2nd baby - C section decision

[germl]

Hi

Maybe I am just getting myself in a bit of a tizz, but had my booking in appointment at my hospital, am only 17 weeks with my 2nd (am covered by a consultant and local midwives due to previous EMCS) and when I mentioned I am certain I wanted planned CS this time round as I struggled immensley after DS was born due to an underlying health issue, I got the strong impression that the decision would be taken by a consultant and was told I have no medical reason to have a ECS....

I then told the doctor speaking to me all about what happened (induction due to pre-eclampsia, 18 hour labour, failure to progress, EMCS, hideous aftercare and my health problem flaring up causing massive amounts of pain due to my exhaustion) she went to talk to the consultant and came back to say that the consultant said I have a 70% chance of giving birth naturally and that I would have to discuss it at 32 weeks with the consultant and an anaesthetist (sp?) regarding pain relief (eg epidural) but really really stayed away from even mentioning a C-section, wouldn't even say the words and gave the distinct impression that having a c-section was not something they thought was necessary.

We left it at that, I was in a bit of shock and I thought it would be a pretty cut and dry decision that if you have a c-section previously, you are a lot more likely to have a second, or am I completely wrong? I have NO INTEREST in having a VBAC - I made this very obvious at the appointment.

I know I am WAY ahead of the game at 17 weeks, but I won't have the energy to argue for a c-section at 32 weeks, I struggle now to be honest- and if I knew it was not really an option (which is the impression I got from the doctor and consultant) I would never have gotten pregnant. Can they not make a decision now as I can't handle this uncertainty? After the appointment I went into a panic attack once I got back to the car.

Sorry this is so long, I just want some other opinions on this. I am pretty sure I am totally over-reacting but this is a massive issue for me...and I know, I should have spoken to someone before getting pregnant, but I honestly thought that it was pretty common to have a c-section after a previous one.

germl, I'm really staggered that you aren't being allowed to make your own decision about the kind of birth you want to have, especially after such a dreadful experience first time around.

I'm also shocked that you were expected to give birth naturally with pre-eclampsia; I had pre-eclamspia with DS1 and was given two days' notice that I was having a CS at 34 wks + 4. The CS went well, baby was fine, and I was up and about two days later. So I had no qualms about attempting a VBAC with DS2, but in the end had an EMCS after failure to progress - in labour for 12 hours, only 1cm dilated and head not engaged.

Given your underlying health problem, the difficult time you had with your first child, and the understandable anxiety it's causing you this time round, I think that you can make a very strong case now (not waiting till 32 weeks) for an ELCS to put your mind at rest. Can you take your DH with you for moral support? You shouldn't have to endure this kind of stress for another 15 weeks just because the NHS wants to push you towards having a VBAC you don't want.

BTW, there are other women in your position who've posted recently about wanting an ELCS after traumatic deliveries, and they too have met with the same resistance from the NHS that you have. If you trawl through the pregnancy topic you should be able to find the threads, and might find them helpful.

Good luck - you have every right to the delivery you can cope with, and don't let any bureaucrat consultant or midwife push you into something that you don't want.

I feel for you germl, that type of attitude from the consultant is really not helpful and rather rude.

I am 20 wks pg with dc2 and previously had a c-section and I saw a lovely cosultant on Wed who said it is totally my choice whether I go for a VBAC or a an ECS. She is even ordering my birth notes from the previous hospital so that I can go through them with someone to help me with my decision.

Is there any way you can see someone else for a chat? Even chatting with your gp may help. Do you have your previous notes? If not I strongly suggest you get a dr to request them and go through them with your mw, it may help your cause.

Good luck.

Hi,

Sorry you are going through this. If you search in the Childbirth topic there are lots of support threads on this issue.

I am booked in for an ELCS in Oct after a previous EMCS and managed to get my consultant to agree to this (at 14 weeks) without much of a fight. However I know I was lucky in this. From what I've read (mostly on here) it seems to depend largely on the personal view of your consultant. It's by no means a foregone conclusion that a previous CS will guarantee you an ELCS for subsequent deliveries. Even my very sympathetic consultant said she was obliged to officially recommend a VBAC due to the 70% success rate etc etc so the official policy is very pro-VBAC.

Can you ring the hospital and ask to have an appointment with the consultant in person? If that consultant is not listening it might be possible to change your consultant to one who will be more open to the idea.

Good luck. And have a look in Childbirth as there are lots and lots of others in a similar position and someone may even be able to recommend a specific consultant at your hospital etc.

That should be I had a previous emergency cs.

Hi congratulations on your pg- sorry you had a difficult time with your appointment. Are you under mw care or consultant-led care?
If you haven't already I would recommend finding out the name of the consultant you want to be under and asking your mw to change you to being consultant-led, and then at your next appt insist on seeing them directly not one of their team. Best of luck

Hi,
I am also being pushed towards VBAC, consultant let me go away and think about it, then Registrar was even more pro-VBAC.

When I complained to my Midwife, that the registrar had walked all over my opinions on the matter - she said that having had 1 EMCS, I was entitled to have another. They couldn't force me to VBAC.

Logically this makes sense, as although risk of scar rupture is small, it is there - and I think that they would be in all sorts of legal dilemmas if they therefore force you to VBAC having pointed out this risk to you.

So I think you have to stand your ground, and tell them what you are going to do!

I have another appointment at 36 weeks, and now I believe I have my rights straight in my head, I am going to be more forceful. I have also discussed this with DH, and he will back me up - so try and get your partner onside - sespecially if he is better at being assertive than you are(mine is!)

Thankyou so much for your replies - I am going to talk to my GP who is really great, I see her a lot - she must get sick of the sight of me! She is on holiday until next Monday which I can handle - but will see whether she can help with this. I have also spoken to my auntie, a nurse, who was pretty angry at how they dealt with the appointment and the information and has said if I want her to come in to the appointment with me (she is a very calming influence!) that she will.

I understand they may be pro-VBAC but surely they have a responsibility to put all the information across so that you can make your own decision, rather than promoting their own agenda? I would happily listen to the info, even though I know what I want.

clareanna - I am apparently shared care as I have had a previous c-section. I think next time I see the actual consultant, but I want a decision sooner, so will talk to local midwives at my next appointment to arrange another meeting.

Rocklover - I can ask if my previous notes can be sent through, but reading through them from when we had them after DS was born, it was case of induction that didn't progress and was pretty straightforward - ie no distress for me or DS, or physical problems. What I struggled with post-natally was being exhausted which caused a flare up of my condition (fibromyalgia) - none of the MWs I dealt with during my whole pregnancy last time and 1 or 2 doctors/consultants even knew what it was. Fibro affected me during my last pg, and is even worse with this one, and it's the mental health aspect I struggle with as it causes a lot of pain and fatigue before I even get to full term and I don't want to be in the state I was after last time if I can help it.

I am also going to talk to my HV today (if she's about) as she has been a massive support for me and DS when I was at my worst and wants to help this time with getting support if I need it.

Thankyou once again!

I think it is a hospital thing - thy have to put down they recommended a VBAC. I had gestational diabetes last time so don't want to go overdue. My consultant suggested an induction (even though I have had a previous section and the risk of rupture is 5x higher than natural labour VBAC and it is not recommended by RCOG?) Not sure what is going on. I think ultimately you will get a section and won't have to argue too much but they have to make it clear they are against it...

Hi there,
I am also making a decision about having VBAC vs natural delivery after CS last time. In my case the hospital is trying to cut the number of CSections they do, but even so, I know that I can opt for one if I want to.
My understanding is that you always have the right to a second opinion on the NHS. So you should definitely ask to see the head of the consultancy team asap, and you should take some detailed info on your underlying condition with you, plus maybe a letter from your GP? You could also ask to receive some counseling if they are still pushing you towards VBAC. Even if you don't actually go ahead with it, the request should make them realise just how serious you are.

Good luck.

FYI, booked my section today. The midwife told me before I saw the consultant that if you have had one C-section you are allowed another one. She didn't seem keen on induction but did say they could sweep etc on due date. But if you want a section you can have one.

hiya
Hospitals are really keen to keep their c-section rate down and in theory a normal delivery is safer than surgery but given your history (and the fact this is YOUR body!)I'm really surprised that things are being made so difficult for you.
Why don't you write down a list of reasons why you have made the decision to opt for a planned section now so that next time you see the consultant it's all prepared.
You are absolutely entitled to a second opinion and if you have a good relationship with your GP she may be prepared to set that up for you asap.
good luck!
jx

germl I think it'll make more sense for you to insist to see the consultant at your next visit and state that you are unwilling to accept the risk of scar rupture and after the traumatic time you had with your first delivery, you do not want to accept the risks associated with VBAC. They can't force you to have a VBAC if you do not want one, and you have a clinical indication for a repeat c/s. If the consultant is being difficult and insisting that you have a VBAC, ask if you can have your care transferred to a different consultant who isn't so pro-VBAC for the sake of hospital figures, and more concerned about you and your needs. Definitely take someone with you who can speak up on your behalf as it can be very intimidating and difficult to get your views across when you have doctors who talk down to you. Good luck!