asking for an elective c-section

[LucyJones]

I asked this on another thread but didn't get much response!! I thought that the NHS didn't give elective c-sections if there wasn't a medical reason. However on another thread there is debate about whether to have a c-section due to being scared about birth. I don't have a problem with this I just thought that it wasn't likely that a midwife or consultant would agree to this. Am i completely wrong?!!

Don't know if my post makes much sense. Was just wondering really if I can ask my midwife for a c-section because then it wil be easier to organise childcare for ds!! I was assuming she'd just laugh in my face but after the other thread now I'm not so sure!

Did you have a normal delivery with your ds?

Yes. That's why I was sure you can't just ask for one on the NHS. But on the other thread the original poster wants one due to fear of childbirth. Surely the NHS would say no?

I think it is highly unlikely LucyJ but would perhaps depend on the pressures on your local PCT. I know I have read previous threads about people being refused elective c-sections on non-medical grounds.

that's what I thought Miaou - I don't think I'll bother asking anyway!!

I posted on the other thread about SIL having an elective because she was scared.

They did agree in the end but m/w did go over it a lot before she agreed to refer her to consultant.

I imagine if you give your reason as being able to arrange child care, you may have more of a fight on your hands.

I was thinking more from the point of view that it will be harder looking after ds after a c.section and for longer,than if you have a straightforward delivery.

Good point.

We got an elected caesarian after DS1 was a scar emergency one.
Required us to be persistent, and not to rise to the patronising tone of the consultant.

He kept saying that we'd "probably" be OK. I replied asking in mathematical terms what that meant. (distribution, conditional probability etc), got silly answers. Both of us have done non trivial maths, but basically I believe it wa more down to Mrs. D saying she was a lawyer that swung it.
Was partly a staring contest. Every so often his students would offer to explain to us "what 70% means".

They do electives, just don't like it.

That being said, we would never ever consider a private hospital. The stats are truly scary.

That's the sort of analysis that we were hoping to get from our consultant, he was after all an expert.
I was left with a feeling that there is a "policy", and that he has to go through that sort of charade.

We knoew the general issues about later issues, but we were certain that DS2 was to be the last. We wanted an analysis of the risks, not to told that we ought to "give it a go".

I requested an elective c section for no medical reason. I initially told my midwife that i wanted to be referred to see my hospital consultant to request one. She didn't bat an eyelid nor did she in any way try to talk me out of it, although on the other hand she never even asked me why!

When I first asked my consultant, explaining my fear of sustaining birth trauma, 3rd or 4th deg tear etc she was very nice. Said that she had personally had 3 vag deliveries and would recommend that route but if I wanted a c-section then she would certainly not deny me one. We agreed that I would come back at 36weeks and if I hadn't changed my mind then I would get booked in.

As it happens I had emergency c-section at 32weeks because of severe pre-eclampsia, but that's another story.

I would go for it and ask if you think it's what you want. Giving birth should be about choice for women and I really believe that for some women elective c-section is the right choice.

I requested one. I said that I found the prospect of foetal distress, any type of perineal damage and mechanical delivery as unacceptable complications of vaginal childbirth for me.

Got the CS with no further questions asked

This pregnancy, said to midwife that I was having another CS.

The trick is state what you're having for your birth. Don't play the doormat and ask anyone's permission to give birth the way that you want. After all, it's you that has to live with the consequences of any birth - not the midwives or obstetricians!

The day they show videos of women undergoing an episiotomy or suffering a 3rd degree tear as routine practice in ante-natal classes - that's the day they remove their rose-tinted glasses as regards vag births.

DominiConnor, I am also getting some resistance from the consultant for an elective despite my first emergency section. Would you believe the statistic she threw at me: " 90% of VBACs in this hospital are successful without the need for any intervention" and I made her clarify that intervention meant "cs, forceps, ventouse". Apparently, I can even have a water birth!

Even though I am not mathematically inclined, I believe that she was playing fast-and-loose with her figures. If she was not promoting hospital policy, then I don't know what her game is. I allowed her to pressure me into attending a VBAC clinic.

Highlander, my attitude was all wrong - I was asking for permission. I should just say that the risks of VBAC are unacceptable - full stop. AND dh and I are both lawyers.

ooh, blueshoes - play the lawyer card. I was prefectly prepared to play the PhD card if necess. Fortunately my tone of voice must have been scary enough

Sadly, I find these midwives completely clueless when they try to quote statistics.

Lucy, have you read any of the threads about what it's like recovering from a cs? I find the idea of scheduling major surgery so you can organise childcare around it quite freaky tbh.

What about the fact that you'll have a guaranteed 2-3 days in hospital after the op? with a vaginal birth you could be home the same day.

Sorry but I think I've been a bit misunderstood on this thread - my fault entirely. I'm not going to ask for one because of childcare. I just was surprised that no one said on the other thread that it was unlikely that you would be given a elective c-section because you were scared.

Part of my unhappiness was that we "won" the argument. It was us vs them, not getting advice. Maybe we shouldn't have won...

Blueshoes Assuming the 90% isn't a straight lie, it leave open the following questions.
A bit thing is conditional probability, and forgive me if I explain that.
Nowadays, people have far fewer kids, so a large chunk of that 90% are women who haven't given birth before, so any decision needs to know the probabilities of various outcomes given your experience.

Questions to

1: What happened to the other 10 %
2: What % of them died, or suffered some non fixable issue ?
3: What % had to have a emergency casesarean which is a risky (and painful) procedure ?
4: What is the mean time for the arrival of a full team to do an emergency CS ?
Full is definedhere as including both a surgeon and anesthetist.

If they don't have these numbers, say that you are "surprised" that they are happy to quote numbers thatg support their asssertion, but are a bit vague about numbers that don't.

Bootom line, is the probability of a healthy mother and child greater ? And say that you would like that recorded.
Explicitly ask if they're going through a charde because of policy or their own personal judgement.

All that being said. I don't know what's right for you, and I emphasise my medical training is little mpore than first aid.

DominiConnor, thanks for that explanation on conditional probability. Probability was never my strong suit and you put it in words what I could only understand instinctively.

I will grill them on the 10% as you suggested. But I do feel 90% IS an outright lie. The consultant was talking about VBAC and intervention rate (which includes cs, ventouse and forceps). I don't believe that any doctor can give 90% non-intervention rate even for first time mothers or mothers in general. I cross-checked the figure with a obstetrician friend, and she agreed that 70% is a more likely figure and depending on the hospital, some even have a 90% intervention rate!

I know what you mean about feeling like I have to win an argument with the hospital, rather than getting proper considered medical advice and presentation of risks.

It is not just the risk of intervention that I have to consider (whether it be 90%, 70% or 10%), it is the magnitude of the consequences should I fall on the wrong side of it. eg, the risk of uterine rupture in a VBAC is tiny, but the consequences of that risk being realised are catastrophic for mother and baby. Similarly, they might tell me I am at low risk for a second emergency cs, or forceps of ventouse, but if I am unlucky, then the consequences are unacceptable to me.

No one can dictate whether or not a risk is acceptable to me because, as Highlander says, I bear the consequences. Which is what riles me when a medical professional tries to pressure me, particularly on grounds of policy.

I like your approach about saying I will record their advice on whether VBAC is safer for mother and baby. Another thing I will ask is whether they can guarantee that VBAC will be safe for me and baby. Of course they can't. But it would put the fear of litigation into them.

Sad that it has to come to this ... and I hate to bring my profession into anything.

you can have whatever you like. If you utterly refuse to give birth vaginally, they will give you an elective. You do need to be rather persuasive though and may need a second opinion etc.

Does that answer your question? (I admit I'm a bit baffled now about the point of this thread...)

blushoes that is exactly how I felt about vaginal delivery, that the magnitude of a risk as perceived by ME is as important as the percentage chance of that risk actually occuring.

DC, if they are all vbacs none of them will be women who haven't given birth before.

And how is an emergency cs (not crash cs) riskier than an elective? It's likely to happen slightly later in pregnancy so arguably the baby is better able to breathe unaided etc.

Maybe that hospital just doesn't have a very high vbac rate (i.e. lots of people who would have had an em cs if they'd tried for a vbac just opt for an elective) - maybe that's why they are pushing it so hard?

Or maybe they are just great at it and don't leave vbac women alone, flat on their backs and hooked up to monitors as so many hospitals do?

Blueshoes, have you asked for written evidence to back up the 90% figure?

Carolinamoose, I've been at both emergency and elective CS's and it seemed pretty obvious which is the more risky. Not least was hearing the phone call where the midwives were trying to get surgical staff to actually get there.
That's never guaranteed. There is always a finite number of staff, and if they're busy, they're busy. Hence my earlier comment about the mean time for complete medical staff to arrive.
Harlow hospital has a latex-free surgical unit.
One.
What if that's busy ?
I don't know how many is standard, but again, any non-scheduled procedure is going to dramatically increase risks due to resource conflicts.
My understanding is that almost all doctors are competent to carry out a CS. But that's not really quite the same as being someone who does it for a living, but he might not be available.

There is considerable preperation that can be done if you know in advance you are going to do any surgical procedure.
Also you have to factor in that the baby has undergone what they refer to as "stress" which includes non trivial risks of oxygen deprivation.

Also if you need emergency CS, you get it whether you are a high risk candidate for the procedure or ont, because else it's going to be very very bad for you both. That's because it's the lesser of two evils, and checking that your heart et al are up for this is part of an elective CS. Also of course after 30 hours of labour (our case), your ability to get through any sort of emergency procedure is degraded.

But I'm an amateur who merely read up on this stuff and who saw bad things nearly happen.

There are some things that are no-brainers, or where it's worth "having a go" in the words of our consultat. But you don't have 2nd chances with childbirth, and somne sort of bureaucratic political correctness is not the way to make decisions.

CarolinaMoose, emergencies are riskier than electives because they are done under extreme time pressure (in my case, the obstetrician yelled at the anesthetist that he could not wait 15 mins to administer the spinal and I had to go down immediately under GA) - risk of mistakes. An operating theatre with a fully scrubbed medical team has to be ready at the time the operation must be performed, for which there is absolutely no guarantee. There are greater risks associated with GA, including the fact that I was not starved for the procedure leading to risk of choking. Compare that to a nice calm elective where everyone is prepared.

It the hospital is prepared to give me written evidence of the 90% success rate, I would be very surprised, given the subjectivity of interpretation of stats/studies. I would ask for evidence, failing which, I would ask for this 90% advice to be recorded in my maternity notes - something which I know the consultant would baulk at because it is a red flag for litigation if things go wrong. Even so, I could still fall within the 10% and that in itself is not a risk I am prepared to take. Now if the hospital could "guarantee" a successful VBAC, that is different.

I feel sad to have to take such an adversarial approach. But I don't believe in the objectivity of the medical professionals in ensuring I have all the risks spelt out. But the reason why I ended up with a em section for first birth was because the hospital did not disclose the risk to me of first time mums being induced at 40 weeks ending up with em sections. It all has to relate to MY situation and risk profile and MY appetite for the consequences. And I have heard horror stories of non-VBAC vaginal deliveries coming out of this hospital.

It could be that this hospital is supportive of active birth and therefore has a high VBAC success rate. But bear in mind that however active a mother is at birth (and I was a proponent of this), babies (as my dd did) do go into distress for all sorts of reasons and need to be whipped out. So minimising risk can never eliminate it.

The fact is, there are risks to both sections and VBAC. But I am more comfortable with the former, not saying that applies to anyone else.

Write all over your birth plan that you want a planned section. Make it clear that if they deny you this section any and all complications resulting from natural childbirth will be a consequence of their decision, not yours. And tell them thay you have a copy of these notes. Stand your ground. Don't ask IF you can have a section. Ask what day it will be on?

If the consultant still says no, find another consultant.

I definately agree that 90% is unrealistic. Can you change hospitals? Perhaps you don't want to go somewhere that will be so very unsupportive.