To demand a caesarean

[angel772]

I’m 33 weeks pregnant and have gestational diabetes. I’ve been discussing birth options with my midwife and she’s adamant they should induce me early if the baby’s getting too big, or let me go to 40 weeks if not. I suggested a caesarean but she said induction was the preferred route with an EMCS if required.

Having looked into this, I came across this link and am now absolutely panicking that my baby could have oxygen starvation during birth, leading to severe disabilities:

www.gestationaldiabetes.co.uk/ceiras-story/

I can’t for the life of me understand why the hospital are even considering making me try for a vaginal birth given the huge risks to my baby, who is already on the large side (5.5lb!!) and so could very easily get stuck. I feel women are offered caesareans for much less and can’t see why it’s not been put forward as an option for me. Why are they risking my baby’s health and WWYD?!

@TrashKitten10 was your csection emergency?

I've heard of that happening but again we were fine. Looking at my nct group, it was the emergency c section babies or the normal but extended labour whichhad more issues.

That is a worry. But I read it’s higher risk for caesareans performed before 39 weeks, and my hospital’s policy is to wait until 39 weeks for elective caesareans.

If the hospital need to induce me earlier than 39 weeks and that ends in emergency caesarean, that would actually be higher risk for the baby. Another reason to push for an elective caesarean at 39 weeks?!

@HelloItsmeAgain1 It was recorded as EMCS but it wasn't an emergency in any real
sense of the word. I started induction 48+ hours earlier and made zero progress so ended up with c-section. Never went into labour so can't think DD was ever distressed. Maybe just one of those things.

No issues with breathing or mucus here.

You can def ask for a c section. (A friend di after having 10lb baby but second wasn,t as big so perhaps wasn,t as big.). You can,t demand.

Induction is no picnic medically along with the forceps and ventouse that almost always go with it.

Does induction almost always lead to instrumental then?

I think I read that the earlier you get induced the more likely it is as well

Induction has a higher rate of intervention including ventouse forceps and emergency c section

At my local maternity unit 45% of first-time mums being induced will end up with an emergency c-section. The annoying thing is this was never even mentioned or explained when I was casually booked-in for an induction when I became overdue with my first. Of course it’s still often the safest option but I really feel women should know something so statistically significant beforehand, if only to prepare and have a better idea of what’s ahead.

At my local maternity unit 45% of first-time mums being induced will end up with an emergency c-section.

That’s so high. How do I find those figures for my hospital?

Induction doesn't inevitably lead to intervention at all. It is a higher risk than natural labour, but not inevitable. I had 3 inductions (35 weeks, 38 weeks, 40 weeks) and no instruments of any kind.

Because I’ve read that hospitals are often reluctant to offer caesareans to meet their targets and I’m worried thats why they’re not offering one to me.
Where have you read this? Is it a trusted source? It's certainly not true at my local hospital where I know women are encouraged to have a section if that's what the consultant feels is safest, often even when the women has said she wants to try a vaginal birth. Consultants seem on the whole risk adverse and will always reccomend the safest option.

@Nonnymum it really varies with hospitals, I know some hospitals were in the news because they were refusing maternal request c-sections. When you looked closer at some of them they seemed to be really tough in general on granting elective c-sections- even in situations that other hospitals would deem a ‘medical reason’ to have one. So surely it could be assumed that some trusts indeed do use this approach in order to keep their overall numbers lower?

@angel772 I think I googled my hospital maternity unit and statistics together, pretty sure all units will have data online you can view.

You can request an elective section but crack on as you'll soon be out of time. Read the NICE guidelines and be informed as they are very used to, and good at, disuading people.

kittykat7210 I also had a shoulder dystocia with first baby and I had none of the risk factors. He was only 7lb4oz and he was born in the pool until he then got stuck. Midwife pulled the plug and I stood up so gravity brought the rest of him out and caused a third degree tear.

For second baby, I asked for and was granted an elective section. However, I went into labour in the night a week early. Surgical team were doing an emergency when I arrived and I progressed so quickly that I gave birth vaginally within an hour of arriving. Baby was 8lb9oz and I had only a couple of stitches. I was home before he was twelve hours old. I had been really worried about causing more damage but it went really well. In hindsight, I’m glad I didn’t have the section but at the time of requesting it, I just didn’t know how it would go.

Op take a look at this page

It’s a charity set up for women who need support getting the birth they want. They also have useful info on if your hospital follows nice guidelines etc

www.birthrights.org.uk/

At my local maternity unit 45% of first-time mums being induced will end up with an emergency c-section

OP I am sure you will come to the conclusion that’s right for you, together with your medical team.

Just wanted to pop in to say that you have to think carefully about numbers like the above - the reason there is a high rate of CS following induction is more to do with the reason for the induction, not the induction itself. The most common reasons for inductions are either being over 41 weeks, or waters having broken without going into labour, or baby being small (amongst others). All of those things have a higher risk of CS regardless of whether you induce or not. Just to put things in perspective a little!

I’d suggest it would be a good idea to wait and see how baby is growing and how you are feeling at 37-38 weeks and make a firm plan at that time.

Good luck :)

For those saying you can't demand a c section. Well obviously demanding isn't the right word, but legally before a baby is born it is the mother's choice what happens and they legally have a right to oblige I'm afraid.

You sound really anxious about the birth so yes, if a c section would help that then you should have a c section. You can absolutely demand one. Hospitals have their targets but medics are only ever there to advise and not make the decision for you. You are 'allowed' to give birth any way you choose and that includes an elective section.

Do bear in mind that weight estimates are notoriously inaccurate though as you can't tell the difference between weight and length in utero. My DS1 was predicted to be 11lb and he was 8lb 11oz at 2 weeks overdue. DS2 they swore would be 13lb! Glad I told them to f off and carry on with my homebirth because he was also 2 weeks over and weighed 9lb 1oz.

DS1 was induced and if I had to have another induction for any reason I would insist on a c section. Inductions don't work unless your body is ready for labour. How we didn't end up with forceps I'll never know.

I’ve been looking into this more and a caesarean sounds so much safer for the baby. There’s no risk of the baby being deprived of oxygen or getting stuck, or brain damage from the use of forceps. I really can’t see any positives to induction at all from the baby’s point of view (not bothered about myself).

@angel772 that was the exact conclusion I came to.

I've got no experience of GD but I do think you sound very worried about a VB and it would help your mental health to have an ELCS.

I don’t feel my mental health even comes into it sadly.

Sections are virtually NEVER the safest option, all things being equal.

Totally disagree. ELCS sounds extremely safe for the baby from what I’ve read. They won’t be starved of oxygen or face distress from getting stuck for starters. The only issues are recovery for the mother but I don’t care about that. I just want a healthy baby.

Also, with Covid 19 I want to be in and out of hospital as quickly as possible. ELCS is actually likely to be quicker discharge than an induction!!

If they won’t agree to caesarean then what can I do - can I say that I will need to change hospitals to a different trust?

I’m not putting my baby at risk because the hospital is reluctant to perform what is a very basic surgical procedure that takes them 1 hour tops.

They have to provide an ELCS for maternal request. You don't have to have a good reason. Or any reason at all. If you want one, you get one. If your consultant won't do it they have to refer you to one that will. Or that was the case when i did my research- check the NICE guidelines.

My advice - at every appointment tell the consultant that you have done your own research into the risks of induction vs elcs and you have decided you want an elcs. If necessary, tell them you do not consent to an induction. They cannot do anything without your consent although some consultants forget this.

I did all my own research and i came to the same conclusion as you - elcs is overall safer. You know the risks with a cs. If you go for an induction, you have a higher chance of other interventions such as forceps, which have a relatively high risk of injuries to you and the baby. I seem to remember that with a c section the risks are mainly to the mother. Personally i was happy to take those risks onto myself. Any benefit from them being pushed down the birth canal are minimal compared to the other benefits of a c sec. You completely avoid the risk of serious tears, baby being stuck and having to be pulled out. You may have the best natural birth ever. You might not. You've no way of knowing until it happens and by then you could have all sorts of issues.

I was talked into attempting a natural birth. If only id insisted on my right to a c section, i could probably have avoided developing ptsd from a traumatic birth. I trusted the consultants and in hindsight i should have trusted myself. Listen to your instincts and stand up for what you want.

Some hospitals are targeted on reducing c section numbers by the way.. that's why they're so keen for you to try natural.

@angel772 speak to another consultant, ask to be referred to one who will agree. Have a look at the NICE guidelines.