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Childbirth

Can you be refused a repeat c-section?

53 replies

notalreadyinuse · 22/04/2011 20:43

I've seen other threads about this, but I'm not sure what the definitive answer is. Can you be refused a repeat section and forced to VBAC against your wishes?

Please don't anyone try to extol the virtues of VBAC in responses - I know some people are very pro, but I'm not.

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Mumcah · 22/04/2011 20:46

I think it depends on the hospital but I'm pretty sure you would be able to get an ELCS.
My hospital is very pro Vbac but they still said I could choose what I wanted and would support me either way.

mouseanon · 22/04/2011 20:47

I didn't try and fight my case but they pretty much refused for me.

notalreadyinuse · 22/04/2011 20:58

I was really shocked that the consultant seemed to be refusing one for me. She didn't talk me through any of the risks of VBAC and she hadn't read my notes. All the other medical professionals that I've seen so far have told me to expect a section and that it would be advisable...

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Himalaya · 22/04/2011 20:59

They should talk over the risks of both options with you and let you choose. At least that was my experience. One thing they asked me was how many children I wanted, as each repeat csection gets riskier, so it can stop you having a big family (or put you at high risk if you do). But if you are planning on stopping anyway after this one than the ELCS becomes a more attractive option from a medical POV.

notalreadyinuse · 22/04/2011 21:00

mouseanon - hope it all went ok for you in the end.

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notalreadyinuse · 22/04/2011 21:03

Thanks Himalaya - do you know if there is anywhere that's its written that they should follow this procedure - is this based on NICE putting maternal preference as the top criterion?

This is going to be my last baby. I also have other pregnancy complications (100 centile abdominal circ, low lying anterior placenta, SPD, baby currently tranverse)

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SardineQueen · 22/04/2011 21:05

I was offered a straight choice for DD2. They talked through the pros and cons etc and I decided.

I take it you want a section? Talk to your midwife, see what they say. You have plenty of time left? Make your feelings known, that other HCPs have recommended a section and it's what you want etc etc etc and keep at it. I'm sure you will get one.

Himalaya · 22/04/2011 21:06

Maybe go back for another appointment or change hospital or consultant? Are you expecting another CS because you will have the same risk factors which caused the first, or is it because you've weighed up the relative risks of trial of labour/VBAC and CS and decided that CS is the better option for you?

I had a VBAC. The consultant was supportive either way, but my GP said 'you will have another CS', so I changed GPs.

Himalaya · 22/04/2011 21:14

Sorry x post....

Don't know about NICE guidelines, hopefully someone else will, or Google..

I do know Drs never like to make a plan till the last opportunity (when they have as much info as they can have) so yes keep at it, if you don't like the consultant in general try to change. Or fix up the next appointment with a a different Dr on their team and get them to make the recommendation.

notalreadyinuse · 22/04/2011 21:19

I think the NICE guidelines put maternal choice top of the list of deciding factors, but I'm not sure if there is an NHS protocol that reinforces this.

Thanks for support - I'm going to ask the hospital midwives to transfer me to a different consultant.

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Ushy · 22/04/2011 22:47

VBAC carries about 11 times the risk of uterine rupture and higher risk of the baby dying or being brain damaged. The risks are not great in numbers terms but they are still there. (Info on the RCOG site -green top guide - birth after caesrean seciton) www.rcog.org.uk/womens-health/clinical-guidance/birth-after-previous-caesarean-birth-green-top-45

This is how it opens:

"The proportion of women who decline VBAC is, in turn, a significant determinant of overall rates of caesarean birth. New evidence is emerging to indicate that VBAC may not be as safe as originally thought. These factors, together with medico-legal fears, have led to a recent decline in clinicians offering and women accepting planned VBAC in the UK and North America"

Why should you be forced to take that risk!!

If you are being denied a repeat c/s for a last baby I would change consultants AND do a formal complaint.

Good luck:-)

notalreadyinuse · 23/04/2011 11:02

Thank you - it is so lovely to have some support. I think my husband thinks I am being difficult and should just shut up and put up, so I have been feeling quite alone on this one.

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mouseanon · 23/04/2011 12:47

notalreadyinuse yes it did fortunately. Just over 2 hours labour and no pain relief (lack of time) almost perfect birth. The only intervention was an episiotomy which the MW insisted on as she was worried about rupture. Baby shot out after that!

Now pg with no.3 and worried about either ending in emergency cs like no.1 or an even faster birth than no.2 so part of me would like to opt for an elcs this time round but the assumption is that it will be another VBAC. I have to wait until 36 weeks to see the consultant and check that they are happy to go ahead with that.

notalreadyinuse · 23/04/2011 17:22

That's great news - and congratulations on no. 3!

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KaraStarbuckThrace · 23/04/2011 17:51

I would have thought it would be the other way around that they would guide you into having another cs rather than a VBAC?

I would definitely talk again to your MW/Consultant but insist on changing - they cannot force you to have a VBAC!

tigercametotea · 23/04/2011 18:12

I thought the opposite was true - that if you'd had a CS, then its very likely the doctors will want to perform a CS for any subsequent children you have, and that many doctors would prefer not to have VBACs for fear of complications.

BikeRunSki · 23/04/2011 18:19

EMCS with DS, now 13 wks pg with DC2.

My hospital only give you a CS just because you've had one before; they will do it if the 2nd (or subesquent) pg justifies it alone, but have one of the highest VBAC rates in the country.

Now v worried with all this talk about ruptures etc. Hmmm.

BikeRunSki · 23/04/2011 18:20

Sorry, 2nd sentence should be "My hospital won't give you a CS...

VivaLeBeaver · 23/04/2011 18:27

Some hospitals will refuse it. I think if you get the stats of scar rupture, do your research you are more likely to be taken seriously if hosp is difficult.

notalreadyinuse · 23/04/2011 18:36

BikeRunSki - that's interesting. How did you find that out? It's not Royal Surrey is it?

VivaLeBeaver - when I mentioned some of the stats the consultant said she hated it when people who didn't really know anything think they know better than her.... Sounds like other people have had better experiences with their consultants though, so I'm trying to feel optimistic that a different consultant will be better.

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BikeRunSki · 23/04/2011 18:39

No, it's Barnsley General! Community MW told me. Was thinking, had EMCS last time, am over 40, am BOUND to be offered ELCS. Nope. Not considered high risk at all as had succesful pg 3 years ago.

BigBadMummy · 23/04/2011 18:40

I had three C-sections, all elective as I was diabetic and my babies were huge.

I was strongly advised to think long and hard about getting pregnant again as I had been very ill with number three. I was also advised that due to the amount of scar tissue I would now have internally it would be inadvisable for me to have another C-Section.

They also said that if were to get pregnant again I should wait at least two years to allow the scar tissue to heal as there was a danger of rupturing.

Suffice to say I decided to be sterilised after C-section number 3.

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notalreadyinuse · 23/04/2011 18:41

Jesus - why do they do this! It's crazy forcing us to put ourselves and our babies at risk...

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tigercametotea · 23/04/2011 23:20

My mother had 3 elective CSs - I was the first. When she had my sister - her third DC - she suffered from uterine rupture and very nearly lost her life and lost loads of blood. Maybe it was from watching how she suffered that time as a result of my sister's birth, but ever since then, I've always been quite wary of CSs in general. And if I had a CS the first time, I'd actually rather try to VBAC... though I believe uterine rupture could happen even in VBACs so honestly if I got pregnant again after a previous CS I'd just be quite worried I think, whether I was gonna go for CS or VBAC! But CSs in general, just are more dangerous for a healthy expecting woman. They are, on the whole, generally quite safe today - many of my friends opted for elective CS (not in this country though) but there's always a little chance things can go wrong. Its a risk you just have to take regardless of what you choose. Childbirth itself is risky business ! (though not as risky as it was in the past, but still... )

notalreadyinuse · 24/04/2011 07:00

tigercametotea - I did specifically ask in my OP that people didn't try to present the case for a VBAC. But, since you mention it, the risk of uterine rupture is more than 10 times higher in a VBAC than in an elective repeat section, which is why normally women are offered the choice of a section if they have had a previous section.

And yes, I am "quite worried" as you put it, because neither option is without risk, but elcs is the less risky option.

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