Booked c-section but may have to give birth vaginally if go into labour naturally

[NotAgain77]

Hi - 38 weeks, I have a c-section booked for next week. I requested it at 10 weeks due to a previous traumatic birth where my son got stuck in the birth canal. This was agreed by the head consultant and head midwife as a borderline medical need/maternal request.

I have been 'counselled' today by a consultant about the possibility that I go into labour naturally and they are so busy with c-sections that I won't be able to have one. I understood this risk from the point of view of a fast progressing labour, but this isn't what the consultant covered, he essentially said as yours is maternal request and you've had a 'normal' delivery before you would be low priority for a c-section.

I am really upset and stressed by this. I was incredibly physically (3 episiotomies, damaged coccyx) and mentally impacted by my last labour and my son had head damage from being stuck. It took 4 years for us to agree as a family to having a second child and this was done after discussions about whether I would qualify for a c-section.

I am trying to find a way through this, so I have requested my c-section date be brought forward to 39 weeks, from 39+2 to try and avoid going into labour naturally. But I am not hopeful this can be accommodated as the consultant said he wanted to see how things went.

For context - I was made to have an emergency induction at 37 weeks last time, I had OC which they'd lost the blood test from 3 weeks earlier and my levels were dangerously high to baby, so the hospital wanted to deliver asap. I requested a c section then as baby's head was measuring large but it was declined, he then got stuck, and I almost ended up with an emergency c-section, but instead ended up with him being cut from my vagina. This baby's head is measuring larger.

I should also say I am not saying that I deserve priority over some one with medical need/ risk to baby/ mother, I am just trying to avoid more trauma and my baby getting stuck again. Any thoughts on anything else I can do? Or anything that may help me de-stress?

What does the consultant mean by saying he wanted to "see how things went"?

Do you have a midwife you could talk to? I would agree that sounds stressful and I wouldn't be happy till I got some more confirmation.

I think it was just a way of dismissing the request tbh. A bit like, oh just wait and see what happens.

He said having to give birth vaginally was a low chance in the above scenario, but gave "1/10 women have to" as an example.

Kick up a fuss instead of accepting what they are saying. Contact PALS. Make a formal complaint. Ask to be treated by a different consultant.

Do not accept what they are doing.

"I do not consent to this plan". Ad infinitum.

Thanks @Mistressinthetulips I have emailed my midwife to ask for her help in moving the c-section date forward. And I will see her later this week for a check up, but it's all seeming mighty late to be bringing all of this up. I have had a fairly relaxed pregnancy re this as from 10 weeks I thought I was going to have a c-section and now I am trying to get my head around what feels to me like a lot of uncertainty.

I am having lots of pains at the moment, but I also have never gone into labour naturally, so I have no frame of reference to what the start of labour feels like, another thing that is causing me stress.

Contact the head of midwives. Ask for assurances.

Obviously if they’ve got two theatres and two emergency caesareans happening when you go into labour then there isn’t a whole lot they can do about it, but they should be telling you to call at the first sign of labour so you can go in and wait for a space in theatre.

Contacting the head of midwives is a good idea.

I worry that putting in a complaint will actually lead to worse treatment...

Request another consultant perhaps.

My planned induction at 36 weeks became impossible when baby turned transverse. My consultant was loathe to agree to a 36 week section however my previous 37week stillbirth was a date I was not willing to reach again. My midwife was fantastic and found me a consultant who agreed whilst making sure I was fully informed. All was well and I give thanks every day for it. My son died from dramatic cord entanglement - my daughter had her cord around her neck and it had a true knot. After delivery it was made very plain had I not insisted and stuck to my guns the outcome would have been unspeakable. She is 12 now and still the midwife recalls it :(

Could you contact another hospital and see what they would offer in this situation? Could always transfer care 🤷‍♀️

@NotAgain77

Contacting the head of midwives is a good idea.

I worry that putting in a complaint will actually lead to worse treatment...

I work within maternity and honestly it won’t, as long as you are polite and reasonable and don’t send the HoM 50 emails a day and complain that they’ve not been responded to within an hour, during a pandemic... 😬

Seriously though, in my experience HoMs will want to know about this. You could also ask if they have a professional midwife advocate who could support you and perhaps attend your next appointment with you. The ones here are bloody wonderful and help a lot of women.

You have experienced traumatic birth and you need compassionate and reassuring care, not to be dismissed (I had a similar experience when pregnant with twins and I had awful tokophobia and the consultants were so dismissive).

Just explain the impact of the uncertainty on your mental health, that you know they can’t predict emergencies but you’d like support to come up with a plan that reduces the likelihood of you not getting the caesarean you feel is essential.

Oh and you could also ask if they have a consultant lead for those with perinatal mental health issues - they are likely to be the most empathetic and supportive.

Thank you @SinkGirl, that is so helpful. I am trying to be so careful with what I say to the MWs and consultants for fear of causing myself worse treatment that I think I am in danger of not being assertive enough.

I will ask my midwife for the contact info for the Head of Midwives. I have also jotted down my history and my birth plan and uploaded it into our maternity notes app as I felt this was one way of me having my say and having it recorded somewhere.

I don’t think any hospital can guarantee a section in such circumstances but it’s very unlikely to be an actual issue.

So if you came in in labour and the unlikely even there were 3 people with raging pre eclampsia or fetal distress already in labour they’d get done first. So very slim chance of that happening but if it did and you laboured quickly yes you might give birth before they can fit you in. They only have so many doctors and so many operating theatres.

Chances are you won’t go into labour before your section date (not may do) amd if you do chances are it won’t be that busy.

@itsalltrue22 thank you so much for posting and sharing that. I am so sorry about your son.

Amazing that you saved your daughter, I imagine that never leaves you. So glad your midwife supported you and found you a supportive consultant. The alternative doesn't bare thinking about.

@CovidCorvid I do get all of that. And I am trying to be as reasonable as possible while advocating for myself and avoiding another traumatic delivery.

Part of what is upsetting me is the pre-discussions about how I am going to be the one that gets bumped. I feel it is minimising my previous experience.

I know the hospital is massively oversubscribed on c-sections, as I struggled to get a pre 40 week date booked for the elective. Which in my mind makes what seems a low chance event, slightly more likely. Again, on booking my c-section they were talking about me being low priority/ getting bumped. I know others that are booked in for a c-section for no more than I am, who have not had this level of forewarning.

Re changing consultant - I have a named consultant who I spoke to one the phone at 10 weeks and was fantastic. He totally got the mental health side. But I have not been able to see him since, and have seen upwards of 5 different consultants throughout the pregnancy (I am under consultant care because of my age, blood clotting condition, suspected high blood pressure, and the c-section).

I've had two sections and for one of them I did have to wait till late in the afternoon as emergency ones were cropping up - the other I was taken straight away. So even when they were really busy I still had the section on the day booked, just later on.

Just a hand hold because I understand Your worry. I was booked for an elective caesarean second time around. I had to go through all the hoops of discussing a vbac although I knew I didn’t want one. I was in the meantime referred to the perinatal psychiatric service and I found the uncertainty about the birth very stressful (among other things) and I also kept seeing different consultants who kept saying ‘let’s see how things go’ until at 36 weeks they booked in the c-section for 39 weeks. I’d only reached 38 weeks before and I was scared too but it all worked out. I really hope it does for you too.

I agree with others as long as you are polite and firm then you should escalate your worries.

I was booked for an elective c section after an emergency one first time. I went into natural labour before the date but kept pushing for the c section after they offered induction. I just kept saying no. Keep being insistent OP! I was booked in for 40 week C section as got bumped twice so definitely try to get it arranged earlier than mine was.

But he’s been honest. If it comes to making decisions about who goes first a lscs for physical medical reasons will take priority over a lscs for mental health medical reasons. If he didn’t warn you that it’s a possibility and then you had to wait while someone else was done you’d be cross you hadnt been warned. 🤷‍♀️

You’ve been booked in for an elective at 39 weeks which is as early as Nice guidelines allow for an elective. I get it’s stressful thinking what happens if I go into labour before then, what happens if they’re busy but there’s nothing they can do about that. They can’t guarantee that someone will be there who takes priority over you on the day.

Where I work we even warn the elective lscs women there’s a small chance they may go home without having the lscs on their elective day if we’re busy. Happens very rarely. In 15 years I’ve had to tell women that maybe 3 times.

@CovidCorvid nope I wouldn't be cross, that isn't a forgone conclusion at all! Both my consultant and the HoM covered this off, but in a reasonable pragmatic way and certainly didn't make it clear that I would automatically be the bottom of the pile. When the point is repeatedly laboured it feels like more than just a small warning. Also 1/10 women not getting their planned c-section is not small odds.

I feel its odd that my c-section was agreed by one consultant as part medical need (i.e. baby getting stuck and ensuing traumatic delivery) and is now purely a maternal request. This is a change and a late one.

Well a lot of people would be cross if they weren’t warned. Guess the doctors can’t please everyone, some want to know some don’t.

@CovidCorvid

Well a lot of people would be cross if they weren’t warned. Guess the doctors can’t please everyone, some want to know some don’t.

There is a difference between preparing someone for this possibility and trivialising their concerns, causing unnecessary anxiety and not dealing with your service users with empathy, especially those who are traumatised by a previous birth. I see consultants behaving this way frequently and it’s not okay. This is one of the reasons why I won’t be having any more children. I’ve spoken to maternity staff who find it baffling that someone would choose not to have a child due to tokophobia / secondary tokophobia following trauma, which I find quite shocking in frontline staff.

She does want to know. She’s been told sensitively already. What has this consultant achieved?

Since Ockenden I’m seeing so much resistance to the “informed choice” element and have heard senior staff say service users aren’t capable of understanding, or that some don’t want to know, or you can’t please everyone. It’s very depressing. Isn’t this what personalised care planning is supposed to be about? And as a service in 2021, if we still can’t give women the information they need in a way they can understand, it’s maternity services that are failing.

I booked a CS after an emcs first time. It was booked for 39+2. I did go into labour before which was a surprise and I decided to change my mind to a vbac but I was asked a few times and DP was asked to make sure I was sure I didn’t want an emcs now I was labouring.
It awful that not everyone gets a CS who wants one after it has been booked.
Could you ask to speak to your named consultant? You can usually get hold of consultants by phoning their secretary.
Failing that would a different hospital be better.

That's what I was told when I was pg with dd2. ELCS booked in for 39+2 but if I went into labour naturally before then, I would have to labour for a certain number of hours before the operated on me.

Thankfully, I didn't go into labour naturally so it didn't apply. But I did feel like I was having to accept something I wasn't really prepared to actually do 😏