How to get an ELCS after EMCS?

[AbbeyRoadCrossing]

Sorry if this is long, but I want to give all the information in one go

With my 1st pregnancy I had placenta praevia and ended up with an EMCS at 36 weeks due to a large bleed. I'm now 18 weeks with DC2 and have had conversations with the midwives about giving birth next time.
They are very keen on me having a VBAC, whereas I'd rather an ELCS.

My reasons are:
I'm worried about rupture. I know it's rare but I've read it's more common if you were sewn up small (as I still had a month to go) as there is extra stretching on the scar.
I'm also worried about an unsuccessful VBAC that turns into an emcs. I really don't want another EMCS. I understand my chances of success are lower because I've never had a labour.
I had postnatal PTSD after my EMCS. Probably a multitude of causes but I have flashbacks to it, I really fear another one. If they could guarantee a successful vaginal birth I'd do it, but of course no one can.

The midwife said I have no medical reason for a c section (although we don't know this yet, as I haven't had my 20 week scan) and if there's no reason I will have to have VBAC. Yet I read about others on here who've been granted sections for various reasons, maternal preference being one of them. I thought my previous emergency was a medical reason, am I wrong?

I'm seeing the consultant midwife after my scan and am getting very worried about being turned down. Has anyone got any stats or anything that can be used to back my argument up? I can't find much on what's safest.

[thebooleanoperator]

Abbey I'm in the same position and not sure what to do... That's really interesting about the chance of scar rupture being higher if you had your section earlier... I didn't know that! What is the vbac course? Is that at your hospital?

[AWimbaWay]

I had an emcs for exactly the same reason as you Abbey. I was referred to a consultant in my next pregnancy who asked me what I wanted. I went for a vbac but they were more than happy to give me an elcs if that's what I wanted.

[AbbeyRoadCrossing]

Hi boolean yes it's at my hospital and they like everyone to go on it before they see the consultant, so I guess it covers the main questions. I chanced across premature section risks of VBAC in a research article. It suggested that because you're sewn up small it then puts pressure on the scar if you go to term next time. Which makes sense really, many women get massive in that last month and I never did that bit

[jmojo]

Just insist be firm don't deviate, tell them you have read all the recommended literature and you understand why they recommend a vbac, but don't deviate. Be completely reasonable, and keep to your reasons. They cannot force you to do one thing or another. It really is that simple. Don't worry about them not agreeing with your decision. It is your body. They have to recommend VBAC as medically it is the better way for you both, but the decision about it is yours.

[MummyPiggy87]

Wow chief, thanks. Some of us may have no choice in having to have a csec like me, saying things like "I've seen people die" is VERY inappropriate!!! Nice way to scare the shit out of people, idiot.

[GymBum]

Op you may find the link below of interest. Quite a few of the women requesting ELCS got them. Old thread but the guidelines haven't changed much since. I know, I had an ELCS agreed.

www.mumsnet.com/Talk/pregnancy/1849354-Elective-C-Section-medical-non-medical-reasons

[Whatabout]

Can i just say the nice guidelines are just guidelines, the hospital can choose to follow them or not. Do quoting the nice guidelines may not get you as far as you think, it isn't a guarantee they will agree.

I am pretty sure they will listen to your concerns about it all and take you seriously, I'm having a section this time but my midwife wanted me to have a home birth! She won't be happy when she finds out! Community midwives and the hospital teams are very different, so try not to worry about her attitude as it may well be very different when you see the consultant.

Oh and Chief, people die after normal child birth, people die in their sleep, people fall down the stairs. Life is s risk and your comment did seem unnecessary.

[JoandMax]

I had an ELCS after EMCS - I found the midwife a lot more pro VBAC but the consultant was lovely. We chatted through the options, she explained the processes we could try and said I didn't need to make my decision until the later stages. I found her very reasoned and impartial and no pressure either way. In our area previous EMCS was a recognised reason to have subsequent ELCS.

I hope your appointment goes well and you get the information and outcome that works best for you

[comeagainforbigfudge]

Whatabout is right. Nice guidelines are just that, but they are a good starting point for researching your situation.

Read through them and note questions/thoughts as you go.

(It's how I started researching essays when at uni - long time ago now, I digress sorry)

I would also recommend you speak to gp about some kind of counselling if you still having flashbacks. That may get worse as pregnancy goes on. Best to tackle it head-on.

And definitely see about requesting a different MW. You need someone who will LISTEN to you. Promoting vbac is fair enough BUT they still need to listen to your concerns/acknowledge your medical history.

[Jackiebrambles]

I had an Emcs too and decided at 16 weeks I wanted an elcs. I told my midwife and she referred me to the consultant midwife. She was a sort of gatekeeper and we went through my old notes together. Her feeling was that my situation was unlikely to happen again but that they didn't want me to do anything I didn't want to do. She was pro vbac as midwives tend to be!

But we went through all the pros/cons together and then she referred me to the consultant for 36 weeks. I had that appt 2 weeks ago and my elcs is all booked!

I was expecting to have to argue with the consultant but she was so kind and just agreed straight away!

Good luck op. I think it's very annoying your notes have been bloody lost as you have very good reasons for having an elcs. I honestly don't think they should be allowed to refuse you.

[AbbeyRoadCrossing]

Thanks all. The notes thing appears to be because I've moved hospital and there's some problem with getting them. I know the basics of what happened but was pretty out of it as you can imagine at the time.
With the PTSD I've asked for help some time ago and am waiting. Most of the things suggested to me in my area are focussed on PND. I know there's often overlap between the two conditions but I just don't find that I relate to any of the PND feelings and those sessions don't seem relevant to me. Mine seems to be pretty classic flashbacks, anxiety - no feelings of being down or depression at all if that makes sense.
And don't worry about whoever it was said I might die. I nearly died last time and a c section saved my life, so been there done that!

[AbbeyRoadCrossing]

Sorry meant to add. I am happy to consider VBAC, and if it is safer I will do it. The studies I've read seem mixed though, and it depends what is meant by safer as both have risks of different kinds.
The latest RCOG study has found VBAC isn't as safe as they thought for some groups and it appears I'm in a few of those categories (premature c section, never had a VB / labour, older mother, less than 2 year gap, previous placenta issues) but it's unclear on by how much. If I can get an idea of my personal risk from the consultant that will help a lot.

[hazelnutlatte]

Do you have an appointment to see the consultant yet? If not I would ask to be seen ASAP so you can talk about this with the person who is in overall charge of your care, as the midwife is not the person who makes the decision here.
I had emcs with my first dd and will be having elcs with the 2nd. When I mentioned my preference to the midwife at my booking appointment she was dismissive and told me that vbac was the preferred option and I might not get the choice to have elcs. I then had a consultant appointment, he explained both options to me and asked me what I wanted to do, with no pressure either way. I'm booked in for a section at. 39 weeks.

[AbbeyRoadCrossing]

I'm seeing a consultant midwife at 24 weeks, I think so my 20 week scan is done as if I have placenta problems again we'll be going down the c section route anyway and they couldn't see at my dating scan

[AWimbaWay]

As mentioned earlier I had the same issues as you, placenta praevia resulting in large bleed and pre-eclampsia, was also my first pregnancy, EMCS at 37 weeks, only 18 month gap before I had my VBAC which went very smoothly.

I was swayed by the fact I hated the EMCS though, so was put off ELCS even though I realise it would have been very different. Every pregnancy/birth is different and nobody can make the decision apart from you.

[freshlysharpenedpencils]

Haven't got time to read entire thread I'm afraid but just thought id say I had Emergency C and have PTSD - this time around I asked for a planned C section. Thought there would be a fight but they've been very nice about it - but that's because of my MW who is lovely and has been through the same experience - she told me they will (off the record) try and put you off it and not give you one. Generally because of stats ... But you just have to be persistent. (This is her opinion... Not mine) good luck OP

[Number3cometome]

It's really simple, no one can tell you how to give birth, and no one can refuse you anything. As you have had a CS before, you can say that's what you want, you don't have to see anyone about VBAC if you don't want to.

Even if you hadn't had a CS, they cannot refuse you one!

[Lilipot15]

Abbey my midwife appointment in the VBAC clinic had a more pro-VBAC slant than my consultant one the following week. The midwife wasn't pushy, by any means, but didn't even consider my small age gap as a risk (I only remembered to ask about it afterwards). When I asked the consultant, she felt it was indeed a higher risk, and that combined with other factors for me, such as not having got far through labour, older mother, the fact I found the emergency CS quite traumatic (even though I totally focus on and fully appreciate that it gave me the result of a healthy baby), swayed me for an elective CS. I felt that the consultant had less of an "agenda" to get a plan for a VBAC and more of an individualised take on it.

I found my emergency CS okay at the time, but it hit me a few days and weeks later, once I'd made a good recovery. I would much prefer to avoid this happening again. I found discussing my first delivery in the VBAC clinic really upsetting, probably because I had never really felt it was the right time for a proper debrief, then I became pregnant again.

Good luck, in your situation I can't see you being refused an elective section. And if you were, you should ask to see another consultant. Likewise, don't allow community midwives to put doubt in your mind - I have been lucky that mine was very positive about my choice.

[AbbeyRoadCrossing]

Thanks all very much
Lilipot thanks for mentioning I might have to go through my 1st birth in the VBAC session. I've had a look at my letter and it does say group discussion. Not my cup of tea at all, especially if I've got to discuss my emcs. At least I'm prepared for that now though

[Thepurplegiraffe]

Abbey when I had my group vbac session there was little or no discussion of individual cases. My individual concerns were discussed much more at the one on one session with the consultant midwife. I am yet to have a one on one with the consultant.

[Lilipot15]

Abbey, I very much doubt that a group VBAC session would involve going through individual cases. Mine was just an individual appointment. I would have probably walked out if it had been a group discussion which involved going over personal stuff. I made us deliberately late to our post-natal class first meet up so we missed the delivery debriefs, I just didn't want to talk about it. Although as I learnt afterwards, none of us had an easy ride. Good luck and congratulations on the pregnancy.

[AbbeyRoadCrossing]

Ah sorry Lilipot I misunderstood and thought the VBAC clinic was the class. I'm not a group discussion fan in any circumstance but they wanted me to book this before I see the consultant, so I thought I'd better

[AbbeyRoadCrossing]

Just updating this. So I did the VBAC course as requested and saw the consultant midwife. I was in there almost 2 hours and presented my arguments about my PTSD and the research I'd read. Anyway, request declined as I have no medical reason and am "the worried well" apparently.
I did say about the NICE guidelines but she said they've changed and they now don't advice c section with no medical indication.
I've managed to get a psychologist appointment to go through my birth trauma from DS. I think this will be useful anyway as I've been after some help for a while. Also seeing the consultant at 34 weeks, so looks like nothing will be decided until then.

I'm not sure how I feel really. I'll prepare for labour anyway, I don't think I'm scared of it was she suggested, I'm just scared of it turning into an emcs (40% chance) not the pain / pushing if that makes sense.

[Sisterelephant]

Sorry you are not getting properly heard.

My story is similar to yours, I had a emcs with ds and i found it traumatic and it took me a while to hey over it, counselling really helped me. When I fell pregnant with ds2 my anxiety was there from the beginning about the birth. The first midwife i saw was very blasé about the birth and was pro vbac, when I pushed for more reasons she booked me an appt with a consultant at 20 weeks. I was so pissed off to find that the appt was a group vbac clinic with another 20ish women just as pissed off as me! It was just a presentation of the pros and cons of vbac. At the end they told me that the consultant would see me at 40 weeks to discuss what was the best option! No did I want to wait untill the last minute.

I'm with a hospital so I see a diff midwife at every appt and every time I mentioned my birth worries they pretty much fobbed me off and not really listening to my concerns to help me make the best decision. I pushed for an appt with a dr at 34 weeks and she was great. Went through my notes with me and was blunt that its unlikely I'll get a vbac but we can prepare for a c-sec within a time limit which has put my mind at ease. I'll go for vbac and if no progress I'll have a section so it's planned to a certain extent.

Maybe this is the angle you can try and go on? That way you can be at least prepared for a emcs.

Good luck!

[AbbeyRoadCrossing]

Thanks sister elephant yes I think something similar will be happening with me. They said if I don't progress it'll be an emcs, but not an emcs like the first one, I guess a calmer one as they'll have more time. I'm going to decline induction, although that feels like a weird thing to be thinking about having only done 8 months last time!