ELCS due to high BMI?

[Motherl0de]

Hi,
Just looking for some advice before my 28 week appointment with my midwife on Thursday.

My BMI was 40 at my booking appointment and is obviously higher now. I've decided due to a number of reasons (listed below) that I'd like an ELCS. Has anyone else been in this scenario, and what was your midwife's response?

My reasons are:

• Tommy's, the North Bristol Health Trust (not my health trust, just one I found when researching) and various other NHS sites state that the risk of needing an emergency caesarean when you have a high BMI are higher (some say double that of a woman who is a "healthy weight"). I don't want to try for a natural birth that's just going to end up in an emergency situation - I'd rather everything be calm and planned and the risks be minimised as far as possible before the birth.
  
• Having an scheduled ELCS rather than a random emergency one means that I can prepare in advance - making sure someone is around all the time to help me out, drive me to appointments, etc.
  
• I categorically do not want an assisted birth - the thought of forceps or a ventouse makes me incredible anxious (not sure why).
  
• My partner isn't British, so English is not his first language. While he's fine day-to-day, the thought of putting him in an emergency situation where there's lots of medical jargon flying around and no-one has time to explain anything to him properly is just adding another layer of worry in my mind - I don't want to be worrying about him when I'm also worrying about my baby. My nearest family member is 4 hours away.
  

I don't know if my concerns seem significant enough, or how my midwife is likely to respond. If anyone else has been in a similar situation, what was the response from your care team?

[HacerSonarSusPasos]

Just quote the NICE guidelines at them and assure them you are well aware of the risks of a c-section and find them more acceptable than the risks of vaginal delivery. They might push back, but they have to grant you a c-section if you insist. It's your right.

[InTheNightWeWillWish]

I have a higher BMI and I thought about asking for an elective but eventually decided to try a vaginal birth. This was down to the recovery. At all my midwife appointments I told them that if it was going to end up in a c-section, I wanted to make that decision. I’ve had surgery before when I was a child and broke my arm. I had emergency surgery which I don’t remember as I was on pain relief but I also had outpatient surgery to remove plates in my arm. Going into the outpatient surgery was quite scary at the time and I know they had to sedate me, I didn’t want that experience when I was vulnerable and in labour. Ultimately I decided I’d rather avoid surgery if I could. The midwives told me it was a conversation to have with the consultant and by the time I’d got to that point I’d settled on trying for a vaginal birth. Different hospitals will have different policies though.

I was induced and had an unassisted vaginal birth. Just because you have a higher BMI it doesn’t automatically mean it will end in a c-section. I had gestational diabetes and knew I was likely to be induced so I familiarised myself with the induction process and I had a point in my mind at which point I’d ask for a c-section if induction wasn’t looking like it would work. Officially that would still go down as an emergency c-section but wouldn’t be everyone piling into the room and throwing medical jargon at you, just a decision made by you when you’re in control of the situation - www.pregnancybirthbaby.org.au/emergency-caesarean. For me, my cutoff point was the drip as they recommend an epidural at that point which increases the risk of instrumental births. The consultant also recommended that I have an epidural and have it done early due to the issues with higher BMIs but in the end I didn’t get on the delivery unit until it was too late for an epidural. You will probably be offered additional growth scans due to your higher BMI, so you can use those to see if baby is in a good position or ask for an additional scan to check the position/size and make a decision after that last scan.

[Bunny2607]

Hi OP
I had an elective section on friday last week. My BMI was 48 at booking at 50 on delivery. The c section was for a number of reasons, my BMI being one of them and also baby was big (11lb 5oz) and i’d had a traumatic birth with my first baby. I was really scared and on edge throughout but it only lasted about 45 mins and i was back in recovery. I left hospital after 2 nights and its been hard, baby blues hit hard etc but keep on top of painkillers and ask for stronger ones if you need it. For me the control aspect was a big plus like you say you know when and can plan and organise for it. Hope that helps :-)

[LC84]

@Motherl0de just wondering what midwife said?
Am having similar thoughts but not sure if I'll just be dismissed as difficult for saying Im leaning towards ELCS!

[Justgamboling]

I'm having a maternal request C Section. I mentioned it to my 'stand in' midwife who was a total dick about it but referred me after lecturing me. I then spoke to my actual midwife who was keen to push for vaginally birth and keen for me to consider all options available to me (can't fault her for that).

I had my consultants meeting, went in with all of my facts and figures. Sat down, explained briefly that I would like a section, he immediately ok'd it, went through the risks and that was that. I was fully prepped with notes, facts, figures and none of it was required. I was booked in there and then.