Requesting an ELCS

[Warpaint]

Looking for some advice - after a lot of thought and research we have decided that an ELCS would be the best option for us (family history, health) and as I am swing the OB Consultant tomorrow I was just after some tips as to how to frame my request in order to avoid a big fight about it!

Am booked in at C&W in London so am sure they've had these requests before, am unsure of their local policy.

Thanks in advance....

*swing = seeing, bloody autocorrect!

Hi there. It really depends on your doctor. I had an ELCS approved by my consultant at Queen Charlotte's very very easily, but then I would have had to be induced at 37 weeks otherwise due to health problems so I had a good argument. The most important thing I think is to know your rights and go in there making it clear that it is a well thought through decision and that you have done your research. Read the NICE guidelines thoroughly. The thing to keep in mind is that they no longer actually have a right to refuse you an ELCS as much as some doctors will make you think otherwise! If, for whatever reason, your doctor refuses your request, they now have a duty to refer you to another obstetrician who will not refuse! If they try to give you safety statistics, make clear that you do not want information for ALL C sections, just ELCS. They often lump ELCS and EMCS statistics together which skews things massively for obvious reasons.

www.nice.org.uk/nicemedia/live/13620/57162/57162.pdf

Legends, both of you - thank you!

Just so you know that family history has been researched and shown that it doesn't mean you are more or less likely to have a difficult birth. I was surprised to here that, but apparently true. It could be used as an argument against you, if you chose to use it, so be aware about the truth of this one.

Thats not to say its not a valid point to make as long as you do frame it correctly. The problem is more that if you have negative view of childbirth in general - which could come from the experiences of close family members - this may be causing you a great deal of anxiety about it.

Bare in mind that extreme anxiety about childbirth IS a valid reason to have an ELCS and this is in the NICE guidelines.

It will probably be put to you that your options might be to either tackle your anxiety or go for an ELCS.

P.S. Despite what VickyU says, you do not 'have a right' to an ELCS. Its been really badly reported. NICE is merely recommendation; hospitals are not obliged to follow NICE's guidance and many are not doing so. It does give your argument more weight, but it is not a 'right' as such.

FWIW I THINK if memory serves me correct C&W is a hospital which is more favourable to ELCS requests than a lot of others. It did have one of the highest rates of ELCS in the country. It may be under more pressure to reduce that as a result though, and that rate may also be in part a reflection of the local demographic (a much higher maternal age particular for first child) and the rate included numbers from their private wing (which will distort things as there are a limited number of private maternity wards in the country). But I think you'll probably find it easier to get one there than many other places as a result as the consultants should have a more pro-ELCS stance.

Good Luck.

Thank you Red ...

I successfully requested an ELCS with DC1.DC2 then followed and DC3 will also be ELCS.
I had a sympathetic consultant.
My main reasons were 1) age :was 35 and risk of interventional delivery increases after 35,failure to progress is more common.
2) Fam

Sorry,was saying..
2) family history; of unexplained still birth at term which gave me anxiety about going past 39 weeks.
3) worry about complications in labour
4)My medical background..had seen a bit too much of things not going well ( applies to all types of delivery though so made the whole idea of how to deliver a v difficult one for me personally).
5) my expectations of not having a large family : 1-2 sections ok,after that more likely to get complications each time.
Consultant did not try to dissuade me,merely point out the pros & cons of normal v ELCS and agreed that risks were quite finely balanced between both methods of delivery for all the above reasons if only having 1-2 children but if wanted big family would not advise ELCS for 1st delivery.
Told me to go away and think about it and come back at 35 weeks to give final decision.
Went to NCT,read a lot,thought a lot still decided ELCS.
Here I am now,expecting DC3 in a few weeks by ELCS and due to the recovery and the fact that I have 2 young DCs to look after as we'll,I can't say I am relishing the thought of yet another ELCS with the risks of surgery and the frustrating recovery period afterwards.
Yet at the time,with DC1,I still think it was the right decision for me.So a good consultant( and I know at C&W the section rate is high) will point out the pros and cons,give you more info & time to think,and ultimately make it happen if you are making a fully informed decision.

Thank you Beatrix , excellent advice.

This will prob be our only child, I'm 38 (will be nearly 39 at delivery) and both sisters have got lifelong complications as a result of difficulties at delivery. And I have a diagnosed heart arrhythmia and we don't know how it will act in labour even though it doesnt bother me on a day to day basis, so.....we shall see how it goes!

Coming at this from the same position as a mother who wants a homebirth against normal hospital protocols, I don't see why you should have to persuade your consultant that a c/s is better for you or have to argue your case. You simply have to say that you would prefer to have one. Say you would be happy for them to set out the pros and cons for you, listen and then tell them that on the basis of the information they've given you you would still prefer a c/s. Get the supervisor of midwives and PALS involved if you come up against any significant resistance.

Thank you Fabsmum - I shall just request it, set out my reasons why and deal with any response as it arises....