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Childbirth

Share experiences and get support around labour, birth and recovery.

How to get ELCS for 'no medical reason' ? Please share your experience.

96 replies

Mumtobe1503 · 05/05/2016 18:24

Hello
As suggested by a member I have started a new thread.
Question is to all experienced ELCS and those who are going for it with no medical reasons.

I really want CS. I'm only 14 weeks.Please tell me what are the best arguments to get ELCS ? When to tell them ? I have my next meeting with consultant on 26.07.16 (I have PCOS that's why consultant)
I have my reasons but I don't think that would be enough .

The VB fans please save me the opinions on why CS is a 'bad' choice ...
It's my choice.
Experienced ladies ...What did work for you?
My next appointment in hospital is not till 27.06...
Is it possible to somehow chose the person performing CS ? Maybe you can recommend good contact for Lister hospital?
If I could I would have paid for private but I simply can't :/ I can cover the NHS difference in cost but not going all the way private.

I am starting to write my 'story ' to be ready for the consultation ;)
Obviously if I win the lottery I'm off to Portland Hospital ;)

Any tested suggestions are welcomed.

I am sure there is loads of future mums who are trying get ELCS like me.
Thank you.

OP posts:
FutureGadgetsLab · 05/05/2016 21:22

Unless you're alluding to sometimes abortions are carried out for medical reasons. I wasn't talking about those, this thread is about choices when there is no medical need.

AndNowItsSeven · 05/05/2016 21:32

Future no I don't believe abortion should be free on the NHS either. Contraception I guess so as I imagine it saves more money than it costs. Having said that I pay for my contraception in the chemist.

FutureGadgetsLab · 05/05/2016 21:45

At least you're consistent. ELCS could potentially save money long term though, as you could run the hospital more efficiently and staff it accordingly, you'd have a more predictable birth and less chance of horrendous VB vomplications that aren't included in the cost of VB birth.

mrssiriusblack · 05/05/2016 22:06

My "natural birth" has cost the nhs 1000s more than the c section did second time around, and is still costing them money now! Huge amounts of damage caused and my ds was very poorly as a result, so his stay in nicu also included. We both nearly died.

My c section was perfectly normal... No complications and we were home the next day. I got an infection in my scar but that cleared up in 2 weeks.

This time I'm hoping for a vbac.

The problem with both options is they are totally unpredictable... There are risks with both and you don't know until you've had one, whether something will happen to you so you just simply cannot predict the costs of either.

hazeyjane · 05/05/2016 22:27

you'd have a more predictable birth and less chance of horrendous VB complications...

There are NO guarantees of a more predicable birth in an ELCS
Blood transfusion
Stay in NICU and SCBU
CPAP, heart scans, xrays, tube feeding, abs
Vein infection
Wound infection
PTSD
Antidepressants
Ongoing stomach

All of this and a totally overwhelming feeling of a loss of control over my body, which still gives me nightmares 6 years on, are the things I couldn't predict with my elcs.

And I know VB can be just as unpredictable and traumatic, i have also had 3rd degree and 2nd degree tears double incontinence and pain from bad stitching, but nothing was as bad as my section.

That does not mean that sections are better or worse than VB, but they can have difficult and painful complications for mother and baby and these need to be taken seriously when considering a section.

FutureGadgetsLab · 05/05/2016 22:34

Hazey By predictable, I mean you have a better plan of what will happen. Obviously sections can have complications, but if you have 3 women coming in for a cesarean, you can say with a good degree of accuracy how long the operation will take, the steps that will be taken (stockings, drip, spinal, catheter, cut, birth, stitches and so on) and what time it will occur.

Contrast this to three women having a vaginal birth. They could take 5 minutes or 5 days, one might be in slow labour for weeks while another progresses in an hour. You have no idea what is going to happen, you have no framework to work from.

With a cesarean, there is a plan. It doesn't always follow the plan but it's there. A VB, you have no plan.

hazeyjane · 05/05/2016 22:39

That kind of flies out of the window when the anaesthetist is looking terrified, you can't stop shaking and vomiting, there suddenly seems to be more people in the room, your dh is looking pale and all you can hear of your baby is a strange grunting sound.

But predictable as in, know the rough date (can be bumped for emergency), know it won't take 3 days and it won't happen at midnight - yes.

sparechange · 05/05/2016 22:48

I think the 'c sections cost the NHS too much' myth has been debunked many times over.
When you look at a cohort of vaginal birth mothers vs c-sections births over a couple of years, the cost of physio and follow ups after traumatic births evens out the initial higher cost of a CS

About to go to bed so haven't got any links but it is very easy to google and find the research.

And future made a good point. It wasn't out of order Hmm

sparechange · 05/05/2016 22:51

Future no I don't believe abortion should be free on the NHS either. Contraception I guess so as I imagine it saves more money than it costs
You don't think abortions 'save more money than they cost' also?

AndNowItsSeven · 05/05/2016 23:12

No I am sure they save money I just don't think they should be provided on the NHS.

Junosmum · 05/05/2016 23:51

I also want a section due to birth trauma from a vaginal birth. My vaginal birth has cost the nhs far far more than a section would have and continues to do so.

I'm approaching it with a cost/ benefit analysis -basically my research (mainly using nice and bmj data) on the risks of further birth trauma (physical and emotional) of VB vs risk of complications of CS e.g there's an 11% chance of me requiring forceps again, a 25% chance of permanent incontinence and 90% of episiotomy. There is also a very high chance of ptsd and post natal depression due to birth trauma. This is vs a 2% chance of CS complications (overall, I have a break down based on my age& build plus I tend to heal well from previous surgery). Presented factually and as though you've done your research.

You don't say why you want one, but just make sure that CS is known to reduce what ever it is that you don't want to happen.

If men had to give birth we'd have had all this sorted by now!

MissBattleaxe · 06/05/2016 06:36

Why do you want one Op? Are you anxious?

FutureGadgetsLab · 06/05/2016 09:04

Hazey that's true. My own DS was ill at birth which was unexpected, and required NICU, so I'm not at all saying things don't go wrong.

But like you said, you know the date barring emergencies, you know it won't happen at midnight when there's hardly and staff and so on.

sparechange · 06/05/2016 10:40

andnow
Thankfully so very few people agree with you that it will never happen

FutureGadgetsLab · 06/05/2016 11:26

No I am sure they save money I just don't think they should be provided on the NHS.

So it's not about the money is it? It's about some bizarre moral judgement on women who get abortions and choose to have cesareans.

TurquoiseDress · 06/05/2016 11:36

OP- as others have said, you need to set out your reasons for wanting an ELCS.

I ended up seeing my GP at 36 weeks, in a bit of a panic asking for referral to consultant at local hospital. He was fabulous, didn't ask too many questions, just write the letter there & then.

Had an appointment with a consultant around 37 weeks- I had to chase up via secretaries etc.

She agreed to it pretty quickly & booked date in diary there and then, explained I had to see another consultant as a formality.

Also had to see a psychiatrist too, I was a bit Hmm but obviously went along with it as that's what I needed to do.

I'm a doctor & put together a pretty watertight case for why I wanted an ELCS.

The whole birth was great (post natal not so much), no complications & we were both well.

Recently found out am expecting number 2, I will be requesting another ELCS but am ok will leaving it til late.

Figure there is no point getting anxious about it now, so early on.

AgathaMystery · 06/05/2016 13:27

Hi there - you don't need a robust reason, NICE guideline supports maternal choice. If your consultant says no, they must refer you to another consultant who will agree.

You need to ask your midwife to refer you to the consultants. I wouldn't bother yet - wait until you are 18+ weeks.

RedToothBrush · 06/05/2016 13:28

I want to know WHY you think women request ELCS?

Do you want to quote the NICE guidelines on ELCS?
And more importantly, the reasoning behind them? And what NICE said about the cost effectiveness and health economics of maternal request ELCS?

The thing is you won't because you can't and because you are spouting so much UTTER UTTER BOLLOCKS on this thread.

Let me enlighten you.

NICE decided that any women who wants an ELCS should be allowed one BECAUSE TO NOT DO SO COULD BE POTENTIALLY MORE HARMFUL TO THE HEALTH OF THAT WOMAN as ELCS in this country were now comparatively sage.

That's right. They evaluated that it could be bad for health not to do ELCS on the NHS.

When they did the evaluation they looked into the research available about why women ask for ELCS. Contrary to that well know Medical Journal known as the Daily Mail, they found they women who asked for an ELCS were not 'too posh to push'. They were overwhelmingly in a vulnerable group - they were statistically more likely to have be raped / sexually assaulted or suffer from mental health issues for example. Thus making it even more critical that their cases were treated with care or sensitivity. They were more likely to be older - and therefore more at risk of complications, more likely to be planning a smaller family - and therefore additional risks from subsequent pregnancies were potentially less of an issue, more likely to have gone through fertility treatment and were often very well informed / educated on the subject and well aware of the risks of having an ELCS. They were also far more likely to have had a previous traumatic birth experience which had, had a lot term impact on them either mentally or physically.

Remembering at all times that the remit of NICE is also to consider - and to effectively ban the NHS from using treatments that are not cost effective this is what they concluded about cost.

They looked at the costs, including the long term costs to the NHS from complications and felt strongly and I quote here "cost alone should not be used as a justification for refusing an ELCS" as it was economically cost effective. Looking at continence issues alone they real cost difference between an ELCS and a VB was substantially smaller than other analysis show. In fact, they highlighted the fact that if we wanted to go and have the most cost effective option for the NHS, then EVERYONE should have an ELCS as at a certain rate of ELCS this was cheaper than VBs. Yet they of course said they would never advocate this. Indeed, when they pointed out that the costs of denying an ELCS and damaging someone's mental health were considered there was a real case to be answered financially.

So yes, next time you SPOUT BOLLOCKS on this subject please consider who you are actually attacking and whether your argument has anymore merit than hot air from celebrity mags, because it just doesn't.

There are some weaknesses in the NICE guidelines. They notably don't properly look at risks for women who have already had one child or planning to have another in the future (but still concluded that ELCS overall were on balance a safe procedure - noting that risks for CS in general were stacked in EMCS).

They also point out that little to no research has been carried out to assess whether any form of counselling is effective (they point out that some that is currently being used could actually be harmful too as a result).

Anyway, I'd still like to hear why you think women should be refused an ELCS together with research into why it is a more effective approach than denying access to ELCS.

Alternatively if you would like to educated yourself, the NICE guidelines can be found in full here www.nice.org.uk/guidance/cg132/evidence. Read from about page 100.

For the record, I don't think that ELCS ARE the solution for everyone. Better care during pregnancy and childbirth, particularly in mental health support, would be more appropriate for some. There IS a growing attitude that an ELCS is almost a 'magic solution' to problems, which it may well not be. The problem being that granting ELCS is coupled without ALSO providing mental health support, which in many cases is crucial OR it is made compulsory thus making the process incredibly and unnecessarily stressful. (More support and simply extra contact with midwives can be enormously beneficial to mental health, even if there is no mental health focus). In part this is because so many NHS Trusts have NO Maternal Mental Health support at all. Which is utterly scandalous, though thankfully has been picked up by the recent Maternity Review (which again has gaps imho).

Otherwise, please do one and keep your damaging ignorance to yourself.

OP, I will simply say, the reaction your post has had today is highly unusual. This section is usually a lot more enlightened and not judgemental at all. There is no 'right' or 'wrong' in an ELCS only what is most appropriate for you. As there is in every aspect of health care, which isn't usually assessed for its morally in the same way as childbirth.

In deciding that, your reasoning is important, especially if you want some advise here. If you feel able to share, you WILL get good advice.

AgathaMystery · 06/05/2016 13:31

(Forgot to say, am also an NHS person & had to ask my colleagues which was Hmm but still fine).

Thankfully the days of having to argue your case are coming to an end.

TeamSteady · 06/05/2016 13:56

Red it doesn't really apply to me, as i am happy with my birth options, however i noticed in my notes that it says in big highlighted bold letters in it's own special box:

"We believe that childbirth is a normal physiological process. Caesarean section for maternal choice is not supported by the evidence and is not safer than vaginal birth. Elective Caesarean section is not performed without medical indication at WHHT"

How does that square up with NICE guidelines?

Oly5 · 06/05/2016 14:03

You CAN demand a C section snd they can't refuse, even if you have no medical reason.
You need to look up the NICE guidance on the issue and take it with you.
Tell them continuing with a natural delivery will harm your mental health.
They may refer you to a midwife counsellor but at the end of the day it IS your choice.
It's all in the NICE guidance, have a read

Oly5 · 06/05/2016 14:07

Team, all you would do in that case is say you want to transfer to a hospital that will do elective C sections.
Or say you will start a complaint based on the fact they're not following NICE guidance - which trusts are instructed to follow

FutureGadgetsLab · 06/05/2016 14:18

Team That's awful that they have put that on there. As Oly said, if you were wanting one you could ask for a transfer or complain (I'd do both)

RedToothBrush · 06/05/2016 14:26

The problem is to do with the definition of 'maternal request' and 'mental health'.

NICE failed on this and the Maternity Review has also failed in this respect too.

Thus we have a situation where maternal request is effectively being defined by individual hospitals and there is no classification over ELCS on mental health grounds.

If you read the detail of the NICE guidelines, it very clearly comes down to their justification for allowing ELCS is primarily on the basis of mental rather than physical health (plenty of evidence to suggest there are benefits to a controlled birth which matches expectations better being psychologically preferable).

And therein lies the rub.

So many NHS Trusts have fuck all specialist maternity mental health provision. It does not exist. It politically is unimportant. It is not measured nor considered in outcomes by many hospitals.

So it may well be right that PHYSICALLY an ELCS is not safer.

What frustrates me about it, is my ELCS was on mental health grounds. The consultant went to great pains to stress this. Everyone who treated me said it was appropriate and my best clinical interests.

Yet it was recorded as maternal request as there is currently not classification for ELCS on mental health grounds. (This will have implications if the Maternity Review goes ahead because they have separated funding for mental health into a separate pot).

By not acknowledging mental health in the NICE guidance as being separate from maternal health in someway, it validates publically the myth of 'too posh to push' and serves to persist in the idea that mental health is not a health consideration. Something that is reflected in the poor lack of maternal mental health facilities across the country.

I also note here, that the act of asking for an ELCS should be viewed as a potential sign of a vulnerable person for the reasons I stated previously. Asking for an ELCS does not commit a woman to an ELCS. It can merely provide an 'emotional safety net' whereby she can develop a better relationship with her care givers and maybe change her mind and have a VB (the hospital I went to, took this approach and found it effective). It provides a clear way of identifying women who may need extra support. If you close this door from the outset, you close lines of communication and immediately drives a wedge between doctor/midwife and patient before they even start.

Thus disclaimers like that, stop women from seeking an ELCS on Mental Health grounds before they even think about it (remembering here they are a vulnerable group to begin with so challenging misconceptions will be particularly hard for many in this situation).

And this is why I think they are particularly abhorrent as they are effectively going to disproportionately going to impact on individuals who need the most support.

So yeah. I have massive issues with disclaimers like that, and think they are hugely damaging.

RedToothBrush · 06/05/2016 14:27

yeah the term 'no medical reason' by NICE is bollocks for this reason too.

Mental health is a medical thing.

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