Can you request a C Section and are you likely to get one, especially for your first pregnancy?

[Unsure96]

I’m in my mid 20’s, never thought I wanted children until I recently started thinking about the other side of things and realised one of my biggest reasons is being absolutely terrified of pregnancy and giving birth.
If I was ever to get pregnant then I don’t think I could mentally do a natural birth, not so much because of a fear of the pain but all the ways it can cause damage, such as incontinence, tearing your clitoris etc. I understand that a C Section seems to usually come with a much harder recovery afterwards, but would this be a realistic request for the NHS?
I have also thought about surrogacy and adoption, also if I did have a child then it wouldn’t be for around 10 years anyway, but I’m not sure how affordable those would be as options

You legally have the right to request a CSection. They may fight you on it but they have to relent.

Also i don't think anyone's torn their clitoris during labour...it tends to be the perinium which is lower down

Yes you can and some consultants will try and scare you and talk you out of it but you’re entitled to one
www.nice.org.uk/guidance/ng192/chapter/Recommendations#maternal-request-for-caesarean-birth

With all due respect, I felt exactly like you. Jumped through all the hoops and said all of the right things to get referred to birth choices so I could opt for an elective c section.

I had a missed miscarriage.

I’m not thinking about my birth plan until much later when I am pregnant again, but I know that I don’t care how they get here- I just want them here.

Yes you can. I had an elective

There’s a blogger - Forever Amber - who has blogged about her fear of pregnancy and birth and how she managed in the NHS system through her pregnancy. Obviously every pregnancy and birth is individual and each trust is slightly different but a real life experience might be helpful to read.

Yes - I was absolutely you. Had almost ruled out having a baby because there was just no way I could do any of it. I’d spend hours and hours watching videos and researching it all, almost just to scare myself even more. I found the birth rights website last year where you can check your local hospital and what their policy is on a maternal request c-section (without medical reasons). NICE guidelines state all hospitals should be offering them but some make it harder than others. If a consultant says no to you they must refer you to someone who will do it. I decided after looking up my local hospital that I could do it and I would be able to get one!

Since the second I saw a second line on the pregnancy test I was worrying about how I’d get the baby out. Long story short, you can do it! My c-section is just over a week away now and being pregnant has been soooo easy compared to what I imagined. I’m not extremely uncomfortable or waddling about with a sore back at all, that’s definitely how I imagined it would be. I’m sure it is for some people but I’ve had the easiest time ever! You just have to put your request in from the booking appointment at 8 weeks and don’t stop asking until you get to speak to the consultant

@Bells3032

You legally have the right to request a CSection. They may fight you on it but they have to relent.

Also i don't think anyone's torn their clitoris during labour...it tends to be the perinium which is lower down

Normally you tear downwards, some women do tear upwards though and yep you can tear your clit.

I'm 35 and going through the process of requesting one atm. I've had to be assessed by a clinical psychologist (who did recommend that I have a section) and I'm waiting to speak to the consultant to get a yes or no. I'm 27 weeks and I asked for a decision (not necessarily with a date yet) to be made asap because being in limbo is ruining my pregnancy. Everyone I have spoken to has been supportive. I really hope it gets approved because a midwife and a gyno couldn't get a speculum in me a week ago - they gave up after I screamed with pain while they tried to ram it in me. There is no way a baby is coming out and I'm terrified about the effects a vaginal birth could have on the baby. I work with kids with SEND and it opened my eyes to the fact that kids can end up with permanent mental and physical disabilities due to issues during childbirth. As in, a perfectly health newborn can be damaged during the birth due to getting stuck and lack of oxygen. Then as you say, there's all the horrible consequences for us women. Pelvic organ prolapse is one of my biggest fears. I know it can happen anyway but vaginal birth increases the risk so I want to avoid it all costs.

I'll let you know how I get on :)

@Labyrinth86 a girl who lives near me had a completely normal pregnancy, healthy baby then went into labour and was sent away from the hospital again and again to spend more time at home. The baby had gone too far down and was stuck and ended up starved of oxygen for a long time. She now has major disabilities that will mean she needs to live with them for life. They’ve had to get carers in to help during the night etc. Theyve been told she won’t live past childhood ☹️ So unbelievable that she would have been completely healthy if she’d just got out in time! This same girl faced questions when requesting a c-section for her second too 🤦🏼‍♀️

@sarah13xx I'm so sorry to hear that. That's awful.

I've decided I'm not taking no for an answer! Especially after my clin psych recommendation. I'll threaten the NHS trust with legal action if they try to force a vaginal birth on me.

@Labyrinth86 you will be able to get one! It’s just the stress of the unknown bit when you’re already pregnant, they don’t seem to understand how much anxiety that causes people. I’m still stressing if I go into labour early the midwives at the hospital won’t take me seriously and might try to keep me at home when I will be asking to come in asap for my section. One week left though, surely I can make it 😂

A couple of things.

1. All fear of childbirth is not the same.
2. A woman in her 20s who isnt pregnant should probably take a different course of action than a woman who is 35 and heavily pregnant because of the pressures of time.
3. A csection isnt a magic solution. Its still major surgery and carries other risks. It also may not be possible in all situations even if one is agree if the baby has other ideas. This is something you need to be honest with yourself about and prepare for mentally.
4. A fear on this scale needs to be properly unpicked because its a red flag for other issues and anxieties (eg a history of abuse / assault or other chronic anxieties /depression which are relevant to looking after a child).
5. Research has shown that women who request a csection and are granted one in principle don't always go on to have one if they are given support. This is through their own personal choice. The decision to allow a csection lets them relax and helps them build trust with their hcp and a good birth plan may let them feel able to attempt a vb afterall within certain parameters and perhaps with a csection being on the cards earlier than normal if problems arise. This depends on the individual. This has crucially resulted in greater patient satisfaction with the birth they have.
6. Covid may throw a spanner in the works if there is a lack of critical care beds - there is less ability to perform surgery and cancellations are more likely.
7. Risk is not equally stacked. A woman in her 20s is less likely to have complications than a woman in her late 30s having her first and likely only baby. This is also relevant to how likely you will be granted your request. A 20 year old, who isn't in a solid relationship and want 5 kids is much less likely to get one because its not necessarily in her best interests or that of her child(ren).

In the care of a 20 something year old, not pregnant, getting counselling and looking what is the nature of your fear is your starting point. Most likely down the private route if you are single and not looking to start a family now. You can later go down the GP route if in a relationship and older to seek out options before pregnancy but the onus is likely to be on you to know your stuff and where you can get relevant support (it may not be your local maternity unit but one further away) not for your GP to tell you this information. Fine out what support is out there. Nice state that women with a history of mental health issues can get support about starting a family prior to getting pregnant - if you have a history of anxiety / depression this may well be relevant.

If you go in blazing guns demanding a csection you may find hostility rather than support. The key is how you frame things and highlight what your concerns are. Use the system and nice recommendations to your advantage.

You do not have a right to a csection even now. You do have the right to the most appropriate care for your situation.

I personally think that a lot of women are now looking to csections as a magic bullet who would be better served with better maternity care in the first place and requests are a consequence of poor care and poor relationships with hcp. The csection doesn't necessarily solve the problem in a number of cases.

I say this as someone who has been down this route successfully. But I've seen so many of these posts over the years and i am well aware that when you start picking at women's fears they reveal a range of concerns and issues which can be managed in multiple ways and hide what the woman really wants (its not always a cs. Its often simply competent care and not being neglected in child birth)

@RedToothBrush I would agree this is often the case or sometimes women aren’t even sure what they want, they maybe just don’t want to experience what they did with their first birth again. There should be way more support and check ups on women during pregnancy in my experience. Many of my appointments have been cancelled due to covid or lack of staff or moved to a quick telephone appointment. For me personally, a c-section was the only acceptable option. I have no history of abuse or anything else, I didn’t even have a bad experience to go off of. I have just always known since I was really young that I would either not have children or if I did I would need it set in stone that I could have a c-section, before I was even pregnant. The operation still terrifies me (and it’s only a week away now) but it’s a much more manageable level of fear for me than the alternative. I physically could not have got through the last 9 months if I hadn’t had it approved. I turned down any counselling (and I’m so glad I did). I might have been more likely to accept it if there was better care provided but it was extremely difficult to get the ball rolling to even speak to a consultant that I felt I wasn’t willing to put myself any further to the back of the queue by going down the ‘birth reflections’ route. A girl I know is also terrified of giving birth, but not quite on the same lifelong phobia level as me. She accepted the birth reflections option and was initially to be sent on a hypnobirthing course and they would then discuss her options. She’s now due in a couple of weeks, has been contacting them weekly and is yet to receive a single session of hypnobirthing. To add to it, my hospital are no longer doing birth plans because they don’t do them in face to face appointments anymore (due to covid). They don’t phone to do them either and even if you phone up, you’re just told to fill out your preferences on the app - which unless you’d had a baby before you wouldn’t know how to do because it’s not even questions to fill out. I would never under any circumstances have considered giving birth vaginally anyway but I cannot imagine the level of anxiety I’d be feeling right now if I’d said I would give it a go. The controlled aspect of the section is the only thing keeping me going right now. I’ve had people in the past comment on my posts saying these phobias need to be tackled head on and I should have counseling etc but in my case I wouldn’t agree. It’s like a fear of jumping off cliffs or swimming in open water. If there is an alternative option and I’m only being asked to do it once (maybe twice) in my life I would take the alternative option, even if there’s other risks associated with it. People have phobias of all sorts of things and the majority of people just avoid that thing rather than go about making themself feel that scared/anxious/uncomfortable. I don’t know, maybe some people would rather face a fear but for me there is no hope in hell 🤣

Counselling isn't for everyone. I didn't have it and wouldn't have it. However the extra support I was given was invaluable and actually I think other women in a similar position, would have then gone on to counselling...

Tbh my phobia centred on authority and the process being part of the issue. They couldn't understand that I wasn't afraid of having my blood taken or needles. It was them, themselves.

It shouldn't be compulsory for this reason alone. However, I do think there should be a better carepath way before pregnancy that goes through all this - and identifies women who are more at risk (severe anxiety does seem to be a risk factor for complications so there is a clinic reason to do this).

Managing anxiety isn't necessarily about counselling or medication. It can simply be about trust and appropriate levels of support for individuals rather than assuming that all women can just get on with it and suck it up. If women don't have adequate levels of support for their individual needs they are more likely to end up with mental health issues resulting from their birth experience.

In terms of cost to society in both financial and social cost its actually cost effective (if not cheaper) to act in a preventative way rather than trying to pick up the pieces after the fact.

My concern really is that its pretty clear from many threads of this nature is that there is a sizeable chunk of women for whom a CS is really their choice because of fear of poor levels of support and care rather than because they have issues that mean they fear a vb itself. And people suggest a CS more flippantly than they should rather than addressing the individual issues of a patient.

I am pro-individual care being appropriate rather than mass care which favours process over the individual. I do think there is a danger of women being pushed down the planned CS route as a cost / time saving measure.

I benefitted from the extra support as much as the actual CS which I think is hugely important to stress. It eased some of my phobia (to an extent I thought unlikely). I'm struggling now because covid has made it more difficult to get time face to face with doctors easily which is really what I need (for other medical issues) and I don't see this improving...

You do have to be really pushy, pardon the pun. I was far too meek and ended up with a really horrible induction and EMCS.

@RedToothBrush

A couple of things.

1. All fear of childbirth is not the same.
2. A woman in her 20s who isnt pregnant should probably take a different course of action than a woman who is 35 and heavily pregnant because of the pressures of time.
3. A csection isnt a magic solution. Its still major surgery and carries other risks. It also may not be possible in all situations even if one is agree if the baby has other ideas. This is something you need to be honest with yourself about and prepare for mentally.
4. A fear on this scale needs to be properly unpicked because its a red flag for other issues and anxieties (eg a history of abuse / assault or other chronic anxieties /depression which are relevant to looking after a child).
5. Research has shown that women who request a csection and are granted one in principle don't always go on to have one if they are given support. This is through their own personal choice. The decision to allow a csection lets them relax and helps them build trust with their hcp and a good birth plan may let them feel able to attempt a vb afterall within certain parameters and perhaps with a csection being on the cards earlier than normal if problems arise. This depends on the individual. This has crucially resulted in greater patient satisfaction with the birth they have.
6. Covid may throw a spanner in the works if there is a lack of critical care beds - there is less ability to perform surgery and cancellations are more likely.
7. Risk is not equally stacked. A woman in her 20s is less likely to have complications than a woman in her late 30s having her first and likely only baby. This is also relevant to how likely you will be granted your request. A 20 year old, who isn't in a solid relationship and want 5 kids is much less likely to get one because its not necessarily in her best interests or that of her child(ren).

In the care of a 20 something year old, not pregnant, getting counselling and looking what is the nature of your fear is your starting point. Most likely down the private route if you are single and not looking to start a family now. You can later go down the GP route if in a relationship and older to seek out options before pregnancy but the onus is likely to be on you to know your stuff and where you can get relevant support (it may not be your local maternity unit but one further away) not for your GP to tell you this information. Fine out what support is out there. Nice state that women with a history of mental health issues can get support about starting a family prior to getting pregnant - if you have a history of anxiety / depression this may well be relevant.

If you go in blazing guns demanding a csection you may find hostility rather than support. The key is how you frame things and highlight what your concerns are. Use the system and nice recommendations to your advantage.

You do not have a right to a csection even now. You do have the right to the most appropriate care for your situation.

I personally think that a lot of women are now looking to csections as a magic bullet who would be better served with better maternity care in the first place and requests are a consequence of poor care and poor relationships with hcp. The csection doesn't necessarily solve the problem in a number of cases.

I say this as someone who has been down this route successfully. But I've seen so many of these posts over the years and i am well aware that when you start picking at women's fears they reveal a range of concerns and issues which can be managed in multiple ways and hide what the woman really wants (its not always a cs. Its often simply competent care and not being neglected in child birth)

If that time pressure comment was aimed at me (quoting my age), you're wrong about time pressures! I wanted a c-section before I even got pregnant and the only reason we started trying was because I read women could request them on the NHS website. I raised it at my booking in appointment at about 6 or 7 weeks and have raised it again at every appointment since.

Are you a qualified mental health professional or just throwing out random accusations about why women want c-sections? I am actually a qualified psychologist myself. I know the difference between a phobia (irrational fear) and a rational fear. I have done my research and in every single way a c-section comes out on top. Perhaps not so if a woman wants lots of kids but if you only want one or two, I can't actually see why anyone would gamble on all the unknowns of a vaginal vs routine, albeit major, surgery. Unfortunately, I had to play on the fear angle to get approved and I am terrified of vaginal birth for genuine, proven reasons.

@lavenderandwisteria

You do have to be really pushy, pardon the pun. I was far too meek and ended up with a really horrible induction and EMCS.

Yep. I told my clin psych I wasn't taking no for answer because I couldn't do this any other way and she said "Good! Keep that fire!"

[quote sarah13xx]@Labyrinth86 you will be able to get one! It’s just the stress of the unknown bit when you’re already pregnant, they don’t seem to understand how much anxiety that causes people. I’m still stressing if I go into labour early the midwives at the hospital won’t take me seriously and might try to keep me at home when I will be asking to come in asap for my section. One week left though, surely I can make it 😂[/quote]
Thanks, Sarah all the best with yours next week! I know what you mean. I'm dreading my little monkey coming early.

Labyrinth, I was talking about this on MN before pretty much anyone else. I know my shit. Like really know my stuff on this subject.

I got a CS agreed in principle before getting pregnant which even know is pretty unusual and unheard of. I chose to go where I did because they had a pro-woman centred care approach, rather than a pro-elcs one. Indeed the midwives who pushed it through for me were very much pro-natural birth but supported me 100%. They got where my head was because of their experience. I was given an actual date when I was 16 weeks.

Despite this, all the research and information I've read on the subject, still means I do think your age / when you want to get pregnant are particularly relevant here because of how risk stacks. If you are in your 20s and thinking like this, I don't think its necessarily clinically ethical to treat women the same as those in their late 30s because of the risk of having more multiple pregnancies. Women having children later will have fewer children and more likely to have complications in childbirth. I think if you want to go for it younger then you have to understand the difference in risk and might not be appropriate in the same way and reach a higher threshold of clinical need based on your mental health, because the physical risks aren't there unless you have other health considerations. Its about understanding risk in minute detail and how it stacks on an individual level. The politics of poor maternity care are an entirely different debate (again one I've made a point of for many years, and even said on MN there was an institutional level crisis across maternity services in the uk before any damn newspaper or report was saying it).

As I said in my previous post, I think there should be a better carepath way for women to talk about vb v cs BEFORE getting pregnant to properly discuss this in a neutral way. Unfortunately there is still a huge amount of ideology and I actually think, increasing levels of fallacy around the subject, which has gone past where it probably should have. This should principally be based / prioritised on clinical need - which includes mental health. I know here are now some places doing birth choice clinics but demand is so high that women who aren't pregnant / arent intending to immediately are regarded such low priority they don't get seen. I think perhaps now, because there is so much more awareness of the subject, I would never have had DS because I would never have got an appointment with someone before getting pregnant and my issues were so severe I wouldn't have done that.

When I started talking about this subject on MN there were no clinics for childbirth fear out there. When I first started out exploring the subject the NICE guidelines didn't even acknowledge tokophobia. It was unheard of. It was taboo. I spoke about it and pushed for changes on the guidance as they didn't reflect actual risks - there was a blogger Pauline Hull who did a lot of campaigning on this. Even then, after this had changed when I was ready to try myself a couple of years later, I literally wrote to someone who was researching the subject out of desparation who had some knowledge of the subject. There was no one at all in the North West other than them in the NHS and my only other alternative was to go private in London which simply wasn't viable due to where I lived (there are now private facilities in Liverpool I believe).

I still find it deeply frustrating that my notes tick the box for an ELCS on maternal request not for mental health. The person who helped me most wrote in capital letters across my notes that it was for mental health. I get the impression they stuck their neck out for me and it was somewhat controversial at the hospital. They left before I had my son and have subsequently done a lot for birth rights. I was told by one of my midwives that my case had struck something of a nerve.

I learnt a hell of a lot about the subject. I've helped a lot of people on here in the past. I only pop by in this section every now and again now.

So no, I'm not a professional but I really had to fight in ways that people now don't because I campaigned on this over a decade ago. Even my GP said I knew far more about this and had better understanding of risk, care pathways and had good knowledge on the research that had been done without being blinkered about it.

If you would like to check my posting history in the childbirth section on this subject, go use the advanced search. I don't think a vb is right for everyone. But I also don't think an elcs is and I think people are being pushed for them as a substitute for poor care (which tends to shit on those least able to advocate for themselves - who also tend to often be those who need this support and care pathway most). Sadly talking about most subjects has become much more obsessed with black and white thinking rather than case by case thoughtful consideration and weighing up of issues though

So if you want to question my credibility as just someone posting bollocks on the internet, I suggest you go away and check what I've been saying for goddam years. (And when I said it and whats changed since).

I am not just some plopper who knows fuck all. I have spent hours and hours sifting through research papers both for and against on the subject.

I've posted about this since 2009 under a couple of usernames. It was why I came to MN in the first place.

Nice post @RedToothBrush.

Just want to reiterate that even if an elcs is agreed there is still a chance you may not end up with one, so that is definitely something you need to be prepared for

@RedToothBrush I wouldn’t really agree that you can change your preference based on your age. Im under 30, very low risk and potentially would have a straightforward vaginal birth but it’s just not an option. There’s not a single fibre of my being that would allow me to even enter the hospital building if I was being told I would have to give birth vaginally. You can’t turn phobias on and off based on what age you are and whether you were high risk or not to start with. It’s completely level. It’s still a woman with a baby inside her that needs out and she could have tokophobia the exact same as someone aged 39 only planning to have one baby. If my c-section is really disastrous I will only have one baby, obviously I’d hope it’s not. As long as women are given all the accurate risks and not the false skewed risks some consultants like to give out, they should be allowed to make an informed choice (regardless of what age they are).

@Labyrinth86 thank you, I will let you know how it goes! Keeping my legs very tightly crossed for the next week 🙈

[quote sarah13xx]@RedToothBrush I wouldn’t really agree that you can change your preference based on your age. Im under 30, very low risk and potentially would have a straightforward vaginal birth but it’s just not an option. There’s not a single fibre of my being that would allow me to even enter the hospital building if I was being told I would have to give birth vaginally. You can’t turn phobias on and off based on what age you are and whether you were high risk or not to start with. It’s completely level. It’s still a woman with a baby inside her that needs out and she could have tokophobia the exact same as someone aged 39 only planning to have one baby. If my c-section is really disastrous I will only have one baby, obviously I’d hope it’s not. As long as women are given all the accurate risks and not the false skewed risks some consultants like to give out, they should be allowed to make an informed choice (regardless of what age they are).

@Labyrinth86 thank you, I will let you know how it goes! Keeping my legs very tightly crossed for the next week 🙈[/quote]
I am well aware of this. I also think that there a lot of people are now being encouraged to have ELCS who do not fall into this category. Thats the problem. Thats due to care in maternity being that shocking - which is what multiple independent inquiries have said in recent years.

As I said above not all people requesting ELCS have the same fears. Thats why it is crucial to unpick that and go through with women on a case by case basis to discover what is driving their request.

I also think that even those hostile to counselling and don't go down that route can have their phobias eased by proper support and care. I know because I've been there myself and I was surprised by where I started mentally compared to where I finished.

Building up relations with a team over time - including pre-pregnancy would be beneficial for all women in this boat. Its about understanding their needs and what makes up their fear.

Over the years on these threads its been really interesting to see the vast range of what makes people consider an ELCS. It really isn't a one size fits all approach which you seem to be suggesting based on your own experience alone. A lot of women don't really understand what is driving their concerns and don't give consideration to alternatives because they are never presented with them as an option. Its so wrong.

My experience and fears were on the more extreme end. There are few women who are at the level I was at even with greater awareness of the subject. Its atypical. Most women fall inbetween where I was and having a 'normal' level of concern. My point is precisely that there needs to be a proper process of assessment of the level of phobia and risk on an individual level. As my midwife said at the time, there will be some women within that, for whom anything but an ELCS just wouldn't be a consideration for them because their fear is that extreme. But its not normal. Thats precisely the point.

Making an informed decision has to be based on that - if you are making decisions based purely on your fears, you aren't making an informed decision. And that comes back to the inescapable point that having a baby in your twenties is lower risk. If there is then a discussioin between you and your HCP who decide that in your individual circumstances that the risk of harm to your mental health is that significant that it outweighs the physical risks to you, then thats fine. But the problem is that conversation isn't always being had in discussions like this one. That makes them uninformed. Women need to know the reality of risks - a woman in her late 30s has a different risk profile to one in her mid twenties (in a similar fashion to covid has age based risk profiles, but there are also other mitigating factors which might mean someone got a vaccine earlier because of other health issues or because they worked for the NHS).

Accurate risk assessing means talking about this. Even when faced with someone going 'I'm going to have a cs no matter what' precisely because not everyone is at this level and accuratingly talking about risk might make women think differently. I think this conversation is particularly relevant to women who want more than 1 child, because a lot of the headline data is based on women who have only had one child and the risk with each subsequent pregnancy increases for CS and decreases for VBs. We should not be ignoring this, to satisfy people who just think ELCS should be done without question. Its unethical and frankly dangerous.

Address issues properly and don't get sucked into the ideology or your own personal position.

My case is only representative of a small number of women who seek help and support for a ELCS. Others have other needs. Others have other risks.

I want the best and proper care for ALL women.

@RedToothBrush I’m not sucked into my own personal position. You were referring to younger women (me) therefore I’ve justified why ive made the decision I have. Forming a relationship with healthcare professionals may have helped you in your own personal situation but would do nothing for me if the end goal was for me to give birth vaginally, as my fear isn’t around the staff or what they might do.

I think anyone who dares to get pregnant while experiencing tokophobia (whatever that looks like to them) is extremely brave and should be fully supported and encouraged to have whatever birth they choose to have rather than made to feel worse about a situation they’re already highly anxious about

Yes . and do it. Read the NHS protocols for your area and plan what you’ll say according to that. That’s how I’ve got what I wanted.
The chances of damaging yourself giving birth are very high these days , I suspect babies are getting bigger and we aren’t . Id rather a scar on my belly than a leaky bladder or not enjoying sex so much. The majority of obstetricians have c section births tells all you need to know. I think all women should be given all the facts and allowed to choose .
Our bodies have to last us .