when and how do you start asking for an elcs?

[peeapod]

i was reading on the thread about birth plans, but thought it best to start my own thread.

How do you, and at what point do you start to ask for and discuss the possibility of having an elective C section?

I'm not sure if i have a 'medical need' or not, as there is little information on what this actually means, so I know this is the first step, but im really not sure who and how and when I need to start the process.

I'm not wanting to discuss the reasons for/ against the decision on here, just the mechanics of who and how and when to ask for it?

Speak to your midwife at your next appointment, unless that's ages away then call them to ask. They will be able to guide you.

If you are consultant led then speak to your consultant as they would be the one that will confirm the details of it.

I agree that it would be best to raise it sooner rather than later.

I am having an ELCS and I have no medical reason. It's personal choice and this is my first. I am currently 34 weeks. I starting speaking to my MW when I was about 8-10 weeks from memory. If you don't have a medical reason then you need to do your research because the medical team will fight you all the way. They will try and push/guilt trip/do pretty much anything to get you to have a VB.

I also started a thread on this some time ago if you want to have a nosey.

www.mumsnet.com/Talk/pregnancy/1849354-Elective-C-Section-medical-non-medical-reasons

Certain NHS trusts will refuse to do Caesarian sections without a medical reason. Mine is one and I was notified of this when I booked in... I think the sooner you ask the better, because you might end up having to go elsewhere!

LittlePeaPod
Thank you for posting the link to your thread, very interesting stuff.

I'm 33 weeks & now seriously considering asking for a CS- currently my baby is breech and so I could (fingers crossed) be heading for one anyway.

The pregnancy was unplanned and only found out at 20 weeks, so there has been so much to digest in a short space of time. There's not been much opportunity to discuss the birth with a midwife- I get the impression there won't be much time.

I've not brought up CS strongly yet- other day had midwife appointment, baby seems to be breeched, I asked about CS but she totally brushed it off & said baby will move any way.

It's dawning on me that I need to move quickly if I want to organise try and organise a CS!

Also, regarding the reasons why- I'm a trainee GP and through work I have spent a lot of time on labour ward & quite frankly I've seen too much for anyone to pull the wool over my eyes.
I know the theory goes that a VB is best, I would argue not necessarily...but any way that's for another thread.

Thanks again for the info

I saw my Consultant when I was 21 weeks gestation and she bought it up then. I have medical conditions which although don't mean I have to have a CS but they are certainly valid enough to justify me having one if I want. I thought about it a lot and told her a few days later that I wanted to have the ELCS. She said she can't officialise it until I'm 36 weeks pregnant but that she is perfectly happy to go along with my choice. I'm glad she bought the topic up herself because I had no idea how to broach the subject and thought I'd get told it wasn't an option as they prefer women to have vaginal births whenever possible.

I asked about options at my 16 week consultant appt (emcs at first birth but told vbac was possible), and at that point I was wanting a vbac. By end of that appt I had swung to elcs. At 28 week appt I requested, was told they'd do birth plan at 34 and if still wanted it then I could (I had bad anxiety by that point relating to first birth and other personal issies), requested again at 34 weeks and then finally I was back in at 37 weeks to book it as they said it was too early to book it at 34 (I think they thought I'd change my mind as I was going through counselling at that point). Got 12 days to go, cannot wait to get it over and done with and my baby in my arms

thanks, i have next appointment on 1st december so il start asking then.

Peeapod i hope i am not over stepping the mark here. But, I would advise that when starting the conversation regarding an ELCS you do your research. It's is likely your request will not be received well if you have no medical reasons for this choice.

From all the research I did, the best way to ensure you are taken seriously and not fobbed off is to use facts as well as your personal feelings to explain your reasons for wanting an ELCS. The way you present your request will make all the difference to how your request will be received.

Below are some of the things I had thought through and prepared before I started the discussion about my ELCS and my ELCS was approved and confirmed when I was about 23/24 weeks:

• I understood my reasons for wanting an ELCS
• I had researched VBs and understood the risks and benefits of having a VB to me and baby
• I had researched CS and understood the difference between ELCS (planned) and EMCS (unplanned). I also understood the risks to me and baby. I also understood the implications of a CS birth on future pregnancies.
• My DH was with me and was very vocal in his support of my decision to have an ELCS
• I did my research on the hospital. i requested a copy of their childbirth policy so I could understand their policy on ELCS and what challenges I may face with regards my request. I also requested (from the hospital) statistics about CS rates, other forms of intervention rates, VB after CS rates etc.

When presenting my case/request, I stuck to the facts, which I had written down so I didn't forget. I wanted to demonstrate that I was organised and meant what I said. I tried to keep my points rational and factual.

Just thought I would share a few little pointers because I know just saying you want an ELCS without the research can result in the hospital declining your request. Even if they decline you are entailed to a second opinion (from a consultant in the same hospital, a different hospital or even a private consutantio).

LittlePeaPod

Thank you for posting all of that information, it looks very comprehensive...you are very right about needing to prepare & come across with clear reasons why you wish to have a CS.

I will use the pointers as a basis for when I get to meet with a consultant.

You definitely need to be very clear about why you want a CS and also very clear that you do want a CS. It sounds like you are not completely clear on either point (otherwise you would already confidently be asking for a CS, and feeling/fighting/powering your way through any objections from staff).

You need to decide pretty quickly if you do or you don't want a CS and on your own terms/from your own research, as it's unlikely you will be encouraged into one from the medical team, with no medical reason. You then need to be able to present your info/reasoning with conviction as you may get probed an awful lot on exactly what your reasons are.

I had an EMCS with my first and had to put up quite a fight to get an ELCS with my 2nd. I had to attend a kind of interview where I was probed and questioned for around 30 minutes and had to work hard to present my case (I'm not sure what would have happened if I was inexperienced at presenting cases/arguing points/lacked the power of reasoning) but I was absolutely firm that it was right for me, following my experience during my first, though research, and also (like you) because I personally don't believe VB are safer.

a point to note though is that they seemed most concerned with whether I was frightened of the pain of VB and I explained that I was not frightened of the pain of a VB, or the pushing, but that I saw CS as a controlled experience and a known quantity and procedure whereas a VB is not. I had the ELCS and all was very calm and I had a great recovery.

Anyway, to answer your question you need to raise it at the first opportunity, likely with your MW as the initial port of call. But it would be easier if you have definitely decided for yourself if you want one or not in advance as I don't think it likely they will offer you a choice and leave you to make up your mind.

(When I say "you need" I mean "It would be ideal if". :) Just to rectify. I have no factual idea if you need to do those things or not.

Wispa I don't know if this is fact or heresay but I was under the impression that if any woman is adamant they want a CS then they will eventually be accommodated.

In the past I have been given in the past.. ahem... selective information, shall we say, during pregnancy. :) (not about CS actually but concerning other matters). Things that were presented as a "That's not really possible" that actually were perfectly possible (and reasonable).

Hi Op I asked from the very beginning....If memory serves it was booked at about 28 weeks by consultant.
Good luck.

If you can get another medical professional on side, and get them to speak for you, that really helps. I did have medical reasons for my CS but what made it happen was a letter from my consultant who had treated me previously to my obstetric consultant saying on no account was I to have one. Obviously I don't know what your circumstances are, but if you have a connection with a doctor who will support you it will go a long way. Anyhow, I would start discussing it early and be calm and consistent in what you say. Good luck.

HayJud you are right. A hospital can't just say no we won't do ELCS. Under the new guidelines they have to give each woman/case a specific reason as to why they will not perform an ELCS. They can't simply say its a blanket policy. Although they may say that to try and put women off asking in the first place.

amandine07 you are welcome and best of luck with your discussions. I have found it very frustrating that these discussions aren't part of the normal antenatal education women receive not that we get much in terms of any antenatal education on anything really

thanks for the help. I'm sure I need a elcs, and I think I have legitmate grounds for it medically (but as its mental health related it muddies the waters somewhat)

I have armed myself with enough knowledge and facts and reasons, being able to articulate them might be tricky but I hope it wont have to come to a massive fight...

My hospital says they can refuse a C-section if they don't agree with your reasons for requesting one, they will just refer you to another hospital, and this is a really big regional specialist maternity unit. Guidelines are just guidelines.

I'm thinking about asking for an elective or trying to persuade them to give me an extra growth scan as my emcs was partly because of DS1's size and DS2 is measuring bigger. Doubt I will get it though.

vj - my friend had an ECS with her first due to the size of her baby. She had an horrendous labour and baby got wedged so she was rushed straight off to theatre for a CS under GA. When she got pregnant with her second it was decided that she would have an ELCS as the obstetrician didn't want to risk it happening again. They suspected her 2nd baby was bigger than her first (based on bump measurements) but she didn't actually have any scans to confirm it. Her second experience was far nicer (obviously) and she was glad that decision was made for her.

VJ if you have had a previous EMCS or ELCS then the hospital have to give you a very good reason before they refuse your request. If you stick to your guns the hospital will not be able to refuse. Even if they make it sound/look like you have no chance. That's just what they all do but ultimately its the woman's choice.

Everyone I know that has had a previous CS got an ELCS with subsequent births but the hospitals tried every trick in the book to put them off

iv just started a list of reasons written down. that way I can communicate the difficult stuff and the reasons a lot easier than being put on the spot.

peeapod - for what it's worth I would have thought that even if your medical reasons were focused around your mental health they would be just as valid. The last thing you want is to feel anxiety around the birth of your baby and research has been done about how traumatic births can affect the bonding process - and obviously you want/need to be stable (from a mental health angle) after the birth in order to care for the baby too. Good luck with your argument, I'm much better with lists than just being put on the spot too and having to rely on my memory

Good idea. With regards the MH issues you mentioned. Can you get a referral from a doctor/Consultant that is aware of the MH issues to a consultant obstetrician supporting your ELCS request as mentioned by another poster. Effectively bypassing the MW. The MW can't make any decisions on ELCS and they have to refer you to a Consultant MW and eventually to a consultant obstetrician. Getting a referral bypassing the two (MW and consultant MW) that can't say "yes or no" stops you constantly having to justify yourself to people that won't make the decision anyway. And the whole time these people will be doing everything to guilt trip you, put you off, make it as difficult as they can for you. Plus its wasting time.

I personally think it would be a positive if you had your GP on your side. Compared to cases I read on MN I had a very smooth time arranging my section and didnt have to wait until late In the day for agreement (which would have been stressful I feel). I wish you luck with your appointment.

Ask as early as possible, I hope things have changed as I asked 12 years ago and was given the brush off - 'a healthy girl like you doesn't need a CS' (I was 42 - first time birth ) - I ended up having to have an EMCS - it didn't bother me at all but it would have saved a huge amount of NHS expense and time if I had been allowed the ELCS I asked for in the first place.