ELCS with Complex History

[Mumtonone]

I have an appointment in two weeks with a consultant to discuss birthing options. My intention is to request, and really push for an ELCS.

My main reason is I have a long history of vaginismus. Being pregnant is a minor miracle in itself and I'm terrified a VB with make me go backward. I have a real concern that the consultant will try to convince me that a VB will 'cure' my vaginismus. I can find no online evidence that this will be the case, and feels like a big risk to take.

The other complication is that I've had a previous DVT and am on Clexane injections through out pregnancy. Any vaginal trauma creates increase risk of DVT, although again I think medically the argument will be ELCS would be more dangerous. My counter argument would be at least it's controlled (I have to be off Clexane 24 hours previously for either) and a VB can always end up in an emergency CS.

I can already feel myself getting worked up for this appointment. And will be devastated if I get refused. Any guidance or advice would be appreciated.

I had an ECLS with my second child after birth trauma with my first. I went expecting a fight to get the ECLS despite an appalling first birth but found that the consultant agreed immediately that a section was the best course of action.

It may not be a fight at all, so try not to worry too much. Instead, see this as a chance to present them with all the info that makes it easy for them to give you the birth you want.

Have you been to professionals about your vaginismus before? If so, take details of this to show that you have a long-standing medical reason to choose an ECLS.

Also, I don't know the causes of your vaginismus so please forgive me for any ignorance, but if there is any psychological component, they do have specialist midwives trained in mental health who can help you put across your point. I contributed to another thread where a Mumsnetter had PTSD and when the consultant was unhelpful, she asked to see the specialist midwife, who helped argue her case more effectively as she had more detailed understanding of PTSD.

Do keep an open mind about what the consultant says if they are anxious about the DVT risk with an ECLS. It may be a case of telling them you accept the risk of an ECLS with the DVT over the consequences long term of a vaginal birth given your vaginismus. Rather than ignoring the risk, it might be better to explain that you understand it, you are not ignoring it and no birth is without risks so you would rather risk the ECLS version.

I think keeping an open mind generally is always good. Even though I knew I wanted an ECLS after my last delivery, I did listen to the consultant when he explained how they would handle a birth for me vaginally. Hearing their plan made it easier for me to explain why it wouldn't work for me (and he immediately agreed). So you could also do the same - say, if they explain that your hormones will take over and an epidural would mean you would feel nothing, you can think now about how to counter that with why it wouldn't work for you.

Sorry I can't really offer any very useful help but hopefully this will bump your thread and someone else will have more to offer.

You can request a c section even without medical reasons, have you read the NHS guidelines. There was a thread on requesting a c section for medical/non medical reasons it has some useful bits of information on there what other women have experienced when requesting there c sections. I personally think you have reasonable grounds to request one, a friend of a friend developed vaginismus after having her dd and it's took her a long time to get anywhere near back to normal. I agree with you that giving birth could ruin any process you've made, hope you get your elcs. X

Progress* auto correct

link to thread on elcs x

Hi Ruby, thanks for your reply. My vaginismus has largely put down to psychological reasons, although previous counselling has had limited effect - found the woman I went to very judgemental and difficult to talk to (my husband felt the same, so wasn't just me!)

Have had long history of painful periods, so much so I took the pill constantly, to stop my periods, for years. Coupled with the vaginismus, I was eventually sent for a laparoscopy to find out what was going on. That came back without any answers and a few weeks later I suffered a bad DVT with accompanying pulmory embolisms.

The vaginismus is not a subject I like talking to strangers about, particularly given the counselling. So very nervous to speak to a consultant (who I've never met before) and worried they will be anti-CS before hearing my concerns. I've had GPs in the past tell me 'I just need to have a baby' to get over the pain - which although meant light heartedly, felt very flippant.

I've been told I need to be off Clexane 24hrs before birth, to avoid excessive bleeding, which I'm not sure how they would calculate without a crystal ball! I've also heard that I would be refused an epidural and certain pain meds if not off Clexane in time. The idea of going through VB is terrifying, never mind without certain pain relief!?!

I just would feel better all round, if things were planned and controlled - as much as possible at least!

I'm also worried I'm almost at 20 weeks and not had the opportunity to discuss this with anyone yet, despite pushing. Is that normal?

Hi Terilou. Yes been reading the other thread with avid interest, and trying to take pointers.

Not sure if I'm reading the right NHS guidelines, is there a clear link available anywhere?

I suppose I'm worried that guidelines are taken just as 'guides' and if I get a hard lined consultant they will just ignore them.

Tbh the guidelines are just that but if you do get a consultant that is very pro vbac you are well within your rights to request to see a different consultant I will get the link for you for the NHS guidelines x

link hope this helps x

I didn't even see the consultant till I was 16 weeks and that is the earliest I know of, so it's quite normal not to discuss delivery options until later in pregnancy. So don't worry about that. You have plenty of time.

So it sounds like you can explain to the consultant that you:

• have had counselling for the vaginismus but found it largely unhelpful so you have tried to address this but it hasn't been a success
• find it very difficult to discuss with people, meaning you worry about being able to effectively communicate your fears during a vaginal birth
• feel very anxious due to the vaginismus about not knowing what with occur due to the unplanned nature of vaginally births

...and so on.

If the consultant is unhelpful or you have difficulty explaining your views, ask to speak to a specialist midwife with experience in the area who can help you advocate to the consultant.

However, the hospital concerns may also not turn out to be about pushing a vaginal birth but about your DVT risk. The consultant might be more concerned about the DVT risks and you getting blood clots after a section than anything else. In that case, I'm not sure what to suggest but perhaps someone else will come along who has had a section following DVT/PE.

Are you taking your DH so he can help you put forward your views? Is he comfortable talking about it? (My DH was extremely vocal to the consultant about my birth trauma and I think he could have argued my case alone if needed!)