Elective C Section - when to discuss with midwife?

[joojoobean99]

I'm 16 weeks pregnant and had my second midwife appointment yesterday, in which I wanted to discuss my labour options and whether having an elective c section would be possible at all (please don't judge, I have my reasons for wanting CS so don't want this post to be about why I want one and if it's the right thing to do). Basically the midwife said we won't discuss labor until 34 weeks, and that was the end of it. 34 weeks seems awfully late though, and I'm so stressed and anxious at the thought of a VB that I can't wait until 34 weeks to know what's happening. Is this normal? Do they normally make you wait until then to discuss how you want to give birth? I kinda figured the earlier I got the ball rolling the better?

TIA x

I discussed this with my midwife at about 16 weeks and she seemed fine with it. Just before that id seen a Dr who'd suggested it as a potential option and they booked me in for another consultant appointment at 36 weeks "to discuss options". I assume they'll give me an appointment for the c-section at that 36 week appointment. Apparently they do electives at 39weeks. I am seeing the midwife again in a couple of weeks and I'll mention it again in the hope she writes it down! I think the NICE guidelines basically say you can have one now even if you have no medical reason to do so though so maybe just keep mentioning it.

I think 34 weeks sounds pretty reasonable. Most people won't know the circumstances that will influence when and how they choose to deliver until much later (is the baby breech, any medical conditions like gestational diabetes that might arise etc). In both my pregnancies decisions weren't made until the last couple of weeks (and changed a few times!).

I think if it's a c-section is an option that is "usually" available to women in your position, for example if you've had a previous section, serious birth trauma or a previous stillbirth for example, it's the usual time for discussing it. If however this would be your first birth, or perhaps you've had a previous traumatic birth but aren't sure if the consultants would think it was traumatic enough (can't think of another way to put it, sorry) then it's too late IMO. If consultants don't agree with your reasons for wanting a section they may advise you first to be referred counseling or indeed refer you to another consultant, all of which takes time. If this could be the case for you I would push it some more with your midwife!

Having thought I was going to try for a vaginal birth, at 36 weeks the midwife thought DD was breech, the scan at 36+5 showed her to be transverse, booked ECV, it was successful initially but DD turned transverse again, so at 37+2 I was booked in for c-section at 39+1 (I was also admitted, but that's another story). My point is that at 37 weeks there were still a good number of elective slots available two weeks later, so I don't think you need to worry just yet.

I had an early appointment with a consultant due to a high risk of genetic disorder (all well) - was told they would discuss elective section at 36 weeks but I could have it for maternal request if I had a sensible argument. Was expecting more of a fight (did with pregnancy 1) but in light of issues (the issues I thought would arise which did) in my first pregnancy they told me they understood but didn't think the issues would reoccur. I wasn't prepared to take that risk and showed them I was aware of the issues. Just show them you have informed consent and take them the bits of information relevant to your concerns. I also had a sympathetic consultant who wasn't adverse to maternal requests. If you find yourself with someone who doesn't entertain the idea (they don't have to) ask to be referred onto someone else for a second opinion and someone who is more sympathetic. If you have a reasonable argument it should be your choice alone.

More than happy with my choice.

No the midwife is fobbing you off. You need to put more pressure on and ask to be referred to the hospital- usually it would be first meeting with a consultant midwife or supervisor of midwives and then meeting with consultant obstetrician. They may ask you to go to counselling with the perinatal mental health team also. The process for me took 28 weeks in total. Yes it is very easy to book a cs in with only a couple of weeks notice but it is getting it agreed that will take time. Depending on your nhs trust a simple maternal request may not get this approved, however mental health reasons- anxiety or fear over birth- will. Some areas make it much more difficult than others but it will be possible if you are persistent. Good luck.

Thanks for all the replies. I think I might have a bit of a fight on my hands to get a CS, so want to have enough time to make the decision if they feel I need to be referred for counselling, etc. I basically just wanted a bit of comfort from my appointment yesterday by knowing that a CS was a feasible option for me, but now knowing I'll have to wait until my 28 week appointment to bring up the subject again just makes me so anxious.

A friend had a similar experience as mimiholls describes. It took a significant part of her pregnancy to get the elective CS and she talks about having to see the 'end of level boss midwife' to get it agreed. Lots of hoops to jump through. I think you have to be a bit proactive and say this is what I want, let's get the ball rolling on the process to make it happen etc. Good luck!

Thanks mimiholls. That was exactly my worry, that getting it agreed is what will take the time. And waiting until 34 weeks to discuss and then potentially be refused is just a situation that I don't think I could cope with mentally!

Definitely, it is really stressful and imo completely unfair to put women through this especially as they are often suffering from extreme anxiety or effects of previous trauma, and a long period of uncertainty can be terrifying. I would phone your midwife and ask for a referral to discuss it with someone at the hospital (there is usually a birth options clinic or something like this with a senior midwife). A cs is a valid choice if you are fully informed, it is your body!

They should be able to agree to you definitely having a c section before then. The 34 week appointment is to book date. Keep pushing to get it stamped in your notes that you have chosen to have a section.
I got to 28 weeks and suddenly couldn't face birth and it was all arranged quite smoothly. In the end I needed one for medical reasons so my gut instinct was right!

I requested a consultant appointment at 32 weeks. Told them I was considering a planned CS (lots of reasons - last birth, my chronic illness etc etc).

The consultant heard me out. Said he would still recommend a VB as it's always the best option if it's possible, but that it was ultimately up to me.

He gave me a leaflet and asked me to come back 4 weeks later to give my final decision. That was today!

I said that I had decided I definitely want a planned section and they booked me in there and then for 38+6.

So I don't think those dates would be too late for you. But perhaps bring it up with your midwife sooner rather than later and see what she says

It wasn't my usual midwife I saw yesterday as she is on holiday, so I might give her a call next week and hopefully she'll be understanding about the situation and refer me to whoever I need to speak with. Thanks for all the replies, this has definitely made me feel more confident in asking for what I want rather than waiting until it may be too late! X

Second mimiholls The midwife fobbed you off and YOU need to get the ball rolling.

NICE guidelines say the discussion you have about ELCS needs to be recorded and healthcare professionals need to know it is an appropriate mode of delivery for you and your baby. Ring them up and make an appointment. You'll need to know what the risks of ELCS are because ultimately it may be the procedure you undergo. Good luck

The specific NICE clinical guidance on maternal request CS is here of you need it:

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]

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

[https://www.nice.org.uk/guidance/cg132/chapter/1-Guidance]

It's worth arranging an appointment with your midwife now and requesting a referral to a consultant as these things can take time