If first birth was EMCS can they force you to have 'natural' second? What happens if you refuse?

[Pinkflipflop]

Do you have the right to refuse 'natural' delivery after a section?

Are you allowed to ask to be referred to another consultant?

Sounds extreme but what would happen if I refused to have natural delivery?

You can't refuse a natural delivery, as that is what your body will (attempt to) do.

What you need to do is discuss delivery options and work out what is the best plan. The circumstances that led to your previous EMCS will be a factor, as will the progress of this pg. Generally, VB is safer, but all factors need proper consideration.

In November 2011, NICE published new guidelines which allow you to choose a section. Hospital trusts will likely make you see a couple of consultants and probably counselling as well, but you DO have the right to choose a c section birth. Have a read of the [[http://www.nice.org.uk/nicemedia/live/13620/57163/57163.pdf NICE guidelines - you need page 15) and take a copy with you to your appointments!

Proper linky here you need p.15.

I was told I would only be 'allowed' to labour for 6 hours second time round (EMCS first time). I refused a sweep and induction and was told if I was overdue I would have a CS. All discussed with a very sympathetic consultant. Yes, ask to change consultants.

When I fell pregnant with DC3, I was asked at y booking in appointment what kind of birth I was thinking about (I had elective CS with DC2 due to placenta praevia) I said VBAC, which they were pleased about. In the nd I had an elective CS booked for DC3 (placenta praevia again) but ended up with an emergency one a week earlier.

It may depend on the gap between DC, a cousin was refused VBAC when the gap was less than 2 years.

It should be your choice. If not ask to see another consultant. You can opt for an ELCS, usually from 39 weeks, but need a back up plan if anything starts sooner ie CS or VBAC.

It's not as simple as natural is safer after a previous CS though as it depend what risk you're looking at. I found the RCOG guidance very useful here to help me make my decision and also arm myself with justification for it if challenged (although I haven't been).

Technical answer to this:

You do not have the RIGHT to a c-section under British law. However if you have medical reasons to have one you should get one and you have the right to the appropriate medical attention in this country.

Which actually makes the situation very unclear rather than simple and straight forward!

Whilst NICE update to their guidance says all women should be allowed a CS if they request one even if there is 'no clinical indication' (Note: this is not a RIGHT as it has been widely publicised in the press), the NICE guidance is only advisory and many hospitals have actively dismissed it and are following a policy of deliberately going against it in several respects.

Further to that, what constitutes a 'medical reason' is wildly open to debate. At the moment, many doctors only consider a 'medical reason' to be something that is physical. Even the NICE guidance, whilst stating that the reasoning behind their update is to reflect the fact a request for a CS is very often for mental health reasons or that being forced to have a vb against your will, in some cases, results in damage to mental health, term requests for a CS on these grounds as being for 'no clinical indication'.

Other doctors are considerably more progressive and living in the 21st Century and realise that mental health considerations are a health reason and a very valid reason to at least consider and take requests for a CS a lot more seriously - and women who do request a CS should be given extra support so they feel comfortable with a VB or should be granted a CS if they still feel unable to go ahead with a VB.

So in terms of a VBAC, yes they can theoretically force you to have a VBAC, because its not a medical procedure so you don't get a choice about consenting to it, as its what will naturally occur if they don't intervene even though there is risk attached to it. It can and does happen - rather more frequently than it should be.

More practically though, if you adamant you want a CS the chances are you'll be able to get one. You might find it easy, however you might be refused initially and find yourself with a real battle on your hands. If you have a consultant who is being obstructive - CHANGE. I've seen loads of women on here be in a situation with an unsupportive consultant, who have managed to eventually get a CS after seeking a second (or third) opinion.

The truth is, the reality of this at the moment, is that it doesn't matter whats in the NICE guidance. Its a total NHS lottery about what your local hospital policy is, and what the attitudes of the individual staff you see are.

Good luck, I hope you end up either managing to get proper support you need to have a VBAC or getting the CS you feel you need. If you get neither you are being let down and not given the care you do have a RIGHT to.

I am so that these kind of threads pop up regularly.
Sorry you are worrying about this, OP.

Hopefully you will not find yourself in any kind of confrontational situation and will have a consultant who will listen to you, understand your concern, discuss the pros and cons of an elCS vs VBAC with you. Yes, CS is a very safe procedure, and VBs carry a risk too.
As far as your indivudual risks go, a lot will depend on why you had a emCS first time round and how likely it might be to run in to similar problems again.

Yes, you can of course ask for a second opinion from another consultant or hospital.

Because CS are proper operations with all the risks inherent to any operation (the main ones being bleeding and infection) everybody inolved in your care will want to be very certain to make sure you are making whatever decision for the right reasons.

FWIW, I had an emCS with DS2 at 31 weeks. When I was pregnant again I was fully prepared to fight my corner 'demanding' a go at VBAC and had my wind taken out of my sails by my consultant saying 'We'll with whatever you are more comfortable with' . I appreciate my experience has nothing to do with what yours might be, but do try talking to those is charge of your care.

IMO and IME HCP rarely go out of their way to pick a fight for no good reason, and not in the context of pregnancy/delivery.

I really hope you get the delivery you are happy with.

I had an elcs recently after an emcs first time. I was straight up asked if I wanted vbac this time. I said I'd consider it but I wouldn't make a decision then and there. I decided on an elcs after reading their literature! They did try to talk me out of it, then a different medical condition played up which made me determined to have one. They agreed to it but the reason they put down was my previous emcs... A friend also had elcs as she was so traumatised by the events leading to her emcs first time. Be prepared to fight a bit for it.

I knew I would need to have a planned cs with DC2 for medical reasons. However the midwife at my booking in apt poo-pooed me when I mentioned it and said the consultant would decide. Obviously he was just as keen as I was for a planned cs .

Once you see the consultant you can talk to them about it, midwives aren't the ones who decide.

Please don't think about having to consider your position as 'fighting for it' - I don't think it is wrong to weigh up the pros and cons, rather than going with a gut feeling, possibly after a horrible first experience.
I am saying this in general, no specifically to the OP.

For the record, I think it is appalling that women still don't always feel that their wishes and preferences were listened to wrt to their labours and deliveries. Childbirth is inherently a 'risky' process (anyone remember the thread about all the things that can go wrong with animals giving birth?? The mind boggles....). And no birth plan in the world is guaranteed to give you the delivery you want.

I wish all pregnant women could feel that their MW or consultant is 'on their side' rather than some kind of 'opponent' . And that nobody ended up feeling coerced into one mode of delivery or another.

I had an emcs with my first and when I got pregnant again was simply asked if I wanted an elective section or a vbac and they would support me either way.

Forgot to say I didn't even have to see a consultant,just the midwife and I was under midwife care.

I was given a completely free choice this time. I was told what was statistically safer for me and the baby with my background and why. (A VBAC.) I was told what could happen to change that (long labour or needing to be induced) and we discussed what to do in those circumstances and we discussed the risks of the VBAC.

But I'm the end I was told it was completely up to me.

I was also told I could go away and think and come back if I wanted but I didn't as my instinctive desire matched the advice.

I was given a free choice after CS with DD1 for placenta praevia. The fact that the 'natural' option would have to include CFM and no pool option meant I opted for a second section (which I am quite please I actually did)

Genuine question, so don't all have a go!

Why do some women who've had a CS first time want one so much for the second time? Is it dangerous to give birth naturally after a CS?

Why is the choice given?

Curious as I gave birth naturally the first time (well, as natural as induction and forceps gets!) and just presume that next time you're back to square one regardless of what experience you had first time round?

For a lot of women the events leading up to an emcs are traumatic and many don't want to repeat it.

Theres also things like going from a 1 in 5 chance of needing an emcs to less than 1 in 3, far higher likelihood of uterine rupture, etc. The stats dont tell a pretty picture if you're that way inclined.

When they handed me that leaflet I knew vbac was not the route I was going down given the stats and dd's birth.

Frisson - for me it was that I knew what to expect with a CS and it was fine. I didn't feel any 'need' to give birth naturally, so went with what I knew.

The 'danger' can be scar rupture and hence they want continual monitoring. If I was going to give a VBAC a go, I wanted to try a water birth and they wouldn't allow this after a CS as they couldn't continually monitor. I felt this would be the start of a 'cascade of intervention'.

Also, the risk of uterine rupture during labour after a previous EMCS is very small, but it is there. If you know someone who it has happened to with the subsequent fall-out, then that will colour your judgement, whatever the stats.

I was given a choice, I opted for a VBAC but ended up with another EMCS.

Frisson - because I can't face going through 3 days of absolute hell again. The emergency section at the end of my unsuccessful induction was the best part of my hospital stay.

And to Pink Flip Flops - I've prettying been offered the choice between an ElcS and a VBAC. I do have to attend a birth choices clinic to discuss in more detail but have been warned that this is very much a box ticking exercise.

It's been great to read the replies on this thread; really appreciated.