Can they refuse a C-section?

[DownstairsMixUp]

Hi all,

I am currently 21 weeks pregnant with my second child. I am high risk due to epilepsy and i had pre clampsia with my first pregnancy and a PPH where I lost 2 litres of blood. It was quite traumatic. I went into have a sweep at 40 weeks and found my BP was sky high and protein in urine, they told me to go home get bags and come back to be induced. When i got back I was already 5cm dilated but they broke my waters and were concerned about BP so stuck the drip on me. I went from 5cm to 9 pretty quickly (less than an hour) it was horrendous. I had no time to take any pain relief apart from gas and air, I wasn't allowed the pool room as they worry I'll have a fit in the water and they wanted me flat on my back all the time incase I fitted. I felt very confined and the experience was something I don't wish to repeat. During pushing the head kept coming down but wouldn't come further so I had to be cut then had him delivered via ventouse, straight after I bled and had the crash team called and was ill for weeks and weeks after. This all mucked up my convulsant levels in my blood to and i had constant seizures for 3 months after the baby was born till i could be seen by a neuro so couldn't even be left alone with my baby for that time either.

Anyway this time I have decided it would be better for me to have a c section. I know all the risks as I have worked in hospitals but it is what I've decided for many reasons, the thought of giving birth naturally again makes me panic and they have already told me I'll have to go to labour suite, no birthing centres, no pool room again, my family live miles away so having a date and not waiting round when i could go overdue for 2 weeks means I can get help from family coming down and booking time off work IF anything does flare up from the epilepsy to. I told the obsterician i wanted one at my 13 week check up she said "think about it more" and didn't even put it in my notes then yesterday I saw her again and she's said she won't refer me to a surgeon wants me to think more but has scribbled I have mentioned it in my notes.

I feel like they are just pushing me and waiting for me to just do what they want and I really don't want to. I am not scared of the pain, it's the whole experience I don't wish to go near again and feel I am better suited to a c secton this time because of my health problems. I plan to breast feed etc as they have told me i will have trouble if I have a c section (??) can they refuse to give me one??

Hi op and congrats on your pregnancy. I'm sorry to hear what an awful time you had first time round.

Re planned section, Short answer: no they cannot refuse you

However some nhs trusts really seem to push mums to be towards vaginal births, as yours is doing. which is probably to do with saving money

However, I have had my 3 dcs all by section, all my choice. My first one was for psychological reasons (fear of childbirth) then my next ones were because it's generally thought safer to have subsequent sections once you've had one.

However, being granted the first section (with dc1) was a real battle as neither midwife or gp took me at all seriously. I was young and I think they just thought typical first time young mum but my fears were way beyond that of first time nerves. I saw 2 different obstetricians plus a psychologist, I really argued my case and showed proof I knew all the risks etc. eventually they finally agreed to a planned section when I was 34 weeks, (to be done at 39 weeks.)

If I were you (if you haven't already) I'd push for a referral to an obstetrician because ultimately they will be the one having the final say

And good luck, I'm sure with your history you'll be granted one no problems. (Another option of course is to go private but iirc I looked at private prices and it's around £15k )

Unfortunately I disagree with the above poster. Yes they can refuse you in theory.

However this is EXTREMELY rare (I've only seen one case on MN so far).

Many hospitals will strongly try and push you into having a VB though and may even be obstructive or discourage you by saying that you are unlikely to get one. If you come across this, then you may need to fight your corner, but ultimately they do almost always allow one eventually. Its more rare for them to say you can have one straight away (though this does happen). A lot of hospitals won't approve it until after 30 weeks, creating a lot of unnecessarily worry and stress.

The NICE guidelines are actually in your favour though. They support women who ask for an ELCS - especially for psychological reasons which might be the angle you might want to go down (which is why in the end hospitals find it very difficult to refuse in the end).

If you really want an ELCS then push for it, and just don't take no for an answer.

Watching this with interest as someone who had a cat 1 emergency c section. I don't have health problems like you OP but I'm adamant I want a c section if I have a second child in the future.

I am surprised they haven't agreed with you already after what happened with your first child!! I'd have thought they'd have agreed. But like another poster said they do seem to wait until after 30 weeks to agree so maybe it's just a waiting game.
I would be EXTREMELY surprised if they didn't allow you especially with your health complications.
Best of luck OP

I really hope you get what you want.
For what it's worth I had a c section, DS is exclusively breastfed, we've had no problems at all and he's now 7 months old (and 26lb! )Telling you you'll have problems BF is scare tactics IMO. Obviously I'm sure there are cases where it will make it harder, but everyone I know who has had an elective c section and has wanted to breastfeed has been able to with no problems good luck!

HeyBungalowBill, it is possible to discuss this prior to getting pregnant in some places in the country. I have a different set of circumstances, but did get an ELCS agreed in principle before ttc. They have subsequently booked me in very early as promised.

I would say it is probably worth investigating sooner rather than later, because highlighting the problem early can make them take you more seriously. However it really is a lottery as to where you are, and how enlightened the staff you come across are unfortunately. Sadly you will be treated better in some areas than others.

Be adamant, ask to see another consultant. I would actually use the "think about it more" in your favour. Ask in return, well I need to discuss it more.

Be aware that they generally dont give confirmation of a C section until 36 weeks unless there are physical medical reasons why not.

Remember, pyschological medical reasons are just as valid as physical health...

Hmmm they said I could choose to have one but DD arrived early and so had an unplanned VBAC (very fast labour), when I asked for a c-section they then declined. It was not really what I wanted and I still feel stressed about her birth.

BTW I had an emergency one with DC1

Hi Downstairs

Afraid I know nothing much about the procedures getting an agreement to a CS so wish you lots of luck on that side of things (but if it was me I would stick to your guns ) and for what it's worth, I think you are incredible brave and admirable having DC2.

My two pence worth is on the BF side of things. My personal experience is all I can share. Had EMCS with DC1 as he couldn't enter the birth canal and because my body didn't get the trigger from the birthing process to produce milk (so they tell me) my milk didn't come in straight away. This meant nobody realised DC wasn't actually feeding for 24hrs, after which I had to pump every three hours for a few days to get my milk going, during which time DC was bottle fed (bad mistake) because he was loosing weight. He never did manage to feed from the breast properly and I expressed for about 6 weeks (feeding BM by bottle) before finally admitting defeat.

I was told that if I want CS with DS2, I could try hand expressing/massaging for a day or two before the CS to encourage the milk to be ready this time. Several midwives have told me this and say they have found it works. Not to bottle feed in the interim.

Must admit I am opting for VBAC this time and that BF is one of the factors in this decision, but even the final decision for this they wouldn't accept until I was 30weeks so looks like that guideline is in practice.

Good luck. X

I had section and was able to establish EBF very easily

its placenta removal

Hi all,

thank you for the replies, I've been out so only just got back to this!

I have another appointment at 28 weeks, I am under an obs but I always end up in with the registrar as it's two of them running the clinic. She seemed nice enough just like it was textbook rolling out natural birth is better, etc, etc! I honestly don't think I will cope as well this time, just the thought of it again makes me panic and stress is a real trigger for my seizures (the main triggers for them are tiredness/stress) which is another reason I really woul dlike a c section, labour has no time limit, it can go on for hours and hours and its exhausting, at least with a c section I know I time, I can prepare myself, I'll know what is going to happen and how long it will go on for. Basically i just want to avoid any chane of triggering them off again really!

Is it worth printing off the NICE guidelines and bringing them along next time? DP is a bit more insistant than me but he has always been at work when I've gone so I've been alone and felt a bit more like I just go along with everything, maybe I should try and bring him next time to be a bit more firm!

You can be refused an ELCS if you don't have medical or psychiatric grounds for one. If a consultant feels it is not in your best interests on a safety level for both you and baby they can decline signing a consent form. They have signed an oath which states do no harm, which is basically on medical grounds. NICE guidelines did change but to use this to get an ELCS requires psych input.

However, you can request a 2nd opinion, and there are always consultants within hospitals who will agree to a maternal request ELCS.

Good luck with whatever happens

Thanks, I def feel I have both grounds for having one so will certainly push if I am refused, the thought of going through it again just terrifies me!

RedToothBrush- thank you for your advice, I was wondering if it'd be ok to go discuss it before TTC in the future. I think that would also make it come across as more serious to them too.

It's a shame as I had a wonderful GP who knew me well and respected my opinions and would have trusted me to make that decision about the c section. He would have supported me for definite. Sadly he left the practice.
Would it be a GP I should talk to or would I ask to see someone else?

I went through my GP. I spoke to them about it, but unfortunately they were unsure who to refer me to because unlike you, I've had no previous children so there is no care pathway for women like me. However after I'd done some legwork and found out somewhere that could help she was happy to refer me to a consultant midwife at a local hospital who had some experience with similar cases.

However I do believe it is much easier to get assistance if you have had a difficult or traumatic birth before as its more common, its better understood and services do exist for supporting and helping women like yourself (though not as widespread as they should be). They are more likely to take your worries more seriously than someone like me purely because they have some sort of 'evidence' to back up your feelings if that makes sense. I also know that some hospitals will go over your previous experience but there tends to be a certain time frame within which you need to do this. Alternatively so places do offer some sort of birth reflection therapy which may or may not be relevant to you.

I had tried to contact the midwife at the hospital directly, but the letter walked, but he did tell me that if he had received he would have been happy to contact me directly.

So my understanding is you can go through your GP or you may be able to access some services directly yourself. It may be worth approaching the GP first though as they may have knowledge of local services available to you which might save you a lot of hassle. They may not be exactly what you are looking and may not direct you straight to someone who can say "yes you can have a CS", but longer term may help your case and make it less stressful further down the line. You, unlike the OP, have the luxury of time and can try several different avenues if you need to. I appreciate that not all areas of the country will be as supportive as I've found and you may hit a deadend with it, but it is at least worth a try in my opinion.

Hi downstairs - I know we've spoken on another thread

I had my DS five weeks ago via ELCS and my epilepsy was the reason. I also have a history of arrythmias and tachycardia so this was also considered, but my Cardiac Consultant said my heart issues were not grounds for needing a c-section.

I don't know how stable your epilepsy is, but I have been seizure free for 8 years and my Obstetrician was still happy to agree to the CS. She herself acknowledged the risks of extended labour and lack of sleep triggering seizures and so wanted to avoid it. I think it helped my cause that her background included a stint of working specifically with women who had epilepsy.

The Anaesthetist that I saw in the Pre-OP clinic didn't seem too impressed that having stable epilepsy was being used as a reason for a CS but heh-ho.

Be firm about what you want and I hope you get the right results

Hi writer I've only been seizure free since 2009. The labour from my son triggered them off plus the blood loss and tiredness so it's pretty much why I want to avoid an unplanned labour so I can have myself sorted! FX these tablets are the one but I was on lamotrigine with DS and i was stable throughout the pregnancy but they suddenly stopped working after I had him. I came home 3 days after the shitty labour, had a tonic clonic at home and had to go back to hospital. I had jerks every day till November 2009 when I saw a neuro and was put on keppra which stopped them again.

I'm trying to think if I can get DP to get time ff work to come with me next time as he is a lot more firm than me whereas I get a bit quiet and don't stick up for myself! It's a pain in the bum really i just don't want to muck the tablets up this time and be back to square one and i certainly don't want to have to go through never being alone with my baby again "just incase"

Downstairs, when I've seen similar cases to yours with women trying to fight the case - having a partner there really seems to make a difference - not only to their confidence but also because it seems to make it more difficult to refuse as a) it makes you look like you've discussed it/given it a lot of thought b) you have support and c) I don't personally underestimate the influence of having a male presence there.

Thanks toothbrush I will defintely see if i can bring him then, I'm really too much of a pushover!

Very much agree with Red on the point of having your partner there. Having my partner, who was also a witness to the catastrophe that was our DD1's birth, in the room with me was really helpful. We talked through everything before the appointment and he seemed clued-up and thoughtful about it all. Perfect backup. I wish you all the best in getting the birth you want and deserve.

It sounds like you had a really crap time with your epilepsy last time and I really can't see how anyone could refuse you a CS, for both the health of you and ensuring the baby is safe in your care.

I have always been on Lamotrigine since I was diagnosed 14 years ago but I did have to increase my dose during the pregnancy. I'm still on the increased dose (400mg) for now but I'm seeing my Epilepsy Nurse in May with a view to decreasing it back down to my normal dose (350mg). My Epilepsy Nurse told me that the first month after the birth is when I'm most at risk of seizures so advised I not be alone with the baby, and so I haven't been. However, come Monday, my DH returns to work and the time has come for me to take sole care and I'm crapping myself. Even though my epilepsy has remained stable I still have that dread in the back of my mind; What if I have a seizure.....what if I hurt the baby? It's a horrible feeling.

I don't think you will have any problems if you tell them that you don't want your epilepsy stability compromised and you especially don't want yo risk your new baby's safety by having active seizures.