Elective section , first baby, maternal request

[FTMRLH]

For several reasons I would like to ask for an elective section even though I am pregnant for the first time and considered low risk.

A few are:
Severe anxiety surrounding the thought of birth even before being pregnant, this has prevented me trying for a baby
Anxiety about lack of control during birth and the trauma which may ensue if my labour doesn’t go to plan
Prevention of an emergency caesarean
Anxiety of not being able to bond with my baby if the birth is traumatic, family history of PND

I’m not afraid of the pain, it’s the lack of control, the unknown, the panic if an emergency happens and the responsibility I have to birth my baby without causing any stress or birth defects.

I have educated myself on all the guidelines, the risks, the recovery etc and feel this is something I 100% want but don’t feel like I am able to discuss it at my appointments.

I mentioned my anxiety in my booking appointment but the midwife was then more encouraging of a home birth which pushes my anxieties and worries through the ceiling.

I’m 13 weeks now and can’t talk about my pregnancy to anyone including my partner because it triggers severe stress and worry which often leads to nausea and migraines

Any advice from anyone who’s been in a similar position would be greatly appreciated

thanks in advance

Bear in mind that lots can go wrong during a C section, it's not always the controlled, clinical procedure you hope for. It can lead to an emergency general anaesthetic for which you'd have no control at all.

Would you consider counselling?

Ask your midwife for a consultant appointment to discuss your fears and your plans

Have a look on the birthrights website.

You should be able to discuss the risks and benefits of cs vs vaginal birth with a doctor or midwife and make an informed choice - either to have the cs if that is your informed choice, or get support to try a vaginal birth if you decide that is better.

Unfortunately many hospitals are not supportive of maternal request cs so if you do definitely want to go that route you will have to be assertive. Raise it with your midwife as soon as you can, and don't be fobbed off- they should refer you to some kind of "birth choices" appointment to discuss your concerns/options as a first step. Be aware it could be a long battle to get booked in for cs so try to get the ball rolling with that birth choices appointment soon ( don't let them book it for 30 weeks!)

Good luck

I don’t think saying lots can go wrong in a c-section is necessarily helpful to someone who is clearly very anxious about birth. An elective section in a low risk patient is very safe. Not without risk, as you’ll have read about, but an emergency general in an elective section is not likely.

I would consider if you have tokophobia, and if so use that word rather than anxiety (not to diminish anxiety at all but they’re clearly fobbing you off). Repeat that you are not comfortable with the risks of vaginal birth and your fear of going through it is affecting your health. Ask to be referred to a consultant.

How to give birth is a very personal choice but unfortunately lots of NHS trusts (maybe all, I don’t know) try to put women off caesarean, so my advice is really not to downplay your reasons and stick to your guns. Birthrights is a good website to check out.

Good luck

I had an emcs with my first, after a long labour and failure to progress because he was too big to exit. I booked a elcs for my second, went into labour before hand and chickened out of the elcs and had a vbac.
The stress and anxiety of going into the operating theatre as a totally rationally human being not one in the hormonal fog of labour was huge by the end of pregnancy for me. Until 38 weeks I was adamant about the elcs.
Having done both its either pain during or pain after. I had an epidural in my first labour and if you want to remain pain free and lucid have one at the earliest opportunity. Give pethadine a wide berth as I found it trippy first time but find second time.
The second trimester in my first pregnancy was the worst for worrying about the birth itself. Mother Nature is kind by the time you get to the end you are so uncomfortable you are really quite looking forward to labour.
In your position I would plan for a normal delivery but if you go overdue and they start mentioning induction refuse and ask for an elcs. My first birth plan simply said I don’t consent for forceps I’ll have a CS instead. Because of that and DP telling them it wasn’t coming out (he’s a farmer) and to do a CS. I got the CS a lot earlier than most women would. We are quite strong minded pair and I knew he would make the right call.
You can ask for an elcs at anytime until your pushing. Whatever you have make sure they give you the suppository painkiller afterwards it’s brilliant.
My scar healed quick from my CS, my episiotomy healed quick. Same issues with numbness, twinges etc on both scars for a good 6 months plus. I was doubly incontinent for a bit after my CS but only pissed myself once after the vbac.
If you want a CS ask for one. The consultant will talk you through all the risks, none of the risks of vb will be discussed. They should then say when they will give you a date. I only got my date a week before I went into labour.
The risks to the CS are more to you rather than the baby.

I had an elective after docs tried to turn by dd and she wouldn't! My ECS was calm and controlled and I was walking within 2 days and driving after a fortnight. No issue with lifting baby or kettle either.

Theoretically, NICE guidelines state you should be allowed a c section on maternal request but as previous posters have mentioned many NHS trusts do not support this.
I decided not to have an ELCS in the end but a consultant was happy to agree to one if I decided that ultimately the risks of induction were unacceptable to me. We had a discussion of the risks and benefits, like you I had read up on everything beforehand so I came across as well informed. I am a confident person and a HCP myself so I think that helped to reassure them that I fully understood what a c section entailed.
Personally, I was very concerned about the long term effects of a potentially assisted delivery (incontinence , pain, sexual dysfunction etc) and this outweighed the risks of a c section (DVT, PE, placenta accreta in future pregnancies). I opted for a vaginal birth in the end and all went well but the choice was mine.
The consultant was very keen to ensure I was aware of the complications c section can have on future pregnancies.

Oh my goodness! I could have written your post OP.

I'm 6 weeks 2 days pregnant, first pregnancy and I only took the leap because I read on the NHS website that women could get a c-section if, after jumping through hoops, they still considered a vaginal birth to be unacceptable. Well, after reading into it more when I turned 5 weeks, I've spent most of this week crying, in bed, not eating at all, and with severe headaches and nausea. I am very well informed of the risks of c-section - from my own reading as well as trying to read any thread that dares mention it sigh However, what is little discussed are the benefits of a planned c-section. There is less risk than with an emergency c section, though for the purposes of statistics they lump both together - sneaky, given that emcergency c sections began as vaginal births. The two things I am not willing to compromise on are the increased risks of urinary and faecal incontinence and the increased risk of pelvic organ prolapse - the latter being one of the most horrendous things I can imagine, it makes me nauseous just thinking about it. I know my grandma had prolapse after childbirth and the thought of that happening to me keeps me awake all night - I couldn't cope with it tbh. It's not about pain - obviously both are painful - and it's not about laziness (although the unpredictability of the length of labour is something I can live without), it's about knowing all the risks I am minimising by having a c-section. Yes, the risk of dying may be slightly higher (the jury is out - one paper I read stated planned sections have the lowest mortality rate followed by uncomplicated vaginal followed by instruments followed by emergency c section). The risks of incontinence and prolapse are staggeringly high in comparison. I know that pregnancy can do a number on your pelvic floor and women who have c sections can still end up with incontinence issues or prolapse, but the incidence is much, much lower so I'd rather hedge my bets on that. I know many women I know and many women on this forum probably suffer from these issues and I mean no disrespect, I'm just trying to make my own informed decision and I already have to cross my legs when I sneeze and wee myself when I throw up so I don't think it's unfounded or a 'phobia' - it's not irrational, the research is out there.

I had a bit of a traumatic first birth and was adamant I wouldnt risk that again and wanted a c section. I talked to the midwife at my 16 week appointment, she took me seriously and we had a good conversation about. I now feel a lot more level headed about the whole thing, talking really helped and the midwifes are there for that. You have the right to choose a c section but I strongly suggest you talk to someone, it will help clarify your anxiety.

I know once I am able to get to speak to a consultant I will be fine at discussing my concerns and the research I have done.

I am also work in healthcare (although completely unrelated to maternity) so feel I have a good understanding of everything I have read.

My first hurdle is getting the midwives to take me seriously. Did anyone have an issue with this?

And of course I know a csection can result in an emergency GA and other complications but as a healthy first time mum my research indicates this is much less likely than suffering trauma or needing assistance during a vaginal birth

Thanks for everyone’s help and advice so far

Because of that and DP telling them it wasn’t coming out (he’s a farmer) and to do a CS I got the CS a lot earlier than most women would

Surely you don’t REALLY think DP giving his farmer’s opinion made any difference to the doctors’ decision!

@FTMRLH

I know once I am able to get to speak to a consultant I will be fine at discussing my concerns and the research I have done.

I am also work in healthcare (although completely unrelated to maternity) so feel I have a good understanding of everything I have read.

My first hurdle is getting the midwives to take me seriously. Did anyone have an issue with this?

And of course I know a csection can result in an emergency GA and other complications but as a healthy first time mum my research indicates this is much less likely than suffering trauma or needing assistance during a vaginal birth

Thanks for everyone’s help and advice so far

I felt like you OP, although didn't have the guts to actually ask for a C-section or request consultation regarding this due to fear of being fobbed off and judged. As faith had it, I ended up having a planned C-section for different reasons and boy I was glad! It was a smooth, relatively stress free and positive experience. My recovery was fairly quick too and I have zero regrets! Well, I regret not speaking up right at the beginning, I could have saved myself a whole lot of anxiety. I wish you all the best x

A friend of mine had a C section for this reason.
She asked and they organised it!

Instead of saying "I feel anxious" and hoping they make the connection to what you're hinting at, you need to say "I want a caesarean section" so they start the process.

Don't waffle, don't explain your reasoning, don't justify yourself, don't provide backstory, don't apologise - start with those 5 words.

Lots of women will tell them they feel anxious but won't be saying it because they want a c section. You need to tell them that's what you want.

If you're worried about getting the words out practise it over and over when you're alone, take a deep breath and say it. Write it down as back up as necessary.

But you have to explicitly communicate it to them because they can't read your mind.

As a 60 year old mother who had straightforward vaginal births with no stitches, I’d have an ecs every time and shall advise Dd to have them. I have had a weak bladder for 26 years and a weak sphincter muscle for 6 or 7. It’s all manageable but frankly I’d rather not have to.

Just tell the midwife what you want and expect and brook no argument. If you get an argument write to the director of midwives.

@RosesAndHellebores what she said!!

"My first hurdle is getting the midwives to take me seriously. Did anyone have an issue with this?"

You don't need them to take you seriously. You just insist on being referred to the consultant until they do.

I had a elcs booked with my first. I am a type 1 diabetic so my risks of an emcs were higher than normal, I'd also have been induced at 38 weeks, another increased risk of emcs. This coupled with similar concerns as @Labyrinth86 made me request a c section. This was grudgingly granted. I was 23 and the whole way through hated my consultant who constantly pressured me to say I would try naturally if I went into labour spontaneously. I was kept in for overnight monitoring and on reflection I was in early labour, my consultant knew this, even mentioned that heart rate was indicative of labour but sent me home as I wasn't in pain. I'm assuming in the hope that I wouldn't get my c section. Thankfully he wasn't on call over the weekend and when I went back in, in active labour, the next morning I was taken straight to theatre as they could see I was booked for an elective.
I have been lumbered with the same consultant again but this time I will not be pressured by him. I have done all my research yet again and he can try persuading me otherwise but this time I will simply ask to be referred to another consultant. Your birth, your decision. State you want a c section but offer no explanations or apologies. It is your choice.
They talk about informed decisions but is it really an informed decision when they provide you with all the risks associated with one option but none associated with the other? They don't stand there and give you numbers of women going for corrective surgery years after delivering vaginally to sort incontinence, women who suffer sexual dysfunction, prolapses, the dangers of instrument delivery.
I have a real thing about this at the moment and I think it's realising how poorly I was treated during my first pregnancy. I'd advocate for any women who want to make their own decisions regarding child birth. I don't mind being labelled a difficult patient this time round 🤷🏻‍♀️

For a start you need to tell your midwife about your anxiety. There is a lot of support for maternal mental health and she will help you access it.

Second you can request a c section. You will have to attend an appointment with a consultant to discuss it. This is because it is major surgery which carries risks. They and you need to be sure you are giving informed consent to the surgery.

They can't refuse, but they have a duty of care to ensure you've fully weighed up the risks.

I am soon planning to TTC my first and if that goes okay... Well I imagine my thoughts would be very similar to what you have just posted.

Do you have an appointment with your midwife soon? If not I would contact them, given they stress this is causing you. I would say that clearly that you want a c section, rather than focusing primarily on anxiety which they may misinterpret.

Failing that, I would put your thoughts in writing for the record and CC in your GP. I find that this can be a better negotiating position. Can be a polite of course, but assertive letter.

I have a scan next week and a midwife appointment at the end of the month. I presume they won’t be time to discuss at the scan?

It’s a struggle trying to book an appointment due to misinformation, wrong telephone numbers etc.

Hopefully the midwife next time will be willing to listen. I will give myself a pep talk and just request the csection and take it from there.

I will report back with my progress.

Thanks so much everyone.

Having just your cofindence and reassurance has made me feeling a tiny bit better. I thought I was alone in this

Best to tell mw as soon as you can - I had a elcs 2nd time around, adamant I was not having another vb. At booking appointment I told mw and it made a difference to what hospital (we have 2 maternity units in our city and can go to either) they put on my notes.

Then there's not much to do until 35ish weeks when you get an appointment with consultant to discuss the birth. I went in fully prepared with stats and a ton of research, totally not needed, we had a chat, I chose a date to have my baby. Incredibly civilised, and as with a lot of childbirth related stuff, I had no idea how lucky I was until a long time after.

My elcs was lovely, the scariest bit was the spinal, (which they did before dh finished getting changed!) but absolutely everything else was calm and controlled, and ds was skin to skin after being weighed and was bf in the recovery room. Home within 48 hours, driving within 3 weeks.

Made dealing with toddler ds1 a bit more tricky for a few days than perhaps a vb might have done (couldn't pick him up etc) but benefits absolutely outweighed the cons for me.

Personally I would advise having some counselling around the anxiety and then make an informed decision about the type of birth you would prefer or want to go ahead with :)

For most planned c sections do go well but that wasn’t my experience unfortunately. I won’t go into details as that will be unhelpful but my second birthday with my son was great and far less traumatic then my section.

Good luck with your pregnancy and your decision :) x

You won't be able to discuss it at the scan; that's not what the sonographer is there for. You need to bring it up at your next midwife appointment and go from there. I had a planned section due to my baby being breech and found it a positive experience and was back home the next day. Good luck

I'm pregnant with #2 (VB for my first) and asked for a c section at my booking appointment at 7wks pregnant. I have a medical reason to ask for c section this time around, but the NHS don't view this medical reason as one indicative of c section so its being treated as purely 'maternal request'.

I'm 27 weeks now and have seen 3 obstetric registrars, 1 senior consultant and am due to see another consultant next week and then another at 30 weeks .... and it's still not signed off by my NHS trust yet. So my advice is to get the ball rolling ASAP as certain trusts will actively drag their heels with maternal request c sections and make you jump through quite a few hoops before eventually agreeing to it. You'll likely find they eventually agree to the section, but be aware most won't give you an actual booking (date/time) until far later in pregnancy (e.g. 35 weeks seems a common time at which they bring you in and book the section date).

You need to be so so firm with them if this is what you really want. Educate yourself - not just about the NICE guidelines, but read up on some facts and stats surrounding risks of things not going as planned in VB. Be aware that the risks they will present you with (time and time again, if your experience is anything like mine) focuses only on risks of c section (often EMCS, which is a different ball game to an ELCS) vs a straightforward VB... and be ready to query this with them.

I went to my scan today and saw a midwife afterwards. I told her my concerns and that I wanted a csection. She was amazing and got a doctor in to speak to me right away. I explained what was causing my anxieties and the research I’d done on my own. I’m booked to see a consultant when I’m 24 weeks to discuss further.

She said everything is my choice and as long as Iv spoke to the consultants and been given the information to make an informed decision it is up to me. And I can even change my mind on the day of the op if I decide against it.

Just wanted you all to know how I got on.