Please help me with this - antenatal / ELCS St Thomas's

[CouldBeAGreatMum]

I've posted this in childbirth but posting here as I am hoping get this sorted out today.

I would really appreciate advice on this. I am choosing where to have my antenatal referral currently. After much research I had thought St Thomas's sounded best for me overall. However, I am planning on requesting an ELCS and have just seen some additional information on their website which I've pasted below. It is such early days to be thinking about birth and I am only 6 weeks along, but I am scared about choosing thew wrong hospital for my care.

For context, I am 40 and I have a history of anxiety / MH and have a therapist. My concerns are anxiety based and the ELCS is very important to me.

Here is the information they have on their website in the form of a letter to patients. Do you think it sounds like they are basically saying they won't accept ELCS requests? Has anyone ever had an ELCS at St Thomas?

This letter is to inform you of the policy at Guy’s & St. Thomas’ NHS Foundation Trust regarding request for caesarean section as a birthing option, when there are no concerns about the health of the mother or baby and no medical reasons to undertake this surgery.
If your pregnancy progresses normally, a natural birth is safer than a caesarean both for that birth, and in future pregnancies if you decide to have more children, and it is therefore policy not to offer a choice for caesarean birth.
If you are anxious about giving birth, we can arrange for you to talk to a specialist midwife or an obstetrician where you will have the opportunity to talk about your concerns. They will consider your personal circumstances and agree with you an individualised care package to help you feel confident about your birth.

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They’re saying they don’t offer CS unless there is a medical reason to do. It does say they will offer specialist support if you are anxious though. Maybe have a chat with them at your next appointment and see what they say? You can always ask to be referred to a different hospital if you’re not happy.

They are making a good and clear offer to arrange a discussion with a specialist so that they can understand your particular circumstances. This is to work out whether requests are for a good reason or not. As a midwife I would be very open to discussing elective c/section with you, I don't think it is an unreasonable request, but to my mind it shouldn't be automatic that people request and get c/section just because they ask for it. No everyone has a good reason or is well informed.
I would encourage you to accept the offer and have the conversation. Good luck!

Perhaps go to the discussion and see what they say?

Surely anxiety and mental health IS a health reason that falls into ‘concerns for the health of the mother’.

I would also ask for statistics regarding giving birth at 40 to see whether it is definitely much ‘safer’ to attempt a VB than have a planned section. If the informations shows otherwise then surely this counts as a ‘medical reason’?

I had an emergency c section followed by an elective c section at St Thomas's. I had to attend a VBAC appointment to discuss having my second baby and I was steered towards trying for a natural birth but when I said I really didn't want to try for a natural birth I was able to have the section.
The main concern seemed to be about scar tissue if I was planning on several more children but when I said I wasn't the consultant was happy to go ahead with the section.
I think severe anxiety about birth can be a medical reason for a section. Do other hospitals have a different policy to St Thomas's, I would imagine they all say similar.

Thanks for these thoughts. @Allthebubbles that sounds promising then. Doesn't sound as though they piled on the pressure too much- which is what concerns me. Would you say your overall experience at St Thomas's was good / ok?

Yes my experience both times was good. Even with my first which was a failed induction/ long old process ending in section I always felt well supported and had a midwife with me all the time.

I'd say at the VBAC appt, there was a definite steer towards natural and I felt some downplaying of my concerns. I think I remember saying what if I just refuse to try naturally? It was more in a follow up with a consultant that the section got approved. I went for a due date section as my first was really overdue and I thought if my second came naturally on time or early I'd give it go but as it was there was no sign of even engaging at 40 weeks and it was another big baby with a big head! So right decision.
I think doctors are often more pro section than midwives.