C sections and requesting (midwifes on here can you help!)

[Summersunx]

Hi there, I'm 39 weeks and 4 days baby hasn't arrived yet and I'm just wondering if I go over 40 weeks can i request a c section instead of going way over and having inductions etc.

Many thanks

You have nothing to lose by calling the hospital directly. I would do it right now.

"Actually there is evidence that maternal request c sections (that is, c sections that are not being carried out due to health risks with mum or baby) have lower complication rates than vaginal births."

Just like it's useful to differentiate between likelihood of complications between electives and unplanned caesareans, it's also really important to acknowledge that the likelihood of a labour becoming complicated and ending in surgery or an instrumental birth will also vary according to the range of factors. It's nonsense to lump everyone trying for a vaginal birth into one group when you're talking about risk. A healthy woman having her second or subsequent baby who opts for a home birth or a midwife led unit has an overwhelming likelihood of a straightforward birth. A healthy woman having her first baby in an obstetric setting in hospital is more likely than not to end up with an unplanned caesarean or an assisted birth.

Nobody ever acknowledges this and it drives me crazy. They talk about the risks of a vaginal birth as though they're the same for everyone. They're not. Just like the risks of major surgery aren't the same for everyone (eg, obese and diabetic women are at higher risk from surgery).

I got induced at 40 weeks and 1 day. Horrifically long induction with no sleep. Delivered at 40+4 assisted with forceps. On day 2 of the induction the consultant came around and asked if I wanted a c section instead. Saying no is my biggest regret!

The recovery from a traumatic assisted vaginal birth was 50 times harder than my subsequent elective C-section. I still have damage and issues nearly 4 years later. Probably always will. Ask for the C-section!

Thankyou so much and my midwife seems really against it and when I last saw her on Tuesday she was like yea I will need to speak to the consultant for you etc but have heard nothing and she isn't replying to me that's why I think ringing the hospital itself is next option I just see it as she could be sorting it all out for me in the meantime specially as she knows I've refused the induction and do not want to go any further then 41 weeks this baby will be my one and only and I'm just so anxious I just want him out safe now

I wonder if it's more difficult because you are near/at your due date. My planned c section was booked from about 20 weeks and I know that at the major London hospital I was at the only book 4 planned per day. It might be that they don't have space left on the list to book you a planned section.

When I got offered the c section post induction I was already on the labour ward, taking up a bed in the induction bay, and I know they didn't have a labour room for me to go to (part of the reason things took so long). It's cynical of me but I wonder if I got offered the c section because it was easier for them capacity/space wise. Once you are in labour it would be treated as an emergency c section, even though not strictly an emergency situation.

Keep pushing. Tell everyone you can that's what you want. Ask PALS

A c section DOES make subsequent births more risky.

Ideally planned c sections carry the lowest risks if you are an older woman likely to only have one child for this reason.

Planned c sections possibly are not the best idea if you want a big family.

Risks for VB decrease for a subsequent children after your first.

The trouble with the data is it doesn't factor this in well when risks are assessed.

If you are younger and want a few children, then if you go purely on statistics then a VB works out the statically lowest risk for those multiple pregnancies.

If you are saying 40 and only having one child, then actually the numbers look a bit different.

So it's not as simple as you are sometimes led to believe and you really should factor in individual circumstances and plans.

I had a planned C section and looked into this data a lot.

I suspect this is ultimately true.

There's only a limited number of theatre slots available and they will need to keep availability for EMCS or if someone else presents with a physical issue.

And it will be different to get an appointment with a consultant unless there is a pressing need to.

I would keep calling but, my suspicion is they will want to see if they can avoid making a decision prior to the point you need to consent for induction on the hope you'll go into labour anyway.

Did you call the hospital?

Sorry yea I did they just said basically my midwife needs to put in request to speak to consultant and I told her my reasons she kind of was just like that is a option to have but how long that could now I don't know. I'm not happy with my regular midwife as I asked her last week to ring hospital and speak to someone and she didn't so another week has passed now

I would just keep calling triage & midwife and say you're getting anxious! Someone's got to listen! Good luck x

Maternal request is a valid reason and you can absolutely just ask for a section, but are you sure you have thought this through? I’ve had a difficult vaginal birth and I’ve had abdominal surgery and even with birth complications, the surgery took far longer to recover from.

@izimbra A healthy woman having her second or subsequent baby who opts for a home birth or a midwife led unit has an overwhelming likelihood of a straightforward birth. A healthy woman having her first baby in an obstetric setting in hospital is more likely than not to end up with an unplanned caesarean or an assisted birth.
Can you reference this please - I find it astonishing. I never saw a Doctor during either of my pregnancies and births, despite being formally under Consultant led care rather than Midwife/GP shared care because of my age. The vast majority of my antenatal group friends, like me, had straightforward vaginal births in hospital.

I had an ELCS and this was not my experience at all.

" I would support a woman to make any decision regarding type of birth. However, it does seem on mumsnet - vaginally birth is generally written about negatively. In my experience, I have supported hundreds and hundreds of women give birth vaginally . Yes, some women have had horrible traumatic births, but the majority ime have been lovely!"

But they might not think it was lovely a month, three months, six months, five years down the line. You aren't dealing with the repairs and long term damage.

https://birthrights.org.uk/wp-content/uploads/2019/03/Making-a-complaint-2019.pdf

PALS

Practice Managed

Three pronged attack

@thankyouforthedayz Stats from RCOG

•		The chance of you needing an assisted vaginal birth if you are a first time mum is between 1 in 2 and 1 in 3 in the UK (1 in 8 including women who have given birth before).
•		The chance of you needing an emergency caesarean birth is 1 in 3 if you are a first time mum in the UK (1 in 5 including women who have given birth before).

Your midwife is not respecting your wishes. I would call her, the surgery she is part of and the hospital again. It should be your choice.

I chose a section over induction for my second and never regretted it. The medical staff made sure it happened because it was my choice.

But I know loads, have had very straightforward vaginal births with zero intervention (no pain relief etc) and I know people who have needed lots of recovery time post c section and it has made their next pregnancy require male support. And absolutely none of that info is of any relevance to someone’s else situation and decision because it’s my experience won’t be their experience - a C section might very well be the best route for someone else. I think it can be tricky to extrapolate our own experience and think everyone has had this - rather than look at facts and have individual consult with medial team.

and it has made their next pregnancy require male support

Why would any pregnancy require male support?

Place of birth study done a few years back.

Home birth not the best option for first birth - that's a midwife led unit which has least complications. Consultant led has more interventions.

But it changes for subsequent births. Home births work out statistically more favourable for those who had uncomplicated first births. And midwife and consultant lead units come out slightly less favourably with interventions. (With consultant led being the least favourable).

This is for all low risk women and discounting higher risk women for whom a different approach might be more appropriate.

It's fairly well known and quoted. But the key bit for me on this is about self selection and about most appropriate on a case by case.

We know anxiety interferes with the birth process. So a woman choosing a consultant led unit may well be most likely to be anxious to begin with. A woman who actively choices a home birth the least anxious. For first births there is an element of unknown physical issues - with adds another layer.

Equally though women who choose to have an ELCS tend to have a different profile, and are self selecting, so is you take this all into consideration it may make sense too.

But again if you have one planned c section this DOES increase your risks for subsequent pregnancies over a woman who has a VB. Which is why if you plan to have more than one baby it's not necessarily the best option to opt for an ELCS (and this isn't particularly well demonstrated in the data that is given to women considering an ELCS - it's a big over sight in the NICE guidance and advice that doctors are supposed to give. It should discuss future pregnancies but fails to do so, which is wrong as it fairly crucial and may lead others to make different decisions). If you have a VB first successfully, your risks overall go down for future births. Again this isn't well talked about.

Of course if you plan for a VB you can always end up with the most risky outcome of an EMCS. That's the problem. You don't have a crystal ball.

I actively looked at all the data when having DS and wasn't planning on having more.

Yes I'm curious.

Male support? What fresh hell is this?!

Likewise. I don't know anyone who had a planned ELCS who had this issue.

Plenty who had a complicated VB or EMCS who did.

But that's reflected in the data, an uncomplicated VB is least risky, followed by a planned VB, then a complicated VB, then an EMCS

A uncomplicated VB is by far the least risky BUT it attempting one risks if it goes wrong that you end up with a complicated VB or an EMCS.

A planned ELCS usually ends up with an ELCS. It is highly unusual for it to end up with a different outcome (and associated risks) but it's possible. The fact it's planned is why the risk is reduced. This includes may factors even down to the fact that they occur in hours where hospitals are better staffed.

Quite!

I don't think people realise the difference between:

1. an emergency section after a prolonged labour, an exhausted mother who has been in agony for hours/days without properly eating/sleeping and who may have had vaginal cuts from attempts at forceps etc before surgery. A surgery which often has more urgency and that the person isnt psychologically ready for.

2. going into birth pain free, having had rest, no other stitches and psychologically ready. The night before my first section I went to the cinema and out for dinner before going to bed. Thats not how most people spend thr few hours before birth. My body and mind were ready. I lost about half the blood you'd expect in a regular vaginal birth, so I want even tired from blood loss.

Can quite see why you wouldn't want induction as a first timer OP. I would only ever consider it in those circumstances with a verrrrrry ripe cervix, and perhaps not even then.