barbar123, I think your circumstances are quite complex and I think its wrong that you have been refused an ELCS in the way you have. It should have been explained to you better so you feel listened to and properly informed. From what you've said it does sound like you don't feel like you have been given enough information to understand why they are saying what they are.
It is true that NICE have recommended that women be allowed an ELCS on maternal request, if they want one regardless of medical need. They particularly focus on anxiety though. It does sound like you are extremely anxious, but I'm not sure that anxiety is your main issue here. I think its whether you think might have more damage to your coccyx which is a slightly different kettle of fish. I think you need to look at what exactly your fears are and why you are considering an ELCS though to determine whats really motivating you.
In terms of your BMI and a CS, there are definitely more risks than normal and think you need to give them careful consideration before you push for an ELCS.
The most recent NICE guidelines also make a point that they do not recommend an ELCS for women with a bmi of over 50 on the basis of their BMI alone. Now obviously you are not this big, but I think its relevant to you, because it does seem to show that NICE can't see a benefit to ELCS for BMI. I think its possibly worth asking a few questions about why this is.
From what I can see in the data in the document it doesn't seem to show its better (or indeed worse). In fact the only conclusion that really seems to come out of it is that the quality of research is generally poor. Which isn't particularly helpful to you. But they certainly didn't feel that they could recommend an ELCS based on BMI and thats after they weighed up the potential risks.
Reading what you have said, it seems that one of your biggest fears is that you are worried that you will end up with the worst case scenario of an EMCS and that you are at elevated risk of this due to your BMI. You might be, but this isn't as straightforward as it initially sounds. Are you looking at data that is for first time mothers and/or does it take into account previous births? One of the best indicators of whether you are capable of giving birth vaginally, is whether you have done so previously or not. In your case your doubts about whether you possibly more reflective about how you feel about the birth rather than the statistical chances of you being psychically able to. (That doesn't take into account whether this will cause you more damage to your coccyx though). You say you are quite convinced you will fail at natural birth but you have succeeded in the past. In terms of the 'logical choice of a ELCS', given your circumstances it is perhaps less logical than you might want to believe. You probably have a better chance than you are currently perceiving.
Indeed all the comparisons between planned VBs and planned ELCS in the NICE guidelines are based only on women who have had one child. On balance NICE say that women should be allowed a ELCS on maternal request on the basis of this information as it is comparatively safe. However, this data is misleading to women who have already had children, and it doesn't give a true picture of the risks to women who then have a second child and this is the major criticism of NICE's recommendations. It means that the NICE guidelines make ELCS look better than they should for women who have had a VB.
Having a higher BMI does have certain extra risks. I believe the main two are problems with anaesthesia (more likely to fail) and wound infections.
The rate for wound infections for all types of CS for all women is 9.6% but it is disproportionately higher in women with a high BMI or under 20. Women with a BMI of over 30 are over 2.4 times more likely to have an infection than women with a normal BMI (and the risk is higher, if your BMI is more than that).
Now having said all that, I am definitely pro-choice. The point is you need to be informed to make that choice. And thats where I think your consultant has failed you. It sounds like he has told you what they are going to do, rather than properly explain why it is more difficult and risky for them to do an ELCS and why given the risk of an EMCS, they feel it might be better for you to attempt another VB anyway.
I think in order for you to go ahead with a VB you need better support and advice than you have been given. And I think to go down the route of an ELCS you need better information about the additional risks than I can give you.
So thats what I would be saying you should be pushing for, rather than an ELCS as such at this stage. I would also be pushing for a referral to someone who can give you more information about how likely further damage to your coccyx is. What you may find is they say that once the damage has been done, it is unlikely to get any worse and that may influence your decision. The fact that you say you are confused and feel powerless are actually the issues you have right now and thats because you have been given inadequate advice and support. You might want to consider changing hospitals for this reason, rather than perhaps whether they will perform an ELCS or not. You have to have trust in the people who are caring for you and believe that they will involve you in any decisions about your care, which clearly doesn't seem to be the case here.