When to start requesting a c-section?

[mynameiscalypso]

I'm just over 13 weeks pregnant with my first child. I have a history of mental health problems stemming from a rape a decade ago (PTSD, anxiety, depression and an eating disorder). I see a psychiatrist weekly and am on medication.

Because of all of the above, the community midwife has referred me to what my trust call the complex caseloading team (from what I understand, this means I see my specific midwife more frequently and don't just see a community midwife). That's fine with me particularly as I'm finding pregnancy hard for a number of reasons.

My first appointment is this week when I'll be 14 weeks. I strongly feel that a c section would be the best choice for me - with my history, a vaginal birth would be very traumatic and if I feel like I'm not in control (which I would if I had to have a vagjnal birth), I tend to seek control in other ways which would be bad for me and the baby.

We didn't discuss anything about birth choices at my booking appointment but is it worth bringing it up now (and filing a copy of the NICE guidelines with my maternity notes)? I know that I might have to jump through various hoops and won't likely get anything confirmed this early but I think it might be sensible to start the process. For what it's worth, my psychiatrist is supportive and would advocate on my behalf if needed.

Any advice or words of wisdom would be really appreciated. I feel like I've had to fight a lot over the last few years in relation to the rape for various reasons and I'm worried I don't have the mental strength for another battle.

Thank you.

I had an ELCS for similar reasons - PTSD meaning that I really struggle with loss of control. I tend to ‘shut down’ in difficult situations which I knew would be very dangerous and I started discussing this with my midwife at 16 weeks or so as I was already getting very anxious about the birth. It was actually her who suggested having a section. I went away and though about it til my next appointment and decided it was the best option. At my next appointment she phoned the hospital who wanted me to wait until 36 weeks to see the consultant. She basically told them to piss off with that suggestion as there was no way she’d make me wait that long when I was so distressed. I saw the consultant at 29 weeks. I had no problems getting mine agreed, —possibly because I was sobbing in the waiting room as I was so stressed about it— I just explained my history and that I understood all the risks but felt that this was the best option.
I think I was very lucky that I had a midwife willing to back me and then an understanding consultant. If you search on here though you’ll see that not everyone is so lucky. There’s some awful stories of people with extremely good reasons who’ve had huge battles on their hands. I would start telling them ASAP so they can get the ball rolling. I would just be firm and keep repeating that you know the risks but that it is the safest choice for you. Could you get a letter of support from your therapist? It might help if you run into problems.
Good luck with it. Mine was lovely - really chilled and I got to see him straight away and almost instant skin to skin.

Thank you so much for sharing your experience @birdybirdbird and I'm so glad that you had a good experience and a supportive midwife. My psychiatrist is very keen to speak to the antenatal team in any event so I'm sure a letter won't be an issue if needed. I have a hefty dose of disassociation going on in relation to the whole pregnancy so can totally understand what you mean about shutting down and I fear the same thing would happen with me. Thank you again for your advice, I really appreciate it.

Is it an nhs psychiatrist? If not, they won’t engage, and will refer you for nhs psychiatric assessment.
Be careful taking this stance, if you claim to have dissociation in pregnancy they will involve other services to monitor you after you baby arrives, and that can be tough to manage.
Just be careful how you pitch it to a midwife and consultation, I often see women oversell their symptoms to get an elected, then seem shocked that post birth they are being monitored by other services.

Thanks for your thoughts @Ambs81, I have no problems with monitoring either pre or post birth. I think it would be very sensible as I know I'm at a high risk of PND (to put it in context, I was nearly sectioned about a month before I found out I was pregnant and needed a trip to A&E for stitches just before I found out). I'm not trying to claim or oversell anything - my paramount concern is my baby and, by extension, my mental health. That's a useful tip re NHS psychiatrists though, so far they've been happy to engage with him but I'm totally open to seeing someone within the NHS. As I said, the only thing I want is for this baby to be born healthily and for me to be in a position to actually be able to look after him/her.

Congratulations on your pregnancy, so sorry to hear of your past issues.

I wouldn't be waving about the NICE guidelines from the off - it might be that as a pp said, just telling your midwife your plans, will be enough to get you the ELCS you need. Your midwife might feel affronted if you go in assuming she doesn't care for your needs and doesn't want to help you. But by all means if she isn't helpful, start with the guidelines and letter writing to higher ups and so on! Certainly tell your midwife sooner rather than later, so that everything can be arranged in plenty of time.

Thanks @mussie, you're probably right about the guidelines! I will definitely mention it to her this week (it's supposed to be a relaxed 'getting to know you' chat) so will see what her response is before I start getting difficult!

Just to update this for anyone googling it, met with my midwife today and she said there will be absolutely no problem with an elective caesarean. The date won't be confirmed for a while but I think she felt like it was the most sensible option in the circumstances and was very supportive - no attempt to change my mind at all. Thanks for all the advice that people had!

So glad that you’ve got the outcome you wanted @mynameiscalypso Lots of luck to you and enjoy your LO!

@mynameiscalypso great news! Glad it all went well.