Pregnancy, midwives, trauma and C section requests.

[Peoniesandpink]

Hi all,

I've been a lurker on these boards over the years and the advice that is given is always so helpful and supportive. Please beware this is a long one but any advice around how to navigate the world of medical professionals during pregnancy would be hugely appreciated.

I found out I am pregnant (only 4/5 weeks) a few days ago. I am 38 and this is the first and only time I have ever been pregnant. Myself and my partner live together and have been together almost 3 years.

I've had a rough time with all things sex related since my early adulthood. When I was 19, I was sexually assaulted and contracted an STD. Following this I developed a vulval pain syndrome which took over my life for many years. I developed a burning, stinging sensation in my vulval and vaginal area and was unable to have sex. I sought lots of help for this as it impacted on my life significantly. I wasn't able to enjoy going out with friends, dating, I could never wear jeans, sit for long periods of time, have baths and had to avoid all scented products. Every relationship I have had has ended as my appetite for sex was very low as I was always in pain (my fiancé of 4 years left me for someone else because of this condition). I even had to leave University as the pain was impacting significantly upon my mental health. As a result, I have always suffered with anxiety and have been medicated for this at varying levels since I was 19. I recall times when I thought it would be better to end my life. I currently take the lowest dose of anti anxiety medication I have ever taken (only 10mg) and this has been confirmed by my GP to be safe in pregnancy.

I never told anyone at the time about the assault but have been to counselling and sought support since. I believe that I have come to terms with (as much as is possible) what happened to me.

I have received varying levels of support over the years from medical professionals to address the vulval pain. I have been told by doctors that 'its all in your head', 'just use lubrication', 'most women struggle with pain so put up with it' and have developed a real distrust and phobia of medical professionals and settings. I have been dismissed so many times as a young woman who had suffered an extreme trauma by people you should be able to trust.

Through my own strength, I decided not to let this ruin my life and I researched, accessed counselling, attended acupuncture, hypnotherapy, changed my diet, addressed my mental health by accessing counselling and for the past 5 or so years I have been able to have an active sex life, enjoy life and have become the happiest person I have ever been.

To add complexity to the above, my closest friend also had an extremely traumatic birth about 5 years ago and is now incontinent and this has impacted upon her mental health, relationship, she has lost her job and has become a shadow of her former self. She has times where she does not want to live. This has been difficult to see. My auntie also had two still births when she delivered vaginally when I was a child and this stays in my mind to this date.

Three years ago I met the most fantastic human and we fell in love. I had decided that I didn't want to go through having a baby due to the stresses of birth and the impact this might have upon my condition and the fear of the long-term potential impacts/risks of vaginal birth. However, since meeting him, my desire to have a baby has increased and we fell pregnant. I had decided in my head, that if I were to fall pregnant, I would have a C Section. I didn't realise at the time that this is not something you can just request and this needs to be agreed.

So here I am, four/five weeks pregnant (which I know is very early days) having panic attacks about the idea of having to give birth vaginally. I feel very low and am not sleeping properly. My mental health has dipped significantly and I have (I feel awful admitting this) considered termination, as I do not want, under any circumstances for my mental wellbeing to be affected again. My life is the happiest it has ever been and I do not think I would be able to go through with a vaginal birth without it becoming dangerous for myself and baby. The biggest fear I have is that a traumatic vaginal birth may trigger the vulval pain or cause more/worse damage.

I suppose my questions are as follows:

• Has anyone got experience of asking for a maternal elective C Section, that could support in helping me to understand the ways in which to navigate difficult medical professionals who may challenge my request?

• Does my history sound like something they may give me permission to have a C section for? What are other people's experiences?

• I think it would be useful for me to access support from the peri-natal mental health team, does the midwife have to refer me to them? Would they be more likely to be sympathetic to my early experiences?

• I understand that in most circumstances it is a consultant that has to give permission, this is usually at 30 something weeks. I don't think I could continue with this pregnancy feeling this anxious if I had to wait that long for a decision. Is there a way of having this decision made earlier?

• Does anyone know where I am able to access information on maternal request c sections have been performed in the last few years in your chosen hospital? I have seen somewhere that hospitals are highlighted as red, amber, green to show how accepting they are of this. I would be willing to travel.

Also to add, I am very very petite woman with a very small pelvis. Whilst I accept that some teeny tiny women do give birth to big babies without problems, the reality is that I would struggle and that there may be complications.

I have been reading the messages on here from over the years about maternal elective C-Sections and have learnt a lot about the NICE guidelines and my rights. I understand that C sections are not a walk in the park and have their own associated risks. I have also accessed the birth rights website. I understand the processes to a degree and know that I need to let my midwife know at my booking in appointment that this is my preference. I am also aware that if I went in labour before, there is a risk that I would have to have a vaginal birth.

I know that I would be able to manage the difficult feelings I am having now if I knew early on in my pregnancy that I had a date for a C section so would like to get the ball rolling as soon as possible.

Thanks in advance for reading and your support.

Lucy x

My understand is you can request a c- section and you meet with a consultant to go through why and they agree. My c-section was maternal requested but this wasn't agreed till 37 weeks as I was told I couldn't meet with a consultant until then.

There are often threads about this, so I’d suggest checking some of the advice given before. It’s fine to explain you would like a c section. Read something like Birth like a Feminist and check out her suggestions of how to have a conversation and at what stage in the pregnancy to discuss it and with whom.

You absolutely can have a c-section due to maternal request. When you have your booking appointment, your midwife will go through a long list of questions, at which point, you will be able to tell her everything you have written above.

Your midwife should be able to refer you to the perinatal mental health team and/or a specialist mental health midwife at the same appointment. It’s your midwives job to advocate for you, allowing you to have the birth want, be it c-section or otherwise. You will have a consultant appointment to discuss a section but this isn’t something they should be allowed to ‘allow/decline’.

You can make a maternal request for c-section and usually you would have an appt with an obstetrician who would counsel you on the pros and cons of your options. Then ultimately how you give birth is your choice and professionals should support what you decide. Usually the date isn’t booked in until later in pregnancy though.

It’s really important for you to be open with health professionals about your past so they can arrange appropriate support for you during pregnancy, the birth and postnatally.

Thanks for your advice. Anyone know how I go about finding out which hospitals are more accommodating when it comes to requesting them?

People have mentioned that the NICE guidance is helpful in outlining how many each hospital has performed and also labels them red amber green in relation to whether they are supportive.

Thanks again

I had my 10 week midwife appointment last week and she told me it's completely my choice and booked me in for a consultant phone call at 16 weeks. She said they won't say no. I have vaginismus and will not even consider a vaginal birth.

Thankyou, that's so helpful. Glad she was understanding. I will be open with them about how I am feeling.

Oh my goodness it is absolutely your choice, you have a right to have a C-section if you want one - especially with your history and condition. When you book in you explain the situation and state you would like a C-section, your midwife will put that in your details and when you are further along you will have a booking appointment with a consultant who will go through the risks and pros of a C-section with you and then books a date for you to have your C-section. That's it. Please don't worry yourself over it, you'll be fine x

Also in my experience the perinatal mental health team are great, such a support. You will have your own mental health midwife and you can also have your own psychologist to support you too x

I’m pregnant with my first baby. For reasons I won’t go into, I’ve been adamant from day one that I want a section, and I still am.

I raised it at a consultant appointment at 18 weeks. She asked my reasons and we talked about how they made me feel, which I didn’t object to at all, and then she said she had noted the request on my records, and if I wanted a section, then that’s what I would get, and they’ll make firm arrangements at 36 weeks.

I’d heard horror stories about having to fight tooth and nail, but there was none of that.

Thanks for your reply. I keep reading differing stories about how difficult it is. I’m in the midlands so can go to Birmingham women’s which I know on the birth rights society is a green.

I think I’m worried they won’t think that my reasons are valid enough. I read stories of people having terrible first births and I think that would be a completely understandable and they would be able to evidence that whereas I feel like they will just think I don’t want to go through with the pain of childbirth. For me, I’d go through that ten times over to avoid major surgery if I was sure I would not experience any ill after affects which would impact on my mental health long term. But that cannot be assured.

I was given my maternal request C Section date at 24 weeks.

You won't have any problems being granted this, the NHS policy on these have completely changed last 12 months. I went in overly anxious and prepared with my birth rights and NICE guidelines memorised, and I've literally barely had to explain why I want it done at all.

It's been a breeze for me the whole pregnancy, and it's something I was extremely anxious about even before I was pregnant for many years.

The only small thing that worries me, is they say if you have very fast and rapid labour before c section date - then there will not be enough time to perform section and I will have to give birth vaginally. The chances of this happening though are extremely slim so I'm trying not to think about that too much

Hi op, I just had an elected section a few weeks ago. The reason I wanted one was because my mum had a very traumatic birth with me and was left with ptsd so the idea of the uncertainties around vaginal delivery with my first child was very scary to me. I took my time with the decision and did all the hypnobirthing classes and antenatal classes and did my research on what type of birth I felt I could manage. I surprised myself in that I felt I could manage a very hands off natural water birth but due to my own health complications this was taken off the table. I then decided I wanted a section so i spoke to my midwife who made a referral to the birth preferences consultant. It's their job to make sure you're fully informed on your options and they do whatever they can to alleviate your concerns but ultimately they will accept your wishes, they just want to make sure you're making a fully informed choice basically. I was really worried about asking for a section incase they felt my reason wasn't 'good enough' but they mainly just wanted to know i was informed and that they understood my rationale.

If you have anxiety and you've had previous experience of SA and have difficulty with pain you could let them know from the beginning. My friend had a very similar experience and she was open about this with the midwives/consultant and she found that helped them to tailor her care, for example they decided with her against having a sweep so as not to trigger pain and they didn't do any internal checks during her labour but monitored in different ways and the midwives were very sensitive and supportive around any examinations. So I'd encourage you to let them know, they don't need all the details just enough to help them know how best to support you. They should put it in your notes so you don't need to repeat it over and over again.

We got information on the section rates for our trust from the midwife who did our antenatal classes but it wasn't broken down between elected and emergency. At the end of the day, its your body and your baby and you need to trust your instinct. You are entitled to ask for a section and they will weigh up the risks with you but it's not a decision you need to make immediately- I'd recommend doing the hypnobirthing courses, and some reading around it. I also followed lots of positive birthing accounts and looked at positive birth photography to familiarise myself with the process which actually really helped me with my section because I had an idea of what to expect and still used all the breathing techniques to stay calm. You have plenty of time to make a decision and you are also allowed to change your mind if that happens.

For what it's worth I'm so glad I had my section, if I'd known then what I know now I'd have been excited going in rather than nervous. Only recommendation is to air your wound as much as you can multiple times a day to avoid infection and make sure you've got support round you for the recovery because it is tough and you will feel quite weak and sore for bit. I'm 8wks now and my wound has just healed and I really only felt back to myself in terms of activity and energy last week. So you'll need too just be patient with yourself but it means an extra excuse to rest and enjoy baby snuggles.

Just to help ease your mind further - you absolutely can request a section and even if there is an issue later down line in terms of that request (for me, I was referred for elective section at 24 weeks, but at 35 weeks still didnt have a date and then they said they were full aargh!) - you can still insist on a section and they will either admit you on a set date and put you in sort of standby queue for next section slot, or if you go into labour early you can still request a section as soon as labour starts - or even during labour. My consultant advised the only time it may not be possible to do a section would be at the point labour was so established that babys head is literally in birth canal and cant be moved back out again - which is quite far into the process for pretty much everyone!

So please try not to worry - your midwife will refer you to consultant and peri natal mental health team at booking appt, and my advice would be just be really clear from day 1 that you want (and need!) A c section :)

My section was great in the end and would 100% choose to have one again!

Congratulations on your pregnancy!! ♥️

You can absolutely request a C section.

Just to manage expectations somewhat though. As it would be a maternal request, you won't be high on the list for having a date secured.

First they will schedule the women who have medical reason from the off, then they will schedule those who develop medical reasons, finally the non medical requests. Reason being you likely have more flexibility over whether you deliver at 38 or 39 weeks.

It might mean you don't meet with the consultant until your third trimester and you don't have a date confirmed until after that.

It might also mean you're bottom of the surgery list on the date given and get bumped.

None of this means you can't have or won't be allowed a c section, it's just admin.

The meeting with the consultant is to ensure you're giving informed consent. They will have to discuss the risks with you. It's not to 'put you off'. They need to be sure you understand that there are risks.

A positive birth is one that places the woman's feelings and needs as a top priority.

I think it would have to be very very quick labour as I went into labour before my elcs (previously had an emcs) and the number of people who came in to check I really didn’t want the cs was huge and they all arrived very quickly. They even asked DH in the end if I knew what I was doing and if he knew I was sure about refusing the elcs! I think if I hadn’t changed my mind I would have just been whisked off to theatre.

I decided about a week before birth I wanted a c and they made it happen. Don’t worry they are very understanding. They all said in the surgery room unanimously that I made the right choice and that if they birthed they would c too. The men included 🤣

Hi OP, not sure where in Birmingham you are, if you are Sutton Coldfield area just be aware that you won't be able to have an ELCS at Good Hope, you'll be sent to Heartlands.

OP you don’t need a good reason to request a c-section. Anyone can request one.

They will discuss the risks etc with you because they have to but given your history they will hopefully be very understanding.