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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:
RedToothBrush · 19/05/2016 11:13

Oh god.

DO NOT ask at the skepticalob!!!

Its a biased website full of people who are not going to give you a balanced point of view and as you rightly point out its American based, which is very different in the way they practice (the role of doctors, nurses and midwives are different).

I am pro-choice. I am not pro-ELCS.

The difference is massively important to making an informed decision.

You do not want to get biased information for an ELCS just as much as you don't want to get biased information for a VB, even if you want an ELCS.

Just because someone has a study 'at their finger tips', does not mean the quality of that study is good, the study relevant to you or medicine in the UK, the source reputable or the analysis unbiased.

I personally think the Skeptical OB is to be taken with a gigantic pinch of salt and is actually potentially doing harm, as its so biased to a degree which is not accurately reflective of the real problems it tries to address. It just scares women rather than informs them.

FutureGadgetsLab · 19/05/2016 11:22

The NICE guidelines are only guidelines which do not have to be adhered to. Not all hospitals are following the guidelines. Some are actively refusing to.

But they have to refer you to someone else? My consultant told me that and my own research confirms it.

Majorlyscared1993 · 19/05/2016 11:45

So what's the upshot red? How does one go about getting one

Alasalas2 · 19/05/2016 11:53

This reply has been deleted

Message withdrawn at poster's request.

FutureGadgetsLab · 19/05/2016 11:57

They have a c section rate of near 100%, alasalas2?

Alasalas2 · 19/05/2016 12:06

This reply has been deleted

Message withdrawn at poster's request.

Alasalas2 · 19/05/2016 12:11

This reply has been deleted

Message withdrawn at poster's request.

RedToothBrush · 19/05/2016 13:25

But they have to refer you to someone else? My consultant told me that and my own research confirms it.

No. That's still part of the guidelines.
They are not obliged to give you an ELCS and they are also not obliged to refer you to someone else.

That's the problem.

There are hospitals essentially refusing to acknowledge that the guidelines are there and are doing their own thing.

So what's the upshot red? How does one go about getting one

Well you might be lucky and your hospital might be fine and you'll get one agreed no problem. Or you might be unlucky and be at a hospital that's has a policy of being difficult or you might just get a individual who is obstructive.

The problem is, it does come down to your postcode and luck.

The thing to do, is do your research.

  1. See if the hospital has a maternal mental health facilities (they are usually more accepting of an ELCS on mental health grounds at least, as they actually acknowledge its a mental health issue - unlike others - and have specialist staff trained to help).
  2. See if you can find out whether the hospital is heavily promoting its VBAC or low CS rates and is 'proud' of them. Being proud of statistical outcomes over wellbeing isn't necessarily a good thing especially if you are looking for an ELCS. 'Woman centred care' is a much better type of phrase to look for, as it implies that the concerns and health of the woman, rather than the hospitals statistics are the priority.
  3. Ask around. Do you know anyone who has local experience of asking for an ELCS at your hospital of choice? Can they give you a name to try and get referred to?
  4. If you have extreme feelings about this, enlist the help of your GP. Either whilst you are pregnant or even before. Get them to acknowledge or recognise you have an issue you want to be considered as grounds for an ELCS. It might hep strengthen your case or give you an ally.
  5. If you have previously had a traumatic birth, look for birth reflections type sessions/appointments as this will a) be a reflection on the hospital and their attitudes to trauma and b) if you do have a real problem it will strengthen your case.
  6. Use the information and studies in the NICE guidelines as a template to make your case. This evidence is evidence that has been evaluated (each is rated as to its strength), it is relevant to the UK, and the analysis proved by NICE means its not too biased or flawed (cavet here being there are a few issues with it, namely over the fact that they looked at first time mothers only and didn't look at how this affected subsequent births).
  7. If you are over 35 this may well be a point to argue in your favour due to the additional risk of ending up with a CS anyway (but the converse is also true). You are also less likely to have many children so this also might stand in your favour
  8. Do you have any existing medical conditions / problems that might make you a better candidate for an ELCS. Stress these. They can include a history of mental health problems or physical issues (but note there can also be a case for a VB for some women too, depending on the problem so know your stuff)
  9. Make it clear you understand what you are saying; don't use 'facts' that are not true - eg I have small feet so therefore I am unlikely to be able to give birth naturally - this is mentioned in the full NICE guidelines on reasons that are not statistically proven to be an indicator for an ELCS. Also a family history of difficult births is not a valid or proven reason. Instead, focus on facts that are in the document. Eg. I see that a risk for a hysterectomy is greater for an ELCS but I feel I could cope with this better than the risks associated with severe tears if the worse should happen. In short, be able to hold a conversation about it and demonstrate your understanding.
  10. Bring someone with you to the appointment to back you up, and if you do get negative feedback, someone who can help you with what's been said to construct a counter argument. Emotional support is important.
  11. If you do get a refusal, and you are still unhappy, and do not feel you have been listened to push for another appointment. They have a duty of care to make sure you are ok. Whilst you do not have a right to an ELCS or another referal, you DO have a right to the most appropriate care (which might actually be an ELCS) and if you are still anxious about having a VB they have to address that somehow. If they don't try and address your concerns adequately or properly they are leaving themselves open to complaints. (So that referral under the NICE guidelines you were refused, although the hospital does not have to do it if they don't follow the guidelines you can force under your other rights) It sounds arse about face, and it is, but that's the way it works. You have to know how to navigate your way around and how the system is constructed. Its dreadful as only those who are able to do this, can access the care they feel they need.
  12. Do not demand. You won't get anywhere.
  13. Do explore other options. If only for a worse case scenario that doesn't go your way. You might be surprised and find that one of these is more acceptable to you than you thought. Equally, ask what other options might be available based on your concerns. EG. If your concerns revolve around pain relief, ask whether there is a possibility of early pain relief, and how they might be able to accommodate this. Sometimes they will make concessions or compromise in ways you did not think. But you have to ask. Don't worry about being 'demanding' or 'cheeky'. You are just trying to address concerns. This is perfectly acceptable. Also demonstrating you are potentially open to other ideas, may help a case for an ELCS, if you then say none of these options are acceptable to you for X reason.
  14. WRITE THINGS DOWN. It can be very overwhelming when talking to medical staff. You might forget things or get emotional. Having something written down stops this, and is a way to articulate things you wouldn't otherwise be able to.
  15. Don't give up. Some hospitals seem to have an attitude of making things difficult or saying initially you have no chance, but if you push for another appointment will then surprise you in being supportive. Equally some will not make any decision at all until relatively late (which is stressful in its own right and I think is poor practice).
  16. There is NO RIGHT way to give birth. Only the right way for YOU. Don't compare yourself to others. What is right for me, might not be right for you. ANYONE, who tells you differently (including medical staff) is wrong. Everyone is different and everyone needs different levels of support and care.
  17. There is nothing wrong with changing your mind. If you do get an ELCS agreed. You are not obliged to have one.
  18. And finally, an ELCS is NOT a magic solution. It is still a hard thing to go through (Do not believe the tonnes of stuff saying its easy by anyone. It may be easy for some, but things can and do go wrong too and its very easy to get sucked into believing people who say 'its brilliant'). If you do have an ELCS, and it is for mental health reasons, your problems don't go away. You might still need other extra support AFTER the birth. Think about this too, when you are considering WHY you want an ELCS as its important and relevant. Its easy to focus completely on the birth, and nothing else. This is a potential issue in its own right.

The NICE guidelines don't give you a right to anything, but they are very useful and do give you a really good framework for making a case for yourself. They can be used to put pressure on difficult hospitals and individuals.

I've seen few people post about it on MN and be refused in the end (There have been some). But they do go through varying degrees of stress and difficultly to get to that point. It is not an equal system and the inequality nationally is a disgrace. There are some very vulnerable women being told that they do not have a medical reason for an ELCS in some places, whilst others in a similar position are being treated properly and their mental health problems fully acknowledged and considered.

I hope that answers your question!

FutureGadgetsLab · 19/05/2016 13:30

Red ah I didn't know they could refuse to refer you.

Can you not just change hospital if that happens?

Good post, although I would say that

"Also a family history of difficult births is not a valid or proven reason."

Is accepted as a reason as to why you might be afraid of VB. It's not proven to mean you will have a difficult birth but my consultant was understanding when I explained it as one of the things that put me off.

RedToothBrush · 19/05/2016 14:54

Is accepted as a reason as to why you might be afraid of VB. It's not proven to mean you will have a difficult birth but my consultant was understanding when I explained it as one of the things that put me off.

There is no evidence that a family history of a difficult birth, means you will also have one.

HOWEVER

It is fair and acceptable to say, that although you know this to be the case, you still can't come to terms with that in your head. What you know true rationally and logically is still not removing your emotional worries and fears about what could happen because you have someone close to you who has found it difficult and this has a disproportionate influence on your thinking. This is causing you anxiety and stress in its own right.

Its a subtle but important difference which makes it a fair argument.

Fear and phobias by their nature are very emotional, and are difficult to negate with logic and reason. If you can demonstrate you know the difference, it puts you into a position where they can look at other ways to deal with that rather than just giving you information or merely saying you are wrong.

If you can articulate what part of the family history of difficult births is the thing troubling you the most, they might offer a way to try and cope better, or try and manage a natural birth better. If you say X risk associated with a VB is something you are not comfortable with, but you are more comfortable with Y risk associated with a CS then again you are demonstrating an understanding of risk and something they can work on managing.

Yes, an ELCS might ultimately be the best way to deal with it, but equally its also about pinning down exactly what element of giving birth is giving you most cause for concern and then giving you a range of options to deal with that.

I have to say, I found the process of breaking down fears, very useful in its own right, as it helped me to understand the fear. Just being able to articulate and rationalise it, even if my irrational fear won out made me feel a bit more in control of the situation. I felt 'stupid' at first, but other people saying, no you are not stupid, how you feel is understandable given your knowledge and experience was important in a variety of ways. It helped to build trust and respect on both sides.

Its very much about framing and opening communication channels, particularly ones you didn't think possible when you start out.

Which is why I do say that, just saying 'no' without listening is just about the worst thing that could happen. Even if that is eventually the case, then there has to be a process of listening, communicating, exploring options and a explantion which answers your concerns to the best possible and most comprehensive standard. The eventual outcome has to be about whats in your best interest in the long term.

RedToothBrush · 19/05/2016 15:12

Can you not just change hospital if that happens?

Yes in theory you could.

But there is no guarantee will definitely get a more favourable response elsewhere. You still might have to go 'through the process', which can be time consuming and it might well be the case that by the time you get an appointment and refusal at hospital 1 you are 30 odd weeks gone, switching to hospital 2 is not practical as they can't give you an appointment immediately anyway. In which case, pressing the issue at hospital 1 might be a better option as you can argue that they haven't sufficiently given you appropriate care as they are not dealing with the problem, they are just saying a flat no.

It really is rubbish, and I do think more constant and universal acceptance and application of the guidelines, in tandam with actually having proper support services is essential to the future of good maternity care in this country. That doesn't mean that the guidelines are set in stone, just that if the guidelines are not followed, a better explantion and alternative models of care are offered than currently are.

FutureGadgetsLab · 19/05/2016 15:23

If you can articulate what part of the family history of difficult births is the thing troubling you the most, they might offer a way to try and cope better, or try and manage a natural birth better. If you say X risk associated with a VB is something you are not comfortable with, but you are more comfortable with Y risk associated with a CS then again you are demonstrating an understanding of risk and something they can work on managing.

This is what I did, I explained exactly what it was about VBs that I was uncomfortable with and why I felt more comfortable with the risks of a cesarean.

I didn't actually have to talk about my fears with anyone, my hospital just said "okay" and booked me in, but that was fine for me because I'd already analysed and made a list of pros and cons.

Re your second post, that is awful. I got referred at 15 ish weeks and saw someone then, and at 20 and at 34 and it was explained from 15 weeks that I could have an ELCS. I didn't realise some women have to wait until 30 weeks to know one way or the other.

AlphabetSt · 19/05/2016 15:48

Following my earlier post, I just wanted to say that possibly depending on the reason for it, it isn't always a nightmare to get an ELCS. Sadly I think that my experience isn't particularly the norm, and it really does seem to depend on luck. But during my first pregnancy, I had a really wonderful midwife, who very understanding. She referred me to a particular consultant who she thought would be sympathetic to me, and he was. He was marvellous, and did everything he could to make things easier (I was in a very bad place with the tokophobia at the time). I had my ELCS booked quite early in pregnancy. Second pregnancy, different hospital, and I didn't really have any problems getting them to agree to an ELCS either. I'm really concerned that after seemingly moving forward, what with the 2011 guidelines (I know things were far from perfect but it was certainly a step in the right direction for birth choice for women), it seems to be getting harder again for women to obtain an ELCS. Like Red I am not pro ELCS but pro choice and personally think women should understand and be made aware of the risks and benefits of all types of birth. And should then be able to choose whatever mode of delivery, without having to justify it at all. Arguments against ELCS based on cost are just ignorant- and I can think of many ways the NHS does waste money, but ELCS is not one. For one thing, I honestly believe that a woman stands the best chance of starting motherhood the best way possible if she has had the kind of birth she wanted, and I think freedom in birth choices reduces (I say reduces not eliminates) the risk of PND too. I can't imagine what the cost would have been to the NHS to try and patch me up mentally had my births not gone to plan (particularly severe tokophobia here).

I won't give too much info here as I'm trying to remain a bit more anonymous on MN these days Grin but if anyone happens upon this thread I am happy for them to PM me and I will share more of my experience.

flowerpower22 · 13/02/2017 21:56

I will be hated for this I had a emergency c -section Due to baby being small and in distress

But I had a elective booked because I couldn't cope with vaginal exam and possible tearing interventions pain in that area because of PTSD it was the best experience I could have hoped for I truly believe that if you feel it's for you having a elective c-section birth plan is great letting the wonderful Staff know what you would like helps having someone walk you through it and what to expect is a good thing but be open to needing to be flexible is a must

TheFullMrexit · 16/02/2017 16:24

Op I don't know why you want one?

I have one "normal" delivery, in medical terms it couldn't have gone better but emotionally for me it was awful I did loads of research on here, and told my MW I wanted to deliver by ELC. An appt was made with consultant, and luckily she was part of birth trauma assoc.

I told her my "story" and she said she felt it would be a good idea if I felt control over this birth and said I could have ELC, no problem.

She did say it would be good idea to talk to head MW which - was a real insight into a brain washed type of MW!!! But it was fine and I had one and loved it. good luck op.

TheFullMrexit · 16/02/2017 16:35

Anyway the bottom line is its your body - its barbaric to decide for any woman whats the best way for her to deliver is. Its your body and no one can assure you your labour will be risk free.

3luckystars · 16/02/2017 16:35

My sister had 2.

She went privately to a gynaecologist and it cost her£1800 to be a private patient. She still went to a public hospital but her c section date was sorted with the consultant at 20 weeks.

Even on the day of the c section, the midwives were pestering her to have a 'normal' birth. They just did not understand her. She just couldn't do it.

It went very well and she was delighted with her decision.

TheFullMrexit · 16/02/2017 16:38

Yes the HM who spoke to me was glowing re my first labour - how my hips were made for birthing Hmm how I was so lucky and had such a quick labour.

I had to say to her I am a whole person and more than a pair of good birthing hips but she was lost in reveries of ocytocin etc, candles and massage ( which I had first time!!)

TheFullMrexit · 16/02/2017 16:39

The EKC was an amazing way to bring baby into the world. I was rested, had a good sleep the night before - oppose to two nights of sleeplessness with contractions, no fear, no nothing! It was all amazing, we got off to a great strart and unlike with my first I was so much more relaxed etc I was able to BF and we carried on for three years Shock it was all lovely!

TheFullMrexit · 16/02/2017 16:39

L

Fighterofthenightman · 16/02/2017 16:54

The OP was 14 weeks in May 2016 so she's already had her baby

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