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.

Change your due date on your notes and remove your scan so that you go 'overdue'.

When you are 6 weeks overdue and still refusing an induction but asking for a c/s they'll be too scared to refuse you

Snowlight - I think they'll see through that - they're quite computerised Nice idea though

Muppetgirl - I'm OK thanks. Spent ages trawling through the NICE guidance on c/s over the past few days, and I was quite surprised how much of the data on outcomes of c/s vs vaginal delivery fail to differentiate between planned and emergency c/s. So if the consultant starts quoting those statistics at me I will at least be informed... The one that startled me was that 2% of babies are cut during the procedure (although there is unhelpfully nothing to say whether we're talking a scratch or needing stitches); 2% is quite high but I hadn't heard about it before. I'm going to start trying to put together a letter, or at least a list of points to make, in the next few days. Are you OK?

I had an emergency c-section first time and asked for an elective the second time.

1st hospital appointment was with registrar who just went on and on about the risks of c-section and hadn't read notes on my previous birth which i found annoying. But like you i'd done my research and just politely said i'd thought it through and wanted a c-section.

No decision made at this appointment and had to wait till 35 weeks to see the consultant. He was fab just got out his pen and diary and booked me in for my elective - no quibbles at all.

In the end i went into labour at 37 weeks and they just brought my c-section forward.

Am pregnant again and will definitely request a c-section again.

Of course it is major surgery but some of us would have died giving birth years ago and this is the safer alternative for us and our babies.

Good luck!

You'd think lucasnorth, but ime they don't know their arse from their elbow and your records are as likely to be wrong as they are right.

They may 'suspect' you are lying, but they'll also know that you could well be telling the truth.

....................

Tell them: Your fear of VB is stressing you out. You haven't slept for days. Your adrenaline is pumping whenever you think about the birth. The stress is not any good for you or your baby and if there are any complications that arise from you being stressed or due to you giving birth vaginally you are holding them to account. Your fear means you will not labour properly and increase the likelihood of an emc/s and if this happens you will hold them to account.

However, can I ask if you know why you experienced what you did? Have you seen your notes/been for a feedback session at the hospital? There are things that you can do to increase your chances of a good 2nd birth if you choose to go ahead.

Thanks traceybath. Glad to hear you got what you wanted, but the wait to 35 weeks must have been worrying.

Snowlight - the meeting with the consultant next week is dual purpose: a debrief on last time and a discussion about what to do this time (although I have visions of the consultant dashing off halfway through for her next appointment...)
I had to stay in hospital for 3 days last time, and at one point asked a MW what had happened; she said that DD turned her head as she entered the birth canal and got stuck. That doesn't add up at all though as they tried ventouse first (which I have now read is no good for turning, only for pulling); also it doesn't exactly scream emergency so there was no apparent reason for them not to offer me a spinal block. Anyway, if my suspicions that they messed up last time are correct then hopefully that will help the argument for a cs this time.
I was actually quite impressed at my booking this time round - the MW had my complete file from last time! But refused to talk through with me what happened - said the consultant needed to do that . Which is another thing making my cynical mind think something wasn't right last time.
Anyway, thanks for the tips. The point about holding them to account if I need an em cs is a good one. Will come back next week to post the outcome of the meeting...

lucas I was in a similar position to you, for fairly similar reasons. Being told I had no choice but to go through a vb was hell and made me very very angry.

I eventually managed to get agreement for a c/s though, and when I did, the regaining of control and choice I felt actually led me to reconsider a vb.

I made an appointment with the Supervisor of midwives to go through my notes (for 2 hours) and whilst she didn't 'admit' fault, she didn't exactly deny it either. What she did do, was follow up and make sure that I was pretty much 'guaranteed' an pool available and a very good midwife.

Do try to get as much detail of the birth as possible and request a copy of your notes.

In addition to this I hired a trainee doula and through research became very empowered. I reflected on everything/anything that may have led to the outcome of the last birth and wrote a 7 page birthplan for every eventuality.

I just laughed when my cmw suggested induction (when overdue) because I didn't even feel I had to battle against it, and I laughed when they suggested that at a homebirth you wouldn't be allowed in the pool before 5cm, because I had every intention of getting in the pool when I damn well wanted to, and in my own home I'd like to see them try to stop me. And in anycase I wouldn't be allowing any internals.

I didn't give birth there, I gave birth at the Edgware Birthing Unit, which was lovely. And the birth was amazing.

I would wish this for you, but you need to go on your own journey. Good luck!

Just wanted to say good luck for your meeting with your consultant. I had a similar story - really traumatic first delivery, requiring lots of treatment and corrective surgery afterwards (not to mention the depression, flashbacks etc) and when by a miracle I became pg again, I just said that I could not go through that again, there could be no guarantee that I would not need further repair surgery following another vaginal delivery and I was therefore opting for an elective CS. The consultant said, yes that was a perfectly reasonable request in view of my previous experience and in the notes gave the reason as "previous maternal trauma" My CS went like a dream compared to my first delivery, the recovery was much quicker and it was all a lot less painful than my so-called normal delivery. It was definitely the right decision for me. I think when people drone on about CS recovery they underestimate what the recovery from a traumatic and damaging vaginal delivery can be like - far far worse in my experience.

So, stick to your guns, don't be fobbed off and good luck!

Lucas, I had a similar experience first time around and had a terrible tear, resulting in much pain and a difficult recovery following the birth of DS.
As a consequence I was under consultant care (for what that was worth) for my second pregnancy. I was determined that I would have an epidural and no intervention unless absolutely neccessary.

Long story short, Epidural was the best thing ever, no tears and no intervention. But I had an excellent team of midwives second time around, and I'm pretty sure (and subsequent midwives have agreed) that if my final stages of labour had been managed properly the first time around, I wouldn't have torn.

Every labour is different and this time your body has stretched a bit and you know better what is going on, which might give you a bit more control.
I can recommend the epidural . I can't advise on CS, but the recovery from CS could be just as hard.

Good luck and try to keep an open mind about your next labour, you'll be fine

I wrote to my consultant asking for a cs with my 2nd child, due to being traumatised from having my first. I said that I suffered flashbacks for up to 2 years afterwards and that I felt unable to bond fully with my 1st child because of the trauma. He agreed to the elec cs instantly.

Also, read up on your rights (there is a website somewhere with these on but I can't remember it - Googling should find it). You do have a medical reason for wanting a c/s - medical doesn't have to mean physical, it can mean emotional too. If you have read up on your rights and make that clear at your appointment (eg. if a consultant refuses you a c/s, I believe s/he is obliged to find you a consultant who will agree) then I bet you'll get your c/s.

And don't listen to ANYBODY who says "it isn't the easy option, blah blah" - of course it isn't, everybody knows that. But it can mean a relaxed pregnancy and a happy birth. Good luck!

tell them you were fecally incontinent last time; works a treat

that is glib of me, sorry

I had a traumatic delivery and was keen to avoid the same for my 2nd. It was the fact that for a short time I had urge incontinence and some weakening of the muscles during my 2nd pg that made my consultant cautious and recommend, on balance, an ec. They don't care about urinary incontinence but fecal they do. If the existing damage was causing you problems in this area they would in all likelihood consider an elective.

Hi, thank you all for your experiences and advice.

I saw the consultant today and she was lovely - really reassuring. I'm so relieved! I've been like this for the last few hours. I couldn't sleep last night and spent this morning shouting at DH

The consultant talked me through what happened last time, and the reason I had the instrumental delivery on gas and air (plus local for the episiotomy) seems to be that there is only ever one anaesthetist on duty on maternity (), and they were busy with a crash c/s at the time. Which I guess helps to an extent; although I think they should have more staff available scarce resources are an NHS fact of life really, and knowing this makes the decisions of the people involved on the day more understandable to me.

About the birth this time round - she said she will not stand in the way of me having a c/s this time round if that's what I want; I have an appointment to see her again at 34 weeks to talk again. In the meantime she is going to write to me explaining what happened last time, and get me invited to the VBAC group (apparently this is where all the experienced midwives hang out, and they can talk to me about CBAV(?!) as well).

Although she was trying (gently) to persuade me to give a natural delivery another try she was also very reassuring about the risks of an elective c/s. She said the only significant risk as far as she was concerned was obstetric complications - future pregnancies - as even though we don't plan to have any more kids (this will be no.2) we might change our minds. Otherwise she believes it to be a very safe procedure. When I said that NICE said that 2% of babies were cut she was shocked - said it only happens maybe once a year, and generally during an em. c/s (when waters have broken already).

So it was really a very measured, adult conversation which I was so grateful for. She made it clear that she thought a natural delivery would be better (and offered to guarantee an experienced m/w with direct consultant support), but that she would respect my choice either way, and she went out of her way not to scare me out of the idea of surgery. And, as a result, I kept a more open mind than I thought I had. I'm genuinely going to talk to the midwives about the other option.

So, I hope the others of you going through this now are as lucky as I was. And thanks again to all of you for your support.

Crikey all, have just read all the posts on this thread and although now terrified of second birth I think having read the advice on here I have the confidence to tell them - I AM HAVING A C SECTION.

Good news lucasnorth, congratulations.

Goodluck Muppet Girl. x

Fantastic lucasnorth I hope you get the birth you want, whatever you choose.

So it's an old thread, but I thought I'd post one more time just in case it helps anyone searching through old threads.

Well... I went and spoke to the senior midwife who was lovely and very supportive. Then I vacillated right up to the consultant appointment at 34 weeks. At that appointment I saw a registrar who was wholly unimpressive. She did the whole risks of a caesarean spiel at me, including forceps as one (!), then looked shocked when I asked her the risks of a vaginal birth. Anyway, in the end she booked me in for a section at 38+5.

I kept on seeing the senior midwife, and between us we decided to move the section to 39+4 as I was prepared to accept the risk that I'd go into labour earlier in order to decrease the risk that DD would need assistance breathing.

I made it to 39+4, DD was born healthy and needed no assistance breathing. The experience was immeasurably better than last time. One week on and I'm walking around fine; really just lifting that I'm holding back on. Everything much less stress than last time, although how much of that is because it's a second baby I don't know.

Anyway, good luck to anyone else with a similar decision to make.

Many congratulations on the birth of your new daughter...really pleased that all went well and you got your CS .

if they say no get another consultant. don't take no for an answer. I am sure that you should get what you need when you explain your reasons. I didn't take no for an answer and in fairness I had no medical reason. It was my first child but I knew I wanted a c-section and got one. I am sure that you will too and wish you all the very best of luck. xx

Congratulations Lucas

Just read this thread and glad all went well Ema76 you too, I remember your early threads but missed your birth announcement (I think)
Congratulations to you both!