Caesarean at Portland or C&W Kensington Wing? Epic, Waffling Post...

[kitstwins]

Brief outline is that I'm hoping to have another baby but I'm in two minds - largely because the first 'go' was a bit of a nightmare: placenta praevia, hideous recurrent bleeding, month in hospital on bedrest until haemorrhage in night and emergency section at 35 weeks (under GA as epidural was bodged), hideous recovery, haematoma behind scar so open and leaking blood for six weeks, PTSD, PND for a year.....F*cking terrible. Gorgeous twins though who are the love of my life so all well in the end.

Anyhoo, I'm pretty nervous about having another baby as I just don't feel I could go through that again. I know there are no guarantees in life and I was lucky to have my twins born healthy and alive (I know this) but the experience was a shocker. I know caesareans are life-saving, and in my case probably so as one of the placentas was very unstable and bleeding on and off like a tap, but I really don't want to have one again. I'd do anything to avoid the grim recovery as it took me weeks to feel anything close to normal afterwards. And even now, two years on, the scar is still slightly bruised and I have adhesions.

So I'd love a VBAC but also I'd like a consultant who, if I had to have a caesarean, would look after me well and not leave me with a dreadful scar. I know it's a point of vanity which I'm sure lots of people will find pathetic, but the only thing that can be said about my caesarean is that my scar is small and neat (bruising aside). So my only way to guarantee this is to go private and throw money at the issue. I don't want to run the risk of ending up in hospital at night with a surgeon at the tail end of a nightshift who cuts me hip to hip and leaves me with a wonky, lumpy scar (this happened to a girlfriend and she's so upset about it - she won't show her husband her stomach 18 months on). I'd like to find someone who is willing (if no complications) to allow me to try for VBAC.

Can anyone recommend a great consultant at C&W or Portland who would be pro-VBAC but excellent at caesareans? This post has been massively waffling but I'd really appreciate anyone's thoughts or help. I've toyed with doulas and independent midwives but I'm still scared of running the risk of ending up in hospital at the hands of some tired, anonymous surgeon. And even worse, someone who doesn't care if I have another secion under GA again, etc.

Thanks in advance. As you can see, I'm a bit lost about it all.

That's good to know. Am not so close to the Portland (C&W is pretty much on my doorstep) but I have heard of a very good consultant there - Nick Morris. I know if I had to have a section at the Portland it wouldn't be a bodge job and I would be very well looked after. My previous consultant was excellent and gave me a tiny scar and the things that went wrong weren't his fault but I just CAN'T bear to go back to the hospital. Too many flashbacks and bad memories I think. I see that place and I see torrents of blood coming from me. God.

It's very difficult. I'm not even pregnant yet/not even sure I can get pregnant again but if I do I want to be prepared so that I can book the consultant that is right for me and will give me the best chance at a VBAC. I'm going to google Jeannie Yoon.

Thanks for all your help. Will be interested to read of any other recs.

Also, how did you find the Portland on everything else. Was the midwife care consistent? WAs the post natal care good?

Thanks,

K

Go to Cathy Roberts, who is now with the Birth Company on Harley Street. Looked after me at the Homerton, now delivers privately at the Portland as well. Fantastic. Pro VBAC (I had one) but when I discussed my worries about it, very sensitive and wuld have supported whatever decision I made. I really cannot recommend her highly enough.

I know nothing about London birthing but from what you say I think you might benefit from talking to someone about your previous birth - did you have any counselling afterwards? It sounds absolutely terrifying and I can well imagine it must influence how you feel about an addition to the family.
I've seen this organisation linked too a lot on here - might be worth a look

Good Luck with whatver you decide to do.

My consultant Keith Duncan at C&W was absolutely great throughout the pregnancy. I did not have a section myself but if you mumsnet search his name others have and were very complimentary about the scar they had! I loved the brand spanking new Kensington wing, it was lovely. I had a great stay there end of September, highly recommend it.

Why do you think a private consultant will give you a neater scar?

I've had two sections on the NHS - at the Royal Free and UCH - and both gave me very neat scars (the 'best' he'd ever seen, said my private gynaecologist! )

MrsMattie - I guess because I'd probably be guaranteed my chosen consultant at my delivery if I went private and paid for it. As although I'd get consultant care on the NHS there would be no guarantee I'd get the consultant I'd been allocated to deliver me and, if I went into labour/things went t*ts up (again) at night, I could get someone at the tail end of his/her nightshift. It's unlikely to happen but it's still a risk, and a pertinent one to me as it did happen to a friend; she has literally been carved from hip to hip.

I suppose I'm keener to go private because I can chose my consultant (assuming he or she has a free slot as and when I do get pregnant) and, accordingly, I can chose someone who is pro-VBAC and will help me towards the best possible birth, whatever that might end up to be. And I guess if I DO have to have the dreaded caesarean again, if I were in a private hospital the level of care would be good.

If I could avoid paying £10k I would but if I am brave enough and lucky enough to have another baby I just have a feeling that a private hospital and a private consultant would give me a good level of individual care, which I feel will give me my best shot at a VBAC. Am also toying with the idea of a doula too as I know these can improve your chances of a VBAC, but again it's cost spiralling so it probably won't happen.

K

Northernlurker thank you for the link. I have had counselling (CBT) and also a hospital debriefing through their PALS and six months of conscious striving to get better and get over the birth. And although my ramblings probably sound pretty loopy I'm actually in quite a good place now and feel heaps better about the experience. I'll never forget how truly grim it was, but I accept that I was just really unlucky and that the majority of caesareans are much easier than mine.

I really appreciate you forwarding the link though - a kind thing to do given my waffling. I found the BTA really helpful in my days of struggling.

Thanks.
Kx

Have you thought about having a trainee doula? We're really very reasonable!

I am sorry to hear about your friend. If she has a big scar it may be for a good reason - some indications, and some people's bodies, just require for the scar to be bigger. I would hope that a private CS would also do this if necessary. It can be dangerous to make the incision too small.

Scars can be revised on the NHS you know - there is a wait, but it might be worth your friends while if it is unsightly as well as just longer than average.

Maggie Blott is fab. Think she does some private work at Portland

turtledove23 I am considering a doula as I really want to do anything I can to maximise my chances of swerving a caesarean. I realise the odds are stacked against me though as I would only be given six hours to labour before they intervened. And as this would be my 'first labour' (although second pregnancy and birth) I wouldn't imagine it would be that quick. And then I run the risk of having another emergency caesarean, which is harder to recover from than an elective. And equally, because epidurals can increase your chance of failed VBAC I'd run the risk of having to have another GA caesarean as if things did go t*ts up they wouldn't have the time to site the epidural.

It's actually writing this stuff that makes me realise I'm probably mad to even consider it. A girlfriend said I was thinking about it too much, but then she had a straightforward birth (no intervention, no stitches - very lucky) and so probably doesn't get my panic over another caesarean.

Probably the best option is to accept that the risk of having another nightmare is high and that I should just quit whilst I'm ahead and enjoy the two children I'm already blessed with. The thought of not having any more children really makes me sad but it's not the end of the world and it's life; not always perfect and what you want.

Mylitlemousie I'm not sure about my friends scar but I don't think so - her babies were tiny (4lbs each) and so not whoppers by any stretch. Plus, the caesarean wasn't a race against time or anything - she went to hospital at around 2am when her waters broke and had the babies at around 9am. She says she spent most of that time stuck in a room on her own with a monitor stuck to her tummy.

Her theory is that the surgeon was just blo*dy lazy and didn't take the time to be careful. She's of the view that he could have made the incision smaller - certainly all other friends who've had caesareans for larger babies, etc. all have much smaller scars. Apparently when she met him he did a MASSIVE yawn, which struck her as not the greatest vote of confidence so clearly he was tired. Anyway, I've seen her tummy and I don't want to end up in that surgeon's hands. To have another hideous caesarean AND to end up butchered after it would feel like the final insult. It shouldn't matter (aren't mothers supposed to be above vanity? Aren't we supposed to surrender our bodies to childbirth?) but it does to me.

God knows what my solution is really - I think probably to not have another baby. I just WISH it was easier to predict. I need a crystal ball.
Kx

k, I had a similar experience with my DT's - we all almost died and swore I would never do it again, had a section too. The whole experience left me very poorly and traumastised (I can see this in retrospect, but not at the time). Having another child wasn't really planned (I would physically shake just driving past the hospital) but I did get accidentally pregnant in 2005. However, I had a MC. This experience made me realise how much I did actually want another baby. I had another baby (just one this time!) last year by c-section (at another hospital I hasten to add). Was wonderful, was really hoping for VBAC but cord had huge knot in and just wasn't a risk I was prepared to take. Ironically, I had such a good experience last time round that I feel much happier about the DT's birth too, I felt much more empowered to but my foot down and also it was just one baby which isn't anywhere near as hard on your body. Anyway, sorry for the waffle but I just wanted to let you know that sometimes the thought of another CS is much worse than the reality. Best of luck and enjoy your twins

kitstwins-It isn't true that you only have 6 hours, you know. If you want a VBAC and are commited to it, you should be able to have one assuming all is well. The risk of rupture is actually .5%, which is lower than the risk of having a cord prolapse...nobody ever warns you of that one. If you would like to chat about what you are and are not "allowed" feel free to email me.
sarahturtlehopewell at gmail dot com

Hi there,

Sorry to read about your traumatic experience.

I can strongly recommend Mr Armstrong at the Portland, he performed my c-sec with dd1 and was outstanding.

I am due any day now but if I go over, he will be performing another c-sec on me.

I must also say that the aftercare at the Portland was absolutely fantastic and worth every penny if self funded!

Good luck x

Rosbif thanks for posting. My story is more similar because I also got pregnant after my twins (four months after) which ended in a miscarriage at 6 1/2 weeks. Although the timing was shocking and it wasn't planned it did make me realise that I would love another baby (I loved that baby, even though it was only in me for a very short time).

I think caesareans can be really positive experiences but mine was so brutal and both the experience on the day and the awful aftermath and struggles with healing and pain were such that I'm very, very frightened of having another one. Simply because there are no guarantees. I was unlucky the first time (0.5% chance of what happened to me occuring) but the result of that is I now have no faith in statistics. If you can be the 0.5% the first time round then there's no reason why you won't be the 0.5% the second.

Thanks for your post - I really appreciate it and I'm glad that your second birth was so much more positive. I don't know if I'll ever get that for myself but it's good to know that it CAN happen.

Kx

Thanks Lecohen. Can I ask what it was about Mr. Armstrong that was so fantastic? It's so difficult to get an idea of these consultants just from reading their names from the Portland website.

Good luck with your second birth. Hope it goes really well and it's good to hear feedback on the Portland.

Kx

turtledove23 thanks for your email. I think I'd read somewhere that if you're trying for a VBAC then the second you arrive at hospital the clock is ticking and you get a finite amount of time before they give you a c section.

I'm not sure if my risk of rupture would be higher as I had a haematoma behind my scar and adhesions. I don't think this affected the uterine scar, rather the muscles and skin over it, but it could be that midwives/consultants would be more twitchy about the risk of rupture. As always, it's the balance. A successful VBAC would be so much nicer than an elective caesarean (oh, the novelty of being able to stand up and walk around after the birth and being mobile for the first month of my child's life!) but equally a failed VBAC means emergency caesarean, which I'd desperately want to avoid, knowing that it brings with it greater healing issues and the risk of delivery under GA - both of which I have had before and were largely responsible for my PTSD/PND. It feels like I can't win, which is why I feel I shouldn't have another baby as the risk feels too high and my 'luck' feels pretty minimal when it comes to childbirth.

What do you think?

I went with midwife-led at the Portland so can't comment on the consultants. I had a really lovely experience there and wish I could go back! We now live in deepest, darkest Kent though so don't want to risk giving birth on the M20

Go and visit the hospitals though - I had 'decided' on John & Lizzies before I visited but decided on the Portland.

Many thanks for your well wishes.

To respond to your question, I find his manner extremely reassuring, he is very professional in his conduct, very calm and certainly knows his stuff.

He is not the type to force his view on you, just gives you the facts and tells you your options. He makes you feel confident in your decisions and his abilities as a doctor.

Hope that helps x

I had a fantastic elective c-section at the C&W on the nhs. I know you are preferring to go private but honestly if C&W is practically on your doorstep, it's really worth thinking about nhs treatment there. My surgeon (can't remember her name, sorry) gave me a tiny and fantastically neat scar. Recovery was also very straightforward for me (could have just been the luck of the draw) and I was up and walking fairly easily about 4 - 5 hours after the birth. As soon as I could walk, my catheter was removed and I was given a room to myself (because i had twins - it's their policy to do this if a room is available).

Have heard nice things about the private care in teh Kensington Wing. It IS possible I've been told (if they have the room) to go private for the post-natal bit (approx £900 per night, as opposed to thousands if you go private for the whole thing) - which I would definitely do if I ever have more kids, as I found the NHS post-natal care at C&W rather crap, if I am honest. Hope this helps!

try Gubby Ayida at the C&W. she was my backup consultant at John and Lizzie and she has an excellent reputation for being supportive of patient choice yet extremely competent and responsible from a clinical point of view. she see patients privately at her practice so you could try and have a chat with her beforehand to

(and to complete my post)

... to discuss your situation and what she would advise.

btw, i completely sympathise with your position and i think in your situation i would also be keen to "shop around" to find a consultant i trust. if you have some money to throw at the problem this is the sort of problem i would be throwing it at!

have had dd1 at UCH and dd2 at J&L- and i have to say that second time around i went into the birth a lot more confident and comfortable knowing what was ahead.

good luck, whatever you decide!