What's the likelihood of getting a ELCS?

[MsHopey]

Hey,
I have previously posted a thread regarding my fears and anxiety surrounding childbirth and all the worries and things that could go wrong with it. I have done loads of research and made several pro and con lists and spoken to many people about their birth experiances, both vaginally and c sections. I've decided that a ELCS is best for me with my pregnancy related problems and my anxiety. I was wondering what other people's experiences were regarding ELCS and if midwives flat out said no to some people or tried to talk you out of it? I'm 32+5 and have my big birth appointment with the midwife next week and I do think want to be told no when this is something that I think is best for me.

I had hoped for an ELCS after a very traumatic birth and was feeling increasingly anxious about my impending birth this time. I did manage to get an appointment with the consultant but when I went for it, there was a midwife to see me first (I was unaware of this) and she pretty much made it clear I needed to get on board with a natural birth as she did not think there was any way I would qualify for the CS. In the end I left without seeing the consultant. She told me if things changed I could request an appointment again but I just knew it was a waste of time. I am still very worried about this birth.

Midwives very often say no there's no way. Mine did and I didn't even want a cs. I had to go to the consultant due to previous complications. I asked the midwife what the consultant was likely to say and she said "oh there's very little chance they'll let you have one even if you wanted it". Went to the consultant and she gave me very balanced advice and said at the end of the day it's up to me. Please go to a consultant and speak to them rather than letting someone who has no say in the decision put you off.

I had an elcs with ds, of my 3 births it was the most traumatic. There are no guarantees (unfortunately!), for either method of birth.

I think if you are determined and confident that you are aware of all the potential difficulties associated with csection, then they have to consider it.

The NICE guidance is here if you haven't already seen it: www.nice.org.uk/guidance/cg132/chapter/1-Guidance

Section 1.2.9 is the relevant bit.

Sadly your chances vary between Trusts, and even between HCPs, but it's worth remembering that it is not a decision the midwife can make unilaterally - it is for the consultant to decide. You've done your research and made an informed decision - don't be afraid to push for it.

It's also worth noting that the RCOG have recommended that women be given the risks associated with a VB in the same way they are for a CS: www.newscientist.com/article/mg23130813-000-uk-doctors-may-starting-warning-women-of-childbirth-risks/

Perhaps once this starts happening women won't be put in this ridiculous position of getting half the information and being expected to suck it up based on the mantra about VB being 'best'

A midwife can't agree a cs either way so at this meeting you need to make clear how serious you are based on your anxiety, that you are fully informed of all the risks, and that you would like a meeting with a consultant asap. Depending on the consultant and the trust you may still have a lot of difficulty getting them to agree, and you don't have much time for jumping through hoops. If you can get back up from your gp or any other professionals that know about your anxiety issues that could be really helpful. Mental health reason is a valid reason for cs, and a totally valid choice provided you're fully informed.

I've got 4 handwritten pages of statistics, pro and cons, my own anxiety and fears and the NICE guidelines. Just worried I haven't left enough time if they make me jump through hoops. At my midwife appointment I'll be 33+4 and I'm starting to stress that they'll just try and prolong the process so I and up in labour. I would be absolutely petrified of going onto natural labour, then having to go through hours of pain and end up with an emergency c section, when everything could have been avoided if someone had just listened to me. I have a few medical problems, nothing that generally presents me as high risk, but something that puts me in to crapper statistical categories.

Ah Ms I did the same as you with my lists. The consultant didn't force me to go to the choices clinic at 13 weeks on the basis that I'd 'clearly understood the discussion'. The ELCS was booked in at 33 weeks for 38 weeks (I'm 35 weeks now and utterly disorganised).

The advice I was given that really helped was: stay calm, firm and fact-based if possible. If you feel you're being fobbed off you still have access to the supervisor of midwives and PALS - both of whom should be able to assist you.

Good luck at your appointment - I hope all goes well for you!

Just came back from my midwife appointment. It turns out I am under consultant care due to my high BMI. It sounds ridiculous that I didn't know, but I've had extra scans and have seen a doctor after them every time, but they've been calling it clinic, which it seemed almost everyone had to go to. Thankfully that means the midwife hasn't got to book me an appointment with the consultant as I already have one scheduled for the 5th July. I can at this time bring up that I want a c section. My midwife didn't seem overly keen but could see when I started crying that it's something I feel strongly about. She said the consultant I am under is thorough, not sure if that's code for I have no chance in hell. I went presented with lots of statistics and how I feel, she basically said everyone feels like me. Sorry, but sleepless nights, panic attacks, constant though of birth and all the bad things that can go wrong, and generally feeling miserable is not something I think everyone feels. And dear god, if everyone feels this way than we need some better therapy on the lead up to the birth. Fingers crossed for the 5th.

Good luck op. Having panic attacks and sleepless nights due to anxiety is not just the way everyone feels. Let us know how it goes.

Good luck for your consultant appointment - I hope they're more open minded . I very much doubt VBs would be championed the way they are if everyone felt the way you do.

One of my friends had a traumatic first birth and felt very much the same as you describe when it came to having her second. She was referred to a consultant obstetrician who specialised in perinatal mental health. Friend said it was great. Apparently the consultant said she absolutely would sign off on an ELCS on mental health grounds, but she would be failing friend if they didn't talk about it first. In the end they agreed a really detailed birth plan that included a really early epidural, going straight to section if there was any foetal distress, no forceps or ventouse, going to section if friend's labour didn't progress etc. etc. The consultant wrote a letter to go in the front of friends notes and wrote things like EARLY EPIDURAL all over them. My friend had a really easy second birth that she said she (almost!) enjoyed and the MWs were supportive and not pushy.

I don't know if they have a perinatal mental health team at your hospital but may be worth a shot if so?

Good luck.

I've had two c-sections that I didn't especially want (operation phobia!), but can completely understand why someone would want one.

In practice, the way to get one of there is no obvious "medical" need is to illustrate that there in fact is a covert medical need -- a psychological one. The best person to diagnose this and convince the consultant will be a psychiatrist. The midwife can't diagnose your psychological condition or do a c-section, so I think you need to bypass her entirely and ask for a referral to perinatal mental health.

My appointment with my consultant isn't till I am 35+2, I can't get to speak to anyone else before then. Would this still give me enough time to have a perinatal mental health assessment and have a decision made before 39 weeks?
Just really worried everything is getting away from me as every appointment keeps being put 2 weeks away :/
At some point I'm going to run out of time and end up with a birth that is completely the opposite of what i want.

I had bad anxiety during both of my pregnancies, I won't bore you with the details as with both my dd's I had a lot of health issues and my anxiety was down to whether I'd give birth to a healthy baby so was more about timing rather than methods IYSWIM. But one thing that stuck with me was when my consultant saw me at 32 weeks with dd1 and we discussed ELCS vs Induction vs natural labour and he told me that I shouldn't fixate on one certain outcome as literally anything could happen and one random dreary Monday at 34 weeks I could go into early labour and my whole 'ideal plan' that I'd pinned all my hopes on could go out the window anyway. I don't know why that one sentence stuck with me but it did and somehow it changed my outlook and I used it as my mantra during my pregnancy with dd2 which did help my anxiety hugely. As it happened, things really did happen very quickly and completely differently to my plan with dd2 (it was literally the complete opposite to what I'd wanted and thought I'd needed and if I'd known what was going to happen i would have had a breakdown worrying about it!) But actually it was all really positive, not as bad as I thought it would have been and both dd's were born healthy and happy and I was fine too. In other words, as easy as it is for me to say, it's really true that anything can happen in pregnancy and a degree of flexibility is a good thing. Stick to your guns, press the consultant and state your case clearly but be prepared for the unexpected just incase.

I found all my appointments were made very late in the pregnancy and I wrote to PALS to get an earlier appointment with the consultant and also saying if he couldn't or wouldn't agree to my ELCS, I wanted to be transferred to a consultant who would.

I did get my ELCS agreed when I was 36+5 and went into labour two days later, so if I hadn't pushed for an earlier appointment my notes wouldn't have said one was agreed. I also insisted my notes said I would have an EMCS if I went into labour before 39 weeks and I am so glad I did that.

My advise would be to write to PALS and someone else who is assertive with you to your appointment. Regardless of what pressure you are put under, keep repeating you want an ELCS and to be referred to another consultant if they won't agree. Get the person who goes in with you to say the same thing and stay in the room until it is agreed. Say that you will be happy to go through any birth options course etc but only once you have your appointment booked so you are able to relax and take on board the alternative options and advise better, whereas your anxiety will just be too overwhelming otherwise.

Good luck.

I doubt they will have time to refer you to perinatal mental health people but that could work in your favour. At your appointment I would stress the impact this uncertainty is having on you as you are now so close and could go into labour at any point- and that you want an answer at the appointment- no more waiting around. If you get it agreed they will do a emcs if you go into labour early so you don't need to worry about that.

Not sure how many people are reading this still.
But just updating as it's something that has really surprised me. I had my appointment with my consultant today, within 10 minutes I had my elective c section consent form signed and my date set. Absolutely unbelievable. I was all ready to jump through the hoops and fight for my right. But he literally listened to me, and agreed that it's my body and what I want is important. He did all the legal stuff he's supposed to, discussed the pros and cons and asked me to sign my consent form when I told him i was still adamant it's what I wanted. Wow. Juat wow.
It's like a weight has been lifted and I can't believe it was all done so professionally and has really raised my opinion of the health care system who listen to their patients wants and needs.

That's great news Ms - and good that you can have confidence in your consultant! Now you can hopefully relax a bit before your new baby arrives.

Wonderful update 😊

Brilliant news and great to hear!

Op I was reading the thread in the hope you got your section agreed, I was like you, I had 2 electives as my anxiety was not within the normal range, no regrets, they both went well and I recovered very fast after both.
Good luck I'm really pleased for you.

Excellent. I had one for very similar reasons to you and it was one of the best decisions I've ever made. It was a straightforward and actually pleasant experience. Ok, putting in the drip and the spinal I found scary, but the Op was a doddle, and rather than birth being unpredictable and painful, I had delicious pain free skin to skin cuddles immediately after birth and felt amazing. I also recovered faster than most people that I know who had vaginal births.

Enjoy the rest of your pregnancy knowing that you have the birth you want in the bag, and that you'll meet your little one soon.