Planning an elec c-section before pregnancy. Worth a try?

[1001questions]

Hi all

I joined up a few weeks ago after I unfortunately miscarried. Since then my partner and I have talked about trying again (it was an accident) and this is hugely exciting, however I have a problem: I have a serious phobia about childbirth. The pregnancy only served to worsen my fear, as the whole time I knew I was pregnant I was freaking out about the birth even though it would have been months off. So I no know that I won't magically stop worrying about it once the hormones kick in.

My fear has not come on suddenly, however: I've been this way all my life, particularly since watching a video of a lady giving birth at sex ed in school (ugh). While all the other girls were cooing over babies, I was just absolutely repulsed, and resolute in my assertion that I would never put myself through that. I thought that childbirth was absolutely horrific, and I have not changed this opinion one bit. It's why I've left having children rather late in life, but it's not changed my overall desire to be a mother.

However, I'm not quite as afraid of surgery, so I've decided that the best option for me would be a cesarian. I like the fact that I'd have a degree of control, that I would know more or less exactly what was going to happen, how long it would take and what order things would happen in. I also wouldn't have the worry of putting my baby's life at risk because I'm unable to follow instructions or control my panic response when in pain.

I don't have any reason to think my view on this will change any time soon, and knowing a bit more about my issues (I've been treated for anxiety more than once since my teens) I think it would be completely inappropriate for me to attempt a 'natural' birth. However I'm aware that the NHS takes a rather unhelpful stance on this issue and frankly this scares me. My partner and I could probably stump up the funds to pay for it ourselves, so I'd be interested in hearing what people here have paid - but this would be a last resort.

Is there anything I can do BEFORE I get pregnant again to make sure I've got the best chance of having the procedure as possible? I am wondering about seeing my GP and explaining all of this so that he'll write it on my notes, and I'll have this to refer to when I'm inevitably called upon to defend my decision. I don't want it to look like someone who's just decided they want an easy ride. I'm quite aware that there are post-op issues with this route, but the fact that I am willing to suffer them should be testament enough to my certainty of what I want.

But I don't really know how the GP will react to this - I'm worried that he'll just laugh at me or worse, tell my I'm a time waster.

Can anyone help? I have quite a lot resting on this :(

In my case, I had contact with a consultant midwife with the authority to agree in principle to an ELCS. It went on my notes and I had a letter to that effect and I was told to contact them again on becoming pregnant so they could book me in formally at that point. It was a bit of a faff and letters went awol through no ones fault (stressful under the circumstances) but I had an official date at 16 weeks which I'm led to believe is exceptional early. I get the impress I landed on my feet and was lucky with where I ended up and who looked after me.

My consultant midwife did actually leave their position at the hospital later before I had DS (I only found this out the day after I had DS). As far as the hospital were concerned though, I wasn't an issue and I was mainly under the care of the specialist midwife (mental health) as I didn't have any additional physical problems. I didn't actually see a consultant until three days before my ELCS for the pre op. The consultant midwife was the one who had the authority because it was their specialist area. (Last I heard they were supporting homebirths in their new position - so not someone who had an ELCS agenda by any stretch of the imagination - just an interest in birth fear and getting the right care for the right woman which was actually why I wanted to be referred to them in the first place and my GP helped arrange this. I liked the fact they weren't biased).

I do think this set up is out of the ordinary though, and consultant midwives are not in every hospital and where they are, they don't always have the power to do this.

I would say that getting the name of a consultant who had an interest in mental health would be help as they are more likely to be aware of the latest research and ways of helping and less likely to be pressured by targets etc as their focus is on mental health as much as physical outcome. It can be difficult to find this out though - try trawling through hospital websites for names - they often have positions and special interest details, or even news articles on maternal mental health can turn up names you can track down.

Its frustrating that being able to do this can potentially change your experience of the system tbh. The more informed and the more you are able to research options available to you, the more able to are to access it. It should be universal and everyone being treated equally but its not sadly. Its part of the problem of the 'too posh to push' stereotype unfortunately as those most able to do this and navigate their way to the most appropriate care for their situation are more likely to fit the profile thus perpetuating the fallacy. They are not too posh, just very very anxious and better able to articulate it and get access to the right people.

Overall from the comments regularly posted on MN there does seem to be a trend of discouraging women by telling them they don't have a legitimate problem and have no grounds for requesting an ELCS. (Which is why the NICE guidelines are just so important as they clearly recognise there are mental health issues that should be considered and taken seriously and aren't being - the 2011 update was in fact directly in response to this lack of acknowledgement by some quarters of the profession but the problem still persists) It does seem that you need to be determined in many places to get taken seriously. The problem I have with this more than anything, is in this refusal they also don't offer any other form of support for anxiety and just expect women to get on with things even when the woman has made it clear by making a request for an ELCS that there is an issue with anxiety going on. That's just shoving the problem under the carpet and pretending it doesn't exist which is failing so many women. Its ultimately not about ELCS but about mental health support.

In my experience, its not a very national or equal health service by any stretch of the imagination. I do my best to get the message out there and get better awareness of the issues where I can as I don't see there is any other way of changing things.

indicators.rcog.org.uk/

Trust comparison tool, published a few weeks back by RCOG.

Just be aware that a high ELCS rate does not necessarily mean you'll find it easier to get an ELCS. Quite a few hospitals are being pressured in London to reduce rates where they are particularly high from what I gather. I would be more inclined to pick somewhere where the ELCS rate isn't sticking out as being really high for that reason unless you can get a referral to someone with the right specialism. Equally I would be wary of anyone actively boasting of 'being proud of their low CS rate' as its not about rates but appropriate care.

Hey 1001.

I have a 2.5 week old beautiful baby boy - who I delivered by elective c section as I have tokophobia relating to child birth not pregnancy.

I want to tell you my story as think it will help - will try to keep it short and not too yawn.

I've always had a fear of child birth since I was very young. Talking about it can make me have a panic attack. I can't even watch call the midwife without looking away for certain parts fgs!
(Perspective - I am pretty hard core, independent and confident person - don't consider myself pathetic and have an extremely good pain threshold which I proved walking down a mountain with my ligaments ripped in my leg one time!)
I don't want to have tokophobia - I don't want to be afraid - but it is what it is.

I had a panic attack during a scan when they said they wanted to do an internal scan. It was horrible. I've never had a panick attack in front of my husband before. After a few minutes they continued scanning and said they'd need to wait to measure babies heart because it was now stressed and its heart was beating fast. There and then I thought fuck this, I'm having a c section and no one will make me feel shit about it or make me feel like I'm being difficult / pathetic etc.

Every midwife appointment I had a different one due to mine being off sick. When I finally got settled with a permanent one about 6 months in she got my consultant appointment booked to discuss c section. The midwife actually said to me "darling you can't do this" - I was like THANK YOU cos I bloody know that !! I couldn't even go to NCT class because they would discuss birth. We tried some avenues for help but a-they caused me a lot of panic and stress which in my condition was not ideal and b-it was all too little too late. I was now 7 months gone and still no agreement for c section.

When I saw the consultant she made some last ditch attempts to "fix" me (fair play to her) including sending me to the hospitals birth centre - I walked in and within 5 mins was in floods of tears - the senior midwife there listened to me and agreed I was far better for my own mental state having a c section.

I went back to the consultant - now we are talking 36/7 weeks preg and starting to shit a brick (in between all of this is had sleepless nights, the works)
To be told by consultant no problem we will get you booked In today "we can't book you in before 36 weeks anyway" - if she has just TOLD me that in the first place she would have saved me another 3-4 weeks of panicking....

So we booked it there and then. Went in and had my lovely baby - who was certainly ready to arrive as he screamed his head off before they even had him out properly and cord cut (had him 5 Days before edd) weighing a good 8.8.

It was an amazing experience. For many women the thought of a c section is harrowing. For me the thought of birth was enough that I would not get pregnant. Everyone is different after all. I don't think I would have coped mentally with birth, I think I would be at risk for PND as I think it would blow my mind not having that choice or control over something that frightened me so much.
There are risks with a c section, of course, but there is with vbirth too, and of all my family and friends the amount of emergency c sections are way over the amount of successful vaginal births.

Do what is right for you. Do your research. If you want help try to get it.
Be prepared to have to repeat you 'story' / the reasons to atleast 10 health professionals that deal with you throughout your pregnancy. I think my last count was 12 different midwifes, 3 receptionists and the consultant.
Don't be afraid to tell nosey acquaintances who ask 'oh, why c section' to mind their own or in the end I just said "because that's what I want" because funnily enough I didn't fancy telling every Tom dick and Harry that I had a 'problem' in that area.

Nearly three weeks on I feel amazing and am blessed with not only a beautiful son but also a positive birth story - my section was amazing, the hospital staff were fab and so friendly - and actually that was the first time during my pregnancy I didn't have to explain why!

If your midwife or consultant are not supportive ask to be referred to someone else.
Ask your midwife if she can write tokophobia in your book so you don't have to keep bloody explaining it over and over. Expect to cry your eyes out every time you have an appt !! I found the whole thing v frustrating and having to talk about your fears with preg hormones going mad equals lots of tears usually.
But most of all don't be at all alarmed if you are not booked in with a date before 36 weeks - that is normal - do ask however that you have a consultant appt early on the agree on principle - that's all you need to settle your nerves and then if you went into labour early etc you'd have it agreed so wouldn't be an issue as far as I was told.
They cannot deny you a c section under the NiCE guidelines so please don't worry, just try to relax and enjoy your pregnancy.

Some people can be very shitty about people who are too posh to push and all that rubbish - just try to blur them out and think funny things so you don't get down about it.

Needless to say I will be having a c section next time, and will be a lot calmer now I know how the system works etc.

Also learn to shut your ears when you get pregnant as everyone seems to want to share with you the gory details of their birth stories which if your anything like me can make you pass out!

Some women would feel lesser than having not given birth. Or feel they are missing out on something special. I certainly didn't feel that way. I am lucky to have a supportive husband and for us this was the right decision. My husband actually rang his mum afterwards and said what an amazing experience it has been and why doesn't everyone do it that way ! Lol, but seriously for us it was a very special unforgettable time - so please do not feel that it will be anything less than amazing.

Another one here with a success story - I was (eventually) granted an ELCS for tokophobia with no previous children (though I did have two traumatic ectopic pregnancies). At one stage it looked like it wouldn't happen, so I started to ring round the hospitals in my area to ask about their policy on ELCS. I found the best approach was to go to the supervisor of midwives - straight to the top - to ask them about their hospital's stance. Also, be prepared for the fact that your GP might not be well versed in birth fear. I had to explain the term to one of the GPs I saw! Not a happy moment. Hopefully you will have a supportive one.

Not much else to add to the excellent advice you've already had but good luck! It can be done!

Hi all, so I now know that my GP completely supports me on this point and essentially made me feel that I had no x reason to worry about my wishes being denied. As per my other posting I'm delighted and relieved, but should I still be wary?

Does having a sympathetic gp who will fight your corner, recommend and liaise with specific consultants mean you're basically sorted, or would I still need to jump through a bunch of hoops?

The doc basically said I didn't even need to explain myself and of course it was achievable. NICE updates were quoted a lot. I want to believe this but just being careful I guess...

That's great news! What a relief to have someone sympathetic on your side.

I think much now depends on your hospital trust's policy. Mine has a very strict policy and so I went through a lot of hoops - appointments with:
consultant
consultant midwife (called a "birth choices" clinic)
Perinatal psychologist
Another consultant
Regular discussions with my community midwife as part of standard check ups.

After which the section was granted. (DD turned out to be breech anyway!)

I think this amount of appointments is a worst case scenario and your trust may be very different. It might just be one appointment with a consultant to make sure you fully understand the risks. My trust are quite transparent about the process on their website so yours might be too.

Thanks Fizzy feet. That sucks...but glad it worked out for you in the end. Am I right in thinking you'd have to go through this Circus even if you had a consultant that agreed with you though? Would they be obliged to put you through that by the Trust? This is what I find confusing.

That's wonderful news!

I would still be wary if it were me. Simply because of the nature of my fear. Not because there was necessarily a reason to!

I think the process does depend on where you are and your reasons for waiting an ELCS. If they feel that you need help with anxiety for example, to ensure you are making the right decision for you.

I had a lot of appointments despite having an ELCS approved. I actually found this beneficial in hindsight as I was able to get to know the hospital and the way it worked. This helped with other parts of my fears.

The main thing is you now have an ally who had a medical opinion that carries weight. If you do have any problems you have someone who can fight on your behalf if necessary.

I guess you need to go get busy now!