John Radcliffe - Maternal Request C-Section

[iaMHannah91]

Hi all,

As they have only just started allowing maternal request caesareans in Oxfordshire, I found it quite difficult to find any information!

So I wanted to share my experience (so far), in the hope it will help others in the area :)

Step 1 - SPEAK TO YOUR MIDWIFE
Speak to your midwife as soon as you start thinking about it. I knew before I was pregnant so raised it at my booking appointment. My midwife was very supportive and said it wasn't a problem and they could get me referred to the birth choices clinic.

Step 2 - REMIND YOUR MIDWIFE.
Don't be afraid to remind your midwife if you don't hear anything in a couple of weeks. I'm pretty sure mine forgot...

But I just got myself worked up about it, assuming they were going to make the process difficult to put people off (based on past mumsnet posts about the old system). I waited until about 23 weeks before I spoke to my midwife again, and I had myself in a right tizzy by this point. But the conversation was exactly the same as the first one... so I'm pretty sure she had just forgotten.

Step 3 - BIRTH CHOICES CLINIC.
You will get a letter with an appointment to me a midwife at the JR. You can go in prepared having done all the research in the world or you can arrive and just ask them to talk to you about the different options. I did both really...
I researched it a lot and wrote up my pros and cons lists (see my other thread if you're interested). But then I went into the appointment and just asked them to talk me through the differences between various options. This was useful because they were able to tell me things I hadn't thought about/realised.

Eg. Have a low threshold for CS - I had just assumed that if I choose vaginal birth, then I would only end up with a section in an actual emergency. But they said that if things are taking a while, or not progressing as expected, I don't have to go through all of the stress, I can just opt for a section at that point.

It's important to note that they said at the very beginning that I didnt have to convince them and if I wanted a section, then I could have one. So it was just an appointment to provide me with the information I needed

Step 4a -
At the end of my birth choices clinic, they offered me another appointment in a couple of weeks time after I'd had chance to review everything.

But I then realised after looking at the booklets, that I would have this, and then have to be referred on to speak to a consultant to get it booked in.

So if you are already sure you want a section, just tell them at the first appointment.

Step 4b - Speak to a consultant
I actually had a consultant appointment booked 2 days later for my 28 week review, so I brought it up then and she agreed to book me in.

She did question my reasoning but again, started off by saying "you can have the caesarean, I'm not arguing that".

But it did still feel like you were expected to justify yourself, if you know what I mean?

Step 5 - Wait for an appointment!
I was advised that they wouldn't book it in before you are 39 weeks, so I already have some idea when my slot will be.

I'm at this stage now (13th Nov) so I don't know how long it will take to get an appointment, but will update when I know more!

---

Other steps I've already been told about:

Week 38 - meet an anaesthetist at the JR to discuss the procedure and be given antibiotics and steroids to take just before the op.

Week 39 - planned section will be set for this week

I hope that's useful for people to know!!

WHAT IF I GO INTO LABOUR BEFORE MY SECTION?
** In caps, because I was (am?) quite worried about this! But this is what I was told.

1. Call the JR - tell them you have been booked for a CS but think you are in labour already. They will invite you in straight away - none of this waiting at home lark.

2. Be assessed - they will want to know for sure that you are actually in labour. Otherwise they may be putting your baby at further risk unnecessarily by delivering early.

3. if you are in labour, they will move you to delivery suite. In the case of a maternal request caesarean, they will have a discussion about whether you still want one or not.

They will also need to factor in, how far along you are (is the baby about to come now???), and when a slot in theatre will open up. You will now be classed as an emergency (as you aren't on the schedule), but if there are any actual emergencies, then you will be bumped down the list.

4. Depending on all of the above - you may need to actually labour for a little while. So it's worth looking into the breathing techniques and pain relief options before you are able to get your nice lovely spinal block.

^^ this is something I hadn't considered!! So starting to think about it now...

Going into labour before the date us definitely possible. I had my first at 38+1.

Good luck OP

Thanks for this. I'm 17 weeks and will be going through this process. I told them at booking appointment I wanted an elective due to tokophobia and midwife said no problem straight away.

Haven't heard anything since though, but I haven't had my 16 weeks appointment yet. I'm so thankful I haven't had to spend my pregnancy so far worrying about whether I will be granted one or not, as was reassured immediately.

I had mine at Stoke Mandeville. Was a straightforward process . I saw a midwife who counselled me and then the consultant. She listened to me and DH and then said. “I can see that you have really thought about this . I agree that CS is the right option for you both” and then gave me a date.

Thanks @PritiPatelsMaker - I'm 37+2 and just waiting now...

@sorchaedwards - Hoping you've got a date now and are all set up! Sending love. I'm going to add an update on the process now and then will leave a review of how it went after :)

@olympicsrock - so glad your team were so supportive!

UPDATE

Step 5 - Wait for an appointment
This was confirmed only a couple of days after my original post. So it was quite soon after the consultant had authorised it.

I was given a provisional date (first Monday of week 39), but advised that this could change closer to the time and I'd be made aware if it did.

Step 6a - Anaesthetist appointment
A video call has been scheduled for this, which was a relief as it saves me from trekking all the way to Oxford!

I got a letter with a link in a while back and then a text (this morning) to remind me. This is for halfway through week 37. So after getting confirmation of the section, you probably won't hear anything about it until much closer to the time!

This appointment is to discuss the process for the spinal block / epidural and any personal needs (eg. allergies).

Anaesthetic procedure for elective caesarean section (OUH)

Step 6b - Pre-op
Face to face appointment booked in for a couple of days before the op. In my case, pre-op is Friday and section is scheduled for the following Monday.

I've been advised that this will be a health check, with blood pressure checks, urine samples, bloods, etc. And they will also provide some pre-op medication to take.

Step 7 - On the day!
To be continued...

Hi Hannah! Any update on how you’ve been getting on?

thanks

Hi @iaMHannah91 - I am in the early stages of this process. My midwife has sent off my request and now just waiting to be contacted for an appt to see the consultant. I am 25 weeks and raised this with my midwife at my 24 week appointment last week.

Did you get your c-section on the day as planned? How did it go? What was the aftercare like. I would love to hear the experience as I am also John Radcliffe and there is virtually no information on this at all.

Hope it all went well for you.

Hi @alh26

Congratulations! Apologies for not returning with more info as I had planned. Looking after a newborn, recovery from the section and a bout of PND has made it a very difficult year.

But! I'm still very glad that I had the section! However, I would highly recommend planning in to have lots of support around you if possible though. I really struggled for the first few weeks and although my husband took 4 weeks off work, having my parents and in laws around to help was a blessing.

Good luck with your consultant appointment. Take someone with you if you can. I felt a bit like I had to fight my case, but I guess they have to make sure that you know what you are signing up to.

I was offered a birth choices appointment first which was really helpful. It gave me an opportunity to ask questions and get some more information.

I would also highly reccomend asking your midwife to book you a private room for the planned date!

Apologies for the lateness of this!

Things didn't quite go to plan for me, so I can't comment on the planned c-section experience or the delivery suites. But I thought it would still be useful to explain what happened for me, despite it ending up as an emergency section!

Step 7 - On the day!

My waters broke the night before my planned c-section, just before midnight. I went straight to the hospital after calling to say that my waters had broken and I was due to have a c-section. They were a little bit dismissive at first at the assessment unit, because they couldn't ascertain if it had been my waters or not as nothing more was coming out on a pad and I hadn't taken my wet underwear with me.

I did start having contractions, which came about quite quickly after having been told that it had been my waters but I was still 0cm dilated. However, being my first baby, I hadn't known what to expect and didn't recognise at the time how strong the contractions were. I was advised by the midwives that I was just in the very early stages and it would be a while yet spoiler NOT TRUE!

I was moved to the antenatal ward overnight to wait and had been warned that I was at the bottom of a long list of emergency sections and would likely not go through until the following morning. I could barely walk down the corridor at this point, which in hindsight, should have been a clue to the midwives that I should have been on the labour ward instead. Perhaps they thought I was being dramatic!

Shortly after arriving on the antenatal ward, someone threw open the curtains after hearing me "mooing" as my husband described it. Before I knew it, a consultant was there and it all became a bit of a rush!

This bit is all a bit of a blur, so I am going based on my husbands recollection! They advised me that there may not be time for a c-section and they would like to consider a vaginal birth, despite my little one being breech. At this point, it did feel like I wasn't being given an option and I just agreed. However, my husband spoke up and reminded them that I did not want that and they would need to sort something out.

Thankfully, someone was bumped off the list* and I was wheeled through to theatre within a few minutes. The worst thing about that was having the spinal block in between quite strong contractions!

*I later met this person at a baby group! We realised the baby's had the same birthday and we were talking about the births and how busy it was that day. Apparently she was already in theatre with cathetor and spinal block and got taken back out again! I could only apologise!

However, as soon as the spinal block was in, the pain was gone and I was able to relax! I just lay back and listened to my music, whilst patiently waiting for my baby to arrive! Apart from the poo he did as they were bringing him out, this all went without a hitch!

Unfortunately, the attending midwife in theatre was not great! As part of my birth plan, I had requested that the weighing and checks of my baby were left until after we left the theatre, to allow us the all important first hour. But with the emergency c-section, none of this was met. My little one had latched on straight away and the midwife in theatre pulled him off of me to take him to weigh him. It was only a few minutes and my husband followed her with our baby, but it was quite traumatic for me. Not great, given one of the main reasons for requesting a c-section being to reduce trauma. Thankfully, this did not have a detrimental impact on my breastfeeding journey, but it did negatively impact my mental health.

Additionally, nobody told me that my IUD was not fitted, due to it being an emergency section in the end. I only found out about this after asking my GP about a follow up appointment.

I wouldn't say it was a great experience, but I expect a lot of that comes from the rush of things with the emergency section in the end.

Comments on aftercare to follow

AFTERCARE
The aftercare was a mixed bag. I was grateful that my husband was able to stay with me as planned, but it was not a wonderful experience all in all.

PAIN RELIEF
You will have to wait for someone to sign off on the medication, so don't wait until you are in pain to ask. I learnt the hard way and it really set me back!

BREASTFEEDING
The support on the ward was minimal, except for one lovely HCA who sat with me for nearly an hour. Having had a few children herself, it was wonderful to have her with me for guidance and support.

The support from the midwife team consisted of someone just giving my little one some of my expressed colostrum from a syringe and making him sick... I had been advised that I obviously wasn't producing enough/doing it right, because he was still taking more from the syringe. However, I can see now, with my 15 month old, that he just takes after his dad and won't turn down food if its going!

ADVICE - pester them! Ask for help again and again until you get it.

DISCHARGE MEETING
I cannot recall what this meeting was even about, but it was portrayed to be especially important and a requirement to being allowed to be discharged.

FOOD
Just take your own and/or ask family to bring some to you. I was drained after surgery and breastfeeding a newborn all night and it was just awful!

Apologies if any of this worries anyone! It isn't meant to. I just wanted to be honest about my experiences.

But the best part of it all is my cheeky little boy! So, despite having a few complaints, nothing scary happened and my bundle of joy arrived in the world safely ♡♡