Can I insist on a c.s. rather than a vbac or am I at the mercy of whichever midwife is at the vbac clinic/on duty when I go into labour?

[MrsFogi]

I had an emergency c.s with dd1 and am due in a few weeks with dd2. I've read the vbac leaflet and done my own research and decided I wish to have a c.s. rather than a vbac. However, I went to the vbac clinic yesterday and the mw clearly thought I had made the wrong decision (not least for her statistics) so tried to give me a date for a c.s. at 41 weeks (!). When asked what would happen if I went into labour before that I was told that on arrival at hospital the expectation would be that I'd labour unless it was decided otherwise at the time. To me this is effectively saying we're giving you the choice between a c.s. and a vbac but if you chose a c.s. we're going to ignore your decision. I'm really very annoyed and would be very grateful if anyone knows anything about my rights in this situation and for views on how I should try to sort this out as I really don't wish to be in labour arguing for a c.s. I'd prefer to have it sorted out beforehand.

If you are absolutely sure this is what you want I think you may have to make an appointment with your consultant. BUT be prepared for a battle. Mine told me pretty much i was having a vbac (which is what i wanted but he didn't know that) I almost wanted to argue with him for just being so arrogant. If you want any (honest)advice on vbac rather than the rather dry literature they give you I'd be happy to chat with you. I promise I'm not pressuring - genuine friendly offer if you would like.

the NICE guidelines say that maternal preferences is one of the factors they should consider, so they can't just ignore you.

(Pg94)

"The risks and benefits of vaginal birth after CS compared with repeat CS are uncertain.
Therefore the decision about mode of birth after a previous CS should take into
consideration:
? maternal preferences and priorities
? a general discussion of the overall risks and benefits of CS
? risk of uterine rupture
? risk of perinatal mortality and morbidity."

Thanks mistypeaks, I've really done my research and made up my mind given that I had an abruption of the placenta last time I'm just not willing to take the risk this time now that I've looked into it and given my experience of how it was handled last time. Does anyone know how I get to see the consultant though, do I just call up and demand to see him?

what betsy said !

also, the chances of you having a succesful VBAC, when you are not in the right frame of mind, and don;t want one, make it unlikely you will have a positive birth experience. Do you have a named consultant, you should do if you have had previous c.s... ask to speak to his sec, and make an appointment..

not the MWs decision to make, and she should be supporting you as you have clearly made a decision, and there is no ambiguity on what you want

what lulumama said. Good Luck.

I agree that you should see a consultant. I had an elective CS for DD (she was a transverse lie - across my womb). When I was pregnant with DS, the MW made it clear that she favoured VBAC and gave me some literature (which I was unconvinced by). When I saw one of the consultants (at about 34 weeks, I think), I prepared myself for a battle. But her attitude was the opposite. She tentatively suggested that I might not want a VBAC and said that it would be my decision. She seemed to think that I might be very pro-VBAC. In fact, I'd already decided that I wanted a another CS, and so that was the end of the discussion. So you might find the consultant takes a different attitude. If not - well, it sounds as if you should be the one to decide.

MrsF, a cs date at 41 weeks is NOT an elective. The mw is trying to fob you off into having a VBAC, as you have said.

Go to see the consultant.

They should book you in for 39 weeks. Be firm and strong. I mean you had placental abruption ffs! I would just ask the consultant to guarantee that there would be no risks if you had to deliver vaginally so that you can record them in your maternity notes. If they cannot (and they won't ), then say you have no choice but to go for an elective cs because you will hold the hospital responsible if anything goes wrong with a VBAC.

LITIGATION.

I was given the option, and opted for a second section. My date was at 39 weeks, in the end it was brought forward as my pre-eclampsia was getting worse.

I thought everyone who'd had a previous cs was entitled to a cs at 39 weeks if they wanted one? Certainly that's how I was treated. My consultant booked me in for 39 weeks and said if I arrived at the hospital in labour before that date, they would do a section.

Mrs Fogi, ask to see your consultant now and be really firm about what you want.

No - it's not once a section always a section - the only reason for an automatic repeat is for women who have had a fractured pelvis and been pinned and surprise surprise for previous abruption - most consultants would go with that because your risk of another abruption rockets if you've already had one . Other than that, most things are none recurring, thought they'd be careful if you'd had pre eclampsia and were having a second child with the same partner.
The NICE guidelines are pretty misleading - all they really considered was the possibility of complications in labour - forgetting that many of them were caused by the habit of bullying VBAC women into continous monitoring, early epidurals and augmentation .They did not consider what they call 'morbidity' and general satisfaction , or the spiralling effect that having more than one C/S has on the risk of having to have a hysterectomy, or the risks to the baby of being born at 38 weeks (they are several times more likely to need special care for breathing problems than babies born at 40+ weeks).
So it's not a case of being forced into VBAC - it is safer if you're previous one was for a none recurring reason -obviously the odds are different and you'd be a bit bonkers not to if the other option is a crash section you knew you might need anyway.
BTW In law, no one has the right to demand a section for no reason, the same way as you could not go into hospital and demand they saw your leg off!
Lisa x