Going to push for an ELCS next week - have written notes to take in with me, can anyone read them and offer feedback please?

[ELCSadvice]

Hello,

I've got a consultants appt in a week in which I'm going to request and ELCS.

Am 29 weeks and have done nothing but think about and research my birth options, so please, no helpful 'advice' suggesting I reconsider and try for a natural birth!

But I would be very grateful if you could read through what I plan to say to the consultant and give me any advice.

Thank you!

Reason for request
Previous traumatic delivery, not wanting to repeat or make worse damage

Baby: trauma to head, (non permanent) birth injury, poor feeding ? hospital admission.

Me: episiotomy site still sore, pelvic floor weakened ? worried about more damage.

Absolutely will not consent to forceps or ventouse delivery ? 2007/08 instrumental delivery rates were 11.5 per cent.

Understanding of risks of c-section

Recovery ? will be well supported by husband and family for up to 6 weeks.

Bladder and bowel damage ? rare.

Surgical cuts to baby ? rare.

Baby breathing problems ? reduced if section performed at 39 weeks.

Future fertility ? no more children planned.

Scar rupture ? no more children planned.

Increased risk of stillbirth ? no more children planned.

Understanding of risks of natural birth

2007/08 17.2 per cent EMCS rate ? 1 in 6 chance of having a c-section anyway.

2007/08 11.5 per cent instrumental delivery rate ? would want an epidural but will not consent to instrumental delivery which is more likely with epidural plus big baby (previous baby almost 10 pounds).

Pelvic floor problems.

Repeat tear/episiotomy.

Birth trauma to baby as a result of instrumental delivery.

Nerve damage to baby.

Shoulder dystocia.

It's well worth discussing all that.
How long ago was the last birth?

Thanks Paisley, was 20 months ago

Mind you, the consultant should be up to date with the risks themselves - I just meant those concerns particular to you and your baby.

I just want to know the risks myself so that I can prove it's an informed choice rather than me just thinking an ELCS sounds rather cushy or something.

Just wanted to say you seem to have really thought this through and to stand firm in what you want.

I had an ELCS for my second but I had to insist, my first birth was traumatic and ended in an emerg section. The consulatnt wanted me to "give it a go" but like you I didn't feel it was right due to much the same reasons. You have thought about it stand firm good luck

My main concerns are the risks to the baby.

Having seen the effects of birth trauma on a newborn firsthand the risks of an ELCS are more acceptable to me than a natural birth.

x-post thanks happy.

Can I be allowed a small snigger at pushing for a cs?

Obviously I'm not expert but you sound like you have good reasons and have thought it through.

Good luck.

SD

Big baby may be your best argument.

I had a scan late in pg with DS1 for other reasons and it turned out he was quite large, especially his head. The woman doing the scan suggested a cs, but in a very vague way so I didn't understand she really meant it - also I didn't know she was a dr not a sonographer, since at the crap hospital (Royal Free, London), no-one introduced themselves. It was only during the difficult and protracted birth when she turned up and said "well, I told you you should have a cs" that I realised that she'd meant it and actually had the authority to arrange one. Anway, DS wasn't that big, only 9 pounds when eventually born at 39 weeks, and his size was apparently sufficient to potentially indicate a cs.

Thanks umf.

Am concerned though that if I push purely on those grounds that they will just fob me off with growth scans and I will have to wait til 36 weeks to know if they are even prepared to do a c-s.

But I will definitely be mentioning previous birth weight when I go in.

Yes, expect you're right about fobbing off with growth scans.

Good luck next week.

I asked for and got an ELCS on the grounds of previous maternal trauma. With my first delivery I had an episiotomy, was allergic to the stitches, needed two surgical repairs and was told if I had another vaginal delivery I would probably need further repair surgery. When I asked the consultant re: ELCS, she said no-one would refuse me on those grounds, and that it was a perfectly reasonable request given my previous experience and given that I would probably need surgery anyway.

I had the ELCS, went like a dream and recovery was 100x better than from my 'normal' delivery. Definitely the right decision for me.

Good luck.

previous trauma and birth injury should be your starting point. you are making an informed decision and if your consultant is not sympathetic, ask to be referred to someone else

The woman in the bed opposite me when I had DD had an ELCS because her previous DD had shoulder dystocia. So in some hospitals that can definitely be a reason for agreeing to ELCS.

Just emphasise the anguish the thought of it all going wrong again is causing you. Say you can feel the tension building up as your pregnancy progresses and now the birth seems like a huge wall at the end of the road that you simply do not feel you can get over. Or something like that. Emphasise that you need it for your mental health. Good luck.

Thanks all.

Lulu - do you know how frequently episiotomys can reopen in subsequent labours? Wondered whether to put that as a risk or not. I really, really don't think I/my body would cope with it reopening.

The birth injury my baby had wasn't permanent, but the baby was very traumatised for quite some time and I can't face putting another one through that.

One of the risks of ELCS is an increased risk of stillbirth in subsequent pregnancies.

So if the cons puts that to me as a risk then I am going to explain that it is not a significant risk to me as we won't be having any more children.

It's not very clear I know - but I just wanted to know what the risks are and how I am going to answer them if/when the cons brings them up.

it really depends, some women tear the same place they were cut or torn before, some don't.. scar tissue can be more rigid and less stretchy, so can be more inclined to tear again.. i dont have exact stats

it seems to be you have good grounds , maternal request is one, but not enough, but the previous trauma is.. i dont thikn you will have a fight, you dont have to prove you are making an informed chouice as it were, you say you are making an informed choice that you wish to delvier with a c.s this time

fear and anxiety re a vaginal birth , fear of birth itself is a ground for c.s.. esp if you are concerned abiout more damage to oyurself and baby

ELCSadvice - you may be pleasantly surprised and find that the Consultant does not try and talk you out of it, but rather accept that you are an intelligent grown-up who has thought long and hard and made an informed choice. That's what happened to me. I was quite worried about having to argue my case, but I think, in the event, my first birth story made the case for me! I hope it all goes well for you.

Agree with Bibbity - you may be pleasantly surprised. I was - mind you i did start sobbing as I explained why I wanted an elcs so that may have helped (I didn't do it on purpose - I blame my pregnancy out of control hormones)

I had been warned that I might need to see a MW Counsellor to go over my reasons - but this never happened. When I saw the Consultant she just listened to what I had to say - passed me a large box of tissues and signed me up to having an elcs.

I think you sound as if you have thought through your options really well and will come accross as someone who has made an informed choice.

Hope you get what you want.

OP, I think your notes are very clear and practical. To echo what others have said - if you feel anxiety or fear on your part about attempting a VB are significant, then you could always add it to your list as a 'factor.'

Also, these may be notes for yourself, to help you stay on course in terms of a meeting - but personally, I think it is worth typing them up (very much as you have done here) so that if necessary, someone else can have a glance at them too. You might be totally calm and in control on the day, but if you do get emotional, there's no shame in that! and a clear list on a piece of paper might be a very useful 'prop', for you and the consultant. IYSWIM.

Good luck and I do hope/expect you get a professional and sensitive response.