Advice needed - will I be allowed a c-s?

Hi everyone,

I'm really glad to find this forum! Apologies in advance for how long this post is...

My second child was born 5 years ago, and my first was born 18 months before that. Both my children were born in NZ, and were delivered by a midwife. I had completely normal pregnancies, and my labours were without intervention of any kind. My kids were born in a birthing centre, with midwives (and my husband) only present. The deliveries were not particularly terrible - I was pushing my son out for about two hours, and my daughter was born very quickly (with cord around her neck though) after half a dozen pushes. Both kids weighed 7lbs 12oz (3.5kg) and had head measurements of 33 and 35cm. I never saw a doctor at any point, and had the same very relaxed midwife throughout both pregnancies. When my second child was an infant, we moved overseas and have been here in Singapore since.

I have a private gynecologist here, who is wonderful. When my daughter was in kindergarten, I finally found the courage to tell her that having sex was still excruciating and had been since I had delivered my first child... I had not told anyone this, and no one else had ever talked to me about it (as a young mum, none of my girlfriends had given birth yet...) I half expected to be told to breathe through it, or try different positions or something.

She says I tore internally when my children were born, and there has been damage done to my vaginal tissue/muscles (?) and pelvic floor. (I do not recall anyone checking this after my deliveries and I was certainly never stitched). My vaginal walls were very weak and completely collapsed when I coughed, and my bladder and rectum were beginning to prolapse. With a lot of monitoring and with pelvic exercises etc, things are much better (it no longer feels like my insides are falling out) but she says it would not be a good idea for me to go through a vaginal delivery again as the muscles/tissue have probably healed badly and will get much weaker. I am certainly not back to the way I was pre-children (I have just turned 30, so it isn't my age either). I still have a lot of issues with constipation and bladder control. If I were staying here, this would not be an issue, as birthing here is highly medicated and doctor-controlled.

We are moving home to New Zealand, and I am going to try for baby number three in a couple of years. Given my previous experience with midwives, I know how 'pro-natural birth' they often are - which obviously is a good thing and I'm not disputing that. However, I am terrified of being made to go through a natural birth again because of what happened before, but I'm not sure if I will 'qualify' for a c-section either. I highly doubt we will have the funds to pay for a private obstetrician for the entire pregnancy, but I am willing to look into private insurance in advance if that would help...

Can anyone shed any light on how this is likely to pan out in NZ? Am I likely to be told to give birth and see how things go - and will an obstetrician even do an elective c-section for this? Can I just have an obstetrician for the delivery, and have a midwife as my LMC for the rest of the time? From what I can tell, I could be charged for the delivery - approximately $1800 in a public hospital? Does anyone know of any other mums who have done this?

I'd really appreciate any help or advice!

-expatkiwi

Private ones vary on price. Auckland seems to be so much more expensive than Christchurch or Dunedin. I paid $1200 in Chch in 2007 and $2000 in Dunedin 2009 (emergency c-section). I chose to have a private specialist both times and so glad I did.

With regards to medical insurance...it may be cheaper to save the money up front. you generally need to be on the top plans for about 3 years.

I'd also recommend getting a letter from your obstetrician in Singapore. Then discuss with your MW that you dont want to go through a ntaural birth and they should refer you to see an OB at some point.

I know I had an almost prolapsed uterus after my first son..he was a quick ventouse delivery. I asked my OB if it was likely to get worse next time. She said yes and that she wouldnt be interested in doing any "repair" work until after I had finished havign kids. That scared me a little...but I wasnt too bad and we knew it was just a case of being vigilant with pelvic floor exercises before and after....as it was i didnt get a chance.

As for MW getting paid....apparently they just need to get you into labour to be paid.....but there must be something in it for them if you end up having to have an elective c-seciton for medical reasons.

There are a couple of MW students on here...they may be able to fill in the gaps.

My thoughts would be to save up and go private!! That way you get what you want, when you want it and you have an "expert" in that field (no offence to MWs...I'm just going off my experiences)

You could pay for an obs and then if they deem it necessary you would get the c/s for free on the public system or if they say it's not necessary you can pay for one anyway (I think they are about $10,000). You can however just have a mw and then get referred to an OB, I am sure if you get your notes from Singapore there would be no issue with this. Lots of women get mw knowing they are having a c/s and the mw's still take them on (they don't get paid for the labour but they do get paid for the pre and post natal care) so finding one shouldn't be an issue.

The other thing you could do is talk to your gp when you get here and maybe see if you can be referred to an ob/gyn before getting pregnant, if things are quite broken down there then it might be a good idea to be checked out before getting pg anyway.

Ok whoever says midwives don't get paid for C/S are not correct, they get paid for antenatal and postnatal care and get a one off payment for the C/S providing they were there, its not as much as a birth but its nowhere near as much work as a birth either. So just because you want an elective doesn't mean you should miss out on all other great aspects of midwifery care.

At the end of the day it is the OBs decision to whether or not you get the elective but to me it sounds like you should get one. If I was you I would ring around local midwives before you get pregnant and see what they say. Find one who is on the same page as you and go from there.