Elective Caesarean - What are my rights?

[whattheduffz]

Hi All,

I had a bit of a nasty first birth (induction, forceps, baby in NICU etc). I will spare the finer details, but just to say I was terribly traumatised for months afterwards.

This time I want an elective caesarean.

I just want to know what my rights are with the NHS. Do I have ultimate say in how I deliver my baby?

I went to speak to the doctor at Hommerton today who was sympathetic to a point but wants me to have a natural birth. She's asked me to go away and think about it for another 4 weeks and told me I'll need to see 2 consultants and both will need to agree on what's best for me.

When I pushed her and said 'so can they refuse my request' she was a bit cagey and didn't answer me directly.

Anyone know the answer? Thank you oh wise Mumsnetters :-) x

It sounds like they will agree to it eventually, but they make you wait until later on in your pregnancy and go through your reasons over and over again in an attempt to put you off and test your resolve!

The first doctor I spoke to at 20 weeks was quite dismissive of my concerns and insisted a vaginal birth would be best for me. I then saw the consultant at 28 weeks and, while she also recommended a vb, she was much more sympathetic and I felt she actually understood why I want an elcs this time. She said if it's still what I want at 34 weeks then she will book me in (so we'll see what happens next week!)

The Nice guidelines say that, if after careful discussion and consideration you still want a section, then they should give you one or refer you to a consultant who will do it.

Sounds like i'm going to go through the same as you then. I do get why they want to make sure people are informed in their choice and that they're not just too posh to push (ha ha).. but it's causing me anxiety and waiting for the answer really isn't going to help!

puts on armour and gets ready for fight!

Sounds like i'm going to go through the same as you then. I do get why they want to make sure people are informed in their choice and that they're not just too posh to push (ha ha).. but it's causing me anxiety and waiting for the answer really isn't going to help!

puts on armour and gets ready for fight!

I had to see 5 or 6 doctors at great expense to the NHS despite being adamant that I wanted a elcs right from my first midwife appointment. I had a very long first birth, back to back, lots of stitches, 3day stay in hospital etc. my second via elcs was a dream - I was in M&S within 24 hours and felt at 6 days, how I did at 6 weeks with my first. You are absolutely entitled to request a section - in the unlikely event I have more children (being 41 and recently divorced - more likely to have an immaculate conception ) I'd have no qualms about another section - I loved mine

I know, I felt quite anxious after my 20 weeks appt and it was such a relief when the consultant then basically agreed to the elcs. Good luck, just stick to your guns, read up on Nice/Royal college of obstetrician guidelines and you should get there in the end!

I believe they will push you towards a vaginal birth, however if you are forceful enough and continue to request a C-section, they should refer you to someone who will do it.

I'm pregnant with my first and 2 days after I found out I was pregnant (4+2) I went to the Drs and stated I wanted an ELCS or I wanted to terminate straight away. I've got horrendous anxiety and needlephobia and after witnessing my sisters terrible birth 2.5 years ago which resulted in very bad injuries (she can't even talk about the birth and has said she'll never have another child) there is absolutely no way in Hell I could ever go through that, even if there's a 0.01% chance of it happening to me.

I've been very adamant so my Midwife wrote an appointment to the Consultant when I was 4+2, requesting one and writing down my history. The Consultant replied that there was no point in seeing me before my 12 week scan, but if that was all OK, then an appointment could be made to discuss things. I've had my letter through and I see the Consultant in 4.5 weeks time - My scan is this Friday.

I'll be 14 / 15 weeks when I see the Consultant - If it's not signed off, I will terminate, I am 100% adamant. The level of worry I'd have if I went over the cut off for a termination and not having an ELCS signed off would be too much to cope with as I wouldn't be in control any more. I'm hoping the Consultant will be sympathetic and appreciate why I am making the request - if not, I still have options which I am glad about.

If you come armed with facts (make sure they don't lump EMCS and ELCS statistics together... I don't know if there are separate facts) and keep stating your case over and over again, hopefully they will respect your decision. Good luck .

I've had two and had the various possible complications described to me each time, but no real push not to have one. Signed off in second trimester both times, and my fears subsided greatly each time. Sorry you're having a struggle.
If it affects you medically (which can be mental as well as physical) I don't think they can refuse in the end.

FluffyPersian I think you are right to ask for what you want, but needlephobia doesn't sound like a good reason for an ELCS as you will get an IV, spinal or epidural (both needles) and probably a local anaesthetic via needle as well. I'm probably having one due to baby in breech position and jus thad the process explained to me. It's definitely got more needles involved than a typical vaginal delivery. Just wanted to make sure you are aware of that.

FluffyPersian I think you are right to ask for what you want, but needlephobia doesn't sound like a good reason for an ELCS as you will get an IV, spinal or epidural (both needles) and probably a local anaesthetic via needle as well. I'm probably having one due to baby in breech position and jus thad the process explained to me. It's definitely got more needles involved than a typical vaginal delivery. Just wanted to make sure you are aware of that.

Newbian – I know there are potentially more injections / needles involved in an ELCS, however the fact you know what will happen, what those needles will be and when makes it more palatable than a Vaginal birth – If I tried for a VBAC, Will I need an epidural? How many blood tests will they need? Will they need to put a cannula in? If it’s an emergency, they probably won’t have time to put numbing cream on (which has helped a lot in the past year with things) What about stitches? Will I need them? Will I need a local anesthetic before hand? If I need an EMCS, what happens and how many injections will I need?

There are way too many ‘unknowns’ for me to even comprehend and whilst I know an ELCS has needles (and stitches, and a canula) I coped with having my wisdom teeth out under a GA in January this year (first ever operation) as everyone was incredibly sympathetic, used loads of numbing cream, let me turn my head and I didn’t see any needles and when I woke up, the cannula had been bandaged up so I didn’t even see it in my hand .

I don’t think it’s the easy option, far from it (not inferring you said that, but I know a few people who think that) however it’s the less horrible option for me as there seems like there's more control, I can plan and therefore hopefully I am less anxious and worried

They will advise you to have to birth that, in their expert view, they think is safest for you and your baby.

This may not be the sort of birth you had in mind (as anyone who wanted a home birth, but ended up with a planned CS would tell you from the other end of this issue).

Yes, if you insist, you should be able to secure a CS. But you may have to be referred elsewhere. Because although NHS has a policy of increasing access to elective sections to include maternal preference in addition to medical need, some doctors think it is unethical to perform an operation when, in their medical opinion, it is not the right thing to do and likely to lead to a poorer outcome. The NHS cannot compel individual doctors to perform procedures which they consider unethical. But the NHS at a bigger, more corporate level, has a policy that it will provide this service so if yours won't ask to be referred to someone who will.

It seems to depend on the hospital. I had a massive fight at mine to get an ELCS signed off after a previous emergency, even though I'm high risk of rupture and 60% chance of successful VBAC.
I had to discuss it at most appointments, go on a course, see a psychologist, see consultant midwife, then 3 different consultants and the senior consultant. Finally signed off at 37 seeks which was rather stressful as DS was premature so felt late in the day for me.
Go in armed with the NICE guidelines and show you've read up on the risks / research studies and are making an informed choice.
Good luck!

I think you have a right to a c-section if you feel very strongly about it, but different hospitals seem to behave differently. I'm with UCH. My first birth was all sorts of traumatic and ended in an emergency C-section. This time they've advised me to have an ELCS for medical reasons but even if that weren't the case, the midwives have been very sympathetic to the fact I'm emotionally still pretty traumatised by the first one, and say that they want me to have a 'good' birth experience this time so a C-section would be good for me as it takes all the worry away.

UCH can't be a million miles away from you if you're at Homerton - it might be a pain, but you could always switch hospitals?

That's horrific, Abbey, especially after you'd have an EMCS. Sounds like they try to bully women.

Yes, I think many women would've given in. I got it on mental health grounds in the end due to having PTSD from the crash section last time. But the whole VBAC / ELCS thing seemed debatable anyway as the consultants seem to vary in opinion.
Anyway, all agreed now, phew!

I had one, and it wasn't a battle. I just said at 16 weeks I wanted an ELCS and I had to speak to a mental health nurse and two doctors. My consultant was great and really understanding. It was my first baby but I have a family history of traumatic birth and have depression, so I didn't want to have a traumatic birth and end up with PND. No one tried to bully me into a natural birth. I was told they have to give you one.

It was still traumatic, DS ended up in NICU as he'd got distressed and they should have done an EMCS earlier. If it hasn't been a cesarean though the outcome would have been worse, and DS is fine now. If you have any questions about ELCS you can ask me :)

newbian I'm a needlephobe and had an ELCS. I was able to prepare and use EMLA, which helped vs if I'd been in labour and suddenly needed an epidural I'd have panicked.

TaliZorah - I've got 2 tubes of EMLA at home (I thought I'd be prepared in case they didn't have any). It's really helped me and I've been able to get through the blood tests a lot better than I thought.

It's nice to hear you coped even though there are needles involved - They terrify me so much but I appreciate there's no way of getting around them.

I'm requesting a c section because I've had 3 miscarriages prior to this birth and I'm so frightened of losing this baby / something going wrong.

My consultant has told me that he's happy to sign off my elcs at 32 weeks but I need to demonstrate a clear understanding of the risks and not only the risks, but the impact.

You need to study the NICE / Royal College guidelines and go armed with them.

If your consultant is still refusing, under NICE guidelines, you are entitled to be referred to another consultant

Bear in mind that you want the section booked relatively soon so you get the date you want - I had mine a bit before 38 weeks as the next date was almost my due date and I was scarf of going into labour. Mine was for the same reason as you Brummie.

You don't have a right to a CS if it is not clinically necessary. I don't think there's any branch of medicine where patients have the right to dictate their preference of treatment, just that they get clinically appropriate treatment. And I think it will put their backs up if you approach it as a matter of rights.

Having said which, it's a dreadful thing to force a woman to undergo vaginal birth if she is freaked out by the prospect. I think most doctors and midwives consider it good practice to encourage you to consider vaginal birth and to put a bit of gentle pressure on, but ultimately will accede to your wishes. I think if you talk with them reasonably but be insistent that just the thought of vaginal birth is causing you immense anxiety, and that you cannot conceive of a way that you can manage this anxiety enough to go through with it, then you will get your CS.

Best of luck.

Fluffy I was able to cope a lot better than I thought I would. Ask for a butterfly needle as well, it makes a difference for me.

I didn't even feel the drip with the cream and the spinal wasn't that bad at all. This is someone who is terrified of hospitals too.

Read the NICE guidelines. It's your choice but you will need to be prepared that some of the consultants will be irritated by you! Good luck!

www.nice.org.uk/guidance/cg132

NICE guidelines

Maternal request for CS

When a woman requests a CS because she has anxiety about childbirth, offer referral to a healthcare professional with expertise in providing perinatal mental health support to help her address her anxiety in a supportive manner. [new 2011]

For women requesting a CS, if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned CS. [new 2011]

An obstetrician unwilling to perform a CS should refer the woman to an obstetrician who will carry out the CS. [new 2011]

I speak from experience by the way. Also, you need to put your decision and the reasons in writing - copy in your GP (and any others that are relevant)! I loved my C-section.