Elective Cesarean

[Cocobean1]

Hi,

I have just found out I am pregnant with my first baby. I have read/heard alot in the news recently about elective cesarean and a new move to allow women to choose this as a childbirth option. I have looked this up on the internet but there is limited information about this as well as plenty of reasons why this can be a more difficult birth option. Furthermore there doesn't seem to be any useful information about allowing first time mums to choose elective cesarean as a birth planning option.

My question is: Does anybody know how I would go about choosing a cesarean section for my first birth plan. (Before I discuss birthing plans with my midwife I would like to have every and all information at my fingertips as I want to be sure about what I need to ask for.) Also can anybody tell me if I go privately is this something that I can more easily achieve?

I am aware I sound like a complete coward however I am genuinely petrified by the idea of an natural labour.

I would be grateful for any advise or information anybody out there may have regarding getting an elective cesarean

Many Thanks

www.nice.org.uk/patientsandpublic/index.jsp?action=guidancesearch

Nice guidelines provide very Good information on the pros and cons of a c-section.

www.nice.org.uk/nicemedia/live/13620/57166/57166.pdf

Speak to your MW who should refer you to a consultant. The consultant is the person who will (or won't) give ELCS on the NHS the green light.

Bear in mind that NICE Guidelines are only guidelines and therefore don't mean that you will get ELCS on the NHS, even with the recent stories in the news, especially if you haven't explored other avenues first (perhaps counselling on your reasons for being petrified of vaginal birth, that kind of thing)

I had an elective section last October with my first child. I talked to my Midwife about it first and she referred me to see the consultant. Go armed with information about the risks and show that you've done your research about it but be warned that they will try to talk you out of it. As long as you're strong and show that you're an intelligent woman they can't refuse.

Thanks Jo178!
When you say 'armed with information' - I presume you mean the pros and cons of vaginal v cesarean births and why you would prefer to choose the cesarean option. Do you have any good recommendations for getting reliable information to support cesarean options as I can't seem to find balanced and reliable information via internet and else where ... its hard to put a strong case forward when you feel a bit in the dark.

Hiya :) There are good things and bad things about having a c-section.

My first child who was born in Nov 09 was an elective c-section but i did not have any choice in this. The side affects after this were very little and it did not take long to heal.
Although after my second i did not have a very good experience and it still affects me till this day. The spinal has given me very bad nerve problems and now pregnant with my third child and wanting a natural birth i have been told that this is not likely to happen.

I hope all goes well for you & good luck xx

HHi OP - I will try and be as helpful as I can. I had an ELCS for my 1st DC a couple of years ago - it's a long story but I had to be referred to a psychiatrist who diagnosed me with severe tokophobia, and recommended to a consultant that I have a CS.

Flisspaps is right - NICE guidelines are just guidelines. The media has been very misleading in implying it is a 'choice' available on the NHS. If you are able to go private, you will have vastly more choice about every aspect of your care - there are plenty of women here who have had planned CS's with private care, who I'm sure can provide recommendations. Be warned though - private care outside London for birth is virtually non existent (I'm not sure where in the UK you are).

It is impoossible to find 'balanced and reliable' info about CS's versus VBs. This is partly because it is a minefield of propoganda - partly because there are genuine gaps in research about CS's (probably VB's too). For example - when you find stats about Csections, they will almost certainly lump in emergency C-sections with planned Csections carried out for no physical medical reason. So statistics about maternal mortality, infant mortality and morbidity etc are all deeply skewed. Emergency CS's are just that - carried out because there is immediate and severe danger to mother or baby. Of course you will see significant health problems for that group after birth. A healthy mother and baby having a non emergency C section are in a very different situation and won't see similar outcomes. Can I back this up with research? No. There isn't enough. The NICE documents are probably as good as you get, and they are not a comprehensive survey of the risks or benefits, I'm afraid. Bear in mind too that MWs and HCPs will be giving you information based on this partial research.

Also, different women place different values on the same risks. I have a phobia about vaginal birth - some women have phobias about needles, and are terrified of hospitals and doctors, so as you can imagine, for them, CHOOSING to have a CS sounds insane. I have no problem with hospitals, docs or needles. I found my CS a fantastic, enjoyable and very moving experience. But that's why 'debate' about CS versus VB is nearly always emotive, uninformative, sometimes downright vicious and rarely enlightening. A lot of women just can't seem to imagine anyone wanting something they don't.

If you intend to get a meeting with a consultant and argue for a Csection, frankly it's pot luck, in all honesty. Some women have gone in and argued strongly in a 'lawyer' type way, and got what they wanted - others haven't. IME, consultants and HCPs in general dislike the idea of a patient 'demanding' a particular procedure - it can get their backs up. If your main reason for requesting a CS is fear of VB, you will need to be VERY clear about the strength of your negative feelings. You are basically arguing that you need one for your mental health, and need to convince them that the consequences of you NOT having a CS will be serious trauma.

You can ask to see another consultant if you are refused a CS by the first one, btw. The new NICE guidelines say that if you are refused a CS by a consultant, you should be referred to one who will carry out a CS. But of course, they are just guidelines... no one actually has to follow them.

Re: counselling - this is an option - in my case, I was already pregnant so there was a 'ticking clock', and the psychiatrist didn't think it would be effective. It would also cause me anxiety throughout my pregnancy, whereas having a CS agreed and in the diary gave me IMMENSE peace of mind. I'm not ant-counselling, btw - I've had it for depression and found it very helpful, but having been through the process, I'm aware of how it works, and that it isn't a magic wand.

Ask if there's anything else. I don't mean to sound negative - but I've been in a similar position myself, and the lack of meaningful research and info out there is very frustrating.

Hey there, I know the thought of giving birth is rather scary and unimaginable... but the reason they will probably try to talk you out of it is that it really is the more dangerous birthing option for moms who don't need it! It will only reduce risk if medically recommended, but increase risk of maternal death, infant death, admission into an intensive care unit, blood transfusion, hysterectomy or internal iliac artery ligation.

Our bodies cope with natural birth amazingly well, and there are loads of painkilling options to help you cope with it. Even though it hurt like hell, I'd recommend natural birth to anyone as an incredibly moving and emotional experience!

What about the thought of a natural birth is scaring you?

In answer to your question, yes, you can guarantee an ELCS by going private - I felt much the same as you and went to the Portland to ensure that I could have the birth I chose. You'll not find much support for this approach on Mumsnet though...but it's possible and highly recommended!

I've found MN to be very supportive re. Maternal choice for an elective.

Yes that is what I meant coco. I think a lot of consultants see women who, because of the celebrity culture within the media, think that a caesarean is the easy option, the 'Too posh to push' brigade. But I think if like me you have a genuine fear and you can show that you've done your research about the risks etc, they will listen. They are human after all! I had my elective caesarean before the new NICE guidelines came out and I didn't have to fight too hard to get one, I did read them thoroughly. The new guidelines state:
Dr Gillian Leng, NICE Deputy Chief Executive, said: “This guideline is not about offering free caesareans for all on the NHS; it is about ensuring that women give birth in the way that is most appropriate for them and their babies. For a very small number of women, their anxiety about childbirth will lead them to ask for a CS. The new recommendations in this guideline mean that these fears will be taken seriously and women will be offered mental health support if they need it. If the woman's anxiety is not allayed by this support, then she should be offered a planned CS. For women who ask for a CS in the absence of any clinical indication, physical or mental, the guideline says they should be asked why they are requesting the operation, and be provided with full information about the risks and benefits. They should also be offered the opportunity to discuss the procedure with other members of the obstetric team. If, after this, they still want to have a CS, they should be allowed to have one. Offering these women a planned CS in these circumstances is a very long way from saying that CS should automatically be offered to every woman.”

I was worried that being forced to give birth in a way that I found terrifying would affect the bond with my baby. I had already spent the best part of the pregnancy worrying about it. In fact my consultant scolded me for not having seen him sooner to discuss it so we could have planned the op and saved me all the worry. The female consultant I saw before him however was very unsympathetic. I recommend reading the NICE guidelines: www.nice.org.uk/newsroom/pressreleases/CaesareanSection.jsp

and also looking at this website as an advocate for caesarean birth: www.electivecesarean.com/index.php?option=com_content&task=view&id=350&Itemid=470

My experience of a caesarean birth was very positive, calm and moving.
My daughter was born at 10:31 Friday morning, i was up and about with minimal pain the same afternoon and we came home the following Saturday evening. I couldn't have asked for a better experience and I wouldn't hesitate to have another. Every woman should have the right to choose what birthing option is best for her. Good luck and please get in touch of you want any other info.

If you go private then you willl be able to have a CS regardless of any clinical need.

Try to get as much information as you can about the options and effects before you decide which to opt for.
I have had both traumatic VB and a lovely calm CS, but years on there are no effects whatsoever on my body from the VB (that I can detect), but the CS has left me with adhesions, numb patches and overhang. Obviously there are pros and cons to both procedures though, and what suits one person doesnt suit everyone.

www.csections.org/?page_id=13

I have had both my children by NHS ELCS (in the last 3 years) for no medical reason, both great experiences with quick recoveries. The guidelines have changed although I suspect it still isn't easy. You need to speak to a consultant as soon as possible as it's not a quick process. Good luck.

Hi there, I have found this link to be quite useful in fathoming the risks/advantages of ELCS and VB, in a low risk mother who has not had a previous CS. You will hear a lot of frightening statistics that go against CS; not much is mentioned about the benefits, other than you will know your baby's birth day on advance. There are, however, other benefits as well as some occurrences that seem negligible between the two birth options. Here's the link:

publications.nice.org.uk/caesarean-section-cg132/appendix-c-planned-cs-compared-with-planned-vaginal-birth

My own situation is that I'm 31 weeks pregant with our 2nd baby. I developed coccydynia (awful tailbone pain) during her delivery. I'm trying to decide whether to have an ELCS (my thread 'Coccydynia and second delivery - what to do' might be of interest to you).

Good luck to you x

Many Thanks for that reassuring message. I look into tokophobia further as I was unaware that VB is an actual phobia all I know is that I have been always terrified of the idea of VB and have put off having children as a result - although I am with a long term partner we never expected to get pregnant. Thanks you also for all the other useful information ... I will not hesitate to look into Private care if necessary.

Thankyou so much for your very comforting words... its really great to know there are people out there who understand and can help!

I should have specified the last message was for Jo 178 and the one before for fruity bread .... thankyou! thankyou!

I agree about trying to get an appointment to talk to a consultant as soon as possible. If they are unsympathetic or unhelpful, you can see another consultant for a second opinion. Don't let midwives fob you off - it is not their decision to make.

Private care is good as a back-up - it is expensive, but if you're prepared to pay you should have no problem finding a consultant willing to agree to a CS. If you don't want the expense of full private care, I believe there is an option to transfer to private late in the pregnancy just for the birth itself, and still have your ante-natal care on the NHS. Unfortunately I doubt tokophobia would be considered a medical reason for CS by insurance companies (though you never know, always worth checking if you have insurance). But personally I think even the full cost is worth paying if it's the only way you can be listened to, treated humanely, and not forced to birth in a way that is unacceptable to you.

Take my advice with a pinch of salt if you like, as I haven't actually been through the process yet (not actually pregnant yet!) but I have similar feelings about VB and this is my plan!

I'm a little different in that I had a very traumatic vaginal birth 8 years ago with my dd and I am now in the process of trying to persuade my consultant to give me an elective c section with this baby (I am 24 wks pregnant).

So far I have seen a consultant at my 12 week scan appointment and I was basically told that a "vaginal birth would be better for me" (grrrrrrr - after a 70 hour labour and severe pnd and ptsd???) and that a "normal vaginal delivery is always preferable" - well what happens when your vaginal birth isn't or wasn't normal?? How can you then compare that with a c section as opposed to a proper "normal vaginal birth" which in my eyes constitutes a birth less than 13 hours long, no assisted delivery and only minor stitching... Not like my experience at all.

Anyway I'm ranting, sorry.. Makes me so angry. I had a row with him about it and he's agreed to see me again at 32 weeks to "discuss it further". I know he's hoping that I'm going to have changed my mind and he will probably try and talk me out of wanting a c section but I'm going to fight tooth and nail to get one. I'm going to see my GP as well to make my feelings really clear that I do feel my mental health would be at risk if I did not get my request for a c section.

I think it's possible to get an elective on the NHS but my experience shows that you really do need to fight your corner!!

I'm expecting my first baby and im not very comfortable with a VB too - raised this with mw at first appointment, and at first she said NHS don't offer elective cs for all who asks for it, only when I mentioned the nice guideline and after some debate she reluctantly referred me to a consultant.

In the mean time, I was thinking what is causing me to worry about VB, and I think it's the negative press NHS gets in the news where women in labour are left to suffer on their own without much support, which resulted in complications or something even worse. (Redbridge hospital rings a bell) although this might be different between different hospitals, and i'm sure some people get great care from some MW, it feels like pot luck as to who you will get and also depends on how busy the ward is on the day. So I'm now looking into the option of independent midwife who can provide a 1-to-1 service pre natal and post natal. I'm happier to have VB a go if I know I'm in safe hands.

I think it all depends what you are worried about with VB.

There is lots of information on www.csections.org and the book 'Caesarean birth: a positive approach to preparation and recovery' is very comprehensive.

Uk guidelines are making it easier to request a caesarean but it is still dependent on whether or not your hospital has a ban in maternal request ones. NICE state that a practitioner has the right to refuse your caesarean but should refer you to someone within the NHS who will agree.

All I'd add to the great advice you've had here is to see what you can find out about how c/s can impact on subsequent pregnancies and births, as almost all the information and advice you get surrounding the vb versus elc debate tends to ignore this issue.

That's assuming you're planning on having more than one child!

Be very wary of discussing pros and cons of VB vs elec CS with your midwife. You'll find that they could talk for years about the risks of a CS but are strangely reluctant to be as blunt about the risks of a VB.

You don't have to ask for permission for a CS. If your consultant isn't willing to do it, then simply ask to be passed onto one who will. The current NICE guidlines are very clear about this.

With regard to private care, if you live outside SE England you are out of luck. There are no consultant led private maternity facilities outside the SE. None. That means you can only get a private ELCS in the SE. (And people wonder why the Portland has such a high cs rate compared to the national average...)

Which means you either will need to find someway of getting around the geographical problem or face the NHS lottery.

From what I've seen on here, some people have been able to get one without question, others have had a distressing and difficult time after being initially refused one before they eventually get the request granted and in a small number of cases are simply unable to get one under the NHS. Policy differs massively from hospital to hospital and between consultants.

If you are budgeting to go private, the Portland is definitely the most expensive option out there. There are private wards at several NHS hospitals. Watch out for what fees include/don't include. Antenatal care and consultant appointments aren't always. And if there are complications, for example if your baby needs SCBU, you may also face additional fees. I think the cheapest options start at about the £8000 mark for a problem free ELCS but depending on where you go or what you need you may be lucky to have change out of £15,000.

I actually disagree with HereIGo approach. I think such is the mood in many hospitals that if you go in with that type of attitude, there is a tendency to think if you aren't taking it seriously that you are easy to give the brush off. From what I've seen on MN, the most successful way to go, is armed with your facts so you can appear that you are taking it seriously, take your partner and get him to back you up... and if all else fails cry, ask for a referral to another consultant or ask to speak to peri-natal mental health midwife.

The "maternal request" thing is an odd term and the NICE guidelines are aimed more at the mental health aspect of a request than one for lifestyle. The trouble is hospital policy seems to be taking the attitude that maternal requests are about lifestyle and connivence when the reality is very different. This is why, if you are serious, pushing this aspect of your request is essential. It makes it a lot more difficult for them to refuse for a variety of reasons.

I do think Shagmund's point about the number of children you want, is one you do need to seriously consider. There is nothing in the NICE guidance about this which is unfortunate and to an extent is effectively glossing over a very important point - it could mean that some women are deciding to have an ELCS without crucial information. Also the NICE guidance points out that no research on the long term health effects on mother or baby from an ELCS just hasn't been done. This isn't about having a VB v CS debate. Its about helping you to decide whats the best option in your personal circumstances and what the consequences of any decision you make might be - an informed decision rather than a biased opinion.

If you look at the NICE guidance on the risk of death for a planned ELCS and a planned VB they are very similar - they were unable to say one was more risky - mainly due to such a small number of maternal deaths in the UK being so small that the data was unreliable. Childbirth in the UK is very safe for women. But have a GOOD look at the risk table as different complications are more likely for each planned mode of delivery. For example a hysterectomy is a slightly more likely with a ELCS (though the absolute risk appears to remain low), and there is a slight increased risk to your baby needing SCBU care with an ELCS. These might be something you consider unacceptable and make you reconsider your options. I don't know.

A lot of advance/guidance being given out there seems to be painting a very different picture from the NICE guidance. Bizarrely some MNetters have found a VB being forced down their throats and the CS risks pushed heavily by HCP - until the request is granted when an ELCS amazingly becomes very safe and nothing to worry about! My point is here, is not to push you down one route or another, but to make sure you are prepared to do your homework and question and challenge what you are being told in order to get your views listened to and your questions taken seriously. There are too many HCP who have their own agendas and unfortunately, in the case of maternal request ELCS, it seems its often at the expense of patients.

I also think its very important to consider your fear and whether you could benefit from counselling and potentially consider an VB and not discount the idea completely if you possibly can. What is it you are afraid of and are there ways you think you could minimise problems or be more comfortable with a VB. A doula, hypno-birthing, an independent midwife, a homebirth, cognitive therapy amongst others are options.

If thats a total nonstarter as your fear is too strong, then thats fair enough, but honestly none of us here know that, and it would be unwise for anyone here to push you too heavily to an ELCS without suggesting potential alternatives. We simply don't know the extent and severity of your fear.

This is a thread that I am very interested in! I am pregnant with DS1 and work in maternity at the local hospital. My mum told me to ask for an EL LSCS as she had 2 traumatic deliveries, and her thinking is that 'if you don't have to go through it then don't, ask for a section!'.Working in maternity does make you anxious. I'm terrified of having fetal distress and being rushed into theatre for an emergency caesarian and given a general anaesthetic. The thought of this makes my blood run cold. The fact that noone is safe from having fetal distress in labour and an emergency buzzer does not help!
I'd feel embarrassed asking for a EL LSCS where I work, incase people judged me or started gossiping about me and calling pathetic. I don't want to deliver in a different hospital. Don't know what to do.