Help - How to get elective c-section / caesarean - which NHS Trusts allow this?

[indiehubbie]

Hi all, First post - I don't know the abbreviations yet...

My wife is 36 wks pregnant. The baby was suspected breech, and so we started to look into c-sections. We read the NICE Guidance (www.nice.org.uk/guidance/cg132) and she concluded that she wanted a c-section even if the baby wasn't breech.

It turns out the baby is head down.

So, we are now trying to get a c-section where there is no clinical reason. The NICE guidance says that this should be possible. "For women requesting a CS, if after discussion and offer of support ... a vaginal birth is still not an acceptable option, offer a planned CS. An obstetrician unwilling to perform a CS should refer the woman to an obstetrician who will carry out the CS."

The Oxford University Hospitals NHS Trust don't follow the guidance (apparently it's not legally binding?). The Oxford policy is to send you for re-education until you change your mind. Or... there is a slim possibility that they will refer you to an obstetrician in another NHS trust. We think this is our best hope at this stage, but we are having to do all the leg-work to make it happen. 36 weeks doesn't leave us much time to sort this out, especially with Christmas.

So, does anybody know if their NHS Trust DOES follow the NICE guidance and offer c-section based on maternal request (no clinical need)?

Does anybody have experience of how to make this happen (ideally in Oxford University Hospitals NHS Trust)?

Thanks all in advance - really appreciate any help/experience you can offer!

Re the ivf thing , the babies are deemed as more precious ! My friend had an Ivf baby after many loses and was offered a c section because of this !

The ivf thing boils my piss. Sorry it truly does.

Firstly there's no research to back up sections or early inductions for ivf.

More importantly all babies are precious. A parent wouldn't be less upset if they lost a baby and it was a natural conception rather than ivf.

Care needs to be evidence based.

-losses-- I agree all babies are precious so feel it's unfair but I guess someone decided it was along the way.

Not officially they didnt. Like I said there's no research about it, there's no guidelines about it.

Some random Drs do this, though its getting less frequent ime. And when I've pointed out the failings in their thinking to the Drs they generally concede I'm right.

Early induction for ivf is now banned where I work and section as routine for ivf I've never known.

I don't care what your DW's reasons are and I will not divulge my reasons but I knew I wanted an ELCS the day I found out I was pregnant. I started the process far earlier and was agreed for CS at 14 weeks by my consultant that I'd insisted I was referred to at my booking in appt. Print a copy of the NICE guidelines and take them with you to see the consultant (you can insist upon seeing one at any time) and keep repeating the part which states if they are unwilling to section you themselves they should refer you to someone who will. NICE guidelines are not rules but they should be followed, it is good practice to do so. If the consultant is still unwilling threaten them with PALS and do go prepared as to the pros/ cons of ELCS. For what it's worth I recovered from CS brilliantly, discharged next day and walking pram and dog to park within 3 days, showered and hair washed night I came home, suffered very little in terms of pain. If it's what dw wants and she is capable of making an informed decision don't let anyone put you off!

Surely the only sure fire way, this late on is to pay for it?

Sorry don't want to derail thread but re IVF- what?!

All babies are precious regardless of whether they are naturally conceived or IVF.

What does this say about vaginal birth then? It's more 'safe' to have a CS for a 'precious' baby...?

OP- I've got my fingers crossed for you both. Definitely need to get ringing round the trusts close to you.

I agree that most of it comes down to an individual doctor. I'm thinking about how you might locate someone who is known to be ok with ELCS for no other reason than psychological issues. A close friend was offered an ELCS for just this reason (and she didn't become hysterical at the thought of birth, she just got fairly anxious). That happened in Belfast. I don't know anything about this, really, but what I would suggest is this. Go privately. Work out who you are going to chat things through with at your nearest BUPA hospital (ask them the name of the practicing doctor so you can request a GP referral addressed to that person). I would ask for an emergency appointment because you haven't got much time left to make these arrangements and I'm sure the strain is intolerable for you, not to mention unacceptable for the baby.

Stay at the level of consultants. They don't really feel bound by anything and only talk about their trust when they're trying to justify their decisions IMO. Only if you feel really desperate and like there's a chance your baby's health could be affected by the situation, it might be worth getting in touch with the Royal Supervisor of Midwives. You may have something similar. I couldn't get near a consultant once and desperately needed to see him. One phone call from her and he suddenly had an appointment free later that day!

A lot of CCGs (those guys paying hospitals) refuse to pay for ELCS on maternal demand so if a hospital agrees to your request they will have to bear the cost themselves. CCG is responsible for all patients in your area so you can't escape it by going to another hospital. Saying that it comes down to individuals and she should definitely try.

I don't think that is the reason re IVF. I think women who have had IVF may be more inclined to request CS because they have less faith in their bodies ability to give birth 'normally'. Consultants are more more likely to agree because those women are also more likely to be older and less likely/able to go on to have lots of further pregnancies.

I requested an ELCS as I have severe anxiety that something will go wrong and just want baby out safely ASAP. I had fertility treatment and have lost faith in my body which has impacted me severely ie signed off work due to panic attacks. However I was also told no despite seeing two consultants as it is not their policy.

I am now 38+3 and preparing for a natural birth. Having seen most of my NCT group having waterbirths with stiches I feel a lot more positive and the fact you can come home the next day if no complications is very appealing.

I would advise your wife to read lots of positive birth stories and books as it has made me feel tonnes better. I have also had the consultant agree to a low threshold so I can have a section immediately if it looks like anything could go wrong.

Hello OP

I had a maternal request CS for my first child's birth at the John Radcliffe in Oxford last year.

I, too, was referred to a "mode of birth" clinic which was a meeting with a consultant midwife who, like the consultant I originally met, tried to convince me to have a vaginal birth. After the clinic I was referred back to the consultant and the midwife wrote him a letter saying I still wanted CS. It was at the second meeting with the consultant that (after a further attempt to dissuade me) the CS was booked.

They were very forceful in their attempts to change my mind and had I not known of the NICE guidelines I would have left believing I could not have the CS. It seemed key to me to keep saying "ok, you're not willing to do CS, please follow NICE guidelines and refer me to someone who will". I also knew risks and benefits inside out.

If I was in your position, I would be calling to get an earlier mode of birth clinic appt. - a cancellation perhaps - and pre-book an appt. back with the consultant ASAP after the MOB clinic. I think you have to jump through the hoops. I asked from my very first midwife appt. but it wasn't booked until pretty late in the day.

The actual CS and recovery etc. were really great. Everyone I dealt with apart from the consultant and his junior was lovely. I recommend the level 7 private rooms (partners can stay).

Very best of luck to you both and merry Christmas .

Just to add that in the process I was told that they don't do maternal request CSs at the JR too and I am walking proof that that isn't the case!

The recovery from the CS was fine - just take it easy in the beginning.

The reasons are quite relevant as if she's just decided she wants one maybe the doctors think it's a massive waste of time and resources which it would be in that case. That's what your post made it seem like. Unless there is a genuine need whether that be something from genuine anxiety or previous c section and those other genuine reasons, I don't see why they should.

Since onthematleavecountdown is only poster who said IVF was part of her desire for CS it would be nice if that poster came back to explain why, & stop everyone speculating.

I thought maybe contra-indication for spontaneous vaginal birth was something to do with how placenta implanted or functioned or hormone balance or sensitivity (etc).

Do IVFers find breastfeeding harder too, due to lack of trust in own body?

I sometimes wish I was infertile so I could see if I'm as weird as I think, coz I don't think I would ever attach so much self-esteem or body belief to whether or not I was fertile. Didn't happen that way. so that's just my own speculating.

I googled IVF and Cesarean and came across the following view expressed by a consultant: "I feel that on the basis of “only opportunity ever”, an IVF pregnancy plus any problem is an indication for a planned elective Caesarean section. That problem might be the older patient pregnant for the first time, twins, a breech presentation, previous surgery for fibroids, or any subsequent antenatal complication sufficient to cause concern. No prizes are going to be awarded to the 38 year old patient who after a number of years of infertility and eventual successful IVF, then tragically loses her baby or has a baby that is handicapped as a result of complications arising in labour. An elective Caesarean section is not a guarantee of a live healthy baby, but is safer than an emergency section in labour or a prolonged and difficult vaginal delivery". I worked with a woman who preferred a vaginal delivery to anything else having got pregnant with twins at 40 through IVF.

I don't know why I'm browsing here as I'm not pg but I have had an emcs previously. But in response to illjkk, although I am not infertile, I have mc'd repeatedly. And in my experience, not being able to bear children can shake your self esteem to the core. And that effects my whole perspective on trying to become pg, my experiences during (and losses) and any choice of birth.

I can understand the poster who mentioned elcs for ivf. If I successfully carry a pregnancy towards term again then I will also be requesting an elcs (although they may not give it to me), as it's all about a personal tolerance for risk.

lljkk, I think saying sometimes I wish I was infertile IS a weird thing to say, if that helps with your understanding of things.

You wish you were infertile sometimes? No, you really don't.

What a stupid thing to type.

I agree that you need to do your research, and be ready with a strong and rational argument.

But FWIW I would add that my own planned section (2nd pg after first emergency C/S which was absolutely fine) was the most miserable experience ever, with complications and a long, painful and horrible recovery.

An elective C/S will (shouldn't but will) affect all or any of your subsequent birth choices. And it is major abdominal surgery. So be very, very sure.

Actually I DO wish every day I had been infertile. Don't care if you think I'm stupid. What I say about me is not a statement about anyone else. Wouldn't it be boring if we were all the same.

That consultant is saying that anxiety due to IVF conception is a valid reason for having a CS. I imagine anxiety for any reason is fine as reason for CS with that same consultant, because they approve of CS in all or almost all cases anyway. Anyway, the reason is maternal anxiety, for whatever reason. I think NICE acknowledges anxiety as valid, too (?).

Being an infertile woman who is currently carrying an IVF baby I can chime in with my two pence worth.

We moved trusts at 16 weeks, our first trust didn't treat my pregnancy any different to 'normal' at all and we were told we would go down the normal route. When we moved trusts we were immediately classed as 'high risk' due to those three letters...no idea why and the midwife just said it was 'protocol'.

I haven't been offered or swayed towards ELCS or CS in anyway, however we have been told that they will not let IVF babies go over their due date and will induce at 40week due to research showing an increased risk of still birth in overdue IVF pregnancies. The consultant couldn't explain why.

Do I think my baby is any more precious? Not at all. But I think speculating that us with IVF babies think our pregnancies are more precious and jumping to conclusions can be quite offensive.

OP I hope your DW manages to get some answers and quickly, each woman and pregnancy is different and I think the right to choose is very important. Good luck

lljkk, of course maternal anxiety is a valid reason for ELCS. I didn't get from you post that you are experiencing this, and sincerely hope that you get the birth you want.

Infertility, however, is a completely different game. Infertility when you're trying to get pg is like all of your worst fears coming true, and more. The two are completely incomparable and it's not right to say "sometimes I wish I was infertile". It's very insensitive.

Sorry for the slight derail in your thread, OP.

Ah, another one of those things folk aren't allowed to say on MN.

I was only curious what the physiological link between IVF and risks of VB might be. Damn that curiosity. Oh, and the honesty. Damn that too. Shouldn't be allowed, I suppose.

Knowing why she wants a section is actually really helpful for us to give good advice!

North Staffs will do it on maternal request :)