Has anyone requested a c-section?

[loverrrr]

For a variety of reasons, I think I would prefer a c- section for my upcoming birth. Has anyone requested this in the NHS? Is it something that is optional? Any shared experiences would be appreciated!

Well I’m sure it you spent some time in Gynaecology outpatients you’d see for yourself that birth injuries & ongoing pain/morbidity is not that uncommon at all

In my sphere of friends/acquaintances I know of a fair few who had episiotomies, 3rd degree tears (and one with a 4th degree!) and some going in for ‘repair’ surgeries within the first year of giving birth

One of my best friends from school had the dream birth centre experience with her first baby- until she had to transfer to delivery ward, had to be cut then vontouse/episiotomy, extended 3rd degree tear

I’d be interested to know the financial figures/overall costs of elective CS (not emergency) vs instrumental delivery/repair costs not to mention impact on mental health…

’elective’ simply refers to the timing of the section. Maternal request and medically advised are both reasons for elective/cat 4 sections.

@Waitingfordoggo Two of my closest friends have had surgery for birth injuries. One still has pain 10 years later. It's really not that uncommon.

My sister in law asked for a c section with her first, was denied, went overdue and ended up with an emergency c section anyway. For her second she was much more forceful and made it clear she would be having a c section.

@houseofisms - you don’t need any evidence at all. It may be though, that depending on your HCPs that you need to be determined and insistent. I had that with first DC when I wanted a home birth. Had to be v firm as they kept trying to fob me off with various spurious rules such as no home births for first time mothers. Stay calm but don’t take no for an answer.

Yeah so it was supported by the doctors not by request of the patient

Following

Yes I did for both my children and both times it was granted

That is irrelevant.

Really we need a third category of c section as at the moment it’s elective (planned before and carried out at a set date and time), and emergency (carried out unplanned). It needs to be elective, planned and unplanned.

There are already 4 categories of section -
cat 4 - at a time to suit - either for medical reasons or maternal request.
cat 3 - no compromise but needs delivering early.
cat 2 - compromise (either maternal/fetal) but not immediately life threatening - aiming to deliver writhing 75mins.
cat 1 - immediate threat to life - target decision-delivery time of 30mins.

A mat request section can be cat 3 or even cat 2 if they present in labour before their elective date.

My NHS consultant said planned C sections are actually cheaper. It’s nothing to do with finances - it’s purely been prejudice that’s stopped people having them in the past.

@TurquoiseDressand @BelleEpoque27I’m not saying birth injuries that need repair don’t happen! I’m saying I’d be surprised if the costs involved with those outweighed the costs of elective C-sections.

By themselves no not least because the NHS doesn't do that much anyway. ELCS works out broadly similar in cost to attempted VB because of a range of other costs, vaginal birth repair only being one of them.

Probably the biggest is legal costs. The births that go the most wrong and cost the NHS the most money are mostly attempted VBs.

As others have said, they are not allowed to refuse you a C section. If there’s push back - stand your ground.

As an aside it’s funny how much you’ll be told about the various risks of C sections, but absolutely nothing about the risks of vaginal births. I thought I’d read up about it enough myself and I was pretty clear eyed about the whole thing, and I still didn’t expect some of the complications of my vaginal birth!

Cheaper than what? An emergency c section, which isn't planned and an emergency? What you comparing?

Vaginal midwife lead births are the cheapest, after home births

I presume ELCS v attempted vaginal birth, that's the usual way.

EMCS is a consequence of attempted vaginal birth and doesn't happen with ELCS, so the costs of EMCS all go in the attempted VB category.

I am not the PP but of course that’s the cheapest option.

But you can’t chose that option.

The only option you can chose is planned vaginal or planned c section.

Costs for planned vaginal include all the outcomes (including emergency C’s)

It’s right they can’t legally refuse.

But you also have to realise the do nothing results in vaginal birth. So getting it signed off is an active process of you deviating from the natural course.

I don’t want to make assumptions about Louise Thompson birth because only she and her consultants know. But my guess is this is what happened to her. As she gave birth in a London hospital with very high maternal request rates. I am assuming it was a case of she was unsure about best options for her due to her existing bowel issues. So was hesitant and was asking advice. They obviously would have said it’s probably not a good idea to have a maternal request c. That’s not a refusal.

This is what I mean about if you want it you have to go in there saying you are having one.

NICE looked at the costs of C-sections as opposed to natural childbirth some years ago and found that there isn’t much in it at all.

Why? Because the initial slightly higher cost of the C-sections are offset by the higher costs entailed in episiotomy care, reconstructive surgery, physiotherapy etc that is often required following natural childbirth and interventions.

Just had a c section 5 weeks ago that was my choice. It isn’t something you have to beg for or make a power point presentation about to try and convince them you deserve.

Yes you will have to meet with a consultant to talk the whole process through but that’s because they want you to know all the facts about the whole thing so you can make a fully informed decision.

You don’t need to convince anyone that you’re “worthy” of a c section.

I asked for one and it was granted with minimal pushback. I was over 40 though and it was during Covid so I suspect they were happy to agree to what was almost certainly going to be a shorter stay in hospital. As it was I was there for barely 24 hours in total. It was such a straightforward process.

I gave birth at the same hospital as Louise Thompson and there was no hesitation in recommending a section for my second (and third) child. The perineal midwife and several consultants all agreed it was the best option. One consultant said “after what happened last time, we do not want you going into labour naturally”, as they moved my section from 40 to 39 weeks. On one occasion a registrar started to ask if I’d considered a vaginal birth and the consultant waved her away. That said, I was very clear myself from the start that I was having a section and there was no way I would have changed my mind.

They are so chill about the second one. I remember they just looked at my notes; looked to me and said ‘c section?’. And I said yes please. 😂

The first one was not impossible to get by any stretch but I remember distinctly it hadn’t been signed by anyone so I had to do a last minute sit in at 37 weeks in the maternal monitoring unit to catch the floating registrar.

They grilled me for 20 minutes quite intensely - telling me I could die, my baby could die. I might be paralysed. I played along politely for the majority until the end when I just said. Right, so where’s the sheet for vaginal birth risks which also have the emergency c risks on it. He looked at me and did a little smile and said ok I will sign it. 😂

And on my second C I went into it planned, on the table everything good and then bang! I nearly ending up with a Cat 1 GA C 🫠

Aneathetist looked like he had just got back from Glastonbury and was paying no attention what so ever to my blood pressure - which I warned him was very prone to dropping off a cliff. I went unconscious. Bells went off. DP thrown out. They were just about to put me under GA because the babies do not like it when the mother’s blood seizes to function correctly. And I thank the lord because my little trooper didn’t give a shit 😂 so they spent 5 minutes bringing me back to earth and we continued on from there.

But I have never heard of anyone else having this. Even on googling. So I am still a big advocate for planned C as it’s the only way you can (99.999%) guarantee a plan C outcome.

Yes you have a right to a c-section if that’s what you’d like. Be firm.

Also, from a sample of one (me), here is how a vaginal birth that starts with just a midwife can end up way more expensive than a C section.

Vaginal birth:

• time with midwife on the labour ward
• theatre with full medical team for instrumental delivery; ends up with 3b tear and episiotomy repair and treating a PPH
• 5 nights in hospital, including a night in recovery
• multiple rounds of blood tests
• blood transfusion
• IV antibiotics
• antibiotics at home
• additional midwife appointments at home because I’ve failed my urine test, have been sent home with a catheter and leg bag, and the catheter keeps leaking
• two further follow ups in maternity triage for said catheter
• admission for another night because the bladder still isn’t working
• IV antibiotics to prevent a UTI from taking the catheter in and out
• follow up hospital appointment with urology
• 2 GP appointments and antibiotics because the episiotomy stitches are infected
• scan to check extent of 3D tear
• follow up with perineal midwife
• I should have added many months of pelvic rehab, but luckily my work insurance paid for that (the NHS doesn’t offer the level of rehab I needed anyway)

C sections:

• pre op
• theatre time
• two nights in hospital (normally one night, but I have a heart condition so the protocol is to monitor for two)

Of the 5 mothers in our NCT group who were planning vaginal births, only one had a straightforward delivery. One had an episiotomy; one an emergency C section; one a third degree tear, episiotomy, and the baby had to be resuscitated; and one (me) 3b tear, episiotomy, bladder trauma, and 2.9l PPH.