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?

Indeed - I am trying to get my trust to stop using the term VBAC generally (except when referring to an actual VBAC), and use the term BAC when discussing women’s options with them. It’s something I feel very strongly about it. The consultants I saw were so patronising (“pregnancy is an anxious time isn’t it?” with the obligatory head tilt). Even when I produced studies showing that with DCDA twins the safest option for everyone was an elective section, they still refused to even discuss it until very late on and there was no need for that.

Good points ohtheroses.
I think a lot Of whether or not they would be liable depends on what they actually record so I see what you mean about requesting that to be explicitly documented.

Sinkgirl I know exactly the head tilt you mean and you could reply yes it is anxiety provoking growing another human, and you are making it a million times worse!
So frustrating.
Good points about vbac I agree the clinics should be about discussing women’s birth after cs. Not that a vaginal birth should be the desirable!

Have a read of the case Montgomery v Lanarkshire beforehand as well. It doesn't mean you can insist on any medical procedure, but it does mean they need to advise you of all the relevant risks. There are plenty of those in attempting a vaginal birth, so bring it up if you think they're trying to minimise it.

In reality, even in Trusts that don't want to do maternal request, if women kick up enough of a fuss they usually get their ELCS. It shouldn't have to be this way, of course.

Since2016 and Shitmewithyourrhythmstick are both spot on.

You can't compel a doctor to provide you with any treatment that they don't deem to be in your best interests (physical and psychological), but they should refer you to a colleague if after a discussion about treatment options you decide on one they are unable or unwilling to provide.

I can't see many people going into obstetrics with the firmly held belief that they'll try to do anything over than provide an informed choice for their patients, that said there are plenty of reasons that might tip the balance of risk away or towards one birth plan or another.

Thanks.
Yes I’ve read the summary of lankashire v Montgomery. The lady concerned is not similar to me at all in terms of the issues she had but I think I know enough about the principles it raised to bring it up if they seem to be very one sided towards vaginal delivery.
I simply just do not think it is fair for information to be withheld in this way.

And the law would agree.

If you're more normal in terms of your risk profile, the discussion would include things like risks of tearing, EMCS, instrumental delivery if you attempt a normal delivery and of increased risk of future pregnancy loss, rupture etc if you go for an ELCS. The point is they should be doing it. If you do end up with the typical deflecting discussion, trying to persuade you against a section, this is when you bring the case up. Shows you're aware of the law.

I'd also say that whilst a vaginal birth may be cheaper in the short term, it isn't necessarily in the longer term. Various prolapses and weakened bits, fistulas etc. Quote some of those at them.

Another really good point ohtheroses.
I often think the issue is that maternity care don’t pay for the physiotherapy, and the prolapse repairs.
And treating the diabetes/other illnesses that women get from weight gain because they are too scared To go to an exercise class in case they wet themselves......

I’ve read that in coming years the amount of women expected to require surgery for prolapse will increase hugely because this generation aren’t prepared to accept the debilitating symptoms from age 40 or so potentially for another 40-50 years. And why should they! (I must try to find source for this before my appointment).

So yes the financial cost is not what it seems, but unfortunately budgets don’t seem to be thought of in context of a patients lifelong healthcare. It seems to be all about saving money for that department, right here, right now.

Ah well this is where they are reminded that the NHS is paid for by the people and the people must start to insist it is joined up to safeguard resources overall and stop being grateful because the behemoth is "free". It isn't. Who would insert their pin number upon leaving the post natal ward without kicking up a stink?

It's also a realistic possibility that an attempted vaginal birth will cost more than an ELCS even in the short term. The most expensive births on average are EMCS and instrumentals, each of which is a consequence of attempted vaginal birth. And your fear following on from your experiences last time is a risk factor in itself.

Hi @Mistletoewish.

I'm having my second child and have opted for a section because of my first labour (long story short - awful).

I was worried, like you, that they would point blank say no - but they didn't at all. It was a really good meeting, they went through all my notes from previous labour (I cried a lot!!) and there was no argument whatsoever! She was really understanding and although she pointed out the risks, in no way did I feel put off etc.

I read up on all sorts before the meeting but nhs website states clearly this;

If after discussion and support you still feel that a vaginal birth isn't an acceptable option, you're entitled to have a planned caesarean.

Good luck xx