Consultant appointment for ELCS - Help preparing my case please

[ExeterMummaMia]

I've requested an ELCS for this baby and I have a consultant appointment later this month to discuss my case. As I understand it, the process at my hospital is to meet and discuss with consultant, and then the consultant will take the case to a panel for decision (panel includes consultant plus a head midwife etc.).

My community midwife supports my request and thinks it won't be denied, but me being the classic worrier I am I'm keen to get my supporting evidence/stats together ready to present a solid case to the consultant. For background, #1 was a natural birth with some perineal tearing but manageable. However, I had a small (but excruciating!) anal tear which no one picked up on until a month PP when I was still in huge pain. It took months, and lots of GP and colorectal specialist appointments to get on top of the issue, but it isn't fully 'fixed' now. That issue is now a chronic condition, which I manage well with stool softeners daily (years later and still on them!) - as such, I'm requesting a section to avoid the pushing stage as any straining causes flares. Plus, if I am unfortunate enough to tear badly during a vaginal delivery e.g. 3rd degree the extra trauma to the region places me at more risk of anal incontinence.

However, that isn't strictly listed as a 'medical need' c-sec at my hospital so I'm going to have to present a well rounded case. I just don't know what to expect from the appointment - will it be quite adversarial (e.g. will they come in with 'no' as the default answer to my request)?

Has anyone had a consultant appointment to request a section, and if so what evidence/case did you bring to the consultant? Are there any other potential benefits of a c-sec that I'm missing which could also help make my case more substantial?

[Twizbe]

From what I understand, the purpose of the consultant appointment isn't for you to prove why you need one. Rather it's for them to be sure you're aware of all the risks that come with the major surgery.

There are a lot of myths around C Sections being 'easier' and they want to make sure that women make an informed choice.

With your complications after a natural delivery it would make sense to have a section. I don't think you'll have any issues.

[Lastnamefirst]

You shouldn’t have a problem with your history. Bring notes with you - have all your reasons written down. Read the nice guidelines, read the rcog stuff. Know the evidence. Try and stay calm and come across as nice but firm. If the above doesn’t work state clearly that your 100% preference is caesarean, you do not agree to a vaginal delivery and to force you into this would be completely against your wishes. State that you want this written in your notes and you will be requesting the notes to check what is written. Be clear with them that ultimately, should you have problems afterwards, even if there there is no evidence of labour mismanagement, you will take it up legally if a caesarean could have avoided it.

[MyCatShopsAtAldi]

I would also tell the consultant that the possibility of the birth exacerbating your current issues is causing significant anxiety (and if it is causing you excessive worry, eg trouble sleeping or similar, do mention this).

At my hospital, the default answer seemed to be that I could have one - I had previously had an EMCS - but they did take care to emphasise all the risks of surgery (rightly) and all the benefits of a straightforward vaginal delivery. They ignored the risks of a vaginal delivery, especially if not straightforward, and the benefits of an ELCS, and were vague on the likelihood of me having a straightforward VBAC (the odds were not high). In other words, they did not provide objective information, even though they were quite correct to make sure I understood the risks of surgery.

[BornOnThe4thJuly]

I got mine agreed in a matter of minutes, and that was for my first DC. I wrote out my reasons and listed all the possible complications for me and baby and said I was happy with those risks. The doctor said I can see you’ve made your mind up and went to get the senior Consultant to agree it, she just said it was obvious I wasn’t going to change my mind and for the diary out there and then to arrange the date.

[ExeterMummaMia]

Thanks everyone for your responses! :-)

I've looked up a lot of the risks of c-sections and feel quite informed. I see that a lot of risks mentioned refer to potential complications in future pregnancies - these don't apply to me anyway as this will be our last baby (i'd wanted to ask for tubes to be tied at same time, but they don't do it at my trust so DH is getting the snip!).

@MyCatShopsAtAldi - this seems to be a common theme in all the literature I've researched on c-section risks i.e. that 'uncomplicated' vaginal birth is less risky. However, my point here is that no one can assure me that a vaginal birth WILL be uncomplicated, and so in the event of a complicated one involving 3rd degree tearing or intervention I could very well end up in a worse way!

I think my mantra will be "I understand the risks involved, but a c-section is still my preference".

I'm usually a bit timid in medical situations but I'm willing to stand my ground here and start quoting NICE guidelines and asking to be referred to a consultant who will agree if things don't go well. Annoyingly, the consultant appointment this month is only the beginning of the process and they will then need to take it to a panel (I'm not invited to the panel discussion) to decide. It all feels rather convoluted in my opinion!

[Mincepiesallyearround]

I’ve had two electives at different hospitals and no problem either time. Consultants made me aware of the risks but signed me off no prob and booked me in then and there. No panel or anything.

[olympicsrock]

You will be fine. Sounds like you are well prepared.

[EvelynBeatrice]

I’m sure you’ll get the outcome you want but if you don’t you could opt for the nuclear option at end and say very nicely that you’ve taken legal advice and that you’ll be writing to him to confirm the assurance he’s given you that you won’t suffer any injury or exacerbation of the injuries you already have when you’re forced in to a natural birth .. and when he looks appalled /angry say gently that you do hope he’ll reconsider or pass you on to another consultant In accordance with NICE guidelines.

[Lastnamefirst]

I’d say the recommendations on the latest Shrewsbury report re maternal request c sections will most definitely go in your favour - do have a read

[ZadieZadie]

You have a right to request a c section- look up the NICE guidance.

I'm sure that in practice it's not always that easy, but(unless there are medical reasons) in theory they can't just say No.

[rookgizzardpie]

if they say no, ask for an appointment with another consultant. squeaky wheel gets the oil

[naturalyoghurtmuncher]

I think it's really awful that in this country a woman has to go to a panel to request a c section. You can choose as you like/ need in other countries.

Good luck op

[Antipodeancousin]

You need to emphasise that you are aware of all the risks of a c section delivery but you have weighed them up against the risk and likelihood of further exacerbation of your chronic condition/anal incontinence and come to the conclusion that you are more comfortable with the risks of a c section.
Be confident, articulate and demonstrate that you have done your research.

[FrostedCupcake]

I had an ELCS with my second for similar reasons. I really worked myself up for the consultation and prepared myself for a having to push my choice. I wasn't even questioned. They asked why I wanted one, I said because of my previous birth, they went over the risks and just said is it still what you want, I said yes and that was that! It won't be as bad as you're thinking in your head. Stick with you reasons and be confident in your decisions and you shouldn't be met with any resistance. Good luck!