I am so so upset when I read about women who have had previous extremely traumatic labours who want an ELCS being made to fight for this and not being given any guarantees until late pregnancy. The stress this must cause the woman and her unborn child must be huge. I have been so so lucky to have my ELCS (if I want it) agreed from 9weeks pregnant (and it could have been sooner even before I was pregnant as was on a gynae waiting list to see my consultant to try and get this agreed before I got pregnant but that appointment was a long time away which wouldn’t have mattered had I not got pregnant in the meantime so they bumped me onto the antenatal waiting list and I saw a birth reflections midwife at just past 6weeks pregnant and only reason it took til 9weeks to get appointment was I was away- my consultant could have seen me before then- so I am incredibly thankful to my hospital for doing that for me as it has made all the difference to my mental health.
Anyhow in case it helps anyone currently battling with their hospital to get an ELCS here is what I did. Firstly I got my psychologist who I saw in immediate aftermath of Munchkins birth to write me a letter documenting the psychological impact of her birth on me and reccomending I be allowed to chose an ELCS for a subsequent birth if I chose. (this letter could be from any health professional really- MW, GP, previous consultant etc) but I really think it helped my case massively. I also did my research to make it clear it wasn’t a decision I was making lightly. I also basically begged and cried quite a lot- I made sure they saw exactly why this was so necessary for me (It wasn’t playacting though- I genuinely had those reactions).
So here is my letter- obviously it is personal to my case but feel free to copy and paste and adapt to your own case:
I am writing this letter in advance of our appointment to try and document why I am making this request for a ELCS for my next birth as I am currently very aware that I have a tendency to get extremely upset when discussing birth options and it makes it harder to try get my point across. Originally my plan was to try and see you before I got pregnant again so that I could feel positive going into a future pregnancy, however as I got pregnant in advance of our appointment (I will be approx. 9weeks when we meet) it means I am feeling very worried and anxious about my options not helped by all the pregnancy hormones!
As you have probably seen from my notes I had an assisted forceps delivery and episiotomy and my daughter ended up in NICU with Grade 1 HIE (& congenital pneumonia and other symptoms) as a direct result of her birth with suspected brain damage, which after an MRI was confirmed as some kind of “possible hypoxic injury”. Thankfully my daughter is now meeting all the normal developmental milestones, although we have not had her MRI repeated.
The birth of my daughter in London was the most traumatic and horrific experience of my life. There were many factors that compounded this; the extreme level of pain I experienced with no respite from the contractions and failed pain relief for first few hours; the large baby (9.5lbs, 4.25kg); the failed epidural; cannulas; failed ventouse and eventual assisted delivery (forceps, episiotomy) of an extremely ill baby, as well as her time on NICU (including traumatic and very worrying investigations such as a lumbar puncture at 2days old and an MRI at 8days old). During my labour I felt completely out of control, in an incredible amount of pain (apart from the middle bit where the second epidural worked), and absolutely terrified. I was left on my own for some of it and not really reassured at all by the unsympathetic health care professionals I had with me during the birth.
The only way I feel I am going to have a healing experience is to be in control of my next birth. Currently that means my having an elective section for my next birth. I have read all the NICE guidelines (http://www.nice.org.uk/nicemedia/live/10940/29334/29334.pdf) and I appreciate that it is a major operation and not to be undertaken lightly. I also understand the risks involved compared to a vaginal birth. I have also read the draft updated NICE guidance (http://www.nice.org.uk/nicemedia/live/12156/54552/54552.pdf) which differentiates the risks of ELCS versus EmCS and vaginal birth and I am happy with my own risk assessment of it being the best option for me both mentally and physically at the current time. I also have a history of miscarriage and a recent ectopic pregnancy and so my bottom line is I cannot risk losing or damaging any more babies and I feel that ELCS is my best option in this case.
The draft NICE guidelines (Published 23rd May, 2011) (http://www.nice.org.uk/newsroom/pressreleases/CSectionUpdateConsultation.jsp) also state “when a woman requests a CS because of a fear of childbirth she should be offered a referral to a healthcare professional with expertise in providing perinatal mental health support to help her address her fears in a supportive manner. If, after providing support, a vaginal birth is still not an acceptable option to the woman, offer a planned CS.” I am just completing my second set of trauma counselling following my ectopic pregnancy, but most of the sessions were in fact related to my daughter’s birth. The birth reflections midwife is also going to look into some CBT which may help me. I am happy to undergo further counselling but I am unlikely to change my mind that ELCS is the only real option I want and need for delivery of this baby.
I do appreciate that most women report that second births are so much better than first births; however I am also aware that second babies can be bigger so I am utterly terrified of another agonising labour and not being able to get another big baby out resulting in another oxygen starved baby. Mentally I will not cope at all with another traumatic birth. I appreciate the hospital would do everything to minimise this, and I am being supported brilliantly by my midwife, but you also can’t guarantee that I won’t have another bad experience next time. I feel that having an ELCS will minimise the trauma I will experience compared to last time. Having said that although it is a very unlikely option for me, I am still willing to consider and explore the possible option of a vaginal birth (and my midwife is helping me with this- and perhaps this could be discussed at a future appointment with you too) but currently it is extremely important for me to know that I am not going to be forced to give birth vaginally and that you are willing to give me an elective section due to my secondary tokophobia.
You will also have seen my letter from my psychologist documenting the immediate psychological trauma I experienced in the months after the birth and documenting that psychologically it would be best for me to know early on in my pregnancy that an ELCS would be offered in my case. At the minute I am feeling so fragile that I urgently need you to agree to my request for an ELCS so that I can stop worrying about having to “fight” for an ELCS (which I currently feel is the best option for me) and get on with enjoying the rest of my pregnancy. I found myself crying “if I can’t have an ELCS then I want a termination” during my appointment with the birth reflections midwife. I was surprised at myself for saying that as although I meant it at the time I don’t know that I would pursue that course of action in reality but the reaction I had shows how deeply my previous traumatic birth affects me, and how important it is for my mental health that XXX hospital agrees to my request for an ELCS as soon as possible.
Many thanks for taking the time to consider this request.