Can anyone help me to firmly state my case for c-section with the consultant on Friday

[Titsalinabumsquash]

I am in the early stages of my 4th pregnancy.

After my last 2 labours I have decided that I would like to have a c-section this time for a number of reasons.

I have a consultant appointment on Friday and I'd like to make my case early on, firmly and clearly. After having the same consultant last time, I'm anticipating her putting up a fight.

The reasons are as follows,

I have had 2 silent labours, as in no signs of anything then a gush of waters followed by babies head, I don't know why I don't feel contractions but I don't, luckily I was already an inpatient the last 2 times when this happened but I don't plan to be this time and I'm terrified of being in a position where I'll be delivering my own baby whilst dealing with the 3 children I have.

I'm not near enough to a hospital to get there I time and an ambulance would need to hit ridiculous speeds to reach me in time.

Due to the speed of my last labour I am now terrified of giving birth again,I don't sleep due to nightmares and flashbacks and for this reason I'm not keen to be induced,

I have a councillor who I have discussed it with and we both agree that having a supportive consultant agree to a section early on will help to prevent 9 months of crippling anxiety and antenatal depression and also help avoid another year of post natal depression.

I was treated really quite badly in my last pregnancy by the hospital, I felt like I was being treated as a nuisance and I spent a lot of time with my dignity taken from me, by the time DS finally arrived I was in a very dark place and I was having some quite intruding thoughts.

I am not a candidate for home birth, I am a high risk delivery due to the severity of the SPD I get during pregnancy, I am usually wheelchair bound from 20 weeks+ and I am on blood thinning injections due to a previous pulmonary embolism during my first pregnancy.

I have done my reading, I know the risks of a section and I know the recovery can be tough and long, I have support in place as needed afterwards so thats not a problem.

I discussed my fear of another silent labour with this consultant after the first one and she was really quite patronising and gave me an head tilt and a dismissive "oh you'll know when it's time" response.

I didn't know, I was terrified when my waters went and suddenly I was on the floor in pain I've never known, I was then whisked up to the labour ward with no clothes on in an open bed for all to see whilst I sobbed and cried as DS crowned. It's not something I've gotten over lightly and I do blame it on my PND.

Now I need to present this to the consultant without,

A. crying, I'm exhausted I've been so anxious about this since I found out I was pregnant (not planned) I get really emotional talking about my last birth and I find they use it as a way to interject and dismiss my request.

B. I don't want to get her back up and launch into a "you treated me appallingly and it's your fault" type thing. I need her on side, I need to be diplomatic and calm but firm.

Can anyone give me any advice please?

Sorry that should say I blame my getting PND on the experience I had.

I will be taking DP with me, I won't be going alone either. I'm currently 10 weeks.

Just calmly state the reasons you've said above, if she says no repeat you'd still like one, then quote the nice guidelines her which say they HAVE to give you a CS if that's what you want. Go in remembering you have the choice. I hope it goes well.

Link was meant to say here not her

Particularly read section 1.2.9.5 which says 1.2.9.5 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. [new 2011]. And then calmly tell her a vaginal birth is NOT an acceptable option for you. If she disagrees she may have to get someone else to do it for you, but can't refuse.

I would write down all your points in bullet form. Also write down the guidance ZylaB has included so you have something to refer back to. It might be helpful if you feel you're starting to get upset to have something in black and white to focus on. Good luck.

Definitely read NICE guides. You are entitled to choose, if this consultant won't allow it she has to refer you to another that will. They may make you see their counsellor but that should be easy enough to get him/her on side too.

Is your counsellor NHS or private? Private ones are normally happy to write letters backing you up (I'm not sure about an NHS one but ask nicely and they may too). So she/he could write a letter saying they have been seeing you for x time and have discussed at length the traumatic 2 previous births you had and you are very clear that you feel a csection is the only way forward for you.

Oh and like pp says I always find it helpful to write down all my points in bullet form, so if I do get upset I'm confident I'll at least remember everything I want to say

Thanks for the help.

The councillor is private so I will ask him to write a letter for me and I'll make sure to print out the guidelines and highlight the appropriate bits.

Also, they may suggest a planned vaginal delivery (eg induction at 38/9 weeks) as an alternative to section, so have a think about how you would feel about this.

I am not being induced, I was in hospital for 4 weeks at the end of my last pregnancy (completely immobile and in severe amounts of pain) I was finally allowed an induction after 2 weeks after asking another consultant because mine (same person as this time) point blank refused, every single day I got told I was on that days list to have it done and every day I got knocked back because of some reason or another, this combined with the level of fear I have over another traumatic, shock delivery it's not something I will be willing to do.

How would you feel about an induction if you could have an epidural first?

I'd rather not go through induction and labour at all, I don't trust the hospital to be organised enough to arrange it properly.
I had an epidural with my first son after an induction and then got left in a room and I ended up pushing when I didn't realise I was (because of being numb) so DS was being pushed out as a midwife walked in, I ended up with a 3rd degree tear inside and tore through into my back passage

I'm aware I'm a terrible excuse for a woman, I can't manage to get birth right. I have just shut myself down to trying now, I'd feel better if I could have a section and be done with it. Plus after 4 children (1 with a life limiting progressive illness) I want to be sterilised during a section to make sure I don't have another unplanned pregnancy.

TitsalinaBumSquash you're not terrible at all. I can really understand why a planned CS would be the best option for you.

In your shoes I would be calling the Supervisor of Midwives at the hospital to find out if they run a birth choices clinic for parents who have previously had traumatic deliveries, and to see what support they can offer you with getting the birth you want this time, especially given your wish for sterilisation at the same time.

I would also push your GP to write to the consultant about your case. Having the referral for the sterilisation in place may make it easier to get the consultabt to agree a surgical birth.

Finally I'd get copies of your last 3 labour notes to take with you to the appointment.

If you go in saying:

"I need to talk for a few moments, please could you let me get this off my chest, so we can make a plan for delivery together? This won't take long, I've been thinking about this a lot.
Here are my previous labour notes. You may already know that I've had 2 very fast labours. I have a severely ill child at home, and 2 others so I need to ensure my 3 existing children are sorted out for when I give birth this time. I've also got a referral to be sterilised. I have suffered with depression during and after previous pregnancies and I need your help in reducing my extreme stress about how this 4th birth will go. Bearing all of these things in mind, what I need from you today Is a date for a planned section, with the sterilisation performed at the same time please. I understand I can choose to have a section under the 2011 NICE guidelines and have taken advice on this. You will help me?"

Could anyone come with you to the appointment?

You are in no way a terrible excuse for a woman. Having a good or bad birth doesnt change what sort of woman you are.
What you went through sounds horrible so try and make sure you have all the information close at hand to help get your point across.
If things get too much then ask to take a minute to compose yourself and read through your notes so that you can be direct and informative.
You have every right to have the sort of birth that you deserve and if she flat out refuses request to speak to another consultant and quote the NICE guidelines to show that you have really thought about and researched your options.
Good luck.

You poor thing, you've really been through the mill!

I think you just need to refuse to take no for an answer. You're early on so you've got time on your side. Can you take someone with you? Someone unemotional and forthright who understands, and will fight your corner if you get too upset to put across your points?

Other than that, I would go with the attitude that they will grant your request, because they would be crazy not to. You never know, she might surprise you and say yes straight away.

DP has offered to come with me but he's not really one for pushing points across, I don't think I have anyone who is!
Most people are a bit about me wanting a section, they think a silent, super speedy labour sounds ideal.

But I do have time on my side so if she refuses point blank I will request immediate referral to another consultant and keep the guidelines with me at all times to refer back to as and when needed.

I had totally different reasons for wanting an elective CS. I won't derail, but they were very valid - as are yours.
Consultant and Registrar continually insisted that VBAC was a better option for me. My MW totally disagreed, and advised me to state that 'regardless of anticipated physical outcome, I genuinely believe that my mental health during the pregnancy would be severely impacted by planning VBAC'.

I used those words, and they didn't argue any further after that.

id b very suprised if they agreed.
im on my 6th pregnancy, very quick labours, longest 3 hours, last no pain straight to delivering, I hav spd also, belt and crutches at mo, with my last couldnt walk by 28wks.
im on twice daily fragmin injections aswell.
im very high risk as had 2 prem babies, still they deem home birth safer.
csection is a major op!
planned induction would b better surely!

I have been told categorically that I am too high rick for a home birth even if I wanted one. I have hyper mobility syndrome which puts me at a much higher risk of a PPH.
Dealing with a potentially very quick, silent labour could end very badly for both me and my baby.

I am more than aware of the risks of a csection and that it is major surgery, but my mental health concerns are trumping that of a possible harder physical recovery.

I am NOT willing to go through another induction, I don't trust my hospital to conduct it with the level of organisation that it would need.
I'm in a position where I'm not sleeping, when I do nod off my nightmares are just flash backs of my previous births and the feeling of isolation and humiliation I felt during the stay in hospital, I was constantly treated like an inconvenience for taking up a bed when I really needed inpatient support, I was talked down to on a daily basis and it destroyed the relationship with my baby for a long time.

I'm NOT willing to let that happen again and if it means I have to spend the next 30 weeks fighting daily then so be it.

I think blondieminx has it spot on, and if they put up a fight say what mrsjuice suggests.

Ive always found making a list of bullet points of the points that you want to make sure you get across very important in situations like these. And yes try and take someone with you who you have first discussed this with at length so that they can take over for you if you get upset, or just for support.

gingermop you say you'd be surprised if they agreed, yet it is a woman's right to choose. NICE guidelines were changed in 2011 to help women be able to make this choice. Plus mental health is as valid a medical reason for csection as any physical reason, thankfully for women like op NICE recognise this.

OP, you have plenty of time and the NICE guidelines are on your side. If your consultant won't do it, just remember to insist on a referral to another who will, as per NICE guidelines.

Mental health is a perfectly valid reason to request a ELCS. The guidelines are on your side.

Good luck. I will be requesting a CS for mental and physical health reasons, so I completely understand your anxiety.

As someone who fought for a planned c-section for DC3 (hyper mobile & spd and the months of physio after my babies have been born, having been literally stranded, physically unable to pick up my crying baby because of the pain) under NICE guidelines, I can assure you that it gives you little leverage - they are only guidelines and the ultimate decision comes down to hospital policy (and targets).

That said, my argument to them was that whilst it was their duty to deliver my baby safely, they needed to take responsibility for my well-being (physically, emotionally, mentally) after the baby came home and that giving me a definite date of delivery and not going overdue were my biggest priorities.

Like you, I was a mess of hormones when I met with the very unsupportive, unsympathetic consultant.

So I emailed all the consultants, the head midwife, the hospital board, the complaint department (basically anyone on their website) stating my case.

They responded in 24 hours.

We agreed on a planned induction (a due date at 39 weeks and not going overdue were my priorities).

They messed me around for 12 hours so I emailed the consultant from the ward. She responded immediately and I was hooked up to an epidural 20 mins later, waters broken, baby born. All very civilised.

My point is, don't expect them to agree straight away, but keep going. You will get there.

Hugs

Two extracts from my email:

To date, this baby is measuring large for dates, looks to be a similar size if born at term (obviously bigger if it goes overdue) and currently has a head size on the 95th percentile. I keep being told that every birth is different, but given that the last two were identical, I find this far from reassuring or supportive. It feels as though the health care professionals are not interested in the after effects of birth because it will no longer fall into their area of responsibility during the postnatal period. I feel very strongly that I have to protect myself and my family from the debilitating damage that I have had to endure postnatally and this means having informed choices over how to birth this baby.

I would ask that the board please consider this case favourably, especially as a women who has experienced vaginal childbirth twice, I am aware of my body and what its limitations are. I am asking to have a genuine say in my birthing options and to be given a genuine choice as to how to deliver my third and final baby.

(Obviously now pregnant with dc4!!)

Thanks chocolate, I will certainly be calling and emailing everyone and anyone to get my case heard.

The head of midwifery was really nice last time, I got to know her over my long stay at the end of the pregnancy and my councillor knows her as well, he's already said he is willing to make calls to whoever he can to support me.

I might be lucky and go in there and them be sympathetic and helpful, sadly from all accounts it's not likely to happen, I think after this I will very much get involved with helping women to achieve the birth they want rather than to repeatedly come up against consultants who are more concerned about targets than giving women free reign over their bodies.

We have another hospital with a maternity department in our trust, does anything think it might be worth contacting the consultants there if I have a bad time on Friday to see if it's something they can help with?