[Feeling lost and scared] Elective C-Section

[dolly1234]

Hi ladies,

This is my first time posting on this forum, and I am somewhat of an imposter. The reason being, I am not yet pregnant!

My husband and I are ready to start a family in the very near future, but there is a problem.

I don't want to go into great detail, forgive me. However, I need to have an elective c-section. A natural birth is simply not an option for me.

As a teenager, I was raped. Due to a variety of reasons, that makes a natural birth absolutely impossible for me. I have had support, therapy, counselling etc. over the years and am generally doing well and in good mental health.

However, thinking about family planning and giving birth has caused a lot of emotions to resurface, and I have resumed counselling with a therapist specialising in rape survivors. She is wonderful and, knowing the full circumstances and having explored options with me, she completely understands my need for an elective c-section and inability to cope with a natural birth. My husband is supportive of this.

I have spoken with my GP, who has told me that psychological reasons can warrant an elective c-section, but "it depends on who you speak to". I have asked to speak with an obstetrician or midwife, but referrals are not made until I actually fall pregnant.

I need to know before I fall pregnant if I can have a c-section.

If I were to fall pregnant and then be told I must have a natural birth, I would be in a completely impossible situation. I would not want to terminate a very much desired pregnancy. And I could not have a natural birth.

It seems that access to maternity professionals only happens once you fall pregnant.

My husband and I are now in "limbo" because we will not start trying to conceive unless we know I can have a c-section. Our backup plan is adoption, and we would need to start that process fairly soon.

I would so appreciate any advice. Who can I speak with? What can I do?

Any pointers in the right direction would be so appreciated.

I hate that such an exciting time, planning for a baby, which should be filled with joy and hope... is actually dominated by this horrible incident that happened so many years ago. I hate that it affects what should be a wonderful time. I am losing sleep and am so worried about this. I am desperate to be a mother and my husband is being patient with me, but we need to move forward with this.

I am keen to find out what my options are. As my GP was not very helpful, I am turning to the people that surely know best - you!

[user1483291956]

I also have a fear of childbirth, the whole thing-examinations, complications, being touched...the list goes on! It's called tokophobia and has a variety of 'causes' for you it seems its the childhood trauma, I've no idea why I have mine. But I do. It's horrible isn't it. You want something so badly, but yet feel completly unable to do it! I am currently in the process of getting a c section agreed before pregnancy, it us possible, but not always easy.

I first approached my gp in January, in a bit of a state, he didn't think c sections are agreed before pregnancy and so refered me for cbt. There was quite a long wait for this so I went back to him in May and asked him to do something else. Think he was at a bit of a loss and so sent me to a gynaecologist.

The gynae was amazing, she has said there is absolutely no reason a section can't be agreed before pregnancy and is going to write me a letter confirming that it is what she feels best for me. I do have to see a psychiatrist and c section midwife before this can happen, to check I have the mental capacity to understand the risks/benefits and make the choice for myself.

The cbt us also really helping, the first lady I saw wasn't great and didn't understand at all, the new one im seeing understand that I'm not going to change ny mind, but is working on helping with staying calm, how to approach the doctors etc in an effective way, worries I have about c section etc.

It feels to me that once I'd got to the actual people who can make these decisions they totally understood and are sympathetic to tokophobia. However getting to see them has been a challenge. Don't give up though, it's taken me about 9 months to get to see the gynae and I finally feel like I'm being listened to. It really is possible, but probably won't feel like it at times.

I'm happy to message you in private and share more details if it would help? Good luck, we can do this....i hope!! :-)

[RedToothBrush]

I live on the border between Cheshire and Merseyside. Any ideas where I should be going to and who I should be asking?

Are you Warrington/St Helens/Runcorn/Widnes?

The good news is you aren't in a bad location to get help.

Ask to try and get a referral to Liverpool Womens if you can before getting pregnant. They have the most experience with people suffering from the condition in the region. And you definitely can choose it to give birth in, although this does have some complications and difficulties (you need to be on the ball with your test timings and chasing up results as there are different policies between Trusts for this).

I think the situation is improving elsewhere, but its not as far advanced as in Liverpool Women's who have carried out research projects into the subject with Liverpool University.

Most importantly it means you will get taken seriously.

You can get referred before getting pregnant. Its down to your GP to do this. The key is therefore getting your GP on board. You are not a priority for a referral but it is possible to do if you can make a case that your fear is severe enough to merit it. Its unusual and difficult but not unheard of. If you are being told you can't get a referral without being pregnant this is categorically wrong unless Liverpool Women's have changed their policy since 2014. This is potentially about your GP being difficult not the services that are ultimately out there and available to you.

Check out the NICE guidelines on
www.nice.org.uk/guidance/CG192 Antenatal and postnatal mental health.

These state that women should be able to get appropriate help BEFORE being pregnant if it is relevant if they have mental health issues. This includes for tokophobia. This is your friend. Make a case from this to help get a referral before conceiving.

The whole thing is about being able to navigate the system and knowing what your rights are (and are not) and what care pathways should be available to you. Unfortunately a lot of HCPs are unaware of this or don't follow NICE guidance which means it is often down to you to take the initiative and be pushy about it.

Liverpool because of its experience in the field is not as backwards about when they discuss birth choices, particularly given your history.

The worst case scenario is that you can now go private at Liverpool too.

Good luck.

Feel free to PM if you want.

[Rockandrollwithit]

Just wanted to share that I am having an elective CS in two weeks, on the NHS. It's due to mental health reasons associated with a very traumatic previous birth.

I have not had to 'push' for this. I had a few appts discussing different options with my consultant and with the perinatal mental health team. All the way through it was emphasised that this would ultimately be my decision. I was not made to feel bad at all. And there have been no vaginal exams.

Just be aware that my trust will not discuss birth choices until 34 weeks. Although it was easy to get the CS I worried about it for a long time before.

[EdgarAllenPoe]

Firstly kudos to you for trying to be proactive and find a solution. It's a pity the system is not set up for such thinking, but at least you are prepared.

Lots of NHS trusts will do ELCS on maternal request alone, but you may have to argue your corner. If at first you are denied, you have the right to request another consultant. It's often commonplace to refer you for counselling if it's not for a physical reason, which isn't necessarily a bad thing as it could help you, but means it could take a while to get everything organised or confirmed. Doesn't mean to say they'll deny you though.

The other issue you may face is once you are pregnant, there is often no great hurry to confirm your birth plans until much later on. So in my case I'm 6 months pregnant and I wanted an ELCS in order to avoid the EMCS situation I had with my last pregnancy. I had no issue getting the consultant to agree to my plans, but I didn't see her until 16 weeks, which is standard, erring on early. She booked me a date in then and there, which is actually quite lucky. I know plenty of ladies who have to wait until much, much later on to get their ELCS either confirmed or booked. This makes the option of termination much more difficult (even though it would be difficult regardless). Just be prepared for it to take a while, doesn't mean it won't happen.

As for vaginal exams, you don't get any during a normal pregnancy. If you need an early, early scan, that is usually done transvaginally, but it's unlikely. Likewise if you have a weak cervix you might need that checking regularly, but that's rare and even then, you don't have to consent of course, but you have to accept that risk. For a CS you will require a catheter, but this can be done once the spinal block is in place, and you won't feel a thing.

Last but not least there is the private route. I looked into this before getting pregnant with my second. It varies a lot by region. In the northeast/Yorkshire, it was about £9000 including prenatal. If it's something you could fund, it may help ease your mind. But I think you have a very valid shot on the NHS. Mental health is just as important as physical. Good luck to you.

[mimiholls]

Just to correct whats been said before, the consultant midwife has no power to make the decision. Only a consultant obstetrician can agree cs. But the consultant midwife is the person who will refer you to them and you will usually need to go through them first.

[Ketchup123]

Hi there,

Firstly, there are no vaginal examinations done in the UK - the only time this would happen would be during vaginal birth/to induce birth. And that is with consent.

Secondly, I can guaruntee they will allow you to have an elective c-section. I suggest going to a private psychiatrist first to try to get a letter of support. Sometimes the consultant midwifes can really try to delay your decision/push back against your decision. But I honestly can say that you will get your ELCS in the end. The absolute worst case scenario is that they will refer you to another hospital that will be happy to do it - but that is highly unlikely to be the case in your situation. Mention the suicidal thoughts so you'll be referred to their pregnancy psychiatrist, who will OK it (definitely), then you're on your way. Really strongly push your community midwife to refer you to the consultant midwife (who makes the decision) early - this usually doesn't happen until 20+ weeks. Hound them.

You won't have any problems getting your ELCS. Good luck!x

[BewareOfTheToddler]

Also wanted to add that vaginal exams may well not be required - I had none until I hit my due date and agreed to a sweep (which would obviously not be offered to someone booked in for an ELCS!). Nobody showed any interest in my vagina until I was well overdue and actually at the hospital being induced - the only exams I had as part of my pregnancy care were scans and to feel the bump and where baby's head was, none of which required knickers off. Hope that helps and good luck! You sound very brave

[notsobeachready]

Firstly, for your bravery in moving forward.

Secondly, I think it's your local health authorities' policies that defines how much of a hard time you get with having an elective C-sec. I've known ladies who have had them simply because they didn't want a vaginal birth. Simple as that. One of them had a very hard time and had to see two consultants before it was signed off but I don't think they can refuse you a C-sec, and given your reasons I can't see why any doctor would put up a fight.
Best of luck with the baby making

[allthecheese]

Lots of people on here saying you have to be insistent to get an ELCS. I am with Kingston Hospital and they are letting me have an ELCS for no other reason than my not wanting to give birth vaginally. They haven't been pushy at all about a vaginal birth.

[PacificDogwod]

Once you are pregnancy you might be referred to a peri-natal MH team who could help as well.

[PacificDogwod]

I am sorry you have to live with what happened to you

Please seek help in RL about this.
Read up about tokophobia.
Consider hypnobirthing.

While you will not get any cast iron guarantees from anybody while you are not even pregnant yet, as per the linked NICE guidelines you choice of delivery when the time comes will be part of the decision making.
And IME (professionally) if you still feel the same when the time comes to deliver your baby, you have had all the information about CS and VB and with your history, no obstetrician worth their salt will decline you an elective CS.

I have known of some rape survivors who did have VBs and found that this helped them to recover from the trauma of their rape.
I think you should seek RL help before you consider TTC.

Pregnancy and childbirth (whichever way you end up delivering) brings up many feelings and old trauma, this can be even more significant if you have a daughter

[Pigface1]

Hi OP

Seems I was wrong about the vaginal exams - I didn't know you could opt out of them!

That issue aside, other posters have obviously posted information about how to get a maternal request c-section, but I still can't see how you would get a pre-conception guarantee from the NHS that you can have one - which is what it sounds like you want for your mental health.

I think that the only way to have an absolutely cast-iron pre-conception guarantee of an elective would be to go private. However, I don't know of any private maternity hospitals outside London. It might be that an NHS hospital in your area has private maternity facilities though - could you do some research online?

In the meantime here's the price list for Portland - see elective section. It doesn't include the consultant's fees which I understand are circa £6k.

www.theportlandhospital.com/uploads/data/files/consultant%20led%20prices%202017.pdf

[DuggeeHugs]

If you haven't already seen it, the NICE guidance for CS is here: www.nice.org.uk/guidance/cg132/chapter/1-Guidance

Section 1.2.9 covers maternal request. Although it isn't compulsory for Trusts to implement the guidance, many seem to follow it so it might be worth finding out where yours stands on the subject

[HariboFrenzy]

I have had an elcs on request. I've always been terrified of childbirth. My midwife was very supportive, and as far as I understand it a consultant may refuse a c section but must refer you on to someone else. The second consultant I saw agreed. It was not too difficult, although I did need to be insistent. Good luck

[mimiholls]

Hi dolly, you should be able to get an elcs on mental health grounds on nhs. I have had one for much less reason than you have, as have many others on this board. It depends on your nhs trust as to how easy it will be to get it agreed but you absolutely have valid grounds. You would need to talk to your midwife at your first appointment and ask to be referred to a consultant. They may make you see a supervisor of midwives first who's job is to deal with birth choices. They may also ask you to go through counselling with perinatal team. If you keep being persistent and pushing for these various appointments I am confident you would get this agreed. That said it is very stressful to go through this during pregnancy without knowing the decision for sure. I think it may be difficult to get a guarantee prior to pregnancy but you could try seeing your gp, and also writing to your hospital- perhaps ask for a contact for the supervisor of midwives (sometimes called consultant midwife) as birth choices is often part of their job.
With regards vaginal examination, no I never had one during pregnancy or elcs, and there's no reason why you should. If you did go into labour before your elcs they would perform emcs.

[Primulas]

I had an elective C-section booked (ended up as an EMCS as DS came early!) largely for mental health reasons (lots of medical phobias), though I was probably helped by the fact that DS1 was an EMCS. Do you have a GP with whom you have a good relationship? I went to mine as soon as I found out I was pregnant and explained everything to him. He then wrote a letter to the consultant explaining everything and there was no problem at all getting the CS agreed.
I agree, no vaginal examinations required during pregnancy! I also found that, because everyone knew about my phobias in advance, they were very kind in talking me through everything and agreeing with me what I could cope with and how they could make it easier.

[DeadButDelicious]

I had an elective section for mental health reasons back in November. Without going into too much detail, our first daughter died, there were complications and due to that vaginal birth was completely out of the question when I found myself pregnant with our second. I won't say that I had to fight to get it but they did try to talk me out of it a bit. However I stood firm and clearly stated that due to previous trauma I did not feel that a vaginal birth would be the best option for me and my mental health and as such I wanted a section, I understood the risk, I felt that the benefits outweighed them. May have cried a bit but that's by the by. They ok'd it and I was booked in not long after.

Given your history, I would imagine that you wouldn't face too much of a battle. A letter from your councillor may go a long way to helping secure it. Your mental health is just as important as your physical health.

I'm in Cheshire (in between Manchester and Liverpool) if you'd like to know what hospital and doctor I was under feel free to PM. And good luck.

[KittyIsHungry]

Nothing to add but reinforcing what others have said. No vaginal exam during pregnancy. In your situation I don't see the NHS forcing you to have a vaginal birth, but if you want 100% certainty, go private.

[ItsALardBaby]

You can absolutely have a maternal request c section. It is likely you would need to be reasonably insistent

[Freshprincess]

I can't advise about the likelihood of you getting a CS on request. However Wanted to say that I too had an ELCS and didn't have a single vaginal exam throughout my whole pregnancy.

[2014newme]

You could go private that would guarantee it. I'd do that in your position. Even if you're booked for a section you can get bumped for an emergency

[newbian]

I would suggest continued therapy and checking out the Body Back project. I'll tell you why. A friend had an ELCS booked but she went into labor 4 days before CS and had to deliver vaginally as there was not time for an EMCS by the time she reached the hospital.

Even if you can plan and get an ELCS agreed - nature may have other plans.

Best of luck in your decision.

[dolly1234]

DuggeeHugs - the fact you did not need any vaginal exams has made me so happy! I had been advised they were somewhat inevitable. That's music to my ears, thank you.

I wrote a list of my fears and feelings and shared it with a counsellor. The counsellor agreed that a c-section was right for me, but of course she could not advise whether or not I would be given one on the NHS. Understandably, that isn't her job. My GP advises that I could not discuss birth plans until pregnant. That's also understandable but puts me in an impossible situation. If I am not able to have a section, I will not have a family. It's that simple! But no medical professional seems able to help me.

[dolly1234]

DuggeeHugs - Thank you for your kind reply and linking me up with that resource. I will contact them and see if they can provide any support.

Pigface1 (great name!) - I understand the problem with the NHS saying I can have a c-section prior to even falling pregnant. But without any guarantee, I would not even consider getting pregnant. If I were forced to have a vaginal delivery... I would have to consider termination. However, that thought is completely unbearable to me.
Honestly, the only way out of that hideous situation that I can think of is suicide. And obviously, that's concerning (both to me and, I'm sure, any medical professional).

I understand the risks of a c-section. I have friends who have had them, and I definitely do not see it as "easier". Through my profession, I have had involvement with women who have had terrible times after a c-section. I am very alive to the risks. But it is the right choice for me.

I am aware that I would still need vaginal exams, and to prepare for this I have been attending STI clinics as "practise". It is a total waste of time, because I have been married to my husband for 7 years and I have zero chance of having an STI, but it's a good way for me to familiarise myself with it. I am able to get through an exam without crying now, which I consider a huge positive.

The advantage of a c-section for me is the element of perceived control that I can have over what is happening to my body. Of course, I accept there is always the possibility of unforeseen circumstances, but it would allow me to have the most control possible and I am far more comfortable with that.

I have considered going private, but I have been unable to get price lists out of anybody! I live on the border between Cheshire and Merseyside. Any ideas where I should be going to and who I should be asking?

I feel really sad that we will be limited in the size of our family because of the prohibitive costs of having to go private. I feel cross and upset that this man's act of evil towards me as a child is having these consequences in what should be a happy time.

[DuggeeHugs]

Pregnancy and childbirth do not have to include vaginal examinations - you do not have to give consent for these procedures.

I've just had my second child and went through the entire pregnancy and birth (ELCS) without any vaginal checks being undertaken. The only thing they did do was insert a catheter during the CS, but this wasn't until the spinal anaesthetic was working so I didn't feel it at all.

Perhaps make a list of your concerns, if you can, and use this as a start point for conversation with either the project or maybe a counsellor prior to conception, to give yourself the most time to get to grips with your fears and hopefully begin to feel some control of the process.