C-section on mental health grounds

[Luckyme30]

Hi all

Just wondering if anyone has been through the process of requesting a c-section on grounds of mental health?

I have PTSD and also Tokophobia (fear of pregnancy/childbirth) and I am seeing a psychologist privately as the peri-natal team have said I am low risk so can not support me.

I have requested via the midwife an appointment to discuss a c-section with a consultant.

I don’t know what to expect and I am very anxious which is worse when I’m in front of a medical professional having to explain my thoughts/feelings and my phobia and wondered if anyone had been down the route of requesting a c-Sec for this reason and if they were understanding?

I should probably add my local trust (the John radcliffe in oxford) have a really strict policy on maternal requests and do not allow them unless there is a ‘medical need’.

My best friend had one , terrified of giving birth, had some counselling by NHS but still had elective C section

That was 2017 York Trust

Thank you, I’ve looked at my particular trusts guidance and it states ‘you will be referred to the perinatal team for counselling’ which is ironic as I have literally had to beg the Perinatal team to speak to me - even after begging they decided I was low risk...

Hi, I’m requesting a c-section on similar grounds. I have a history of anxiety and hemiplegic migraine (stroke like symptoms - temporarily disabling) brought on by severely stressful situations. Although I’m not tokophobic, the thought of the unknown in childbirth worries me greatly in terms of the risks to the baby and I - if things are prolonged, a problem occurs, etc. My choice is for a c-section on the basis that it’s planned surgery and gets baby out quickest/safest (IMO) and if there’s any problem like haemorrhage, I’m in the right place to deal with that immediately.
I’m at a Trust that very much supports maternal choice. I have been asked to keep an open mind about my options but my Consultant said ultimately he will grant me a c-section at my 32 week appointment if that is what I decide and he does completely appreciate my reasons. He is also very supportive of the woman’s choice. I was referred to him specifically by my midwife team as I have been open from the start about my concerns about a natural birth in my position.
Have you considered potentially moving hospitals? Birthrights (the charity) will list the hospitals in your area and provides the data on how in favour they are of and how many elective c-sections they carry out. Ultimately according to NICE guidelines, it is your choice as to how you give birth and if you choose a c-section and your hospital won’t grant you one, you do have the right to be transferred to a Consultant who will grant you one.
I’m researching all the risks and benefits of both types of births so that my Consultant knows that I’ve fully considered all of the issues and am making an informed choice. It’s hard because I feel like the onus is on me to justify why I should be granted one/that I will be grilled in an interview type scenario, so that’s stressful, but I’m prepared to stand up for myself because ultimately I have to do what I know to be right for my baby and I in my situation.

Yes I had one. I have Tokophobia. I had to speak to the perinatal mental health team. It was only over the phone. Then the consultant made the decision but it was fairly late on in the pregnancy I think around 32 weeks so I was anxious until then. I also have vaginismus and had a bleed during my pregnancy. The doctor couldn't examine me even with gas and air as I couldn't handle the pain. The next step was to be examined under general anaesthetic so I think they realised that doing sweeps or giving birth just wasn't going to be possible!

Check the NICE guidelines you are entitled to it.

@PoodlesAreMySpiritAnimal thanks for that info, it sounds like you have a very understanding consultant which I feel is half the battle!

I have had a look on the Birth Rights website and have contacted them as they are currently in a legal battle with my particular trust over their policy on maternal choice c-sections :(.

The other unfortunate issue is that the nearest hospital in my area that offers c-secs is about an hour and a half away, to make matters worse, my partner does not drive to Epilepsy so it adds a whole lot of extra stress to getting me home after the procedure - whereas if it were to be done in Oxford at my local trust I could ask a friend/family member to collect us as we are only 30 mins away.

I feel like if I were to mention that my partner does not drive as one of my reasons for requesting they would use it against me and it would look as though I am requesting for ‘convenience’ which certainly is not the case for me.

I psychically can not tolerate Gynae exams anymore due to a traumatic gynae procedure and last year when I had CIN3 cells removed it was done under a GA due to my PTSD so I do feel justified in requesting but I am so anxious and nervous that when around Med professionals I can not get my point across and just become anxious and flustered :(

My psychologist I am seeing privately has said that she will be happy to support me and write a letter giving her opinion to a consultant but I don’t know if that would be enough.

@eyesbiggerthanstomach thanks for your reply - I am exactly the same with gynae exams due to a previous gynae procedure I can’t tolerate any kind of vaginal exams and have had abnormal cells removed under GA last year due to this.

I have spoken to the perinatal team as I begged for support so I hope that if a consultant refers me I will be taken seriously.

I think I would struggle to wait until 32 weeks to be told I can definitely have a c-sec. did you only see one consultant?

The fact you get anxious around them could help your cause? I had my two kids by maternal request sections, best decisions of my life. I just insisted, didn't need to see anyone etc, just said I have a fear of birth and procedures and giving birth will be extremely traumatic for me.

@luckyme30 I wouldn’t worry. I went to a central London NHS hospital and requested an ELCS - I told them I was frightened of giving birth naturally and also in my professional life have seen some of the implications from a bad VBAC. It was probably a 15 minute chat with a specialist consultant whose job it was to point out the risks with a CS, I communicated the fact that I understood and was a rational human being capable of making a decision and voila my ELCS was booked :-) It is a NICE recommendation that women who request an ELCS get one. If you live in a tricky trust then you might want to print out that bit and show them. I think you will be fine, just put your foot down. Good luck!

I requested an elective c-section in Oxford and was pursued against it, which in the end was the right decision for me. They are very strict and I was told that I would need to go to another hospital to have one. They did not seem prepared to to help arrange this. I was offered a planned induction as an alternative. I had an appointment with a senior midwife first and then the consultant. I would start the process off early and make sure that you have done your research and have a strong argument. I would have thought that there is a good chance that the reasons you have mentioned would be counted as a medical need. I hope it works out for you.

Sounds like you have good medical reason for section. Mental health counts as medical.

If you're concerned about getting your points across, write a list to take in with you and read it out point by point and note down their responses. This happens regularly in OPD appts so don't worry about it being unusual.

Best of luck x

@Twigletmama it’s good to hear from someone who has experience of dealing with Oxford in particular. I have done a lot of research and found that they are very very strict and this is what worries me.

Would you mind me asking what your reasons for the request were? I’m 16 weeks and have just asked my midwife to refer me to the ‘mode of birth clinic’ which I think is the first step. Sorry for lots of questions but how many weeks were you when you saw the senior midwife to get the ball rolling?

@Ginfilledcats thank you for your reply. I’m hoping that my concerns will be taking into consideration. I think a list would be a very good idea and I’ll get that started before my appointment :)

@Luckyme30
It sounds like you've got a good understanding of how they operate in Oxford. Extremely unfair when people in other areas seem to
be granted one with very little bother. It really puts a lot of stress on the situation. My request was due to a traumatic first labour, so different circumstance. I really hope you have more luck than I did.

My details on the dates are a bit hazy as it was 4 years ago but I've just looked back at my calendar and I actually think I saw the consultant first first ( around 24 weeks) and then the midwife a few weeks later. I then went back to see the consultant again around 30 weeks. I think was one of the main frustrations I experienced is that they won't make a decision until quite late on which can be very stressful

@Twigletmama thank you so much for looking back at the dates :)

I’m really shocked that they didn’t respect your request to be honest - I see lots of ladies on forums etc where they’ve been allowed a section. It’s really not fair how Oxford operate, I think I’ve already come around to the idea that I won’t get my request but at least I can try..

I’m hoping as I’ve asked my midwife early on that they will see me in enough time that will allow me to make plans to go elsewhere :(

Don't be too disheartened by my experience. I think if I'd really pushed it they probably would have let me have a csection but I was persuaded otherwise. I think you just need to be prepared to fight for it and not back down. Oxford doesn't seem to be like other areas, they will make you jump through numerous hoops.

I was in London rather than Oxford but my request for an ELCS on mental health grounds was never questioned and accepted immediately. My midwife and consultant went out of their way to make things as easy as possible for me - because of my PTSD, I was given a private room for example. I had an initial chat with the perinatal mental health team but didn't need more than that as I also had my own private therapist (who was 100% supportive of my ELCS). In my experience, the perinatal mental health team are really only concerned about the highest risk women who are at imminent danger of harming themselves which makes sense as their resources are pretty stretched and they have to prioritise somehow.

Hi @Luckyme30

I am in exactly the same position as you (although now 36 weeks) and in the Oxfordshire area.

Happy to chat on pm about the approach I took and where I am in the process of organising mine. As you are I am petrified of labour and have been pushing for e c section due to maternal wishes. I have written letters and emails and done a lot of research on the best way forward. Let me know if you want me to share any of this with you x

Thanks again everyone for your replies! It’s so helpful to hear from you all :)

@JKD1982 really good to hear from you and if you don’t mind please can you share your experience with me, I would be so grateful! I will drop you a PM now :) x