ELCS, midwife discussion outcome, worries.

[BagCat]

So, 22 weeks pregnant with a lifelong phobia about all things medical I had 'the chat' yesterday with my midwife about ELCS, all my worries, fears about childbirth, losing control, interventions and uncertainty.

Came away feeling very stressed and not taken very seriously. At first she was a big dismissive, the old 'every woman is scared' argument. So I gave her examples of previous times where I've freaked out in dentists, smear tests, having bad dreams, that I don't see ELCS as 'the easy way out' (eh, far from it actually) etc. Eventually I felt she started taking me a bit more serious (a few times I had to really hold back my tears, it was very emotional saying all these things) but that she thinks I can just get over this really easy.

She told me Scotland goes by NICE guidelines (which I did not think they did for CS) but then proceeded to tell me both the consultants at my hospital will not give an ELCS to a 1st time mother who has no 'reason' not to give birth vaginally. she said she knows the consultants very well as she worked at the hospital for 16 years. She told me 'hardly anyone' has forceps these days - I told her the hospital figure suggest otherwise and in fact show only a 1 in 3 chance of a normal, non intervention birth. She did not agree with me on that even though those are the published, actual figures.

So I'm feeling pissed off. I told her I familiarised myself with all the NICE stats yet she still maintained ELCS is a 'very high risk' way to give birth - I told her again that NICE guidelines say 'very low risk' for the vast majority of ELCS complications. She has agreed to pass me to a psychologist so that I can learn to accept the risks of vaginal birth and if that does not work, to see the consultant who will be able to explain properly why they can't do ELCS.

So I feel stuck. Yesterday was an emotional battle, I'm drained today. I don't know where this leaves me - terrified and feeling like I should pull my socks up and man up, or something She offered me hynotherapy but I had that in the past for the dentist and it never worked - or rather it did not work for me.

Any advice, wise words? (sorry this is long)

Hello sweetie, I am not an expert but have done the birth thing twice, once with a CS and once VBAC. The CS was by far the most medicalised, clinical, scary out-of-control experience of the two. So if it's the medical aspects that you fear, then it seems to me that an ELCS may not be the best option for you.

Have you considered a midwife led, low intervention unit so you can just let what happens happen and give yourself the best chance of a non-medicalised birth?

I so wish I had never had a CS. I have a huge ugly scar on my stomach with an overhang that will never go away. The VBAC was a million times easier to bounce back from and hasn't left my body visibly scarred.

You are still only 22 weeks so lots of time to prepare yourself mentally. Why not read Ina may Gaskin or similar to reassure yourself that your body IS designed to do this and that medicalised birth interventions are often the result of a spiral of interventions that wouldn't be necessary if the body was left alone to do its thing in peace? I know I sound like an old hippy, and yes there are plenty of cases where medical intervention is ABSOLUTELY necessary, but many more where the midwives/consultants tinker for the sake of it and then it just leads to a highly medicalised delivery.

I had an ELCS for my second birth as the first was so traumatic. I decided when I was 7 months or so. I did speak to my GP and she was prepared to refer me to another hospital if necessary. I asked to see the consultant at my first hospital and she said yes straight away.

With ELCS you have to stay in hospital for a few days. You have a visit to hospital the day before to see the anaethiestist. On the day itself they shave the top of your pubes, paint your tummy with iodine and you have an epidural which is painful to put in. Assuming you are awake you feel a pulling sensation in your tummy. You will have a catheter put in as we'll and are fairly immobile after the birth. You have a suture which is removed a week or so later (by midwife at home). You do have to take painkillers - it is painful. I have a scar which still itches nearly 14 years later. It is a medical procedure.

In your circumstances I wonder if it might be possible to have a home birth or birth in a midwife led unit. Your existing Midwife sounds unhelpful ask for a different one or to be referred somewhere else.

I'm going to try to add my opinion here - I had an ELCS (well a semi elective anyway - it was planned but I went into labour 2 weeks early so ahead of schedule) and it was a positive experience. The theatre staff were wonderful and calm, it was all very relaxed and went well. Yes I've got a scar but I had that anyway from my previous EMCS and it's not that bad! I was up and about that evening, home the following day and completely back to normal within a few weeks.

I can understand your need to try and keep control - that's partly why I chose a CS over a VBAC. I saw a mw counsellor about my previous delivery, and then I had a few consultant appointments and they agreed on the second one. I've never ever regretted my CS. I would push for an appointment with a consultant and if he/she doesn't agree you can ask to see someone else. Good luck.

Thanks for the replies so far

My biggest worry is the uncertainty of vaginal birth ending up with intervention after intervention or midwives not listening to you. This happened to a friend who recently gave birth. She ended up being cut, having an epidural and other drugs hours and hours after requesting them in a midwife-led unit. She had also spent 8 hours in a pool with the midwives saying 'you don't need drugs just now, it won't be long' ad infinitum. Another friend was induced, gave birth in 3 hours, tore very badly and wasn't allowed pain relief as birth was 'imminent'. Both are traumatised by their experiences, particularly my 1st friend, she took 5 weeks to recover and not sit on a rubber ring.

These things terrify me to the bone. And they are far from the worst that can happen.

I balance the possibility of those things in my head, the scary unknowns, against the known statistical risks of an ELCS. I do not want to end up in the position of going through a birth plan and ending up with an EMCS where the risks are higher, or millions of drugs, forceps, a sweep (boak), uncertainty or having things either delayed or forced on me - the lack of control. I know that might not make sense but it's how my mind works. I don't want to be a hero. I can't rationalise this in my head. I don't think that an ELCS is a lovely, amazing thing. It's just less terrifying than the uncertainty of all of those other things that statistically, are highly possible in comparison. I know it may seem totally irrational and pathetic but that's how the phobia affects me

Its definitely not irrational and pathetic!

I was not worried in the slightest about birth with DC1 6 years ago but when it came to it my body literally shut down and would not go past 3cm after 16 hours of painful and fast contractions, as it turned out my soon was trapped with the cord around his neck twice which was essentially strangling him with every contraction so I had to have an EMCS which was terrifying add I was so confused about what was happening!

I said I would not go through that again but I am now 35 Weeks pregnant with DC2 and fighting for a CS purely because I can't bare the thought of being so panicked again.

I was told by my consultant at 15 Weeks that a section would be less risky because I have a high BMI and I was against the idea at first but on Tuesday we discovered baby is double breech and he would rather I gave it a shot "normally" I could've screamed and I did burst into tears as he scared the crap out of me offering a CS and is now trying to back out of that so I need to return at 37 Weeks to discuss again :(

If I were you I would request a new midwife because your posts do indicate a serious phobia which could lead to high stress and an ultimately awful birth experience.

Hi OP, I can see you're terrified about this and wanted to wish you well.
I do agree with several posters that a normal delivery would be easiest for you, but it seems for you it's the lack of control that bothers you.
Would a doula be within your means? Someone to advocate strongly for you so you get the pain relief you want when you want it, and pushes for a section over other interventions if things don't go according to plan. Bare in mind your stats include all women, and if you look at low risk first timers only then the risk of intervention is much lower.
I know you found hypnotherapy no use in the past but I would still recommend you try a natal hypnotherapy cd, it's only £12 if it doesn't help, and as a bit of a control freak I found it superb. They do one for ELSC too.
Maybe ask your gp to refer you for CBT or similar before delivery.
If you're really, really sure that ELSC is the way for you then ask for a consultant appointment. If they refuse, ask for a referral elsewhere. Keep asking. If need be ask for a mental health assessment to back up your request for a section.
FWIW I'm an anaesthetist and had seen all the horror stories Pre delivery. I was so worried about things going out of my control. Self hypnosis was brilliant for me. 48hours non painful prelabour. 5.5 hours total from proper labour pains to birth, last 2.5 hours in hospital, tens and entonox. All v straightforward. It is very possible to have a normal first delivery, you just tend to hear the horror stories. Being relaxed is a huge help to things progressing well.

Complications and unexpected events can happen with an ELSC too. Please think about some form of therapy too even if this is what you choose.

Hello Bagcat, I've had 2 emcs, the second I wanted an el, but was made to attempt vbac as I went into labour early.

The emcss were fine for me, but from what you say they would be very upsetting for you.

It is not your midwife's decision. My advice would be to see a consultant asap. If they won't grant you an elcs, see another one. You sound very clued up.

For me, elcs is the controlled way to do it. No, cs isn't easy, but a vb when your heart's not in it and you're not confident in your abilities is far from a better option.

Good luck. Elcs is a valid birth choice, it's sad that it's still a battle to have this recognised even now it's in the nice guidelines.

Can I suggest two routes - get a consultant involved - they are the ones with the decision making power, not the midwives. Google 'tokophobia'. You don't have to put up with dismissive, bullying treatment.

If funds allow you could consider hiring an independent midwife to make sure you get the care you want. An IM is working for YOU not the NHS. They will come to NHS appointments with you if you want, explain things and advocate for you.

I had a home birth with an IM and although I ultimately had to transfer to hospital for an emergency Csection (which was fine, by the way -- I seem to have had a lot less pain and complications than friends who delivered vaginally) I felt well consulted at every point.

It is your body and your right to give informed consent to anything that happens. You're not wrong about the statistics either, but hospital staff aren't very honest about them, partly because they're not responsible for repairing the damage as far as I can see it seems to be something you're supposed to put up with as the focus is on delivering the baby safely and partly because the Govt has put them under a lot of pressure to reduce the csection rate so they seem to try other interventions first and take a very risk averse approach based on averages.

By the way, this might sound random but try to take plenty of exercise as good muscle tone definitely helps with labour and recovery as well as with your mood.

Thanks again for the replies. I think that having someone understand the thought process in my mind is really helpful and I said to the midwife I am totally up for any kind of therapy because it's not something I enjoy living with. It does however only crop up at times where I am faced with any sort of medical appointments, which means I can live my life happily avoiding it for most of the time and then it's BAM! Panic!

A doula is something I have definitely considered and I think it would be helpful especially as DH and I don't have much support nearby. Also, £12 on a hypnotherapy cd is not going to break the bank.

I think feeling as if you're being told that you're being a bit silly puts the back up and the defense modes come out. I don't expect the NHS to fall at my feet, I just want someone to take me seriously and see what happens from there.

I really appreciate the advice on here. Thanks a million, it really does help to clear the fog

The more time I spend on Mumsnet, the more upset I get about stories like this. If they have said that they follow NICE guidelines then its very simple. They have to refer you to a psychologist. If, after seeing him/her you still want an ELCS the consultant has to offer you one or refer you to another consultant who will offer you one. The wording is very clear. They are only guidelines, and some hospitals simply don't follow them. But you are being told that the hospital follows the guidelines, but it sounds like they are not. Let's be very clear - this is absolutely not your midwife's decision. I was told by my midwife that I would never be offered an ELCS (even though I do have a lot of medical issues). After seeing her I was terrified. However I asked to see a consultant who said yes immediately. I have more recently been moved to another consultant who also agreed to an ELCS straight away.

I can't tell you whether a VB or an ELCS would be better for you as I have had neither yet (although I am booked in for my ELCS tomorrow!) But if you do decide to have an ELCS, know your rights. The guidelines could not be more clear:

Maternal request for CS

 When a woman requests a CS because she has anxiety about childbirth, offer referral to a healthcare professional with expertise in providing perinatal mental health support to help her address her anxiety in a supportive manner. [new 2011]

 For women requesting a CS, if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned CS.

 An obstetrician unwilling to perform a CS should refer the woman to an obstetrician who will carry out the CS. [new 2011]

Sorry about where it says "&#61623" - in the guidelines these are bullet points.
www.nice.org.uk/nicemedia/live/13620/57163/57163.pdf
Go to the maternal request section.

Apologies I have just skimmed through all the posts, but change your consultant. Find one who is more flexible and be under their care. I have had 3 C sections - all maternal request so don't be fobbed off and best of luck

Thank you, thank you and good luck tomorrow VickyU