Elective C-Section (medical/non medical reasons)

[LittlePeaPod]

I understand this subject has been done before. I also know that ECS particularly as personal choice rather than as a medical need is an emotive subject and the debate about CS birth can be particularly contentious.

Considering 1 in 4 women in the UK experience a CS birth I have been disappointed to see how inadequate access to CS antenatal information is, so women can make a truly informed decision. Personally I think it's short-sighted to focus solely on VB and continually emphasise managing pain relief. The NHS is so focused on their target to reduce the 1 in 4 CS due to cost that they are neglecting their responsibilities to those women that choose or want a CS birth regardless of medical need.

I am currently 23+6 and I have chosen to opt for an ECS. There is no medical reason for a CS but this is a birth choice that I want. I understand that CS and VB both carry real but different risks but I believe these risks should be explained to women so we can make informed decisions about which birth risks we wish to take. Unfortunately this is not the case and the push for VB is so endemic in the NHS that women are not receiving the true facts on CS.

For those women like me that want an ECS birth. I just wanted you to know that due to the new NISA guidelines if you want/choose a CS the NHS now have to give you one. They will do everything they can to try and change your mind to the point of trying to scare you and make you feel guilty about your choice. But, regardless of medical need if you insist that a CS is the right choice for you the NHS have to honour your wishes and give you a CS. I am fortunate to have been able to privately pay for independent advice on VB and CS from three different very well respected professionals in the UK (two consultant obstetricians and one consultant in fetal medicine) and also received advice from a close family friend who is a consultant anaesthetist. I was shocked to hear how target driven VBs are in the NGS and how in fact this is what's driving the push for women been made to think they should have a VB and not the safety issue.

Ladies it is your choice how you have your babies and what you do with your body. If you want a CS you can have a CS regardless of medical need on the NHS. My DF and I have just spent a lot of money finding that out. I am 23+6 and the NHS have now confirmed I will be having an ECS and there is no medical or psychological need. I am having it because its my choice. I wanted to share this because prior to spending a fortune getting non biased information I was under the impression that I had to prove a VB was medically necessary, would psychologically affect me or that I had a fear of VB before a CS would be authorised by the NHS. Well that's not the case, its about personal choice. VB or CS you have a right to choose and the NHS have to honour your choice. It's just a shame and has royally pissed me the fuck off that if your choice is an ECS for non medical reasons the NHS are making it so difficult for you to opt for that choice in an informed way.

Littlepeapod I've had an elcs and wasn't given codeine or oramorph (I didn't have any morphine at any time) so didn't feel drunk at all during my CS or at any time during my recovery. Equally the 'painful trapped wind' felt a bit like the pain you get when you've slept funny, a sort of crick in your neck but in your shoulder....so although I wouldn't be advocating the bubbly, I really wouldn't worry about how you'll feel post op!

I was given diclofenac and paracetamol once the epidural wore off. I WAS offered morphine for 'break through pain relief' ie if I wasn't coping on just the other drugs but it was fine. Sore - esp. when due for more meds, but fine. And it was less painful than my previous VB recovery AND it was quicker then my previous VB recovery AND it was far less distressing than my previous VB recovery AND my baby bf beautifully from the off unlike my previous VB recovery.

The VB 'facts' was are given tend to be those of an optimal complication free delivery whereas you get the warts and all 'facts' for a CS - but of course you know this already.

Good luck I hope your ELCS is as wonderful an experience as mine was. (And it was on the NHS and I can almost guarantee it cost less, all in, than my VB and the follow up care me and DD needed)

herethere tank you for sharing that. I really appreciate it.

Thank not tank...

LittlePea, I've taken a quick glance back to the Pregnancy section to find you still battling over the C Section debate. It has made me smile, poor you.
I'm still in NICU!!! I hope you make it to your Section date. Plus i hope you fully embrace your choice. I would have done xxx

Ah, good to see the thread back up!
LittlePeaPod and Terilou - it seems we must be at a rather similar stage in pregnancy; I'm due 9/1! Now the debate about which date/when to have the ELCS made me think...
As I have previously mentioned, I want my ELCS to be at 40+ weeks (my first two were both late, so I think I have a longer gestation time anyway). However, my due date is a Thurs and I thought maybe aim for the next day, as it's a Friday; which would mean minimal interruption in my DCs' lives as I'd be back home after the weekend (I assume). OTOH, I'm also aware how short staffed hospitals can be over the WE, and how the quality of care can suffer due to that.
How would you decide? I'm really torn!

What also comes into play, and I know this is completely irrelevant but means a lot to me, is the date itself - I'm a bit of a number nerd and 'beautiful dates' mean a lot to me... Both my DC have a lovely birth date (by chance) and I'd struggle with an 'ugly date'!

Fraggle ahhhhhhhhh, so lovely to hear from you. How's your little boy doing? He must be 5/6 weeks old now? Sorry to hear you are still in NICU. Have they said when you may be able to go home? Yes here I am battling away with other women about all women having a choice! . I will never understand how women would ever support anything that limits other women's choices. It still confuses me Fraggle.

GreatJoan lovely to hear from you too. It does look like the three of us are having Christmas/New Year babies. What a wonderful way to start a year. . I haven't really thought about a delivery date all that much. Well outside of wanting the section post 39 weeks. And my MW advised maybe better early week due to staffing over the weekend. Because I will be scheduled between Christmas and New Year it only leaves me with three options (27th, 30th and 31st December). If I could choose I would go with 30th or 31st.

This is a fascinating thread, I've not read the entire thing but have dipped in & out, readings the most recent pages.
LittlePeaPod
Thank you for starting it! Sounds like you're almost at the same stage as me, am 34 weeks due 11th Jan.

The comments regarding MW appointments struck a chord with me- each appt I've seen a different MW (not all that bothered about this, just lots of repetition) & each time it's just urine test, BP check & feel of bump/listen to baby's heart.

Not much chat regarding birth options or the pros & cons of different pain relief. I had MW appt this week (there were 2 in there) tried to discuss my fears re having a VB but felt it was totally brushed aside & was asked half a dozen times whether I wanted to sign up for the birth centre.

I had initially thought I'd broach the subject about speaking with an O&G doctor re an ELCS, but didn't get the chance. How can I do this without having to wait til my 36 week MW appointment? Should I take a GP appt & ask to be referred?

I know I'm leaving it late but I feel that I've really made efforts to read up on VB/natural birth but have come to the conclusion I would prefer to have a CS instead.

Plus, I should add that I'm training to be a GP- I've done a stint in O&G and some of the things I've seen during VBs are seared on my memory forever- and do not wan it happening to me if possible.

It's not the fear of pain or the unknown- I think I unfortunately know too much!

Hello LittlePea. Our little boy is nearly 7 Wks old and we are hopefully heading home on Tuesday. He is fully breast fed and just lovely, although i am bias.
I just can't imagine being 36 Wks pregnant now, seems very odd.
I hope you're progressing well? I will keep looking back to the thread for your post and C Section update.
We are already making plans for the next baby and yes i will be again requesting a C Section, because it's all about choice.
Good luck xxx

Fraggle, that's lovely to hear he's doing so well. And well done on making the BFing work! It's hard enough as it is; but with a baby in NICU it must have been even more challenging.
Good luck for Tuesday! I bet you can't wait to take him home!

LittlePeaPod, thanks for your reply. I guess all the holidays are a bit restricting for us when trying to find a date!
I'm still in two minds, maybe it should check with my DH and see what the consultant has to say.
When are you going to set your date? I'll have my appt on the 12th (can't believe it's already December tomorrow!).

Thank you Joan for your kind wishes xxx

If you don't want to give birth then don't get bloody pregnant !

Stella grow up. You are making yourself sound ignorant, childish and unintelligent. If you have nothing of intellectual value to add to the debate then its best/advisable you don't post at all. You simply made yourself look pretty idiotic and immature!

I haven't had an opportunity to review other posts. I will later and respond.

Very Interesting thread, especially the posts by RedToothBrush I read most of the way through. I still haven't decided about my birth plan but seeing my friend walking around and making a great recovery after a horrendous 24 hr labour and episiotomy is making me lean towards VB.

I do agree that I have had no information from my midwives so far. They just check urine, Bp, listen to heartbeat, and away I go. I asked them about childbirth options and they gave me a leaflet for the NCT and nhl classes.

When I was hospitalised although they were lovely, the midwives couldn't answer most of my questions and I had to wait for the doctors to get any answers. The doctors too were incidentally juniors and weren't sure of anything. So at this point I my trust in both the midwives and doctors is extremely low.

Stella
Your post really is extraordinarily unhelpful and does not add anything intelligent to the debate.

Not every pregnancy is planned & some women do not find out they are pregnant until relatively far along, meaning there is so much to take in during a short space if time.

Woooahhh steady there with the sensitivity Stella...

...perhaps you'd like to examine the reasons WHY women might feel like that, they come back and give us a full explanation of why they don't deserve any support and empathy.

amandine07, I can't find where it is at the moment, but part of NICE's quality standards for C-Section (I think they are dated last year or very early 2013) is the fact that women should be able to talk about and arrange a C-section AT ANY POINT IN THEIR PREGNANCY, if that is what they want. This follows on from the fact that NICE recognised in their 2011 guidance that one of the issues that existed was that women who wanted an ELCS were likely to be extremely anxious if they were only able to do this at 36weeks regardless of their circumstances and reasons for requesting one. They felt this was totally unacceptable. Quite rightly. I'll keep looking for its and if I can find it I'll link you to it. It may help you fight your corner by asking why they won't let you discuss this now, when NICE think you should be able to and this is their vision of what the standard of excellent through the country should be.

My own personal experience is also this; I am not pregnant - I went to my GP to be referred to someone regarding wanting a CS prior to ttc. My GP was to be honest, pretty clueless, and didn't really know what to do with me because I don't fall within a normal clinical pathway. She didn't really have a lot to offer, because she didn't have a clue where she could refer me to for help.

So in the end I researched local hospitals and wrote to a consultant who had a speciality in anxiety about childbirth asking for an appointment. I didn't get a reply at first... BUT I did go back to the GP and ask to be referred to him, and to her credit she did actually do this. The consultant said that the first letter went missing otherwise he would have arranged an appointment without the need to go through the GP. So you can go down either route in theory. Unfortunately he also said that getting access to this type of care and support is difficult and very patchy across the country as there is so little understanding and recognition of the problem. It is changing but its slow progress. I do know that there have been several hospitals across the country which have done some work on researching the subject in the last couple of years, so the situation is should hopefully improve as the interest is there and there is an awareness that there is a problem here that deserves to be taken seriously rather than just women being 'pathetic' or 'selfish' or any of the other very nasty comments directed at women who consider this option.

My result is that I was taken seriously by my consultant and have an an ELCS agreed in principle and an plan for how to proceed (which doesn't just include the birth). Without hoop jumping. To say its a relief is the understatement of the year. I feel like an enormous weight has been lifted off my shoulders. I just have to do the difficult bit and get pregnant now...

I am not the first person he had seen in this situation but I am unusual. From what I know about him, he is not pro-ELCS as such, he is just pro-supporting women as individuals which may be to help women who request an ELCS to have a VB ultimately, if doing the course of their pregnancy they decide that they feel they want to change their mind. He simply recognises that some women have different needs and some need more support and reassurance than others.

Thank fuck there there are at least a few health care professionals out there who take my fears seriously enough to want to help me, rather the more usual ignorant and flippant remarks made by the likes of Stella. Lets hope that the subject and attitudes across the board become a lot more enlightened in the next few years, so that more people can get similar support.

The bottom-line here is the need for listening and recognising issues and not being judgmental and projecting your own beliefs onto others.

amandine07 Red is right. You can request a CS at any point in your pregnancy. I followed a similar process to Red when requesting my ELCS. However I researched and found a Consultant Obstetrician that specialised / had an interest in the following fields first.

Gynaecology and Obstetrics
-Prolapse

• menstrual disorders
• reproductive health
• menopause
• laparoscopic
• infertility
• hysterics copy
• fetal medicine
• endometriosis
• miscarriage
• fibroids

-prenatal diagnosis/screening

My reasoning for looking for someone with an interest in these specialties was because I felt they would be more likely to understand my reasoning for an ELCS. Once I found someone I then spoke to my GP and got a referral straight to that Consultant. In my region you need a referral letter from your GP to get direct access to a consultant . My GP was really supportive and provided the referral letter at my appointment.

I would strongly recommend you try and get referred. Don't waste your time with MWs, Registrars or Consultant MWs etc. Their job is to try and put you off or talk you out of a CS. They can't actually make a decision on whether or not you can have a CS. But, they can make it really near impossible difficult for you to get in front of a consultant. Also I would request a copy of your hospitals birth policy so you know what you are up against. Some hospital trusts will say they have a policy not allowing maternal CS requests my hospital has this in pace. Just remember that even if that's the hospital policy if a Consultant agrees your CS as was in my case you will get your ELCS. If your request is declined you can ask for a second opinion.

Also try to research and find out as much as you can on risks attached to VB. eg.

Mums

• medical intervention - ventouse, forceps, episiotomy, induction and the need to an EMCS who's is the worst result for any woman/baby.

-injuries - cuts,tears, potential broken pelvis, pelvic organ prolapse (uterine,bladder, vagina etc.)

Baby

• instrumental injury -facial and sever brushing
• injury - nerve damage to baby's eyes, arms, and shoulders.
• injury - bleeding / haemorrhage in baby's skull
• potential breathing difficulties due to baby getting distressed (eg meconium on baby's lungs)

Before going I would also recommend you

• try and understand your reasons for wanting an ELCS
• research VB and also try to understand the difference between an EMCS and a ELCS
• read up on how a CS could impact any future pregnancies and make sure you are happy with those risks
• is your DH/DP going to the meeting? It helps to have them there and to have them vocally supporting your decision
• think about what is important to you about the birth
• question the consultant. Eg. How often (percentage) do VB end in EMCS in their hospital? How often (percentage) of VB end in some form of medical intervention? How often (percentage) are forceps/ventouse used? Etc
• try and get a hold of the hospital stats. The stats should be available from your hospital itself as well as national surveys (CS rates, other forms of intervention etc.). Ask them for a copy if their childbirth policy so you can understand what you may be up against.

Good luck with your request..

Fraggle fingers crossed or Tuesday. I bet you can't wait. I am delighted that the breast reading is working so well. That's brilliant ECS and I be he is gorgeous. . I can't wit to meet DD..

great my dates are already agreed as one of the three above but hopefully we will agree on one of he dates on Monday. . When do you get your date agreed?

Zinher thanks for your post. It's such a shame the antenatal information we get s so poor. I really hope you get the birth you eventually decide on.

LittlePeaPod that does sound very similar to the process / thoughts / research I've done.

One of the big things I did was look at the local hospitals and see what they said about themselves as I found it very difficult to establish what their 'policy' was as such as they don't advertise it. In fact it seems most do as much as possible to actively not make it public which I think its horrendous.

That said the phrases they used were very quite interesting and helpful. Any that said they were 'proud of their low CS rate' rang alarm bells with me as it suggests they are more interested in figures than what women themselves wanted/needed. I also figured they were also more likely to attract women with different priorities to me, so the overall culture would not necessarily be sympathetic or understanding about my issues.

The hospital that I have been referred to is not my local one, but still within a reasonable distance for me and prides itself on 'women's centred care'. This is a phrase that I find more telling than any boast about your c-section rate. It suggests you actually view your patients as individuals and the way you give birth is less of the target and treating you well is the bigger priority.

I personally think this is wrong, as all hospitals should be able to identify that women have a range of emotional needs as well as physical ones. Especially since birth is also a hugely psychological process as well as psychical.

publications.nice.org.uk/quality-standard-for-caesarean-section-qs32/quality-statement-2-maternal-request-for-a-caesarean-section-maternity-team-involvement

Quality statement
Pregnant women who request a caesarean section (when there is no clinical indication) have a documented discussion with members of the maternity team about the overall risks and benefits of a caesarean section compared with vaginal birth.

Rationale
The purpose of this statement is to inform decisions about the planned mode of birth. It is important that the woman can talk to the most relevant member of the maternity team depending on what her question or concern is about her request for a caesarean section. It is important that access to members of the maternity team is possible at any point during the woman's pregnancy and promptly arranged following a request.

Quality measure
Structure: Evidence of local arrangements to ensure that pregnant women who request a caesarean section (when there is no clinical indication) have a documented discussion with members of the maternity team about the overall risks and benefits of a caesarean section compared with vaginal birth.

Process: The proportion of pregnant women who request a caesarean section (when there is no clinical indication) who have a documented discussion with members of the maternity team about the overall risks and benefits of a caesarean section compared with vaginal birth.

Numerator – the number of women in the denominator who have a documented discussion with at least 1 member of the maternity team about the overall risks and benefits of a caesarean section compared with vaginal birth.

Denominator – the number of pregnant women who request a caesarean section when there is no clinical indication.

Outcome: Women's satisfaction with the process of discussing options with the maternity team.

Red yes the hospitals are a real pain in the rear when it comes to providing information. The whole process is a complete joke to be honest! I really focused my research on trying to find the right consultant. We have a family friend that's a consultant anaesthetist and I knew from him that if I got a Consultant Obstetrician to agree the ELCS then the hospital birth policy would be over ridden. I get the feeling most hospital trusts are starting to hide behind the "we don't allow material CS requests". .

I totally agree with you. I think its down right appalling negligent that hospitals are consciously neglecting the needs of all women. Rather than trying to hit targets they should be speaking to women and understanding our needs. It's really fucks me off.

One of the things that I find worse is that one of the things that hospitals are judged on in terms of standards by the NHS is their CS rate. And there is no distinction between ELCS or EMCS. This means their funding could be affected by their CS rate.

I think there is such a paranoia about avoiding 'unnecessary caesareans' as the mentality is that all women don't to have want one. The result is that people fail to see the whole picture. The idea that there are a small number of women who might want one, doesn't even enter the equation.

Its such a blinkered approach, that at no point looks at the satisfaction and mental well being of women. It happily forces women into a situation where they are not the focus of care and their needs are secondary to a target.

So Stella, because I was abused as a child and have severe phobias about anyone touching me down there and having flashbacks and a complete mental breakdown if I was forced to have a vaginal birth I shouldn't have got pregnant?

The healing process that I have been through to even let my husband be intimate with me has been incredible. A baby completes this process.

When I started on this pregnancy journey I hadn't even thought how I was going to give birth. The more I thought about it the more I think I need to have a C section.

Would you genuinely prefer me to abort my growing baby because that would be my option if I were to be forced into a vaginal birth?

Pee really sorry to hear that....very brave....it just goes to show there can be a whole myriad of reasons for a woman to request an elcs.
I have always been terrified of giving birth which can be seen as strange by many women....So much so that I always put it off. I had a wonderful experience with my elcs 3 years ago and will be opting for the same again in May.
Wishing you all the best x

peeapod I think narrow minded stella needs to look up the definition of giving birth, to give birth is to at the end of a pregnancy empty the uterus of one of more foetus, the method that the uterus is emptied is irrelevant, although vb is the natural way, a c section is still giving birth!
Really sorry to hear what you went through, and thank god there is the choice of elcs for people who have gone through what you have.