Elective CS or Natural?

[JlouiseR]

Hoping someone can offer me some advice! I am currently 35 weeks with my second baby boy. Due mid November and mid pandemic. I suffer with very bad anxiety among other things and I am contemplating an elective c-section.

My first birth wasn't straight forward in any sense. Planned a midwife unit let birth with just G&A however I ended up stuck at 8.5cm (transition stage and also one of the most painful stages) for over 12 hours with very strong contractions coming very close together. I didn't receive an epidural till I was 9cm and 10 hours into transition stage (one of the most terrifying experiences of my life getting it done between constant 9cm contractions) I also had involuntary pushing for about 6 hours which was exhausting.
My son ended up getting distressed and had Meconium (required additional monitoring)
My front waters didn't break so they had to assist there. They gave me the induction hormones right at the end to kick start that last cm and get him out.
I was literally minutes off an emergency c-section and was given 5 minutes for things to progress. Thankfully they did and my son arrived shortly after. He wasn't small and weighed in at over 8.5lbs
I ended up in ketosis, tachycardia, had excessive bleeding and a jagged placenta.

Overall not at all what I had planned but at least he arrived and was healthy. This time round I planned to have the birth in labour ward (rather than Midwife led) as I want the support from the beginning if I needed it.

HOWEVER,
I have my concerns about labouring naturally with my second son due in a few weeks. He was on the 97th percentile line up until I hit about 30 weeks and now he has jumped well above the 97th percentile line. I am 35 weeks and he is already estimated to be 8lbs!! Midwife said she wont offer a sweep until 41 weeks or an induction till 42 weeks. If I go to my due date he is estimated to be between 13-15lbs based on his accelerated growth?! (I cant even get my head round that).
Obviously I have my concerns about this and especially so because of my previous labour. However my midwife doesn't seem at all concerned. She believes I should try to labour naturally and "what will be will be" . She is also not giving me any growth scans due to COVID although has said several times "if covid wasn't about I would have sent you for one weeks ago" just adds annoyance more than anything.

I am questioning whether to request an elective CS due to previous complications and also the fact I could well be growing the Incredible Hulk. Although midwife doesn't seem to even acknowledge CS as an option.

Just to add I am only 5ft1 average build, my husband is 6ft 4 (not sure if it makes any difference)

Looking for some advice on what other people would do in my situation, try natural and risk complications and a possible emergency CS or try and request an elective based on previous experience?

p.s sorry for the life story ;)

C section all the way.

I had a c-section and could have been out the next day but I stayed for help with breastfeeding

@JlouiseR i has my ELCS during covid lockdown, I was in 24 hours. I think it’s standard practice anyway to get you out quickly after a section these days but with covid added in since we were both medically well and happy to go they let me out the next morning (baby born 9.30 one morning and home at 10 the next morning). Equally if I had wanted to stay in for BF support etc that was an option too. I actually ended up in for 8 days after my first for drips etc so I know exactly what you mean! My bump was 49cm at 37 weeks (I’m 4’11’m so a complete shorty!) which wouldn’t even plot on the growth chart so please try not to worry too much about fundal height!

@Mylittlesandwich thanks for letting me know :) !

@Itsalwayssunnyupnorth im hoping this is the case! I need to mention it to the midwife but i'm now worried its going to be too late to go down the elective route, next appointment is at 37 weeks on Tuesday.

Thought I would pop on a quick update :) . I ended up asking for a phone call so I could get the ball rolling ASAP.

Just got off the phone to my midwife, she basically said she would send for a referral to a consultant for elective but said that she thinks they will refuse because there aren't any medical grounds. She mentioned that they would just essentially try to talk me out of it/really wont do it at the moment because of everything that's going on. Theres no medical need for it so its not essential =/ .
The fact i'm almost 37 weeks was also mentioned so its a bit of a time crunch (although if they were to find out baby was breech then I would have been planned in for an elective anyway? ) so I don't think time should be an issue . She's going to send the referral off for me today anyway and i'll have to see whether anything comes from it. As it stands I currently have no choice but to try and labour naturally and see whether it ends in an emergency section based on his size =/ or whether it goes smoothly.

We talked quickly about the growth scan how it was refused due to Covid. So there was no surprises there, she wasn't surprised they refused it because it was only accelerated growth and not slowed.

A shame that the NHS are so stretched at the moment =/ . I have my 37 week appointment on Tuesday with a different midwife (mines now off for up to 2 weeks) so she said to bring it up again then. Im just hoping that there's enough grounds for them to accept me, based on a history of poor mental health, a bit of a complicated previous delivery, SPD & sciatica and a possible giant baby.

Which part of the country are you in, is it Tier 1, 2 or 3?

Covid is not an excuse to deny women appropriate maternity care, and restrictions have to be proportionate, so unless you're in a tier 3 area, I don't see how on earth they could justify denying you a growth scan and an ELCS if that's what you want.

I had a growth scan in August, and plenty of women throughout the country are having scans as and when they need them.

I strongly advise you to contact PALS about the growth scan.

Also if you definitely want an ELCS see www.birthrights.org.uk/factsheets/right-to-a-c-section/

@NameChange30 i'm in the south west, and Tier 1, so not in any form of lockdown etc. I think they are using it as an excuse in a lot of areas to do the bare minimum =/ which really frustrates me.

Ive had a look on the birthrights page, I will be mentioning the NICE guidelines etc if they agree to see me. And they refuse to even see me then I would like to refer to a consultant who will. I just think they will keep delaying it until I go naturally anyway because i'm already pretty much at term. It's a waiting game for them. If they can prolong it then they don't need to deal with it =/.

Yeah I have heard of tons of people getting them. Just seems i'm having the worst luck this time round and they have an excuse to brush it under the rug.
Thanks for the PALS recommendation, If they refuse to even consider it I think I will ring them as soon as I know, but from the sounds of it I might not even get told if they refuse the referral (like I didn't get told my growth scan was rejected, they just didn't contact me) certainly doesn't help the anxiety being completely in the dark!

I am saying you should contact PALS now about the fact that your midwife referred you for a growth scan (but dragged her heels with it) and you never even heard anything. You should ask for a growth scan ASAP.

Unfortunately you can't afford to be passive about any of this, you need to kick up a stink and raise a complaint if you are going to get anywhere. You don't have time to wait and see.

Also you might be interested in the campaign #ButNotMaternity
www.thedouladirectory.com/butnotmaternitycampaign
They are on social media, I've been following the Facebook page and recent posts include what to do and who to contact about your maternity care, they are also looking for people who would be willing to share their stories, to help the campaign.

Another one saying elective section here! I had a traumatic first birth and severe tearing so was offered a section for my second and it really was a lovely experience. Worlds apart from the shit show blood bath that was my first.
It’s so much more controlled and peaceful and in my option safer for everyone

Midwife appointment with a different midwife is booked in for tomorrow. I think that will hopefully help clear a lot up.

@NameChange30 yes I signed the petition months ago :) hopefully something comes from it although it wont be in time for my birth. But still not right the way they have gone about maternity restrictions in this whole situation.

I have had a text through today from the antenatal team at the hospital to say they have booked me in for 2 urgent referral appointments with 2 different consultants. One is on this Thursday and one is on the 2nd (i'm not sure why there are 2?).

So that's a start at least, they accepted the referrals, just don't know yet if they will accept the request for an elective. They are video appointments as well. I will be 38 weeks by the second appointment so cutting it very fine.

Promising update! Glad you will be seeing a different midwife, hopefully she'll be more helpful. And hopefully the consultants will be too. Good luck!

Great to hear you are seeing consultants. Let us know how it goes.

WELL!! back from my midwife appointment, things went a bit crazy.

The midwife thinks he's breech, foot first AND back to back. Very much not ideal!
She also did his measurement and he hasn't grown at all in 2 weeks.

So i've been asked to attend the maternity unit for a positioning scan ASAP first thing tomorrow and also been sent for another referral for a growth scan.
But the midwife said that they could well deliver him in the next day or 2 depending on what the scan shows! Not the news I was expecting this morning!

Hmmm. I'm suspicious of fundal height measurements as they can be inexact. If the other midwife measured slightly over 2 weeks ago, and this midwife measured slightly under today, then it could look like there has been no growth. Also i would have thought there would be some variation in bump size not caused by size of baby but by other factors eg volume of amniotic fluid, position of baby etc... I'm not sure though and if it was me I'd do more research on it.

Anyway see how the scan goes, I think they can check things like blood flow to/from the placenta to make sure that is all ok.

For advice on encouraging baby into a better position see www.spinningbabies.com/pregnancy-birth/baby-position/breech/
(Not sure whether a breech baby can turn at this late stage?? But maybe?!)

Anyway if baby is breech and stays that way, you won't have any trouble getting an ELCS if that's what you want!

Good luck for tomorrow.

@NameChange30 yeah that's exactly what I was thinking! he stayed on the 97th line for ages and then as soon as my midwife measured me he jumped up for all her measurements. The one from the midwife today was bang on the 97th percentile line again.
So I think maybe my midwife just measured me different to the 4 or so other midwives that are all on the same growth curve.

Did make me think about his positioning though, as again every other midwife that has seen me throughout my pregnancy all said breech (even those who have seen me at the later stages of pregnancy in triage etc) and she was the only one who said he was head down. So we will see.
The midwife today was a lot more realistic about the fact I could need a c-section for his size/position ect hence getting me in for an urgent scan. She thinks hes feet first, which he was at my last scan as well.

Thank you, ill keep updated :)

Good luck today and I'll be interested to hear your update.

Just got back baby is head down, just a bit wonky haha. So pretty much in the right place. They are happy to let him carry on naturally anyway.

I also got a call just now from the scan department to do a growth scan! so all seems to be happening all at once! But moving in the right direction.
Midwife Tuesday, positioning scan Wednesday, growth scan and consultant appointment Thursday.

First consultant appointment is tomorrow.Depending on how the growth scan goes I think I might mention the "Flo-chart" type option commented above. If I get any signs of stalling then try to have plans in place for a c-section. If not then at the very least I would like to push for an earlier sweep that 41 weeks!

That's really positive and sounds like you have a full diary ahead of you. Keep us posted! And what a relief.

well, not the news I was hoping for.
I had my growth scan this morning. He is measuring exactly where the fundal height chart measures. So he's currently sitting at 8.7lbs approximately at 37 weeks.

He is measuring at 41.2 weeks, 3 weeks ahead for size and weight. His stomach circumference was so big she measured 3 times to be sure. when plotted hes looking to be about 130th percentile for stomach, crazy! he is well above the 95th for weight as well. She said you can see he's chunky.

Then had my consultant appointment, he didn't actually let me talk before he had said no to the elective request. He said I had no case for it and that a natural labour is how they are proceeding. If I need a c-section on the labour day or he turns then they will do one. But only if essential/emergency.
He said he doesn't know why the other appointment was made and to cancel it, and that I will continue with regular midwife care from here.

So as it stands:

i've had a position scan - hes head down
growth scan - chunky baby at 3 weeks ahead (matches fundal height)
elective - no go

How are you feeling about it all?
It's not good that the consultant didn't listen to you at all
Don't cancel the other appointment, keep it and if it's with a different consultant you'll have another opportunity to discuss your options.

@NameChange30 Sorry for the delay! Ive been feeling pretty peeved with it all to be honest. Just very frustrated.
My midwife still hasn't returned back so i've been without a midwife for the last month+ of my pregnancy which isn't ideal.

Still very much pregnant and now overdue, I had an appointment for a sweep at 40 weeks but they didn't do it because baby cant engage. My body is ready apparently but the baby isn't. So Im booked in for another sweep at 41 weeks =/ . So it just seems they got exactly what they wanted to be honest for me to have a natural birth with a sweep at 41 weeks. Regardless of the history/way this baby is looking to measure & position.

To add to it, baby is very much back to back so that doesn't help. My SPD is horrendous and no matter how much I try to encourage him down the baby is having none of it.

At my last appointment on Monday the midwife told me how big hes looking etc and that hes OP "so its good that hes not engaged yet because then I would have a back to back baby" but at this point the more overdue I go the bigger he is sooo, its a bit of a catch 22 to be honest.

They briefly mentioned that they would induce at 40+12, but she made no plan to book anything in or plan a date etc. Im hoping to avoid induction entirely as I really don't want a big baby/OP/induction labour

Trying to stay positive but it is very hard when the odds are stacking against me.

I'd be continuing to argue for a section if I were you. Ask for a second opinion. If they refused they should have offered to pass you to another doctor who may have been willing to be more sympathetic.

I had a back to back. My DD’s head position wasn’t ideal for labour. I wish I could have had an elective. I feel like jumping up and down and demand that they listen to you and agree to it.