Please please help me persuade the consultant to let me have an elective cs

[lucasnorth]

I'm 18 weeks pregnant with my second child.

DD was born 2 years ago, a forceps delivery. It was a terrible experience. It was on gas and air (and they tried and failed a ventouse delivery first) - I almost passed out with the pain. I had internal tears that weren't quite stitched right, so sex was incredibly painful for almost a year after the birth.

Anyway, I really can't face going through any of it again. To the extent that before my booking appointment with the midwife I was crying just thinking about it. I FINALLY have an appointment with the consultant in a fortnight ('to ask her if she'll let you have one, when there's no medical reason' wtf?) and I'm frightened that she's not going to agree. My DH is coming with me to the appointment because he knows I am still upset talking about DD's birth, so hopefully I'll be able to stay calm.

But my question for you guys is - WHAT can I say that is going to convince the consultant to let me have an elective CS? I know the hospital (QEH in Woolwich) is under a lot of pressure to reduce its CS rates so I'm fairly sure that me just saying I can't face it isn't going to be enough.

Anyway, a rambling post, but thanks to those who've read it and particularly to those with any advice.

I had ds 1 induced, vetouse, episiotomy, tore anyway, 9lb 1oz
ds 2 spontaneous labour, got stuck, forceps, no episiotomy, 3rd degree tear, 9lb 15 1/2oz

I am 5 foot 2 and 8 1/2 stone.

After the 3rd degree tear I had incontinence both faeces and urine for around 6 weeks and an infection and couldn't even contemplate having another child. I was experiencing wind from my vagina and was referred to a consultant and had tests to find what the problem was but nothing was found, I was then referred to a general surgeon and I never received an app and I didn't follow things up as I had had enough of procedures!

I am 17 weeks prgt and have just seen the consultant today and asked for a c-section and he agreed. I was worried about re-opening the tear and the incontinance returning I was also very worried about having another big baby and although my body seems to like growing lovely large healthy boys I can't seem to deliver them without instrumental assistance which is very traumatic, especially the tissue damage of my second birth.

If I were you I would detail what has been wrong -have you been seen by a dr? Referred to anyone?

I was just as traumatised as you and part of my relife of today's app was making it through and not crying whilst talking about the delivery and my experience afterwards. I think the medical profession looks at the 'medical' side and does not take into consideration our feelings and thoughts about it. Those feelings and thoughts surely can't be conducive to a positive birth if you're terrified and have spent 9 months being terrified!

Completely understand your anxiety. I was in the same position with my second (though first had been a crash section) and was petrified of going through the whole thing again.

The consultant was very resistant to the idea of a second 'planned' section but when I burst into (genuine) tears all over her she agreed to one. I think what swung it was that Dh asked if she could explain what had gone wrong with birth no 1 (ds had a close call and was lucky to emerge alive and undamaged). When she went through my records she admitted that it had gone astonishly badly and I got a planned section - which allowed me to 'enjoy' the rest of the pregnancy.

(coda: the 'planned section' went completely pear shaped and I ended up with a PPH and horrible infection so have now hung up my stirrups and decided I won't do either form of birth in future ).

Thanks muppetgirl. Sorry to hear what you went through, it sounds so much worse than what's happened to me.

Regarding what you said about being referred - I saw my GP and then a consultant about the scarring problem (although I was on the waiting list for corrective surgery long enough for the problem to subside by itself). So thanks, yes that's some good solid medical evidence and I'll make sure I bring it up. Hopefully it should be on my file as its the same hospital.

Glad you got what you wanted today. Hope it means you can enjoy the rest of your pregnancy.

Cross posted LuLu (I'm a slow typer )

I was planning to ask what had happened first time round (no-one ever told me); from what I've read since I understand that it is very unusual to have an instrumental delivery without spinal block?

Sorry the planned section didn't work out either. I'm kind of blocking that from my mind though I'm afraid - it still seems the least-worst option I have...

I think if they need to get the baby out, there is no time for a block when whipping out the forceps or ventouse.

I am demanding a CS outright. There will be no discussion. The baby can stay in there otherwise. I did have an eclamptic fit with no pre-eclampsia though, so they really cant say no.

Mind you, my consultant didnt bother to see me at my appointment, I was seen by a registrar who said, 'well you had a vaginal birth before, with forceps, there is no reason why you cant do it again'. Followed by, 'dont worry about your epis, we'll just cut it again, and if your blood pressure starts to rise give you an epidural'. Fu(k off, needless to say I'm waiting on a second opinion.

I couldnt wait to give birth last time, did it up to the babies head crowning with just gas and air. I wont be guilty that I've never been lucid for a VB.

Get the scalpel out and cut away...

Lucas - sorry, didn't mean to frighten you re the c-section horror story! I'm a great believer in the theory of 'if you've considered it as an option you can be certain it won't happen'. Consequently I have done you a weird favour by putting the thought of a botched c-section into your mind - because now it WILL NOT HAPPEN TO YOU. (The prospect of a rotten section hadn't occurred to me so by reverse logic that's why it happened to me!).

Having said that it the consultants were all scratching their heads as to why my c-section went tits up (and I suspect that someone was fired not long after) - complications like that are really, really rare. And if I ever got pg again- I would still go for another section!

Good luck, be honest and stick to your guns. And don't try to be too stoic when you meet the consultant - show him/her exactly how distressed you are.

I had a block though my ds 2 was stuck so maybe not an emergency? There was time to unhook the epiduaral (which only worked down one side and the pressure in my bum from ds being stuck was unbearable!) and wheel me into theatre. I was loosing the plot by this point as I was terrified of having the 'whole' pain iyswim!

I would def quote the medical evidence...

Take a letter with you - be brief and to the point. Don't ask for a CS - say you're having one.

Points i would make:

ventouse/forceps was performed without analgesia - unless there was a damn good reason, it could be classed as assault.

You were left with a pretty severe birthing injury. You do not want further vaginal/perineal damage, and the OBs know that they cannot guarantee that you will suffer an even more horrific injury next time. The physical and mental distress of a birthing injury frequently is dismissed by healthcare professionals.

You do not want your next baby to undergo the distress of a mechanical birth.

Whilst you are aware of the increase in maternal mortality with a CS, the actual risk is very, very low.

There is no increase in risk of PPH with a CS.

An elec CS under spinal does not interfere with BF.

Just insist, I spent a happy 20 minutes with the registrar explaining to me why I shoudl go for a VBAC, I listened politely and said thank you but no.

sorry to hijack but am i right in thinking you can just say you want a cs and that's that?

I had to go through the whole birth on just g&s because no anaesthetist was available and it was horrendous. Ended up with a ventouse delivery. then my placenta wouldn't come out, so was given the drug that induces contractions after the birth and so was in horrendous pain again and an hour later was taken screaming down to surgery to have the placenta removed. lost 3 pints of blood.

tbh, if i can't be assured of a cs before getting pregnant again i think ds will be an only child!

I have the horrible suspicion that the gp will say whatever i want to hear and then will refuse a cs at the last minute.

INSIST

Gavvalar -I must admit I did say 'can we clarify I am havin a c-section?' and I also said when I was told I would be seen again at 34 weeks I said 'You won't change your mind?????'

They said they would gp through the options with me but would not force me to have a vaginal delivery.

I understood that you couldn't just walk into an app and say you're having a section...

My last baby (the one that got stuck) was shown to be large at the 20 weeks scan, I had growth scans every 4 weeks and ds 2 was always measuring big, on the 36 weeks scan he was measuring 41 weeks!!!! I was TERRIFIED! I had a ventouse with ds 1, severe pnd (ad's and seeing a psychologist for over a year for weekly 1:1 sessions after being referred to the mental health team and being unable to work) I was unable to attend any app without crying and kept saying I was terrified of having a large baby (ds 1 was 9lb 1oz and I'm still 5 foot 2 and 8 1/2 stone) and that I was terrified of the pnd returning. My consultant said that as I had delivered a 9lb baby I could easily deliver a 12lb baby (?) and that there was no medical evidence that having a bad birth increases your risk or can cause PND. I have to say I wasn't in the best frame of mind when going into labour. Ds 2 got stuck early on around 10pm and I was demanding they help me and they finally did and ds was born 2.30am -4 1/2 hrs later by forceps. I didn't want forceps and told the consultant that I was was afraid of tissue damage, he said it would fine and that was that, I was wheeled into theatre. A 3rd degree tear later and a 9lb 15 1/2oz baby later I was very shocked but elated ds 2 was fine (although very wierd shaped head and even now his head is an odd shape!)

I felt with ds 2 that I was not listened too at all and that my concerns were definately not listened too. Fear is a very real emotion and needs to be handled carefully. Also trust is important between consultant and mum. I lost any trust I had when I was put in the position of delivering a too large baby that they knew to be large.

I am extremly happy that they have wrriten on my notes 'wants a c-section' but as I saw the under dr and not the team leader (sorry can't think of proper name now!) I am worried they may change their minds.

This is interesting reading that some hospitals are so resistant to offering C-sections, I know they are trying to reduce the CS rate but I think in circumstances like tearing / trauma at the birth it's perfectly reasonable to offer one! I'm having the opposite experience, I tore badly with DS and at my 12 week scan they called the consultant in to talk to me (I didn't even ask to see her) and she advised I may need a CS this time to avoid it happening again. They have even booked me in for 2 sizing scans in my 3rd trimester to check how big this baby will be. They made me feel so comfortable and would probably support a CS if I wanted one, weird cos I hadn't even thought about it before!

It makes me angry that the hospitals aren't all like this, they don't realise how traumatic and painful childbirth can be, plus that's not inc the aftereffects. I couldn't sit down properly for weeks, couldn't have sex for about 8 months, got an infection, had gynae investigations etc etc. Good luck Luca, stick to your guns and emphasise the traumatic aspect of your last birth too, not to be taken lightly IMO.

I totally agree ilikeyoursleeves, there seems to be no blanket poilcy and it is all just down to the opinion of the dr you see at the time.

I had a really traumatic time with DD (apparently the hospital did their own internal inquiry afterwards)

As a result, I wanted a c-section and my Consultant wanted to address my reasons for wanting one. She said the pain could be controlled via epidural, and in fact would be the same for a c-section. She couldn't promise an epidural, but would do everything possible.

Also, she said she wasn't saying, 'no' to a c-section, but that it isn't an easy option, is major abdominal surgery etc.

ilovemydog - a section isn't the easy way out. I will have major surgery and still have to care for a newborn, estalish b/f ect. I have 2 children already and ds 2 will only be 20 months so we will have to have paid help for around 4-6 weeks as dh leaves for work 7am and doesn't get back till 7.30-8pm. I have thought and thought about this and feel my concerns are very real but beacuase of my past experiences with consultants was absolutely dreading today's app. I haven't slept properly for days such is my anxiety about this birth...

Thanks all.
Highlander - I'll definitely write the letter. It'll help me get my thoughts straight, I'll have a crib sheet when I'm talking to the consultant, and then hopefully they'll keep it on my file.
Salleroo/FiveGoMad - it sounds like there may be an element of luck involved in who you actually get to talk to? Fingers crossed my consultant is of the less arsey persuasion...
Gavlaar - all I know so far is that the decision has nothing to do with the GP (or the MW) - it's all the consultant.

Thank you all - it really is helping, both practically getting my head around what to say and also just the process of talking about it.
Any and all other suggestions gratefully received.

Agree Muppet that a section isn't the easy way out. Was just repeating the response from my consultant.

For some, a c-section is absolutely the right thing to do. Actually, now that I think about it, everyone I know who has had a c-section does not regret it, and most were planned.

sorry I sounded very defensive there!

WOW
I started typing the last one when Gavlaar's first post was there. That's how slow I am. Anyway...

It's interesting that there are so many of you making the same decisions/already been there. I don't know anyone in RL that feels anything like this, which makes it impossible to talk about with RL friends. I tried it with one friend who tried to be nice but was clearly of the 'too posh to push' view of elective cs and I've not broached it with anyone else.

I hope everyone with decisions to make/consultants to persuade finds a way through it they're happy with.

I feel I have to justify why I'd like a section and then trot out what has happened in the past. My friend detailed to me how having a section isn't easy you know, how she would never have one as you can't drive for 6 weeks and then I told her about not being able to sit down, being incontinent for 6 weeks, having to take spare clothes not just for ds 2 but for me also as I would mess myself, to still have to wipe myself when I go for a poo (sorry of tmi) I have to wipe myelf bum to vagina as due to the scar I have to be careful to get all the poo off and to keep clean.

Having a section for me would guarantee, at least, these problems won't get any worse!

I get really annoyed when adult women are forced to ask for permission...shouldn't it be your body your choice? TBH Cs would freak me out but thats just me and I feel that if thats what you want then you should be able to have it. Otherwise "choice" means nothing. You shouldn't feel guilty or need to justify yourself. Stick to your guns and I think you will get what you need and so sorry that you are being stressed out by all of this.

You must make your own decision. But I was offered an elective c section after a rather horrific first birth but refused as my dd would have only been 17 months and still needed lifting out of cot etc. I will tell you that my second birth was easy, 4 hours in total. The one thing that I was absolutely certain of was that second time round my DH knew the score and knew when to say enough was enough and that I wasn't to be left to go on. In the outcome he didn't need to, the hospital, having read my notes, were one step ahead and were constantly offering me help. I had a really good second birth. Please don't be frightened, just make sure that you have somebody there to say what had gone wrong the last time and make sure it doesn't happen again. My ds's birth is a lovely memory and it is good to have that after my first birth.

How are things lucasnorth?