Please no flaming - how to word this to midwife.

[kiwifluff25]

Please no flaming or shouting down as I'm finding this difficult enough as it is, I know these topics are controversial.

I'm looking for some advice on how to tackle this. I'm currently 23 weeks with DC1 and I really strongly feel now (after a LOT of thinking since being pooh-poohed at 9 week appointment with prevous baby [MC] when I brought it up first) that I would like to try to pursue an ELCS.

There are a LOT of reasons I want this, and I'm definitely not ''too posh'' or mistakenly thinking it'll be an easy option in any way shape or form. But... for me and for the baby I think it'd be for the best.

Historical abuse brings up many issues and fears (these are currently being dealt with by CBT, but wont be magically fixed any time soon) the main one of these is being left with trauma injuries, particularly any relating to incontinence. I have a weird sort of phobia around continence, and basically have to plan my entire life around how quickly I'd be able to get to a toilet if I fell ill (very miserable!). It's totally understandable when you look at the causes (abusive mother- lots of shaming when I was little, making me show myself to people, infecting me with illnesses on purpose then shutting me somewhere with no access to sanitation/cutting off comforts like privacy, access to toilet, or a bed etc). I get an upset tummy/diarrhoea literally every time I have to leave the house because I get so worried about it. If I ended up incontinent (over 50% of VBs have urinary incontinence and up to 25% faecal incontinence for 6 months or longer) it'd completely ruin my life, I find it hard enough as it is being ''normal'' with just the psychological causes never mind physical ones.

My mum had long labours and EMCS/baby in NICU due to distress; my sister was induced with a 36+ hr labour, baby got stuck and was consequently left brain damaged, she almost died from blood loss and suffers from PTSD and double incontinence now which has totally destroyed her life; my other sister also had 30hr+ labour, bad tearing, PND and incontinence.

I have HSV1 (herpes virus, not the STD one, but it manifests literally all over my body, the virus was originally caught in a few years ago through dermatitis cuts on my hands when working with disadvantaged children ). Outbreaks tend to happen when I'm very stressed, and if I had one near due-date I'd have to have an EMCS anyway as it can be fatal if passed on to the baby.

I'd psyched myself up over the past 23 weeks towards a home birth to minimise intervention and so I can feel more relaxed, safe and secure, but all the women in my family have gone beyond 42 weeks (the cut off for home birth and mid-wife led unit) and I know that if I didn't ask for an ELCS now it'd be too late then and I'd be coerced into induction or risk harming the baby. I really have given it a chance, but I just feel like I'm fooling myself that it's even a good idea, given the reasons above.

I've also found out at my 20 week scan that I have an anterior placenta so my chances of a long labour and baby getting stuck due to being back to back are slightly higher still.

I'm really really scared of asking about it though, I find all the reasons listed above quite personal and intimate and I've been put off asking since I brought it up before. When I asked at my 9 week appointment, I merely said ''can we discuss electives as I....'' to be cut off with ''oh no, you don't want THAT, babies are unpredictable, that's just how it is''. I'm the sort of wallflower who will smile and say 'oh ho ho silly me! You're right'' then cry as soon as I've left the room.

Any practical advice on how to word this next time to the midwife? (or should I go to the GP?) Should I tell them everything? Would it even be enough or will I just be talked over again?

Please, please, no flaming. It's taken a lot of courage to work myself up to writing this down as the whole topic makes me want to cry.

OP you have every right to ask for a CS. I also think you have good reason and if you state trauma and mental health as the main reason backed up by the fact that you are already undergoing therapy then they can't argue as much on stats etc.

I do want to just warn you that it may be worth discussing the details of CS so that you are aware of what will happen and prepare yourself in advance. For example you will need to have a catheter fitted.

Good luck and I'm sorry about your MC and all the things your mother put you though

I agree that you should ask for a section if you want one, but I also question those statistics. They simply don't reflect the experiences of me and my friends who have had babies. For example, in my MN baby bus of 90 (with whom I am in contact everyday through a Facebook group) none of them have experienced anything more than the sort of mild bladder weakness that is common following childbirth. Neither they nor I would describe that as incontinence.

I'm concerned by this for two reasons - first, that you are getting yourself unnecessarily worked up by statistics taken without context and second that this is likely also to sound unbelievable to a medical practitioner and will undermine your case. FWIW, many of the continence issues associated with motherhood are caused by pregnancy itself, not vaginal birth.

I completely agree, you have every right to request and have a CS. Write everything down so you're not sidetracked and get a referral.

Your relatives labours have no resemblance as to how your labours will be. Most of my family have had very simple quick labours, whereas mine have been anything but.

Get your referral done asap so you can get a date booked & enjoy your pregnancy!

If you want a CS then that's your right and you shouldn't feel bad about it at all.

I would say though that try and keep an open mind just now but don't be bullied. Remember the midwives and doctors want the best for you and your baby too - they are there to look after you - physically and psychologically.

However, have you considered the impact of major surgery on your toileting habits? Ive only had two VB and no CS but you will not be able to get around as normal.

Don't think too much about your mum and sisters births. My sisters had two CS - one emergency and one elective. Both early. Mum had us all almost bang on time with easy labours and I had both of mine 2 weeks late and had to be induced!!

If you find it hard to talk about the things you wrote to us, maybe your CbT therapist could write a letter of support with an over view of the issues you are working on together?

Very best wishes OP

Ok ok, a few things in this thread that are not quite correct. I'm currently writing a lot of this on another current thread which is also running at the moment, so rather than repeating a lot of that here (some of it isn't relevant, but some is) the thread is
www.mumsnet.com/Talk/childbirth/2611415-Planning-an-elec-c-section-before-pregnancy-Worth-a-try

FIRST UP. This section of MN is a 'safe zone' for anyone wanting to request an ELCS. The majority are clued up and supportive and anyone who doesn't respect that is quickly given short shrift. You will be treated with respect talking about the subject here. It is NOT a controversial subject here.

There is no right to an ELCS in the NHS. There is however the right to the appropriate care. From your post it is quite clear the thing you need most is not an ELCS but proper mental health support and this IS your right. If they are phobing you off by refusing to discuss your anxiety and your desire for an ELCS they are failing you as you are suffering here.

Severe anxiety in pregnancy is when something is dominating your thoughts and you are unable to think about anything else. You have clearly got google problems from this which are not helping the matter!

As someone who has been through having an ELCS on mental health grounds for anxiety for first baby I know all too well how easy it is to become slightly obsessed with stats. The ones you are quoting though are definitely incorrect and misleading. And as someone else stated urinary incontinence can be caused by the pregnancy itself and not the birth.

Next up, there is NO EVIDENCE that the experience of your mother or any other close female relative has any correlation with what will happen to you. Trust me. I've spent many hours of my life looking for the research. The research out there only states the exact opposite. Its much more to do with things like the position of the baby. I know you have also go yourself in a tis about that, but even then, that's not the be all or end all. The position you labour in also has a massive impact on your experience. In short, none of the above are predictors of what will actually happen on the day. If they were, there would be guidelines in place to try and help women in those situations.

Next up, I echo others who say to write this all down. Otherwise you are going to end up in an even bigger pile of snot. (I did a lot of crying too). It will also help the midwife to visually see all your issues. Its therapeutic in its own right too, as you'll be able to break down your fears into individual components. The trick with dealing with things is to break it up and tackle it issue by issue rather than trying to eat the elephant whole. It will show you have given it thought and its not just you being a 'silly little girl'.

Anxiety is a health issue. You have a legitimate reason to ask for it. Your issues are not just about giving birth but wider issues which it sounds like you need to tackle. This unfortunately puts you more at risk of PND even if you have the 'perfect birth'. Getting support now, will actually help more than how you give birth as it will give you the chance to build up a relationship with someone and you will know where to go for help if you need it. It sounds and feels big and scary but admitting there might be a problem but this is a positive step.

What I find alarming in your case, is the fact you are already going through CBT for your issues and no one has flagged you up as potentially needing more support / sensitivity through your pregnancy. Are the midwives aware of this? Or is your CBT private or unrelated to your pregnancy? You have more of a case to answer with regard for an ELCS than most, because you are already under this type of care and you feel it is not progressing you quickly enough. I have to say, I have a bit of a feeling that you are already being let down slightly with regard to your wellbeing.

If you want to find out information to help and support you, I strongly urge you to step away from searching randomly for things and start looking for information and statistics 'in the right places' if you must do it. Cochrane Peer Reviews of studies are good for sorting out the bollocks from the biased and giving you a better picture. NICE exist on all sorts of care pathways for how to tackle things. Stick to the 'official' stuff that has been assessed as reputable by the NHS.

Honestly what you need more than anything is someone to sit and listen to your fears and to go through how you deal with them. An ELCS might be the solution (it might not be too), but you really sound like you need to have your concerns taken seriously and given support to stop this spiralling even more out of control than it already appears to be. This is what you should be pushing for - stating that you feel that discussing the option of an ELCS might be an important tool in helping you cope.

As I say, there's a lot of other stuff on the other thread. Don't rule out going through the GP too. Since you are already pregnant and 'in the system' then approaching your midwife for a referral is your best way forward, but if you are being dismissed and ignored do go through your GP. It is a legitimate pathway to access the care you need.

I would also stress that you should do a little research into what is involved in an ELCS with regard to catheters etc given your particular phobia and past traumas. You probably will need to prepare yourself for it and an ELCS may not necessarily be as easy as you think for that reason. Some of the practical stuff did surprise me and I found harder than I thought I would. If you plan your whole life around the need to get to the toilet quickly if you are ill, then an ELCS is going to prove hard in its own right I'm afraid.

Good luck. It will be ok. Just reassure yourself that you have legitimate need for help and support here and you are not weak, pathetic or any of the other negative emotions for needing that.

OP I'm so sorry you're having such a stressful time with this

I've just had a elcs agreed for psychological reasons / anxiety and the process was far easier than I envisaged it would be. My reasons are different (I lost first baby at 20 weeks - delivered in a traumatic way at home) but I also spent a long time reading statistics, worrying about potential outcomes and trying to decide between my options. It sounds like our fundamental reasons for wanting a elcs are also the same - in that we require a safe, controlled environment which limits any possible problems as far as possible. You are completely entitled to feel that way and reading your history it is incredibly understandable.

I was already consultant led so just brought it up at my 36 week appointment but I understand you would need to go through midwife to obtain such an appointment. I would also say writing notes would be helpful (I took this route) as it's an emotive topic and I wanted to stay on track, plus I knew I would probably end up crying discussing everything so wanted to appear as together and as informed as possible! The consultant agreed my elcs no problems, he ran through the risks as he was duty bound to, but didn't try to dissuade me further. He was respectful of my reasons. One of the major factors that I think supported my request so well was that I too have been having therapy regarding the trauma and could tell him that, and that my therapist supported my decision of elcs (this was never followed up, she didn't have to actually say that to anyone). So when you do speak to midwife / consultant I would focus on that point.

You are doing nothing wrong in requesting an elcs, you are making a decision which is best for you an your baby - a hard decision at that. You don't need to apologise to anyone for this or feel any kind of guilt about it. Best of luck

Just wanted to say that while I had nothing like the childhood situation you did, I went through a period of about 6 years until 2014 where I developed a similar phobia of being "caught short" for a poo in public and it was extremely horrible, had to plan everything, take ridiculous precautions etc, many near misses.
My only helpful comments to you are that:
a) it did eventually happen that I couldn't control it once, and it was mortifying but also strangely releasing, as I was less stressed afterwards, the worst had happened and people were only kind to me.
b) since starting a new job in new country and having a child I have not had it happen once. No idea how - maybe just so much else on my mind most of the time there's no space for it now.

Really hope you can get the care you need for the birth and afterwards in dealing with this issue- maybe consider psychotherapy, CBT for coping mechanisms might not be enough if this has deep causes.

I understand your fears, I have had 2 EMCS s and with the second it was a fear of what might happen to my existing continence issues that tipped the balance between a forceps attempt and the CS. Not everyone has understood my choice and I felt a lot of pressure to try and continue with my VBAC but 6 months on I am still glad I held my ground and refused to give consent for forceps.

I would recommend asking to have an appointment with the supervisor of midwives. They can be very useful, with ours she had the time to go through my concerns and issues, which the doctor didn't, but had the power to 'interpret' the hospitals policies which my normal midwife was following. They will help you to construct a birth plan which you both agree to and can arrange any 'sign offs' with the doctors if needed.

You've had a lot of good advice here, but I wanted to add that most antenatal units have midwives who specialise in looking after women with mental health issues like the ones you have described. Your midwife or hospital consultant should be able to refer you to them. They can act as an advocate for you during your pregnancy and birth and be with you during whatever birth you have.

"I absolutely agree you are entitled to a section"

The OP should be considered for a c/s on mental health grounds. However - nobody is entitled to a c/s. NICE guidance describes best practice, but it's guidance and hospitals/doctors don't have to adhere to the recommendations. :-(

Sadly this is happening across the NHS and not just in maternity.

That said, I think the OP stands a very very good chance of getting consent for a c/s, especially if she gets the supervisor of m/w's involved in her care.

Oh, and listen to RedToothBrush! She is spot on.

:-)

As an aside I have the HSV virus. It was never flagged as an issue with both my births (both VB). My understanding is that it's the same virus but that genital herpes is highly unlikely to be spontaneous so unless you have had herpes it's not much of a risk. As others have said it's worth seeking clarification or getting medically accurate info. I might be wrong of course but that was my experience of giving birth as an HSV sufferer. Good luck and I hope you get the support you need.

No flaming. You have had some excellent advice here (especially RedToothBrush) which is definitely worth following. Once you have agreed a plan with the consultant (assuming its an ELCS), I would start thinking about aftercare. Speaking from experience (I had an emergency c-section), you will be knackered, recovering from major surgery and looking after a small baby. Even doing something as simple as walking up the stairs will be painful to begin with. So, start thinking about support, easy freezer meals and (if you can afford it) a cleaner or mother's help for a few hours each week.