Can they refuse an elective c section?

[RosieBorealis]

Hello!

I'm pregnant with my first baby. I was diagnosed with MS last year and have since had a few relapses that have involved fatigue and muscle issues (spasming etc.). My muscle fatigue can get so bad that I struggle to walk up stairs without supporting myself on the wall, or needing to sit and rest frequently after just a short amount of activity.

I am under the care of a consultant as due to the MS and my low BMI the pregnancy is considered high risk.

So, my dilemma is- I would like to have an elective c section. I am extremely aware that this is major surgery and comes with it's own share of risks but due to my MS and muscle fatigue I am so worried I will not be able to give birth vaginally. I don't want to go through a traumatic labour to find out my muscles won't let me push properly and end up needing an emergency section or forceps delivery.

I'm also very aware that post delivery I am very likely to have an MS relapse. My thought behind an elective section is that it would be less traumatic/ stressful so hopefully the relapse wouldn't be as bad? At the end of the day, how can I care for my son if I have a terrible relapse after birth and suddenly my legs don't work?? I can deal with a small relapse; fatigue, muscle twitching, even going blind in an eye again but mobility issues scare me. Especially as the damage done can be permanent.

My midwife was a bit dismissive when I raised it and said 'oh well you can have an epidural if you need a rest'. I'm not medically trained so might be speaking out of turn here but I don't see how an epidural would help fatigued muscles?... She also said 'well a consultant might not sign off on a c section', yet when I mentioned it to the consultant he said 'we can certainly explore the option, I have seen many births and certainly know how I would give birth', however he didn't officially confirm anything and might have been saying that just to placate me.

My big question is- can I be denied an elective c section? It's causing me a lot of anxiety and I'm trying to do everything I can to avoid a relapse.

Yes you can (I did) you may have to be quite firm but you can

Am fairly sure you have a right to a c section if you want one. However, midwives are very good at putting pregnant ladies off the idea. It will need to be signed off by a consultant but if you’re being looked after by a consultant right now and he is open to the idea that doesn’t sound Like too much of a barrier? Next time I would just lay it on thick that you want a section.

No. You have a right to a C section and if the obstetrician won’t do it for whatever reason the hospital have to source one that will.

Was it your obstetrician who was open to the suggestion? I’d raise it at your next appointment and make it clear that it’s causing you anxiety and you wish to schedule an appointment now so you can relax.

You can change hospitals if you need to.

Depending on your hospital they can make it very difficult , although you should be ok as you have a medical reason. Even if no medical reason they can't ban you from having one, they can just refuse to do it themselves. but you can self refer to another hospital if necessary. Try the consultant first and if they won't help look at Birthrights website.

Many maternity services will refuse to discuss birth options til third trimester. If they tell you this, push back as it will be very late in the day if you do need to transfer hospital

No you can't be denied one, and you have medical reason to anyway! My oldest friend has MS and had a c section a year ago and recovered very from well it. She was able to stay off her meds until her baby was 7 months and then weaned him onto formula so she could go back on them.

It's actually not true that you have a "right" to a CS, as is often suggested on MN. There are trusts in London for example that do not offer elective CS for no medical indication and they are very up front about it. However in your case you will probably find that they will grant your request.

Its quite a complex area. To the best of my knowledge no Trust saying they don't offer maternal request section has ever been legally challenged on that. My suspicion is that the women who kick up a fuss are quietly given what they want.

OP, NICE guidance is that you should be appropriately counselled about the risks and benefits of both options, then if you insist and they won't do it, they should refer you to somewhere that will. They also have a legal duty, following the Montgomery v Lanarkshire case, to proactively and accurately advise you. The NHS is not the best at doing this when it comes to ELCS. If I thought my care providers were going to try and gatekeep I'd be asking them exactly how their actions were in accordance with this legal duty.

If you haven't already seen it, the NICE guidance on maternal request CS can be found here: pathways.nice.org.uk/pathways/caesarean-section#path=view%3A/pathways/caesarean-section/deciding-whether-to-offer-caesarean-section.xml&content=view-node%3Anodes-woman-requests-caesarean-section

It's a useful starting point for reading around and gives you the basic information you need to not be fobbed off.

I'm 37 weeks today was diagnosed with group strep B 2 weeks ago. I'm severely anxious have Insomnia and reading too much i can't do another 3 weeks I'm glad speak to my consultant about early induction r elective section I'm really terrified and hope they understand