Worried - want a cbav!

(13 Posts)
Madsy1990 Mon 14-Jul-14 22:50:03

Hi everyone, this is my first post here smile I'm 27 weeks pregnant with baby #2 and basically, I've been referred to a consultant next month to discuss a possible c section at my own request as my previous birth was absolutely dreadful, a harrowing, terrifying and agonising experience where my son was more dead than alive upon delivery and I'm petrified of going through similar again, I'd run through the whole story but it'd take me a couple of hours to type out, every time I think about it my heart races and I feel nauseous. It's happening right now actually I can feel it thumping at my chest worryingly rapidly. The problem is that the midwife has told me I basically have no chance of being granted an elcs sad and the only reason I'm going to see the consultant is so that he can probably refer me to a mental health midwife, which personally I find insulting as it suggests that I'm over reacting about the horrendous experience I had before. Do I have any kind of rights? I know the NHS have to fund it so does that give them the last word on the matter? Really panicking I can't get it out of my head since I had the 12 week scan..

notoasthere Tue 15-Jul-14 06:49:41

If you want an elcs, then that's your choice, and they have to abide by it. They might advise against it, but ultimately it's not their decision

aussieandrea Tue 15-Jul-14 07:31:59

Hi I would look up the NICE guidelines on elective c sections and before your consultant meeting write down everything you want to say about your past experiences and why you would prefer a c section this time. If they are able to refer you to a mental health midwife that would be useful either way I personally think so that you can talk through your concerns and find ways to manage your anxiety(which sounds like is very understandable). I'm about to have my 3rd c section next week and had no issues requesting any of them but it does depend on the hospitalsad hope it works out for you x

Hedgehogging Tue 15-Jul-14 08:24:17

There's a huge thread on this somewhere where the OP wanted (and got) an elective section by reason of maternal request- no mental health issues/trauma etc.

I get the impression you really have to dig your heels in and be absolutely unwavering in your wish- no, demand!- for CS.

I'll try and find the thread- it was on the pregnancy board back in Jan/Feb I think. Lots of strong opinions but great info too.

Hedgehogging Tue 15-Jul-14 08:53:17
Madsy1990 Tue 15-Jul-14 10:58:16

Thanks everyone, I'll have a look at that thread and also look up the nice guidelines, get prepared to fight my battle!!

squizita Tue 15-Jul-14 11:51:02

I have anxiety and have always been told MH is a health reason (in my case for wanting a particular birth place with particular consultant team even though out of area for me - but they mentioned Csections etc' when they told me). You can have your birth and ante-natal (physical) care adjusted for MH reasons: it's entirely valid and written into policy. Preserving your mental wellbeing makes sense, as well as being humane.
So the MW was wrong because MH is health, and you are entirely in your rights to cite it as a reason for choices regarding ante-natal and birth.

FavaBeanPyramidScheme Tue 15-Jul-14 12:46:50

I had a maternal request c-section on the NHS. As PPs have mentioned, you are entitled to one under the NICE guidelines if a vaginal birth isn't an acceptable option for you. Expect a fight and dig your heels in and you'll get there in the end. grin

HaPPy8 Tue 15-Jul-14 14:38:35

It is commonly said on here that consultants have to agree to a section if you want it but that is just not true. NICE guidlelines are just that - guidelines. They are not the law and drs do not have to follow them. Most do and there are good reasons for them to follow them, but it wont necessarily help anyones case to go in believing it is their right.

You sound like you have good reasons to request a CS though OP, good luck.

squizita Tue 15-Jul-14 14:50:11

I think in this case the OP has been misinformed that a MH need isn't a 'need'. It is: mental health is part of health and thus she isn't choosing based on nothing but putting a case forward based on a clinical need. Sadly many 'physical' HCP (like her midwife) don't seem to understand that mental health is health.

FavaBeanPyramidScheme Wed 16-Jul-14 22:38:54

Happy8

While there are endless posts in this forum about women's wishes regarding c sections being dismissed by consultants, I am yet to read of a single case where a consultant did not follow the NICE guidelines once they were raised by the woman.

It seems that women are being prejudiced by their lack of knowledge of the guidelines, not their knowledge of them. Unfortunately, consultants appear to be happy to disregard the guidelines when they are dealing with a patient who has no knowledge of them.

So while the guidelines may just be "guidelines", they clearly carry substantial weight. In practical terms, women are at a huge advantage in the process knowing that the NICE guidelines support them in choosing a section when a vaginal birth is not an acceptable option.

I highly doubt any woman has been prejudiced by thinking that the guidelines give her more rights than they do.

DeadCert Fri 18-Jul-14 13:51:37

I very much doubt, given the circumstances your consultant will refuse. They may try and dissuade you and talk to you about the risks but you obviously suffered a very traumatic experience and repeating that could damage your health even further.

In my experience, the midwives have been more hesitant to agree I "could" have an ELCS but the consultant was totally supportive. I looked into other hospitals in my area where I could self refer and I had heard as they were smaller than the large city based hospital I had my son in, they were in a better position to provide 1-1 support for women. Can you look at other hospitals? When are you due to see the consultant?

Good luck, it's a very anxious time and you will feel better I'm sure once you have seen the consultant.

RedToothBrush Fri 18-Jul-14 15:34:03

You are asking for an ELCS, on the grounds that:
as my previous birth was absolutely dreadful, a harrowing, terrifying and agonising experience where my son was more dead than alive upon delivery and I'm petrified of going through similar again, I'd run through the whole story but it'd take me a couple of hours to type out, every time I think about it my heart races and I feel nauseous. It's happening right now actually I can feel it thumping at my chest worryingly rapidly.

This is trauma, and is therefore a mental health issue. There is no shame in this.

The problem is that the midwife has told me I basically have no chance of being granted an elcs and the only reason I'm going to see the consultant is so that he can probably refer me to a mental health midwife, which personally I find insulting as it suggests that I'm over reacting about the horrendous experience I had before.

Lots of midwives hold this view. Its wrong and not reflected in NICE guidelines. It is completely appropriate and in line with NICE guidelines to do this. At this point you should be offered counselling. Note the word offered. You are under no obligation to take it if you do not want to. And if after this you are still not comfortable with a VB you should be granted an ELCS.

HOWEVER, and this is a big however, you DO NOT have a right to an ELCS. You have a right to the most appropriate care, based on your medical need though. Medical need INCLUDES on mental health grounds.

The NICE guidelines currently, are strongly worded, to favour women who request an ELCS on similar grounds to you. Hospitals are not obliged to follow them, but they do provide a very strong back up to any argument you have. UNFORTUNATELY, there are a number of hospitals who currently have a 'blanket ban' on maternal request ELCS, and they are wrongly classing requests on these grounds as being maternal request rather than based on your mental health needs.

There is a general attitude about trying to put women off following through with such requests for this reason. Rather than try and offer support, there is, in some places, HCP who try and deliberately undermine and belittle women's feelings and suggest they have 'no chance' in getting an ELCS.

In some places, this may well be true, due to the above mention blanket bans, whilst in others its just not.

The good news, is that, if you are serious about this, and feel this is the way ahead for you, then if you pursue it and are prepared to fight and understand this may drag on until late in your pregnancy then the chances are you will eventually get an ELCS. Equally you may be surprised and have no trouble at all. Its a real lottery at the moment, I'm afraid. I've been on MN looking at threads like this for several years. In that time, I have seen only 2 occasions where there hasn't been a positive outcome and I've seen a LOT of similar posts. (In one of those, the lady in question switched hospital and DID end up with an ELCS in the end. In the other, the lady was granted and ELCS, went into early labour and then had a very difficult consultant who delayed things until it was too late. But these are exceptional.)

However, I would encourage you to engage with the mental health team. The team at the hospital I am at are extremely good; the consultant midwife I have seen has a policy never refuse a request. They have an approach of trying to build relationships with women and finding out exactly why they want an ELCS and trying to address each issue and see if there are alternative ways to provide reassurance. In cases such as your they have a track record of getting women to build up trust and feel confident enough to go through with a VB after all without pressuring them. Many others don't change their minds, but feel more reassured because of the non-judgemental non-pressured approach they have. My point is to see what they have to offer as an alternative at the same time as pushing for an ELCS. You can change your mind at any time, an ELCS is ultimately NOT right for everyone. There is no right or wrong in this, just a right or wrong FOR YOU.

I am personally having an ELCS on the grounds of mental health. My circumstances are different - perhaps less in my favour than you have - but I have had success. It is NOT a maternal request in the definition that you will see in the newspapers. It has been made clear that my request, is a sensible one based on my personal circumstances and that they view it as medical need. My experience has so far been very positive and easy. So its not always a battle.

Good luck.

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