Being refused an elective caesarean section - help?

[Smithy007]

Hi everyone, Merry Christmas

I've had two vaginal births, and the result has left me with what is now a mild-moderate bladder/bowel prolapse. On examination by a gynae I was also told I had a slight uterus prolapse which was 'normal' for women who have had children.

It has been nearly 4 years since my last child was born and I'm just over 20 weeks pregnant now. My prolapse has worsened significantly, I'm having lots of pain and aching and I'm finding it difficult to walk or stand for more than 10 minutes at a time. I also have a lot more difficultly emptying my bowels (TMI sorry).

I spoke to my midwife about my extreme anxiety and fear of further damage being done with this pregnancy and another vaginal birth and was given a referral. I did post in another section of the forum and felt very reassured with the helpful advice until I had the first appointment with a member of the consultant's team at the hospital yesterday, where she dismissed my queries about an elective cesarean literally within 5 mins. She told me that because I'd had two fairly uncomplicated births already they would not consider me for a cesarean, and that at my upcoming appointment with the consultant he would agree with her.

I am gutted, because prior to this pregnancy I was told that an elective cesarean would be an option for me, and now I am being told it is not. I'm terrified that I'm now going to be effectively forced into another difficult vaginal birth, and that my prolapses are going to become even worse than they were after my last. That itself was a difficult recovery and it has taken me years to get where I am now both physically and mentally. I really don't want to go through it all again and I'm feeling really down about it all. I'd just like any advice really because I feel like the meeting with the consultant is futile and I don't know how to fight my corner alone.

if consultant refuses, ask to be referred in to a cons who will do it. you have a right to do this under nice guidelines.

That's shocking tbh. Don't accept that decision. You have good reason to think that a vaginal birth may result in damage which would adversely affect your quality of life and may require some sort of repair not to mention the fact that the possibility is causing you stress and anxiety. Good luck.

If they refuse you can ask for a different consultant and/or hospital they cannot just refuse you especially with all the grounds you have. They might be trying to sway u off but u have a right to it and certainly a proper discussion about it

Thank you everyone.

I'm hoping the consultant will at least hear me out, because the woman I saw didn't even let me explain myself, and shut down the idea from the get go. I tried to explain about further damage being done to my pelvic floor, and her reply was "And you think a cesarean wouldn't damage your pelvic floor?" - urgh. I actually came close to tears because I feel like prolapse just isn't taken seriously by anyone I've seen so far in the medical field.

I'm planning on bringing my mother with me to my next appointment (she's a nurse) as support and backup because I feel she can better explain a lot of the complications I had as a result of my previous births than I can. I've also booked an appointment with the GP and will speak to the midwife about what will happen if I am refused, about getting a second opinion and possibly moving to a different hospital if I absolutely have to.

Ok, what witchesbrew said isn't correct. The NICE guidelines don't give you a right for anything sadly. Lots of hospitals aren't following them unfortunately and they are perfectly within their rights to do so.

What they do give you, however, is a damn good framework to challenge any decision like this.

You DO have a right to be involved in any decision about your care and to be properly consulted about any refusal of treatment. The fact that you were previously told you could have an ELCS gives you a very good case to argue, as the medical advice you were given previously may have affected your decision to get pregnant again in the first place.

I personally would definitely be asking to see a different consultant. Not on the grounds that you disagree with her decision, but because he has acted in a way that has not properly explained why she has decided to contradict the previous advice you have been given so has left you confused, upset, distressed and very anxious. THIS IS NOT ACCEPTABLE.

Even if you do not end up with an ELCS you need to know why this decision was reached so that you can feel confident in it and so you don't feel 'forced' into it. You need to feel that what ever decision is made is absolutely the right one for you.

From there, it does leave you in a better position to challenge the decision if you wish. It makes it clear you are suffering from anxiety over this and you have lost confidence in what you have been told because it is contradictory.

I would also try and find out the policy of the hospital on ELCS. Are they trying to reduce CS and do they have a 'blanket ban' on them? Basically are you be the unwitting victim of NHS politics or is the reason behind the decision medical ones.

If its the latter, then you will need to discuss the implications so you can mentally deal with this. Your mental health is as important as your physical health and if the thought of having similar problems to the ones your have had previously is causing you this must distress, the hospital have a duty of care to help you tackle this accordingly.

If the former is the case, it leaves you with the knowledge that you may have a fight on your hands and you may even want to consider going to another hospital which is more open minded. It makes you aware of whether your interests or the interests of the hospital are being put first.

You do have the right for the most appropriate care for your situation. If this means an ELCS is the best option, then you technically have a right to an ELCS. If they are neglecting this, by putting in policies which could have a negative effect on your health, you have really good grounds to fight your corner.

Being honest about it, you probably do have a fight on your hands given they are being difficult now. That said, I've seen a lot of threads like this which are similar and what happens is that they try and put as many women off an ELCS as possible but tend to relent after they are challenged by more determined women. There are a few hospitals who are just being impossible though. As a general rule, if you are prepared to fight, you will get an ELCS in the end one way or another.

Just because this first meeting has been off putting, it does not mean its the end and that the first consultant isn't basically lying through her teeth. Your meeting with the consultant is not futile. Your aim has to be to convey just why you don't think the previous consultant listened to you and understood why you wanted an ELCS. Just because you have given birth vaginally does not mean it has been successful, because if you have suffered damaged which has left you in such a bad state that it has let you struggling to cope both psychically and mentally on a daily basis this is NOT a good outcome. Do not accept what the first consultant said, because its clear this is not true to you. And your mental health is as important as your psychical health. This is what you need to stress and to ask, if they are not going to allow you to have an ELCS how do they intend to support you physically and emotionally with a VB?

The best way to fight is to be prepared to arm yourself with as much knowledge as possible and to have a partner, relative or close friend back you up when you go for your next appointment as it sounds like you need support rather than feeling you are facing this alone. It makes it harder for them to ignore why you are questioning the decision as it might give you the extra confidence to stand up for yourself.

Good Luck!

Cross posts

Just reading what you've said, in terms of damage to your pelvic floor, I believe that most damage is done with your first VB and that subsequently VBs may weaken it further but not necessarily. An ELCS as a means of preventing pelvic floor damage is therefore most effective for your first birth but only reduces the risk not eliminates it as it can be the pregnancy itself that causes problems rather than the method of birth. In subsequent births an ELCS may only have a limited protective effect, if any, as a result.

I don't think its true it every case. It depends on the extent and the type of the damage you have, but this might be where the first consultant is coming from.

I think you need to check whether this would be the case, in your circumstances, and to also consider whether your reasons for wanting an ELCS are purely about your pelvic floor. This way you can make an informed decision about how you feel about an ELCS. If there are other reasons, such as anxiety, this might give you more of a case for one too.

If the consultant had done her job properly, you might have had this information already, and it might make you feel differently to how you do now. Like I said before though, either way, it sound like you need extra help and support to deal with your psychical and emotional needs right now and you are being failed in that at the moment. I think the fact you don't feel your concerns are being taken seriously and you are being phobed off without understanding why are your biggest issue.

Thanks RedToothBrush your post has given me a good starting point when it comes to things to consider.

I think I will push to at least be given better explanation if I am refused an ELCS because a lack of explanation/support has really been the thing that has caused my anxiety. I'm pretty sure my prolapse was caused initially by my first prolonged and difficult vaginal birth, but was worsened by the second pregnancy/birth and it probably didn't help that my second child was 9lbs 5 oz and I had tears with both. I do know that I definitely didn't have any noticeable long term issues with prolapse until after my second child was born, so in that sense it has worsened and this is what my fear is based on.

The risks of a cesarean were briefly mentioned - that I would become a 'high risk' pregnancy, risk of DVT, infection etc. but I think the biggest problem I have is that no one can assure me that if my prolapse problems do worsen I won't just be fobbed off like I have been so far. Being under the age of 30, and already having 2 young children I really don't want to have to get to the point where it gets worse, or I end up needing surgery.

Saying that, I do understand that cesareans are far from being a walk in the park and for me this is really a last option because I definitely will not be having anymore children.

I guess I'm semi-prepared to fight my corner now, but will try to arm myself with as much info as possible like you said. I will keep the thread updated just in case it helps anyone else.

I've never been convinced by this shtick about pregnancy, not VB causing issues. As the proud owner of 2 cs I can tell you I have no ishoos downstairs and have never needed to do kegels.

Anyway, along the route I had a doc who didn't want to refer me for elcs. Her locum told me to 1) ask for another consultant and 2) print out any applicable notes from both RCOG and my hospital itself to support my case.

As per above I got my elcs although I don't think it was agreed until 28 weeks because of the pillar to post stuff.

It may help to put your wishes in writing in the form of 'this is my background and therefore here is my birth plan and I would like a c section. And yes I understand the risks etc'
This is what I did after seeing a dismissive consultant, I wrote to her colleague. He emailed me back the same day and said I am happy with this and booked me for a meeting specifically with him in which my ELCS was then booked.
Putting things in writing is powerful stuff and I think you have a good case for an ELCS.

Good luck

no I said under nice guidelines you have a right to request a consultant who would be willing to do it. They all have diff opinions. I didn't say you had a right to a section.

sorry, see what you mean.

nice guildelines are followed in our area so wouldn't know anything about that.

we have cons that will refuse but will refer to other willing cons if requested.

suppose it depends on your area.

Is it possible that, if you're brushed off when you make a request, you immediately reply saying that you'll make the request again, formally, in writing and will be expecting them to provide a written explanation of why they're not going to grant your request?

I find this situation so strange because what if the third baby gets his chin stuck or has the shoulder thing, wont that cause even more trauma? I mean its a risk isnt it?

If you have issues down there...wont the labour simply increase the risk by dint if being ...un predictable labour?

I mean, no one can guarantee the baby will fly straight out in a simple un complicated manner...which is sort of what an ELC guarantees you...

A c section will cause you short term damage whereas labour has caused you long term damage with the potential to cause more...

Anyway as you said the lady didnt even listen to you....

FWIW in my hospital, I was pushed to the sort of closest one, its closer by a mile possibly...I insisted on going to the other hospital despite my MW moaning to me ( more paper work).

I did quite a bit of research on the two main consultants there, using MN nad google..I found out that one was a witch who sounds like your lady and one who was amazing.

I was booked into see the amazing one BUT, I discovered actually either one of them covers the appointments, so I sat sweating to see the right one!

I did and everything went well and I got my section no problems and it was the right thing for me, but had by fate I simply got the other one, it could be a different story. I had a small vignette of the other one just as we were about to go in for the ops, and she was horrid.

SO...by a small twist of fate, your fate is being decided. I would kick up a stink, say how nervous you feel, not the best mental state to go into labour with, terrified, can they put in writing that your inards wont be damaged by third labour...and why and so on..google the consutlants names, do tons of research, can you try another hospital, look on here and so on.

Sadly as Red says, I do not trust the NHS anymore for basic medical advice on this issue...I trusted my consultant as she was a member of the birth trauma ass.

Following up to mydarlingclementine, during my elcs (which I needed to push for) it was discovered my baby was so severely wedged in that they needed a ventouse to get it out via the section hole. My mw told me after "good call" - the baby would never have arrived vaginally, just mashed up my insides and needed an emcs anyway.

Don't have any direct experience here but just wanted to say - go and see your consultant with an open mind. I've had a lot of experience dealing with consultants and their teams in another field (fertility treatment) and have more than once felt fobbed off/dismissed by their registrars who won't listen and are patronising and/or downright rude. I've then had follow-up with the consultants who have a completely different attitude and will either agree to what you want (often without hesitation) or will clearly articulate why they don't recommend x, y, z in a way that doesn't make you feel like a naughty schoolgirl. My point is that more junior team members tend - IME - to stick more rigidly to the 'rules' or 'guidelines' or 'good practice' or whatever, whereas the more experienced senior guys tend to be much more flexible, they've seen it before and generally have a better bedside manner. Good luck.