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!

Hi OP I had my first consultant appointment at 14w but they were mainly concerned about me at this stage (blood pressure, any sign of UTI, prescribed aspirin etc). I did mention I wanted the option of ELCS due to previous birth trauma and I was advised there is plenty of time to decide and discuss that and try not to stress worry about it at this stage just focus on a healthy pregnancy.

My midwife did refer me at booking because I raised the preference but I didn't get my appointment through until 31w. It was verbally agreed to (by this time a telephone only appointment due to Covid) and I got my ELCS date at 34w.

I think it must be on your notes already but they just don't schedule that conversation/decision until later.

Your midwife saying no because it's too expensive is being ridiculous though - but good you know your rights and really be insistent on what you want. They can say things to discourage or convince you but if that's what you really want just stick to your preference.

Good luck!

Hi,
I have attached the RCOG (royal college of obstetricians and gynaecologists) information leaflets on instrumental deliveries. They are all in evidenced based so safe information.

Here is the one on instrumental deliveries:
www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi---vaginal-birth-final-28.04.2020.pdf

This is the Caesarean section one:
www.rcog.org.uk/en/patients/patient-leaflets/choosing-to-have-a-caesarean-section/

When you go to your appointment you can discuss them etc and will help guide your decision.

Hope this helps x

Your way to early - wait until over 30 weeks.

I have to say though that I always preferred c section as an option for the same reason - I was desperate to have one - I've known children left brain damaged through forceps delivery.

I ended up with a c section due to having a breach baby.

4 years later I'm completely infertile - scar tissue and adhesions from the c section destroyed my tubes and led to 2 ruptured ectopic pregnancies where I nearly died.....twice

If I had my time I again and there was no medical need I would never have a c section

It all depends on your health trust. With mine I had an initial discussion at 18-20 weeks where I was told to think long and hard about if an elective c-section was the right choice. I then had an appointment at 36 weeks where I had to argue my case. It was approved and I was booked in for 39+2. It varies greatly with different trusts. A friend who lives in a different health trust area was approved for an elective c-section at 12 weeks! She knew her date at 12 weeks! Its much more expensive for the NHS to provide c-sections than vaginal births; but fundamentally your midwife should support your decision. Ask for a different midwife or ask your doctor to support you in your birthing choice.

It is your body and your choice - whatever anyone else thinks is irrelevant! Be prepared to fight though if you have no underlying heath condition and its purely based on choice! Good Luck!

Hi op, my ELCS wasn't confirmed until 36 weeks so don't panic - just make sure you have an appointment around then and chase up if not. I believe women are entitled to the birth they want. I also would add that I have had both a vaginal birth and a c section and a c section was by far the better option - I was home after 24 hours. After my vaginal birth I was in theatre under GA for 6 hours after and HDU for nearly a week. I also couldn't stand / walk for weeks afterwards. I was up and about the next day after my c section. My ELCS was 6 months ago and I honestly feel so much better at this point than I did 6 months after my VB. It is NOT guaranteed that a vaginal birth will be straightforward or easy. It is also not the case that every woman who has a c section is in pain and unable to manage for weeks afterwards. I went home and was able to manage with my newborn and toddler fine. Good luck OP with whatever you choose.

It’s standard practice to discuss this closer to the time but dependant on the hospital you may not be given a C-section simply because you want one. They’re becoming increasingly popular and some hospitals struggle to meet demand and have to prioritise those with genuine health reasons.

I gave birth 7 weeks ago and was very nervous, as you are. Personally I would strongly recommend an epidural, other than a lot of pressure (you would get this in a C-section anyway) I had no idea I was giving birth. It’s all the benefit of c-section but without the major surgery and should things take a turn for the worse then they’re more likely to sweep you in for an EMCS than start faffing with forceps as you’ve already got your anaesthesia in place. Good luck either way XX

If it's the woman's choice I dont understand why it can only be discussed at 36 weeks or why you should have to argue your case.

With my second child I had my elective section agreed very early on about 15 weeks but that was only because I have health issues and also my first child caught strep b from me during natural delivery and ended up in ITU, so they were happy to agree early for my health and babies health, but my friend who's baby was due the same week as my second, and had no "reason" to have a section except she wanted one, she couldn't get hers definitively agreed until after 32 weeks.

@KatnissK totally agree and well said

Can I ask would you go through a major operation if you didn't have too?! No I'd imagine?!
The safest route for mother and baby is normal vaginal delivery. An elective / emergency lscs is either for women who's baby is hypoxic (lack of oxygen) and showing feral distress, multiple pregnancies (even twins can delivery and safely)! Breech, amniotic fluid embolism, placenta praevia, placental abduction, failed induction, pre eclampsia etc. Also if you were paying for an elective lscs would you choose it over natural delivery? And also forceps are used much less it's more ventouse and the baby has to be very low in the pelvis and in the correct position. I think unless you have an actual reason the NHS should never agree and won't agree to an elective lscs because it is still major abdominal surgery! The nhs want women to choose and have a birth plan suited to them but not to choose an elective lscs for no medical reasons is ridiculous because they don't want to go into Labour.

I had to have forceps during my elective section (2nd child, didnt want to VBAC). I had no idea that could happen, but my daughter was completely wedged in my pelvis and they couldn't manually get her out.

Having a section doesn't always mean you avoid forceps!

It was decided by my consultant team that I was having a cesarean when I was 14 weeks. Failed GTT 2 weeks later and moved to my diabetic consultancy team who said cesarean was my safest option.

Hi, here's my experience with 2 different trusts 30 miles apart
Trust 1: Mentioned it at booking in appt, they said I'd get a consultant appt at about 30 weeks to discuss it. They then didn't sort this and I had to chase it after my 30 week scan. At the consultant appointment, she explained the risks (aka all the things that COULD go wrong), asked me some ridiculous questions (What will you do if you go into labour naturally and you are 7 cm dialated when you arrive? What about if you are 3 cm dialated? -Er, how the hell am I meant to know until I'm in that situation). Didn't listen to me, talked over me, agreed to c section, signed off on it and then said they'd call me 2 weeks before the c section. I was requesting this for mental health reasons due to a traumatic first birth. As you can imagine, not knowing when I'd have the baby didn't help my mental health.

Trust 2: Went along at an appt at 28 weeks, they explained the risks, listened to my reasoning, explained my options, brought in another consultant to explain the procedure. I agreed to go away and think about it to make sure that was what I wanted and we made an appt to come back at 34 weeks to get me booked in if that's what I wanted. I decided at about 32 weeks that I wanted to definitely have a c section, so called the consultant, he booked me in then and there.

So what I'm trying to say is, all trusts are different. I'm sure you can tell which is the more women centered trust from the 2! I actually am having all my antenatal care at 1 trust and having my baby at the other so you can switch trusts.

Don't let them to fob you off - if you know what you want, you know what you want. Even if you have to wait until 32 weeks, get that appt sorted NOW and go in armed with info and if the consultant says no, tell them to refer you to another consultant.

Oh, and if I can recommend 1 book to help you understand your rights about birth, it is Give Birth Like a Feminist.

Good luck x

I raised elcs at 8 weeks with midwife, saw consultant at 16 weeks where it was agreed in principle (not confirmed) it was great had an anxiety free pregnancy as I knew my birth choice was in hand. Got to 36 weeks and two different consultants told me I shouldn’t be having a csection, I told them I didn’t care I discussed it with the consultant at 16 weeks and as far as I was concerned it was agreed. They reluctantly agreed. I went into labour early, consultant on duty again questioned having the c-section. Thankfully the midwife called everyone in for an emcs which I thankfully got. I was in no way prepared for a natural birth.

It was great, recovery was easy and has no problems breastfeeding (almost two years ago).

Stand firm you are allowed an elcs under nice guidelines.

Mine was arranged at 36 weeks so I do think that’s the norm- makes sense as they don’t really know the lay of the land til then, for example most sections are at 39 weeks but I had mine at 38 as there were concerns about my gestational diabetes and the baby being too big.

@LondonernotinLondon, it’s really not the case that any vaginal birth is the safest route. A straightforward vaginal birth is. And no one can guarantee you that. As it turns out, a C section would probably have been safer for both me and my daughter. And re forceps not being used a lot: 3 of the 5 of my NCT group who went for vaginal births had forceps. Three of us also had episiotomies. I know many others who had forceps also. Anecdotal evidence maybe, but it doesn’t sound rare to me.

There seem to be quite a few posters (mainly who've had vaginal deliveries) pointing out how painful a CS is.

I've noticed this too. As someone who has had two very easy (proper walk in the park) recoveries and had zero issues with pain, it makes me dubious. It might be these anecdotes came from friends of friends with crash sections etc, but most women that Oct known (including me) who have had planned sections have had excellent recoveries. As for me, I was the most spritely out of my NCT group, as everyone else had either emergency sections, forceps, ventose, or extensive tearing. Only one out of the other 6 had an 'easy' birth.

My sections have been confirmed at 12 weeks, but I'm severally tokophobic, which was very obvious to them. I wouldn't want to wait until 36 weeks to discuss, but I agree it might not be finalised until then.

Hi OP - well done you for being firm about your choices. I have ongoing issues 9months pp after a forceps delivery and my baby has permanent scarring (registrar attempted forceps delivery on back to back baby before baby was eventually removed in theatre with Keiland’s rotational forceps).

My recovery was horrendous and I would definitely be requesting a c section if I wanted another child. As it is, my husband has already had the snip because the whole thing was so traumatising.

No-one ever mentioned forceps or their potential dangers prior to the birth, and it was not presented as a choice at the time. I feel quite angry that a lot of energy seems to be spent on putting women off having sections and not enough on informing them about the risks associated with other interventions.

Sorry - rant over!

I had it written in my birth plan that I would prefer a c section to forceps unless there was no other option. When I was transferred to the labour ward from the birth centre my midwife said that this decision was absolutely fine and my choice to make. So you could always do that and attempt a vaginal birth rather than going for an ELCS if you wanted.
In the end I had an EMCS, with minimal pain and a very easy recovery - a much quicker and easier recovery than several friends who had vaginal deliveries - so a c section doesn't necessarily mean a harder recovery.

mummymathsteacher
This happened to me during my second and last EMCS.. MY DS2 was so firmly wedged in my pelvis he had to be got out with forceps.
I only found this out when I asked why he had a red mark down the side of his face and this was three days after.
I had a failed trial of labour (this is the name attempts at VBAC was given nearly 48 years ago)I was refused an elective section because ''we like to give you a try''.
Well I had the tubal tie done so no one could give me a try again.

I told my midwife at 12 weeks I wanted a section, she referred me to the consultant. I saw him first at 20 weeks where we discussed my reasons for wanting etc then I saw him again at 36 weeks to get my date. I think the current NICE guidance is that is the patients choice and if you see a doctor who isn’t happen to perform the op they must refer you onto someone who would be willing to.

I have just been booked in for a c-section and I'm 28 weeks. My two previous deliveries were via c-section.

Although I'm not high risk, the consultant seemed happy with (in fact he expressed a preference for me to have) another c-section.

I don't think you're being fobbed off, but you may need to brace yourself to have exactly the same conversation with (another) consultant at 32-36 weeks...

My elective was booked at my next appointment after my 20 week scan; my consultant said she didn't like to book them before then. Mine was maternal request and I had no issues getting it agreed (the consultant said she would always go for one herself) and it was a great experience with a very easy recovery. I basically just said that there was no way I was giving birth vaginally and that was that. You're absolutely within your right to keep asking - you should be referred to another consultant who will agree. Obviously things are a bit up in the air at the moment so I'd probably leave it a month or two.