Denied ELCS - is this normal?

[Sk1sk0]

32 weeks, had a consultant appointment today for elective c section and she rejected my request. Did not talk through any data, just brushed through some c section risks, told me second vaginal births have next to no complications and then asked why I’d do something ‘crazy’ like subject my baby to an ‘unnecessary ordeal’. Rushed on to say there were absolutely no medical grounds for my request so she’d obviously be denying it, bye, we won’t need to see you again.

I’d already had a birth choices appointment before this so wasn’t expecting a thorough conversation but is it normal for these appointments to only last about 10 minutes? And can anyone offer any insight into next steps - do I contact my midwife to ask for a different consultant?

Contact your midwife or antenatal clinic and ask for another appointment where you want to discuss a date for your c section.

That's not good enough. You can find out your rights and how they should deal with your request here: https://birthrights.org.uk/factsheets/right-to-a-c-section/

Good luck!

Thanks so much this is super helpful

Thank you, I will. Do you think I should wait for my 34 wk midwife appointment or call her sooner?

I'd contact her now. You need another appointment. And take a copy of the NICE guidance with you. Also of the Montgomery v Lanarkshire case, in case it's her/someone else who needs a wee reminder of their professional duty around informed consent.

You have a right to choose an elcs at my consultant telephone appointment i was told all the risks in great detail which I found quite amusing because I’d signed the consent form for my emcs previously when I was pretty much out of it! So you need to ask to see another consultant.
I ended up with an unplanned VBAC which I was happy with and had fewer complications than after my emcs. It is your choice (and I fully support choice) but a cs is not always the easier option.

@QuimCarrey
@Autumn1990 thank you both I’ll get those docs together. Yes very true about cs not being easier, I was requesting one because of pelvic floor damage from my vaginal birth and the health anxiety this has caused but I am also very anxious about potential cs complications. Giving birth either way is terrifying to me at the moment!

I had one of these appointments where the doctor was awful (wasn't the consultant, was a junior "in their team") and basically read me all the general stats and told me how awful a CS was (I had had one EMCS) and gave me the general statistics on VBACs and then when I asked her what the chances would be in MY SPECIFIC CASE she admitted that she hadn't read my notes and could not advise on my specific chances. I complained that this was a totally stupid meeting that was a massive waste of resources if only to tell me that I had a better than average chance of having a VBAC if my situation closely mirrored that of the average person in my trust without checking if that was actually right. I got my ELCS.

I think that I would be emphasising very hard in this situation what is on the records - ie I would make sure that there is an email address that I can email and bring a copy to add to my notes that summarises what the consultant said to you and that she refused to consider your individual case and concerns and dismissed you out of hand. You might find that making every medical professional that you see who continues to deny you a CS (or at least a detailed discussion with an open mind) effectively responsible in writing for any future issues arising from that might focus the mind!

Sorry you had a crappy appointment too - glad you got your CS in the end! That’s such a good idea to make a really clear paper trail, thank you. I’ll get on that!

Without intending to sound dismissive of health anxiety, @Sk1sk0 , do you actually suffer with health anxiety or do you have legitimate concerns about a vaginal birth because of the damage caused by your first one?

Womens health, particularly when it comes to what it's considered ok to live with is, is particularly bad when it comes to post-partum injury and just because a doctor (consultant or not) is dismissive about birth injuries, does not mean that their attitude is the right one.

Other countries are far better at making a priority of women's health after childbirth.

@DuchessDandelion not at all, I agree with you. I do have diagnosed anxiety and also longstanding pelvic floor issues from my vaginal birth.

My support as a result has been far better during this pregnancy, including with the perinatal mental health team and physio. Everyone up until this point has been more than willing to discuss risks of birth options and talk through what would be right for me. Which is why I’m so taken aback with receiving a blunt ‘no’ after a ten minute consultant appointment and was seeking further advice on whether this is normal and what to do etc. I will definitely contact my midwife on Monday and go from there!

Omg this makes me so so angry. I'm so sorry you were treated this way. Definitely go back and show them NICE guidelines. You're 100% entitled to one.

I'm sorry this happened to you. I made it clear from 17 weeks that I intended to have an ELCS and my decision was fully respected. That Consultant sounds a bit unprofessional in their response.

And how can long standing issues with your pelvic floor not being classed as medical grounds? Honestly, you just couldn't make up some of the experiences women have with the NHS.

Agree with @hotnotgrot about paper trails. Let it be seen that you're not someone who's going to be fobbed off easily.

It may also be worth familiarising yourself with the process for complaining to the GMC. I'm not saying you should do it, but the threat of complaint to a regulatory body can be a useful tool when a clinician is trying to get away with ignoring professional standards.

the consultant is allowed to decline to be involved in an elective section, however they are supposed to refer a patient on to a colleague if they decide they do still want the section (is there a chance that at the end of the consultation they might have felt you'd agreed with them/were going to think about it further (wrongly or rightly), in which case that might explain the lack of onward referral?). It would be unusual in the UK (assuming that's where you are) for a consultant to just flat refuse these days...does make you wonder if perhaps there was something else going on for them that morning? Just every so often you'll be seeing a doctor who's just gone from managing a absolute catastrophe and then has to pretend to be all jolly and excited about a clinic and, from experience (different specialty though), that's incredibly hard and can interfere with performance. It may be nothing like that of course, but I wouldn't be quite so hasty as others on the thread to assume this doctor's just an arse on the basis of one conversation!

They're also supposed to explain the risks and benefits of each approach. That has evidently not happened here.

OPs concern needs to be for her own care, not whatever the reasons might have been for the particular doctor to have done such a poor job.

Thank you all so much for the comments and advice.

@Greybeardy absolutely, my sister is a nurse at the same hospital and I’d never rush to make a complaint on the basis of potentially one bad day for the consultant. You’re right in that by the end of the appointment I wasn’t very strong willed and didn’t push for a second opinion so yes, she probably just assumed I’d accepted the decision. I’ll ask my midwife for advice on what to do next.

I had a consultant exactly like this and contacted my
midwife immediately.
I was upset that I wasn’t listened to and was just talked down to. My midwife put in a complaint with the hospital and I was provided with a new consultant who then approved my c section.

There are unfortunately still some ideologues within maternity care who've not got on board with the idea that women have the right to choose. Glad you were able to push back.

@Lostworlds that’s awful, so glad it all got sorted for you. What was your second appointment like? Did they ask you much about why you wanted one etc?

The first appt was all over the place. It was with a registrar who instantly approved my right to have one and didn’t ask any questions. The consultant phoned me at 7:30pm and got more and more aggressive on the phone that my dh wanted to take the phone off me and hang up.
Thankfully the call was recorded and a second appt was given straight away in which they apologised and said it was my choice. They explained the pros and cons and said if I go into spontaneous labour before the planned c section then I have a choice of getting an emergency section or trying natural labour. They didn’t ask me for any reasons as to why I wanted them but part of me thinks they were just so worried based on the first time around.

@Lostworlds that’s so bad, good on your dh for hanging up! I also had an appt with the registrar 4 weeks ago when I was meant to first see this consultant but they were too busy, she told me she wasn’t authorised to ok elcs so interesting that yours could.

Just something to consider about pelvic floor - it’s part of a bigger muscle group system. A c section also weakens pelvic floor group muscles (your core) so you’d have another area of weakness to your pelvic floor to add to the weakness you have vaginally from first time around. It might be doing your more harm than good (than you realise)

@Nellyelephanty thank you I didn’t even think about that really so that’s something else to consider! Will need to keep researching.