Help - How to get elective c-section / caesarean - which NHS Trusts allow this?

[indiehubbie]

Hi all, First post - I don't know the abbreviations yet...

My wife is 36 wks pregnant. The baby was suspected breech, and so we started to look into c-sections. We read the NICE Guidance (www.nice.org.uk/guidance/cg132) and she concluded that she wanted a c-section even if the baby wasn't breech.

It turns out the baby is head down.

So, we are now trying to get a c-section where there is no clinical reason. The NICE guidance says that this should be possible. "For women requesting a CS, if after discussion and offer of support ... a vaginal birth is still not an acceptable option, offer a planned CS. An obstetrician unwilling to perform a CS should refer the woman to an obstetrician who will carry out the CS."

The Oxford University Hospitals NHS Trust don't follow the guidance (apparently it's not legally binding?). The Oxford policy is to send you for re-education until you change your mind. Or... there is a slim possibility that they will refer you to an obstetrician in another NHS trust. We think this is our best hope at this stage, but we are having to do all the leg-work to make it happen. 36 weeks doesn't leave us much time to sort this out, especially with Christmas.

So, does anybody know if their NHS Trust DOES follow the NICE guidance and offer c-section based on maternal request (no clinical need)?

Does anybody have experience of how to make this happen (ideally in Oxford University Hospitals NHS Trust)?

Thanks all in advance - really appreciate any help/experience you can offer!

[goshhhhhh]

You probably need to go back to your gp & get a referral.
Out of nosiness - why does she want a c section. It has a longer recovery time & is major surgery.

[indiehubbie]

Thanks for the quick reply! I don't think GP can refer to another trust?

If possible, I would prefer the thread not to move on to reasons, pros and cons etc.

But all practical suggestions for how to achieve this would be wonderful!

[Reindeerballs]

Have you actually spoken to the obstetrician about this? I am not in your area (London) and I did not have a clinical reason as such (just traumatised by previous delivery). My consultant agreed straight away. Perhaps your wife's reasons are good enough?

I had mentioned it to my GP and she was prepared to refer to a different hospital (different trust).

In London it seems possible to be referred to a different area - GP went through a whole database with me recently looking for waiting list times for a routine op. Some of the hospitals were definitely way outside my local trust area.

[magpieginglebells]

I think you have to be firm with your reasons with the medical team. The reason why they are reluctant is because of the increased risks associated with surgery.

For what it's worth I had an elcs 4 months ago due to breach. It was traumatic, had breakthrough pain, lost 2 litres of blood and was hugely jealous of

[magpieginglebells]

..friends who had vaginal births who were up and about quicker than me. Of course that is my personal experience.

[indiehubbie]

Thanks, Reindeerballs and magpieginglebells, for your experiences. magpieginglebells, I'm really sorry it was traumatic.

We are struggling to get to see an obstetrician! We have been referred to a "Mode of Birth Clinic" with consultant midwife (=re-education - all arrows on the flowchart lead to vaginal birth). Also, that clinic is much too late for any referral to be made in time.

Maybe GP is the best route after all.

[AuntieStella]

The issue is more likely to be with the individual doctors, not at Trust level.

Even when a Trust agrees that such procedures can be carried out, there is no way of compelling a doctor to provide a procedure if s/he does not think it is in the best interests of the patient. And I don't think you can remove individual conscience/ethics.

Being referred to another consultant will be the quickest solution, but I'm afraid I have no idea how to find one who has the ethics stance you seek.

[indiehubbie]

Thanks, AuntieStella - actually, in Oxford's case it is the other way around. The Trust has taken the stance against it, even though I suspect some obstetricians would be willing.

Based on what's been said here, I'm thinking we need to bypass the mode of birth clinic and get to an obstetrician ASAP, either in or out of the Trust.

[TK1930]

Not sure really..... So not much help sorry.
I paid for private to ensure I got c-section.
Though a friend(of a friend) told me a few months ago that she's sure I'd have got a c section on the nhs (I had no clinical reason)
Please don't listen to "oh it's so much harder to recover from blah blah blah..." Everyone is different and often people who make these comments aren't the ones who have actually had a section.
I hope your wife gets the birth she wants :-)

[Moreisnnogedag]

Hmm I am not sure how quickly you can get this sorted tbh. I think the gp is the best port of call; they may know of someone who is easier on doing purely elcs but I think most obs consultants would think its a bit late in the day.

[bishboschone]

The reason you are hitting a dead end is because she is healthy and the baby is fine so there is no reason to have a c section . It's costs the nhs a lot of money so they don't offer them unless necessary . I was terrified of giving birth and for me it was horrendous ( induced / pre eclampsia / episotomy / ventouse / ) but I got through it .. Women do .. I had a c section next time ( bad pre eclampsia ) and it was calmer but the recovery was horrendous .. Really bad .. There are pros and cons of both but don't take the c section lightly . It's major major surgery .

[indiehubbie]

Thanks, all, really helpful to get your views on this. I'm sorry to hear about your awful recovery, bishboschone. I agree that it's a big decision, not to be taken lightly.

GP referral seems to be the most popular suggestion here.

I'd be really interested to hear from anyone who has had specific experience of Oxford University Hospitals NHS Trust, or who was referred to a different trust.

[WhyOWhyWouldYou]

I've got a maternal request elcs booked. My reasons were medical but it was lots of things that in themselves dont qualify for elcs on health grounds, I felt all the problems combined I was better with a c section than vaginal this time.

Reason(s) she wants it are relevant to the thread really though, it makes a difference to how its viewed by health professionals and course of action that should be taken. She needs to see an consultant immediately but she needs to be able to demonstrate she understands the risks and give reasons for her request. Also if its a request based on anxiety/mental health, then the hospital should refer to someone specialising in perinatal mental health to discuss further and see if there are other solutions to help with the anxiety/mental health problem - it sounds like that's the path they are following with the birth choices thing they are sending her to.

Also NICE guidelines are not law but lay down best practice. The vast majority of hospitals follow them, if they don't they must be able to clearly demonstrate how they will meet your needs fully - again its relevent to the thread why she want one.

[Molotov]

I got a mat request ELCS granted in 2012. I'd had a protracted labour in 2009 which, to cut a long story short, damaged my tailbone (I still get pain almost 6y later).

That was medical reason enough for me, but not my consultant. It was a hard-fought battle and he reluctantly agreed in the end.

The ELCS was a wonderful birth experience and recovery was better than my VB - but I didn't have a straightforward birth and as well as the tailbone damage, I had an episiotomy. I found the cut on my tummy more tolerable to the cut on my perineum.

Anyway, I'm digressing. If you and your DW want your baby delivered by ELCS, then you nees to be insistent and if the trust where you are refuse - move trusts to one that will offer one.

One thing that really should be given very serious consideration is how many children you would like to have. Up to and including 4 CSs are considered 'safe'; the risks of increase each time. If you would like to have more than 2 dcs, I personally would not choose CS for a first birth.

[UsernameAlreadyInUse]

Are you willing to look outside Oxford? if it's planned, then no need to worry about getting to hospital in time.

UCLH have a 'no maternal request caesarean' policy plastered all over their website but I got one at 18 weeks in 2 minutes flat. I suppose I could have gone vaginally but a c-section on balance was the better option. A friend had a c-section at Addenbrookes a couple of months ago based on fear of childbirth (which is a clinical need). She did have to jump through some hoops though.

Going private is your other option. At this stage you'd be paying for ob's fees for delivery only (£3-4000) and hospital fees (could be another £10 000 on top). You'd need to start ringing around quickly though as your time is running out.

I had a completely trouble-free recovery. I think electives are really quite different from emergency c-sections.

[TurquoiseDress]

OP- go to see your GP who can then refer to local hospital or hospital slightly further afield.

Try to get sympatic GP or one you've had good experiences with before.

I wouldn't bother with the consultant midwife route- too long winded and they will push for a VB anyway.

You need to get in front of a sympathetic consultant ASAP!

[onthematleavecountdown]

If you want an elective c section where there is no medical need you literally need to mention it at your booking appointment as it's a long slog to get it agreed! Bringing it up at 36 is far too late and shows it is a panic or last minute decision.

I'm having an elective c section as this is an ivf baby, I brought up this request at 9 weeks and it took till 28 to be officially booked in the system with a date booked.

I think she has a case of cold feet. The baby is happy and healthy and it the correct position. A cs carried its own risks, risk to future pregnancies, blood clots, infection etc. you need to read up on these and show your gp or whoever you are thoroughly researched in the area.

[whereismagic]

I got referred to another hospital by my community midwife for other reasons at 38 weeks. I think Medical director of Obstetrics at John Radcliffe toes the line of management decisions so I wouldn't waste my time if I were you. Look further afield, 50-60 minutes drive as with ELCS you can afford it.

[TheJiminyConjecture]

Your DW could ask her midwife. I'm hoping for a ELCS with this baby (medical issues after first birth) and spoke to my midwife at booking in. She was able to advise which consultant was more pro home birth/low intervention and which was more sympathetic to maternal requests. Obviously I asked to be referred to the latter!

[Purplehonesty]

I've had two c sections and the recoveries have been fine.
Your dw needs to go back to midwife for referral to consultant and prepare to argue it out with them!
Even when I went into early labour before my elcs date the labour ward staff were trying to persuade me to 'have a go'. I had to be very firm!!

[Molotov]

My ELCS was 'pencilled in' (as in, I was given a date), at 36 weeks for 39+3, if my memory serves me right. They'd kept trying to convince me to change my mind up until that late juncture.

The thing is, an ELCS is a perfectly valid mode of delivery and birth choice for the woman. An ELCS is a safe mode of delivery for both mother and baby, second only to an uncomplicated, unassisted vaginal delivery (followed then by an assisted vaginal delivery, then EMCS). There are things to consider with ELCS; it has it's own merits and demerits. It just depends on the risks you want to take.

Action needs to be taken now, though, if she wants to have an ELCS. Firm, decisive action.

[TurquoiseDress]

36 weeks is not too late but you need to get moving quickly!

I was almost 37 weeks when I got in to see consultant x2 and the obligatory psychiatry appt to check you weren't mad.

In fact the first consultant I saw booked me in provisionally for ELCS date.

Show you have done your research, know the risks, benefits etc.
Be rational & calm in your approach, set out your reasons why you would like to request a CS.

Be warned a lot of people will try to persuade you otherwise.

Yes the recovery duration with VB is generally shorter on average, but it's not a guarantee.

[TurquoiseDress]

Previous poster who mentioned IVF- were they more sympathetic because it was IVF or is IVF pregnancy indicated as a reason to go for ELCS?

[lljkk]

Same question as Turquoise, why does IVF make a difference?

[VivaLeBeaver]

If the trust have taken a stand against it I suspect you need to move trust.

A friend of mine is a consultant in a different trust which has also taken a stand against it. Under no circumstances can she book a section unless there's a medical reason. The CCG (old pct) won't pay for it unless there's a medical need. Which means the trust loses out on £1000s. So it is strictly enforced and would be disciplinary action if broken. Accountants run the nhs these days.

My advice would be to ring hospitals in other trusts near you. Ring the labour ward and ask to be put through to the on call supervisor of midwives and ask what their trusts stance is. You could try a supervisor at Oxford and ask if they will advocate for you. Problems is it may well still be a no due to money and will take time,,,,which you may not have. Monday morning you need to get ringing.