Planned C-Sections going ahead?

[LondonGirl83]

I had my first DD via an emergency csection and as a result the NHS had agreed to a planned csection for my current pregnancy as is fairly standard.

Given many hospitals are cancelling all non-emergency surgeries so they can convert operating theatres into ICU beds and generally free up other resources, I was wondering if planned NHS csections are going ahead? Has anyone had theirs cancelled?

Ta

It just doesn’t make sense not to proceed with them as most are not elective in the same way as say a knee replacement.

If they don’t proceed with elective C-sections then instead of them being staffed correctly during core hours most will turn into emergency c-sections at any time with a scramble for staff and resource. This is plain silly and won’t be done.

The only people this may affect are an incredibly small number of women who insist on having one with no medical indication to do so but ‘just because’ and badger people mercilessly to get what they want. These will not occur but the vast majority will.

My relative is due in a few weeks. She had a consultant appointment yesterday and a c section was recommended due to her previous birth and big baby, so normal procedure so far.

@HoppingPavlova nobody has a c section "just because" - they have them because they have weighed up the advantages and disadvantages on both sides and decided that is their choice. Do you actually work in a maternity unit or are you just scare mongering about elective sections?

@LondonGirl83, yes, London (Homerton). That's what I was told last Monday.

The below document also doesn't mention any proposed changes re elective sections.

Of course things might change (I'm not due till July so god knows what will be going on then) but so far the signs are positive.

www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/rcog-staffing-options-for-obstetrics-and-gynaecology-services-during-covid-19-pandemic/?utm_source=Royal%20College%20of%20Obstetricians%20and%20Gynaecologists&utm_medium=email&utm_campaign=11409649_Coronavirus%20guidance%20-%20%233%20%7C%20March%202020%20%7C%20Public%2FSeedlist&utm_content=%3E%20Staffing%20options%20for%20O%26G%20services&dm_i=15N0,6SJQP,1J9FEF,R6LR3,1

Sorry for the crazy long link!

A huge thanks to everyone who is pregnant letting me know what their hospitals are saying and doing. I actually can't get through to my midwife to ask what St Thomas are doing as the line is constantly engaged. I'm partly concerned because Tommy's already gently encourages women to go for VBAC's rather than elective C-sections but don't force anyone: its currently mother's choice. You do have to do a workshop on VBACs though before you can make the choice.

UnrulySalvia thank you for the link.

I actually need to speak to someone urgently because my GP accidentally prescribed me antibiotics that I've only just discovered through google are contraindicated for people with a penicillin allergy (which I have and I informed her about!). I've had an adverse reaction this morning (almost fainted doing my daughter's hair). I need a new prescription to treat my strep throat and ear infection but I can't get through on 111 or to maternity services for help and the GP is closed.

It feels like normal access to help is already falling apart even if you don't have coronavirus...

Anyone on Instagram @maternitymedic has just done some very reassuring Instagram stories about elective c sections

I spoke to my midwife yesterday as I'm booked in for the 21st April for mine and she said it will depend the day before if I have a cough fever or any flu symptoms it will be cancelled also if anyone in house has symptoms too it would also be cancelled she did also say it's 4 weeks away and things are changing daily with this virus so the right answer she gives today may be different tomorrow. Also at my hospital u get a phone call the morning before any appointments to check your health and they will tell u if to still attend or not same with normal midwife appointment

• @HoppingPavlova nobody has a c section "just because" - they have them because they have weighed up the advantages and disadvantages on both sides and decided that is their choice. Do you actually work in a maternity unit or are you just scare mongering about elective sections?*

No, never worked in a mat unit post training. I do know a number of people who have indeed had them ‘just because’, quite a few colleagues wives in fact and that’s recently. Also, it was definitely an option for me albeit 20 odd years ago. I didn’t take it up but many others I know did, you just told your ob you wanted a C-section and it was a fine deal and as I said nothing has changed talking to people who have become new parents recently including my best friend a year ago.

@HoppingPavlova so they told you that they just tossed a coin and that was that.. right..

And given that you don't work in a maternity unit, how exactly do you know that "these will not occur"?

So most units will have the same anaesthetic team for emergencies and planned sections. They can't redeploy the planned section anaesthetists without severely compromising the emergency list, plus its the same docs who provide the epidurals/intubation if something goes wrong.

Most likely thing to happen is you may not get a choice of date, or you will have delays due to staffing shortages. I really doubt they will cancel elective c sections. And if they do, they'll risk stratify, women with medical reasons will be prioritised, then traumatic previous births etc, and people who have elected to have them because they have the choice rather than any other reason. But that's not to say they won't get them.

Obviously the situation is changing daily, I wouldn't preoccupy your mind with it until much closer when they can give you a difinitive answer subject to the National situation.

Hope that helps (from ex manager of anaesthetic dept inc maternity anaesthesia)

That sounds sensible Ginfilledcats

I think you are absolutely right to ask the question and wish that only the people with some relevant knowledge would reply as anything that starts with "I would think " can be immediately disregarded.
Situations are changing on a daily basis so I wish you well x

And given that you don't work in a maternity unit, how exactly do you know that "these will not occur"?

While I have retired from that line of work most of my friends and family still work in ICU’s, anaesthetists, other specialties. At present those running departments are spending their time contingency planning, it needs to be a cross functional approach to free beds/resources/theatres to allocate so obs are included in the planning. Given it’s all the topic of conversation at present, that’s where I’m getting my information.

This includes the private’s as well as private hospital beds, theatres, staff etc may well be seconded at this time. So to answer your question, this is where the majority of ‘just because’ C-sections are done and at present they are looking at potential emergency resource allocation and as mat services are something that can’t be deferred/slimmed down (both public and private systems) this has been discussed, considered and some rules are now coming into play.

We have already started shuffling off manageable cardiac ops from public to private in some places to free up high dependency beds in the public system in case of sudden need.

I don't know the answer, but I am in a similar situation. I am 37+4 and have a CS booked for 39+1 due to two prior CS.

My sensible brain knows that CS will not be treated as low priority, and that Maternity services will be prioritised to run as normal since you can't delay these things. I share your fear though, that whatever the "sensible" approach is, there's really nothing they can do if there's no theatre or anaesthetist available!

I have a midwife appointment on Tuesday and am hoping for some reassurance. Though even then there's still 10 days between that appointment and my planned date, so things could change.

I am also in household isolation as we're fairly sure my daughter (and probably husband) has the COVID-19 virus. I have no idea what happens if I am symptomatic at the time of my planned section. It's all very well saying it'll be delayed until I recover, but there's not necessarily time for that ....

I share your worries. I am trying to take each day as it comes and do the best I can with each new piece of information. I'm keeping notes of family symptoms on a timeline and all I can do is make sure that my midwife knows what's going on and trust their planning.

@HoppingPavlova some rules are now coming into play

What rules, exactly?

What rules, exactly

Are you being obtuse? Well, for instance my friend who had a baby 12mths ago went in to her first appointment and said I’d like a C-section thanks. No reason other than personal preference. Nothing has changed in that regard since I had mine, no reason required. If she went in next week and said the same thing they would instead say, ‘not sure, let’s wait to see what options we have closer to the time’. If she was having the baby now and 6mths pregnant or onward she would be told it’s most likely not able to happen that way for her as they can’t plan something that could take up resource unnecessarily. If her c-section date was this week it would all be fine to proceed as planned because there is not currently a shortage of resources incl theatre staff or beds as mat beds have not as yet converted to any other type of bed at the hospital she gave birth at. So essentially now moving to restrictions the publics usually have in place.

Obviously for a c-section that is medically indicated it is what it is and these are scheduled and proceed as usual irrespective of hospital system. Not sure what in all of this is so hard to grasp?

Ginfilledcats that's very helpful. If they stratify, I think I'd fall into a middle risk group. I've had a previous emergency c-section so there is up to a 40% chance I'll need another emergency c-section and a VBAC comes with the additional risk of uterine rupture as well. Still, its not like this baby is breech, or I have gestational diabetes or a low lying placenta. If I wanted a vaginal birth my trust would be perfectly fine with me trying for one.

I'm due in June so I think everything will largely depend on how stressed the NHS in London at that point. I've been trying to get a private option but no one was getting back to me and I've seen today the government has reached a deal with the private sector to buy up all their hospital beds so the only thing I can do now is wait and see.

Thanks to all the pregnant mom's and active maternity healthcare professionals that have been able to provide useful insight on what's happening at their hospitals.

Fingers crossed for everyone we can access the planned treatment we've arranged!

I have planned c section booked on 2nd July. No medical reason other than me not being comfortable with risks of childbirth. Ive been panicking they will cancel it but doctor assured me that c sections arent in same category of surgeries that can be delayed.. however on the day if they are short of anaethetists they may need to postpone to following days. But with the situation at the moment who knows what will happen? Am considering going private but its soo much money!