Turned down for elective caesarean 18 weeks

[kedooo]

Hi, so I spoke to a consultant about a maternal choice elective caesarean and he said as I have no health conditions I have no need for one. I explained my reasons for wanting one, understand the risks of cesarean delivery, happy to take them, quoted statistics. He said it's too early to be asking at 18 weeks, I asked if I can be referred to another health board or consultant then and he said this is something that would be considered much further down the line when I'm 32-36 weeks, won't it be too late then though?

I already spoke to my midwife who said no as it's too expensive for the nhs, I said this isn't her decision to make, so she referred me to this consultant.

On the NHS website it says it's a mother's choice, and the NICE guidelines say this too. I quoted this and the consultant said it's something they'd consider much further down the line closer to the end of my pregnancy.

Is this correct or am I being fobbed off? Understand things are difficult now with covid. I may talk to the Midwife's when I go for my 20 week scan in 2 weeks or call up my midwife and ask if I can speak to another consultant (although she wasn't very nice when I said I wanted an elective cesarean the first time around). Or is this all a waste of time right now as I've read about other women on here having their elective cesareans cancelled due to covid.

Any advice would be much appreciated!

It’s pretty standard practise to wait until 32-36 weeks, a lot of these decisions are made at 36 weeks. I had an selective cesarean that I chose as soon as I got pregnant; but this was the safest option for me as I’ve had my large bowel removed so natural delivery was too dangerous in preserving my pelvic floor and my consultant told me I needed one so I was lucky to know I was having one the whole pregnancy, but I do know a lot of women are asked to wait until 32-36 weeks.

Also I had my baby three weeks ago and no c-sections in my hospital had been cancelled due to Covid.

Yes I think they're right about discussing it far later on in the pregnancy. I didn't discuss elective c section until well after 30 weeks. Had a natural birth in the end.

I have had both, although my first wasn't a scheduled action but an emergency one. I'd go natural any day

I discussed an elective section at my first consultant appointment at 15 weeks and was told it wouldn't be officially agreed until 32-35 weeks (and this was pre-Covid) then they would book it for about 39 weeks.

It also depends on your trust. At mine it is made clear that elective c section won't be granted without a genuine medical concern. This can include sever anxiety about giving birth.

Whatever stats you quite there are a thousand more against c sections, and any birthing option there are always risks no matter what.

However,c sections and inductions generally aren't booked until 36w as usually the condition of baby and mum at that point will stay the same (breach positioning, mothers anxiety, placenta previa to name a few etc)

So you're not being fobbed off.

I did look at a study by birthrights I think which said that my trust does do them. Just worried won't it be too late to change trusts/hospitals by time I'm 36 weeks? I have seen on here other people say they've had theirs booked in earlier and theirs was maternal choice (no medical reasons) it doesn't seem consistent at all

What's your reasons for wanting one out of curiosity?

I don't think you're being fobbed off, my appointment to decide on vbac or book c section is at 36 weeks. Sometimes they do get booked in earlier but a lot get booked in at this time.

I’m 33 weeks and still haven’t had mine approved yet or signed any forms and I have some medical reasons (breech baby, gestational diabetes and baby measuring big, scar tissue from 2 previous operations on labia), so even with medical reasons they still leave it until 32-36 weeks. I’m seeing my consultant at 35+4 and I imagine it will be discussed here, but until then I won’t have had anything agreed to, so I can’t see why they would agree to one so early on without any medical need. Just wait it out, you’re still early on and there’s plenty of time!

Ok thank you everyone for your replies!

Curious as to why you would want one?

My personal experience has been 2 natural births with no pain relief of any kind not even gas and air. Not through choice as I was open minded and would have probably taken an epidural or some type or pain relief but on both occasions I was too late.

Afterwards I was glad as I had no side effects from any drugs for me or the baby and was able to get up right away and move around.

I had a tear and an cut down below with my first but I could still walk. I seen others in my ward wobbling up and down after c sections and saying they felt very sore and looking more like they where recovery from an operation than just having birthed. I don’t think it’s an easy ride as people may think having a c section.

I recently went through abdominal surgery myself and while I was much more invasive operation that what a c section would be, there is similarities. Having massive cut along your stomach isn’t easy. It took me weeks to manage to get out of bed myself and sit down without yelping and I was taking pain relief around the clock every 4 hours for the first 3 months. I know it’s different from a C section but you would still have to be cut open and that cut healing can be the cause of so many issues.

As painful as labour was at the time it was a natural pain which comes to and end you and get something so lovely from it.

I realise there's risks with cesareans too and I by no way think it's an easy way out. Main reason is to do with use of forceps in vaginal births and the dangers of these, they're used a lot more in UK than other Western countries and its partly the reason why we have the highest rate of infant mortality in Western Europe. If UK didn't use them so much and ventouse (15% of births, compared to 2-3% in Australia, USA, other Western Europe countries) I would feel a lot more comfortable about a natural birth. I feel if I'm supposed to have a choice according to the NHS site I do then I will ask for one. I know the NHS prefers doing assisted delivery to c section as it's cheaper but there are a lot of risks which they don't tell you about, they only seem to mention the risks of c sections which they do a lot of emergency ones anyway which are more dangerous. Also if I have a planned one I can avoid an emergency one

I don't believe a midwife said it's because it's more expensive. She will have no clue how the costs work. You are absolutely within your right to choose a c sec but as others have said don't worry about it being confirmed until 34-36 weeks. Even if you go into labour you can ask for one. They may counsel against but if you want one, no matter your reasons you can have one.
The consultant was probably just being cautious and aware you have 18 weeks or more to make a decision, however sounds like they weren't very clear about that.

The NHS will not refuse c section on grounds of cost.

I'm an NHS manager and although haven't managed women's and children's dept, I have managed anaesthetics and obviously worked very closely with mat and understand a lot of coatings around c sections

An elective is never 100% guaranteed. I was booked for one after a traumatic first birth. The date was agreed at a 36 week appointment. However, I went into labour in the middle of the night at 38+6 and although they said I could have the section even though it was night time, the only surgical team was doing an emergency when I arrived. I gave birth vaginally with only a couple of stitches needed. Baby was 8lb9oz so just decided to come a week early. You can’t plan for that.

You can not consent to forceps. They can't force you to use them

Yeah I'm surprised she admitted that they don't like doing them because of the cost but she did

But if the baby is struggling and is too far down to do an EMCS then I feel I will have to of course to save the babies life.

I realise if the baby is born premature then of course I won't be able to have a planned one

So what do you think they do in other countries of the baby is stuck and cannot have a section?

If during your labour it got to the point of an assisted delivery you could decline and have a c section instead. Forceps aren't a definite in labour (just in case that makes you worry a bit less about this being your only option).

Definitely ask to speak to another consultant further down the line though.

They must do an EMCS before it gets to that point. That's what the stats are so that's the only way I'm assuming they have lower rates of forceps and infant mortality than we do

I'm not offering advice because not in your shoes but, honestly, plenty of people give birth without either a C-section or forceps so why are you worrying at 18 weeks?

DS was a ventouse delivery, he had a funny shaped head for a bit but neither he nor I had any issues afterwards. I don't know if that can help to reassure you? However there is nothing to say you won't be allowed an elective caesarean, just that you need to discuss it at a later date. It must be an anxious wait though.

Can you share sources please OP? I knew UK infant mortality was poor but I haven't seen anything showing specific figures for birth deaths and anywhere that indicates assisted births might be a cause.
I've a friend who is a very experienced midwife who had 2 forceps deliveries herself. I'm sure if she knew there was a good chance this might cause death to her children she would have no way gone along with them.