Chances of ELCS at Chelsea and Westminster? Advice needed on the best approach...

[SJWLondon]

Hi everyone,

I am 6 weeks pregnant and so excited about the prospect of having a little one!

However, I am already terrified of not being allowed to have an ELCS! To my knowledge, I do not have any medical reasons that would require one. I just can not imagine giving birth naturally. To all of you wonderful ladies that can and have, you have all my respect and I think you are wonderful, but it is just not for me.

Can anyone advise me on their experience of requesting a ELCS at Chelsea and Westminster Hospital? What is the best approach to take to ensure a sensible discussion and the result that I wish for?

What kind of questions will I be asked? What would be good answers to justify my request?

Hints, tips, advice will all hugely be appreciated!

Thank you so much for your time

SJW

You don't need a medical reason to have an ELCS. They will give you loads of nonsense about seeing a counsellor to talk through birth fears. Be polite and be firm, do your research on the pros and cons of ELCS and show you know what you're talking about and don't let them fob you off. For what it's worth, C&W has great consultants, a lot of whom are very pro-cs.

You have to have some sort of reason. Contrary to popular opinion the guidelines don't say hospitals have to give ELCS on request.

Although C&W are generally more keen on sections I don't think they will do them just because you don't fancy giving birth vaginally (apologies if that is not the case but there is nothing in your post to suggest you have a valid reason, birth phobias would be medical, as would possible trauma of giving birth due to previous abuse etc etc and you clearly state there is no medical reason).

You could pay to have a section? I think it's about £10,000 at The Portland.

"If a woman requests a caesarean section because she's anxious about childbirth, she should be referred to a healthcare professional with expertise in providing mental health support. She should be offered a planned caesarean if, after discussion and support, she still feels a vaginal birth is not an acceptable option."

Read the NICE 2011 guidelines on caesarean section.

Price list for The Portland There are other hospitals but this one is obviously well known!

to be honest i would highly recommend going through seeing a councellor. It will enable you to go into the process with your eyes wide open and making a fully informed decision.
There is not better or worse way to give birth, just different. Talking through those differences with an expert is imo a good idea, and helped me to confirm i need a c section, which is hopefully happening without any problems.

Are you anxious about giving birth normally? If you are this may be sufficient to be classed as a medical reason. It would depend on your circumstances.

Technically you do not need a medical reason to have an ELCS though. The NICE guidelines actually state this, but hospitals do not have to follow these guidelines.

The good news: C&W have had one of the highest rates of CS (and ELCS) in the country
The bad news: As a result of this they have been under considerable pressure to act to reduce this.

The net result is, that although C&W do have a pro-CS culture, politics are very much an issue here. You may find it harder than you anticipate to get an ELCS for that reason.

I suggest you read this thread as it is one of the VERY few examples I have seen on MN where someone who requested a CS was refused and this refusal was never overruled. I think I have seen 2 maybe 3 cases where a woman didn't have her request ultimately respected on MN in about 4 years.

Normally I would say, if you were persistent you should eventually get one if you are determined, but because the hospital in question is C&W I would be more cautious about doing so.

The woman in question in that particular thread ended up changing hospital to another NHS one in London and did eventually have an ELCS as she wished.

I think the high C-section rate at many of the fancy NHS London hospitals reflects the fact that they are often tertiary centres for maternal/paediatric health and so have high risk pregnancies throughout London/sometimes even the UK referred to them... & these are more likely to end up in C-section.

I agree with RedToothBrush that a high rate is seen as a 'bad' thing though & there are pressures to keep them down - so I wouldn't assume that a hospital with a high rate would necessarily have a low threshold for doing them & if anything it might be the opposite!

I think the best approach for anything is probably to have insight enough to know your reasons, be able to explain them rationally (consider writing down/taking birth partner?), be familiar with any evidence or guidelines and open minded to listen to professionals.

Morgan, the CS rates of NHS hospitals in London I believe also include CS for private patients too, which also distort figures (women more likely to travel further and pay for a CS if they can't get on NHS or specifically want one). The way the figures are done and compared - even when adjusted for demographics - do make it grossly unfair because policy making is being done on the basis of rates rather than individual need or respecting women's wishes.

The trouble with C&W in particular though is that it is one of a small number of hospital who, despite the NICE guidelines, that have introduced a blanket ban for maternal request ELCS (which is not the case with every hospital). This means you have a essentially prove you have a strong enough mental health case, if you do not have a apparent psychical reason for one now.

As the threshold at C&W for 'qualifying' for an ELCS is now higher than many other hospitals, it is creating a situation, where some vulnerable women are falling foul of the policy and for others who may not have such a 'genuine' case, are put through enormous scrutiny and stress creating a huge amount of unnecessary anxiety, that other women do not have to endure elsewhere. The focus on reducing CS and ELCS completely neglects what women actually want and how refusing to listen and respect a request can have a devastating effect - precisely the thing that NICE sought to stop when they wrote the new guidelines.

In the past I would have said that C&W was a good hospital to go to, if you wanted a CS. Now I really wouldn't be so sure. Obviously a lot of women DO get an ELCS at C&W, but clearly it seems to be more difficult than some other places.

I don't think the policy is in the best interests of women. It does not encourage women to take a different route by choice - its being done by force and the example of the lady linked to above doesn't actually solve the issue, because other hospitals have different policies, it just shifts it to other hospitals. Thats not serving women's needs; thats putting your bullshit figures first and passing the buck to others to deal with the distress that it causes in the process.

It is very very different to the hospital I am currently dealing with elsewhere in the country, whose policy is to not refuse any request, but instead work with women to address their request and help them. They do have a record of supporting women to the point the woman changes her mind of her own free will by building up trust, but they also recognise this does not apply to everyone and some women just should have their bodily autonomy and wishes respected.

The trouble is, finding out what individual policies for different hospitals is extremely difficult and that puts women in a very difficult position. C&W happens to be one of the few I am aware of.

Wow! Thank you for all your responses!

Firstly, I should have been a little more specific re medical conditions. I meant no medical history of heart conditions, diabetes, autoimmune diseases etc. I would however regard myself as having a huge fear of giving birth and have done for as long as I can remember... So I guess, as some of the posters above have pointed out, my reason/medical condition would be this. Something I will now remember to clarify...

I have already started gathering the info you have suggested and its all really interesting and helpful with plenty to consider. I will also speak to a councillor if they suggest this. And I plan to be rational and polite whilst firm and ready with my information. Fingers crossed I don't get a feisty midwife... I've heard so much of women being reduced to tears which I can't imagine is helpful either.

Thanks again for all your advice. Wishing everyone congratulations and good luck with what ever stage you are at...

SJW

Honestly I'd go to another hospital. Everything I've heard recently about C&W and elective sections is not great. You won't get an ELCS agreed until quite late and it is harder to switch then because lists get full. At theoment you can probably move very easily because people are only just starting to book.

It's the consultant you will need to worry about, not the midwife btw. Where abouts are you? There are lots of maternity hospitals near C&W. Queen Charlottes at Hammersmith has a good reputation??

I agree with previous posters about not relying on C&W for a planned ceasarean without a medical reason. Their policies have changed a lot and you an expect to have to go through a bit of a mill to get one.

On a completely different note, it may be that as time passes you will find it possible to get on with the idea of a normal birth after all. Just be clear and honest with the midwives about your thought and fears and I am sure you can be given special attention otherwise to help you approach the birth happily, not fearfully. I have never refused to let a woman see a consultant to discuss a planned caesarean, and I have also arranged meetings with labour ward managers to guarantee early epidurals and senior midwife care if I have come accross someone very fearful. You have plenty of time to get things organised and I am sure things will turn out just fine x

If you go down the route of mental health, you need to say just how it effects you, how it is distressing you and making you anxious now, and how you think it would damage you psychologically if you were forced to go through a vb. You will need to prove this is serious enough to be debilitating.

Personally I think you need to prepare yourself mentally for a big fight because its C&W. I think you need to seriously consider whether you can cope with that, and the implications of this being a long drawn out process where you may be initially refused and have an alternative plan of action / coping strategy if they simply refuse.

My honest opinion, is that if this really is the route you want to go down and you have doubts about your ability to cope with the stress of the vetting process with no guarantees (which as I mention above is clearly not as supportive or interested in the needs of women as much as other hospitals), that you should save yourself the worry and change hospitals sooner rather than later as, as K8Middleton says booking in London gets full so quickly, you may find yourself in a position with very few alternative options.

I would normally say to stick it out, but I simply don't have the same level of faith in C&W as I would with most other places, because of how aggressively they have been trying to cut their CS rate (which of course will be hailed a massive success when they do, and will neglect the human element or reflect the real reasons and consequences of what they are doing).

Good Luck, though in whatever you decide. I hope my fears are groundless.