Can I be denied a c section

[Mistletoewish]

I am pregnant with second child. Upcoming consultant appointment at 35 weeks and I am ill with stress that they are going to refuse me my requested c section.

I had complications from a 2nd degree tear and crippling pnd after ds1.
I feel like I know all of the stats and risks for c sections, which I explained to the registrar at 12 weeks.
But they won’t agree anything until 35 weeks and with my appointment Coming up I can’t sleep and I can’t stop crying thinking they may refuse me. I’ve had to leave work today as I couldn’t hold it together.

The hospital declared to the birth rights organisation in their report that they follow nice guidelines.
But I still feel like they are holding something over me and could cruelly snatch it away at any point and what could I do?

I know i probably sound hysterical but I can’t imagine anything worse than being forced to labour again against my wishes.

Has anyone had a request refused recently? What did you do?

..

Why would they refuse you a section OP, have they given any indication?

I asked for one in the beginnings of a difficult labour and they said no at first, until it almost became a medical emergency. I am requesting one this time .

I have read lots about people being refused, personal stories and in the birth rights report on maternal request cs and trusts quietly not complying with nice guidelines. It probably comes down to cost cutting I guess and as I’ve had a vb before and baby was unharmed I feel I could be an easy target for their stats. If you’ve already had a cs then your chances of successful vb will be lower.

I suppose anxiety and nerves are taking over as if they refuse what realistically could I do? I feel it’s such a vulnerable position to be in when heavily pregnant as baby will come out one way or another whether I like it or not.

Maternal request is enough. They may make noises about refusing but the bottom line is, they can't.
Good luck

Honestly, I think you need to wait for the appointment before you panic. You're stressing yourself about something that may not happen. You need to walk into that appointment and calmly explain your reasoning. Excessive panic about what they MIGHT say isn't going to help you do that. You are following their procedure for maternal request. Don't waste energy worrying about the outcome until you know what it is!

Unfortunately the guidelines are just guidelines so they aren't binding - I know Oxfordshire for example has a blanket policy to refuse maternal requests for CS.
But the good news is your trust would have told you that already if they were that kind of trust! So just ensure they see you are prepared, know the risks and know what you want. I was in the same boat and only had my section agreed at 38 weeks after the consultant saw she couldn't change my mind. You'll be fine!

Thanks some good advice here.
Sharksave when you say they can’t refuse, do you mean they can’t refuse if you persist? So perhaps when women say they were refused they were actually talked round/persuaded to try vb and weren’t more assertive about their rights?
Good point about what’s the use in Panicking now I need to keep my energy for the appointment and try to keep some reasonable degree of calm.... somehow.

They can yes as NICE guidelines are guidelines. Put your case forward. Go in and show you are informed. Good luck

They can refuse but have to refer you to someone else who will consider it. Honestly though, do ensure you’ve done your research. A c section is major surgery. I had an EMCS after 4 days of labour and I have elected to have an ELCS this time. Agreed at 32 weeks. However, I AM nervous about it. The pain is bad, like really bad. And with another small child at home I am worried. Because my body just never made any progress for me it’s the right choice, just make sure you understand the recovery.

Hope you get someone supportive to discuss your options with you.

The recovery from an elective section since is
(barring any complications) SOO much better than the recovery from an emergency one. It's different in every way.

Don't be nervous, mine was a great experience. My first was not!

Thanks @srsly I found the c section fine tbh but I did have a lot of pain afterwards but good to know it’s better with an ELCS. Just got the date so suddenly confronted with the reality!

At the other end of the spectrum, I had no pain during cs recovery. It isn't necessarily "really bad" and if it is, make sure your pain relief is sorted out before you're discharged.

Since2016

You will be fine, good luck!

It is major surgery but it's well managed and controlled. When it's and emergency it's totally different really plus after 4 days in labour, you'd be in a lot of pain from that alone. Add in major surgery and you are bound to be in a lot of pain!

But with an elective, you go in fit, healthy and well rested, so your body and mind only has to concentrate on one 'recovery'.

Take the drugs they offer, get moving little and often as soon as you can. And like showofhands said, make sure you leave with the right painkillers and take them regularly.

OP I had no issues requesting a section after a traumatic first birth and a 3rd degree tear. My trust are very reasonable. Hopefully yours are the same. If you.mention the trust other people can probably comment with their own experience with that trust and you should hopefully feel reassured.

Relax.

Please just wait and see what happens at the appointment. In my experience they don’t agree it until the later weeks - date of CS is then usually scheduled for a week before due date. That is just hospital procedure, not them having a pop at you.

In the unlikely event that your consultant refuses then ask them to refer you to another consultant who will oblige. They will know you’ve read the NICE guidelines. Hold nothing back in telling them what you endured last time, and how that is worrying you sick this time.

Thanks square.
Is 35 weeks not the later weeks anyway though?
If 37 is considered full term I think 35 is long enough to wait for an answer! Did you have to wait past 35 weeks at your trust?

Thanks to the other posters also.
I have heard that generally speaking, all things being even I.e. no other complications from the elective surgery, pain from electives is more manageable and heals more quickly than emergency.

I understand what you’re going through. I had twins two years ago and suffered from debilitating tokophobia due to previous traumatic gynae procedures and past abuse. I saw consultants from 20 weeks and they wouldn’t even discuss a c section, they just kept saying there was no reason I couldn’t have a vaginal delivery. I was an absolute mess through my whole pregnancy and knew I just couldn’t do it.

At my 32 week appointment my DH stood our ground and insisted they discuss it as it was making me ill. The registrar we were seeing couldn’t commit to it and kept trying to fob it off but eventually said that a consultant would discuss it with us at my 36 week appointment but obviously the consultant later agreed as I had a call to book me in the next day.

I ended up having an Emcs at 35+1 so didn’t get to the 38 weeks when I was meant to have it. I wish they had agreed much earlier as it ruined my pregnancy. My local trust hand out letters at booking saying they don’t do maternal request cs. I later got a job with the maternity service and have been battling to have that letter changed / withdrawn and am finally making some progress.

Thanks sink.
This pregnancy has been genuinely intolerable due to the worry. I don’t know, quite frankly how I haven’t been really quite unwell with the stress of it. And none of this is good for the baby but that just starts another cycle of worry about how my stress levels are impacting on baby. Which leads me back to resenting the hospital because I feel like this is their doing. If they had a clear pathway when an answer was given at least it would take the guesswork out for Me.
Sounds like you are doing some good work though and I hope it changes things for women.
Has the birth rights publication that has basically named and shamed trusts had no impact on things?

I think it depends on the trust but I only got my ELCS decided and booked in at my 38 week appt. 37 is full term but they often don't do elcs before 39 if no medical reason other than maternal anxiety, as its better for the baby's lungs or something.

Yes I have read that too corny I wouldnt want the section until after 39 for that reason.
But I don’t see why it should take them until 38 weeks for a decision to be made iyswim, they should surely know before then whether they are willing to offer it or not.

Also if I laboured spontaneously at 38 weeks, I would still want the c section to go ahead, but if nothing had even been agreed where does that leave me!

I agree - there’s no reason it can’t be confirmed after your 12 or 20 week scan, barring any changes that might occur and change their plans. That’s what I’m trying to push for here. Most women don’t request major abdominal surgery on a whim and mental health reasons should be just as valid as physical ones.

Interestingly they’re building in a new hospital here and they are adding an extra theatre as they believe c section rates will rise over time. Many staff see this as a negative, but womens choice is paramount.

Totally agree sinkgirl! It should be the woman's choice and mental health is sometimes even more important than physical - scars can heal but your mind can't so easily :(

IME it seems to depend upon the consultant you see. During my twin pregnancy, I saw (mainly) different consultants every 4 weeks, and some would push elcs, and some vaginal delivery. My named consultant told me he’d only consider an elcs for me due to it being twins, argued with me and asked me to prove my research and justify why I wanted a section etc he eventually agreed to, but in the end I got it booked in by another consultant at 32 weeks. I was told if I went in to labour naturally before my booked date at 38+2 to get to the hospital ASAP so they could do an elcs.

I ended up with pre eclampsia a couple of weeks before I was booked in so we needed to get the babies out pretty sharpish, and was told I could deliver them however I wanted, and went for elcs.

I found it pretty stressful getting conflicting advice regarding the best way to get the babies out safely. It seemed that the consultants had their own agendas regarding delivery and very little was based on evidence, just whether they approved of a section or not. For the main consultant who was very anti I did research as to why it was safest to deliver by section, understood the risks to me and that it was safer for the babies (DT2 was breech) and had got so pissed off by that point that I was able to be very forceful about what I wanted and not wobble at his responses (I’d practised what I was going to say in advance to my imagined questions!). Good luck with your upcoming appointment.

It's common that they don't make a final decision on having a section until as long as possible. With my second, I had an elective and I don't think it was until I was around 32 weeks that I had my appointment with the Vbac (says it all!) midwife to make the final decision.

This little sentence will help.

I was ill last time due to a badly managed vaginal birth and suffered serious emotional and physical trauma. I want a c section and want that request noted in my records and noted that you have not observed my wishes. If I suffer any ill effects from your failure to observe my request I shall hold the trust responsible and shall seek damages and shall expect any injuries emotional or physical arising feom a birth I have been clear I do not want, put right without delay or excuse.

And repeat. Hold your ground op and if you meet opposition write to the ceo.