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.

I can't believe how different things are in different areas. I had a VB with my first. Had a tear which didn't heal well and made the decision before getting pregnant again that I wanted an ELCS with my second. The first midwives I saw made me an appointment with a consultant but I got the impression it was to tick the box not to grant me a section so I quizzed midwife 2 at my next appointment and despite being Chief Natural Hypno Birthing Midwife she really listened and said consultant 1 would not grant my section and phoned there and then to change my consultant to another whom she said would listen and understand. Consultant listened and said of course I could have a section and gave me a date there and then - I was 23 weeks when I got my section date. Despite the consultant agreeing within minutes and a section date agreed my midwife (another new one) at my appointment this week was very insistent that I could always change my mind and even wrote in my notes that if I went into labour I would consider a VB, despite me saying that if I went into labour I would be straight to hospital for a section and a letter from the consultant saying the same!
If you do go for a VB I'm sure you'll be fine. I just wanted to explain my experience that some midwives and consultants seem set on VB if at all possible. I don't think the guidelines have changed - consultants don't have to grant you a section but they do have to refer you to another consultant if requested.

That's outrageous. To my knowledge the NICE guidelines haven't changed (I would be amazed if they'd been amended to say that the mother's wishes are now disregarded).

I've just had an ELCS booked for DC2 at VBAC clinic appt with consultant midwife. DC1 was maternal request ELCS (which was hard work to get). I went in expecting it to be like last time but they went through risks and benefits of VBAC vs CS and allowed me to choose.

Per NICE guidelines this decision is effectively yours. I would ask: 1. to be directed to the amended NICE guidelines (mainly because I think that's bullshit and I like pulling people up on things like that) and 2. to be referred to someone willing to carry out a CS (which is the next step under the maternal request process if you are declined). First time around I was "declined" twice during the process, asked to be referred and ended up being ultimately approved without referral. Don't take no for an answer unless you want to.

I think one of the main reasons they sometimes push for VBAC is because if for any reason the mother wants more than 3 children, it becomes challenging ( probably for the consultant performing the surgery dye to scar tissue). Also for some reason ( rightly or wrongly) hospitals wear this badge of honour of having the lowest rate of c/s in (name the area). However, the choice is for you. All they need is to provide you with the risk (and BENEFIT) of both so you can make an informed decision. No guilt tripping, no bullying.

Yes they seemed to be concerned their rate was over 26% - it affects their funding apparently?
I think the bit of the guidelines she was on about was anxiety about childbirth. I'll print them out for next time definitely.
I'm hopefull that I'm seeing a nice consultant. The receptionist, who is lovely, said did I know which consultant I was supposed to be seeing and I said "one that'll sign off a CS would be good" and he's booked me in with a nice one he says, so fingers crossed.
I think they'll give in eventually, it's just a shame it can't be sorted earlier in pregnancy

Well I have no medical reason for my c section and I'm due to have one in 5 weeks hopefully (need to see consultant once more to book date!). A senior midwife confirmed as well that it's my choice. I really don't think NICE guidelines have changed.

X

Abbey I had trouble getting an ELCS following a traumatic EMCS. I'm not in the UK but the hospital midwives were similar in pushing VBAC. I found that my midwife wouldn't even let me see the dr who would decide on the ELCS until I was 39 weeks.

I had perinatal counselling during my second pregnancy with a specialist at the maternity hospital because I had struggled with having the EMCS and not seeing my baby afterwards straightaway and didn't want another EMCS. I just wanted, if possible, to have an ELCS to minimise the chances of an EMCS. I discovered later on that the councillor spoke to the dr to suggest that ELCS would be a good option.

My issues about trying for VBAC were feeling like I didn't have great chances for success with no previous VB and I didn't get very far through the labour before the EMCS and not wanting to go through another EMCS. I think if I'd had previous VB or the first birth was an ELCS without the trauma of a sick baby then I would have been more open to VBAC.

When I finally saw the dr at 39 weeks she was straight on the phone to get me booked in to have the ELCS less than 48 hours later. I got the impression that she was annoyed that I was seeing her so late and it was then a rush to do it before I went into labour naturally.

Even if it is not ideal, and you don't have the reassurance of having an ELCS booked early on, you might find that the consultant is sympathetic. I found that the big problem was getting past the midwife who was pushing VBAC and nice I saw the dr it was ok. I hope it works out for you with the consultant. I found it helped me come to terms with the difficulties of my first birth by having a calm ELCS. It was very mentally healing.

Just to update - my section has been signed off for 39 weeks. The consultant was pretty much "if you've done the course and the reading I'll do whatever you want to do" so in the end after months of pressure it was easy.
If things happen before then though they seem keen I'll VBAC, but baby is breech at the moment anyway.
Thanks for all your help