TTC & already thinking ELCS

[PixieN]

Hi,

My partner & I have recently been trying for a baby & I’m already very anxious about childbirth. I’ve always wanted a baby, but think I’ve subconsciously been worried about the thought of giving birth for a long time. My partner didn’t want any more children for a good while (he has a son at uni) & I felt elated when he changed his mind, but can’t stop worryingly about the birth I’m 35 & he is quite a bit older than me. If we do manage to conceive, this will be the only one.

Anyway we started ttc just before Christmas & it’s suddenly seeming very scary & real. I can’t face the thought of VB & know that I would prefer an ELCS for a number of reasons.

I’ve read so much on the subject, including the NICE guidelines, RCOG, ‘The Caesarean’ by Michel Odent as well as ‘How to Grow a Baby & Push it Out’ by Clemmie Hooper (to have a rounded view) so I know about the pros & cons of both methods of delivery. I’ve read so much it’s becoming obsessive!

A huge factor is that my mum suffered from terrible PND after her 3rd child (ironically c-section due to pelvis size) which was never treated (her midwife told her to pull herself together which led to her becoming an alcoholic. She suffers psychotic episodes & had to be hospitalised at one point. It’s had a huge affect on my whole family. I’ve always hated the idea of being out of control. I’m the same with alcohol & would never drink until I didn’t know what I was doing. I know anything can happen in childbirth, but feel an elcs would be more controlled.

Anyway, I made an appointment to see my doctor last week where I outlined my concerns & he made it clear that I wouldn’t be entitled to an elcs on the NHS & would struggle to find anyone to do it privately either (he mentioned risks of suing the hospital if anything went wrong) because i’m fit & healthy. My Doctor is usually brilliant, but I didn’t feel listened to & nearly started crying. He said if I was his wife he’d be advising Vb & if I was rich I could go to the Portland. I have actually looked into private, but we can’t really afford - it would mean loans & credit cards. My Dr also advised me to just get pregnant & speak to the
consultant

Anyway, I know this is all hypothetical as I may not get pregnant, but I just wanted to ask if anyone has had a maternal request elcs on the NHS in a staffordshire hospital? I would just like to have a choice.

Sorry this is such a long post & thank you if you have read it. I don’t feel I can’t talk to friends & family about this - though my dh has been lovely & supportive

For me, I was always scared of the idea of birth but it mutated into something else - I couldn’t even think about any element of birth without having a physical reaction (nausea, vomiting, palpitations, complete and utter terror). I didn’t expect it at all and initially thought I was being ridiculous but it became clear that I couldn’t control it at all. My midwife referred me for counselling which did help control the anxiety, but I still couldn’t even face the thought of actually doing it without all sorts of other things coming up.

I’d recommend some counselling now, before you conceive, and talking to your
Midwife about this and your fears right from the start so they can support you properly

I would really encourage you to focus on your mental health and anxiety now before you get pregnant. More than likely, the fixation on birth has the potential to migrate to something else and you may be at risk for postnatal anxiety and other mental health issues, much like your mum. It very likely has nothing to do with birth and giving birth in a certain way you think it will (whether it goes to plan or not) won't alleviate it. Postnatal anxiety is awful and if you can prevent it now, then I would.

I don't have any personal experience (I've only had a home birth, planning another for baby who is due tomorrow, so any day and have had only lovely positive experiences, I'm 37). That said, I have a good friend who was very much like you. She had a lot of anxiety about birth as did her husband. She said she always knew she wanted an elective c-section and planned to go private (which is totally possible, ignore what your GP said, though I wouldn't go into debt for it either). She is once she was pregnant, she got much the same advice you did to go for a vaginal birth. She opted to and in the end she had a lovely 3 hour labour. It was so positive and wonderful for her and she is so grateful she was encouraged to at least consider the option.

Ultimately, you have to do what you're comfortable with, but first and foremost take care of yourself and address your anxiety now. If you are prone to it, it does NOT get easier usually after birth and it's so much easier to head it off when you aren't exhausted with a small baby.

Hi OP,

ELCS was definitely the right decision for me- so calm and smooth and didn’t struggle with the recovery. I stayed 3 nights in hospital, mostly because I’d already paid for it as part of the ‘package’ but definitely could have gone home after 2 nights, in fact I was feeling quite cooped up and really eager to be home by the time I was discharged!

I can’t comment on your likelihood of getting an ELCS by maternal request on the NHS but surely you could request one and if denied pay the £9000 instead? Providing you can afford it, at least you know you won’t be pushed down the VB route against your wishes.

Hi @PixieN

Yes, I was referred to a counsellor but it was optional and she made it very clear that she had no say in the decision making process. It was quite interesting to explore where my fear came from but there was no way of changing my mind. I am mid-thirties and have been afraid of childbirth for as long as i can remember. The counsellor wasn't allowed to feedback to the consultant/midwives etc, it was purely for my benefit.

Woman should have a choice over what happens to their bodies in childbirth. Don’t listen to the sexist and misogynistic comments that woman should put up with a VB because it costs less for the NHS. If men were giving birth they would have every option open to them with no judgement from anyone. Unfortunatly we live in a women hating culture and we women need to fight for our dignity and our rights. Good luck OP xxx

More than likely, the fixation on birth has the potential to migrate to something else and you may be at risk for postnatal anxiety and other mental health issues

This is my concern too, in part because I see some similarities between your own anxieties and my own (so I may be projecting, and I apologise if so). In my experience this kind of gripping, growing, obsessive anxiety doesn't go away - I think if you're certain you can have an ELCS then you'll fixate on something else (maybe the risk of going into labour early before the scheduled CS, maybe something else entirely). As you're very aware, this has really deep roots in a traumatic childhood, and treating the symptoms isn't going to get you very far.

My anxiety improved dramatically once my ELCS was scheduled, but then had the emcs, both my boys taken straight to nicu and one had a very long stay and a serious illness diagnosed and my anxiety got quite out of control again. I definitely agree that it’s good to start the process of tackling this now. Unlike the other posters, my counsellor did offer to write to my consultant to back me up, although it wasn’t necessary in the end.

Thanks ladies I really appreciate your comments & advice. It feels good to be listened to & not judged for the way I feel. As I said previously, it’s not something i’ve talked about with friends & family.

@LisaS - have you managed to deal with your own anxieties surrounding childbirth?

@FancyNewBeesly - I will try counselling. I thought I might ask to see a lovely female GP (who’s my Dh’s Dr) who recommended relate to me last time when I needed it & was brilliant when I had a complete meltdown over relationship problems. It really did help me at the time.

@mindutopia - i’m really glad your friend had such a positive experience of birth in the end. I’m still wary of the risks though & keep thinking it’s ultimately like a lottery. You could be lucky or not.....

@Teetotal - I agree. I think it’s having a choice that really matters to me. I don’t like the idea of things being out of my control & having no say at all in what happens. I think it’s inhumane that some women are expected to labour for days on end & might end up with forceps delivery or emergency cs when they’re terrified & absolutely exhausted. One friend had to have an emergency cs after a long, drawn out labour & she said she just wanted to die at the time

Your GP is incorrect. I wanted an ELCS, asked and got one.

I have never wanted to give birth naturally.

@TheCatsPaws - wow. That sounds too easy. Did you have to justify it/go armed with reasons/statistics etc? Whereabouts are you if you don’t mind saying?

I don't have particular anxieties around childbirth, sorry - I meant I identified with what you were saying in a more general sense, because I recognise that kind of fixated anxiety. My anxiety when it emerged (a good few years ago now) was actually initially very focused on my work, and the idea I'd make a serious mistake, but when I started TTCing, and then when I started having miscarriages (I've had three, all early) it switched almost magically to being all about my body in general (I developed some general health anxiety, which was weird as I've never been at all a hypochondriac), and the fear that I could never carry a pregnancy in particular. I'm 17 weeks pregnant now and struggling a lot with it - but the counselling is helping, most importantly in making me realise that while parts of my fear are very legitimate (just as I think being scared of childbirth is a very reasonable way to feel!), a lot of it is about underlying patterns of anxiety, and that until I get a grip on those, the focus of the anxiety will change but not its intensity. That's what I thought I recognised in you - again, if that's me projecting and not something you yourself recognise then I apologise.

You can get an ELCS on the NHS. Look at the NICE guidelines. Print them out and take them with you if you need to. Yes they will try to persuade you otherwise if there is no physical medical need, but this is partly because they don't want people to make the decision based on false information, as well as because statistically vaginal birth leads to better outcomes (and is cheaper!). But psychological need is also a factor and if you genuinely feel so anxious about natural childbirth then you do have a case to argue for one - you don't need statistics of your own.

Also, I read this blog post linked on MN last year and I thought it was really poignant - you might find it useful, OP.

havingitall.family/2017/birth-number-one-a-k-a-the-slowest-birth-of-all-time/

BertieBotts problem with that statistic is they don’t take into consideration future issues for ladies who have VB, such as an increased risk of prolapse years later. Also the statistic isn’t great because they also add emergency sections into that which are obviously more risky. Elective section is statistically a very safe procedure and slightly safer for the baby than a VB

PixieN I had planned to. I researched it and went in with a folder but didn’t need it. Was just told “okay”.

I do have depression and anxiety. West Midlands!

Yes, I realise that, even so, that's the stats they go off - I don't think they would particularly look at other stats.

NICE guidelines OTOH they do tend to listen to because that's basically NHS procedure, if they are found to be going against them they can get into all kinds of trouble. They are a useful thing to have on your side.

@LisaS - I do recognise similar traits in myself so you’re not projecting. I have a tendency to fixate on things - I became quite fixated on wanting a baby in my late 20s when dh wasn’t keen & it caused lots of problems between us (one of the reasons for counselling). I realise that I need to do something about it so it doesn’t become obsessive & extreme - very like my mum - which is what i’m afraid of. She fixates & obsesses to the point where it seriously affects her mental health & ability to function normally.
I can see how the stress of TTC could heighten that propensity, but being aware of it in the first place has to be a good thing. My mum has never wanted to confront her issues & won’t recognise there’s a problem.
I wish you a safe & happy pregnancy x

Great blog post @Bertiebotts - I can definitely relate to the overresearching & reading she did lol An amazing woman. I don’t think I could handle that!

@TheCatsPaws - I don’t think that’s the norm unfortunately, but it’s reassuring. Really glad they listened to what you wanted.

PixieN I was really afraid of them saying no but honestly it was presented as my choice, I did have to have counselling to “make sure it’s what I wanted” but it wasn’t difficult at all.

Hi OP

I had and ELCS for my first child in similar circumstances to you. My NHS trust won't do it despite NICE guidelines (which are not legally binding) but my fabulous GP referred me to a hospital outside the Trust (so, over 50 miles away). It was brilliant, really good experience, not traumatic or painful and (most importantly for me) I felt my autonomy was respected.

I have to say this was only possible because my GP supported me. Legally I think NICDE guidelines are not binding but you can always ask for a referral to another doctor. Your GP sounds like he/she won't consider your request (eg the bit about not haveing a CS if you go private is BS I am pretty sure) so I suggest you try to see a different one.

Good luck. Start early (I started at 8 weeks) and be persistent. You have a right to make decisions about your own body.

Thanks @StraffeHendrik - I will certainly try. Not sure how much of a difference it makes, but is your GP male or female?

Hi op, I’ve not read all of the replies but reading your intro I would say hands down you are tokophobic, almost all tokophobes feel this way (in fact I’m the only one I know who didn’t want a c section although ended up with one, ha!) It is my understanding that on the grounds of mental health and tokophobia you will be allowed one. GPs generally just don’t have the knowledge of this sort of thing as it’s so specialist. Perhaps see if you can speak to a consultant to put your mind at rest? Happy for you to dm if you have further questions about tokophobia x

Hi @LadyPug - I thought tokophobia was mainly associated with vb or is it childbirth in general? I’ve never heard of it being the other way round Hope your c section ended up being o.k. I thought you needed to be referred to a consultant by your GP & that only happened once you were pregnant & had seen a midwife first? It’s all hypothetical at the moment - just don’t want to freak out if I do become pregnant!

Hi @PixieN

The way it worked for me was:

Mentioned it to GP when discovered I was pregnant. GP was quite negative about prospects of an NHS C Section and suggested I'd have to go private.

Then mentioned it to midwife at booking appointment. She said I would be able to have a c section as it was obvious I had a deep fear of childbirth. She referred me to consultant midwife to discuss options.

I then saw the consultant midwife and discussed pros/cons of both options. She then referred me to the psychologist and the consultant.

I then saw the consultant who said I could have a c section if I wanted but I should see psychologist in any event.

Then I met with the psychologist who confirmed she had no input on the decision. I found discussing the reasons for my fear interesting but it didn't change my view in the slightest.

Then I saw the consultant again and she booked me in for the c section.

My anxiety was much better once I was booked in. That's not to say I wasn't very nervous the night before, I barely slept! But I felt much better putting my and my baby's life in the surgeons hands than trusting my body. Most people find that totally crazy but I've had friends who've barely survived childbirth and I've always felt that something would go wrong. It's irrational, but you can't help the way you feel.

I hope that helps. I did a lot of research and reading around the topic too as it was so important to me.

Hey Pixie tokophobia is a really complex and misunderstood topic that can stem from lots of issues but yes, most commonly the main symptom is the concern over vaginal birth (although many ppl who are tokophobic don’t even start a family or go on to have multiple terminations because of the fear). For me, I couldn’t bear the thought of being pregnant and feeling the baby move inside (very common) but I hate hospitals and really wanted a natural birth. Ended up getting induced, being in labour for around 17 hours and then having an emergency c section, it was everything I didn’t want but you know what, it was ok and I have a beautiful child because of it. I’m now pregnant again and going for VBAC all being well. But I know that if it goes out of my control it will be ok and I’m preparing for that as much as I can now with therapy, meditations etc. I don’t know if you need to be referred by a GP. I know a midwife can get you seen by the mental health team but by that point you are pregnant. A good GP should be prepared for this - when I wanted to try for a family I went to my GP and explained my fears and she said she has seen lots of women who have terminated because of this intense fear (they believe it affects one in ten I think although to different levels and for different reasons), she was very understanding and said I can have as much support as I need. Of course, I didn’t ask for a c section as adamantly didn’t want one but I believe they would have supported me if I did.