Does this letter sound reasonable?

[TinselBaublesMistletoe]

I've written a letter to my consultant, which I will hand to her, as I'm not as good expressing myself sometimes as I am on paper. The background, for those that don't know, is Tink was born at 31 weeks, because she was coming fast and feet first I had to have a crash section. They didn't allow themselves enough space to get her out and gave me an inverse T shaped scar. I've been told I can't VBAC - no discussion - and that worries me because I suffered Birth Trauma last time and don't want to go there again.

"I wrote this down because sometimes I?m not as good at expressing myself verbally as I can on paper.

I was told after my last section that it was a good thing I had a general because my back wouldn?t have coped with an epidural. My back isn?t better than it was then; if anything it?s worse. Every time I?ve tried to discuss it with a doctor I get told ?we?ll bring you in a few days before the section and stop your Clexane? but the Clexane isn?t the only concern.

I was reading the RCOG guidelines on caesarean section and it says that the risk of rupture with my type of scar is 19 in 10,000 or 1.9%. It also says that only 74% of attempted VBAC are actually successful.

The way I see it if I have a section I can either risk further damage to my back with an epidural ? I?ve been told that my back is past physio now and needs to be dealt with by a specialist ? or have a general which I really wish to avoid as I think it was a big part of my Birth Trauma last time. Or I VBAC with the possibility that I have another crash section with a general, which would be the same outcome as if I hadn?t tried.

I think that looking at the statistics a VBAC with my scar and the success rate of VBAC that I would like to try for one. I managed both my previous labours without pain relief and my false starts with this one I?ve done without, I am happy to keep pain relief to a minimum so as not to disguise any breakthrough pain and I don?t plan on being a hero, if at anytime I feel something is wrong I will be happy to say."

That should of course read 190/10,000 or 1.9%

cant see anything wrong with it Tink/Tinsel - seems to be quite reasonable, well thought through, not neurotic or hyperemotional - but if you do want to try for a VBAC I think you might want to up the ante on how much you DO want it, you are a wee bit unemphatic (is that even a word?) about it.

Good luck!

I can be a little too logical at times and forget I have emotions (a little Vulcan in me I think!) I'm not sure what to add to it, if I was to talk about my emotions about this I'd be sobbing my heart out. I've said it before but any sentence starting with the words "When Tink was born..." has me sobbing because I know what's coming. I think I'm also a little worried about getting too much into my emotions because a lot of doctors don't see that people with mental health problems can have feelings in their own right, in other words everything comes down to my mental health.

My first idea for a name was TinsleBellesMum, then I realised Belle was Christmassy but I could change it to Baubles to be a bit more Christmassy, then I thought "well, while I'm at it..."

"I think that looking at the statistics a VBAC with my scar and the success rate of VBAC that I would like to try for one"

OK, perhaps this sentence could be re-worded for greater emphasis , maybe something like:

"Given the statistics of VBAC with a scar like mine, plus the success rate of VBAC, I believe that I stand a good chance of success with VBAC and this is the route I wish to take."

just taking out the "I think" and the "try for one" increases the emphasis - you then leave in the rest about not being a hero and changing direction should it become medically necessary.

Thanks I was a little uncomfortable with that line actually, took me a few attempts and I still wasn't sure about it.

Just noticed I'd be better putting the bit about the future for my back, further up. Doesn't make much difference, just a better home for it.

"My back isn?t better than it was then; if anything it?s worse - I?ve been told that it is past physio now and needs to be dealt with by a specialist."

"The way I see it if I have a section I can either risk further damage to my back with an epidural or have a general which I really wish to avoid as I think it was a big part of my Birth Trauma last time."

I can't add any more than the Elf (and certainly couldn't put it any better) but hope you get the outcome you want.
Letter sounds good.

Thank you both, I'm glad I've had positive replies on here, I was a little worried when I posted the letter on here, you certainly leave yourself open to whatever you get when you post.

I guess if I am "allowed" to VBAC then there are there possible outcomes - I succeed, it ends in Crash and the Birth Trauma is made worse or it ends in Crash but because I've been in control I feel a lot better about it all than I did after Tink was born.

Tinsel, can I make a wee suggestion here re. the Birth Trauma? It may not suit you, or you may not have heard of it - but you can choose what to do with the info.
There is a therapy called Emotional Freedom Technique (EFT) which can be very useful in helping to heal past stressful traumas e.g. PTSD. I know people who have used it to good effect to get over awful happenings in their lives.

Tink - are you thinking of having a doula with you if you go for a vbac?

I've ummed and ahed over a Doula, it's something I'm looking into training for myself so I definitely would be interested in having one. Because I'm likely to go early and I didn't know how she would be born I wasn't sure about it, I don't know whether I can now (33 weeks today at getting so far).

I shall have a look into the EFT, thanks for that. I think I need to bring it up with my nurse as it's something I've never had an official diagnosis on. Although he is a mental health nurse he doesn't do mental health, which I actually like, but I think it's an important issue we need to deal with.

I couldn't get my parents printer to work today from our laptop and my dad couldn't read the file so I haven't been able to print it out yet. I've got two appointments this week (growth scan tomorrow because it's fortnightly and Thursday is my monthly clinic) so I'll probably hand it in then, even though I don't normally see my consultant at clinic which is why I want to do it tomorrow (she tacks me into another of her clinics).

Tink, Gabygirl's question is a good one. The doula is a good idea especially for you since you've shared that verbal expression is difficult. The doula can SPEAK FOR YOU, act as your sounding board, and give you insight if things get topsy turvey.

Your letter sounds good as do all the edits suggested here.

Hey TBM! Wondered where you were.... darned christmas names!
You're 33 weeks now, yes? Good going girl!
Letter sounds great- though- wouldn't a planned section would be much more calm than the crash section you had previously? Of course, that doesn't help your back.

Will your back allow you to labour upright though? It could be long...

ooh, another tip, if you want it - if you do get your shot at VBAC, and they let you, try staying on your L side as much as poss if you can't be upright.

I have a shocking bad back, osteo for 10yrs and still just keeps it going, unstable pelvis and sciatica and all that - I wanted to be upright as long as poss, but defo NOT ON MY BACK. As it was, I couldn't have stood if you'd paid me; but was on my L side for most of the last part of my labour (3 hours of it, only last half hour was stage 2) - but then I didn't have a MW around until I felt DS crowning (when I sent DH off to fetch one) so no one interfered with me until the last 5 mins.

I didn't have any tearing and my discharge MW said that (iho, I assume) delivering on your side is the best way to avoid tearing - which begs the qu, why don't they let more women do it on their side??

Hey TBM. Really glad I found your letter. Really wish could come and be a support for you! Come have your baby where I work

I think you're letter is very good - I guess the consultant knows you well and so doesn't need the full background.

By way of showing how really wonderfully 'on side' and cooperative you are despite your PTSD, [who would blame you if you couldn't even face attending hospital appointments after all?] I'd really emphisise the last bit and state your total willingness to accept the risk of crach section, that you have looked into and appreciate the gravity of uterine rupture, and will manage with no pain relief if the consultant feels this would help them monitor for it. Perhaps say you realise that the decision to go to section would be fast and at the earliest hint of a problem, and that you would be as prepared for this as possible.

I think alot of HCP anxiety over complicated and tricky management cases, like yours, are based in the worry that more damage will be done by lack of control. 1st rule of medicine being 'do no harm'. If you really show you accept and understand what you are taking on here, then actually this is entirely your choice.

I've seen lots of ladies hand a letter over to the consultant or post one in so you should feel reassured about that too.

These are all just my thoughts so do feel free to think not much of them!

I think you're a star and so calm and cool in your approach. You seem to have to have no anger or rage which I find inspiring. x

Just read this TBM, have nothing to add to letter because it sounds fab to me and the suggestions you've had for changes are great, just wanted to add to the suggestions about Emotional Freedom Technique, that there are two other related forms of therapy that are extremely successful in treating Post-Traumatic Stress Disorder: OEI, or One-Eye Integration, and EMDR or Eye Movement Desensitization and Reprocessing.
I've had the benefit of having colleagues who use these techniques and they helped me a lot.
oneeyeintegration.com/
www.emdr.com/

TBM - letter sounds goods and Treedelivery's suggestions sound like a good addition. The only other thing I'd maybe say - about attempting a VBAC - would be that you'd be willing to be under continual monitoring (of scar and baby) and open to further discussion as and when required (as shows that you've actually fully considered all implications).

if she keeps turning breech everytime they put me on a ctg i have no hope! i'm back in after i started again last night but it's calmed down since she turned.

i dilate fast so i don't think i'd need to worry about being up, but i find sitting easier anyway.

i'm probably going to need a ga so the main difference will be speed, but i'm hoping having some control over it will help.

thanks for the suggestions, i will have a look at them properly when i'm on the pc (rathr than a pemier bedside phone).

i'm not this calm really, i'm just not good at emotions - not in the british stiff upper lip way, i guess in a too much of them to deal with way.

tinsel, would just add that I think you should be clearer upfront in the letter about your conclusion.. please feel free to ignore if you want.

I would begin the letter with 'Regarding my next birth, due (date), I have decided to try for a VBAC, for the following reasons,' and then list them in order.

The reason is, is just as a complete outsider, I found it hard to understand from the letter what it was you were trying to say, probably because it is a complicated issue..

Wish you the best of luck. I just booked a doula but not sure about it! (25 weeks)

HI, I'm interested in this thread because I have the same shape scar after a crash section. I had just accepted what they told me that I wouldn't be able to have a vbac, so it's interesting to see what you're saying. (I'm not yet pregnant again). Good luck with it.

Hi TBM - probably this is waaaay too late, but I like the idea of saying first "I intend to try for a VBAC" and then "this is why" and then "this is how I am realistic and ready to be of as much assistance to you lot as possible in not having pain relief, accepting monitoring etc etc" and then "now please go away so I can get on all fours and encourage Fifi to TURN AROUND. Thank you".

Love to you! Not sure if a doula would be possible for you with the is-it-isn't-it-labour stuff going on - might there be a friend or relative who can come and advocate where needed?

Hi TBM - hoep your scan today was OK. x

Thinking about what EachPeach said, I realised I need to add something.

"Or I VBAC with the possibility that I have another crash section with a general, which would be the same outcome as if I hadn?t tried, especially if - as is quite likely given my history with previous pregnancies and the current one - I go into labour first. The section won't be done until you are sure I'm in labour and I have always been a rapid progressor which Mr XXX, who did my previous section, said at the time I would be prone to."

That paragraph may not read well because it wasn't written in the roll I was on before, so please feel free to give advice on it.

I didn't put much background in because I think they're aware of it with how much I'm in and having my notes (I walk through the hospital and I've got doctors and MW's saying "Hi [TBM]" sometimes I have to think who it is!) I also planned(!) on handing it over anyway.

I'll edit the letter tonight and repost it.

Edited version of the letter. I'm still not sure about that passage, so if anyone can offer any suggestions, please do!

I wrote this down because sometimes I?m not as good at expressing myself verbally as I can on paper.

I was told after my last section that it was a good thing I had a general because my back wouldn?t have coped with an epidural. My back isn?t better than it was then; if anything it?s worse. Every time I?ve tried to discuss it with a doctor I get told ?we?ll bring you in a few days before the section and stop your Clexane? but the Clexane isn?t the only concern.

I was reading the RCOG guidelines on caesarean section and it says that the risk of rupture with my type of scar is 190 in 10,000 or 1.9%. It also says that only 74% of attempted VBAC are actually successful.

The way I see it if I have a section I can either risk further damage to my back with an epidural ? I?ve been told that my back is past physio now and needs to be dealt with by a specialist ? or have a general which I really wish to avoid as I think it was a big part of my Birth Trauma last time. Or I VBAC with the possibility that I have another crash section with a general, which would be the same outcome as if I hadn?t tried, especially if - as is quite likely given my history with previous pregnancies and the current one - I go into labour first. The section won't be done until you are sure I'm in labour and I have always been a rapid progressor, which Mr XXX, who did my previous section, said at the time I would be prone to.

Given the statistics of VBAC with a scar like mine, plus the success rate of VBAC, I believe that I stand a good chance of success with VBAC and this is the route I wish to take. I managed both my previous labours without pain relief and my false starts with this one I?ve done without, I am happy to keep pain relief to a minimum so as not to disguise any breakthrough pain and I don?t plan on being a hero, if at anytime I feel something is wrong I will be happy to say and I?m happy to allow whatever monitoring needs to be done.