Should I push for a CS?

[Rockandrollwithit]

Hi everyone,

I'm currently 23 weeks pregnant with DS2, very excited to meet him. As I'm high risk, my care is consultant led and I've had conflicting advice from midwives about the birth. I'm due to have an appointment with the consultant soon and don't know whether I should push for a CS or not. Here are my issues:

-previous birth was epistiotomy and forceps.

• I had a third degree external tear and internal tearing from my bladder all the way down.
• blood loss of 3 litres requiring 3 blood transfusions.
• due to the blood loss, I had to have a vaginal pack and was unable to move for the first 24 hours. I found this awful. The blood loss also made me very ill for quite some time after.
• I developed PND and also some hallucinations, although never diagnosed with psychosis. I'm sure about the birth had a role to play in this.

-physically I recovered well considering what had happened. No continence issues.

• this one is unrelated to me but my sister had a series of heart attacks following the birth of her DC2 and had to have open heart surgery.

She is lucky to be here. I'm terrified this could happen to me, although logically I know it's not related at all.

I'm really worried about the birth and literally feel terrified every time I think about it. I'm not convinced requesting a CS would make it better, or even if I would be allowed one.

If you were me, what would you do?

Firstly, always remember that MWs are not your friends and they are unlikely to recommend a section. MW, IME, can be very dismissive of any concerns regarding births (just like pain relief in labour, but that's another thread).

Secondly, get informed. Do your research on what you need to do and say to get your section. If a consultant says no, demand another consultant.

It makes me really angry when I hear stories about midwives being dismissive of c-sections. Please ignore them OP and do what's right for you. I recently had an ELCS due to complications - I could have had an induction but after doing some research decided it might still end up in a CS so why tire myself out first.

You've been through a traumatic experience and there's no need to take risks when a CS is available. As my DH put it, at least with a CS we were dealing with "known unknowns" rather than "unknown unknowns" (in terms of the myriad of things that could go wrong).

I'd expect the consultant to be recommending a c section for you, never mind you pushing (har har) for it.
Do you see the same midwife every time? Can you ask to change? Some of them are so into the whole natural thing that they can't hear reason, but I've also encountered some really good, empathetic ones.

It is true, every birth is different. However, you will be offered an ELCS for previous 3rd degree tear. There shouldn't be a fight.
I wouldn't push for an earlier consultant appt either, no need really

It seems to me that midwives and hospitals in general have targets to meet regarding limiting cs. Everyone they talk "out of" is closer to their target. Please correct me if I am wrong.

If I am correct (and I am prepared to be told I am wrong) your obvious requirement is not as important to them as the target.

Your first experience sounds very tough indeed. It does sound like you'd be an appropriate candidate for an ELCS. I had one after an EMCS and found it straightforward.

Equally important, though, is your mental health - and I think it's concerning that you are not being properly supported after your previous experience. Keep talking to midwives and doctors to flag up your concerns. You do not want to leave this till after the baby comes (I say this from experience of having to navigate the NHS while in the midst of PND, got there in the end but not easy). Good luck.

It is quite right there is a discussion on sections. There are obviously time and resource implications to each one. Not to mention the risks and recovery times of a straightforward natural birth are a lot lower than with a section.

Nevertheless previous births must be taken into consideration. Horrific previous experience makes the chances of a straightforward birth a lot less likely and add to that he psychological impact and the balance starts to tip on the other direction.

Sorry but why did your sis have a series of heart attacks? That sounds terrifying. I'm glad she is ok.

Your first birth sounds traumatic I don't blame you for feeling the way you do. Push for a c section then maybe speak to an experienced doula to see about a more natural birth, discuss your first experience and see what someone who has seen many women birth in many ways suggests. It might help put your mind to rest that you have made the right choice with the c section or you might think well that sounds great I could try that. It would be good to unburden yourself of the trauma of dc1 so that whatever you chose you are not carrying any negativity linked to your previous experiences. A good doula will help you with that and won't try and sway your decisions only empower you in the ones you have made.

Radishal you're right that hospitals have targets. I think they're based on the WHO recommendation that mums and babies have the best outcomes when the 10% of women who most need a c-section, get one. Beyond 10% there's no noticeable improvement in women's/ babies' wellbeing. (Not that any UK hospital has a 10% target; they're probably in the 20s.)
So the targets aren't just based on cost / resourcing for the hospital, although that obviously comes into play too. But they're also based on research into women's wellbeing.
Either way I'd say the OP would meet any hospitals "criteria" even one that's really trying to bring their c section rate down.

It sounds like your birth was pretty traumatic. If I was you I'd be asking for a c section. Good luck

Also OP have you looked into perinatal counselling and whether that is accessible via your hospital? I've had some quite excellent MH support to address and manage anxiety, and have found it quite helpful in keeping my anxiety during this pregnancy as low as I can. You can ask your MW for a referral I believe. In my case my GP referred me to a Link support worker who found out directly from the hospital what services I could access.

fernanie WHO no longer has a recommendation for an "ideal" percentage of caesarians as they have recognised targets should be based on meeting individual needs. They changed their guidelines in 2015. No hospital should be trying to limit their rate of cs purely based on numbers but sadly some still do.

Thanks so much for all of the replies, they have honestly made me feel a lot better. To clarify, I did have counselling to address the birth afterwards but being pregnant again has bought it all back up. I am under the care of the perinatal mental health team but struggling to actually get an appointment to see someone. I'm going to request via email rather than phoning this time so there is a paper trail as I feel a bit ignored. I will go to my GP if I get no further in the next few weeks.

Someone asked about my sister, they believe that her heart was damaged during birth and this resulted in the heart attacks under a month later. Apparently this is very rare but does happen after childbirth sometimes.

I see a different midwife every visit. The midwife who I saw for my booking in appointment was lovely and really took my worries seriously. The more recent ones haven't been as good but I know that it's not them making the decision so I will ignore that. The comments on here have made me feel reassured that I'm not being overly demanding in wanting a CS. My husband is able to attend the consultant appointment with me and will be a good advocate so that's positive.

I will try to put it out of my mind until 34 weeks. Thanks again for your lovely comments, it really has made me feel better.

sunmerlovingirl that's really appalling that the consultant wasn't 'allowed' to recommend you to have a c-section when clearly it was the safest option for you! Surely patient safety has to play some part, however anti-section the NHS is?