How to approach getting an ELCS

[AnnSmiley]

I'm pg with DC2 and have my booking in appointment in a few days time. My maternity notes already say I'd like an ELCS, but I wondered if anyone had any advice on when to start saying you'd like to see a consultant and discussing getting an elective.

I had an EMCS with DC1, who then went to NICU for 5 days. I hated labour and found the care I received on the labour ward terrible - basically they ignored me for 12 hours as I told them repeatedly I was being horrifically sick and wasn't even keeping liquids down. I was unmonitored and had to practically beg them at shift change for some pain relief (3 days awake) at which point they discovered I was 4cm, so I went to get an epidural. At which point then they discovered that I was massively dehydrated and both the baby and I were tachycardic and we ended up rushing to an EMCS.

I'm not prepared to go through that again, I hated the experience and feel that their lack of care on the ward contributed to both of us being ill (I dread to think how ill DC would have been if we'd been ignored and unmonitored for longer). I don't want to do it again and I want an ELCS as it feels more in my control.

However, I'm aware that this might not meet their criteria as there's probably no medical reason for another cesarean, and with no diagnosis of PND or birth trauma they might not accept that (I has shell-shocked and furious but have had no issues afterwards, other than the thought of absolute terror at going through it again) and they might just say that a second birth will be quicker so there's nothing to worry about.

Do I start pressing at my booking in appointment? Do I say that the thought of spending the next 6 months not knowing if I'm going to get denied an ELCS and be forced into something I don't want to do quite distressing?

I wouldn't worry about it just yet.

Ask you m/w at booking in for a referral to your vbac clinic, if there is one. That appt usually happens at 25 ish weeks, they'll go through your previous birth, and what it means for your second. I found it hugely helpful as it also helped me come to terms with a lot of things.

With you, it might aso draw attention to the hospitals failings, which is a good thing if they know, and can fix it.

Ime if a vbac is possible, they like to feel you have considered your options seriously. I went to the first appt, was given a second at 35 weeks to go back with my decision, no pressure, just go away and think about it.

When i went back i said id decided on a section, they said fine and i saw the consultant and booked the appointment for the elcs there and then. The m/w did ask why, but stressed it was for her own interest and i didn't have to tell her.

I had an EMCS with DD3 and am booked in for ELCS in a couple of weeks time with DD4. I didn't have to "fight" for it or push in any way, I was quite surprised actually at how little challenge I got. The reason I had a section last time was dd3 was a big baby and I didn't dilate beyond 7 cm. There's nothing to suggest this baby is big but I was concerned about the scar rupturing so based my decision on that - plus the convenience of it too if I'm totally honest.
I would mention it at booking in just so you've made your position clear from the get go.

I was asked at my booking in appointment what I wanted to do and saw the consultant at 20 weeks. Both she and the midwife said as I'd had a previous section (EMCS for failed induction) that it was completely my choice what to do this time. I was really surprised it was so easy tbh! Hopefully you will get a similar response!

You should automatically get a consultant app that normally takes place after 20 week scan. If you had an EMCS they regard you as high risk so you have to see one.

My consultant looked at my notes and said best thing was an ELCS at 40 weeks. If I go into labour before then they will monitor me closely and make a decision after four hours. (First labour only got to 5cm after 30 hours, then both baby and I got in trouble do had EMCS) if not progressing quickly I'll have a c section then and there.

I was really surprised at how easy it was to be honest! Thought they would push VBAC on me! Try not to worry about it as you may be surprised that they medical team agrees with you. Good luck

Oh what a good thread. I've been thinking this my self after having a dramatic ECS with dd2.

Thanks all, some reassuring stories. I know it seems early to worry about it but the thing is, I am worried about it, quite a lot - the idea that I've got to spend the next 6 months or so not knowing if I'm going to be forced to go through something I found that traumatic again is something that does worry me quite a lot.

My VBAC m/w said since I'd had am EMCS it was entirely my choice.

I think if you can show you've considered all your options, and have decided on the best choice for you, they respect that. I think where the difficulty for HCP is is when some people insist they want x choice, without even considering alternatives. Part of their job is "informed consent"- making sure people have all the information before making a decision.

If someone is determined to have a VBAC, they still need to walk them through it so they know they have considered it carefully. A CS is major surgery still, so it's worth at least thinking through the process so you know you're doing the best for you and your baby.

At your booking in tell your m/w your worries. See what she says first.

I said at my first appointment then my second at 10 weeks she referred me to the consultant at 17 weeks and he was fine I didn't ask for one I told them that's what I was having and no one questioned me they just gave me the info (to cover themselves) then told me I would come back at 34 weeks to double check I still want to go ahead and get a date.

I'm in Glasgow it seems to be the norm here not to fight it ive only heard of battles to get it done on here.

I told at my booking appointment that I may want ELCS (after traumatic birth with EMCS for DS1, who then soent 2 weeks in NICU). I was referred to consultant, who said I should make a final decision at 36 weeks, and also referred me to VBAC clinic, to make sure I know all options. She also went through pros and cons with me. However, she said, that it would be completely my choice, so I did not worry about it. In the end, DS2 was breech and they strongly recommended ELCS, as due to some other factors as well successful VBAC was unlikely. Throughout my pregnancy only one midwife was a bit dismissive when I mentioned I wanted ELCS, but all others were very supportive. My understanding is that if you already had a section, then you are free to choose ELCS.

However, I'm aware that this might not meet their criteria as there's probably no medical reason for another cesarean, and with no diagnosis of PND or birth trauma they might not accept that

As you have previously had a EMCS you DO have a medical reason for another caesarean actually.

The NICE guidance on CS has a chapter about giving birth after a previous CS.

Their guidance is as follows:
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.

NOTE HERE - maternal preferences and priorities should be strongly considered under the guidance because there are risks associated with a VBAC.

Birth trauma or a diagnosis of PND are NOT necessary.

Of course it does depend on the hospital you are at and their individual policies but the guidance is in your favour.

This part of the CS guidance is quite different from the maternal request section of the document, though the maternal request section also has parts which are relevant to your case.

They state that there could be psychological damage caused to a women who is forced to have a vb against her will. This includes women who have not previously been traumatised in anyway. It is the act of withholding the CS that is the issue and the potentially damaging act.

Therefore I do believe it is worth stating this, as it then goes on your notes and does make it more difficult for them to refuse to give you one.