Refused El LSCS at Chelsea & West - advice please.

[DevonLulu]

My wonderful sister, who is currently 22+5 with first baby has a rational and coherent evidence based reason for requesting an Elective LSCS. Both she and her husband are doctors, and she is making an informed decision which she has painstakingly researched prior to coming to her decision.

She met with her consultant yesterday, who was exemplary in his professionalism, listened to her case and engaged in empathetic and highly respectful discussion with her and her husband. He stated that her evidence was correct, her reasons level headed and rational and that in her case, he agreed with her decision. He would in principle like to support her decision, but in practice, there is a blanket ban on C&W performing Elective LSCS for maternal request.

I do not wish to go into her reasoning for asking, but needless to say, she does not fall into the C&W criteria for El LSCS. He is aware of the NICE guidance, but C&W choose to ignore the guidance.

She has been referred to the Perinatal Mental Health Team, but she is neither Depressed, Anxious nor in need of mental health support. Her argument is rational and evidence based and this fact can not be changed. She is willing to attend but not willing to lie or make up anxiety that does not exist.

Has anyone else been in a similar situation. She is going to write to the Obstetrics department, the Chief Exec and PALS. She will comply with the perinatal Mental heath assessment and her consultant has agreed to see her 10 days after the assessment to re-evaluate the situation.

Does anyone know what else she can do? She feels so strongly about this, not to mention let down be her profession.

Many thanks in advance

[littlemrssleepy]

there is a blanket ban on C&W performing Elective LSCS for maternal request.
This is the issue. It's not completley clear from the op, but this line suggests that the reasons, whilst rationale, are based solely on maternal request than any medical reason. I don't know of any Nhs hospital (I was a business mgr for a maternity unit) that would give an elcs based solely on maternal request for one simple reason - their commissioner will have stipulated this and will not pay them for the treatment if it goes ahead. There has to be a medical or psychological reason. Hence why some trusts will try and get round it by referring to psych.

[RedToothBrush]

Except NICE actually recommend that ALL women should be allowed access to an ELCS EVEN IF THERE IS NO MEDICAL INDICATION, because refusing to do one potentially has psychological implications, even if the woman concerned does not have a history of mental health issues.

Everyone seems to be neglecting this aspect of the guidance, quite conveniently because this backs up their ingrained views about CS and women who choose to have them.

The reality is there are women out there who simply due to their age are in a situation when their statistical chances of ending up with a CS is not far off the flip of a coin. Their chances of having a VB without intervention are even lower. Yet they are not allowed to choose the risks; they HAVE to go for a planned VB with all the associated risks for a instrumental vb or an EMCS.

It doesn't make sense to deny women the choice as in any other medical situation where surgical intervention might be a possibility they would be given options. This is the problem and we REALLY need to get away from the idea that its not a legitimate and acceptable request to make.

[Doodle1983]

I agree! And to say that drs need to practice delivering twins naturally would not have my backing either !!!

[littlemrssleepy]

Toothbrush. Yes. But that needs to be taken up with the commisioners not with the hospital trust. As a general rule, a hospital can't carry out treatment if it knows it isn't going to get paid for that treatment - it will end up in financial dire straits.

[littlemrssleepy]

Chapter 2 of thisexplains in simple terms how finances work in the NHS - although PCTs have now been dissolved and their replacements are Clinical Commissioning Groups (CCGs).

[RedToothBrush]

Trusts also have a duty of care to patients though. If their actions are effectively pushing 'a problem' elsewhere causing considerable stress and anxiety in the process and into another Trust's budget, then they are failing that patient and they aren't taking that duty seriously.

Even if they are under constraints within their budget, if the decisions they are making have serious consequences to patients they are liable for that. There is a case to be made about rights of access to appropriate care that have the potential to, ultimately, if someone choose to fight it, bring a legal case against the Trusts doing that if the issue is recognised by others as being detrimental to patient care. The fact that NICE have said quite clearly that they believe that refusing access to an ELCS could cause psychological damage, only adds weight to the argument.

At this moment in time, I do think that there are a number of Trust's taking the gamble that no one will challenge them in this way. Until someone does and has the finances behind them to do so, they'll get away with it too unfortunately. But then we've seen that be something that has been repeated throughout the NHS for a number of years and the culture does seem to be 'don't take responsibility for something if you can possibly help it'.

[amandine07]

DevonLuLu
Thank you for replying...congratulations to you as auntie and your sister!

I am so pleased that she got the outcome that she so desperately wanted- it's just an awful shame that her local trust had to make it so difficult for her!

Sounds like she had to seek out another trust who did take he concerns seriously & were prepared to do the necessary referrals in a timely fashion.

My experiences so far have been nothing but utterly positive, th

[amandine07]

...posted too soon!
Have had nothing but positivity from my local trust- they did all the necessary things, took me seriously, absolutely no fobbing off.

CS now booked for when I am 39 weeks
It felt like such a weight had been lifted from my shoulders!

Initially the baby was breech, then flipped- I was a bit gutted about this...I know it's usually the othe way around, women are desperate to get breech to turn!

Although during my last scan last week, baby was breech again...was hoping this would be my indication for a CS!

I the end I pushed through for a as on maternal request- had to see 2 consultants- who were nothing but lovely, understanding & ready to explore my reasoning.
Plus they referred me to a psychiatrist who was equally professional and we had some totally frank discussion about my fears.

I should add, have never had any contact with mental health services. It felt like a formality though- I was questioned intently by all clinicians I spoke with, however, it seems that luckily my local trust does NOT have a blanket ban on maternal request CS.

The h

[amandine07]

It's awful that it has to be this way, especially when being refused a CS can cause such psychological anguish & distress.

I was surprised at how smooth the process was and could see that the initial consultant put all the motions in place to get referrals & appointments in place v quickly.

Also he reassured that if I were to go into labour prior to 39 weeks the CS would most definitely be done- I knew this would be the case, but it was still a concern of mine.

The threads here on MN have been so helpful, this has allowed me to relax and really enjoy the last few weeks of my pregnancy- thank you to everyone!
Especially LittleRedToothbrush

[amandine07]

Doodle1983
Good luck with your efforts & whatever you decide eventually, the most important thing is being taken seriously & having your fears taken on board and explored thoroughly.
My fingers are crossed for you!

[RedToothBrush]

Brilliant news amandine. Hope all goes well.