Can you be forced to have a natural birth by the NHS?

[Naisy]

Hi all, first time I've posted on this thread and currently only 22 weeks but feeling a little anxious with Chelsea and Westminster. I have somedehydrated discs and an annualr tear in my lower back from a car accient two years ago that gives me trouble with my sacrioliac ligament also. The last 12 weeks have been very painful with back and pelvis / sacrioliac pain as I've started to show and my centre of gravity has shifted.

Initial consultant told me to bering in my MRI and a letter from my spinal consultant and osteo. Then this consultant said that wasn't good enough and I'd need to be independantly assessed again by C&W. That won't happen for 6 more weeks so when I asked her what the possible scenario was if they said try natural she wouldn't tell me. Which made me upset initially and angry later. She said it wasn't possible to just 'choose a c-section and the hospital had to get it's numbers down'. I didn't 'choose' to have a car accident and some days be in so much pain I can't walk either (this occured to me later).

So, long way to say, can I be forced to have a natural birth?

Five girlfriends over the past few years have had natural births that ended in emergency c-sections and that's not a route I want to go down. I'm terrified more damage will be done to my back and the idea of back spasms (which are blindingly painful) coupled with labour makes me want to vomit.

Do I have any options?

Not currently considering suing the hospital post birth as an option! Want to make sure I have a planned and managed c-section...

The short answer is that you can't 'force' them to agree a planned section (just like you can't actually force doctors to agree any treatment plan) but the NICE guidelines are on your side and, with a medical history like yours, I would have thought it was mostly a question of seeing the right consultant and getting it agreed. I am sure others with more knowledge will come along to help you work out how to do that.

Try not to worry yet, you have lots of time.

Don't panic yet, I know this is a frightening time and you'd like to be in control of your labour options-all quite normal. I would start with your midwife, you can book an appointment and discuss your choices. You can put your foot down if you feel things aren't going the way you want them to but obviously be prepared to listen to their arguments. Getting the numbers down isn't a sensible reason to refuse a planned c-section for someone with a history of back problems but there may be other options you can consider first like epidural.
Best of luck xxx

Naisy I was in a similar position to you. It was difficult and a hard-won slog but the good news is that I did manage to have an ELCS via the NHS for my second baby. It was 'Maternal Request' mind you, not the fact that I have a tailbone condition (an injury from DD1's birth).

I urge you to read my thread here www.mumsnet.com/Talk/childbirth/1401146-Coccydynia-and-second-delivery-what-to-do as it's essentially a diary of what processes I had to go through, as well as how I was faring emotionally.

FWIW, the ELCS was a wonderful experience - one that I preferred to VB and would do again. Please do ask if you want to know more. X

no you can't be forced

don't let them pressure you

you sound like you have got more than enough grounds to be granted a caesarean. but IME you have to be FIRM.

Ok, in answer to your question. Yes you CAN be forced to have a natural delivery on the NHS. HOWEVER:

1. NO HOSPITAL SHOULD BE TRYING TO GET FIGURES DOWN PURELY FOR THE SAKE OF FIGURES. Take issue with this. The current WHO advice on C-Sections is that anyone who needs one should get one. There is no target rate - they got rid of that. There is no target rate in the NHS either. Don't be bullied just to fit with targets. Hospitals should be focusing on the appropriate treatment for each and every patient. Rates should not come into it. If someone tells you differently, start quoting WHO at them - they are not up to date with this, and hospital policies should be about the best interests of patients first, not the latest report on the hospital. Sadly, too many HCP do not know this, including a lot of people in positions of authority who are making these policies.

2. Go and read the NICE guidelines on c-sections. This is your Bible. Learn them backwards, forwards, upside down. They are more aimed about the psychological need for an ELCS, but they do have important recommendations that you can use in your case. They are guidelines and no hospital is obliged to follow them. HOWEVER, it does make it very difficult to outright refuse you a c-section if you are prepared to push for it. Legally they are opening themselves up to problems if you have issues after the fact and made it very clear you requested a c-section. Hospitals do not like this. Litigation is bad for their precious figures too...

3. Get yourself over to www.electivecesarean.com/ for good advice and information about the situation. There is plenty on there about busting myths and all this talk of targets.

4. Going by what other people have said on the same subject, appearing like you have fully researched and understand the risks of a c-section, going supported with a partner who supports you helps your case a lot. As does turning on the waterworks, which in most cases where people are determined and really feel like they need a c-section and are being denied one, tends to be a pretty natural reaction.

5. Prepare for a fight. You might have to be really pushy about this and might need to push for second opinions, write letters, just generally make a fuss. Don't take no for an answer.

6. Don't give up! I've seen countless thread here where women have been told they can't have one, only for them to eventually get their request granted. It can be difficult and it can be extremely stressful, but it is possible to change a decision. There was a lady a few weeks ago who was 36wk and was being denied an ELCS after previously being told elsewhere she could have one. She got it in the end (If you are out there Daya I guess you would be due around now - thinking of you and hoping its gone well!).

Good luck. The guidelines are on your side.

This is who you need to see for help with your choices for childbirth: Supervisor of Midwives - info here

What annoys me about this is HCPs telling you about stats and 'getting numbers up or down'. What's that got to do with anything?! They should be assessing each person on a case by case basis to understand what is the best birth for that lady, couldn't care less about your numbers and that shouldn't be driving a decision either way so totally irrelevant.

I'd be questioning their ability to make independent medical decisions if they're making comments like that.

Not sure that was helpful but good luck :)

With the amount of damage to your back you discribe - are you hoping for a general anaesthetic for the section? You should be wary of letting anyone near your back with an epidural or a spinal. Maybe for that reason a natural birth would be better for you.

So sorry . Glad that lunar posted (waves manically!!) - I recommend reading the thread. What did your spinal consultant recommend? If there was no outright recommendation for ELCS (and this is what you want) can you go back to him/her and discuss what's happened and what he/she believes is in your best interests? Can you get your spinal consultant to shout at C&W for you? Do you know what his/her letter said? If he/she does believe ELCS is in your best interests and that VB is inadvisable can you get a more strongly worded letter to go back to C&W with?

X

I think you've generated some sage and practical advice from this thread, Naisy, which bodes well and prepares you for the decision-making processes (and likely possible obstacles) you have in front of you.

Another important thing to mention is that it's a good idea not to let the various HCPs who you will come into contact with encourage you to labour using an epidural. If you have an epidural, you'll have no idea what's going on with your spine and whether you're doing more damage.

My worry was that I'd feel something going wrong with my back during labour, panic, not push as necessary and then have to go to EMCS, which carries increased risks against ELCS. It's why I actively avoided 'trial of labour' sugestions, too. If the trial goes tits up, you're right there in an EMCS situation.

I reckon MRI scans are going to be useful when presenting your case. Ibwas not referred for MRI by my physio, so the suspected disc damage I may have had will remain just that, and I couldn't use it for my case in the absence of the scan. If C&W are still reluctant, though, remember that you can still switch hospitals. If I'd been denied the ELCS by my OB when I saw him at 35 weeks, I would have demanded to be referred to another OB. If that would have failed, I was fully prepared to have the mother of all diva strops and demand to swap to another hospital. I had the backing of my DH and advise that you have someone strong with you to back you up. It can be draining.

You must stand your ground if you decide that you want an ELCS; demonstrate that you know the risks and are prepared to take these risks.

FWIW, there's an excellent book available from amazon that really helped me called Cesarean Birth: A positive approach to preparation and recovery by Leigh East. It contextualises the risks of CS without all of the guff that HCPs mix all the info and stats up with.

Right, I think that's it for now. Do keep us informed of your progress x

Oh, and my spinal anaesthetic for the CS was wonderful. The injection was sited in the ares of my spine around my waist (so nowhere near the tailbone/sacral area) and a slow, liquidy numbness took over ... So no more pain for a while from the old coccyx. Lots of lovely morphine for a couple of days afterwards, then a good 10 days worth of codeine and paracetamol to help with recovery. I certainly didn't have the luxury of those drugs when I couldn't stand up or sit down properly in the few months after my VB!

Spinal anaesthesia is small fry when weighing up the pros and cons in your situation. It doesn't really come into it.

YES. I am similar to u. Have sacialic joint inflammation. Rotated
Pelvis and spd. No way im ever having a vaginal birth again. It could permanently affect my ability to walk. If ur lucky a consultant may agree to an elective c section. But generally they wont approve it. Im having one privately as its too risky. Nhs are on a budget and their medical advice is very much driven by that budget. I would say do it privately if u can.

Thanks for the wealth of advice ladies! It's Immensely helpful. I'll start arming myself with knowledge ASAP. Knowledge is power after all!

Billy, I'll also look look into private costs as a back up - good idea. I do have BUPA but the mothers life basically has to be at risk for them to cover you!

Will report back with progress updates for those interested too...

Bupa paid for all three of my mum's sections. The first shes not sure why she had, second was breach and third was cos the other two where. its worth a try...

Hi, thought that since everyone had taken the time to give me such thoughtful advice I'd post an update on my situation for others who may find it useful...

I've just come back from my appointment with the Chelsea & Westminsters own spinal consultant. Went armed with knowledge gathered based on the fabuluos advice in this thread. Talked though the situation, had an examiniation and have been recommended to have a c-section!

Feel so relieved the decision is made, I thought I'd have to fight and really wasn't looking forward to it.

I think the key things that helped were that I'd had an MRI from before I fell pregnant so my injury was already 'documented', as was the history of treatment. The consultant knew my own regular spinal consultant and clearly must respect / like him / trust his judgement. Ultimately, the conclusion was (whilst there are the standard c-section risks);

A vaginal birth was an 'unknown risk' that could go well or go badly and the c-section removed the risk of further damagaing my back. And, when it comes down to it, the view was why take such a risk?

I think this was pretty similar to the ultimate reason Lunarlyte reached for having a c...

What stuck me was the spinal consultant and her registrar seemed completely at ease and aligned with what my own view was - and they suggested it, before I had to ask. There was none of the pressure I had encountered in the ante natal clinic from various midwives and consultants. I feel like we've the reached the most sensible, logical conclusion from a medical perspective, with none of the drama that had previously accompanied some conversations about it.

So, a very happy result for me!

Thank you all for holding my hand and showing me where to find more information to make an informed decision and, of course, for sharing your own stories!

Well they cat force you into a natural birth but they can refuce planned sections and they can refuse epidurals etc if they want to,but i dont imagine many would.
You sound really anxious about it,the worst thing you can do is go into this being really scared.You could always see how it goes?Start off naturally and try gas and air and then move up from there?Go into it with an open mind and you could be suprised!

Oh sorry didnt read that last post!

Nasiy

So glad you got the outcome you wanted! I have found Mn invaluable on putting forward RL c section experiences that arnt generally out there in literature....they have been very very helpful to me too and I got my ELC granted with no fuss or arguing at maternal request AND with a previous labour that was textbook and read like a second time labour not first.