ELCS vs VB?

[Rollersara]

So, I have a neurological condition which is relatively rare in women of child-bearing age. I'm now 33 weeks pg and over the past few months I've seen a host of specialists from neurologists to obstretic consultants. So far there has been no conclusive advice on birthing methods.

I've got an appointment with a consultant at 36 weeks, when we will "decide" on what will happen (I'm aware it's unlikely that it will go exactly according to plan anyway!). I'm just a bit worried I'm going to get railroaded into something I don't really want. I don't expect advice from strangers on t'internet about how to give birth, but what questions should I be asking? What do I need to think about before this appointment?

Last time I saw this consultant I did ask about recovery times and she said it would be about the same for VB as ELCS, which concerned me as I'd always been told CS was much longer...

I will try for the physio again but it's unlikely I'll see the same one (she's very specialised and only saw me because the rest of her team were on holiday!).

Flowerflo my condition is very different - muscle spasms mean many of my muscles, especially abs, are very strong - but your experience sounds very familiar!

I'm seeing the neuro before the obstetrician and will see if he's changed his view as I'm much worse than I was when I saw him at 6 weeks (then he was open minded but recommended ELCS). What frustrated me most was the two obstetric consultants having different views but as you say that may change as the due date approaches!

Good luck and I hope it all goes smoothly for you!

Did your neurologist explain to you why they felt that a CS would be better? If there is a disagreement between the professionals that isnt helpful to you. Could you ask for a joint appointment between the OB and the Neuro, as that might help clarify the best way forward?

roller that must be particularly annoying having to 2 obstetric consultants disagreeing! Let us know what you decide and keep us updated! Hope it all goes well.

cats thats a good ideas about a joint appointment as sometimes the professinals seem to just send each other letters rather than having a proper discussion....

It's really frustrating, as flowerflo says everyone conmunicates by letter, I even see the two obstreticians one after the other rather than in the same room. And it takes 6 months to get an appointment with the neuro so I'm unlikely to get them in the same room before baby arrives.

Neuro was worried that natural labour would be too exhausting and I'd probably end up with an emergency CS so might as well go for an elective in the first place.

It sounds like you feel overwhelmed by too much information and conversely, lack of information?

What's your instinct telling you? At the end of the day this is your baby, your body, your birth. You have the right to make decisions for yourself that are in your own best interests.

Also..and I know this is somewhat controversial, but everybody should make birth decisions from an informed place - Please don't forget that whilst obstetricians are professionals, they are also well aware of the legal ramifications of not performing c-sects. To date, there have never been any cases of an ob being sued for performing a c-sect...but there have been many, MANY law suits over obs not performing c-sects when it's been perceived that they should have. Obs would rather perform a c-sect and not be sued, than not perform one and potentially be sued.

I know your situation is somewhat unique (which is why, at the end of the day, only you can make the decision about the way in which you're going to birth your baby), but fatigue in labour is not fundamentally dangerous to either you or your baby. Babies still come out - women who were drugged into unconsciousness via twilight anaesthesia through from 1914 through to the mid-40s STILL pushed their babies out of their vaginas - because of the fetal ejection reflex. Women in comas can still have vaginal births. Not being in control of what your muscles are doing because of fatigue does not mean that your body can't push your baby out.

ELCS is inherently risky. Inherently more risky than vaginal birth. Those are fact backed up by the best scientific literature we have (of which I'd urge you to peruse :) ). In every case where something carries an inherent risk, a risk/benefit analysis needs to be undertaken - what are the risks of an ELCS, what are the benefits? What are the risks of a vaginal birth, what are the benefits? Where the benefits outweigh the risks - that's your best option, whatever that might be. For some women that is CS (either planned or emergency)...but in order to make that decision you really need to know what it is that you're dealing with. And I'm afraid you just can't find that out by talking to specialist - because no matter how good they are, they are, at the end of the day, human - and prone to faults, mistakes, and biases. Your very best bet is to do your own research, be really informed, and make the best decision you can taking into account all of the information that you have to hand - and trust that there is nobody, nobody who loves your baby more or wants the best for your baby more than you.

Thanks TamIAm, I saw the community midwife today and she said similar things to you. Thing is, before my last visit to the consultant I was pretty much set on the idea of a VB but she was so negative I came back to thinking maybe an ELCS was the best option after all. My ideal scenario would be a water birth, which the midwife and one consultant said would be fine, but this consultant said wouldn't work and kept saying things like it wouldn't be possible to get me out if I needed an epidural. My bedroom is on the second floor and I manage to get up there, and I have a very healthy 6' OH who is more than capable of getting me out of the bath if necessary!

So far I've gone gone to most medical appointments on my own as I've had them pretty much every other week but I've told OH we'll spend the weekend researching our options and then he'll come with me to the 36 week appointment and make sure all our concerns are addressed.

TamIam has put things really well, I wholeheartedly agree with everything she has said. She also reminded me of this useful acronym for remembering good questions to ask to help you make decisions, either in appointments or during labour itself.

B - what are the benefits?
R - what are the risks?
A - what are the alternatives?
I - what does my instinct say?
N - what happens if we do nothing?

Tamiam i am taking legal action over my CS. Not that it was done, but that it was a poor job, so not exactly right that docs perform CS to avoid this, it still happens

I'm so sorry that you had a poor c-sect experience, mosschops. That's awful. I hope you're recovering and being nurtured in doing so.

You're right, it was probably somewhat disingenuous to say that no obstetrician had been sued for doing a c-sect. I am, in fact, sure, that many woman have sued their obs - but as far as I'm aware, all such cases have been settled out of court (if they've even gotten to that stage). Of course, I also don't know of every single legal case ever to be brought before a court, so, I shouldn't go around stating absolutes. Having said that, it sounds like you're bringing forth a medical negligence/mismanagement case which is somewhat different to suing an ob for performing an unnecessary c-sect (and winning). Nonetheless - I wish you every luck with your legal case and hope you get a just outcome...and some closure with it.

Rollersara, if you're wanting a waterbirth (and I honestly can't recommend them enough, having had one myself at home 3.5 years ago!) then I'd be asking the consultants that you're seeing "What are the absolute contraindications of waterbirthing in my situation?". If they're saying that they can't get you out of the water and that's patently untrue - then that's not a reason, you know? And if your neurologist is saying that there is no contraindication for VB with your condition...well...the ob consultants need to take that into consideration - because while they're the experts at complicated childbirth, the neurologist is the expert at your medical condition.

Thanks tamiam , i agree its a different scenario, my issue isnt that the cs was performed (which was the right decision) just the negligence of the doctor, which is something to consider when thinking about surgery..

do what feels right for you stuff everyone else