What's the likelihood of having a repeat ELCS agreed in my situation?

[QueenMolotov]

I've recently discovered I'm pg with dc3 It's very early days, but I am already thinking of the birth. My booking appointment should be in 4-6 weeks time and I'd like to think things through properly before seeing her and requesting where to give birth.

So, I had an assisted vaginal delivery with dd1 in 2009. It was a long labour: 31hrs in total, 7hrs active labour and 2hrs unsuccessful pushing. She got stuck and was getting distressed, so I had an episiotomy and she was delivered by ventouse.

The worst part was I damaged my tailbone. I felt something happen when I pushed and after that, rather than pushing with the contractions, it felt like I was pushing against the pain in my tailbone. It's never been the same since. I can't sit on my bottom (always leaning on one butt-cheek or the other) and moving my legs in certain ways makes it ache.

I went to a different hospital and requested an ELCS for dd2 in 2012 for the tailbone reason. The (very senior) consultant who I saw was dismissive of my reason and unsympathetic. DH and I jumped through a lot of hoops, but the consultant did agree eventually - but it was an unpleasant and stressful process (and to be frank, has put me off getting pg before now). He pitched worst-case CS outcomes against best-case VB outcomes and it was just a total mindfuck. However, he was an excellent surgeon; he did a fantastic job. I had no healing issues and the scar is great. I just don't know if I can face him again, or if I should just go with who and what I know.

I think I would like to have a repeat ELCS because:

1). My tailbone issue is still present but the first ELCS did not make it worse
2). I could still further damage my tailbone with another VB
3). Small risk of uterine rupture to add to VB risks
4). Therefore for me at this point in time, I think the risks of ELCS are more predictable (obviously haven't had 12w or 20w scans yet).
5). This is our last baby so a second section would be my last.

Oh, and I have asthma which is a new diagnosis since I had dd2. I wonder if that makes a difference?

Should I aim to go the same hospital and consultant as dd2? Same hospital but different consultant? Or somewhere completely different?

Sorry for the ramble, I hope I'm making sense. I'd be very grateful for your opinions.

Yeah you'll get one. Whoever you see, they can't force a vbac.

Congratulations

Sadly the PP is wrong. My NHS trust can and do refuse C Sections. The NICE guidelines, as wonderful as they are, are just guidelines. The best advice is to ask early, go with written reasons so you don't feel flustered when challenged, be prepared for resistance but keep pushing. If the first consultant flat out refuses, ask for a second opinion. It does sound like your case is strong though.

DrE, would you mind either saying here or messaging me with the name of your trust, please? Or just saying your region?

And could I be made to have a VBAC?

You have three strong cases for an ELCS.

One is because you have previously had one and the guidance is that your preferences should be a strong consideration
Two is because of your physical issue with your tailbone
Third is your very obvious anxiety about not being able to have an ELCS (I notice you've posted a few times in the last week about it and seem to be worried).

I do think you should be able to get an ELCS and it should be an easier process than previously now, but there are no guarantees. (I believe that recent revised information from WHO about an 'optimum CS' rate is making hospitals try and reduce rates again which is awful and does not respect women as individuals rather than statistics)

If it is causing you a lot of anxiety now, it might be worth trying to get your GP on board in supporting your case now, so that hoop jumping can be minimised as its on record that the process itself is causing you unnecessary anxiety and you need help and reassurance with that.

Not all GPs will do this, but a good one should recognise that anxiety throughout your pregnancy in this way is not good for you and should support you.

Good luck.

I am a London trust, SW. With my DD I had to fight for one, but did get one. The trust I work in, also S London, also has a VBAC policy. It is not uncommon for NHS Trusts to have a policy contrary to the NICE guidelines relating to ELCS as they are under huge pressure to keep Csec rates low. Send me a message if you are under a London trust and I'll see if I know their policy. You can ask them outright although they may not give a straight answer.

If you've had one elcs then you shouldn't have a problem requesting another. My consultant said it was my choice. I would go with same consultant as you have already done the leg work and he eventually agreed last time so can't see why he would disagree this time?
I seriously don't see how anyone can be forced to vbac- some trusts just may make it harder to request a repeat section. Imagine if your request for a repeat elcs was denied and you ruptured, they would be up shit creek from a litigation point of view due to nice guidelines.
Congratulations and please try not to worry as it may be over nothing I.e. The consultant may ( and probably will) just say yes!

I should also say you do have a very compelling case and it clearly isn't under 'maternal preference' alone. You are able to ask early so I can't see that you won't get one.

Have you not pursued treatment for the damaged tailbone?

You've had an ELCS, I think it's likely that they won't force a VBAC and I'd go back to the same consultant if he did an excellent job but meets the cliche of total cock surgeon.

My NHS trust can and do refuse C Sections

I'm not wrong. They may refuse sections, but they will not refuse a VBAC - vaginal birth after caesarean.

I'm very pro vbac, but it's not for everyone and if you've had a previous section you will be granted another.

Thanks everyone for your replies.

Glad to see you here, Red I've seen your replies on other posts over the years and always think your advice is measured and informed. I think you're right to say that the thought of the process of having another ELCS agreed is worrying me. I have an appointment next week with my GP to confirm the pregnancy, and will raise the issue then.

Tread, I did have quite a few sessions with a private physio after dd1's birth. I was having problems sitting-standing, standing-sitting, sciatica, pain when lowering dd into her cot and was having pain when walking up and down stairs (I was 26yo at the time). It just wasn't normal. The physio suspected I might have had 2 protruding discs, but I couldn't afford an MRI scan at the time so have no evidence of this.

I haven't had treatment since, although I consulted the physio again in 2012 to ask his advice about mode of delivery for dd2. He said that CS carries risks to spinal health because the abdominal muscles are temporarily compromised but that another VB for me might exacerbate the damage already done, which I was at a higher risk of for having already damaged that area.

I also consulted a chiropractor (although I now realise a lot of people view chiropractors as woo). Anyway, the chiropractor also said I was at a greater risk of re-damaging the area and that an ELCS would preserve that area, albeit to the damage being incurred elsewhere. She also said that obstetricians do not fix the problems caused to women by childbirth, which I thought was a relevant point.

I remember I'd been advised by the consultant to inform myself of my risks, which I did by reading NICE guidelines, books on CS vs VB and speaking with the physio and chiropractor. He pretty much laughed at me and then I nearly cried. I don't wish to keep dragging the past up, but I just don't want to be challenged like that this time. I've even looked at Green Top guidelines to see the risks pertinent to a 2nd CS so I have an idea.

My DM said that I need to just relax and enjoy this of and stop reading over and over stuff. In a way, I know she's right.

DrE, I'm not in London but thank-you very much for sharing, and for your perspective, too.

I am pregnant with my second and am booked for an elcs. I had a third degree tear during my first labour. I met with the consultant prepared for a fight but he was lovely and agreed straight away. I think if you can show you understand the pros and cons and have considered the options you should be ok. Hope all goes well.

www.coccyx.org/personal/2013/emma2.htm

This might be useful

Thank-you for that, dreams

I had an emcs with ds. And opted for an elcs with dd.
When anyone asked why j wanted one I just said
"I don't want to go through a long labour back to back with a big baby and end up with an emergency section again"
And repeat.
My midwife was very keen for me to have a vbac as she had had one.
I said that's lovely for you, when is my section date please?!

I think the VBAC success rate is something like 50-85% and I would be placed at the higher end of that statistic scope as I have 'successfully' delivered vaginally before.

But, I just don't want to go through labour again because of its uncertainties - what if I felt the back pain again? What if I couldn't push against it knowing what it is this time and ended up with EMCS?

I remember when discussing labour options for dd2 with a consultant midwife, she said I could have remifentanil, which would block out any back pain so I could push. I may or may not incur more damage to my tailbone but if I did, that would be managed after delivery. That just wasn't reassuring to me and I don't see what could be different this time.

Plus, I now have had one CS which brings another set of risks to another birth. However, I've looked at the Green Top guidelines and the statistical differences between first and second CSs. From what I remember, the difference in percentages was negligible. I would hope that a second CS goes as well as my first.

So, to paraphrase Purple, I could say:

"I don't want to go through labour again and risk re-damaging my spine. I do not want to take the risks of VBAC. I do not want to have an emergency section. I would prefer to take the more predictable risks of an ELCS."

I can't remember if I said before, but I have a GP appointment on Friday where I'll say how the thought of pressing for another ELCS/feeling made to choose VBAC is stressing me out.

UPDATE:

I went to see my GP today to confirm the pg. I told her about my previous ELCS and that I would like to have another ELCS for this baby. I briefly told her about what happened with dd1's birth in 2009 and the consequential reasons for me requesting a CS in 2012. I said how stressful it was and how the thought of going through it again to get a CS was worrying me. I asked for her support/the support of the practice as, ideally, I would like to go to the same hospital under the same consultant again because the outcome of the previous CS was excellent. She said I would get that support from her/them.

She said that perhaps the consultant was reluctant in 2012 was because he couldn't see a clear clinical need for ELCS that time, but that a second/subsequent sections were different because the fact of having had one CS is a clinical need itself.

She said that VBAC carries higher risks than repeat CS and didn't think I'd face too much opposition this time.

That was great to hear - does that sound right to you?

Brilliant. All sounds right to me apart from 'VBAC carries higher risks than repeat CS', in that they both have risks but you just swap one set for another with whatever you choose!
Glad you are being supported and hope you have an enjoyable pregnancy!

Really pleased to hear that. Hope it all goes well for you.