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?

Not terrible at all. Please don't tell yourself that. I was firm on having an ELCS with my 2nd DC due to my first having shoulder dystocia. I calmly stated that the only way I would not have section was if they could absolutely guarantee that it would not happen again, which we both knew they couldn't do.

Even with a significant risk to the baby he still stated the pros etc of a vaginal birth opposed to a CS. He told me that he had a duty to give me all the facts. Which is true, but to be honest the tone of what he was saying was clearly trying to talk me out of a CS, probably because they have targets and budgets to try and stick to.

Anyway, I told him that I was well aware of the facts surrounding vaginal birth risks and CS risks and I was still certain I was a CS. He relented (probably because he didn't have a choice) and I booked it that day. I was 17 weeks pregnant, so quite early to book!

I think the way they try and talk people around is to state all the risk factors associated with both planned and emergency CS's. Go into the meeting having read up on it a little (I'm sure you have), state your reasons. When they try and convince you otherwise, say that you understand, you're making an informed choice that is right for you.

And remember, it doesn't matter if they are patronising you/you think they are patronising you. Annoying as it is, let it give you the determination to definitely not give in!

Thank you.

I'll sit down tomorrow and write everything out, highlight what needs highlighting and try and prepare myself as best I can.

I will let you all know how I get on after Friday.

Mumsnet really does come into it's own with things like this.

What DeputyPecksBentBeak said. I also had to convince a consultant to book me in for a ELCS with DC3. At the appointment, we discussed all of the risks of birth by CS (and none of the risks of VB). I took the broken record approach of, "Of course, I understand, and I still believe a CS is what's right for me and my family". In the end she said something quite illuminating... she said that the figures for good outcomes for VBAC were very high, but that in her experience it only worked for women who were really prepared to try. And that I didn't seem as though I were prepared to try. This was in a disapproving tone, and I wonder if it was an attempt at reverse psychology, but I simply agreed with her that no, I wasn't prepared to try in the slightest, and I got my ELCS booked there and then. Long and short of it is - be prepared for a litany of risks, be prepared for some potentially quite judgemental comments, and be convinced that you have a right to choose.

I think you need to steer clear of some of the elements of them letting you down previously as they will, no doubt, promise that they won't let you down this time.

I think the 3rd degree tear might be relevant, though two "successful" VBs in between might hamper that line if argument.

I think that the stats for the unit may be a driving force in pressuring women into unwanted VBs. I'd be interested to know what a private consultant might say.

Good luck.

I had an ELCS on the grounds of mental health due to anxiety over giving birth for my first only child.

My experience was very positive and I was supported in my decision from the word go, but I think there are a few bits of advice I can give that may help you.

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.

Crying is not necessarily a bad thing. It can work to advantage in highlighting just how much distress this is causing you, so don't worry too much about it, if it does happen. The key is to have an alternative way to get your point across if you do end up upset. The best way to do that is to have EVERYTHING in writing and be prepared by pre-empting responses for any of their comes back in that written statement.

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.

Again the written approach is the way to go, as helps you to articulate those negative feelings about your previous experience in a positive way.

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.

This is where you need a kick up the arse! You are NOT a terrible excuse of a woman. You are a women who has mental health problems that are focussed on childbirth, as a result of previous traumatic experiences. Tokophobia, is a medically recognised condition - so much so that the current NICE guidelines about maternal request c sections are heavily focussed on it. The guidelines are written primarily with women like you in mind, so do not EVER say you are inadequate in some way. You are just in need of the appropriate help and support. You shutting down is a symptom of your anxieties and its worth acknowledging this in its own right, as it shows you struggle to cope.

I would echo what ChocolateBiscuitCake says about the NICE guidelines only being a guideline and it very much being down to individual hospitals and you having no right to an ELCS. However you DO have a right to appropriate care for your health, which includes your mental health - which may mean an ELCS in your situation - its all about how you present your case... The more you can counter arguments for other approaches, the more you present an ELCS as the appropriate care for your situation.

For me, part of my care was making sure agreement was reached early in my pregnancy as the uncertainty itself made me anxious. Having it in writing that I was to have an ELCS made the world of difference, so I think its worth mentioning that the uncertainty itself is a problem, so you don't want to spend your entire pregnancy fighting them.

I think the other thing in writing EVERYTHING down, is it shows how much you have thought about and considered the pros and cons and the alternatives. It is much more difficult to argue with a reasoned statement than an emotional woman.

Good luck. I hope it goes you way. If it doesn't then its not the end of the road and you can fight it as you have time to do so.

I had my appointment today,

Even after hours of note writing and preparation I still managed to get no more than 2 steps in the door before crumbling into a sobbing heap

Luckily, it seemed to do the job and the consultant had said that although she'd prefer to do an induction under a full epidural rather than an ELCS, she will ultimately accept my final decision.

I have asked to have 1 session with the birth trauma midwife to talk over things but she seemed on side, she remembered me from last time.

I have to go and see her in December where she will book in whatever I decide to save me 30 weeks of anxiety.

I'm so relieved, thanks for everyone's support, advice and kind words.

That's excellent. I'm glad it went so much better than anticipated.

Very pleased to read this. Good for you.