Right to ELCS after EMCS?

[RainyDayBear]

I had an EMCS after a very difficult and drawn out labour due to DD's heart rate dropping and my lack of progression. It was all a bit chaotic and stressful, but DD is healthy and I have always felt EMCS was the right course of action, so don't have any regrets.

20 months on I'm pregnant with DC2, and told my midwife at booking in I wanted an ELCS. She said that to be referred to a consultant I had to attend the VBAC clinic and discuss it there.

I had the appointment, said that I still very much wanted a c section, and asked to be referred to a consultant. They apparently won't refer me until 36 weeks when I have to attend the VBAC clinic once again, and only then will they refer me to a consultant.

I am really, really unhappy with this, I have an appointment with my midwife next week and want to be referred sooner. My nightmare scenario is my waters going at say 36 weeks before I've seen a consultant, and the on duty consultant saying no to an ELCS. I really want it agreed ahead of time so I can be confident. I'm terrified I'm going to be forced into a VBAC that I don't want.

Do I have any rights in this situation?

I'm in the same situation as you. Im 28 weeks and still won't know if i can have an elective until im 36 weeks. When i spoke to the midwife she told me just to go to the VBAC and when i see the consultant just say no i want an elective.

Have a chat with your midwife and she will tell you what your options are and help you get the birth you want.

I'm in a similar position. Had emcs with DS as I was induced & failing to progress further than 9.5cm, I then developed an infection & both our heart rates started dropping. He was also a large baby with a huge head & his position meant he would never have come out vaginally anyway. Community mw is fully supportive of elcs. I was referred to the consultant & saw him at 15 weeks, he was broadly comfortable with elcs based on previous experience but wanted me to go to the vbac clinic & explore all my options to see if we could meet halfway. Went to vbac clinic at 25 weeks. That mw was lovely & again fully supported elcs however I did agree that if I went into labour naturally before 39 weeks I would try vbac after she reassured me that there would be no interventions if I failed to progress & it would be straight to emcs. I have a final consultant appointment at 36+5, 4 more weeks, to hopefully get sign off of elcs & agree a date. It all feels very late in the day to get a decision and I'm starting to worry that I'll have waited all this time & he'll say no. I don't know why they need to wait so long to agree it.

Read the NICE guidelines on second c sections. I had an emergency c section with my first. The guidelines at the time were clear that I couldn't be refused an ELCS nor could I be forced to have a trial of labour. I don't think the guidelines have changed that much. I think they have to document that they have discussed Vbac with you. If your assigned consultant won't carry out the CS then they must refer you to a consultant who will.

Check out birthrights.org too... I know there was an issue in hospitals in Oxford flat out refusing ELCS unless medically necessary. Otherwise you are allowed to request this. I think the consultant should just agree it if you've explored options and been to the vbac clinic.

Hi. Everyone has the right to choose an ELCS, whether first or second. I would politely decline to attend the VBAC clinic. I was asked to see a registrar and then a consultant to discuss my EL decision, I said I'd see one but wouldn't attend twice to have the same conversation and they agreed. It's horrible having to keep explaining what you want and your reasons every time you speak to any midwife or doctor!

I would also politely decline, esp as it's your second time round. Read the nice guide lines start to throw weight around a bit eg, is your advice in line with the guide lines, is there anyone else I can talk to, I don't want to wait until 36 weeks, I don't feel anyone is listening to my concerns etc. You have to fight your own battles, if you don't make It fuss for you, no one else will.

You DO NOT have a right to an ELCS. No one does. The previous poster is incorrect in stating this.

You DO however have a right to the most appropriate care for your medical needs. This might well be an ELCS.

This might sound like the same thing but its not. What it does do is make a difference to how you frame your argument for an ELCS. Understanding the difference is important.

You CAN argue that your mental health will be damaged by being forced down the VBAC route as you are extremely anxious over the issue.

Also the NICE guidelines for C-Sections, have a section about VBAC. One of their guidelines is that the woman's preferences should be given serious consideration:

1.8.1 When advising about the mode of birth after a previous CS consider:
maternal preferences and priorities
the risks and benefits of repeat CS
the risks and benefits of planned vaginal birth after CS, including the risk of unplanned CS.

The NICE guidelines don't have to be followed, but they do provide a very good framework and hospitals have to have good reason to go against them. Simply asking, why are my maternal preferences and priorities not being respected as the NICE guidelines state they should be, is a powerful question.

The NICE guidelines are just that, guidelines. However, in your case I would write to PALs and ask them to rearrange your consultant appointment to be earlier in your pregnancy so you aren't soending this time worrying.

I fell pregnant 8 months after an EMCS. I told my midwife at booking that I wanted an ELCS and she said it was no problem. She did say she'd be happy to fight my corner if I did happen to come against any issues but given the close proximity of pregnancies and the circumstances around my last birth (I was fully dilated for 9 hours and pushing for 5) that she couldn't see any issue.