Maternal request C Section

[sorchaedwards]

Hi there

I have very recently found out I'm pregnant, after a long fertility journey (was just about to be put on IVF waist list). We are obviously over the moon, but unfortunately I have tokophobia and have had it since early teenage years. I can't even talk, read or watch anything about childbirth without crying or wanting to throw up.

I have always told myself I would have elective C Section, as all the guidelines say I shouldn't be refused. However, I am now in panic mode at the potential long and anxious road of me having to put up a fight to get what I want. This baby feels like a miracle and I want to enjoy this pregnancy more then anything, the anxiety of not knowing if I will be allowed ELCS would be horrendous.

I was just wondering if anyone has any recent experiences of MRCS? I know in February, NHS England were told to drop C Section targets and to allow all requests even if not medical. Obviously this seems good news, but I was wondering what anyones experience has been with it in the recent months? Has anyone had any roadblocks, difficulties or even rejections since the new guidelines came into place?

I would hope it's all getting much easier with less judgement involved, but I honestly don't know as nothing is written in law.

Appreciate any feedback

Many thanks

I had an ELCS 4 weeks ago, for much the same reason as you. I have no issue with labour itself but do

*was v keen to avoid an assisted delivery (I have a few close friends who had bad outcomes with forceps in particular). There was some pushback when I first raised it in general clinic. I stuck to my guns and was referred to Birth Choices, who were lovely and approved my request pretty much instantly. They told me they just want to make sure people have thought it through / haven't just watched an episode of Greys Anatomy and decided a CS is the way to go. The ELCS itself was a breeze - worst part for me was getting the canula put in! I got skin to skin and breastfeeding established with no issues. Recovery was v straightforward. Would 100% recommend and plan to have another next time. Bottom line is its entirely your choice - everyone wants different things and no one birth method is any more valid than another. Best of luck and congratulations on your pregnancy!

Worth mentioning that the consultant in Birth Choices I spoke to said (when giving me the lowdown on CS risks) "we really should warn mothers about the risks of natural birth too, but we don''t". CS and natural birth both have their own set of risks - its just up to you to decide which you can live with! General clinic might well try to dissuade you (they quoted stats at me about infertility and stillbirth which Birth Choices later said were totally wrong) but as I say, just stick to your guns if you want to and it will all be fine.

Hi, I am requesting a c section for similar reasons as well. I'm currently 29 weeks and they said they will book me in for one at my 36 week appointment once they have completed a growth scan to work out the best date. I would mention it straight away, I mentioned it at my first midwife appointment and she said they won't do one and she had never known of one done. I was referred to a consultant for another reason, and I mentioned it again to the doctor in this appointment. They took me through all the risks and benefits associated with both ways of delivery and suggested I see the GP for therapy and sent me on my way. I then decided to call my midwife and insist on a referral to the perinatal mental health team and a specific appointment to discuss maternal request c section with a consultant. She decided I didn't need to see the mental health team and instead asked her team leader for advice. They called me back and insisted that they would support my choice and would email the consultant to ask her for a specific appointment for me to discuss this. I would do your research, on the phone to the midwife I quoted the Nice guidelines and discussed all the research I had done. The consultant eventually emailed back and my midwife called me to say she had no problem with booking me in for a maternal request c section as long as it was an informed desicion. I had a follow up appointment with another doctor to specifically discuss and they said they respect the mothers right to choose her own birth, but they won't formally book a date in until 36 weeks. I should also mention you can directly email the birthrights charity and they can tell you how many maternal request c sections have been performed in the last few years in your chosen hospital, I also quoted this number on the phone to the midwife. Its funny how it went from, 'they will never do that' in my first appointment at 12 weeks, to 'of course we will respect your choice' in my most recent appointment. I think you just have to ask in every appointment you go to and make sure they know you have done your research and its what you insist upon. If your hospital dont do them they have to refer you to someone who does and you can get all this info from the birthrights charity. I know how scary it can be, and it does put alot of stress on you while you are trying to enjoy pregnancy. I'm still nervous that it will get to the 36 week appointment and they won't book me in, but from what they have been saying they are happy to accommodate. Its worth asking about risks and benefits of both natural birth and c section as well so you are well informed. I hope this helps you. Good luck 😊

Congratulations! I was the exact same as you and honestly looking back pregnancy was physically completely fine for me, even at the end I wasn’t really sore or uncomfortable. Mentally though I felt like I was walking on a narrow ridge at the top of a mountain waiting to fall off at any given second 🙈 that’s the only way I can describe it! I put so much of my effort into fighting for a section for the first 30 odd weeks of my pregnancy then relaxed for 0.2 seconds when I had it booked then just went straight onto worrying that I wouldn’t make the date and would go early. I so wish I could have relaxed. It literally could not have gone better, I made it to the date, the section was beyond amazing and the recovery was completely fine.

I’m in Scotland rather than England though. I found the biggest hurdle was actually getting through the midwives and being allowed to speak to a consultant. I was a nervous wreck telling my midwife at my booking appointment on the phone, as I physically shook while telling her my big sob story about how petrified beyond belief I was and I only got pregnant when I was absolutely sure that I would be able to have a section due to this overwhelming fear. She listened then dismissed me basically and sort of laughed it off saying we’d speak about it at a later date and everyone feels like that at the start. I had this same conversation with her at every appointment until I reached 23 weeks when it had got to the stage I was waking up during the night, mid-nightmare about speaking to the consultant and them saying no. I nearly started crying when I told her this time and said I was starting to struggle with daily life because it was all I was thinking about. She took me seriously this time and arranged a consultant appointment. I heard nothing back so a week later contacted her again to ask if she’d been able to get me an appointment. This obviously then triggered the consultant’s reception team to go ‘oh let’s get rid of this girl’ so they made me an appointment asap 😂

The consultant was way more understanding than any of the midwives had been, it seemed like they were of the opinion that if you didn’t push the baby out you haven’t done it right. The only thing the consultant did do was try to put me off with all of the risks. I had a page of notes and my reasons all typed out in front of me so I didn’t back down if she was really forceful. She also said the purpose of the call was to discuss the risks and benefits of both options. She didn’t discuss a single risk of a vaginal birth, she said I could have a nice easy birth or I could have a section. She then started telling me the risks of me dying etc. Luckily I had researched it all myself (for the previous 28 years) so I was well versed on the actual risks relating to an elective section on a healthy low risk woman and not the skewed ones from an emergency section after someone has been in labour for days. I’d say just have them all noted down yourself to make sure you can say yes to all of them. I’d imagine most people then go away to have a think about it but I was SO sure that she booked it there and then. I had to wait until 36 weeks to be told when she’d actually booked it for though.

good luck, I’d say just get the ball rolling as early as possible and really emphasise the impact it’s having on your mental health as the longer it goes on the worse it gets 🙄

It is outrageous the hoops that you have to jump through for a c section in the UK.

In Australia, I saw an obstetrician at 14 weeks and briefly asked in passing if he thought I would have a c section this time (in a previous, unsuccessful pregnancy, a different doctor had indicated it was an option). The obstetrician asked if that was what I would prefer. I wasn’t particularly forceful, thinking that there would have to be some discussion, and said ‘I think so, probably’. The obstetrician said ‘ok, my secretary will email you with a date’. DH made a joke about wanting a particular date and, lo and behold, a few days later I got the email confirming the date DH had joked about!

I’m mentioning this because a lot of the roadblocks set up by the NHS are for their benefit, not the patients’. You’ll probably have to fight for what you wants d I am sorry about that, but please don’t let that put you off. It is worth the fight.

Also, an effective tool to use is to politely ask for what you want and listen to their response. If you don’t get the answer you want, ask again and listen. If you still don’t have the answer, then say ‘For the third time…..’. That is when people realise you should be taken seriously.

Go's it makes me mad that it's no easier to get one and the way they quote skewed stats to scare you off. I had a vb for dd1 and hated it although nothing went wrong. Was told I'd never get an elcs by awful gp so delayed dd2 until had saved for private. Then asked NHS midwives if I could have one and they said no problem. It was so so much less traumatic than the vb. I'm also angry that they don't tell you the risks of vb and push for the least use of painkillers. At nct class all they did re csection and epidurals was bring in the needle to show us. Clearly designed to put you off. I would have gone for csections both times if there'd been more honesty and clarity around post natal injury for example. Yes, csections take longer to recover from immediately, but my body will never be the same after the vb.

Thank you all so much for your helpful and detailed responses. Sad that they still seem they make it so difficult for you, despite recent updated guidelines and news stories about terrible maternity care.

I'm obviously going to have to go in expecting to jump through hoops, and to try and not let that panic me. It seems everyone gets what they want in the end? It seems outrageous to me, that so many women with Tokophobia, are made to have a long, anxiety ridden battle while they are pregnant. How on earth can that be seen as acceptable for the health of mother and child? Anyone with Tokophobia knows, that being pregnant without confirmation of CS will be horrendous - there'll be lack of sleep, extreme stress, poor mental health...the list goes on.

Before I even started to TTC, I called up the GP to explain my fear and ask about CS, as I didn't think I would be able to ever have children unless I felt ELCS would be guaranteed basically. Of course I was basically laughed at, but she spoke to a midwife who apparently said if my phobia was that bad she couldn't see any reason why I wouldn't be allowed CS. This conversation will be on my medical notes, so i'm hoping that will help me in some way.

I'm going to try and be positive and hope for the best - Good luck to anyone going through this at the moment

I’m currently 29+3 (1st baby) and mentioned to my midwife last week that I’d like to have a c section and gave her a brief outline of my reasons. She said that it’s my right under NICE guidelines to have a c section if that’s what I want and that I should speak to the consultant at my next appointment. I had that consultant appointment today, and she basically said that if I wanted a c section she would be fine with that, but referred me to the birth choices choices clinic to discuss the risks of vaginal vs c section in more detail with the consultant midwife. Then, if after that appointment I still want an ELCS she would pencil me in. So all in - little to no push back (so far!) on the request which I am quite surprised about! Perhaps the publication of the Ockenden report earlier in the year has forced trusts to rethink their policies on ELCS. I’m in London if that helps. Good luck!

I'm in Wales. I mentioned at my first booking appointment with the midwives I wanted a c-section, got a fairly frosty response but they did put it in my notes.

Appointment came through for last week (28 weeks), saw a consultant. Had the pushback I expected but I stuck to my guns, was given a consent form to read and have to go back in 6 weeks time to discuss again. They said if I still want it then, they will sign it off.

Only thing that concerns me, I was told I would be booked in 39+5 as they don't do them on Fridays or weekends.. I asked if I went into labour early if I would still get my C-section and the consultant pretty much suggested I would be better with vaginal.. even if I got to hospital straight away and hardly dilated which confused me..

@mjb0616 mine was on that day too (also due to the weekend and Friday thing) and I was fine. I worried worried worried then decided just to tell myself I wasn’t going to go into labour, my body just wouldn’t, so I believed that and we were fine 😅 I asked a lot of questions to the consultant and asked about going into labour early and she said if I was pre term she wouldn’t recommend a section due to having to push the fluid out the babies lungs (although I know a lot of pre term babies born by emergency section?), but for full term she said as long as I got there quick they’d do the section. How that would actually go if that had happened though might have been a different story!

@sorchaedwards it’s so sad that we’ve all had to go through this. Other people who don’t have tokophobia, particularly those who want to experience childbirth, just don’t have any concept of my fear or why I wanted a section and do still sort of laugh it off as ‘oh you wanted a section’. Sometimes I even go along with it because a) I’m proud that I did and b) I can’t be bothered trying to even sum up the enormity of my phobia. So it’s not like other people are waltzing into consultants offices demanding sections, all of my pregnant friends wanted to go ‘naturally’ (vaginally) and wanted to avoid a section. Chances are you aren’t going to go down that route unless you’ve already researched it yourself!

Its bad that I feel like I’ve got a free pass to actually be taken seriously next time (and also not have to justify myself to the judgey people) since I’ve already had one so they’d try to avoid me being in labour etc unless I was desperate to go myself (guess what, I’m not)😅

If I was booked in for 39+5, I would be having serious anxiety still. Especially if they told me there's a chance I'll go into labour and have to give birth naturally. That's not really a way to deal with tokophobia is it? Being booked on that late almost seems like they are punishing you.

It so ridiculous, I'm not going to let them walk over me. I've already been in contact with Bjrth Rights charity who have said they'll support me through this if there's any push back, so thats definitely helped me feel calmer.

I'm hoping I'm getting all stressed about nothing and my first midwife appointment will be a dream....here's hoping!!

Being booked on that late almost seems like they are punishing you.

They're not punishing you. There's a reason your baby would like to be born at full term. They're balancing the baby's need for lung development against your mental health. Other women with debilitating Pelvic Girdle Pain often go through agony to reach a date that the doctor is happy with for the baby.

I know many babies are born earlier than full term and are fine but there's fine and there's fine but needed help. Doctors have tunnel vision about getting the first outcome, understandably.

@sorchaedwards What month are you due? That often affects how busy maternity units are and when you’re ELCS is likely to be. It can’t be prior to 39 weeks so they book it for the next available date after that. If weekends or bank holidays etc. this can end up being closer to 40 weeks but it can’t be helped as if there is no theatre availability there is nothing that can be done about that. It’s certainly not a punishment!

I'm due end of April, don't really know what months are more likely to have busy maternity units. Would assume it's an even spread throughout the year?

Fair enough re my punishment comment, and was a silly thing to say. I'm obviously just paralysed with fear that I'll go into labour before the CS section, and they'll make me go with through natural birth. Which I will be not prepared for as my fear is so bad I can't even discuss it or read about it.

@sorchaedwards April is a quiet month, you should be ok.

And nope not spread evenly across the year at all! A surprisingly large number of people still get pregnant around Christmas / New Year time so September onwards is always manic.

Link to heat map showing distribution of birthdays throughout the year. Data is from 1995 to 2014.

As you can see it's not even at all across the year. End of April isn't too busy.

Everything crossed for you that you don't go into labour before your date. It is unlikely, especially for a FTM, but if you do, call the labour ward and tell them you're scheduled for an elective. They'll get you in to be done as an emergency. Hopefully it won't be too long until you're fasted. Nobody wants you to go through labour with tokophobia. So long as nature and the fates are kind, you'll get your C-section. Wishing you all the best.

Hi @sorchaedwards I am in a similar position, due to give birth in January and I have tokophobia and PTSD. I flagged this in my initial referral form and didn't spare any detail so fortunately was assigned to a specialist midwife who has been wonderful. She very quickly - as did all the other mental health specialists I have come into contact with - brought up the idea of a c-section as probably being a good option for me and I agree. I have really pushed back against those who have referred to my situation as a 'maternal request', it isn't a maternal request when the doctor decides it is medically necessary and it isn't a maternal request when a midwife and clinical psychologist deem it psychologically necessary. I don't 'want' a section at all, I want a lovely positive natural birth but unfortunately that option has been taken away from me by the mental health situation I am in and the experiences that have got me here. It is great you are getting support from Birthrights and that others have mentioned the NICE guidance - print a copy and take to appointments if needed, it is completely clear that you have the right to a c-section if you want one, but it shouldn't need to be relied upon when tokophobia is diagnosed. Don't be afraid to push for access to every possible source of support available for your mental health, the emotional toll of the interminable waiting for the approval to be granted is huge so ask for a specialist midwife and referral for perinatal mental health counselling to deal with this - it also doesn't hurt to have a set of medical records with multiple qualified professionals all making the case for why a section is needed if you come up against a doctor with no understanding of toko/PTSD (as I unfortunately did) who doesn't get it and is unsympathetic. The clin psych I have been seeing has been doing CBT techniques with me to calm myself in stressful appointments and to feel more confident advocating for myself, I have also hired a doula to be an extra advocate for me in this vulnerable time, if you can afford it I would really recommend it. Good luck!

I had massive tokophobia too with my first back in 2018. I had the most awesome consultant up in Yorkshire and at my first 12 week appt with him said I wanted a c section. He said if you want a section you can have a section. I must direct you to read all the nice guidance and ask two more times. So he asked at my 16 week appt and at 20 week he called and booked my date.

I felt such a relief knowing my section was planned.
I've booked my next section in just over 2 weeks but took me agesssss to decide what I wanted. Becoming a mum made me more relaxed about my body so I considered a Vbac for ages however at 32 weeks decided elective and had the date done there too.

Make sure you've done your reading and be clear what you want.

Good luck xx

Just felt I had to reply to this - this is AWFUL that if you’ve requested an ELCS they will still decline you if you go into labour early?
I have my first midwife appointment coming up and I have SEVERE tokophobia and shit like this makes me honestly want to just end the pregnancy now 😫 o hope everything went ok for you!

@Mumm1993 honestly don’t worry about that. The consultant who said that was just putting their preference across for patients having a vaginal birth and decided to make it sound like the poster wouldn’t get a c section if she went into Labour naturally. There would only be two reasons, I know of, that would mean if you went into Labour naturally and the hospital couldn’t do a c section. 1) you are a category 4 c section so priority wise anyone who is a category 1-3 or planned in the diary would be prioritised. However don’t worry about this really as it’s so so so unlikely you’d go into early Labour, go to the hospital and there be no space at all to do your c section. They would have to be inundated with emergencies/unplanned c sections that were a category 1-3 and yours stayed at a category 4. They will likely always have a full planned diary but you’d be classed as an emergency/unplanned if you went into Labour ahead of your c section date anyway so you don’t have to worry about that. All they’d do is monitor you while they get a team together. 2) the other reason is you get to hospital fully dilated and baby is on their way. Highly unlikely as you’ll go in as soon as you start having regular contractions, it’s so unlikely you’ll stay at home labouring to that extent as you want a c section, you’ll just give them a call and head in as soon as it all starts.

try not to worry about the rarer possibilities or you’ll drive yourself mad, the likelihood is you’ll be fine and get the c section you want either on your planned date or before.

Hi! Would you mind telling us which hospital in London please? I’m booked in at the royal London and am worried they will be against maternal request c-sections even now

Will add my experience from 2022 (I gave birth in August)
I had a MRCS due to chronic vulval pain and not wanting to exacerbate that.
I didn’t meet any resistance at all from the consultant (I was under consultant care anyway due to other medical conditions) - I had mentioned wanting one to the midwife at my booking appointment and she wrote this in my maternity notes so the consultant would see it. He opened my notes and said “oh I see you want to have a c section” - “yes please” - “well I have no problem with that. We’ll get you booked in around the 30 week mark for birth at 39 weeks”.
I had gone in armed to the teeth with facts, figures, arguments, reasons why I had made an informed decision. Didn’t need any of it and from that point on I was free of horrible anxiety that you are currently experiencing.
I did actually keep getting a bit anxious and so I asked around 16 weeks if I could get a date in the diary early, and he kindly obliged. I did of course have the remaining anxiety about the ‘worst case scenario’ - going into labour early and there not being space in theatre. Of course nobody can tell you 100% that will not happen, so it was still going to be a worry until the baby was actually in my arms following uneventful c section, but my consultant assured me that this scenario had happened one single time in his 30 year career. It was about as reassuring as humanly possible.
I’ll keep my fingers crossed that you have an equally easy process, but I do think (particularly since the Ockenden report) that the culture in the nhs regarding birth choices is changing for the better. Best of luck to you and congratulations!
Oh, and the c section was a dream, by the way. The recovery does hurt like f*ck but it’s only a few weeks and so worth it for the wonderful experience of the birth 🤗

Thank you very much for your reply. It’s made me feel a bit better about things. I hadn’t mentioned this at my booking appointment because it all felt too early and hadn’t made my mind up yet. I’ve got my 25 week midwife appt coming up so will mention it then as I’ve been doing the research. Like you, I now feel sure about my decision and feel like I’m armed with all the facts and figures. Hopefully won’t need it, fingers crossed! Thank you again