To ask what the truth is about elective C Sections?

[Moomin8]

I'm not thinking of asking for one myself but I wondered what people's rights actually are because certainly it is not clear (perhaps intentionally)

My friend has a 6 month old ds and she had quite severe tokophobia. It's so bad for her that she can't even cope with smears or internal exams and needs medication to cope with these. So she had requested a section from quite early on, she told me. Apparently her midwives were in support of this but when she got to see the consultant at 36 weeks, her attitude was very unpleasant. She told my friend that tokophobia doesn't actually exist and got really shirty about my friend wanting a section.

My friend stood her ground and the section went ahead fine but she was upset about the consultant's approach. Her midwife told her that the doctor may have been trying to put her off because of cost of a section.

Does anyone know what the facts about this are?

Clinical guidelines are that sections can be performed at the woman's request and if the consultant doesn't want to accommodate it then they should refer her to a consultant who will.

I do think cost if probably a factor. It takes much more staff etc.

Personally having had a vaginal birth and a c section, I would 100% tell any pregnant woman to go for the section.

The NHS is reluctant to perform elective C sections because of cost.

What @Morgan12 said. I ended up having an ELCS privately; clinical need as my son was breech at 37 weeks. However, had I been having my child on the NHS and wanted an ELCS with no clinical need, I would have had a massive bum fight on my hands.

It was a really positive experience and I would recommend. Absolutely no regrets.

Haha *bun fight. Bum fight is probably something different - perhaps a description of my digestive system difficulties after the section; one of the few disadvantages.

Most doctors will be reluctant to do surgery that they don’t see as medically necessary. It’s not to do with the cost but to do with the responsibility of operating on someone and the fact that if things go wrong patients can turn round and say “oh, you didn’t properly inform me of the risks” or “you encouraged me to have surgery I didn’t need” and potentially take them to court. Sounds extreme but it’s amazing how people change their views when things go wrong.

I think in theory women can request but the hospital I booked in to give birth clearly states on the initial appointment letter something like ‘c-sections are done for clinical need only and not at patient request’ or similar. Not sure if that’s really enforced but clearly they aren’t very open to it!

Nice guidance states it’s your choice. However they will do everything to persuade you into a vaginal birth because it’s actually safer. If you keep to what you want it will be given.

Depends on your trust and Drs. Some trusts won't agree to elective sections regardless of guidelines, others will depending on the Dr.

Once you've had one section getting a second is much more straightforward - I had an emergency section, no issues getting an elective second time around.

C sections don't really cost so much if you take into account how much it costs to fix the damage from a VB gone wrong, think it was around £80 difference.

I had a consultant throw a tantrum when I requested a CS (and the midwife who was at the discussion just handed me a PALS leaflet at the end.

Second consultant was lovely though.

Also worth noting none of the MW said anything negative to me, just twat consultant.

Depends where you are in the country, no fight whatsoever here. Just a meeting to discuss your reasons, the risks and that was it. Consultant was happy I'd researched and signed and booked me in within 10 minutes+)!

No fight at all when I requested one, following a traumatic delivery with DS. I was really prepared to be told no, ready for a fight about it, and the first thing they said was don't worry - it's perfectly fine.

Interesting, I also have severe tokophobia and had a c-section for the DT's. A new consultant told me 'You will try vaginally' I had a major panic attack, screaming, crying, it took a while for them to calm me down. Other consultant (head guy) came in and said c-section is safer with twins anyway, of course it's you choice.

I healed fine and was going for woodland walks 5 days later.

@Moomin8

I think your friend should have sorted all this out before hitting the 36 weeks pregnant mark!

I am not aware that you can request an elective C-section (on the NHS.) Doesn't mean you can't, but I am not aware of it.

I had an emergency C-section (with my first,) and was offered elective ones with any subsequent pregnancies - which I had.

I have known around 10 women who had an emergency C-section, (with the first,) and their other children were born through C-section too.

I have never known anyone request an elective C-section, just because they don't want to give birth naturally (or are scared to.) (Except famous people!)

Voilà the NICE guidelines on this. At the end of the day, if you want one you can have one. But efforts will likely be made to get you to at least consider other options first, including offering mental health support if it's tokophobia. And of course different trusts and consultants and midwives will all have their own different perspectives and ways of communicating about these things.

www.nice.org.uk/guidance/cg132/chapter/1-Guidance#planned-cs

To call it " just being scared" is demeaning and very insensitive. It is a deep rooted panic vomiting inducing anxiety and fear for me. I would not have had 3 children if i didnt have this option of a c section. I had no issues asking for mine :-) consultant or midwifes. I have healed really well. Still managed to bf despite scare stories. So if i was to have a fourth i would have one again.

MistyCloud, when having an elective section you don't usually see the consultant to confirm it, do the consent forms, and book a date until around 36wks.

I had an elective section by request. Asked the see the consultant after the 12 week scan, requested and arranged the approx date. No problems at all. Was a lovely experience.

Being calm but firm is key.

I am in Switzerland and here they just ask - would you like a Caesarean section or a vaginal delivery?
And that’s that.

Ps. I just didn't want a natural birth and told the consultant and any midwives who asked so.

I have absolutely no doubt that in the UK the push for vaginal deliveries is cost-driven. Which is understandable in an NHS scenario but not good for women

I’m a GP and did some obstetrics training before that.
I had a section myself, had complications and needed a rapid GA halfway through. It was awful and my recovery was horrendous.
The two patients I’ve seen closest to my own age closest to death were both complications from sections.
I’d choose a vaginal delivery any day. Personally, not professionally.
My experiences probably aren’t typical but they are what they are.
I do think that the risk / benefit counselling re vaginal delivery v section isn’t done very well but the public (and many health professionals too!) aren’t very good at truly understanding risk and how it applies to themselves as individuals. Funding into decision making tools which actually help on this topic is probably just a pipe dream though given how neglected women’s health is in research budgets!

@MistyCloud she told the midwife from the beginning but hasn’t been able to see a consultant til now, how exactly was she supposed to “get it sorted”?

By the way, if you take into account the costs of VB when it really goes wrong, e.g. lifelong costs of looking after people who were brain damaged at birth, CS is actually much cheaper than VB.

My friend had 2 emergency sections. Then got pregnant with a 3rd, and at her 20wk scan the sonographer noticed a problem. A huge one. Doctors were called. And she had accreta.

No one mentions accreta when they talk on sections but they are a life threatening condition. If it had gone unnoticed she wouldn’t be here today.

Im angry that its not mentioned. She’s even been on the local news talking about it and women just aren’t being told