Elcs consultant appointment - Q pls

[Yakadee]

Hi ladies,

For those of you that had an elected section and saw a consultant, when was it confirmed?

I have my appointment soon and a few people have told me you have to go back for several appointments before it's confirmed and I don't know whether this is right? I really don't want to have to keep going back, I'd really just like to know what's going on at the first (and hopefully only) appointment.

Anyone have any experience? Thanks xxx

I think it can depend on the reason why you're having the elective.

I am pregnant with DC2 and DC1 was born by emergency section. I met with the consultant at 13 weeks and she approved the section then and told me they would book in the date at 34 weeks.

I suspect if you are opting to have a section in your first pregnancy or entirely due to choice there might be a few more hurdles to jump through although that's just my gut instinct.

It's my second but had a terrible labour with my first. A lot of complications and recovery but not a section. Thankfully me and my son were both fine but I just can't go through it again.

Maybe that's why it has differed in what people have said to me? Xx

You might have to have a few appointments with your consultant to put your case forward as you've not had a previous section. They have to take maternal choice into account and it is your right to request a section but do be prepared for them to try and talk you out of it. I requested an elective for my second after EMCS with first and was persuaded into a VBAC which failed and ended up with second EMCS. Third I requested an elective again and was confirmed at first consultant appointment and date booked at 16 weeks!

Thanks @GreenMeerkat - everyone keeps telling me to be prepared to 'fight' and that they'll try talk me out of it. My appointment is 23/11 and I'll be nearly 30 weeks and it'll be my first one - making me nervous that it's this far down the line!

I feel I really do have legitimate reason and I certainly don't think it's the 'easy option'. I just think it's the best outcome for me and baby. I've researched all the risks and compared etc.

I really hope I don't need to fight and that they'll just understand my concerns xx

Mine was confirmed that I could have one at my 16 week consultant appointment (I then got this in writing with the clinic follow up letter which I'm keeping in my maternity notes just in case) I have an appt booked for when I'm 31/32 weeks to arrange dates and pre op etc

I had an appointment at 16 weeks when the consultant agreed to elcs, booked it in at 34 weeks. I had an emcs with my first which may have made requesting an elcs more straightforward but I've heard it varies by hospital. A friend had to convince 2 doctors and a senior midwife at 3 separate appointments, but she did get the elcs. Check out the birth rights report on which hospitals tend to meet the NICE guidelines on maternal requests and which do not, for an idea of how hard or not you may have to fight. Some trusts are apparently outright refusing elcs due to maternal request eg the JR in Oxford. I'll try to find the link for you.

It's here www.birthrights.org.uk/maternal-request-caesarean/

I had an ELCS booked after traumatic ELCS. I was so massively anxious about it but I was just very clear 'I am having a csection' and the consultant nodded and that was that. She did say about having a large family it's not advised etc but that was mainly making me aware of my options, rather than talking me out of it.
I also went into labour before the date and the hospital were amazing at getting me the section.

Thanks everyone and thanks @butunlikely - that was an interesting read. I've seen the nice guidelines before but not the breakdown of location etc x

I requested an elcs with my twins as I have tokophobia and it was horrendous. First saw a consultant at 16 weeks and they continually tried to fob me off until I got to around 30 weeks when they booked one / ended up needing an emcs at 35 weeks.

Depends on the local criteria - here they won’t confirm it early unless it’s the only safe option and will make you attend birth choices appointments first.

Hey.
From what I've read it 100% depends on your consultant.
No one even wanted to give me a consultant appointment for my first elcs. I managed to get an appointment at 35 weeks pregnant and they signed off on it right there and then.
I was very firm, I went in with lots of research and my mind was made up.
I'm now 16 weeks pregnant with my second. I had a consultant appointment made for me at 12 weeks along with my 12 week scan, he booked my next elcs that day and I'm having my baby on 25th April 2019!
My second consultant said it like this.
"If you went into a phone shop, and I was the phones salesman, you tell me you want a Samsung, but my person opinion is iphones are better,. It's my job to tell you the facts about what we offer, but my personal opinion has no place in this conversation. I tell you the facts and the risks, and you tell me what you want to do. This is no one's choice but yours."
He was lovely.

I had umpteen appointments before they comfirmed the date, it was confirmed until I was 35 weeks in the end.

I had an appointment with consultant at 20 weeks, one with an obstetrician at 28 weeks, consultant midwife at 30 weeks then a final consultant appointment at 35 weeks to confirm the date. They tried their upmost to talk me out of it every step of the way including up to delivery where DP and I were sitting in our theatre gowns! The consultant came in to offer induction instead.

I wanted mine due to previous very traumatic deliveries and a traumatic miscarriage.

It was confirmed that I would have an ELCS at the appointment, I was only around 24 weeks. The actual date was booked later

Mine was confirmed at 12 weeks and has not (yet) been challenged by anyone but I was very very firm about it.

I had a previous emergency section and suffer from anxiety so had already spoken with GP/ midwife. After that, I was very firm with the registrar and just refused to consider or discuss other options. She just said there was no point in fighting me if I had decided and I just ended up kind of laughing and apologising for being so adamant. It's on my notes as maternal request/ previous emergency section.

I was told if it was my first and I had asked for an elective the answer would have been a definite no. To be fair, I have a high BMI and have never had a vaginal birth, so the odds of a successful VBAC are very low (IIRC under 40%).

Even if you get it confirmed at the first appointment you'll probably have to discuss it again later to actually get the date.

Sorry OP just read it's your first. In that case I think you'd be expected to go down a more difficult route depending on your trust, eg. they may send you for counselling. In your position I'd speak with your midwife and try get a feel for the likely reaction before you go in.

Thanks for all your replies. I'm really hoping I don't need to go down the counciling route as although it was very traumatic it's more the physical side of it all that has made up my mind on this.

In a nutshell;
Induced
Terrible episiotomy
Forceps delivery
Massive blood loss
LOTS of stitches (without pain relief)
Staying in hospital because of an infection
Got another infection a little after delivery
Physio for scaring etc

All in all, a terrible experience and a very long recovery.

There was also issue with babies heart rate etc which was the reason for interception and I'm so worried that will happen again and I'll go through this all again. It's almost a guarantee that I'd need another episiotomy as I needed physio in the first place because of every day discomfort - let alone pushing a 9lb2 baby out again!

I know there are risks and haven't made the decision lightly. I honestly think that the control of a planned section would be much safer overall for baby and me.

I'm dreading this meeting now 😩

Don’t dread it. I had a very sympathetic consultant, they won’t all keep pushing you and if they do, stand your ground. You’ll get the ELCS

@BertramKibbler - thanks. I have no intention of backing down. My midwife was very sympathetic and booked me in with the consultant midwife as said she'll not just focus on risks (like a surgeon might) and really take my comments on board x 🤞

They’ll say lots of scary things about CS, or at least they did to me but your obviously there because you had a horrible experience with a vaginal delivery so don’t panic

Can you take your partner or someone with you? I am generally confident but fell to pieces in front of the doctors. It was my DH who finally got them to agree. After many appointments where they just kept saying there’s no reason I couldn’t have a vaginal birth and that anxiety was normal, DH came in with me at 28 weeks or 32 weeks and said this is enough now, what does she need to do to get you to agree to a section?

We were seeing a registrar who couldn’t make the decision and kept giving vague answers like “well, she should be able to but we will have to see” but he just kept pushing the issue and said no, we need to know what’s happening - not knowing is making her ill.

She said she would speak to the consultant about it and he would let us know one way or the other at 36 week appointment - but the day after I had a call booking me in for 38+4

That would never have happened if he hadn’t been advocating for me.

I was having counselling and she offered to write me a supporting letter but I didn’t need it in the end.

You need to be firm. How it goes will depend on who you see to be honest, but you have had a traumatic time and it’s your right to choose. Some midwives and consultants are very rude about maternal request sections (I attend LMS meetings and I always pull them up when they’re dismissive about it), others are very understanding.

Know the guidelines and your rights and be firm.

@BertramKibbler - I have been looking at that and the comparison between cs and v and from what I have seen, there isn't that much more risk with cs. Plus, that doesn't just consider planned cs it's that and emcs which I know can carry more risks as obviously not planned and there's an issue in the first place which is why it's resulted in that.

I'm prepared for all of that, I may cry lol, but I know they're going to try and talk me out of it xx

I made a maternal request, midwife referred me to consultant. I had a balanced and informative discussion with them, consultant then stated they were happy to perform the c section. I signed forms to say we’d gone over the risks etc and we spoke about dates. I got a letter from the central booking clerk the next week with date. It was my first, no medical reason.

Thing is, CS does have risks and recovery can be Tough but the same can also be said for severe birth injuries - the women I know with the most longterm complications are those who had vaginal births (and of course the ones with the easiest recoveries also had vaginal births). It’s very hard to predict with first babies but after the issues you’ve had there’s a high risk of tearing or needing another episiotomy and everything that comes with that. I know what I would choose in your position.

And remember even if this were your first baby and you had no tangible reason for wanting a cs besides just just wanting one, it would still be your choice. We are told a lot about the risks of cs but vb has many risks too. VB is safer for mothers overall but CS is overall safer for babies. It’s your choice - they might imply it’s not, but it is.

You may have a wonderful appointment like the ones outlined above but you may not. It’s best to be prepared for the worst and not need it.

I was in exactly the same situation as you and they tried to dissuade me. I had to be very firm - I think I had my husband with me also and he also had to fight my corner. I'd read the nice guidelines etc. Keep asking to see someone else if necessary and don't take no for an answer. Mine was fairly last minute which made it a bit stressful!

I was 35 weeks when I got my appointment with the consultant. It was agreed and booked right there and then, though it was a palaver as there were no theatre slots/surgeons available until I was 42 weeks! Clearly that wouldn't work, so they just added me onto a general gynae theatre list instead (at 39 weeks) and told me to come straight in if I went into labour before then. Got home and they rang me to say actually could they section me the week before, as someone was off on the original date so it couldn't happen.