Elective c section

[lauralou172]

Got my consultant midwife mode of birth appointment on Wednesday at the jr to discuss the possibility of having an elective c section...the last few days I’ve been so anxious about the appointment I’m unsure what they are going to say and if they will see my point of view and let me have one based on previous birth...induced, emergency forceps, large amount of blood lose, 3rd degree tear resulting in Physio therapy post birth.
Anyone had any experience with this?

Where abouts areyou based?

I had a 3rd degree tear 6 months ago. Forcep birth & episiotomy etc. I’ve had several follow up appointments at the hospital because of my injury. An the consultant at the perineal clinic advised after the tests to check on the healing of the spincter I’m having done they will write to me and inform me an advise whats for the best re second birth. Either c section or vaginally develivery based on how I’ve healed. But she stressed whatever the letter said. I still have the right to make a choose. So they were very accepting of a c section for a second birth due to mental trauma.

Did you have any follow ups? I don’t believe you will have any issue getting an elective c section at all. Just state all your points and I’m most certain they will agree.

Hi I'm in Oxfordshire where they don't like to do elcs on maternal request but I'm hoping mine is medical. Yes I had a follow up where consultant said all had healed well but I also had to have Physio therapy as well. X

Hi. In a kind of similar position. Saw midwife last week and when I explained the birth and my terrible recovery (things didn’t heal very well and I do still have some lingering issues) she immediately said c section was best for preserving future continence. I was all ready for a fight that never happened. Just be clear that you understand the long term issues of suffering 2 3rd degree tears and that ultimately it’s you that has to live such things, not them - so it really is your decision.

I'm 31 weeks and have been having counselling for labour anxiety due to previous trauma for 3 months. Today I'm seeing my midwife and will be requesting an elective (she said she'd like me to decide how I want to proceed by today). The counselling has helped me deal with what happened previously but not enough to get over my anxiety to go through a vaginal birth again. I'm hoping they will agree without a fuss as I have now done everything they have asked of me.

Previous trauma and anxiety are both valid reasons to request a c section.

Got my appointment tomorrow, are there anything that I should write down so I don't forget to mention or need to ask etc?? Xx

@lauralou172 Yes I’m pretty sure yours would be classed as medical.

I would just make sure you state all your reasons for wanting one. An I’m certain they won’t refuse. Just be adamant about it.
I.e my list would be
Traumatic delivery
Forcep delivery which caused 3rd degree tear
Months of healing & recovery
Physiotherapy for months afterwards to correct what was messed up & scar tissue
Mental health suffered due to injury an don’t want a repeat of that again
ELCS is a controlled environment (as much as it can be)
Vaginal birth is totally unpredictable.

All of those grounds are entirely worthy of asking for ELCS. I know for a fact they would do it for mental health alone. Let alone risk of further problems and if you’ve had physio etc for months to resolve issues.

Good luck. Let us know what they say 🤞🏻🤞🏻

Hi.
Here is a link to the greentop guidelines on 3rd/4th degree tears . There is a part on future deliveries.

**All women who have sustained OASIS in a previous pregnancy and who are symptomatic or have abnormal endoanal ultrasonography and/or manometry should be counselled regarding the option of elective caesarean birth.

www.rcog.org.uk/globalassets/documents/guidelines/gtg-29.pdf

Then there are the NICE guidelines which all NHS hospitals follow. See point 1.2.9.5

www.nice.org.uk/guidance/cg132/chapter/1-Guidance#planned-cs

**1.2.9.5 For women requesting a CS, if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned CS. [new 2011]

There is also a paper written by Croydon hospital which I can email to you if you pm me. I can’t find a link online but do have a copy

If you still have any lingering symptoms highlight this (frustrating that you should have to do this as not having symptoms now doesn’t mean another birth wouldn’t contribute to them arriving)

Best of luck, I really hope you get the support you deserve xx

Hey! How did it go?

I'm following as I could have written the post myself (everything exactly the same except I had episiotomy instead of tearing). It's fairly early days for me (15 weeks) but after such a horrible first labour I really hope I can go down this route too. I hope you get what you wanted

Been to my hospital appointment. She doesn’t seem to think they will let me have a section as what happened last time was down to being induced and Chloe’s position and may not happen again next time around, my old notes have letter from doc in after follow up of stitches saying it had repaired well and would be able to birth naturally next time, ask she thinks the consultant will say the risks of c section are greater than that of me having a natural birth and they don’t do sections on maternal request. I’ve got another consultant appointment on 7th September for a definite yes or no but it’s not looking likely.
My only other option is to go to another trust e.g Gloucestershire and speak to a consultant there but she said they may not agree either. Xx

I’m sorry it didn’t go as well as you’d hoped. This really annoys me because it’s not the midwives decision at all- consultant will make the call so don’t give up hope. It’s your body and you are the one that had to go through a third degree tear with your first. I’m not trying to scare you (many many women want a natural birth after a 3rd degree tear and I respect that completely) but risk of having a second one is 4-7% (One consultant told me it’s much higher) so I don’t understand why they wouldn’t listen to your rational for wanting to avoid that risk altogether.

C sections have different risks yes but your continence / future is not compromised with this delivery choice.

Also, what the midwife is saying regarding your daughters position and being induced being to blame for the tear is simply not true. They really don’t know why some women tear badly and others don’t. They know larger babies, prolonged pushing and instruments increase the risk. I had a normal sized baby (big head tho!) no epidural or forceps and still got one so no one really knows and they can’t say with certainty the same won’t happen again.

Sorry for the rant but this annoys me so much. I do understand (don’t agree but understand ) the nhs not wanting /being reluctant to offer c sections for first time moms but if you’ve proven your pelvic floor didn’t do very well first time why make you go through that again if it’s not what you want?

Print out the links I sent earlier and highlight the nice guidelines section for consultant meeting .

Tumon - please can you PM me Croydon paper

You need to be tough - it isn't about them letting you have a C section. You need to tell them what you want.

Maternal request - pfff - tell them you risk having significant MH issues and anxiety for the rest of your pregnancy.

Hi op I’m in a similar position.
Nice guidelines say that if a consultant doesn’t agree that they will plan a cs for you they should refer you to a consultant who will.
Tell them that you know this. Tell them if they won’t support you or refer you to someone else who will, they are not adhering to best practice guidelines. Tell them if they refuse to do this you will be going to PALS. If PALs can’t help you then will go to complaint and the birth rights organisation.

Tell them that if there is further physical damage to you or your mental health deteriorates after being forced to have a birth that you don’t consent to, you will be seeking legal advice.
Tell them that it is a Human right to have a say in circumstances in which you give birth (see birth rights website).

Also I’d advise you read up on the risks of sections and make sure they know that you know the pros and cons of each mode of delivery.

At the end of the day all they should offer is an opinion, the choice about what happens to our body should be ours to make. We are the ones who live with the consequences if the mode of delivery we have goes wrong. and our partners and our babies who feel the effect if we are traumatised. Tell them you won’t put your family through this.

Please don’t take this lying down
Good luck to you. I hope we both get what we want.

Tumon could I be a nuisance and ask if you could pm me the Croydon paper.
May help in my battle also.
Thanks.

Hi ladies,

This is the link to the paper - you can download the pdf format on there but all the info is on this page

www.nursingtimes.net/clinical-archive/womens-health/obstetric-anal-sphincter-injury-causes-effects-and-management/7017458.article

It’s very informative. A lot of focus on preventing these tears (too late for us unfortunately !) but also addresses the psychological impact on women in this vulnerable post birth (and potentially rest of life) period.

There is a decision making tree type thing for future deliveries but it seems to focus more on women that are symptomatic so if you’re not having any issues it may not help your argument. But I don’t think that’s fair as things can change. Also don’t be afraid of focusing on the things that haven’t returned to ‘normal’ if you have any (hopefully you don’t) plus as other ppl have said it’s not just the physical side of things. Your mental health and the impact this has on your family should never be underestimated .

Also it says clearly:

“Pregnant women who have previously sustained OASIs should be helped to choose between Caesarean section and vaginal birth”

I hope this helps. So far I’ve had a good experience and have been told they will support my birth choices but I’ll have all these tools at the ready in case something changes.

I’ve spent a large sum of money on my mental and physical recovery (physio, therapy etc) from the first birth and have done a huge amount of research so happy to share as much Possible if anyone else is earlier in their journey. I know it can be a lonely and isolating road to recovery but things really can improve with time and the right help

Good luck xxx

Thanks tumon.
It is unfair that the focus is on symptoms, as it’s well known that often the true damage from childbirth (even women who haven’t had serious tears!) doesn’t come about until the menopause or later.

They never seem to push this as a risk of vaginal delivery.
I am completely fed up of fact that everything I read or am told by the nhs regarding vaginal birth seems to be biased, or downright deceitful in some cases.
I don’t doubt in the years to come there will be lawsuits regarding these issues and the information women have been provided (or as is usually the case not provided). Women just aren’t willing to put up with trading their health (and their ability to make a decision) in exchange for a healthy baby any longer.

Hi OP, I am in a similar position. Currently 24 weeks and very disappointed the consultant has said ta this stage we should go for another vaginal delivery. I've found all these comments and links very helpful, thanks @Tumon and @Chocolatepraline! All the best your your next meeting with the consultant.

I imagine this is going to be me very soon. I'm not as far as you ladies but I bet I have the same outcome. Fingers crossed we all get what we want x

Thank you ladies just seen all of your replies I will have a look through all the information later. I've got a midwife app on monday as I don't see consultant for another 3 weeks I'm going to ask to have an appointment at a different trust to see if they have the same opinion.

If you live in Oxfordshire CCG you might well have a problem if you are considering going to Gloucestershire. They may not fund you.

If this is the case, I'd strongly advise getting in touch with birthrights.org.uk

They have threatened Oxfordshires Trust and CCG with legal action, for being in breech of human rights because they are preventing women from having CS.

I've been to see the midwife this morning and she's referred me to the consultant about having a section. She was actually really supportive and didn't hesitate about referring me. She also agreed that they cannot just refuse me x

If the consultant won't perform a C-section then you have the right to ask to be referred to someone else. Be firm.

Yes its that easy and simple.
Places are ignoring the guidance and have a blanket ban.
Being firm won't necessarily get you anywhere this is the case.
Hence legal action being threatened.

Sorry it didn't go as you hoped.... I'm also in Oxfordshire (I guess you're going to the JR?).

I had a failed induction leading to caesarean... The actual experience was ok but a week later I was back in hospital with sepsis. It was terrifying and I honestly feared for my life at times (not to mention trying to care for my 6 day old son!).

I'm not trying to scare monger or anything (because the vast majority of c sections don't have complications and things can go wrong with vaginal delivery too) but it's not necessarily a straight forward option compared to vaginal delivery (though your previous experience does sound awful ). However they come out these babies we adore can cause trouble!!

If I ever have another one I'll be desperately trying to avoid a c section!!