Panicky thoughts re second birth...advice/reassurance please!

[Belle]

For some reason have started to freak out about the birth of my second baby (Sept). First time round was a game of two halves: straightforward until full dilation, then major problems when baby got stuck, ended in forceps in theatre. Was fraught - had pre eclampsia, and as a consequence it was early, baby was underweight, BP soared in labour. For this and other reasons, known and unknown, I ended up with a pretty bad case of PND very quickly after the birth, and was on antidepressants for over a year.

Am v happy with midwives (Brierley) and planning homebirth. But am starting to really panic about the birth. I know in theory should be ok - was able to cope until full dilated last time, reason pushing stage went haywire was because tiny baby slipped into awkward position. But I think that part of the PND root cause was the losing control aspect. And you don't get much more uncontrolled than birth. So am now wondering, do I attempt to argue a case for an elective c-section? If no go on this, do I get into massive debt to pay for one? I don't want to raise this with midwives yet as pretty sure they will not be in favour!

I know there are people who feel that all women should have to go through natural birth - I don't agree. I'm just trying to figure out whether I am one who can (again). without major consequences that is.

[Fuschia]

I would think you have a good case for an elective CS if you decide that's what you want.

Suggest if you decide that's the route you want to take get referred to consultant leonie penna

Sounds to me that you might benefit for the chance to talk this through a bit and release some of the feelings, nurture yourself

Can I recommend christine neillands, hypnotherapist And a lovely woman who really helped me when I was panicking about needing to go into hospital to have my twins? She really rescued me emotionally!

[Lochie]

I have had exactly the same thoughts as you Belle (though obviously not faced with second labour like you are now so you are probably a bit more panicked about it!). C/s really appeals to me from that 'control' point of view. You'd know the date,time, and duration of what you are going to go through etc. But for me there is something about a natural birth second time around that I would like to explore to put old demons to rest as it were (though can't be sure i'd feel like that if I was actually preggers). Have you thought about speaking to the Brierly MWs? Not only to speak about elective c/s but also to see if they can put you in touch with the bods in perinatal at Kings - who help with the associated anxieties that may occur after such a difficult first time experience? I am pretty sure some kind of emotional (psychological) support is available to help with this....its definitely worth asking...

Also don't take for granted how strong you are now you have gone through a difficult first time....you might not feel like it right now but you are strong and you can do this and it won't be the same as last time...

[Belle]

Good ideas...i'm a bit scared of raising with midwives, but think that's prob the first step - and yes then ask for consultant/perinatal appt. My m/w has already flagged me with the perinatal people given what happened last time. She's told me to tell her if I feel any antenatal depression ( I don't so far) or anxiety (I guess I do given my post!).

Fuschia, have thought about hypontherapy and am keen, had christine's name in my head (prob from posts on here!). Agree it all needs to be talked through.

Thanks both of you, it's a relief to hear reassurance and recognition somehow, think that is part of the battle really.

[JessB]

I was terrified of my second labour after a hard first one and flashbacks etc. At about 24 weeks i saw teresa a consultant midwife at kings to talk through it all. I went in with the hope of arguing for an elective c section. She actually put me with the brierleys for continuity of care and a hospital birth. As it turned out the brierleys gave me confidence to make a home birth possible and lent me Hypnotherapy CDs. I decided to make it my project to try to feel positive about the birth ao i ddid the CD everyday for the last month. I really think it helped! I consoled myself that we were so near the hospital and I'd probably end up there. As it turned out it all happened so differently and the home water birth did happen and quite quickly too.

I guess my advice is to talk to the midwives and I think the will be more understanding than you might think. They even put me in touch wwith someone who'd had similar first time experience and a much better second time. I found that really useful. Do pm me if you'd like to meet up for a proper chat through all this.

Good luck!

[Saffron]

Belle, you should be aware that if you have a predisposition to PND, then an elective c-section will not entirely negate this -- just as a difficult labour was not the total cause of it. And women who have had PND once are more likely to have it again. If you had a good response to antidepressants last time round, you might want to consider starting a low dose of antidepressants about 2-4 weeks before your due date.

This is not something midwives and GPs will be very familiar with. I suggest you get a referral to a psychiatrist who has knowledge of this specific area if this is something you want to consider. I'm not sure how quickly you can be seen on the NHS, although I can recommend an excellent private pychiatrist who will be happy to write a prescriptive recommendation to your regular physician.

There is some evidence that this type of prophylactic use of antidepressants can avoid PND or shorten its course dramatically.

xx

[Belle]

That's interesting Saffron, I did raise this idea once with my GP (before I got pregnant) - she wasn't keen but didn't rule it out. If i went on the same ADs as last time it would rule out bfing but frankly I'd opt for sanity!

JessB - also very helpful - will PM you in due course! Very interesting it was the Brierly who got you through really. And I did partly book with them because they have a specialism in mental health issues. Seeing mw next week so will raise it then.

[new mother]

Well, I am a great advocate of elective sections, having had two myself which could not have been better birth experiecnes and meant that my first minutes onwards with both of our children were wonderful.

So, maybe I'm not the best person to listen to but here are some ideas:

1. Have you considered a hospital birth rather than homebirth? Is that not a natural thing to go for given that your history is one of complicated delivery?

2. If you stick with home birth, what is your back up plan if the same thing happens again? how quickly can you get to Kings?what happens there? etc. Can you think through all this now?

3. Be sure you get any stats on elective calm organised sections as opposed to the emergency disaster ones they tend to trot out to discourage people. They are very different categoreis with very differnet outcomes.

4. what does your husband think as if you are in pain/under drugs he will be the one making the decisions presumably??

5. Costs of a private section - not cheap. Guys seems to be the least but there are various packages and you need to control costs a bit. Avoid Portland, not just for cost.

Hope it goes smoothly whatever you decide and that you are able to find some calm in these last few weeks. It is totally udnerstandable that you are worried about it adn my heart goes out to you. I'm so sorry. I think it's a disgrace that you are in this situation when so vulnerable but that is a political issue for another time.

[new mother]

Belle, pre-emptive ads - what a good idea. Stuff the bfing. better to have a year of bonding with your new baby.

Another thought - it would not be an elective surely? Wldn't it be "medically advised"?

[Fuschia]

I think yOu will come to a calm place before the birth. Be confident that you will settle on the right plan . X

[Smiler]

I found a book called "blooming birth" good on 2nd births, managing fear, taking decisions etc. Also talking over anxieties and options with a (private) counsellor.

Also, C-sections are not necessarily predictable/less risky.

[jollybaby]

Belle,

Sorry to hear you're having a tough time. I can imagine I'll be writing a similar post when I come round to having number 2 (although the difference will be that I will be that I had an emergency section for my first delivery).

I would recommend going back to your GP and asking to be referred to the perinatal psychiatry team at Kings. I had a history of depression and was very stressed before I went on maternity leave and so requested if I could be seen by the specialist. I found this very helpful. We elected against starting antidepressants antenatally but I did end up starting them about 2 weeks after when I felt wobbly. I have had excellent support from the team (almost weekly phone calls from my consultant before the birth to check that I was ok) which has been invaluable. Baby JB is now 6 months and I'm still beeing seen every 2 months or so and will probably continue to be seen until after I return to work in September. As, if and when number 2 comes along I will definitely go back to see the team to make a perinatal plan.

[jollybaby]

New mother there are lots of antidepressants that you can take whilst breastfeeding

[Saffron]

Belle Wrote:

-------------------------------------------------------

> That's interesting Saffron, I did raise this idea

> once with my GP (before I got pregnant) - she

> wasn't keen but didn't rule it out. If i went on

> the same ADs as last time it would rule out bfing

> but frankly I'd opt for sanity!

>

I was told by a GP that I'd have to give up bfing if I wanted to go on meds for PND. She offered me counseling -- with a 16 week waiting list!!!! Seriously, I would have hung myself in the closet by then. She didn't even offer to refer me to a psychiatrist but told me instead to the the HVs. Ridiculous. That's when I went private. (I also changed GPs).

SERTRALINE is SAFE for BFING, and it is very effective at treating PND.

If the prospect of difficult labour/birth is already causing you so much upset that you're considering a c-section, you have every reason to press for a referral to a specialist psychiatrist with experience of treating pregnant and postpartum women. Even if you never end up needing/wanting medication, only a specialist can give you the right advice. GPs/MWs/HVx simply are not trained for this.

You have plenty of time to consider your options. Hopefully you can get to see a specialist on the NHS. If not I can very highly recommend Dr Jeremy Pfeffer. He is sympathetic, practical, and very straight forward. He will be happy to work with your regular NHS physician to prescribe the right treatment for you: 02079353878 for the Harley Street office.

xx

[Belle]

Thanks so much everyone, and for the PMs too, so reassuring and some great advice.

I think I am def going to seek a quick referral to the perinatal psychiatric team, not least as I am on their radar already. If there is a wait t hen Saffron I will consider yr private guy, we have private healthcare insurance though you know how picky they are about actually stumping up!

I think once I've had some professional counselling I would still like to speak about my concerns with an obstetrician. I totally appreciate a c-section wouldn't circumvent PND necessarily and is with risks etc. I'm just trying to balance up what is going to be the least destablising option really. I had a v unpleasant and extended post natal stay at King's last time which was also a factor, so there are risks with any option as far as I can see (short of something I can't afford). However I feel bolstered by the support and practical ideas of the forum as ever!

[BellendenBear]

The Consultant who the Brierley team work with is called Mr Marsh. I am seeing him next week for something very different, but the MWs assure me that he is very supportive and respectful of your decisions and more willing than most to deviate from protocol. It might be worth asking the Brierley to make an appointment for you.

I also think it would be a good idea to get a referral to perinatal psych. I am a GP, and given your history I don't think there should be any difficulty in you being seen on NHS. Each GP, midwife or Health Visitor will have varying expertise in this area depending on their individual training and special interests. As you know the Brierley team are very experienced in perinatal mental health. Even if there is a delay in you being seen by the Psychiatrist, your GP can easily get advice from them by phone/Email if needed.

And as has already been mentioned, there are antidepressants which are safe when breast feeding, so if you are keen to BF don't let this put you off. Good luck - I look forward to reading about your relaxed, quick and easy home birth in a few months time!

[Fuschia]

Mike marsh did my ecv, seemed quite nice!

[Fidgetsmum]

Have PM'd you.

[Belle]

Oh thankyou, i've already had a recommendation and am thrilled he is the Brierley consultant, though Leonie Penna sounds fab too.

[candj]

Hi belle just wanted to add my support for you. Sounds like you have loads of great advice. Also wanted to say that I've had three elective sections and panicked for both the second and third (to the point of imagining i would die during both - nice eh?) and agree with smiler that they are not necessarily less predictable. Very best of luck for everything and congrats on pregnancy!

[Em]

Hi Belle

I just wanted to second Fuschia's recommendation for Christine Neillands, I had a really awful time after my first baby was born and ended up staying in King's for a week. I was so scared second time round and Christine really helped to calm me down and the experience was completely different.

I didn't meet Mike but Leonie Penna was my consultant and she is amazing and really lovely, I was considering elective CS but in the end decided on a natural birth but they would have been supportive whichever decision I made.

Good luck with everything.

[Otta]

Nothing to add, just wanted to say thu my wife is in a very similar boat, and best of luck with whatever yo decide.

[Fuschia]

Christine truly is lovely. I almost wish I had a problem so I could see her and be nurtured! She doesn't do straight hypnosis where time disappears and you eKe up having been in a dream. More sympathetic listening and lifting of the burden /soothing the soul with a session of hypnosis tailored for you on mp3 to tSke away and use afterwards

When I was admitted for induction with latest baby playing her mp3 talked me down over and over when I was stressed beyond belief at being in hospital