ELCS maternal request meeting

[Northernbeachbum]

We've arranged a meeting for 34 weeks to discuss options due to a horrendous fear of childbirth. Is that a normal sort of date for these meetings? What happens at them? What do I need to prepare before hand if anything?

If there is a clinical need for an ELCS then you’re halfway there. If not you will certainly face pressure, even if MH reasons are driving your request as MH is not physiological.

It depends on who you are meeting, I’d advise a consultant be present at the meeting else you may find you need to go midwife > supervisor of midwives > consultant.

Trusts are under pressure to keep CS rates low. Bear this in mind as you may be faced with serious pushback.

34w is the norm. But get ready for your meeting as IME it took my trust to week 38 to get the necessary arrangements in place - not good when most CS’ are performed at 39w.

Ps: whilst every woman is different if your mother, grandmother etc had babies vaginally before 40w on the balance of probability you will too. Again, think about maybe bringing the meeting forward if that’s the case.

Its due to severe fear of childbirth. I'd happily pay for one but you seem to have to live in London for that to be an option

Midwife is on side it seems as she said my fears are perfectly legitimate, she's referred me to this meeting at 34 weeks. It does feel late to me!

Is severe fear of childbirth called tokophobia? If I’m right, literally type “tokophobia and how to request a CS” I to google and see how others have handled the birth choices chat.

However, your midwife is on side. This is a very good thing.

Tokophobia is a valid reason for a CS and it is good that you have the support of your midwife. Not all Trusts follow the NICE guidance, but if yours does then it is worth noting the following from the guidelines:

Maternal request for CS

When a woman requests a CS because she has anxiety about childbirth, offer referral to a healthcare professional with expertise in providing perinatal mental health support to help her address her anxiety in a supportive manner. [new 2011]

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]

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

As PP has mentioned, be ready to fight your corner. Demonstrating your awareness of the risks of a CS is helpful, and if you visit the RCOG website you'll also find risks relating to VB which you can use to argue your case.

Good luck

I had no issues requesting mine due to tokophobia. If they refuse then they have to refer you to someone who will do it. Good luck! I'm so glad I had them.

OP I had a traumatic first birth that led to PND so had mental health reasons for electing a CS.

My first meeting with the doc was at 34 weeks. I then saw the perinatal MH midwife at 35 weeks and CS booked at 36 weeks during follow up consultant appt. My trust were really supportive with MH issues and they were treated as just as valid a reason for a CS as physiological issues

Thank you all. Did they try to put you off?

34 weeks is right for the birth choice meeting. I would say write everything down, all of your reasons and take a letter with you.
I had an emergency c section and other complications with my first and they was extremely reluctant to agree another c section this time. I had to really push for it to be agreed and I have some medical reasons.
You need to show you understand and accept the risks of c section and why you want one. The letter seemed to help and he kept it on file and he said he can then show others my reasons. Also I've been getting very anxious about the whole thing and find it difficult to talk about so the letter helped me get all my points across rationally.
One of the main reasons he was saying no was because apparently the trust I'm under does too many electives and is under investigation for it - that's what he actually said! I think a lot depends on your trust. They do put the fear in you about the risks of a c section so I would recommend reading the nice and RCOG guidelines to weigh up the pros and cons.
They will also ask you what you would do if you went into labour before the c section date.

Thank you @chocolatebutton15 thats really helpful. It was actually the midwife who suggested putting me forward for the meeting after me discussing how terrified I am. I'll make sure I know the guidelines inside out and all the risks too with my reasoning written out

He didn't agree with all my reasons but didn't challenge the mental health aspect I listed. Good luck I hope it all works out well for you! Also if the consultant says no you can ask to be referred to another consultant.

Yes, that's the plan. Your letter idea is fantastic so thank you for that! I really do think there should be more options for private ELCS outside of London as that would take so much stress away

I had an elective section due to a traumatic first birth which left me with PTSD. I wouldn't say I had to fight for it but they did try to talk me out of it and to my mind kept on stalling the 'talk'. I was consultant led from day one and I brought up the subject of a section very early on. And kept on bringing it up. When I finally got it booked at around 35 weeks or so I just broke down I was so relieved that an end point had been smacked on it.

Be prepared to stand your ground. I just kept on repeating that I felt a section was the best option for my mental health, I would not cope with labour, I would not cope with vaginal birth, I understood the risks and felt that the benefits for myself far outweighed them. I had the support of my bereavement midwife, who came with us to all our 'big' appointments and my community midwife who agreed that a section was the best option for me. If you have any one like that who can back you up then by all means use them. Ask them to come to the meeting or write you a letter to take with you.

And remember your mental health is just as important as your physical. Good luck!

I don't know if you've had our meeting or not but ALL Trust’s should follow NICE guidelines. If your Trust isn't, I suggest you specifically ask why they aren't following NICE guidelines. They'd struggle to come up with an acceptable answer to that question I imagine.

Thanks gizzymum I'll make sure to use that if need be, got a while to go for it so preparing early really but it makes the meeting easier I think if I have a plan