Been refused an ELCS (DC2) - advice please

[Sallypuss]

With DD1 I was induced at 40+12 had a long unproductive labour resulting in EMCS. DD was a largeish baby (9lb 4oz) with a large head and she simply got stuck.

I am currently 36+5 with DC2 and want to do all I can to avoid a similar birth which was long, incredibly tiring and quite traumatic for us. I was referred to see a consultant at 17 weeks to discuss an ELCS/VBAC. In the end the consultant was running late for her appointments and I saw one of her registrars. I was adamant at the appointment that I didn't want VBAC, that I understood and accepted the risks of CS and that my strong preference was for ELCS which the registrar accepted and documented in my notes saying I should return at 36 weeks and they would book me in for CS.

Went along to my appointment yesterday with DH in tow, not expecting a done deal but the consultant's opening gambit, without listening to any of my rationale, was that she wouldn't support an ELCS, that my case would go before a hospital panel on Thursday but that VBAC would be my only option. I felt the consultant to be dismissive, abrupt and downright rude. At this point I saw red as I had not been given the opportunity to outline my wishes or my rationale, which I told her in no uncertain terms but was so taken aback that I started to cry. I feel very strongly that my case has not been 'heard' or my views taken into account. Since I gave birth to DD1, we have moved house and so will be giving birth at a different hospital and despite saying at my 17 week appointment that they would request my notes from DD1's birth, when I asked the consultant yesterday, this had not been done so I don't believe they are taking a decision based on fact.

Only after I got upset did the consultant offer a growth scan which was done yesterday and showed that DC2 is 'normal sized' but with a head circumference at the 93rd centile! I'm not confident though that the consultant or the panel will take this into account when making the decision tomorrow.

Whilst I appreciate I have no 'right' to an ELCS, I don't feel I've been given any opportunity to represent myself (or my body!!) in the decision making process and at 36+5 I'm running out of time to do anything about this. I really don't know what to do next (particularly if I have to have VBAC) and any advice would be much appreciated.

No advice but I had a similar labour to yours 10 days late, 16hrs, 5 spent at 8cm dilated, was allowed minimal pain relief as they said I was in transition, baby couldn't fit through my pelvis and had to have emcs. I've been reassured next time I could have elcs, the idea of getting to 36 weeks and them arguing it is terrifying, I hope if you can change consultant next will be more reasonable. I don't understand why they are bring so difficult to you.

I'm likely to be in the same position - my take on it is that it's better to have the fight now (ie while pregnant) rather than when you're actually in imminent labour.

My consultant similarly didn't seem to have read my history, didn't listen to what I'd said (that I was not being induced or augmented again, no matter what), and wanted to dictate to me what would be done to my body - including prescribing medication with no indication I can see for it, no explanation of why (well, she thrust a leaflet at me, which explained nothing).

Do you have a midwife you could get on side? At my hospital there's a VBAC midwife who you could talk to who might have some sway with the committee? The supervisor of midwives should also be able to point you in the right direction I think.

You need to kick up a fuss now. Don't wait.

Poor you :( IMO you have been treated very shoddily. Definitely fight, ask to be referred to another consultant today, one without such dogmatic views. Know your stats re uterine rupture etc from reputable sources like rcog and nice. Involve patient liaison advisory service (pals) Take your dh or friend for support. Involve any sympathetic hcp eg midwife or gp. Change hospitals if necessary. I went through similar and now have my elective booked. Good luck

Sorry I do not have time to elaborate too much but you do have a "right" to a c-section. You do not even need medical grounds to request it. Your body, your choice ultimately. Wave the Nice guidelines in their faces now! You do need to kick up a fuss asap though. I am not sure though through whom/how you need to get your concerns accross. Sorry not much help there. Good luck!

Is there a antenatal mental health service at your hosp? I would speak to them about how traumatised & stressed you were after your last labour & ask them to support your request. & the Supervisor of Midwives. I hope you get it sorted soon.

So annoyed on your behalf now that I looked up the guidelines: "An obstetrician unwilling to perform a CS should refer the woman to an obstetrician who will carry out the CS" - they cannot

You can find the guidelines here:

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

This is my worst nightmare. I was two weeks over due, had a 72 hour labour, was given three shots of pethidine on the ward because there was no room for me in delivery suite. I eventually ended up with an EMCS three days after being admitted to hospital. If and when we decided on DC2, I will do so on the basis that there is no chance I will have to go through that kind of trauma again.

You are entitled to an ELCS as far as I know. Check the latest info on NICE and talk to your midwife and GP. Make lots of noise.

I have everything crossed that you get the outcome you want.

sorry posted too early. they cannot just decide on your behalf. They need to refer you to a sympathetic consultant who is prepared to carry out a c-section.

Sorry, to say this but the information on this thread is incorrect. You are NOT entitled to a CS. Nor do you have a RIGHT to an ELCS. Very Sadly. And in spite of the guidelines. Its been really badly reported and talked about in the press and it has misled women about the real situation.

This is the thing. The Nice guidelines are just that - guidelines. Which means they can be - and are being - routinely ignored by certain hospitals in an effort to cost cut. (Ironically something that the NICE guidelines says isn't true and isn't actually proven. They went as far as saying that a CS should not be refused on cost grounds).

It really depends most on the policy of the hospital you are now at. Some are just being prehistoric in their attitudes to this ignoring NICE, whilst others are actually taking on board the reasons why women are asking for ELCS and reflecting the research that was considered and reflected by NICE.

From the threads I've seen on here, if you are getting a hostile reaction, you need to fight and in some cases, I mean FIGHT. Get informed, know the NICE guidelines backwards and forwards and be able to clearly state all your reasons for an ELCS. Do not take no for an answer. Do not accept being fobbed off. Demand a response you want.

These panels don't seem to be a good thing; they seem to result in more negative responses than those that don't have them. I've got to be honest; I think they are a way of bullying women by making it look official and considered, when they already have made up their mind. And they hope that they will make women back down if they say no.

That said, I've seen very few women who are that desparate for an CS not get one. So please do not give up, until you are happy. Push and push until you are happy. Sadly, it does happen though.

I would recommend looking at www.electivecesarean.com. The lady who runs it campaigns for the right for an ELCS. I know in the past she has helped ladies, who are facing particular resistance about getting an ELCS. (She also has a blog at www.cesareandebate.blogspot.co.uk/). If you get really really desparate, she may be worth getting in touch with.

Good Luck. I hope things go your way.

It would be a good idea to contact the PALS (patient advice and liaison) service at your hospital and tell them your concerns. It should be easy to find the PALS number on the hospital's website.

Definitely read the NICE guidance- the hospital don't have to follow it but as the guidance is considered 'best practice' you can ask why they are not willing to.

I hope you get it sorted out quickly, it must be stressful and I'm not surprised you cried!

Thanks all for your support and information provided which I will review and research. I had a scheduled midwife appointment today and she was very sympathetic giving me the direct line of the PALS manager, details of the Supervisor of Midwives and also telling me to stand my ground. She's scheduled another appointment next week so we can come up with a plan which is comforting if nothing else.

I'd get the stats (rcog have a paper on delivery following CS which is good) - pick out the points relative to yourself I.e those that make you higher risk for VBAC and simply say you are not willing to accept the increase risk of uterine rupture for example and if they decline you they have to accept all liability for forcing you to VBAC and if there is ANY resultant damage or distress to you or your baby you WILL be suing them. Put it in writing if need be to the board making the decision (about your body and baby grrrr). Hard ball deserves hard ball!

An update and a thank you to the wonderful mumsnetters who supported me on this thread last week. I met with the consultant today to discuss my case and due to the marvellous advice posted here and elsewhere on mumsnet I researched both the RCOG guidance and NICE guidelines and was able to confidently argue my case for an ELCS and have been booked in for ELCS on 20th June. Exactly the result I wanted.

well done!

Excellent update- well done!

Yay you :) Really pleased you got the result you deserve x

WelL done, very pleased for you!

Well done! Mumsnet is amazing for providing this sort of support (I fought for and eventually got my ELCS in 2012 with wonderful mumsnet advice).

The real shame is the untold stress and anxiety caused to so many women like us, pushed to fight and fight again until we get what we know is right for us.

(And don't get me started on the "increased cost". By the time you add up the treatment for my physical and mental trauma, subsequent breakdown, DDs readmission, incontinence investigations and any potential damages awarded for the scarring of DD from my 1st delivery my ELCS was a bargain by comparison. The only thing that being forced to have a forceps delivery did was push the increased cost into budgets other than maternity.)

In the US they refuse to do VBACs for insurance reasons.

In France and Switzerland insurance companies pay up for elcs a Cs without question. It's considered indicated. Not the only option but something reasonable for the mother to choose.

In England ... I understand they are under pressure to encourage VBACs as a cost saving measure. and you got unlucky and ended up with a VBAC fanatic. Most stories we read here are the opposite - women push for VBAC and consultants drag their feet.

Blondecat interesting post but it is actually the same issue isn't it? Doctors and midwives imposing their views on women when it is women and their families who end up living with the consequences.
I bumped this to give a bit of hope to the person who is fighting for CS at the Chelsea and Westiminster as the OP got her c/s in the end by standing her ground.