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.

Stella is a real life picture perfect example of the Benjamin Franklin quote "We are all born ignorant, but one must work hard to remain stupid"

People like her tend not to think, they simply tend to spout and what they spout tends to be shit! I have always found it difficult to engage with that level of stupidity.

Peeapod I am sorry to hear about your experience but I am also glad to hear how you are moving on. Congratulations on your pregnancy.

LittlePea, you are very brave to share such an intimate and difficult experience. I am sure there are numerous women hiding in the wings who have also been abused and don't want to experience a VB.

Stella, i hope that you are still reading this thread and feel utterly ashamed at your post. So ignorant.

Fraggle it was Peeapod that shared her experience. Not me.. Sorry our names are so similar..

yea sorry. lol.. im going to have to get used to saying if i want to get myself a C section, so I might as well start here. It scares me to admit the extent of my feelings, but I know it to be true in my heart. I couldn't consider a natural birth and would rather not be pregnant if I had to be forced into it.

Sometimes it takes a bit of anger to be honest. People need C sections for many different reasons and sometimes they are co erced by well meaning medical profesionals into a V birth (see I cant even say the word lol) which becomes an incredible trauma for the mum.

Sometimes it might even be the first time the mum has even attempted to address her fears or her experiences and it just seems to me that these so called guidelines are forcing women into revealing some pretty difficult stuff.

ugh. sorry, rant over. I am dreading the prospect of having to tell actual people why I cant face a V birth. Lots of people, over again etc.

Pea....I can only speak from my own experience....I met with consultant....explained my feelings fully....she explained and wanted me to acknowledge all the risk factors involved with ELCS....She then literally grabbed a diary and booked me In. I only ever really spoke to midwife once and expressed my wishes and then to consultant. I really hope you have a positive experience like I did and don't have to relay your case over and over.

peeapod, my circumstances are different, but if its any consolation and if it offers any reassurance, the consultant I've seen didn't even question my reasons behind about wanting a c-section in any depth.

I wrote everything down my biggest concerns rather than my history prior to my appointment in a letter which he had, and therefore had time to read before hand. At the actual appointment I pretty much just nodded and shook my head (and cried - a lot) rather than have anything approaching an intelligent conversation about things. I'm not capable of doing that with the level of anxiety I have.

I think all he really needed to see was that it was causing me genuine distress and that I understand what I was asking for, in order to say "if you think you need a c-section, you'll get a c-section, no questions asked".

I specifically said that I did not want to be forced into having counselling or want to jump through bureaucratic hoops in order to 'justify' my need and he simply said that was fine and not an issue (though he did suggest that I might want to consider counselling as part of my wider issues, but not specifically to address giving birth but that was completely and utterly up to me).

I know it really does depend on the hospital you are at and its policy, but it might not be the interrogation you perhaps fear it might be.

I hope you find the support and understanding that is right for you.

oh and peeapod, why do you have to tell anyone why you can't face a VB beyond the people caring for you? Even then you only have to discuss it with the person who makes the decision. Everyone else has to respect that decision even if they don't like or understand.

I've told a couple of friends I trust about things, but not the specific reasons for me. It did help actually. I've keep it to generalised reasons about why women might decide to have an ELCS and the background behind the subject rather than be about my own personal reasons as I find it easy to talk about that way. I really don't think its necessary to be specific about your own circumstances to even close family or friends.

My consultant has said categorically that if I have an ELCS it IS for a medical need and not to doubt this as he recognised it as such. Not sure you need to go much further than that.

Peeapod from all the research I have done. From what I have read and discussed you have what would be classed as a medical need for an ELCS. Personally, I would recommend that you get a referral from your GP direct to a Consultant Obstetrician. By pass all the middle men (so to say).

This way you only need to discuss your reasons (if required) with 1 maybe 2 people. In my personal opinion I very much doubt any Consultant Obstetrician is going to challenge or refuse your request.

It's honestly pointless trying to go through the midwives etc. They are just a delay in the process. The sooner you get a referral, the quicker you see a consultant, the quicker a decision is made.

I had a decision on my ELCS at 23 weeks after only 1 meeting with a consultant. The only reason I waited to see him till 23 weeks was because I was doing my research prior to that. I am one of those classed as not having any medical or MH trauma which would justify an ELCS.

So as promised here is the first update. Not that I have much to say. As you are all aware my ElCS was officially agreed when I was about 23 weeks. Since then I have had the usual MW appointments (BP, pee test, poke around my tummy, MW clearly disappointed that I refused a home birth because apparently I am perfect for one of those ).

Had my 34/35 week appointment with my Consultant Obstetrician today. I thought that I would have to justify my ELCS again. However, to my pleasant surprise the appointment was quick and no one questioned or challenged my choice this time. It was basically a formality. We agreed my ELCS date (31 December) and had a joke with consultant. Booked my next appointment for bloods and other Pre-op tests and off DH and I went.

For those wondering. Now everything has been formalised, if I should go into labour early then all I need to do is call the maternity ward. Tell them I am a scheduled ELCS and I am coming in. The will prep for me and I will go into theatres as soon as possible when I get there.

Really surprised how easy today's appointment was. It seems once all agreed everyone just gets on with it and does everything they can to make it as pleasant and easy an experience as possible.

Great news, I hope my appointment goes that well next week. And your going to have a Nye baby

Terilou87 I am still a bit [shocked] at how easy and smooth it all went. I really hope it goes as smoothly for you too. I know a NYE baby . DH and I were saying how great it will be for her when she's older. Everyone will be going out on NYE...

Hey, newbie here. Reading thread with great interest.

Currently 26+3 and have been pushing for ELCS since learning of pregnancy. I have a long history of anxiety related to sexual health, and had almost given up hope of ever getting pregnant - never mind considering birthing options.

While my consultant has listened to my concerns, she still hasn't confirmed she will carry out an elective section although has stated 'it's still on the table'. Apparently there is no reason to make a decision till post 30wks.

I've worked myself into a compete frenzy worrying about this, and I have already alot of external worries in addition (work/family/etc). However everyone seems more worried about my general mental health as oppose to what I believe to be the most pressing concern, the birth. I feel I would be better equipped to deal day to day life, if I could get agreement on this now.

I have an appointment with Perinatal Mental Health on Wednesday to discuss all my 'issues'. Not sure if anyone has been through this as yet, and how they got on.....?

Cherry Welcome to the thread. I haven't been through your experience. However, the fact they have referred you for counselling is actually positive progress. One of the NICE recommendations is if a woman requests an ELCS because of anxiety about childbirth etc. she should be referred for counselling. However if after the session(s) you still feel uncomfortable stick to your guns / unhappy with a VB and still want an ELCS then you should be offered an ELCS.

If an ELCS is what you want then I would really focus on the fact this delay in a decision is causing you more worry and the fact you feel they are not listening to what is actually the root of your worries. Keep reminding them that in actual fact the thing that's triggering these feelings is the fact you are currently in limbo. If you don't feel a VB is right for you just keep repeating it and how worried you are they may force you into doing something that you can't even consider.

There are some posts further up talking about how to prepare for Consultant Obstetrician meetings. I would recommend you look at it and try and prepare yourself in the same way. Its really important to demonstrate you have researched the risks / benefits to mum and baby for both VBs and CS. They can make a decision any time (I was 23 weeks) so the whole wait till after 30 weeks is a delaying tactic. I would be pushing really hard for a decision.

One last thought. When you say you have seen a consultant. Was it a consultant obstetrician or a consultant midwife? If its a consultant midwife then you need to push to see a consultant obstetrician. A consultant midwife can't make the decision and their job is to try and talk you out of it using any method necessary.

Hi cherry going for counselling is the first step to getting the elcs the consultant/mw is supposed to refer you to before agreeing elcs if there is no "medical" reason, you don't have to go ( I didn't but my reasons wernt really mental things so I felt it would be no help) but if you do go and after speaking to someone you are still 100% sure c section is what you want " under nice guidelines" the hospital should offer you one.
My hospital didn't really want to discuss me having elcs till later on in the pg, I agree with littlepeapod it's a delay tactic in hoping you'll change your mind, they finally agreed mine at 32 weeks should have my date at next appointmemt in a week.
Stay determined you will get it!!

Very interesting thread. I do think there are some strange politics around the subject that I find hard to understand.

I am in a quandary about childbirth - swinging between a homebirth and an ELCS. Reason being that I am terrified of feeling bullied into brutal interventions in a hospital setting.

I very close friend had an ELCS last year (breech) and had a dream recovery so that is a factor for me.

LittlePeaPod, as I said before, actually counselling, even where mental health is an issue, isn't compulsory and the way people are interpreting the NICE guidance is to suggest it is. Even what you've said seems to echo that.

NICE do not say that someone should be referred for counselling.

What NICE say, is and I quote:
When a woman requests a CS because she has anxiety about childbirth, offer referral to a healthcare professional with expertise in providing perinatal mental health support to help her address her anxiety in a supportive manner.

The two key words here are OFFER and SUPPORTIVE MANNER.

Offer, means you have an option to refuse. You actually shouldn't be under any obligation to HAVE to have counselling. Supportive manner simply means they are obliged to listen to you and understand your concerns, rather than simply dismiss whats bothering you, because they believe x, y and z is best for you. The whole point of the counselling process is to build a relationship and trust between patient and healthcare provider and for the healthcare provider to understand whats bothering you as much as you understanding the foundations of your fear.

In order to satisfy that you fully understand and know what you are asking for, they only have to make sure you understand what you are asking for in a documented discussion, which is a totally different thing to counselling. But the two processes, seem to be being banged into one, which defeats much of the point and actually does nothing to improve trust. If anything it has the potential to further alienate a woman, if this hoop jumping is done particularly badly.

It does sound in Cherry's case, that the hospital concerned, doesn't really 'get it' if she is feeling that they aren't listening to her. How she feels about the whole request is the really important bit - not whether she has an ELCS in the end of not - and shouldn't be under estimated. Saying she can have a CS, does not actually mean that she HAS to have one and that she won't change her mind. In fact, I know that, with the right support, there is evidence that women who request a CS and have it granted, do actually change their minds during the course of their pregnancy because of that build up of trust. I do think many hospitals don't understand this and the need for women to have this emotional space and freedom. The key is understanding that a woman needs to feel she is being supported no matter what above all else.

Given that I can be effectively granted an ELCS prior to even getting pregnant, and have been told that I do not need to go for mental health counselling if I do not feel it is appropriate/helpful for me really does highlight this and the disparity of care across the country.

I know what it feels like in terms of the relief of knowing that and knowing that its up to me, and the consultant will support me in what I ultimately do. I burst into even more hysterical tears when he said yes, because it was such an unleashing of emotions and it took the fear of 'the process' of 'having to prove my case and comply with the process' out of the equation. The hoop jumping is part of the problem, not the solution.

And FWIW, actually a consultant midwife CAN make the decision, and I really don't believe they are always there to talk you out of a decision. I find that bit of information very inaccurate and not reflective of my personal experience and research at all. In my case its a consultant midwife who has looked at and approved my circumstances and is the ultimate decision maker for women like me who are referred to him at his hospital. If he says "yes" then thats it - well unless you change your mind. (Which was precisely why I asked to be referred to him).

I think it really depends on the individual viewpoint of the midwife and set up and the culture/policy of the hospital you go to, rather than job title tbh.

I think that many midwives and consultant obstetricians, both are guilty of having their own agendas above the needs of the women they care for, but I also do think that there are ones who do believe in treating and supporting women as individuals too (though perhaps not nearly as many of these as I would like and think we need). I don't think its fair to tar every midwife/obstetrician as being part of this ideological turf war.

I haven't read all 500 odd posts and don't know enough about either type of birth.
However surely if the option is there, it's down to the pregnant mother to decide and surely we should respect that either way.
If the nhs, or whoever, is giving this as an option it's a 'don't can't hate the player, but hate the game' type thing.
I hate the benefit system, but if someone's being offered benefits they may as well claim them. I don't get annoyed at them, I get annoyed at the system.
Good luck to everyone, however they give birth. X

Reds posts re NICE guidelines very informative and I find true to my experience. I didn't need/require counselling and found the whole procedure extremely straight forward. I didnt have to build a huge case so to speak of. Once I had met with Consultant Obs... date was set and that was that. I found the midwives I encountered were fine and never tried to talk me out of my choice. I am currently 16 weeks and have found the care again so far unbiased....perhaps I've just been lucky.

red you are right. I don't know much about the requirement for counselling as I never had to go through that process.

Littlepea - I really wish you'd stop saying its a midwife's job to persuade you to have a vaginal birth. Largely you present an intelligent argument and you clearly have well thought out points and have researched extensively. But this generalisation is so offensive and lazy.

I had an elective section two weeks ago. I'd been set on a VBAC all the way through my pregnancy but had talked a lot to my midwife about the trauma I'd experienced since my last birth which ended up as a EMCS under general anesthetic. It was her who actually encouraged me to think about an elective to avoid risking a repeat of last time. It was her who made sure I got an appointment with the right consultant at my hospital to book it in time (it was a late in the day change of mind.)

I had a brilliant "natural" section where the screen was lowered on delivery so I saw my son being born and then all my monitoring pads were whipped off my chest and my baby was put on me for skin to skin for the whole time I was being stitched. It totally blew away the ghosts of last time.

None of this would have happened if it hadn't been for my absolutely excellent midwife, it hadn't even occurred to me to have an elective.

Additionally, all of the midwives who looked after me on the post natal ward were amazing. I had incredible support and help with breastfeeding, and general help with everything with my baby. Midwives deserve not to be so sweepingly slated the way you have done throughout this thread. Yes some are bad, but that's true of anything. Shockingly, you sometimes get bad consultants too...

PaasTheCreamEgg IME and the experience if everyone I know that's had an ELCS including my SIL who had her second CS 5 weeks ago all the MW we have come across have tried every trick in the book to convince us to have a VB. including my SILs consultant MW saying to my SIL " what will happen to DC 1 if you didn't get through operation". So I can assure you my experience is that MW do everything they can to talk you into a VB. plus why waste time speaking to them when they can't make the decision anyway. Simply wasting time and energy IMO.

Now I never said they weren't pleasant. They all seem nice enough..

It's great that you have shared your experience. Your MW sounds very supportive and not as biased as the ones I have come across. Thank you for sharing that.

Thanks for messages and advice.

So far I've had two appointments with Consultant Obstetrician, both approx an hour long and both ended up with me in tears. The first I did myself, armed with logical background and history to make my case, but I found each argument batted away and walking away with an urgent referral to perinatal mental health. I work in field of risk, probability and statistical analysis - so am quite well versed in facts and figures in this area, but this seemed to have little influence over this conversation and my frustrations spilled out into tears and me telling them what a mess my life has been and me not being able to handle the stress of birth over everything else.

The second appointment a week later, I took my husband, who reiterated my concerns and pressed for ELCS. At this I got confirmation that ELCS was 'on the table' - but no decision to be made until 30+ weeks. I felt the consultant sometimes used my husband against me in conversations, and left feeling generally uncomfortable and no more assured that I was being listened to.

I have no problem going for counselling, but I'm clear in my mind and at both appointments it is not going to sway my opinion or my ultimate decision (if I get to decide!). I have had previous counselling for my anxieties over the course of the last 14 years - I'm struggling to see how the next 14 weeks will be able to make any difference in this area.

While I appreciate there are concerns I have a high risk of post natal depression; given my ongoing sexual health anxieties, work stresses, recent bereavement of my dad as well as the rapid deterioration of my mum (who I am sole career of); I struggling to see how talking about this with a stranger for an hour every other week is going to help.

What would help is having the pressure of a potentially problematic delivery taken off my shoulders, so I can bear the remaining pressures, try to enjoy my pregnancy and concentrate on how to integrate a new baby into my life.

LittlePeaPod, you don't think thats a very blinkered and ignorant comment? Really? Honestly?

Based on the experience of two women all MWs are the same?

Think about it. Is that a scientific approach to research? Is that really helpful to anyone? If anything, its really alarmist and encourages alienation from midwives/consultants rather than engaging with them (and perhaps helping to change minds along the way). The only way to change minds is ultimately to engage with people who disagree with you in one way or another.

I actually think, that the attitudes of staff are also reflective of the pressures they are under from policy makers and the overall culture of the institutions they work. Even the level to which consultants and midwives are encouraged to work together could make a massive difference to their view point.

If you go to large university hospital doing extensive and well funded research into tocophobia do you think you will get the same attitudes and beliefs as in a short staffed, under funded and resourced hospital?

I'm really not sure you would. Especially at a time when the issue is only just beginning to be recognised as a real problem.

Red as with everything on this thread I have based it on my experience and what I have done/discussed. That's always been clear. I never said this thread or my comments were based on anything other than my experience. So with regards the scientific approach that was never an expectation I set. However its great to have posts with that approach. Also my experiences are based on more than two women.