Friend desperate for an elective C-Section, can anyone advise me how best to go about it?

[krang]

Friend who is 36wks pregnant with her first is in a bad way. Her father died two months ago, her family strongly disapprove of her having a baby with her partner (because they're not married). She had a scan last week during which the technician and midwife repeatedly told her how incredibly enormous the baby is (she is huge, it shows).

So her head is not in a good place right now and she has decided she wants a C-section. She told her MW who clucked at her and told her she should see a psychiatrist.

She is aware of all the risks, etc. I know there is a debate to me had about natural versus C-section but I would just really like to hear the best way of helping her get what she wants so she can regain some control. Any suggestions would be greatly appreciated.

hi there if theres no medical grounds for one they dont normally do it she must see the consultant asap and ask if he says no then ask to be seen by someone else hope this helps

yes, she needs to speak to an obstetrician, or head of midwifery , putting forward her reasons for wanting an elective c.section. NICE guidelines do say maternal request in itself is not a reason, but if she is psychologically struggling already, then she needs to ask.

rather than the midwife telling her how horrendously huge the baby is, she should give her confidence in her ability to do this and to give birth to a larger baby

and tell her growth scans and palpation are not 100 % reliable, many mumsnetters will attest to that

has she though about having a doula to help her get her head more sorted before the birth and to be there with her?

This happened to me. My mum died 10 weeks before dd was born. I was definitely "not in a good place" at all. In fact I was dreadful.

I don't want to go into all details here, but pregnancy changes the biochemical make up of the brain and can make emotions distorted. I was crippled with anxiety.

I requested and was imeediately offered a scetion. I was simply too anxious to cope with anything, and wanted dd to be born as quick as possible. In fact ante-natal care was brilliant, I had a "special" midwife support me from as soon as it happened, and I saw a maternal physciatrist.

Your friend's midwife sounds very unhelpful, but she MAY need to see a physciatrist, one who deals with pregnant mums would be the best, as she was the one who told me about the biochemcal changes

When you are overwhelmed by grief it should be made as easy for her as possible. If she wants a section, she should be alllowed one for medical reasons

After dd was born anxiety disappeared overnight . Hope this helps

Psychological reasons are a reason for having a section, and if she is anything like the state I was in, this should be easliy obtainable. It sounds like she needs a lot more care than just seeing a midwife

for your friend.

this happened to me also, the same loss at almost the same stage of pregnancy. My mental/physical reaction was that I started leaking large amounts of breastmilk from 6 months onwards which the GP said was because prolactin is affected by stress. I wish I had known about maternal psychiatrists (maybe this is what your friend's midwife was getting at in a not very clear way?).

In terms of practicalities, your friend would need to see a consultant setting out her medical case which would include psychological reasons. I had my third DC by Caesarean because the scans kept predicting a huge head (they were correct). My consultant tried to talk me out of a Caesarean, saying they could birth a large baby, but in the end he booked in a provisional date and made it clear that I could change my mind at any time. This might be a good option for your friend as it would give her some peace of mind and sense of control, whilst letting her grieve a bit more and have second thoughts if she wants to.

I know you don't want a debate on natural v c/s but 2 things (slightly contradictory)occur to me. Firstly, this is her first baby and a c/s does mean more complications for subsequent births. She may be making a big decision whilst not in the best state of mind. Secondly, she should perhaps get some more opinions on the size of the baby as it does sound as though she might find an emergency c/s very traumatic.

FWIW, I had a wonderful vaginal (heavily medicalised) first delivery whilst still in a state of deep grief, which I believe was very much a biochemical/hormonal experience ie a flood of very positive hormones after months of negative ones. It was very healing, but your friend may not have the same experience.

Evelina, thats why I opted for a section. If it had gone wrong, a diificult labour would have just pushed me over the edge.

However, I can understand that a good experience could be a healing process.

I had a previous difficult labour, and dd was in a sideways position, and just didn't feel yp to that at that time

Thank you very much for sharing your stories and experience, especially fizzbuzz and evelina.

It is really helpful to know that there are other people out there with similar experiences.

I had a very traumatic (natural) birth myself and I just want to do all I can to make sure friend doesn't have the same experience. I just want her to have the control I think she longs for.

camilla - I'm not sure whether she knows about doulas. I will suggest it, and thanks for the link.

Any other suggestions/experiences very much appreciated. It's all so scary when you're doing it for the first time - I remember it very well...

i certainly do a lot of on line , telephone and face to face support antenatally for women, even if i am not their birth doula, to help them get ready for the birth

i hope your friend gets a more sympathetic repsonse from who she speaks to next and has a positive birth experience

fizzbuzz, I think you did exactly the right thing purely on sideways position alone.

Glad to have helped krang, all the best for your friend. Sounds like you are a good friend to have.

If she is part of a big teaching hospital, they may have a midwife there who is trained to help with fear of birth. I was placed under the care of a midwife like this, and she was really really helpful. In fact she came into theatre with me I'm sure there are others out there

Mine went to live in Australia unfortunately

Growth scans in late pregnancy are notoriously unreliable. They told me I'd have a baby on the 99th centile 4 weeks before I gave birth. When DD was born she was exactly on the 50th centile! I think that, especially if you look big already, they estimate what their best intuition is.

Wow Fizzbuzz that's restored my faith in the NHS

Yes, it was good

BUT, I think most big teaching hospitals offer a similar thing. I'm sure your friend could access this somehow

You need a poster on here called Eleusis, or GloriainEleusis her xmas name as she has some very good tips for getting an elective on the NHS. I think she will have to be quite assertive (demand rather than ask) and show she has done her research and understands the risks. From previous posts the higher up you go in the consultant hieracrchy the more willing they are to give you an elective so needs to be quite insistent and not be fobbed off by the registrar....all of which is not easy when in a state of grief. Does she have someone to take to appointments - dp, you, a doula to be assertive for her?

Yes agree, do not let reigistrar fob you off. One tried with me and was really quite abrupt, whereas consultant was brilliant.

She needs to say, she can request one with good reason (eg pshycological), as she is copping with more than enough, and wants to be in a situation which causes her the least stress at the moment, therefore knowing exactly what is going to happen with no risk of something going wrong, eg a 20 hour labour would NOT be good for her at the moment.

If this is refused (by consultant, NOT registrar) she can ask for another opinion. ALSO, she should be referred for counselling about her fears. This is all on the NICE website somewhere. If they refuse a section WITHOUT offering counselling, they may be in trouble.....that was I was offered it

Yes, I've looked up the NICE guidelines, thanks for that recommendation. I'll be talking to her soon so may well come back with more questions for you lovely ladies if she has them. Thank you all so much.

make sure she is aware of the risk associated with c/s aswell this research was published recently news.bbc.co.uk/1/hi/health/7137945.stm

My mum also died when I was pregnant, I had a natural birth as that was safest and easiest in terms of post delievery/coping pain etc for me.

I hope your friend gets all the support she needs at this sad time. It is such a positive thing that she is bringing a new life into the world.

Just one more thing.....suffering a close bereavement in pregnancy puts you at a much higher risk of PND

Sorry to be so gloomy, but forewarned is forearmed etc

krang, I just want to make a point that no-one else has, I'm not being argumentative, so please take this the way in which it is meant!!

You say you had a traumatic birth experience, do you think that may be influencing her at all??? I mean, had you had an absolutely wonderful birth she may have felt better towards it iyswim.

I think that a pysch professional is probably her best way forward and that she should get to see one asap(a cs is usually performed at 39weeks so she doesnt have long!!).

If they agree to her cs, she needs to be prepared for it.

Unfortunately not all c-sections are the easy way out, so it could be just as horrid for her as a natural birth was for you.

If they do not agree to her cs then again, she needs to be prepared because going into either birth unprepared and expecting one to be great or the other to be terrible is not going to help her in any situation.

Hopefully seeing a professional will make her more comfortable with giving birth whichever way it happens.
Good Luck to her.

I am really suprised that no one in her ante-natal care has picked up on her, and passed it onto a more qualified professional -surely people are trained to spot and help with this sort of thing.

It all happened so easily and seamlessley for me, but I would hate to think I was just lucky, but that it should be the same for anyone else. The care I received was really what got me through, I take my hat of to the NHS here, they were amazing.

Fingers crossed for your friend