Elective section - maternal preference

[whatwouldyoudothen]

Has anyone had an elective section agreed due to maternal preference?

How did you go about it? How easy was it?

What is the process? Does the m/w refer you to a consultant?

I'd be interested to hear from anyone who has had or arranged an elective section for this reason.

Thanks.

Hi (I don't usually post here but this subject is close to my heart!)

Yes - It is possible (I had one myself) but it is not easy to get one and I would never have managed it without my husband supporting me and fighting my case for me with a consultant.

You will need to tell your midwife you want one(It's not her decision to make) and get a referreal to a consultant wher you wil need to state your case clearly and show that you thoroughly understand the risks etc involved. They may refuse you in which case you can ask to be referred for a second opinion (I did). At the end of the day you will need to be very sure it's what you want and be prepared to stand up for yourself and not be pushed into accepting a decision you are not happy with.

Just out of interest - what does 'maternal preference' cover?

If you'd had a v big baby with your first and were expecting a second (predicted) large one would that come under maternal preference, or something else?

i think it depends on your reasons

RB, can you expand?

I would take 'maternal preference'to mean that the mother prefers to give birth this way with no medical reason behind it (just that she thinks it's best for her and her baby). There are many reasons one might have depending on the mother involveds point of view.

I had an elective by choice for my first baby.

Hi KerryMaid,
Expected big babies demonstrate the wide variation in attitudes between Obstetricians. In the US (and some units here in the UK) an EFWt. of >4.5kg is sometimes taken as a grounds for an elective CS (due to the increased possibility of Shoulder dystocia(where the babies shoulders get stuck after the head has delivered)/Obsteructed labour/PPH. Other consultants offer an early induction of labour ("before the baby gest too big") which is not supported by any of the research. Others will be very non-interventionist on the gorunds that USS based EFWT's have a large margin of error/inaccuracy at the extremes of birth weight.
In my opinion it ultimately comes down to a clear discussion with the parents of the associated risks of each approach and after adequate appropriate counselling it should be the mother's choice. Interestingly NICE now advises all NHS Trusts to avoid scanning suspected big babies (in the absence of gestational diabetes).
I suspect most Consultant's would be hard pressed to argue against consideration for an el. CS with a baby with an EFWT>4.5g when pressed by parents who were very especially concerned with the risks of a shoulder dytocia (when the babies sholders get stuck after the head has delivered), which although a manageable complication of vaginal birth, can still result in a significant risk of harm/damage to the baby.

KerryMaid - I delivered a big baby (4 kgs, as macrosomia is defined around here) vaginally and will be having an elCS in a few days because this one is bigger (4.3 kgs) and has a seriously big head.

Last time, nobody discussed options with me. I was sent for a pelvic scan, and told I was A-OK for vaginal birth when it looked like baby could pass through my pelvis. What I wasn't told was that it was a near certainty that I would have a huge episiotomy for some "maneuver" to prevent shoulder dystocia

As soon as it became clear that this baby is bigger than DD, I started asking for a CS. It is of course important to show that you are informed of the risks and have not made this decision lightly, but I also recommend turning on the taps - I cried buckets to the midwife, consultant, and maternity psychologist. (Having said that, I don't know if I would dare pull that stunt if we were living in the UK, with its SS waiting in the wings to snatch newborns)

Yes, I had one. I fought for one but was refused the first time around - but I wasn't completely sure then and I didn't know my rights, so I gave in. I read up on my rights for my 2nd and they agreed. I do'nt have a link to hand but if you Google something like "c-section rights" you will find the info. If memory serves, and unless things have changed in the last year or so, a consultant isn't obliged to perform a section but he/she is obliged to find you a constulant who will perform one. I didn't have to fight for my 2nd seciton at all, I just wrote to my consultant and explained all my feelings and how traumatised I was by my first birth experience and he agreed to a section straightaway. So I haven't really had to face the fighting but as far as I understand it, if you are confident in your decision and armed with all your rights then you should get them to agree. Good luck!