To be annoyed I’m having to fight so hard to have an elective caesarean?

[OutPinked]

Basically, after three 10lb babies, my uterus has understandably lost its tone. I am 28 weeks with my fourth and final baby but measuring 32 weeks. I’ve been referred for a growth scan which will be utterly pointless as they always are. They’ll confirm he’s a big baby then do nothing with that information because there’s not really much they can do. Passed GTT with flying colours and I’m not obese, it’s just genetics.

First delivery was shoulder dystocia with emergency forceps and an extended episiotomy. Stitches burst open and became infected, I was in agony for weeks. Second delivery was retained placenta and huge PPH, again I was rushed down to theatre then later given two blood transfusions. It still took me weeks to recover and feel human again. Third delivery went ok but I needed an injection to stem the bleed.

Last year I had medical management for a missed miscarriage. Had a massive haemmorhage, went into shock, fell unconscious and needed emergency surgery+ a blood transfusion. Again, it took me weeks to feel human and I was on iron tablets for months.

DP can’t face the trauma of seeing me nearly die again and I can’t face the trauma of doctors piling in from all angles, jumping on top of me and being rushed down to theatre either. We’ve both decided an elective caesarean is safest. There’s no risk to future pregnancies because there won’t be any. If I do start to haemorrhage again, at least I’m already in theatre surrounded by medics who will immediately be on top of it.
It just seems far more calm and controlled and to me, is an absolute no brainer.

However, I have now seen two consultants who have tried their upmost to deter me. I’ve had almost pointless risk factors thrown in my face (pointless because there’s more chance of dying in a car accident but that won’t stop me driving). I’ve been told that I may bleed more after a CS and when I’ve explained the fact its still safer than risking that blood loss after a ‘natural’ delivery they shoot me down by saying they will still be on hand if it happens after a natural delivery. They don’t seem to grasp that I don’t want them to have to rush in from all angles, I want them to just be there from the off. They also try to deter me by mentioning recovery time forgetting how long it took me to recover after my first and second deliveries as well as the MMC last year.

After yesterday’s consultant appointment, I now have to see an ‘expert midwife’ to ‘discuss birth options’ . Seems ridiculously patronising because my mind is evidently made up but it’s just another hoop to jump through... then I will have to see the consultant again if it’s still what I want (it will be). Argh! To me, it’s just another example of women not being trusted to make the right decision for their own body and I’m tired of it. It’s irritating they reserve so much energy to warn women of risk factors during a caesarean but never ever warn them of what can go wrong during a ‘natural delivery’ too.

I’m actually very sympathetic to OP and many women who choose an elective c section. But after reading the OP I have to trust my gut. We’ve heard a lot of what was said by OP but no details from consultants. The fact she’s seen two consultants and both have given the same advice speaks volumes. From her history it seems OP’s biggest fear is her own fear. Elective c sections need to requested for reasons greater than fear. Once again it is all ifs.

When I had baby 1&2 I had retained placenta and needed an operation. With baby number 3 I demanded it. There were no symptoms but I wanted it. I was fine. It was an if. It was purely for my peace of mind. I was so convinced that I had to have had it again.

Bloody hell if that's sympathetic I dread to think what you're like when you don't feel any sympathy.

So it was ok for you to request a procedure based on an if but not the OP?

No not at all. I’ve learned my lesson.

Yes, but after the fact.

For all you know, the OPs ‘if’ could happen. If you had retained the placenta again, would you still be saying the same thing? You were lucky. She may not be.

Surely better safe than sorry?

@Londonerlove
What utter rubbish! Not only have you stated incorrectly that csections cost the NHS substantially more (wrong) and are inherently more risky (wrong), but you have also shown yourself to be an absolute hypocrite. Your fear of the "if" is no more legitimate than OP's.

@bumpity yes they are more expensive and yes they are more complicated. They cost roughly the same if the vaginal birth has complications.
I’m not saying I haven’t been hypocritical, hence why I’m sympathetic. But we are still missing the fact that TWO consultants have given her advice against it.
Mumsnetters are not doctors, not consultants, not midwives. It’s all advice. Do we listen to MN’s advice or the advice of a qualified consultant with at least 10 years experience. Decide for yourselves. I think I have to trust in the NHS, the same service which we trust to deliver our children.

Looking at all the issues you have previously experienced I certainly would not have another pregnancy. You seem keen on risk taking either with a normal or elective c section. Did this never iccur to you. Do hope though that you get what you want and all goes well.

I haven’t read the full thread but with my last baby (1 month old) I did get a section agreed by standing my ground. They were constantly quoting stats at me (I had different physical/medical reasons) and stating that vaginal was safer. They agreed to a csection in the end. I however then chose an induction at 38 weeks as feel I’m so unlucky I’d probably have the worst section ever... my induction was fine, 2 hours and recovery better than previous deliveries.

@Londonerlove
On average a C-section is less than £100 less than a vaginal birth. The risk profile for both are different but it is widely recognised there is no definitive safest option.

www.mumsnet.com/Talk/media_requests/3329399-BBC-Victoria-Derbyshire-media-request-elective-caesarean-refusal

This will be on soon

@bumpitybumper please provide your source

Ask them to document their refusal to perform an ELCS despite your previous birth experiences so that you can send it the the GMC if / when the same thing happens next time.

Out of interest can you link to the new legislation that states an ELCS cannot be refused, I’m a midwife and haven’t seen this and my trust do refuse non-medically indicated ELCS, we started doing so after an obstetrician was held accountable for the death of a new mother whose death was attributed to her ELCS for non-medical reasons.

In your case you have a clear medical indication so it’s irrelevant to you but I’m curious.

Really surprised they are making you jump through this many hoops. Was allowed a section after third degree tear. Didn’t really have to put a fight up. Just said I didn’t want to risk incontinance/ prolapse further down the line.

Had two planned sections. The second I had no fight at all. Just got asked at every stage why having a section which mildly irritated me.

Planned sections were a walk in the park compared to my first delivery as was my recovery,

Consultant that deliverd my third baby that was a 10pounderbsaid I

Nice recommendation cg132 says that maternal request sections should be granted, even without clinical indication. They say that they can be considered a cost effective alternative to vaginal birth. That's the national institute for health and care excellence. Surely if NICE say it's appropriate and cost effective for the NHS to provide then we should trust them as experts???

From their "what we do" page...

NICE's role is to improve outcomes for people using the NHS and other public health and social care services. We do this by:
Producing evidence-based guidancee and advicee for health, public health and social care practitioners.
Developing quality standards and performance metricss_ for those providing and commissioning health, public health and social care services.
Providing a range of information servicess_ for commissioners, practitioners and managers across the spectrum of health and social care.

Sorry posted too soon.

Consultant said I had made the right decision due to my third child being a 10lber.

Surprised that the size alone hasn’t caused them to back down.

Personally I would refuse the midwife appointment. What a waste of time!!’

Just to add another perspective.

I’ve had three births, one vaginal and two elective caesareans. My first birth was the stillbirth of my son at 41 weeks, he was 11lbs. It seems strange to say but the birth was pretty straightforward physically. Obviously a different story emotionally and I suffered ptsd very badly.

Five years later I had my second baby (a beautiful healthy daughter). I fought tooth and nail for an elective caesarean at 38 weeks. I was adamant from before I even got pregnant that is what I would do - it was difficult and the risks were outlined for me but eventually, at 32 weeks, they finally agreed to set a date.

All was fine, very easy caesarean and happy baby!

My finally birth was another elective, this time no argument at all. It wasn’t quite as easy, the surgery took a long time but baby was absolutely fine. Afterwards the surgeon cane to see me and told me my insides are a mess of scar tissue and that it took them a long time to unstick all my organs. I was warned about risks of having more children.

I wasn’t planning any more and I was so happy with my new baby I didn’t really care.

Fast forward 10 years since my first caesarean, I’m now 36 and I’ve recently been diagnosed with adenomyosis after 5+ years of terrible terrible periods, extreme anemia etc that has made life very unpleasant. The consultant said after a recent op (ablation and sterilisation) that my problems are undoubtedly linked to my caesareans. My bladder is pocketing through into my bladder and I’m looking at more surgeries, probably a hysterectomy.

I’ve been unlucky, most people are fine. However, when drs are giving all the risks for elective surgery they’re not just thinking about immediate recovery, it’s the effect later down the line.

Listening to all your previous issues you’re probably right that it’s safer for you - but I don’t think it should be easy for women in general to get elective caesareans, having to really talk through it many times may change some decisions for the best.

You could always pay for it. It is elective after all; elective means that it's something you choose.

You could always pay for it. It is elective after all; elective means that it's something you choose.

It doesn’t actually. In this context ‘elective’ means ‘planned’.

One of the (many) things wrong with antenatal care is this terminology.

NICE guidelines are ‘recommendations’ they don’t have to be followed like actual legislation does.

@Ethylred nope.
'Elective' surgery just means 'non emergency' Theatre lists full of patients with life altering, often painful conditions.
Hardly a fun day out

To be perfectly honest. When I read the post, my thoughts were not, she should be allowed an elective c section, but why on earth would you put yourself through a fourth pregnancy after such serious complications with previous ones?
You have three healthy children, but your body has been pushed to its limits. Aside from the costs already incurred to the NHS, what about the costs to your body? I had an horrific time with my second DD, very quick delivery but sudden PPH ending up in intensive care for a week not knowing if I would live or not. There was no way I was prepared to risk that happening again, as I had 2 children to take care of. So I got myself sterilised. You say that you're annoyed that they can't seem to trust you with your own body, but by getting pregnant again, that's precisely what you've done. Your body doesn't seem to like pregnancy, it's told you time and time again, yet you've still got pregnant. You're slagging off consultants as if they know nothing despite them having years and years of training, medical evidence to support their recommendations and have actually saved your life several times!

Obviously you're already pregnant so have to deal with the issues now. I too would probably be so scared that I would insist on an elective CS. You know the risks of surgery, and presumably you have enough support for looking after your children after. One drawback of having an abdominal surgery is that you will be at very high risk of developing adhesions in later life. This is extremely risky. I know, as my dad died of adhesions following abdominal surgery causing a blocked bowel. All in all, you and your husband have put yourselves in a very risky situation with this pregnancy. Be thankful for the NHS. Stop slagging them off.

1 in 3 vaginal deliveries are textbook with no intervention. 2 in 3 require intervention, up to and including EMCS. The cost difference between these 2 in 3 births vs a ELCS averages at £104.

Source: A leading consultant at Kings College Hospital who I was speaking to this afternoon.

@CatchingBabies I'm aware of that. But they are a non departmental public body, accountable to the dept of health. Health and care excellence. To me that means a bunch of experts that have decided what constitutes the best care possible. Surely their recommendations therefore should be considered very carefully before being ignored?

I'm a researcher by nature and frankly it took months, and FOI's to my local trust to get enough data for me to be able to make an informed decision about what kind of birth I'd like. The risks of csections are everywhere, and often overstated or conflated with data about emergency sections. Risks of vaginal birth are much harder to find and often glossed over. This needs to change.

I've just found out I'm pregnant after a missed miscarriage earlier in the year. I know that a section is the way I want to go, and is right for me, my baby and my family and I will fight if I have to, but honestly I hop I don't. The recommendation is there for a reason.

OP - I really hope you get yours approved. But as I said earlier speak to birthrights, they will help support you X

Elective means non emergency or planned c section , I’m scheduled for one I didn’t choose it my womb physically can’t contract due to a previous T incision section due to undiagnosed breech baby .