk being separated in statistics.

As for babies coming out in a terrible condition.

This is also complete bollocks and this is supported by NICE. If a planned CS is carried out at 39 weeks, then there is a slight increase of a baby being admitted to NICU but this is small and NICE did not feel it was significant enough to stop women having an ELCS on the grounds of mental health.

I would be getting hold of the guidance and having a good look at the table of risks NICE recommend that caregivers should be showing and discussing with patients who are considering an ELCS. (www.nice.org.uk/guidance/cg132/evidence Look at the full guidance and the comparison of risks on pages 23 to 28)

My only cavet to this is, these figures are comparing women who have never had children before and the figures for women having a second baby are slightly different with risks commonly associated with vb decreasing and risks for repeat cs increasing. However risks to mental health should be considered AND TAKEN SERIOUSLY RATHER THAN MERELY DISMISSED in women who have previously given birth.

It is appalling that this has not been done and you have been given misleading information which is in fact causing you anxiety and distress as a result. The purpose of the appointment should have been to allay your fears and to give you accurate UNBIASED information to help you - regardless of the eventual outcome and how you give birth. They should not be scaring you or making you feel guilty however you give birth.

Your mental health is as important as your physical health. This approach is counter to that and therefore at odds with the NICE guidance (which admittedly they do not have to follow).

Go to any future appointments armed with knowledge and challenge what they are saying if they are making you feel bad about your decisions. Complain about your treatment so far.

Tell them you have been having nightmares, tears and are distressed about the prospect of a natural birth.

I also recommend Choosing Cesarean: A Natural Birth Plan as something to help you question information being put forward, however I do think that is biased with a pro-ELCS agenda and you need to be aware of that.

At times it falls foul of its own criticisms of how statistics are being put together and presented.

It is most useful as a guide to helping you understand how stats regarding CS are flawed and therefore helps enable you to pick your way through the minefield of bias from all quarters.

What counselling should do, is LISTEN to you and your concerns and try and work out each individual component of your fear and to try to work out ways to reduce them without selling one birth plan as 'better' than another. There is only 'better' for each individual based on their circumstances.

How old you are, how many children you plan to have and any other physical health issues as well as your mental health should be part of that consideration. Has any of this been discussed with you?

There are circumstances where a VB may be in fact preferable but a good hospital will help you tackle fears with a robust birth plan with exceptions to their normal protocols to help you cope.

Eg it perhaps states if x happens we won't wait and will instead go straight for a CS (which though technically would be classed as an EMCS) can be carried out in less pressured circumstances to reduce the risks of an EMCS and to prevent an instrumental delivery.

There are things that they can do if they tailor your care around your needs. Have any such options been discussed with you?

It is unacceptable to merely go 'get on with a vb' without offering some more practical support for your mental health as that is neglecting your mental health.

A CS may be the route that is best for you, but they should be discussing the subject properly and practically regardless.

Oh and mental health IS medical need and should not be dismissed as if it is not.

To do otherwise is to say the same as depression and anxiety are not illnesses and do not require medical assistance.

Medical professionals need a kick up the arse to start accepting that health isn't just about broken legs and cancer and perpetuating the stigma and problems faced by those who are suffering from poor mental health.

I had an ELCS on mental health grounds for my first and my lovely consultant midwife went to great pains to stress it was medical need and not be affected by anyone who suggested otherwise as they were simply wrong