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!

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

You can say it all you want lljkk, but you will have people saying you're not coming across very nicely, as they are allowed to do.

Husband and I took 3 and a half years to conceive this pregnancy. I wouldn't wish that on my worst enemy, even if they wanted a greater understanding of infertility and the mindset that follows.

FoodPorn Thu 25-Dec-14 23:20:06

YY

Op how did you get on.

I agree with Food they make you see other people but its box ticking....

I would also speak to Pals.

And the birth trauma association to get more advice.

i think its cruel to make a woman go through labour if she really doesnt want too

as for cost - I am afraid mistakes cost maternity services more than anything else - babies starved of oxygen and need a life time of care and support cost more than a ELC which has far fewer risks.

I really hope you get the resolution you want op for you and your wife.

I had an ELC maternal request, it was all straight forward and easy and compared to other ladies in NCT group I had a reasonably straight forward birth via elc, whilst they were in and out of hospital for a long time due to issues with vag birth, so its swings and roundabouts.

I would ring up labour ward and ask to speak to the supervisor of midwives. Have a good chat so that you can work out how the land lies. She may be able to refer you to a different consultant. If she isn't that helpful, I'd start contacting other trusts ASAP. I would also contact the charity AIMS. They may well know which nearby trusts are your best bet.

You obviously have your reasons for wanting an ELCS. If they are purely anxiety/mental health reasons then this is a different category to a 'maternal request' but is a totally valid reason.

Personally I am wondering why you want to go against the advice for a vaginal birth given the risks, pain and recovery for a straightforward ELCS if you don't have a 'good enough' reason to be granted an ELCS. BUT... I don't believe that any woman should be forced in to a vaginal delivery if they really don't want to.

OP, you'll have had your child by now so firstly, congratulations! Secondly, did you manage to get the ELCS?

I'm pregnant again and planning another ELCS at the JR so keen to know how they're feeling about them at the moment

I think many have missed the point re ivf and elcs. Ivf pregnancies tend to be consultant led due to gynaecological issues. I wasn't offered one with my first dc, nor did I ask. However they did look into whether my previous abdominal surgery that had led to needing ivf meant I may struggle to deliver vaginally.

Not all infertility is due to unknown causes, many people are infertile for known reasons which may or may not make vaginal birth more risky. It's nothing to do with ivf babies being more 'precious' (though potentially if you've had multiple failed cycles, miscarried etc you may feel quite anxious about birth).

I'm all for choice and I totally get opting for an elective following a traumatic 1st birth. But I just can't understand why anyone would opt for it first time. As I said, I'm not for denying that choice, each to their own but it's one of those things I find difficult to understand. For me being able to get up, shower and leave 5hours later was just fantastic. Of course I was terrified beforehand but I'm glad I didn't miss out on the birth I had.
This isn't judgy, I just genuinely don't understand why anyone would opt for major surgery for their first although if the thought of vb is so terrifying then maybe it is best. I also find the keeping reasons secret a strange thing. If someone posted that they wanted advice to help them leave their spouse but didn't want to say why, I'd think the same. I don't really care what a woman's reasons are but u do think it strange to say, give me advice but I'm not sharing any more ( I'd think that whatever the subject)

The roundabout point of my post was that the keeping reasons a secret thing doesn't help other people to understand the pov. Understanding the pov would help the overall understanding.

But I just can't understand why anyone would opt for it first time. As I said, I'm not for denying that choice, each to their own but it's one of those things I find difficult to understand.

This isn't judgy, I just genuinely don't understand why anyone would opt for major surgery for their first although if the thought of vb is so terrifying then maybe it is best.

I'm afraid it IS judgy though. Expressing that opinion because of your ignorance is a judgement. Look at what you are saying; "Why would anyone do that unless they have had a traumatic first birth?" You have placed a value of what circumstances are acceptable and by that definition what is not acceptable circumstances.

The truth is provided women are fully informed why shouldn't they have a CS for ANY reason? Its about body autonomy. On top of that NICE have stated that cost alone should never be used a reason for denying a woman an ELCS, so that argument is null and void. Which leaves very few justifications for hospitals to refuse to perform ELCS.

In order to answer your question, there is a typical woman who askes for an ELCS for her first pregnancy. She is statistically more likely to have one or more characteristics from the following; have been raped or sexually abused in the past, have a history of mental health issues - eg anxiety (including phobias) or depression, to be older - potentially having delayed pregnancy - and therefore more liable to be a risk of complications with a VB, to be an IVF pregnancy - and potentially be more anxiety about the pregnancy as a result and they are also more likely to plan a smaller family.

So far from falling into the stereotyped idea of being 'too posh to push' they are very often more vulnerable than the average woman. Indeed, there is a strong case to be made that if a woman askes for an ELCS it should be treated as a red flag for that woman needing extra support, regardless of whether she goes on to have an ELCS or not.

There is therefore a problem with making comments like yours as it puts very genuinely vulnerable women in a position where they a) fear seeking the help they need b) makes them feel somehow less of a woman for asking for a CS they might need for their wellbeing c) makes they unable to talk to other women about their situation d) it supports the status quo where hospitals are ignoring NICE because they know that politically they can ignore the issue as it will be deemed acceptable for them to do so by the press and public.

I hope this does something to remedy your ignorance and perhaps make you think more about what you are actually saying.

No, you have misunderstood me. I absolutely think it is any woman's right to request and be granted a CS if that is what they want. Absolutely.
My point is that I personally, find it difficult to understand the reasons behind that choice. That's my issue not theirs but I'd like to understand because it seems so outside my understanding why someone would opt for surgery over the chance of up and out. I just wanted to understand and I don't think a veil of secrecy helps. It really isn't judgey. Women share practically everything on here from sexual preferences to horrific experiences of abuse so I didn't understand why this was so guarded in secret. And of course every poster had the right to privacy. It just seems that this is always wrapped in secrecy. I'm not making a judgement on their choice, I'd just like to understand it more.

Just to clarify, I am nancy, just fancied a namechange as I change a couple of times a year. Not hiding my NC at all.

Maybe op would consider private cs

Beesandbutterfly, apart from the fact the OP will have had the baby by now, can I ask why they should pay? NICE say that its cost effective, denying a request for an ELCS could be harmful in its own right and say that cost should not be used as a reason to refuse one.

So why should the OP pay?

The OP is fortunate in living in an area where that might be a possibility. However outside the SE its simply not an option due to the lack of private maternity wards in the UK.

I have no idea why it is deemed acceptable to suggest this. The NHS should provide access to an ELCS if the woman concerned understands the risks involved.

Redtoothbrush I wasn't meaning to be inflammatory.
It's a way of getting what they want.
The op stated no medical reason it didn't find an update to this, if a elcs if requested for convenience of dates for example then I don't think that should be something expected from a very stretched NHS. I apolegise if I missed a reason and am misreading.
I hope op's wife had a delivery she was happy with.

It's also interesting that if a women wants a vaginal birth but medical advise is that a cs is recommended all hell breaks loose, very different the other way round :-/

Bees and Torwood, I have posted what I have because the subject of why women request ELCS is surrounded by an enormous amount of ignorance and there is a great deal of fear for women to speak openly about the subject because of those preconceptions. And as I have pointed out often those women are vulnerable as a result. More often than not there is a mental health element to requests however even for women who fall into this category, they are still told by medics that this is not a health reason or a valid reason despite NICE doing a lengthy analysis of the subject and validating the fact that the wellbeing of a woman is both physical and mental. I think the fact you have picked up on 'convenience of dates' really highlights your thinking on the subject and how much you have bought into the myth of 'too posh to push'. In many respects knowing when a woman is going to give birth actually makes it easier for hospitals to plan; NICE found that costing models showed if the CS rate reached a certain level it would actually be cheaper, however they do not advocate this. Indeed the example of China shows this in practice and in some areas it is the only way their hospitals can cope with the number of births.

I regularly read posts on MN from women too afraid to speak out or in despair and distress over their feelings about giving birth, such is the taboo. I've never seen anywhere else which is really generally a supportive environment to women to talk about it unfortunately. I do think its important that the message gets across and tries to bust a few of the incorrect myths out there, which are being peddled by politicians, the media and worse of all uneducated HCPs as maternal mental health is given such a low priority and is poorly understood and even more poorly funded. I also think that women need to stop telling others what they think that choosing an ELCS is something that you either should pay for yourself or something that they find unfathomable because frankly its not your birth and therefore not really your business. Do people express views on what other forms of health care people receive in the same way? Why is childbirth so fair game to this? Why is it everyone else's business how someone chooses to give birth?

Under the NHS you do not have a right to an ELCS but you do have a right to the most appropriate care for your issue. Very often the two cross paths but there isn't enough of an acknowledgment of this.

MN really has helped cut through the crap and I do think people understand better than they did a few years ago but there is still a long way to go. FWIW I support women's right to choose the birth she wants provided she understands the risks involved and that isn't just restricted to ELCS.

Wow, high horse,

Fwiw i completely agree mental health reasons are just as valid as physical health reasons but none were given and sadly some people prioritise convenience (whether you want to acknowledge that or not)
And I'm not the only poster to suggest going private, it's a means of achieving what you want, the system isn't perfect. I hope the op's dw had a birth she is pleased with and is enjoying her new baby.

I had an elective c-section at UCLH back in October, because I wanted one - potted version of my argument is that I didn't want any chance of tearing down there, and I would rather have the certainty of a scar rather than the possibility of a badly healing 2nd or 3rd degree tear.

The C-section went very well and I'm very very happy that I did it :-)

It was a hard slog to get them to approve it though I must say! It made the pregnancy a lot more stressful than it should have been. I was physically completely fine, but there was that dark cloud over the whole thing - whether I would have to get into debt for a private section. (I would never have willingly given birth vaginally).

Basically what I did was:

1. ask for it at my very first appointment (at 12 weeks I think)
2. keep asking for it at every appointment

I was armed with facts and stats and printouts from medical journals. I think it was fairly obvious that I had made my choice through rational thinking*, so in that case I think it sort of falls out of their usual counsel-the-mother-out-of-her-phobia remit. That probably helped.

Five months in, they did make me see a psychologist (!) which I thought was a bit annoying as it treats people who want a c-section for non-phobia non-trauma reasons as possibly needing mental health... but I can see their point: I could have been needing counselling, and been trying to hide it, so they were doing their job.
I knew that if I just kept asking and stating my case and going through every hoop then I would have more chance of getting what I wanted, so I went to see the psychologist, she just asked very normal questions, pretty much the same as the midwives before that. And I just repeated the usual, statistics about tears and incontinence etc... I even dug out the stats for occurrence of tears at UCLH to demonstrate my point :-)

There was a fairly stressful moment when one of the midwives said that if I kept stating that it was my choice, then they would have to agree to it... and then the next appointment another midwife said that actually they usually don't agree to it at all!

But anyway I stuck to my guns and in the end (very late in the day, I think week 37 or so) I had an appointment with a consultant, which lasted all of 2 minutes. He looked at my notes, said "I can see you've talked to everyone who could possibly talk to you", then went right to the calendar and asked me if such-and-such date was ok. That was a massive relief.

So I will say, it is possible to get an elective just through maternal request, and good luck to anyone trying it. Just be firm and stick to your guns. Hard I know with hormones and not knowing what the hell is happening if you're a first time mum, but for me it was definitely worth it - I think that's the best choice I could have made.

: that doesn't mean I think that people who give birth by VB are irrational! I just mean it was the rational choice for me*, not anyone else. God knows being pregnant and having a baby is hard enough without anyone trying to impose their choice on anyone.

Anyone have an elective C-section with Princess Alexandra Hospital Harlow Essex?

I am considering having another a baby perhaps next year or the year after, but want to have a C-section. I've had such an awful experience having my first child and ended up in surgery as they couldn't get my baby out (I had pushed to far down so couldn't C-section him out but he was stuck and couldn't come out so I needed a lot of surgery for them to get him out). I am not going through that again. If I was to have another baby then I want a C-section. I am really worried that the NHS wont give consent as I have a child and they will say that the C-section will hinder me in looking after him, it wont as I have a big supportive family who will help me until I am fully healed.
If I cant have a C-section I wont try for another baby as I honestly don't think I will survive this time round, ( I'm not being dramatic, I lost loads of blood last time which they were struggling to get control of).
I know of at least three women who simply said to there GP that they are demanding a C-section and their GP wrote a referral letter and got them an elective C-section. I am hoping for the same, but just want to know how other ladies managed to get there Elective C-sections at PAH and just wanted some advice really. Thanks in advance. xx

OP - can you afford a doula or private midwife to help support you through this process? Navigating these policies is very hard without experience. A local doula or private midwife will be able to tell u based on experience how best to navigate the policies in your area. Have a google and look at who's available in your area and call the more experienced ones asap. They might even be willing to advise over the phone for free. They can even come to the meetings with you and re-state repeatedly your DWs wishes and her reasons and push for u to see the people you need to see. This may also take some of the stress off DW because I can imagine this must be hugely stressful as time is ticking. As you need to do this quickly I think you really need someone who knows how it works locally advising u.

OP- please come back and let us know how you get on. We're all rooting for you! it also might help someone else who's in a similar position in the future.

User- I haven't got experience at that hospital but by the sounds of it you have very good reasons to have one! Do you have any reason to think they may say no?
If they do - just keep the pressure on and be completely certain about what you want (not that it sounds like you'd falter!).
I really think you'd be able to get one given your history. Did it happen at the same hospital? If so they wil have a record of it all. If you didn't then get a letter now from the previous hospital stating what happened and their opinion (hopefully in support of yours)

User- I don't have experience at that hospital but I was successful in requesting a cs elsewhere for no medical reason other than fear of birth. It was a massive fight and in the end it was down to my very supportive GP not taking no for an answer from the consultant who had initially refused. It is possible and especially with your past experience but you need to be very insistent from day one, and stress the affect this is having on your mental health. They will say that second births are nearly always easier and you will have a better experience this time. It doesn't matter that you have another child in the slightest and that isn't their concern. I would see your GP before ttc again to tell them your wishes. I don't think they will actually commit to anything before you are pregnant but it will help your case to have that on record and shows how serious you are about your wishes. Good luck!