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!

Thank you everyone for your input anyway! Feel so clueless right now having no appointments only one 5 min telephone one with midwife anyway, can never get hold of her, feel like I'm just getting all my info on here and online!

I didn't have my appointment to decide between vbac and CS until I was 36 weeks (chose vbac, ended up with another emcs).

CS recoveries aren't always awful BTW. I was up and about within 3 hours each time, took no painkillers, home 12hrs later, doing a school run after 4 days with my 2nd. It is abdominal surgery and each recovery is unique. Mine were a wlk in the park.

Just so you know though, I needed forceps during my first cs. It isn't always either/or.

I would worry less about the birth right now and perhaps stop reading things on the internet and ask for some help with anxiety from your midwife. That seems the best steps at the moment. You're predicting and anticipating something that has a large chance of never happening so this would suggest you are suffering from anxiety

Mode of delivery is discussed much later. How many children would you like? One or two then elective caesarean is fine. Any more than that the surgical risk and risk of placenta praevia may make you reconsider. I would be very interested to know where your data is from regarding infant mortality and forceps. My understanding that lifestyle factors such as increasing obesity rates, maternal smoking status, rising maternal age and congenital abnormalities were the main reasons for infant/neonatal mortality rate.

It should be your choice, according to NICE.

With DS1, I had a long, crappy labour, failed epidural, pushed for whatever the max time for that stage was, failed ventouse, but when they cheerily said ‘we’re going to need to go to forceps’ I just said no. Not consenting to forceps. So we went to theatre for an EMCS. It was okay. I don’t regret labouring with DS1. In my next two labours I experienced problems that had become statistically more likely following that first c/s and had a further two emcs.

Good luck with whatever you choose

I recall my elective c section wasn’t agreed until around week 36/37. I knew all along that’s what I wanted (I had an elective first time due to breach) and due to the really positive experience I wanted to opt for that route again. Had five medical professionals in the room trying to convince me otherwise and it was a little intimidating but ultimately they had to go with my decision. All worked out wonderfully both times quick recovery neat scar healthy kids. We’re all different.

I felt the exact same way as you around forceps, in the end they saved my babies life but I understand where you’re coming from.

NICE guidelines are just that, guidelines. Keep requesting a c-section by all means but maybe look into other ways to ease your worries around a natural birth too. Refusal of forceps on your birthing plan, relaxation techniques, discussing worries with your midwife etc.

Good luck.

They book elective c-sections in at 36 weeks but no, you don’t start discussing having one that late at all so he was fobbing you off.

If I were you I’d ask your midwife to refer you to someone else at your next appointment. They can’t refuse an ELCS anymore for any reason but they do make it difficult to obtain one. It took me weeks of endless hospital appointments with various different consultants to get them to agree to it but we got there in the end.

Should also say I requested one because I’d had extremely traumatic births but they still made me see about three or four different consultants before agreeing to it. Even tried talking me out of it just before we went to theatre which was shit. Glad I had one though, it was great.

I just told them no forceps when I arrived at the hospital and they said that's fine. Sounds like you're worrying too much about what ifs.

Three of my friends had a c section and all said they were in agony for weeks after. Unless you have medical reasons I have no idea why you would choose to put your body through more trauma when having /looking after a baby is enough.

You may also want to consider the impact on your partner afterwards as they will need to take over and do much more in the first few weeks.

I’m not sure where you have the statistics about instrumental delivery from? A quick google search will show you that in Australia for example 26% of women will have a vaginal instrumental delivery for their first birth.

I can't give advice as I don't know the ins and outs but if it says on the nhs it's a women's choice then it should be.
From my experience I am 5ft 2 and my first was 9lb 3 and I had no intervention even though it got to the stage where they said we need this baby out, it was only an episiotomy that was going to be on the cards but that didn't happen, so don't get into your head they're gunna pull forceps out for the sake of it.
Recovery is something to consider also

My elective was booked at 38 weeks they won't discuss it early. Just hang in there

@Raaaa Hi OP,

I've not had any CS but 2 vaginal deliveries, both were very straightforward, no tears or stitches need.
Don't get me wrong it was bloody painful.
1st time round I had diamorphine and an epidural, 2nd time I just did gas and air.

2nd time was 100% more painful so take all the pain relief if your comfortable with if you choose a vaginal birth in the end would be my advice.

We only tend to hear about the less straight by forward births on these threads and the internet which of course will put the fear into us, but really when things go wrong there will be huge amount of woman who have had straight forward births.

If you chose a vaginal labour and it got to a point where you or the baby were in any danger, you can choose to refuse forceps and ventouse and go straight for an emergency CS.

The ladies I saw walking on the post natal ward when I was in looked frail and zombie like with their movement. I don't think it's something to be chosen 'just in case' something goes wrong.

However, if you are still certain nearer the time you do not want to attempt a vaginal birth then you must keep on at the midwife/consultant.

A c section is major surgery. I had no option but to have 2 c sections for medical reasons. After the second one I took arnica tablets and it really helped with the pain.

It’s very early to discuss and make decisions on this. A flat out no seems a bit unfair, but I’m not surprised they didn’t just say yes when you’re only 18 weeks. I would broach the subject again when you’re a further along, 30 weeks +, they may be a bit more forthcoming about it.

Try again at 36 weeks! That's when they book them. No use beforehand unless medically necessary

My consultant appointment with my youngest for an elective was at 36 weeks. My first was an emergency. I was fully dialated and pushing when my LOs blood gases were too low. They took me into theatre and pushed her back up to take her out. So there isn't really a point of they won't do a section unless the baby is pretty much out. She was crashing and they didn't think forceps would be quick enough.

I had an elective section officially classed as "maternal choice" that was arranged at about 35 weeks. My primary reason for requesting it was that I had PGP/SPD so badly I was in a wheelchair and couldn't stand unaided so I couldn't see how I could labour in any reasonable way that wasn't just lay on a bed.

I asked the midwife. They tried to put me off and then said "we'll have to get the consultant, it's up to her". The consultant came in, asked me why I wanted one, confirmed I had done my research on sensible websites, made sure I understood the risks, and then agreed with very little question. The main concerns from her perspective was that my mobility would be reduced post-birth (see earlier comment about in a wheelchair!!) and risks to subsequent pregnancies (so never going to happen - the PGP was just one in a list of things that didn't go well!) so it wasn't a big deal.

I don't think they are ever agreed that early. Just present your case at 30+ weeks and I'm sure you'll be fine. Good luck with the rest of your pregnancy.

@kedoo I had my planned c section (my wish rather than because breech etc) agreed at 37 weeks. Carried out at 40+1 as hospital was busy till then.

First consultant said no, 28 weeks ish from memory and the second agreed

Have you given birth before OP?

A lot of people have anxiety about the birth, I think it is worse during the early days as you barely see your midwife so it feels like they have forgotten about you (it must be worse during this time). I spoke about my birth plan a lot later than I thought I would.

I had a natural birth but nearly had an emergency caesarian and they were relieved when I didn't. So I would definitely make sure you have the correct figures for the forceps vs caesarian risks - I don't know this personally.

@kedooo I hear you, it should absolutely be your choice. Don’t let people fob you off, either here or when you’re dealing with the consultants and midwives. It is your right, you are entitled to it.
We are all different. A lot of people will tell you C sections are painful, and I have no doubt that they can be. Equally, of my NCT group the two who had sections were out and about much more quickly than me, after my failed ventouse, forceps, episiotomy and third degree tear. It was bloody sore, and I was one of the ones hobbling in the hospital corridors and for ages after. I’m definitely fighting my corner for a C section next.
Just to reassure you though that both I and my daughter are OK now. I didn’t want the forceps and the medical team were incredibly sensitive to that. It would not have been done without my consent; I agreed to one gentle tug after ventouse failed and it worked. There was no damage to baby and all the damage to me had already been done by then. Five months and a good women’s physio later, it’s all healed well and I have no discomfort at all.

My ELCs after a previous EMCS was agreed in principle around the time of my 20wk scan I think. I didn't get a date until around the 30wk mark though.
There seem to be quite a few posters (mainly who've had vaginal deliveries) pointing out how painful a CS is.
I have to say that's not my experience or that of people I know that have had a CS. I was up & about within 24 hours both times. Very little pain or scarring. It will obviously differ for individuals though.

Op

Mine was booked at around 20 weeks from memory but that was a good 10 years ago so things may have changed. The date was literally booked in the diary and then was so much more relaxed after that.

It must be an awful time to be pregnant at the moment and I would keep pushing for the outcome you want.

Good luck

It is (or at least should be) entirely your choice as to whether to have an ELCS however, as other pps have said, it's usually formally decided much later.

Re refusing forceps: I talked about this with my obstetrician a few weeks ago and he pointed out that depending on how far along the birth canal the baby is and how distressed it is, it might be the case that the only options are forceps or, if you choose emergency c section instead, they have to physically push the baby back up the canal in order to get it out via c section which is apparently fairly unpleasant (!). NB I'm only 27 weeks with my first so no actual experience of this but maybe something you want to discuss with the doctor/midwife.