to be worried about seeing consultant about elective c section tomorrow?

[heraldgerald]

I'm so nervous I actually feel sick. I had a three day Labour last time as I failed to dilate and spent two days at home labouring because I wasn't 4 cm. I never got to bloody 4 cm even with the syntocin! It was a horrendous experience and I've had trauma treatment on the nhs since as a result. I was shattered afterwards and got very ill with an infection.

I have thought long and hard and I cannot face going through that again.

Anyway. I have been told by my midwife I'll have to 'argue my case strongly' about getting one.

I have no idea how strongly I'll need to argue - I don't want to break down in tears and I'm scared I will.

It's triggering even now issues with body control and fears of invasive procedures like sweeps. Aibu to be so wound up?

I agree I can see and its not the easy option but its a different option with a new set of problems, but up front problems you can try and get a grip of.

More money is paid out of maternity services through injury to child and mother during cb than c sections.

Good posts red toothbrush, I was just coming back to make the point that it isn't actually a right, but an informed discussion between you and your consultant. A discussion that will go well if you go in, explain the past delivery and your worries and fears and have an open and honest conversation. A discussion that won't go well if your opening gambit is about your rights. That's all I was trying to say, don't want to derail the thread.

Good luck with everything

icanseethesun don't forget you are asking a surgeon to do an operation, which has risks. It is their moral and ethical duty to be sure you understand the risks and, in a small minority of cases, to refuse. I wouldn't give someone penicillin if I knew they were life threeteningly allergic to it, even if they begged me. And there will be some patients for whom a CS is so high risk (the morbidly obese for example) that it should be avoided unless completely necessary. But those cases are rare as CS is common and safe these days.

But VB has huge massive risks and more than that a huge array of them.

BTW it is your right to have a section, if you can pay for it.

The rest of us just have to take pot luck with consultants and MW and labour wards.

BTW one of my main reasons to have an ELC was the fact they couldn't even guarantee me entry into the Labour ward, they had much history of turning people away.

Even if you can pay, you cannot force a particular surgeon to operate on you.

(Of course, because both consultants and patients have different attitudes to risk, you will probably be able to find someone who matches your preferences, in the same way that the NICE guidelines talk about referring on to a colleague if an obstetrician does not consider a maternal request section appropriate.)

Sorry to hear of all birth traumas on this thread

I'm pleased in equal measure about the birth successes though.

Thanks for all the support, I feel alot better and ready to face it.

Even if you can pay, you cannot force a particular surgeon to operate on you.

Precisely

Please don't worry about the turn this thread has taken, you will definitely find an obstetrician happy to do a CS for you on the NHS as it is a very reasonable request given your history.

good luck OP

I have been through this and it was a bit of a battle. The consultant was very high handed about it all, belittled my concerns and gave a very one-sided argument in favour of a vaginal birth. I had similar meetings with a consultant midwife and another back with the consultant before being given the go ahead.

Remember that the NICE guidelines support your choice. Should the consultant not be supportive of your decision, ask to be referred to a consultant willing to assist.

Always is right, it's a big operation with risks attached and needs to be done for the right reasons.

Reminds me of my consultant supervisor, whilst doing the elective section list together she casually mentioned that she had gone along at lunchtime to meet the next patient and had been astonished to find that there was no compelling reason to have a section. She told me off about it as we were finishing up. Cue me racking my brains several months before, and remembering the lady at clinic who told me in no uncertain terms that she wanted an elective section. I was busy, stressed out etc, and I put her through. My consultant went ahead and did the op later that day but I have thought about this incident with terror over the years, and have thanked my lucky stars she came to no harm that day. It taught me that you really need to justify surgery to take the risk in the first place.

no compelling reason to have a section

The trouble with this phrase, is as it stands, some people view mental health reasons and not a reason, and some do. And its very difficult to make that distinction with certainty and it is incredibly difficult to distinguish between patients having a 'valid' case and though having an 'invalid' case.

And was indeed one of the reasons that NICE changed their guidelines.

Yeah, this was pre- 2011, even pre- 2004.

I've had two with almost no trouble. I had good reasons (so do you OP), explained these clearly, listened to the potentials problems, and then the consultants signed the forms for me. I remember the first one saying she was glad she could do something to make it easier for me.
(Both were women - not sure if that made a difference!)

Doctors are under oath to 'do no harm'. In essence their job is about balancing risk.

The 2011 guidelines identified a risk that had been overlooked and they felt MUST be seriously given due consideration as it wasn't by all doctors.

Therefore giving an ELCS just because a patient can afford it, in a situation where it could endanger a woman's life, could be even more unethical and wrong than denying a woman an ELCS on the NHS under the NICE guidelines.

However, unless there are compelling physical reasons why a woman shouldn't have an ELCS, then, because its a routine and generally safe procedure, the concerns over mental health should take precedence.

So there are always exceptions to the 'rule' - whether it be in private practice or under the NHS.

Yep, 'First, do no harm'.

Exactly.

Nicola19 - the fact that you didn't find out what the reasons were for that patient wanting a cs doesn't mean necessarily that she didn't have good reasons!
I think it's a shame that someone - on the day of the operation - is still being asked to justify it.

I had a traumatic birth that nearly killed dd1. My second pregnancy I was in a wheelchair due to SPD. My consultant was completely against elcs, so DH and I had an appointment with the head of midwives. To cut a long story short, she agreed that the best thing in my circumstances was to have an elcs, had a chat with the consultant and at my next appointment the Elcs was approved. OP if the consultant doesn't agree, maybe you could also ask to have a chat about your birthing experience with the senior midwife in charge of the maternity unit?

Hope all goes well tomorrow x

I understand a doctor - to do no harm, and in some rare cases not allowing and ELC but if I was a doctor nearly every time I would be granting ELC because that way - least harm would come to baby or Mother. Too many things can and do go wrong in birth

I did elicit the reasons, but I can't go into them obviously because of identification etc. We talked through why she wanted it. She'd had a previous one, no trauma that spoke of. I had the time to talk to her, just not the time to go to my senior and run it by them when the patient was so insistent. When the consultant looked at my notes from that day she couldn't find reason either. Maybe the lady was just not telling me, perhaps.

Sorry am on a different time zone you get the birth you get by this I do not mean you have to be passive and just accept it, and what every HCP tells you. You still need to educate, inform and find a practitioner most suited to your needs,who will advocate for you and help you to achieve what you would like, as, like of has been pointed out it is 2014. However there comes a point where we need to stop saying "I want" and start realising that some things are just truly unpredictable, and that HCP do not always have a vested interested, or underlying motives.

I think having a positive experience the first time around (perhaps following a more negative one if it was an emergency cs) is actually a good reason for wanting to repeat the experience.
Maybe she was doing a good job of holding it all together and not showing her emotions - I imagine some tears are more effective than calm rationality.

In the clinic right now. Registrar says he won't book me in now as I'm 'pre viable'.

Already had a panic attack.

Have asked to speak to lead midwife. Any other ideas?

Doesn't that mean that you are too early on in your pregnancy to be booked in for a CS? In case you don't go to term? How pregnant are you?

I don't think I was given a date (for 39 weeks +1) until I was 34 weeks but there was never any question that I would be given one, once I had made my decision.

Baby had other ideas but that's a whole other story - had to ring them and cancel the pre-CS apt from the ward when I had an unplanned vbac at 37 weeks.

Calm down - no-one has said no, other than the computer

herald, can you get the CS agreed formally in writing - but without a set date?

I believe its normal not to book in early (As far as I am aware that my booking was very unusual). Often its as simple as them not having rotas set up that far in advance and they wouldn't book in women who have a severe physical need for one either.

The agreement is what you really need, not the date. If its on your notes, then dates can be sorted out later, and if you go into labour before this is done, they are also aware of the situation.

Please don't assume this means its a no. Its not, and it does sound like its positive otherwise from the limited amount of what you've just posted.

I think mine was booked in for 39 weeks when I was 34 weeks (at my third consultant appointment).

I would come home and write a letter to the head consultant outlining your case and literally tell them that you've had a panic attack being so worried that you are going to be refused a section. Ask for the c section to be granted in principle and an appointment to be set nearer the time so you can book the actual date in.

I was booked in as it were but not given a date till much later.