Do I have reason enough to request an elective caesarean? Possible TMI and very long

[cornballer]

Hello,
I've been a bit of a lurker on here but I've come to a point where I really need some advice - this may be a long post, sorry!

I haven't had the most straightforward pregnancy and at 36+3 now I feel that I really need an ELCS.

I've tried to talk to my consultant about it twice but I feel she doesn't take me seriously and won't even allow a conversation about it - she talks over me without letting me explain my worries. I've asked my midwife and she just says I have to talk to my consultant. I'm now thinking the only way is to write a letter but first I was hoping some of you ladies could take a look at my reasons and tell me whether I'm wasting my time or whether I'm justified in wanting an ELCS.

Firstly, it isn't because I've suddenly decided I'm 'too posh to push', I am genuinely petrified about my baby's safety.

Here are my reasons...

Reason 1)
For about 10 years I've had thick odourless green discharge (sorry, TMI) and vaginal pain which - despite numerous different tests over the years (by different GP's, different STD clinics and two different hospitals) - they can't find a cause for. All the tests always come back negative. I've been treated with a broad range of very strong antibiotics three times just in case but they haven't made a blind bit of difference. I was told I just need to accept they can't find anything wrong and that this could just be 'normal for me'.

For the past couple of years I've just accepted it as 'normal', but now with the imminent arrival of my first baby I have started to worry about it. I am having nightmares every night about him being covered in this green stuff in the birth canal and it making him ill and then killing him.

I've tried to look into it and all I can find is that green discharge = bad and NOT normal at all.

I am well aware that they can't test for everything. I'm petrified that it is either something rare that tests don't exist for, something that is resistant to antibiotics, or something viral or parasitic (which I have read can still cause discharge). I am petrified that my baby is all safe in his amniotic sac, then when it comes to the birth, he will be exposed to this horrible stuff and it will kill him. We had a next door neighbour who's baby died last year after getting meningitis and then getting herpes straight after due to undiagnosed infections that she passed onto the baby during birth.

Reason 2)
I am extremely worried that my psychological state about this (and I am so worried I can barely think of anything else, it's making me feel utterly ill) will somehow stall the labour as I SO don't want my baby anywhere near the birth canal.

Reason 3)
The baby has enlarged ventricles in his brain which they found at the 20 week scan, so we've had lots of monitoring and tests etc. I don't know how much the plates of his skull can overlap but seeing as fluid can't be compressed surely there comes a point where the only thing that can be compressed is brain tissue. Wouldn't this be quite bad? I'm concerned that if I have so much fear of baby being in the birth canal that my body won't push him out, he is going to end up with his head getting squashed for too long and get damaged. Plus wouldn't forceps and ventouse be more dangerous in this situation?

Reason 4)

They have told me I have Group B Strep. This has got nothing to do with the green discharge I'm concerned about above as Group B Strep doesn't cause symptoms. I guess if the discharge was being caused by Group B Strep they would have told me years ago.
My worries about this are that I will not be able to have many internal examinations, I won't be able to have my waters broken if needed or any sweeps etc. I also won't be able to have that monitoring clip on the baby's head. I'm terrified of the baby being in distress because I'm too scared to push him through the birth canal and no one knowing.

Reason 5)
My blood pressure is high - around 144/92, my resting pulse is 90bpm and I have put on 4 and a half stone during the pregnancy. I'm worried that my heart wouldn't cope with even a relaxed happy labour never mind one where I'm petrified of baby getting an infection.

Reason 6)
My SPD is almost excruciating now, I'm having physiotherapy but it isn't helping. I don't know how I'm going to get my legs wide enough to let baby out.

Reason 7)
I'm experiencing incontinence already despite having been doing pelvic floor excercises every day through the pregnancy. The midwife has said it will only get worse after the birth. A collegue who had incontinence too prior to birth is now having an operation to repair her entire pelvic floor and she says she wishes she'd told her consultant and had an ELCS.

Reason 8)
The baby is breech, though they reckon he might still turn around.

I know I'm not an expert with any of this and I know people have far worse stuff than this that make them want an ELCS but I so desperately want the safe delivery of my baby, an elective is the only way I can see him having a good chance of being safe. I am petrified for his safety and I just need someone to listen.

If anyone has got to the end of this, thank you for reading my worries - do you think the consultant will just laugh at me and say no don't be so stupid? Do I have valid concerns? I guess at the very least I want to put it in writing so it is on my file that I have asked and then if anything does go wrong it won't be like I didn't try. I am so scared and time is really running out.

i have no experience or advice to offer as i am preg with my first but i didnt want ur post to go unanswered so just wanted to say i hope u find ur answers and i hope u get what u want and have a healthy happy baby at the end of it xxx

I think you have considered the issues thoroughly and I think you have sufficient reasons to request an elcs. I think it is a good idea to put your reasons in writing particularly if the consultant tends to overtalk you.

This is probably completely coincidential but my friend was diagnosed with strep b in her pregnancy and she too had greenish black discharge they said the two were not related but it does make you wonder.

You have valid concerns.
The letter idea is actually a very good one, it can be much easier to remain calm and rational that way.
Make sure you a clear understanding of what your asking for ie the risks associated with cs (there is alot of information available) and go in with an open mind.
If the consultant can reassure you about the risks, great.
If you still feel that cs is what is best for you calmly press the issue asking for a second opinion if you must.
Don't let anyone let you feel bad about doing what is best for you and you and your baby but do be well informed about clinical and psychological risks and benefits.

You pooor thing!

Absolutely you can ask for an ELCS and if the consultant turns you down you can ask to see another one.

As an aside - if the baby is breech at this late stage I would also be looking to keep it that way. Basically by doing the opposite of everything they tell you to do to make it turn head down. So make sure you lie around on the sofa with your knees higher than your hips, that kind of thing.

I would have thought the baby being breech was reason enough for a ELCS. As for the infection, I wouldn't worry they wouldn't let you have a vaginal birth if they though it was a problem. I'm sure your consultant has weighed up all of these problems but my understanding is that it's your pregnancy so you have the choice, can you not arrange a time to talk about this specifically?

Gosh, thank you for taking the time to read and for your fast replies!

I had called the hospital a few weeks ago to ask if I could make an appointment to talk to someone about an ELCS and they said I would be able to at my 36 week scan (which was this morning), unfortunately when I tried to mention it she really didn't seem to want to talk about it. I know they are busy people but it I left the appointment feeling utterly useless and quite upset at being unable to protect my baby.

I will write the letter and leave it a couple of days then see if I can speak to her directly. If she still brushes my concerns aside I will ask for a second opinion (I really hadn't thought of that, I was worried I was stuck with a consultant that didn't want to know).

Thank you

It sounds like you're pretty certain about what you want, and at the absolute minimum you deserve to be listened to properly and to get non-patronising, thoughtful and considered advice from someone who has the power to help you. Unfortunately, consultants can be twunts (I had a thread about mine recently; different circs but I am having an elcs at month end and was left feeling blue after meeting with 2 consultants last week).

Can you just toughen your shell and keep on like a broken record? I know that miserable feeling of "they didn't listen, if only I'd said it differently/been more eloquent/pushy/prepared ..." It can get you down, but try hard not to let it and just keep on keeping on. Good luck

Hey Cornballer

Phew. [deep breath]... I know how easy it is to get so upset about something and just be completely overwhelmed. This is my first pregnancy and when that cold white fear grips you in the middle of the night that something is wrong, or will go wrong... OK - first of all - a hug...

I have no relevant experience of any of the symptoms you mentioned, but if it helps - here's my advice...

Whether the green discharge, the enlarged ventricles, the Group B strep, the incontinence, the SPD, the breach baby, the high blood pressure and the worrying mean you should have a caesarean, I don't know. But - I would say that if you are as upset as you sound, you need someone who has the medical knowledge to help you make the right decision. If your consultant isn't listening to you, then you need a new consultant - either at the same hospital or another one.

Whatever the medical consequences are of all of these points, you need to know and to have them explained to you. My opinion is that we should be given enough information to allow us to make an informed medical decision. The high BP, the Group B strep, the extreme SPD, the breach position and the enlarged ventricles in the baby's brain all sound like cumulative factors pointing to the possibility of needing an ELCS, whatever the discharge means. As I said - I have no idea about the discharge but the effects that its having on you and the worries that its causing cannot be good for anyone - even the medical staff themselves who have to keep you and your baby safe at the delivery; surely it will be hard for you to follow commands like push when you're so scared? I'm personally fully intending to be as direct as I need to be when I'm in labour - add weeks of terror in too, and they'd need more gas n air to keep me on the bed !

So - new consultant. I think you have a right to this. Perhaps the way to get this is to go to your GP and discuss it? I changed hospitals because I wasn't happy with the info that I was given (ie - bloody none) and the change was done through the GP. Now - as you're so close to delivering, you need to have it sorted quickly, so perhaps you take a friend or relative or partner along with you to help back you up if you feel that your concerns are being dismissed? I'm going with my MIL to the docs this week because they keep on dismissing her; it does help to have someone there. The person doesn't even have to say anything if you don't want them to - just brief them that if it looks like you aren't saying what you want to have said, or if the conversation isn't discussing the right issues - ask them to step in then. Writing it all down is a good idea - I don't know which are the medically strongest reasons in the list that you gave - but I'm sure someone else will post and tell you - and I would start with them - after you've explained how properly truly worried you are.

Also make it clear that you understand the downsides of a caesarean, and that its a big operation; once its out there and you've addressed it, it means that they have to discuss why its suitable / not suitable for you rather than using the general argument against it...

I don't know if this will help or not - I've tried to be sensible and practical but I don't know if thats what you need. I hope it does help - mumsnet has helped me in the past, and you sounded so upset that I wanted to be able to do that for you.

xxxxxxxxx

If the baby stays breech then you have nothing to worry about, they'll want to do a CS anyway, and you can decline any offers of ECV. Don't worry about it unless the baby turns.

As others have said just do everything you can to keep it breech.

If the baby turns then you can discuss all your other reasons with the doctor.

I read through your reasons until I got to the last one.

You should have been offered a CS already with a breech baby. It's time to make a fuss. Go over the consultant's head if you can.

A midwife said to me that they cannot make you give birth in a way you do not want to. Remember this. It's your body.

You cannot be required to accept the increased (as opposed to normal vaginal birth) risk of delivering a breech baby vaginally. You really need to be firm on this; explain that you have researched the risks of CS, and accept them.

Please let us know how you get on- I would start making some phonecalls, as writing a letter may take too long. Or correspond via email?

Good luck

Another thought is to make contact with the 'superviser of midwifes'. Basically the head midwife at the hospital. I don't think she will have authority to demand ELC for you, but if you make an appointment to see her could eb very helful, as consultants generally listen to the superviser where they normally don't really respect the opinions of midwives.

I wish you the best of luck. You do sound very scared, partly this is normal, the first pregnancy is often about 'surrendering control' I think. But you really do need someone to listen to you and take you seriously, and you are entitled to it.

I was going against the grain (entirely different reasons and circumstances) in my first pregnancy and I finally got the result I wanted once I got in touch with the superviser of midwives at the hospital, so I really help this can help you too x

Cornballer good luck and will you keep us posted?

I really hope this works out well for you xx

Having to have to have an emergency section to save the life of our son I am usually a bit fed up with people wanting to have a major operation, I tell you that so you know that I mean it when I say you should definitely push to get a section and all your reasons are relevant and valid. The next time you see the consultant I suggest you just keep repeating "are you going to listen to me?" until she does.

Good luck.

Why do you get fed up with what other people want to do with their own bodies fab?

Because sometimes I think people think it is the easy option and it so isn't.

Cornballer - here's my advice.

Print off your first post on this thread and make an appointment to see your GP as soon as possible. Just ask him/her to read it and then you can have a conversation on the basis of the very valid concerns that you have very consisely set out here. Surely your GP will know all about the discharge situation as it'll be on your records.

If I were you, at the risk of being seen as a troublesome/stroppy patient I'd make no bones about the fact that you are deadly serious about getting this C Section. Even cry if you have to.

Very often GPs can pull strings and speak to consultants etc directly on the 'phone. I've known my own GP to makle a call while I've been in the surgery with her. Failing that, he/she might be prepared to write a letter for your consultant or at least advise you on the best way to approach it but make sure your GP is left in no doubt that you won't be fobbed off with the old "you're worrying too much, you'll be in the best possible hands and everything will be fine" line.

If you are already 36 weeks + you really do not have much time on your side in which to argue the toss with the medics on this one and wait for them to make various appiontments for you which will take valuable days to come around. Your baby really could come at any time now and you stand no change whatsoever of having a reasoned debate about this with a procession of jobsworth midwives once you're in established labour!

I wish you lots of luck and really hope you'll be able to get the C Section you want and deserve to be able to have. Please let us know how you get on.

I was desperate for a CS...I was utterly terrified of passing herpes on to my child (as it can result in the baby's death, as you mentioned). I told all the staff about my worries and was brushed off and ignored. In the end I sobbed like a baby in front of the consultant (for quite some time) and in the end he said 'Fine, have one'. I think he was just desperate to get me out of his office!!

Your worries are a massive deal to you, they may be right and there's nothing wrong (re. discharge), but even if that's true, obviously you are in turmoil psychologically.

Print off the post that you have written on here. Show them that. Don't be fobbed off, it's v. difficult to stand your ground, but if you're this worked up then you should.

If all else fails, do what I did and have a total meltdown. Good luck.

Not sure where you are but I think in most places the recommend a ELCS at 38 weeks when the baby is breech this alone is a need!

I have Group B Strep I also have SPD & I also have green discharge have had it for years also and had it tested in my last pregnancy and they said its just my body My last little boy was also breech but had turned at my 37 week check!

I am now pregnant with my third baby and have had two natural births with drugs lol! It is quite normal to be worried and it doesnt matter how many kids you have you worry everytime!

Hi, thank you everyone so much I haven't been able to think clearly through the worry and you've given me the most fantastic suggestions and comfort, you've all made me feel so much stronger and that I can push for this.

I have just made an appointment with my GP for this afternoon and I'm going to print off the original post and take it with me - I would never have thought of doing that! Whenever I have tried to bring up the subject before I always end up a blubbering wreck so I think this will really help. I will ask to speak to the supervisor of midwives too.

The consultant didn't mention anything about a c section due to the breech position, she just made me an appointment for two weeks time to have him manually turned.

I will post back on here to let you know what the GP says.

If you have the baby manually turned make sure it is done in theatre and be prepared for feeling very very sick afterwards.

You don't have to have the baby turned. You can turn that down, I think it's unreasnable for her not to have explained that given that the procedure does carry risk.

Refuse to have the baby turned.

I am disgusted that they made an appointment for this to be done without asking you if you wanted it done. shesdrivingmecrazy is exactly right.

Complain. Strongly.

I really think you need to insist on a second opinion from a second consultant- you are entitled to this.

You would complain if you were treated like this in a restaurant- and this is much more important!

FWIW, I would focus on the fact that the baby is breech rather than the other issues. This alone is reason enough for an elcs.

Good luck, and remember that you are only insisting on receiving what you are entitled to.

Let us know how you get on

Dont have much to add really, but having read your post I think most consultants would be able to reassure you about each of the reasons you've mentioned bar the breech one? it seems very very odd that no one has even mentioned the word caesarean to you yet anyway?
I, like some of the others, ended up with an emergency section and trust me, it is really not the easy option and comes with its own set of risks and the recovery after isnt great.
Maybe Im naive but I always think that hospitals will try and do what is best for you and your baby? I don't think they would purposefully ignore any life threatening risks to you and your baby just for the sake of it and force you to deliver your baby naturally??
But as many have said, this is your body and you have a right to do as you please. I would say maybe try to think of the positives of a natural birth, and try not to get your hopes up of having a section coz if they refuse (for whatever reason) you will end up not mentally prepared in any way.
I wish you all the luck in the world and really hope you get the outcome you want, at the end of the day a healthy baby and a healthy is the aim, regardless of how the baby makes its arrival into the world!

Kity, she is entitled to have a cs with a breech baby.

The hospitals don't always offer cs because they have WHO targets to meet, and have been instructed to reduce the rate of cs.

FWIW, I had an elective cs, and it was marvelous; from speaking to people who have had an emergency cs it sounds like a wholly different experience. I'm not sure of statistics, but isn't your chance of ending up with an emergency cs greater if your baby is breech? Perhaps someone will know whether or not this is the case?

OP, do NOT accept a refusal of a cs. You are entitled to have one.

Cornballer I don't have much advice to offer apart from complain very loudly, if you need to is there anyone who can go into the appointment with you to give you some support and to help you in case the consultant tries to talk over you. If nothing else sometimes having someone with you who is on your side can be super helpful and can make all the difference. I hope you get a result today!!

With regards to her making an appointment to have the baby turned, she should NOT have made you that appointment without asking you first. That is a real big no no, I suggest you bring that up with your Doc as well.