Can anyone explain the C section Nice guidelines to me?

[Pregasaurusrex]

Hello everyone,

I'm 23 weeks and beginning to think about the birth. I understand the guidelines have changed recently in terms of maternal request for C section. Can anyone clever help explain?

Thanks 🙂

No idea, but I'd like to know!

I've tried to find the information- but my gosh it is so confusing!

It essentially is that if, after appropriate counselling about risks, you want a c-section then your obstetrician should offer you one or refer you elsewhere/to another consultant.

The relevant bits of the guidance are in section 1.2.9 of the following link:

www.nice.org.uk/guidance/cg132

Essentially it says that if a woman requests a CS when there's no medical indication for it then the doctor should discuss the risks with her and offer appropriate support (eg counselling) if she is anxious about the birth, but ultimately if a woman still wishes to have a CS having understood the risks then that wish should be respected. If the doctor doesn't want to perform a CS under those circumstances then the woman should be referred to another doctor.

Thank you- if the Dr doesn't want to perform under those circumstances- do they refer to someone who will? Or can you essentially be pushed into a VB?

I had a maternal request c-section last October. I was anxious about a natural birth after my mum and sister had horrific experiences which resulted in emergency sections. I also had an anterior placenta and ovarian cyst which was detected at my first scan and which the sonographer said should be removed at the time of having a section. I was referred to a consultant due to the cyst and told her that I wanted a section, and requested the removal of the cyst at the same time but she brushed me off saying it wouldnt be done at the same time, it was a keyhole surgery job for a later date, but she didn't support my request for a section. A friend mentioned that she knew someone who had requested a section due to severe anxiety, who was sent for psychiatric evaluation...so I was prepared for this option. I wrote my consultant a letter stating that I would not change my stance on my request for a section and as I had read up on the nice guidelines, as above, I knew I was within my rights to pursue this. At my next appointment the consultant smugly informed me that should I continue my request, I would be sent for psych evaluation...clearly thinking this would stop me in my tracks. Having been forewarned, I readily agreed. Anyhoo, due to a series of fuck ups by hospital admin, my first and only appointment with said psychiatrist was only a few weeks before my due date. I duly went along with dp who backed up my request, citing the stress was causing me sleepless nights and forcing me to have a natural birth could be instrumental in causing PND, she had no option but to support my request, as there was no more time to see me for subsequent appointments to try to 'talk me round'. she contacted consultant who then agreed and scheduled me in for the section.
Sorry for the mahoosive ramble but just wanted to give a bit of background and if you do want a maternal request section, stick to your guns and don't be bullied into backing down. It was the best experience for me and could never imagine doing it any other way!!

Hi Pregasaurusrex I seen your other post on aibu I think with your anxieties you shouldn't have much of a problem with a section, I'm planning one after a first bad birth when I spoke to the midwife she said I have to see the consultant but I sound sure so it should not be a problem.

From what I've read the key is not to go in asking for a section you go in armed with info on the risks, the procedure and the recovery and tell them I would like a section I am sure I've educated myself I fully understand what I'm asking please arrange it. Do find out all about it before hand somewhat you go in they can't scare you into changing your mind. Also when the talk about the risks remember emergency sections and planned are lumped together in the stats however a planned is not rushed and you have not gone through labour before the surgery so really the risks are different. I read a book I think called a natural cesarean birth or something it was very informative.

The guidelines say you should be referred to another doctor:

1.2.9.6 An obstetrician unwilling to perform a CS should refer the woman to an obstetrician who will carry out the CS. [new 2011]

You should never be forced into not having a CS if that's what you definitely want, so if you're certain that you want to go ahead after the consultant has explained the risks (and after you've attended counselling if that's appropriate) but your consultant won't consider it then don't be afraid to quote the guidelines and ask for a referral to another doctor.

Ok- so should I ask midwife ( quite useless) or Dr who is supportive of my Mh? Sounds like I really have to stick to my guns. Which is fine, as I can't see any other way!

If your Dr is supportive then I would ask them to pursue this on your behalf. I wouldn't have seen a consultant had it not been for the cyst, and I had to fend off a couple of bitchy MWs who took exception to my request, as if I'd somehow insulted their profession...also not sure how much clout they have over these decisions as they seem to always want you to try the VB route first. Good luck, but if you stand your ground then you should be fine!

Yes standing your ground seems to be the key, start with I think I maybe could possibly want and they pounce

They are just guidelines and your Dr can refuse and you may have to request referral to another Dr, who again could refuse but keep pushing!

Some hospitals refuse to follow the guidelines as they are only guidelines. I know of a couple of hospitals where all the consultants are banned from following them because the CCG won't pay for the lscs in such circumstances.