Has anyone requested a c-section?

With DD1 I was given a choice between a CS or an induction, and no pressure on me to choose either way.

With DD2 they asked if I’d like another CS at my booking appointment. I said yes and I was given a provisional date for it there and then.

No issues at all with vaginal birth being pushed on me (in a well regarded London hospital).

I had an elective C-section and was in and out of hospital in a little over 24 hours. I doubt very much the associated costs were more than the alternative as I had virtually no staff support prior to the operation and only a modicum of nursing checks afterwards.

All of mine were maternal request caesareans, only resistance I had was from a female consultant who said I should try a VBAC with second child. I said no and switched to a male consultant who was in complete agreement.

https://www.itv.com/news/2019-04-18/caesareans-cheaper-than-natural-deliveries-once-negligence-claims-taken-into-account

shocking, right…? 😬

I had an elective with DD2. First birth with DD1 was fairly traumatic and I had zero
desire to go through that again. It was all very easy. I told midwife that I’d like a C-section. She referred me to the consultant who was fine with my choice. I had a lovely
section, healthy baby and far easier recovery than from my vaginal birth.

I was told when I had my baby just 2 years ago to come in on the day of my scheduled elective C section and they would get through as many as possible but if there were too many emergencies they would (rightly) be prioritised so there was a chance I’d have to come back the next day instead. So that seems as if it can’t be the case for every hospital / trust.

My DSIS had an elective section for her second. This was 12 months after her first, when she had pre eclampsia and they finally gave her a section after three days. The baby was in icu for two weeks and she was very ill. I don’t understand why they thought she could have a normal birth next time.

No. There is a separate ward and team for emergencies.

Sorry, I should really have said ‘are not more expensive’. Than the average ‘natural’ birth. You can’t choose a vaginal birth after all… you can embark on one but you don’t know what will end up happening from there!

The consultant said that the costs of having a fully staffed and ready surgery are already there because they have to be constantly ready for emergency C sections for life savings purposes. So electives just fit in while they have time when an emergency isn’t happening. Not really an additional cost.

When you go in for an elective they’re clear that you wait until there is a space for you that day and obviously emergencies take precedence.

She said the ‘natural’ births she used to be forced to take seriously and try and accommodate - including giving birth outdoors!! - were way riskier and more expensive, and yet she was forced to deny elective C section requests, purely because that was the trust’s policy, totally due to prejudice / the fashion. She was relieved she could now agree nice neat easy cheap elective C sections as the sensible option where women preferred it!

Also, from a sample of one (me), here is how a vaginal birth that starts with just a midwife can end up way more expensive than a C section.

Vaginal birth:

• time with midwife on the labour ward
• theatre with full medical team for instrumental delivery; ends up with 3b tear and episiotomy repair and treating a PPH
• 5 nights in hospital, including a night in recovery
• multiple rounds of blood tests
• blood transfusion
• IV antibiotics
• antibiotics at home
• additional midwife appointments at home because I’ve failed my urine test, have been sent home with a catheter and leg bag, and the catheter keeps leaking
• two further follow ups in maternity triage for said catheter
• admission for another night because the bladder still isn’t working
• IV antibiotics to prevent a UTI from taking the catheter in and out
• follow up hospital appointment with urology
• 2 GP appointments and antibiotics because the episiotomy stitches are infected
• scan to check extent of 3D tear
• follow up with perineal midwife
• I should have added many months of pelvic rehab, but luckily my work insurance paid for that (the NHS doesn’t offer the level of rehab I needed anyway)

C sections:

• pre op
• theatre time
• two nights in hospital (normally one night, but I have a heart condition so the protocol is to monitor for two)

Of the 5 mothers in our NCT group who were planning vaginal births, only one had a straightforward delivery. One had an episiotomy; one an emergency C section; one a third degree tear, episiotomy, and the baby had to be resuscitated; and one (me) 3b tear, episiotomy, bladder trauma, and 2.9l PPH.

Yes you have a right to a c-section if that’s what you’d like. Be firm.

They are so chill about the second one. I remember they just looked at my notes; looked to me and said ‘c section?’. And I said yes please. 😂

The first one was not impossible to get by any stretch but I remember distinctly it hadn’t been signed by anyone so I had to do a last minute sit in at 37 weeks in the maternal monitoring unit to catch the floating registrar.

They grilled me for 20 minutes quite intensely - telling me I could die, my baby could die. I might be paralysed. I played along politely for the majority until the end when I just said. Right, so where’s the sheet for vaginal birth risks which also have the emergency c risks on it. He looked at me and did a little smile and said ok I will sign it. 😂

And on my second C I went into it planned, on the table everything good and then bang! I nearly ending up with a Cat 1 GA C 🫠

Aneathetist looked like he had just got back from Glastonbury and was paying no attention what so ever to my blood pressure - which I warned him was very prone to dropping off a cliff. I went unconscious. Bells went off. DP thrown out. They were just about to put me under GA because the babies do not like it when the mother’s blood seizes to function correctly. And I thank the lord because my little trooper didn’t give a shit 😂 so they spent 5 minutes bringing me back to earth and we continued on from there.

But I have never heard of anyone else having this. Even on googling. So I am still a big advocate for planned C as it’s the only way you can (99.999%) guarantee a plan C outcome.

I gave birth at the same hospital as Louise Thompson and there was no hesitation in recommending a section for my second (and third) child. The perineal midwife and several consultants all agreed it was the best option. One consultant said “after what happened last time, we do not want you going into labour naturally”, as they moved my section from 40 to 39 weeks. On one occasion a registrar started to ask if I’d considered a vaginal birth and the consultant waved her away. That said, I was very clear myself from the start that I was having a section and there was no way I would have changed my mind.

I asked for one and it was granted with minimal pushback. I was over 40 though and it was during Covid so I suspect they were happy to agree to what was almost certainly going to be a shorter stay in hospital. As it was I was there for barely 24 hours in total. It was such a straightforward process.

Just had a c section 5 weeks ago that was my choice. It isn’t something you have to beg for or make a power point presentation about to try and convince them you deserve.

Yes you will have to meet with a consultant to talk the whole process through but that’s because they want you to know all the facts about the whole thing so you can make a fully informed decision.

You don’t need to convince anyone that you’re “worthy” of a c section.

NICE looked at the costs of C-sections as opposed to natural childbirth some years ago and found that there isn’t much in it at all.

Why? Because the initial slightly higher cost of the C-sections are offset by the higher costs entailed in episiotomy care, reconstructive surgery, physiotherapy etc that is often required following natural childbirth and interventions.

It’s right they can’t legally refuse.

But you also have to realise the do nothing results in vaginal birth. So getting it signed off is an active process of you deviating from the natural course.

I don’t want to make assumptions about Louise Thompson birth because only she and her consultants know. But my guess is this is what happened to her. As she gave birth in a London hospital with very high maternal request rates. I am assuming it was a case of she was unsure about best options for her due to her existing bowel issues. So was hesitant and was asking advice. They obviously would have said it’s probably not a good idea to have a maternal request c. That’s not a refusal.

This is what I mean about if you want it you have to go in there saying you are having one.

I am not the PP but of course that’s the cheapest option.

But you can’t chose that option.

The only option you can chose is planned vaginal or planned c section.

Costs for planned vaginal include all the outcomes (including emergency C’s)

I presume ELCS v attempted vaginal birth, that's the usual way.

EMCS is a consequence of attempted vaginal birth and doesn't happen with ELCS, so the costs of EMCS all go in the attempted VB category.

Cheaper than what? An emergency c section, which isn't planned and an emergency? What you comparing?

Vaginal midwife lead births are the cheapest, after home births

As others have said, they are not allowed to refuse you a C section. If there’s push back - stand your ground.

As an aside it’s funny how much you’ll be told about the various risks of C sections, but absolutely nothing about the risks of vaginal births. I thought I’d read up about it enough myself and I was pretty clear eyed about the whole thing, and I still didn’t expect some of the complications of my vaginal birth!

By themselves no not least because the NHS doesn't do that much anyway. ELCS works out broadly similar in cost to attempted VB because of a range of other costs, vaginal birth repair only being one of them.

Probably the biggest is legal costs. The births that go the most wrong and cost the NHS the most money are mostly attempted VBs.

@TurquoiseDressand @BelleEpoque27I’m not saying birth injuries that need repair don’t happen! I’m saying I’d be surprised if the costs involved with those outweighed the costs of elective C-sections.

My NHS consultant said planned C sections are actually cheaper. It’s nothing to do with finances - it’s purely been prejudice that’s stopped people having them in the past.

There are already 4 categories of section -
cat 4 - at a time to suit - either for medical reasons or maternal request.
cat 3 - no compromise but needs delivering early.
cat 2 - compromise (either maternal/fetal) but not immediately life threatening - aiming to deliver writhing 75mins.
cat 1 - immediate threat to life - target decision-delivery time of 30mins.

A mat request section can be cat 3 or even cat 2 if they present in labour before their elective date.