How/When do you request a ELCS?

[Librashavinganotherbiscuit]

I am pregnant with DC2, I had a EMCS with DS1 as it was found he was a footling breech when I was at 8cms. This time round I would like to request an ELCS for many reasons that occured during my last pregnancy/labour. I have my booking in appointment with my midwife tomorrow (will be 10 weeks), do I request a consultant referral then? Can I request, if possible, a certain consultant? What type of questions will the midwife ask me and most importantly is she able to deny my request or can only a consultant deny a c-section?

TIA

You will automatically be offered a repeat section (everyone is once they've had one).

You can get it all sorted out quite early on, or you can wait till very late to decide (I was going to VBAC with dc2, until 39 weeks when I got cold feet and was booked in for a section a couple of days later!).

Not sure about the consultant question though. I think in most cases you will get the same one you were under previously.

Hi, I had an ELCS with DS as he was frank breech (we found out at scan at 37 weeks). Anyway, when I was pg with DD I felt right from the outset that I would prefer another ELCS because I was concerned that as my pregnancies were only 8 months apart my previous 'wound' may not be as fully healed as it could have been. Also, my experience of an ELCS was entirely positive and I was ok about doing this again. I was mostly of the mind that I could labour only to end up having an emergency c-section - exhausted and disappointed. Anyway, this is all irrelevant to your question.

I was thinking all the way through my pregnancy that I wanted an ELCS but decided not to mention it to MW as I didn't want her to think I thought I was demanding one. I was sent for an appointment with a consultant at about 16wks (I think) which was pretty much just a form filling, wee testing exercise and asked to come back to the hospital at 36 weeks. At 16wks I was asked if I had any thoughts about the birth. I said I was keeping an open mind. They told me all the stats about VBAC and the %s to reassure that there was no reason I couldn't have a VBAC but that unless my birth was completely without deviation from an 'ideal & straightforward' labour I would have to have a c-section straight away.

Ultimately I kept my preferences to myself until about 26weeks when my MW asked me how I felt about the birth and I told her (had a very good relationship with her & very open) that TBH I'd prefer another ELCS. She said "ok, that's fine, I don't blame you, it's your choice - but just approach your decision gently but firmly when asked at the hospital at 36 weeks"

So at 36 weeks I was all set in my mind for a reasoning session where the consultant/registrar would try to persuade me to have a VBAC. I was mentally armed with my counter reasoning. The conversation went like this:
dr"So, how do you want to have this baby?"
me"Well, TBH I have thought about this long and hard all the way through the pregnancy, and I have weighed up all the information, and I would prefer to have another ELCS"
dr"OK, that's fine"
Starts filling in forms - I sit quietly stunned that the conversation I'd been dreading and planning for 6 months had been so ridiculously easy.
MW said that it's a choice based system and although they would prefer you to try for a VBAC they do completely understand and respect your decision to have another c-section.

I hope I didn't ramble too much & have reassured you a little bit. Good luck

The automatic offering of elcs may well depend on where you live.
I had an emergency cs with ds and all in all a really crap experience at my local hospital. When I went for my booking in with my current pregnancy asked my midwife if I could have an elcs and she was adamant that I should try for a VBAC, which I really didn't want to do - so much so at the time that I was starting to look at private care costs!
AS it happens, I'm actually expecting twins, so the chances of me having an elcs are now quite high anyway, although at my first meeting with the consultant she asked me if I wanted to deliver naturally (having commented on the large gap between my children - it wasn't for want of trying!!). I said 'no, thanks' and she said we should discuss it nearer the time, while I was thinking 'we don't need to!'

I had a debrief with my consultant a couple of months after DD's traumatic forceps arrival in Nov 08. He agreed then that due to the damage I had post birth he would offer an elective for a future pregnancy (mostly bladder wouldn't work) though he also thought a vb would be fine for me.

When I got pregnant with #2 (am 29 weeks at the moment) I had already done my reading up of medical journals and talked to my physio and consultants about elective v.vaginal birth for safety and my longterm health.

At my booking in appt I said I was leaning strongly towards an elective. The mw's said given the very long, painful recovery they thought it would be best too. They got my consultant into the appointment briefly and he agreed again.

My hospital has closed and merged now and my new consultant has also met with me at 24 weeks and agreed to an elective without any problem. My community mw has written on my notes 'elective c-section' to help make it clear for everyone too.

I have felt very supported in my choice and reassured - after a lot of damaged trust during DD's birth this is helping me.

I got an letter through at about the same time I got my 12week scan letter with an appointment to see a consultant made for when I was 16 weeks. This happened automatically after I had had my midwife booking in appointment (I had an emergency c-section last time around).

The midwife I saw at booking in was very much pro-VBAC, the consultant appointment was a bit rubbish but essentially "have you decided whether you want to do VBAC or c-section? No? Here's a leaflet on the pros and cons of both, come back at 28 weeks and try to have made a decision by then". I was expecting the hard sell on VBAC but didn't get it.

I have just had my 28 week appointment which was much more positive and I left feeling happy with my (current) decision (VBAC) and don't need to go back until I am 41 weeks (if I last that long) when we will discuss options.

Our hospital (Frimley Park in Surrey) also run "VBAC information evenings" - and I am going to go to the next one and see what they have to say.

I guess it all depends on where you are in the country, but you will automatically be categorised as "high risk" due to your previous c-section and therefore will be under consultant led rather than midwife led care.

morning, thank you all for your comments I think the thing that is worrying me is that c-sections aren't now offered automatically and I had lots of "ohh well you laboured well so next time it shouldn't be a problem" comments from the midwives last time.

tallbirduk - I am in fact talking about Frimley Park! Did they say how much you would have to follow NICE VBAC guidelines at FPH? Which consultant did you see? I had DS there in July 08.

Sounds like your situation has been well covered already, but I would add that I requested my elcs directly from a chosen hospital consultant. I wrote a letter, made an appointment and discussed why I wanted one (previous mentally traumatic birth, although physically trouble-free) with her before ttc, so that I would have it in writing and feel comfortable with becoming pg. I was terrified of falling pg and then finding out that they would not do the elcs so could only contemplate ttc in this circumstance.

The consultant was lovely btw, very kind and reassuring, not at all the fight I expected there to be about it.

HTH

i told my midwife at booking in for DS2 that I was having a CS. Also told her that I wouldn't be making an appt to beg for one from the consultant.

Consultant phoned me at home, date for CS booked. Pointless visit to hospital avoided

Libra they haven't mentioned the NICE guidelines - maybe because I haven't (I am clearly clueless) - but I did ask about how long I would be allowed to labour, continuous monitoring, induction, etc and the answers were all pretty standard stuff as I understand from various threads on here.

If it looks like I am failing to progress I will be taken off for a c-section, yes they would like to continuously monitor me but they have telemetry monitors which should mean I can move about, even if one isn't available I should be able to be pretty mobile with the wired belt on. They won't induce me but will attempt a sweep / break waters if I get to 40 +10 and they want to put a canula in from the start (I'm going to fight that one because it's just so uncomfortable I found - can't even push yourself up off the bed!).

Although I don't have to go back till I am 41 weeks (fingers crossed it's all done by then!) he did say that if I wanted to see them at any time I just had to make an appointment - so I guess if I change my mind about the VBAC that's what I need to do.

I was really pleased I don't have to go back to the hospital any more - is a right pain with a toddler in tow and seemed totally pointless when you still have a full schedule of midwife appointments as well - especially as they are ALWAYS running late!

I would say that the hospital didn't seem bothered either way whether I went for VBAC or c-section, although the guy I saw last week was very supportive and seemed to prefer that I had chosen VBAC. I think if you want a c-section they will be fine with that.

I haven't actually seen a consultant - saw a lady who didn't even introduce herself the first time and although I tried to remember the name of the doctor I saw on Thursday I just can't!

I had DS in June 2008 after 2 days in labour at home (was going for a homebirth) and 6 hours in hospital. He was back to back and just wasn't coming out, he started to show signs of distress as they ramped up the drugs to get things going, so eventually they wheeled me off for the c-section.

I am really tempted by the c-section option this time mostly because the convenience of knowing when the baby's coming (we have no family closer than 3 hours away) but also because I recovered really well last time - walking a couple of miles to M&S and back by the end of the first week, running again at 5 weeks and I don't know what to expect with a 'natural' birth - all seems a bit more variable and I'm not sure I like that!

Anyway. Enough rambling - let me know if I can help any more

at booking.

ask to see consultant asap to see if they are on side.

Use MW knowledge of colleagues to be sure you get put with a sympathetic consultant.

Stand fast no wavering on your stance.

You have the right to the birth of your choice.

I wouldnt mention 'convenience' they wont dig, stick with emotional and physical reasons for your choice

Thanks for all the advice, when I mentioned to the MW I was going to request an ELCS her exact words were "good for you", so all worrying about nothing. She did point out that the consultant I asked to be referred to was very pro-VBAC but I have a little insider knowledge of the consultants and know the one I requested is very good.

tallbirduk - good luck with your VBAC, I have to admit I do feel a little bit of a wuss going for the elcs option especially as I had an easy labour last time really but feel that all the reasons I had an easy labour last time would be denied to me this time.