Help please - consultant refused ELCS

[AnotherWeekAnotherName]

I had an appointment with the consultant today (I am 28 weeks with 1st baby) and it was awful. I have barely been able to function since because I am so stressed out. I have requested an ELCS on mental health grounds because I was sexually assaulted in my teens and have found the idea of a vaginal delivery very triggering. I started a previous thread about it here.

He was adamant that he wouldn't grant a section on these grounds. This caught me completely off guard because everyone else I had spoken with in the run-up (midwife, registrar, and consultant midwife) had been really supportive. The consultant was extremely dismissive of my reasons for requesting a section, and his lack of compassion verged on aggressive. He told me I was trivialising the risk of a section without discussing my views on the risks at all. When I stated that I couldn't accept the idea of giving birth vaginally, he barked back 'can't or won't?'.

Eventually he accepted that I could see anther consultant to get a second opinion, but then proceeded to tell me that if I did get an ELCS he would write all over my notes that if I went into early labour (i.e. before date of booked section) I was not to get a section.

One of the worst things is that I had heard previously that he was actually sympathetic to women who request a section. It just felt like he took against me and was being really vindictive. I now feel in a complete state of panic that I will not get the section I believe I need. At the very least I feel that any trust that had been built up between the hospital staff and me has completely gone.

Does anyone have any advice on what I could do next, and how I can approach the appointment with the next consultant?

Adopt a firm but assertive approach for next meeting. Swot up on Nice guidelines and take someone (husband/partner/friend/mum/mil) with you who is calm but assertive too and will stick up for you if you get upset. Discuss your concerns with your midwife too.

Sorry reading that back it was a bit brief and a bit bossy and which I hadn't intended . Am trying to sort bedtime do will try to pop back later on this evening!

Thanks guineapig I am planning to do those things.

Just trying to keep calm and remember that I do still have time to sort this out. I was just so shocked and upset by his attitude and I'm terrified that even if I did have a section agreed, he would write on my notes that I shouldn't have one if I was in labour before my booked section date.

You poor thing. If you feel up to it perhaps contact PALS with your concerns. It sounds like he was seriously lacking in any sensitivity.

If you see a new consultant who agrees with your need for a section, he will be in charge and decide what to do in case of early labour - your current consultant will no longer be involved.

I would get an appointment with another consultant asap and go from there. I would also lodge a complaint against the other cons as he has no right to treat you like that. Good luck getting the section you need

I would definitely agree with speaking to PALS. The other routes might be to approach your local perinatal mental health team, and / or the gateway midwives (who deal with women who need extra support - usually social services etc but may be able to help you too). He sounds totally unprofessional and in the wrong job, so sorry you had to go through that.

Speaking to PALS sounds like a good idea. I will try to find out about how to do that tomorrow. Thanks everyone for your kindness - it is nice to know that I am not overreacting to what happened today.

I'll also speak to my community mw about a referral to the perinatal mental health team. Quite apart from helping me to get the ELCS, I think it would be helpful to have someone to talk to about what happened today and to help me to process that.

If I were you I would ask to see another consultant (I would also be tempted to complain about the one you saw).

I also think a referral to the perinatal mental health team would be a very good idea.

Good luck, OP - the Nice guidelines are on your side!

I've had a look at the PALS website for my hospital and they have an email address for complaints so I will use that. I have never complained about NHS care before and I am worried that it might affect the treatment I receive.

I don't know if I should complain straight away, or if I should wait until I have seen the next consultant, and hopefully had the ELCS agreed?

Dear God why these men are let loose to look after women I don't know.

Is there a phone number for PALS - if so maybe you could call and see what they advise?

This fact sheet has information about your right to request a C-section, it might be a good idea to print it and take to your next appointment? (For your confidence if nothing else)
www.birthrights.org.uk/library/factsheets/Right-to-Medical-Assistance.pdf

I'd complain now so they know you are serious. You must complain though. if he treated you this badly imagine what he must be like in an emergency situation.

I would complain regardless, what a twat.

He sounds like a complete arsehole. Please go through PALS to stop twats like that thinking they can act in this way.
Do request another consultant. Have you managed to find your Trust/health Board's policy on elective c -sections? They'll be one somewhere and it will give the pathway that should be followed. They pretty much all say that if one consultant refuses you should be referred to one who is willing to carry it out.
This is the stage that i got to before being successful.
Good luck and i'm sorry you've had such a horrible time with this.

PALS are separate from the clinical side of things, so talking to them initially would be separate from your care. I work in the NHS and my experience is that people who complain get better, not worse care. Complaints are taken seriously and make clinicians work by the book, not cut corners, so I'd get in there asap.

This might help.
www.rcog.org.uk/en/patients/patient-leaflets/choosing-to-have-a-caesarean-section/

Can you access a perinatal mental health service where you are? Can you discuss the issue with your GP and see if they can refer you?

OP, have you got the cons I had? Your experience is identical (different reasons though).

I had a second opinion and went in prepared to argue my case. Almost before I had a chance to speak she agreed I could have an ELCS.

Hopefully you'll get the delivery you want.

This is awful! I cannot believe he spoke to you like this. I would make a complaint and ask that he's not involved in your pregnancy or birth again in any way. It's one thing to disagree, it's another to force your opinion on someone without offering any support or empathy. I'm angry on your behalf!

Thanks AnotherEmma and pinguina for the links - they both look really helpful.

I have decided to go ahead with the complaint and I wrote it today. I am pretty anxious about actually sending it though - I really don't want to make things worse. But I've started to get angry now too. Yesterday I was too upset, but I can't believe the way he behaved, it was just so unprofessional, and I feel like I can't just let it lie.

Urgh, I am so anxious about whether or not I will get this c section, and it is just ruling my whole life at the moment.

Sorry to hear this OP.

You should be seeing another consultant ASAP

If one clinician does not agree to the ELCS then you should be referred to a second clinician- who, I believe, should really agree to it.

I really feel for you- emotions are heightened anyway as you are pregnant, going into a meeting thinking that you'll be able to arrange what you are seeking.

To be treated like that by the consultant is awful.

By comparison, I seemed to get lucky with my consultant who, after we had a lengthy discussion about my reasons & the risks involved etc, calmly looked at the diary, worked out my 39 and booked me in.

I was SO relieved!

With your background, honestly, they should be making every effort to listen to your concerns & reasons.

Good luck!

I know exactly how it feels to be in a position where you feel so much is in another person's hands.

Thanks Turquoise.

The new consultant's secretary rang this morning and said the earliest appointment she could offer would be the 13th April, which just feels like much too long to wait. I am in such a state about this and I can't see a way through it. Also, I'll be 33 weeks by then, which leaves me even less time to sort things out if the 2nd consultant says no. The secretary is going to see if there is anyone else in the department who could see me sooner. Just feel really desperate.

Have you sent the complaint yet? You never know, they might make you more of a priority for another appointment if you get the complaint in. You could always call Pals before sending it if you're worried about the implications - I'm sure they will reassure you.

Another thing you could do while you're waiting to hear about a consultant appointment is to ask your midwife or GP for a perinatal mental health referral. That might help things along and either way it would be good for you to get support for your anxiety and stress.

I really would suggest contacting PALS straight away. They can talk you through the options without contacting clinicians if you don't want to. It's very likely they would also be able to get you seen more quickly by the other consultant.