Back from patronising birth choices clinic

[Popeye44]

Hello,

I’m due my second DC in 4 weeks, my first birth was a couple of years ago and was hell, both delivery and recovery.

I was adamant that I would be open to a vaginal birth again and that I would try to relax and let nature take its course however in the last couple of weeks after talking to my community midwife who is lovely, has referred me back to the birth choices clinic (today was my second appointment there). Basically I want an ELC under the grounds that I had a large baby at 9lb 6oz back to back long drawn out delivery, episiotomy,failed epidural and vacuum delivery. The episiotomy has never healed properly I find intercourse very painful, even before I had my first it was painful so there is an underlying issue with my vagina anyway which I had to see a consultant for a year after my first child in outpatients.

This is the thing though, after explaining my problems I was completely shut down again today and told that I was putting myself at harm by having an ELC. I understand it is a very serious surgery with obvious risks that I have read about on the RCOG website and also on the NICE website. I am still in my early 20’s and the consultant has basically told me she will not be happy signing the consent form alone as I may want to have ‘5 children’ which I told her I did not. She continued to tell me she would have granted it if this was my second child and I was 40.
So the over exaggerating of the risks today was pointless after stating this.

-She told me all first births are difficult (I understand)
-if I went on to have further children they could be stillborn (I understand the risk but the way she said it was ridiculous)
-I wouldn’t be in pain after my second birth as she could gurantee it, and that I would not have to get another episiotomy if a senior midwife was on shift

Basically throwing around facts guaranteeing I would find the birth a guaranteed success and that I would regret an ELC

I have been referred to see another consultant this Thursday to try and convince me into the natural birth with a detailed birth plan

Sorry for the waffle, has anyone been through anything similar I stood my ground today but I found it so hard to get my point across and came away feeling very stupid

This is bizarre. Usually you'd have to fight for a VBAC - which in itself holds quite serious risks.

They can only refuse you if it is entirely elective with no medical indication - and even then they have to refer you to a second HCP who has to approve after makjng sure you are informed of risks.

A previous CSection is a major medical indication. I would write a formal complaint to the Trust, the PALS section and the Head of Midwives and inform them that you are putting them on notice for legal action should you be forced to undergo a VBAC against your will and anything happens to yourself or your baby.

This is not a "vanity" request. Uterine rupture is a very real risk. 1 in 200. And VBAC is not guaranteed. According to the Royal College of Obstetricians and Gynaecologists, 1 in 4 women who attempt a VBAC will end up having an emergency c-section anyway. They can't force you to take on any risks that you are not happy to take on.

This is the Official RCOG "birth after previous caesarean" guideline: www.rcog.org.uk/globalassets/documents/guidelines/gtg_45.pdf
It gives good impartial information on VBAC and ERCS (elective repeat csection), and is the guide that all obstetrician have to abide by. I don't see anywhere on here that they are allowed to refuse an ERCS. They have to give you the option of a VBAC if you qualify for that, but the refusal is yours to make if you want to.

They can’t stop you having a caesarean if that is what you want.
You need to stay firm and adamant, tell them that you are not willing to risk your mental health by having a natural second delivery and that if they keep this up you will be putting in a complaint to the trust.
They can push this through on mental health grounds if nothing else.
Telling you you’re going to have a stillborn child is ridiculous.
Well done OP for standing by the choice YOU WANT

Just need to repeat this: Yours is NOT an elective request with no medical indication. Your medical indication is a previous traumatic labour and emergency csection.

Oh and you should've been given this leaflet. Show it to your next consultant. It makes it quite plain that wanting an ERCS is quite normal and tell her that you are prepared to make complaints to the RcoG about the consulants refusing you a choice of ERCS and violating RCOG guidelines.

www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-birth-options-after-previous-caesarean-section.pdf

@Liefievd I never had a c-section, a traumatic Labour with an episiotomy that what infected for 12 weeks that is still very painful and never fused together properly even more so with the baby’s pressure on it. When I first went into the appointment she said she needed to see my after birth (I hope it’s not her) to see about the scar as I’ve always found intercourse painful (likely vaginismus) so she contradicts herself in the sense that if I tear again it’s going to be a nightmare with more scar tissue on top of that makes sense?

@Oly yes she started out saying it was up to me but then kept getting more persistent she wasn’t happy and that she felt she was ‘harming me’

Hi Popeye, I sympathize completely with your situation. I have had a ELCS agreed due to a previous traumatic delivery. I'm having my baby next week.

I'm in Australia so policies may be slightly different, but in my case I was referred to a clinical psychologist who diagnosed me with PTSD and secondary tokophobia as a result of my first delivery. this was then considered a medical need. If you are experiencing severe anxiety around the birth, can you ask to discuss this with your hospitals MH team?

Also, the comment about you having increased risk of stillbirth in future... I am 100% confident I do not want any more children (this is DC2). I have requested a tubal ligation be done during my section. This removed that argument entirely but also gave me a huge sense of relief that I don't have to go through this stress ever again! I'm not sure if you need to be a certain age to have it done though, I'm 33 so quite a bit older than you.

Pretend you're 40.

Go back and insist on a section. Just do it calmly and quietly.

Don't take any shit.

FWIW the doc sounds crackers.

Sorry OP. I read that wrong.

You still have the choice as per the NICE and RCOG guidelines. Stick to your guns.

That sounds terrible popeye. Seems like ‘birth choices clinic” means clinic where we deny you your choice in the name of ideology.

I had to fight for CS second time around too. Had a CS first time and they wanted me to go for VBAC but since my cousin had a uterine rupture and lost her baby I was absolutely not going to do that. It took all my might to get my way.

The journalist Hadley Freeman has written about this recently hence this tweet which contains a link to an org that seems to fight for genuine birth choice. mobile.twitter.com/HadleyFreeman/status/921293344155799552

Thanks everyone for your replies!

I’ll keep you updated on what happens on Thursday, fingers crossed!!

I declined info on the Birth Choices class at the Booking appointment. I happened to be in the hospital for blood tests when the registrar was sending me out the invitation anyway. I asked her not to send me the letter. It remains to be seen how much of a fight I'll have. I'm 25 weeks now and for NI people who might be interested I'm in South West Trust.
Got upset during the Booking appointment.....tears never far away when remembering it all and the failure I felt.
This is a really emotional topic and you have my every sympathy OP. Like most women a straightforward vaginal birth would be great. But not an emcs and the feelings that can bring about.

@Keep I wish you the best I really do, I’m in the Belfast Trust if it’s of any interest

That is precisely what far too many birth choices clinics are backingvocals, yes. Not all, by any means, and women who want to attempt VBAC may well find them useful. But we know that far too often, women are bullshitted and scaremongered if they've not made the 'correct' choice.

You might be right about the same consultant OP.

Thank you Popeye - wishing you well too! You sound like you have read a lot and thought this through. Your first birth sounds so tough and the aftermath so hard on you.
I forgot to tell you that at the Booking appointment the midwife (who was lovely and very sympathetic actually) warned me that without a medical reason, the Trust's current policy was not to elcs until 40 weeks + 10 days.
I came away feeling very pissed off that in my trust or maybe in NI in general they are paying only the most minor lip service to those NICE guidelines. Like they are officially listening to you, but actually they are forcing your hand into vbac by hook or by crook.
She said that it used to be 39 weeks for planned sections but that had changed and I needed to be prepared for going into labour anyway and being told it was too late to elcs. She did this in a very nice way, I should add. I haven't spoken to my cons yet about this new timeline. I understand they have targets to meet etc. and this new timeline feeds into that.

@Dione I’m sure it was, she would barely let me speak, I know there are at least 2 consultants at the clinic (both female not that it matters) I’m seeing both

@Keep that’s very scary, N.I definitely gets the shit end of the stick in regards to budget which is what it’s coming down to everyone knows

With a large dollop of misogyny too of course.

@Popeye44 dig your heels in. If no luck tomorrow ask to transfer to Antrim hospital under care of Dr Dorman! I had a full team of drs and midwives planning to put me on the drip at 38 weeks with GD, polyhydramnios and macrosomnia after 48 hours of propess and a closed cervix! First baby! Dr Dorman came in and said no you'll be getting a CS in the morning. He's the only one in this country who isn't obsessed with natural births.

I don't know if this is fully relevant to you in NI, but do google Birthrights. They have done a really excellent campaign around women's rights to elective c-sections (and respect for birth choices).

@haveagoblet @Shivery thank you for your responses, I’m very nervous tonight, going to print some research and highlight things that are relevant to me to bring tomorrow

Good luck. Stand your ground and insist on what’s best for you.

Good luck.
It must vary between trusts, I had a CAT 1 EMCS with DS1, when I became pregnant with DS2 I said I wanted a ELCS, no problem, no queries, no pressure, booked for CS, sorted. I then went on to have DD, I think it’s advised to have a ELCS after two previous sections, so again no issues, just booked in.
Recovery from an ELCS is ok, it’s sore, and you need to be careful, especially if you have a toddler, but it’s fine, and although it’s a v medicalised proceedure it was nice and calm, DH even cut the cord with DD.
I hope you get what you want.

Good luck for tomorrow, stand your ground and show them you've done your research.

It pisses me off so much how pregnant women are emotionally blackmailed and bullied into having a birth they don't want just to meet hospital targets.

I had a real fight for an elcs whilst pregnant with twins. It was hard and I ended up in tears a few times and reverted to the broken record technique.

I got it in the end, turns out of I had gone ahead with the natural birth the 3 of us wouldn't be here now. A mothers instinct is something that should be valued but unfortunately isn't.