Requesting an elective c-section - help and advice?

[RubaiyatOfAnyone]

In a few weeks time I have a meeting at 16 weeks with a Consultant to request an elective c-section. I have been told by the midwife to consult the NICE guidelines and Royal College of Gynacologists and Obstetricians guidelines as well to make my case, but I'm having difficulty finding the relevant sections to be able to quote as I do not fit any of the main criteria listed, and wondered if anyone who had done this before might be able to advise? The MW did not make it sound like an easy request to make so I don't know how difficult it will be to persuade the consultant.

Just as background, my first pregnancy ended in pre-eclampsia diagonised on my due date, so straight to hospital for induction which took 24 hours and ended in a ventous delivery and episiotomy, and was about 5 minutes away from giving up and going for an emergency c-section when I finally gave birth.

That bit would be fairly standard and I wouldn't mind going through it again. However, the umbilical cord snapped and i had to have manual removal of the placenta. About an hour later in recovery i had a primary post-partum hemorrhage and passed out, and came round to find I had needed two units blood transfusion. I was discharged 3 days later, but never quite felt 'recovered' from my birth and always felt a bit weak and 'off'. Three weeks later I collapsed at home with a secondary post-partum hemorrhage and lost a lot of blood in huge clots. I was blue-lit to hospital and they did an emergency op to stop me bleeding and gave me 6 units transfusion. The surgeon was unsure what was causing it and basically told me that it might be tumours in my womb that the pregnancy had masked so I was terrified. Thankfully, 3 days later the histology results confirmed it to be retained placenta which they were able to remove. Unfortunately, the three weeks it had been there left me with ecoli blood poisoning and a high fever and all my veins had collapsed so I could not go home to be treated with anti-biotics, but had to remain in hospital for two weeks on a central line.

I am understandably not keen to put myself in a position again where the surgeon's first words to my husband whilst i'm still unconscious are 'Well, the good news is she's not dead.' An elective c-section seems to me a good idea to hopefully avoid it. But...this situation is not any of the NICE guidelines, so if i get an obstructive consultant I'm worried he/she would not accede to my request without a bit of concrete evidence to rely on. Can anyone point me in the right direction?

If you look at the birth rights website, that should give you a lot of help. You don't need a reason to request a c section and if the consultant you see refuses, you have the right to be referred to one who will agree. They might make you see someone like a mental health nurse to discuss but they should grant it to you - fwiw, mine was agreed without any fuss at all because I have a history of PTSD and I said I was concerned about the impact that a vaginal birth would have on my mental health and ability to bond with the baby when born. I'm sorry you had such a tough time with DC1 and I hope you get what you want this time round.

Hi!
I had a traumatic birth with DC1 and at my booking in appointment with the MW I mentioned I wanted a ELCS. They made an appointment to see the consultant at 16 weeks and she couldn’t have been nicer; she actually recognised me from in theatre delivering DD 🤣 She went through the pros and cons of a vaginal birth vs a CS but didn’t try and change my mind on the CS and booked me in there and then - I’m booked in for Friday.

My experience wasn’t anywhere near as traumatic as yours and they were happy for me have the ELCS, I’m sure if you explain exactly why you don’t want that again it won’t be a problem - your welfare has got to be a priority.

Thank you both, it's incredibly reassuring to hear that you both had no problems getting what you requested - and very interesting to hear that you can request another consultant if there are problems.
I think i just got spooked by the booking in MW who kept saying things like 'Well, you can ask, but it will just be maternal request which isn't a sure thing'.
Windmill47 - best of luck for this Friday! How very exciting.

I'm currently 15 weeks pregnant and had a traumatic first labour. I requested a section at my booking in appointment. I talked to the midwife about how traumatised I was by my first labour and how it made it difficult to bond with DS and the anxiety I feel about going through another natural birth. She was very supportive.

I saw the consultant about it a couple of weeks ago after my dating scan and he couldn't have been nicer. In fact he was so supportive and put no opposition to me having an elective c section that I couldn't stop crying at the poor man.

I definitely think talking about anxiety about a natural birth seems to help your cause. This seems to be backed up by NICE guidance too. Section 1.2.9 here: www.nice.org.uk/guidance/cg132/chapter/1-Guidance#planned-cs

You want points 1.2.9.5 and 1.2.9.6 of the NICE guidelines:

1.2.9.5 For women requesting a CS, if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned CS. [new 2011]

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]

Basically, if you hear them out but haven't changed your mind, they're supposed to go with that - and if they won't do it, they have to refer you to someone who will.

I had a EMCS with my first DS, with my second as soon as I saw the consultant they started discussing options of VBAC or ELCS & I said no thanks to VBAC I definitely want an ELCS and they got the diary out then and there and booked me in months ahead of my due date, it was weird knowing the birth date so far in advance! I think just be firm and you should not, I hope, meet too much opposition!

Thanks for posting this, I was going to post the same as I have a similar appointment coming up. I'm going to bring the birth rights things too.
I had a similar birth to you with a bad third degree tear, luckily didn't have the complications that you had afterwards but the birth and aftermath were terrifying. I thought I was dying after the PPH.
I have an irrational fear that I'll be denied an elective at the meeting but most health professionals who've treated me since then have been supportive and said it's my choice so fingers crossed the consultant will be understanding.
I know myself that I just mentally can't cope with another vaginal delivery so I hope they take it seriously. Have read lots of nice stories about ELCS here. I'm going in with the attitude that this is what I want and nothing else is acceptable.
Good luck, given your complications I'm sure they will take you seriously

Hello. I'm due in a few weeks and am seeing a second opinion consultant on Friday for a maternal request caesarean section due to a brain condition which is triggered by heat and exertion. You should look at the 2018 birthrights.org.uk report as PP have mentioned. As for the NICE guidelines I have highlighted1.1.1.1, 1.1.2.2, appropriate sections in 1.2.9. You need to show also that you understand the risks of CS and your consent is free and fully informed- see the case of Montgomery v Lanarkshire where the Supreme Court ruled this consent to risk has to be respected by doctors.

Sorry you had such a horrible experience OP. I hope your hospital treats you well and takes your (utterly reasonable) request seriously. Just in case they don't, I can recommend contacting Birthrights as someone else suggested (birthrights.org.uk). They are very friendly and helpful and can tell you all about the NICE guidelines and anything else you need to know. They may also be able to tell you what they know about your hospital's policies before your meeting, if you'd like to be prepared. It's unlikely your hospital is as bad as mine with this, but if they were to refuse your request, you also have the right to go to another hospital. In my experience it was easiest and fastest to get this referral done via my GP rather than go through the possibly very long and stressful midwife/consultant/psychologist route. Good luck!

OP you poor thing! I had a shit labour that ended up in an crash c section. I fell pregnant 10 months later and at the time our trust was really cracking down on ELCS and I was so worried I had to fight.

I went to my consultant appointment armed with all my research and rights but he literally just said to me 'let's not muck about here my advice is an ELCS if you're happy with that' (along those lines) I was so shocked!

So my point is you may be surprised at how they will understand and support you. I think everyone seems to think you have to fight for sections now but I don't think it's often the case

Hope it all goes well OP.

In my experience of a difficult first birth resulting in an EMCS and then having a second elective, everyone I saw was fully inboard with my request for an elective. I only encountered one locum consultant who told me it wasn't a good idea. She clearly hadn't read my notes.

At every appointment, they do explain the risks of a section. They do tell you it is statistically safer to have a natural birth with less risk of complications etc. But no one ever told me no.

I really don’t think you will have any problems being granted an ELCS. Remember the consultants also don’t want you coming back in 3 weeks later with retained products and haemorrhaging as they’ve then got to a) fix it and b) explain how they missed it under manual removal. They won’t want to risk a repeat anymore than you do. Explain what happened, tell them it was traumatic and you don’t want to risk it happening again. I would honestly be gobsmacked if they refused. They will just explain the risks of an ELCS and make sure you’re happy.

Amazing how you have to prove why you want a section.

I had an EMCS with DS and it was basically a given that I was 'allowed' one with DD. No persuasion or quoting guidelines necessary! I live abroad though.

Having an elective caesarean section will not prevent you from having a PPH, OP.

I thought I should point that out as your reason for wanting one isn't valid.

Gosh, i didn’t realise there had been more replies. Thank you all of you, both for the support and for those of you kind enough to highlight specific guidelines and organisations to start researching - that makes it a lot less intimidating.

To the pp that said a caesarian does not reduce the risk of PPH - i am aware of this for primary PPH, but unless i am shown evidence otherwise, i believe it would reduce the risk of retained placenta, which caused the life threatening secondary haemorrhage.

Thank you all again - it has surprisingly been remarkably cathartic just to write it down and have some one other than me confirm it was an unusually crappy experience. You don’t get a chance to discuss birth much after the newborn stage IRL.

I’ve requested a section at my booking appointment last week! I’ve already had 2. The consultant on my last said if I choose to have a section and babies after would be by section. I said that’s fine by me! I’m hoping I have no probs with getting another 🤞🏻

@RubaiyatOfAnyone Did you have your appointment?

I had a second opinion consultant appointment this week and she apologised and said that the request should not have been declined and she was granting on health grounds, not maternal request. She was absolutely lovely and it was so different to my previous experience. Just to give some hope to posters that a first and second appointment may be completely different!