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.

Thank you everyone.

I am still very distressed about my previous birth, to the point that I haven't been able to put it down in my notes!

But I will explain that to the cons. I am hoping that he will be receptive - I do know someone he agreed an ELCS for with no argument whatsoever (although that was after EMCS) so I am hoping he will be understanding.

Thanks Lenin, can I ask how you found your section as compared your previous birth?

Sorry to hear about your first birth lenin, I can't believe they tried to push you into a VBAC after that!

Glad your ELCS went so well.

I was the same Lenin - quite surprised at how I felt in the weeks leading up to dd2's birth. I had said I wanted an elcs from teh beginning - but it became even more right for me the closer I got to the birth.

ELCSadvice - my elcs was really calm. I had an emcs the first time and it felt like the world and its mother was in theatre with me and I was totally away with teh fairies due to tiredness and pethidine. This time I think there was me, dh, 2 surgeons, a mw and the anaesthetist - all very civilised!

It did feel a bit clinical - but after lots f skin to skin cuddles with dd2 that rush of love just took over.

Recovery for me was okay - it took a bit longer than my first because my scar didn't knit together as well. But I did have a toddler to lug about second time round so that was probably why.

I honestly have never regretted my decision to have an elcs.

Like Lenin - I did get the opportunity to go through my birth notes from dd1. Was amazing how my memory of what had happened was actually quite different from the reality

I think your list is great and I would add any trauma/post traumatic stress symptoms you experience too (incl anxiety over this current pregnancy, fears for baby etc).

I have an elcs agreed for June as I had a traumatic and damaging rotational forceps birth 17 months ago when it suddenly became apparant that DD was stuck fast and in serious distress (head side on, mw error).

I have ongoing bladder problems, v.weak pelvic floor etc and took my list of reasons into my appointment too. Was not a problem.

I also cried on both my old and new consultants (not intentionally, I just can't talk in depth about DD's birth without crying) and have been referred to maternal psychology to get some support to try and avoid risks of PND (which I didn't have last time, more PTSD I think).

Another one here that had ELCS after instrumental delivery.

Your list looks fine. I had a similar conversation with my consultant and got an ELCS without too much drama; she was very understanding. Then when it came to booking it in the registrar started being difficult! But a little assertiveness sorted that out (basically told her to go and talk to the consultant!).

My ELCS was so much calmer than my instrumental delivery, and we established breast feeding without any hassle (which had been one of my worries about going for a CS). My one tip would be to make sure you have help for every minute of every day for the first few weeks - it really is impossible to deal with a toddler on your own as well as looking after the newborn and yourself.

Good luck, like the others said your well informed which is the key.
Stay calm and you'll be fine!

Great, thank you everyone - lucas, thanks for warning me about the troubles booking it, I will remember that tack later.

Lovethesea - good luck for June! Sorry to hear of your experience, was it keilands forceps? I only had neville barnes and that was bad enough.

On your list you have put "rare" net to some of the risks the consultant will discuss with you. Now it's great that you appreciate the risks are there but if your cons brings them up and you dismiss with a "yes, but that is very rare though" your consultant will be spooked. You need to say something more accepting of the risks - "yes I know there is a small risk of my baby being cut by the scalpel. I accept that risk". Obviously you won't have to roll out this spiel for every risk you mention, but it's helpful to think of it in the way rather than saying "yes, but that is rare" as a consultant will hear "yes, but that isn't going to happen to me" and get worried you don't really understand that the risks are real and could happen.

The other thing is I would drop the stats stuff. Your chance of a section in labour/instrumental in labour is tiny as you have already had a vaginal birth (albeit instrumental). The consultant may just triumphantly correct you and think that he has solved the problem.

Best of luck.

Thanks harder, what are the stats for instruments/c-secs in 2nd labours, do you know? AFAIK they are not tiny (although I know obviously more likely for second timers).

Sorry, meant obviously less likely.

You should actually be able to get these from your hospital. Ring up and ask for the audit midwife. I will have a look a more general stats - the problem is you need very specific stats of women in labour in otherwise low risk pregs (if yours is). Obviously x amount of prev instrumental delivery women will have a planned section for any number of reasons so to say that, for instance, 75% of women wih prev insrumenal went on to have a normal delivery would be slightly misleading (as most of those who didn't will not have been sectioned in labour).

OK it looks like you risk of instrumental delivery will be in the region of 4% and your risk of an EMCS around 8%.

www.ncbi.nlm.nih.gov/pubmed/19888032

Ok, thanks harder. I asked for their c-s and instrumental stats and those were all they could give me (and only for 07/08 too ) but haven't tried the audit m/w. Will do that.

Going on your later figures I would have a 12 per cent chance of EMCS or instrumental delivery then.

Thanks so much for looking that up.

No problem - keep us updated.

I had my elcs last week following two traumatic vaginal births. I have posted about wonderful experience in another thread.....recovery still going really well and I'm up and about and much quicker than either of my previous births. When I originally broached the subject of an elcs my obstetrician was not very supportive as in her opinion even a vaginal birth with instrumental delivery followed by a manual removal of placenta and a pph was better than a c-section!!! However, I didn't let up and she eventually conceded that psychologically I might be better off with a section - I think that consultants will always have their own opinions regarding what is better and therefore you can never change their mind with a medical argument as it is likely to get their back up. However, if you approach it from the angle of your psychological distress ( which is the real issue at the end of the day) then they are more likely to listen. They are people at the end of the day and if they really believe that the thought of another vb is going to stress you out for the rest of your pregnancy and stop you from relaxing during labour they are more likely to agree. Good luck!

I think this looks great, just really stress the first 2 points:

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

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

Good luck and I am sure you will get one

hi doesnt sound as tho u will have a fight on ur hands at all! good luck hope it all goes well for u
i also am hoping for an elcs i had rotational forcepes last time and a hellish epsiotomy, i am really hoping i get the choice and dont get pushed into something i am scared and not comfortable with i would also not consent to assisted delivery, my dd was only 6.5lb so i feel as tho if i cant do it with a teeny one god knows what state i would b in if any bigger, 8 mnth recovery after dd! sorry to hi-jack do u think i have good argument to??

Hello Sophie, I can't answer your question for definite but would imagine you have a very good case for an ELCS.

My advice would be not to wait to be asked, but to come straight out and ask for one. I would also stress that you had rotational forceps, any pelvic floor damage and how awful your episiotomy was.

Sorry to hear about your experience, but don't be afraid to ask for what you want.

If it helps sophie, the mw's at my booking in said it wasn't my birth that concerned them (dilated fast etc) it was the length of my recovery - seeing consultants in urogynae and gynae 7 months post birth and physio 10 months post birth.

I think if you can go in well read on the risks and explain you have weighed them and feel you have weaknesses already due to rotational forceps they will be willing to listen. If not you can always ask for another consultant so be pushy!

Also mention concerns about longterm health and continence post menopause as they often focus on the birth rather than the longterm health picture.

I found having notes really helpful. Your anxiety and stress levels are part of a good reason to be given the option too, so be as clear as you can on your feelings.

thank u so much for ur responses withorwithoutyou and lovethesea, i feel as tho i have a good case,
i would rather give birth every week than have the pain i had after, i hate that people (my friend) say things like yeah but its only few hours of pain!! iam not scared of giving birth done it b4, i am however terrified about after!

i have already been refered to a consultant next mnth, i wasnt aware i could insist if u like and ask for another consultant if it doesnt go my way, so thanx for ur help fingers crossed xx