Tokophobia and elective c section

[LaraCameron]

Hello everyone!
I have severe primary tokophobia and I was wondering if there are any ladies out there who were allowed an elective cesarean on the NHS on these grounds for the first child. If so, how did you go about it? How easy is it? How did you convince the consultant?
Any tips are welcome.
Thank you !

chynah you are right actually, id say most midwives dont get it.
Even if I wasnt tokophobic, I'd be more concerned about a vaginal delivery than a planned section.
Though, some consultants dont get it either.
My assistant's doctor butchered her with forceps just to keep his c section rate down. Such doctors make me want to scream.
I know someone who got yelled at by a consultant, because she refused ECV. He said she was wasting NHS resources by making a cesarean the only option.
Last time I checked we had the right to refuse anything we didnt want be it ecv or forceps.

Some midwives and doctors have a tendency to make childbirth and pregnancy so horrifying and complicated. I wish they'd stop being judgemental, bossy bullies and ruining the reputation of the people in the medical field who are genuine and reasonable.

seoladair
Congratulations on the wee one! Hope the baby and you are doing well:)
Was this in London though? Hospitals there are more open to c sections.....

Am in hospital recovering from ecs (Tuesday ) and would like to say my NHS midwife saved my life after contradictory advice from consultants, second one wanted to turn baby after 1st had already said too dangerous. M'wife booked section anyway, visited me at home made appointment with senior consultant. Result ecs, baby fine but placenta previa and acretia (fibroid ), lost all my blood and quite a bit more, emergency hysterectomy& general tomfoolery. Have not been to well. Buthave my own room(nhs) and a fabulous hospital mwife who has gone against hospital policy to sort out some nipples shields to enable baby to suck, which he couldn't without.

Hi Lara,
Thanks for your good wishes! No, it was in Scotland. I don't think they're all that open to c-sections here, but I insisted that I felt it was the safest option all round.
Before I had been allowed a c-section, I was being told that it was risky, major surgery etc. etc. Once it had been agreed though, everyone kept telling me that elective c-section is a very safe procedure! I think the medical staff are being pressurised by the men in suits to keep c-section rates down, as I found my doctors were actually very supportive of my decision. Also, a lot of obstetricians opt for elective c-sections themselves.

Actually it's a myth abouth obstetricians choosing elective sections for themselves. One small study conducted within the M25 showed that in the mid 1990s. The subsequent national survey showed the exact opposite.
Yes, a Caesarean is a very safe operation, but it still carries far higher risks to the mother and some risks to the baby. Is it at all possible that the health-care professionals are basing their advice on evidence, experience and dealing with the fall-out of surgical complications? Or are they just unsympathetic and 'don't get it'?!

Actually I think the cost to the nhs would be far greater. You'd need so many more consultants, theatres, anesthetists, more post-natal beds.

I completely agree that the nhs should not offer caesareans except for medical reasons.

You do have a choice to pay privately if that's what you want, but the nhs has to do what is best with the resources it has and the evidence that exists.

4pudding Im willing to pay privately, but where are the private hospitals?!
Either Nhs needs to make private c secyions an option( i mentioned earlier that im not even asking them to pay and i have a valid disorder) or there need to be more private hospitals for maternity care. Otherwise it just leads to a very ridiculous situation. The world ocer c sections are included in the list of birth choices- except in UK. All because of some rubbish NICE guidelines.
They very conveniently mention the risk associated with c sections, but Ive never heard of a baby or mother dying because of one(at least not a planned section). They fail to mention the risks associated with forceps and ventouse calling them a 'safe' procedure. Even when they have killed countless babies and damaged and hurt the mother and child at the very least. The only reason they are promoted is because they are a bit cheaper than sections. That is disgustingly misleading. There is no room for such a pathetic way of thinking in a developed country.

Lara, your situation is very specific and needs to be discussed carefully with the obstetricians and psychiatrists looking after you. I'm not questioning your condition for one minute but just responding to the wider issues raised on this thread about people believing they can make 'informed decisions' based on looking at websites and listening to other people's experiences while completely dismissing the advice of experienced professionals. Anecdotal evidence is always skewed as it's the more sensational, dramatic stories that get talked about.
I, for one, am very grateful for a healthcare system where recommendations about care are not based on your ability to pay, but rather bodies like NICE examining the real evidence.

popstar Thats the point Im making popstar. Thay are NOT revealing the whole truth. Why does NICE refer to forceps as safe and say they only cause mild bruising, when in fact they have killed and blinded babies? Google 'forceps deaths' and see the innumerable stories that come up, all about babies in the UK. I dont think NICE are basing their guidelines on 'real evidence' as you put it, but simply on what is convenient financially. Blind faith in medical guidelines and doctors is dangerous popstar- they are a lot more political than you'd ever imagine.

And yes, if 'informed consent' meant anything in the NHS, I would simply have the right to a section. I wouldnt have to justify my very real phobia and relive my abuse. I wouldnt have to spend most of my pregnancy stressed out.
As I said if c sections are a valid birth choice everywhere else why must it be different here? If forceps are banned in most other countries why are they allowed here?
Reccommendations may not be based on your ability to pay but they are based on money- why else would doctors insist on backward procedures like forceps etc when sections can be performed?
As I mentioned, my friend has been left incontinent for life and her baby has permanent nerve damage because a doctor used a pair of forceps when a section should have been performed. The baby had not fully decended in the birth canal, and even the midwife later said that a section would have been a better option.
What do you think this decision ultimately comes down to? Money.
Im sorry but Id rather they asked me to pay upfront and gave me the care I deserve, since they seem to be so hard up.
Im sure there are some great doctors in NHS- but please dont be blindly 'grateful' for a system that is actually quite flawed.

No decisions shouldn't be based on the patients ability to pay, but then they shouldnt be political either. And when a doctor opts for one method solelt because its cheaper, that comes down to money as well doesnt it?

If NICE mentions the risks of a c section it should also mention the risks of an assisted vaginal birth- nerve damage, bruising and even death for the baby, incontinence, prolapse, possible fistula and sexual dysfunction for the mother. Why call it 'safe' when it isnt? Just because it costs less? As I said any mother would pay the balance to keep her baby safe.

'Ive never heard of a baby or mother dying because of one(at least not a planned section).' quoted from Lara Cameron

Just wanted to draw your attention to the 2010 Confidential Enquiries into Maternal and Child Health which examines the cases of maternal death for the period 2003-2005. There were 4 deaths in this period where the mode of delivery was by elective cs. The leading causes if maternal death have remained the same over the last few years now - thromboembolism, sepsis, haemorrhage and anaesthetic complications which are more prevalent with a cs delivery.

I hope that this information clarifies the situation as mums DO die as a result of cs delivery.

laluna I stand corrected then. All Im saying is NICE should mention risks associated with ALL modes of delivery. Not just c sections - their risks are harped on because they cost more. No method of childbirth is fully safe. How are women going to make the right decision if the full information is not provided to them?
And if you visit the ACOG website or even the WHO website, it clearly mentions that planned c sections have lower risk than assisted births.
If you go on to www.electivecesarean.com, there are several interviews with NHS obstetricians, all of whom say that planned sections are as safe or risky as an uncomplicated VB. Assisted VB carries the highest risks. They also say that they feel women should be able to choose.
Nothing is without risks- there is a reason women used to( and still do) die while giving birth. In such a scenario, we should get to choose which risks we want to take and which we dont.

In any case Im just stating all this to support the women who opted for c sections due to personal preference. If NHS doesnt want to pay, as I said thats perfectly reasonable. But then shouldnt there be an option to go private in places other than London?

Popstar, there are more than 2 studies about obstetricians personal choices around the world. The numbers vary but a substantial number, and in some studies, a majority, support caesareans on maternal request and many believe that it's actually safer for both the mother and the baby than an attempted vaginal delivery. www.guardian.co.uk/society/2004/may/02/health.politics1. www.guardian.co.uk/society/2008/jul/11/nhs.health1
Of course there are 'some' risks for the baby. There's no such thing as a risk free way to give birth. It's relative risk that matters. It's simply not true to imply that all obstetricians are opposed to maternal request caesareans. You can't read the opinions of obstetricians into NHS policy. Many of them disagree with it.

4pudding, I don't think the question of cost is at all settled. It might seem to be common sense, but it's by no means clear which option is actually cheaper for the NHS. The proper comparison is between planned vaginal deliveries and planned caesareans at 39 weeks without medical indication, there are very few studies on that and most calculate costs differently. A long induced labour followed by emergency CS seems to be the most expensive outcome. An elective cs avoids the risks of induction, instrumental deliveries and emergency CS entirely. If elective CS is safer for both baby and mother then the costs of NICU time, follow up treatment and litigation would also be reduced as well as the costs to the NHS of treating birth injuries caused by vaginal deliveries in both babies and mothers. Those costs are frequently not included in the comparisons. There's a link here to one study: homebirthdebate.blogspot.com/2007/06/what-if-cesarean-section-costs-less.html. I agree that a spontaneous, uncomplicated vaginal delivery may be the safest and cheapest. But that's an outcome, not a choice. You have about a 50/50 chance of that outcome as a primipara in the UK. And even if you are in the lucky 50%, you still run an increased risk of pelvic floor problems, stitches, incontinence etc. afterwards. I wish people wouldn't be so dogmatic about these things.

Do you think the obstetricians on that particular website are representative, Lara? Clearly not!
There isn't a perfect healthcare system in the world and no intervention is without risk. I still prefer to be in a system where decisions are based on the greater good. What that means is that no doctor in deciding the best mode of delivery at the end of a lengthy labour actually thinks about the financial cost of their decision. Errors of clinical judgement are inevitable as doctors are human and, yes, some should not be doing more complex procedures unsupervised. Better use of NHS resources amy well be more senior presence on delivery suite 24/7 as the RCOG advocates rather than paying for a riskier intervention such as an elective LSCS when it is not actually necessary.

popstar
I think its wonderful that you have such faith in your healthcare system. I hope to god you are never faced with doctors who make decisions based on whats cheaper for the hospital. It would be rather naive to say that those kind of doctors dont exist. This is not a debate about which mode of delivery is safer, because nothing is without risks. This is simply about women having a part to play in the decision making process instead of leaving it all upto doctors who may or may not have their better interests at heart.As I keep saying over and over again- nobody is asking NHS to pay for elective cesareans. They cost 800 pounds extra and most people I know will be happy to pay that. As for going private, UK, one of the most developed countries in the world doesn't have private hospitals outside London.
So where do you want women like me to go if my tokophobia is dismissed by a doctor who us more interested in keeping the section rates and costs in his hospital down?
Most doctors say that if patients were paying themselves and fully informed, they would not have the right to refuse a c section.
And if the doctors on a website aren't representative, by that logic we should stop looking at websites and newspapers- none of it representative in the true sense of the word!
The 'greater good' is a wonderful concept on paper but it doesnt always work out like it should. It would be naive to think it does.

Actually Lara- I agree with your last point about stopping looking at websites and newspapers. It's the point I've been making all along. Googling is rarely helpful when it comes to medical conditions. A website that calls itself electivecaesarean.com clearly has an agenda and will not be giving a balanced view. The Guardian article mentioned above proves nothing about female obstetrician's attitude to elective caesareans. It quotes the survey I previously referred to and then chucks in some selected anecdotes with no evidence to back up it's claims about 'most' wanting an elective section.
By far the most helpful thing you can do is talk to the professionals who will be looking after you.
I'm actually quite sad that people are so cynical about what motivates their doctors. The vast majority want the safest, most effective care for their patients and fight for that within an imperfect system with limited resources.

laluna it's really misleading to imply that those mothers died 'as a result of' the cs. They had underlying health conditions. This is a quote from the report: "The balance of maternal and fetal risks between caesarean section and vaginal delivery is a controversial topic and in considering the maternal deaths in which a caesarean section was performed, it is almost impossible to disentangle the consequences of caesarean section from the indication for the operation...Only one was performed for these women for maternal request and the remaining cases had serious prenatal or intrapartum complications or illness that required a caesarean section".

You say that 'thromboembolism, sepsis, haemorrhage and anaesthetic complications which are more prevalent with a cs delivery'. More prevalent with doesn't mean caused by. You're probably getting that from studies which include medically indicated caesareans and emergency ones. It doesn't hold up for maternally requested caesareans in women with no medical indication. For example, serious anaesthetic complications are almost invariably due to general anaesthetic, which would not be used in a maternal request caesarean. General anaesthetic is actually a risk you take with a planned vaginal delivery. In a crash section there may be no time for an epidural/spinal block to work. Here's a study that actually reports a lower risk of haemorrhage in planned caesareans:
*2007 Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term, Liu et al, Canada
Here are some that show lower maternal mortality:
*2008 Maternal death rate lower for women who underwent scheduled or elective caesarean than for other women giving birth between 2003-2005. Birth Trauma Association Press Release, UK
*2006 Maternal Mortality With Cesarean Delivery in Massachusetts (1995-2003) and a Review of the Literature. Berger M and Sachs BP, USA
*1988 Cesarean section-related maternal mortality in Massachusetts, 1954-1985. Sachs et al, USA
As far as I'm concerned, when high profile, reputable obstetricians who've reviewed all the evidence believe that maternally requested caesareans are ethical then it should be an option.

sioda I completely agree with you.
But Im begining to see that it is very difficult to convince women who are into 'natural' processes, that c sections are not negative.
There are women who are so convinced that natural is best that they go to the extent of not even wanting stitches after ripping saying that it'll heal 'naturally'. Try convincing such a woman c sections are safer.
There is a complete obsession with natural births in the UK and it borders on ridiculous. C sections are the norm in China,Brazil, America,Poland, Korea,Thailand, India, Italy and many more countries. I doubt all the doctors in these countries are idiots who are risking lives. I also doubt that the women in these countries would continue with something inappropriate- nobody will risk their child's safety or their own. But many women are too set in their beliefs to understand this.
If our bodies were 'made to give birth' as midwives and many mothers claim, there would never have been a need for interventions.

But this is like the breastfeeding v/s formula debate which can go on endlessly. The only solution is simple- to each their own. Pick your own risks.

I really dont mean to offend anyone with my views. All Im saying is we are all entitled to an opinion and have a right to act on it.

Dear Lara,
I wish everyone was as "live and let live" as you. Sadly there are many people who take a totalitarian approach to birth. In the end it's your baby and your body, and you should do what's best for you. Elective caesarean is extremely safe, and if you are encountering healthcare professionals who are being totalitarian about your method of birth, then you must remember that you have a right to another opinion. If a hospital will not grant you an elcs, then you have the right to request a referral to one which will, I think. There's more info about it on the elective caesarean website. Best of luck!

seoladair Thanks so much!
I have a valid mental health issues so I expect to be taken seriously(hopefully). I was just concerned for women who are denied a choice-because someone else's views are being foisted on them.
It just makes me sad.

OP - just thought I'd pop in and tell you my experience today with my ob. Hadn't seen this ob before (I'm 32 weeks today) and I said I wanted to actually book in my c-section. He could see in my notes that was what I was down for but said he needed to talk to me about VBAC first. He went out to try and find a nurse to find the leaflets he wanted to show me and when he couldn't find one he said - "oh well, I just book you in then". He asked me what day I wanted and just entered me on the system. Good luck.

stangirl Thats great! He sounds like my kind of ob;)
I hope things go really well for you:)
Congratulations. You must be excited- at 32 weeks, wont be very long now!
Thanks for telling me about this- positive stories make me feel more confident.

LaraC to go back a few posts, yes vaginal births do occasionally result in dreadful things happening. Recto vaginal fistulas are common in the developing world where many women labour for days and don't have easy recourse to life saving caesarean sections. Often their babies die and they are left with dreadful morbidities that last for the rest of their lives. They are extremely rare in the UK, in fact I think I have only heard of it happening once or twice. Yes sometimes forceps and ventouse births go wrong with horrible consequences for mother and fetus, but this is extremely rare as well, it happened more often twenty years ago when they used rotational forceps, which they rarely use now.

I have seen some difficult births of all types in my time, yes el cs is safer than em cs but sometimes they can go horribly wrong (more likely of course if there are other factors as someone else has pointed out, but not exclusively) Also the more sections someone has the more likely serious problems are to occur, so a third section is FAR riskier than a first section (which won't be a problem for you as you don't plan more children, but many obs will advise women who plan to have more than two children to go for a vbac due to the far greater risks of repeat section.)

No one ever has to accept a forceps delivery, if someone has strong feelings about it it needs to be fully discussed and written down antenatally so that this will be respected without discussion if it happens at the time, I can honestly say in 16 years that I have never seen anyone pressurize a woman into having a forceps or ventouse delivery, if I did I would stand up for the woman. To continue without her consent is assault and could result in a jail sentance, I do remember one woman who did not consent to an instrumental and ended up having a section. I wasn't there at the time but she told me about it herself, sounded like they tried to persuade her and she just refused. A section is quite a bit riskier when the woman is fully dilated though so a low forceps or ventouse is likely to be safer to mother and fetus in most but not all cases.

I'm not trying to upset anyone here just to provide some balance for the people who feel that sections are completely safe. If only it was all simpler! I hadn't realised before reading this thread quite how few private obs there were, although I know that there aren't any in my area.

maxbear
Wow. This has been an eye opener- I guess women have a tendency to exaggerate their birth stories. Thanks for clearing up the fact that we do have a right to refuse and that our wishes will be respected. It reassuring to hear that from someone in healthcare.
I can imagine why someone who wants 4 kids or something would be discouraged from having c sections.All those problems with the placenta sound scary. But since Im only going to have one, I guess I can relax about that.
( unless my hubby begins his emotional blackmail again- but Im not falling for that again.Hopefully )
I completely understand that there are risks associated with every mode of delivery. I was just talking about informed decisions. Despite my tokophobia, I know that a c section is not 100% safe- but Im out of options.
Ive been in therapy back home, and it hasnt helped. I have always had clinical depression as well due to my childhood experiences, but I cant take anti depressants for the depression or the tokophobia. They make my gynecological problems worse unfortunately. So you see it is a difficult scenario.
Im going to pass on what you said to my friend - her doctor used forceps without asking her ( in scotland somewhere ) and she and baby were both quite badly hurt. A midwife later told her that it was not too late for a section so she got very upset. Perhaps she should talk about why that happened. From what you have said, it should have been discussed and she had a right to say no.
I know that the problems I mentioned with vaginal deliveries are rare, but strangely all 5 cases( all within my immediate family ) were in the best of hospitals in Ireland, Germany and Canada ( family all over the globe:))
So, might be illogical, but I think its just my family- no other explanation I can come up with:( I mean they were good hospitals in developed countries with qualified doctors.
So glad to hear rotational forceps aren't used any more! But the cases I mentioned are more recent- for example baby Alexandra who died as a result of forceps quite recently. And baby Markus who was blinded. Its just awful.

And you haven't upset me at all- what you are saying is coming from years of experience, and I'd be foolish not to learn from it!
The new NICE guidelines have made it easier I believe- women with tokophobia will be offered sections, if the new draft is passed. Fingers crossed.

I am writing in response to another poster?s reference to my website. The only 'agenda' that electivecesarean.com has, is its editor?s campaign for informed women to be given access to supportive obstetricians when a cesarean is their preferred birth plan. It also aims to highlight the fact that choosing a cesarean birth plan - with or without a medical or obstetrical indication - is a legitimate choice, and that women should not be criticized for this. There are risks and benefits associated with all birth plans, and it is just a matter of time before more people understand that the risks and benefits (and indeed costs) of 'major surgery' are comparable with those of an unpredictable trial of labor. Different women tolerate different things in every walk of life, and we really need to be more accommodating of each other?s choices when it comes to birth.