Oxford Nhs Trust / maternal request c section??

[thecupcakelady]

Hi everyone,

Does anyone have experience of maternal request csections within the Oxfordshire NHS Trust or John Radcliffe hospital - how the request was received by the HCPs / whether it was accepted/ refused?

From reading different threads and articles I was sure that a maternal request CS could be successful if the couple opted for private maternity services. My husband enquired and was told:

“I am afraid I am unable to take women on privately simply to ensure they have a caesarean delivery. The current hospital policy, in line with a number of other units, is not to offer caesarean section where the obstetrician does not see a medical indication.”

We really wanted to avoid fighting the nhs for a CS but now it seems as though it’s our only choice :(

Xx

Please don't see it as a fight OP!

It's NICE guidance that women can request a Caesarean section delivery - you need to request a consultant referral from your midwife (if you're not already seeing a consultant) to discuss your options.

Please don't be offended if you are referred to a different consultant or a psychologist - this is generally routine practice as a caesarean is major surgery with increased risks compared to a vaginal delivery. The team looking after you just need to be confident that you understand the risks involved in the surgery.

But belle it is a fight. You have to jump through hoops. I didn’t hace the energy for the fight and left in tears and ended up not pursuing it. Mind you I’m glad I didn’t because my fears about VB didn’t come true.

Guidelines are there as a guide only and apparently not everywhere has to follow them but they can advise you of a hospital who does. Mine didn’t and the Midwife told me I’d have a massive struggles on my hands and the consultant would say no she said she’d seen it before.

struggle

Hi OP,
You are entitled to have a planned c-section on the NHS (you need to demonstrate you understand the risks but if first consultant refuses they have to refer you to another)
www.nhs.uk/conditions/caesarean-section/

The problem is that some Trusts refuse them because of the way they handle finances. This is unacceptable but that is the reality in some places.
I'd advise you to contact the Birthrights helpline.
www.birthrights.org.uk/about-us/contact-us/
All the best.

Hi OP,
have you managed to sort this out yet? I've been in the same situation. I asked my GP to directly refer me to another hospital. I've also been to the 'mode of birth clinic' at the JR, but that was not very helpful as no matter what you say, they will refuse you unless you have a medical reason, send you to their obstetrician who will then refer you to another hospital. With my GP, we first tried Stansted, but they did not take me; then Gloucester, they've taken me.
Good luck!

sorry, that should have been Luton, not Stansted...

As a medic I know it's very unfavourable as essentially you're being offered major surgery with no clinical indication (I appreciate there are likely psychological reasons). It's hard for any surgeon to justify but most will weigh things up & it's possible someone may agree.
There are private maternity hospitals where you can pay & choose but I think they're all London based.
Personally I was hoping I'd end up with a c-section having too much knowledge of obstetrics and knowing how anxious I'd be but I ended up managing a normal delivery with an epidural - essentially pain free - & I'm really glad. Recovery has been much quicker and having assisted in many, sections are pretty brutal surgery. What I thought I wanted I'm really glad not to have ended up with & had I requested a section and been refused whichever doc would have been doing me a favour, had they agreed I may have been happy with the plan but in hindsight it would have been the wrong decision.
Try not to see it as a fight. Baby will get here one way or another & around 1/5 end up with a section anyway.

Is this your first or subsequent pregnancy? I requested a C section at Bucks NHS trust (just down the road) as first baby had been emergency C Section. This was agreed without too much palaver. I saw a consultant midwife (who agreed that c section would be best for me) and then a consultant obstetrician who listened to my POV , told me the risks. I didn’t feel bullied or pressured . They agreed my request. Perhaps Bucks might be an option ??

Me. I've had 3 C sections at the JR. 5 years ago for my 1st and 3 for the 2nd. Was accepted after epic battle and much quoting of NICE guidelines and risks associated with vaginal birth.

I would ask for referral to somewhere happy to carry out section (per NICE).

I think for both routes (CS vs. vaginal) there are short and long-term risks and benefits. Which is why I think it makes sense that each woman should be able to decide for herself how much she's happy with either set of risks.

I think for long-term risks/benefits, this new meta-analysis might be the best (even though they lumped all kinds of caesareans together and didn't control for maternal factors that led to the Caesarean in the first place):
journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002494#sec023 [Keag et al., 2018, Plos medicine]. Particularly see their table S7 for % increases/decreases with CS vs. vaginal.

Basically what they report is: risk of later developing urinary incontinence or pelvic organ prolapse is reduced with CS (-10% together - and this is only comparing CS to normal vaginal birth, not to instrumental birth, which is worse). But risk is increased in subsequent pregnancy for miscarriage (+1.4%), placental problems (+0.5%), still birth (+0.1%) or hysterectomy (+0.1%). [And there is also other studies that show that the placental risks increase with each CS] And for the child: reduced risk of inflammatory bowel diseases (-0.1%), increased risk of asthma (+0.6%) and obesity (+3.6%).

For example, for me personally, I was pretty concerned about the pelvic floor problems and given my weight, I think that obesity won't be a problem and I only want one more child, so the set of risks with planned CS seemed preferable.

And in any case, if you decide to give birth in a hospital (rather than in midwifery unity), at 30, the risk of ending up with a CS or instrumental (forceps or ventouse) is ~45% [see bmjopen.bmj.com/content/4/1/e004026.short , Li et al., BMJ open, 2014, table 3]. And both of these have worse outcomes for the baby than planned CS.

So, basically many things to take into account, which is why to me it makes sense that NICE guidelines say that it should be up to the woman after getting all the information.

This is an old thread.

Oxford have taken a controversial decision to ban all maternal request CS. Given that a sizeable number of maternal request CS are for related mental health reasons (which are not counted as medically indicated in the majority of cases) this is an appalling decision and it is forcing women who are particularly vulnerable to other hospitals if they have the means to, or putting those who don't have the means through an ordeal they are struggling to cope with.

Birthrights.org.uk have been trying get the policy changed:
www.birthrights.org.uk/2017/07/do-i-have-a-right-to-a-c-section-update-on-oxford-university-hospitals/

and Pauline Hull @paulinemhull has also been trying to campaign against the policy.
caesareanbirth.org/2017/04/12/nhs-trusts-still-refusing-maternal-requests/