Want a C section, but cant convince doctors, what do i do?

[Jessi28]

Can anyone give me advice? i'm desperately scared of natural birth. My granmother was permanently disabeld by birth. My Aunt and sister both died in childbirth. And my own mother had such a horrific experience she rejected me completely.After a 5 day labour, massive blood loss and literally dying in the delivery room and having to be resusitated. And my whole life has been blighted by it, as 28 years later she still hates me for it. I always wanted to be a mother, but always thought i'd adopt till i found myself pregnant. The problem in my family is the size of head. We all have babies with larg heads and we seem to have narrow pelvises. I'm only 28 weeks but my baies head is huge measuring nearly 35 weeks already. Meaning to me its inherited to same characteristics that have caused so many problems to my family. The doctor told me today they wont do a c section till it becomes medically necessary. As childbirth problems are'nt genetic. Meaning i'm traumatised as i feel like i'm on death row i cant enjoy my pregnancy or form a bond with my baby.As i believe i'll never know her. I genuinely believe it is medically necessary. But they wont even address that. Preffering to lecture me, rather than offer reasurance that what i'm concerned about is not an issue. I think they think i'm jsut hysterical, and need mental help. But would'nt anyone with the history i have feel the same way. And instinctively want a c section. Or at least to be reasurred, and have their medical concerns addressed. I asked to referred to someone who'l listen. But got no respone what do i do?

There is definitely a postcode lottery when it comes to birth and ELCS in particular, and it is not fair.

OP, it would cost ££££ to have a private CS but I totally understand why you might want to try and raise the cash. If that would be really financially difficult for you what about getting enough for an independent midwife (in the absolute worst case scenario they insist on trial of labour)? Then you would have someone there the whole time advocating for YOU, but who can argue on an equal professional footing with the staff at hospital.

An independent MW would also be able to minimise the trauma for you by helping you understand what was happening. Though of course an elective section would be a very simple way of minimising the trauma for you! Hope you get one.

VivaLaBeaver

The guidelines clearly state that if the woman requests a cesarian, the pros and cons of the procedure should be discussed and she may even be referred for counselling. They also clearly state that if after discussion "a vaginal birth is not acceptable, offer a planned c section".

To me that sounds like while women can't obviously force any HCP to perform a cesarian, if a vaginal birth is completely unacceptable to her she must be referred to a different consultant who will perform the procedure.

Nowhere in the guidelines does it say that it's ok to flat out refuse a request for a cesarian.

viva
www.nice.org.uk/nicemedia/live/13620/57163/57163.pdf

I quote from the guidelines-

"When a woman requests a CS because she has anxiety about childbirth, offer referral to a healthcare professional with expertise in providing perinatal mental health support to help her address her anxiety in a supportive manner. [new 2011]
For women requesting a CS, if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned CS. [new 2011]
An obstetrician unwilling to perform a CS should refer the woman to an obstetrician who will carry out the CS. [new 2011]"

Certainly, they are just guidelines and not a mandatory legal document so they can be overlooked. However, the guidelines themselves clearly state that if a VB is unacceptable, the woman must be referred to a consultant who will carry out the cesarian.

Which is exactly what I've said.

That women can't force a dr to follow a guideline as they're only a guideline. As opposed to a legal obligation.

I did tell the op that the guidelines say to refer to another consultant. But again they're only guidelines.....plus what if at your hospital all the consultants say no.

Even a legal right wouldn't get doctors to perform cesarians if they didn't want to.
My point was that the guidelines do clearly state that if a woman asks for a cesarian and cannot be convinced otherwise then she should get one. And if a doctor doesn't agree, he should refer her to someone who will agree. That certainly sounds like the right to choose IMO. Of course this is up against a doctor's right to choose not to perform a procedure he/she doesn't agree with.

If all consultants at a hospital say no (unlikely), she should get referred to a different hospital.

If only it were that simple, eh?

Sorry to hear of your situation op. Ask to be referred, and speak to a consultant about this. You will still have to fight for it, but DON'T give up.

I had a c section with my dd, after my second pregnancy (natural birth) ended with my bladder giving up for 5 months due to the pushing stage. I had to fight them all they way to give me a section though, but it was totally the right decision for me and my Daughter.

Please stick to your guns. Your reasons for needing a section sound perfectly reasonable to me. Good luck.

I find that asking them to put things in writing often shakes out the medical opinion from the personal opinion.

viva

It's not simple unfortunately because in the global maternity care model, women's choices hold very little meaning. Here in 2012, we still believe that epidurals are 'bad', cesarians are 'unnatural' , that childbirth is 'good suffering' and that women cannot be trusted to choose cesarians or anything else which doesn't fit the mould of what is expected and accepted.

Bloody shame.

narkedpuffin
what would she request in writing in this case?

Passing kidney stones is 'natural', but people aren't as keen on encouraging others to do that 'pain-free.'

The confirmation of what was said to her before - that she can't have a cs in spite of her medical history, her fears and her request to have one.

And what I said earlier - handing them a copy of a written medical history of her family along with her fears about the birth - so that they are fully aware of the issues.

Jessi, I have not read all of the comments on here but wanted to let you know my experiences. I have had 3 elective sections, first was maternal request I explained to the male consultant that I was terrified at the thought of a vaginal birth as mother had had awful time with me and subsequent sibling and needed emergency sections. Wasn't keen to have that type of birth. Section agreed without problems. Second pregnancy, female consultant, absolute cow who pushed for a VBAC and would only agree to organise a casearean if I promised to encourage the unborn child I was carrying, if it was female to have a vaginal birth I got on my high horse and wouldn't agree to this and phoned up and asked to be changed to a male consultant who agreed without problems. Third section, again male consultant agreed as expected to a section without problems.

So, gather your info. and go in armed with it. Ask local people who have had sections which consultant they were under and find the most 'pro or sympathetic' to sections, hope that makes sense?

Best of luck

viva

"It's not simple unfortunately because in the global maternity care model, women's choices hold very little meaning. Here in 2012, we still believe that epidurals are 'bad', cesarians are 'unnatural' , that childbirth is 'good suffering' and that women cannot be trusted to choose cesarians or anything else which doesn't fit the mould of what is expected and accepted.

Bloody shame."

Great post Viva BUT what is so disturbing is, as Pink says, MALE health care professionals seem more sympathetic - I've noticed that before!

It's female midwives and obstetricians who cause the problems and don't respect women's choices.

Why is this?

Sorry, whatthehell meant your's not viva!

Have you considered accepting a referral to perinatal mental health, as well as requesting a change of consultant and getting MWs on side? That way they can't beat you with the not cooperating stick AND it sounds like that might be helpful anyway.

I hope you get the best outcome for you, whatever that is.

Ushy

I agree, it's extremely sad that male consultants are more sympathetic. Whatever happened to sisterhood and understanding each other's pain? :(

Maybe it's a bit like "I suffered, why shouldn't she?" or "If I could do it what's her problem?".

Fractal I agree that is really practical advice but isn't it insulting that the OP has to 'prove' she has a mental health need to get a c/s.

It is appalling. Her relatives have suffered the REAL world problems that can arise from vaginal birth. I am sure the OP would agree that she is really distressed and 'on the brink' over this but I certainly do not think she is not mentally ill.

It is the mysogynist maternity services which do not respect women's rational choices that is sick.

meant "but I certainly do not think she is mentally ill. "

OP this might sound like odd advice but in your position I would go down the mental health route. If you go to your GP and explain clearly your level of anxiety and the fact that you're finding it hard to accept your baby because of your fears, he/she will see that your concerns are in fact affecting your mental health and that they can't be dismissed so easily by the consultant. Tokophobia (fear of giving birth) is a recognised condition and can't so easily be ignored by health professionals. Once it's there in black and white that mentally you can't face up to giving birth vaginally, if they insist on you having a vaginal birth they will be in a very dodgy position with regard to negligence. If your fears are down as a medical condition (as in phobia, anxiety, depression) then they are a recognised risk and need to be taken into account.

It sucks, yes, but the OP does seem to be requesting a CS on mental health grounds - her anxiety about giving birth. So it makes sense to go with that because as the PP said they can't ignore it so easily.

I don't think that maternal request - as in 'just because I want one' - will ever stand up.

I agree with CailinDana - go down the mental health route.

I'm not saying this is ideal, and given the whole issue of a woman's right to choose etc, it seems strange that you have to convince a consultant or whoever that you are mentally ill in order to get a CS -

However, from a purely pragmatic POV, it may be the most useful route to go down to get a CS. Arguments about family experiences of birth don't really count for anything - and presenting the pros and cons of a VB v CS as far as they apply to you as an individual might work, but only if you get a sympathetic consultant. It really is a lottery, and as others have pointed out, the guidlines are JUST guidelines. No one HAS to follow them.

Given that you are clearly very anxious about this, I would flag up urgently via your GP or consultant MW that you consider this to be a mental health issue, and ask to be referred to psychiatric services. They might well offer you counselling/CBT etc (which you can explore if you want to) but given that you are already pregnant, and none of these techniques are guaranteed to work, esp at speed! then it may well help you to get a CS.

I had a CS for my first due to phobic fear of childbirth. I had to get a recommendation for a CS from a psychiatrist. It was all fine, although ironically, it was still recorded as 'maternal request' on my notes. Which made a couple of MWs behave in a quite a hostile manner towards me (only a couple, I had a v supportive community MW and consultant MW, to be fair).

Lots of health care professionals seem to think 'NICE' is only guidance and you don't have to comply with it.

Noooo......only partly true and very very unwise. It lands lots of Trusts wiht big bills!

From my day job (no I'm not skiving - day off) - following NICE guidane will usually exonerate but if you don't follow it, you will have to justify why.

Suppose the OP got refused a caesarean, gets totally distraught, has a breakdown, is admitted for psychiatric care and loses her job. She sues.

The Trust will have to provide evidence of WHY it did not follow NICE and in my experience they seem to want medical reasons. e.g Mrs Smith was a special case as she has a bleeding disorder and it would not have been in her interests.

What isn't acceptable is 'we only follow guidelines we choose to' or 'it might cost more'.

That's really interesting Ushy. Would it be sensible then (here and elsewhere where NICE guidelines are not followed) to ask consultants or whoever to give a clear reason WHY they are not following NICE guidelines?

(I'm thinking at the point of negotiating treatment rather than way downstream at the legal end!)