Elec c section denied? Forced vaginal birth?

[RollneckJumper]

Apologies in advance for the long post.

I'm 35. This is my first pregnancy. I am 33 weeks.

I have Group B Strep and genital herpes. The latter has been the root cause of 15+ years of tortuous anxiety and depression. I can honestly say the diagnosis all those years ago absolutely destroyed me. It crushed my self confidence, and anxiety is now a permanent feature in my life. I've had regular counselling, sexual health counselling, CBT and I was taking citalopram prior to pregnancy. I can't begin to describe how much of a negative impact its had on my life, mainly my mental wellbeing.

I wish to have an elective c section as I am terrified of passing Group B Strep and/or herpes on to my baby. Herpes ruined my self esteem, self worth and self confidence. I am absolutely determined not to let it ruin my child's life.
Yes, I am aware the risk is low.
Yes, I am aware that women can take antiviral meds in the run up to labour, but I can't. They actually act as a trigger for me and can bring on a reoccurance.

I am also aware of the risks involved with a vaginal birth V c section in regards to herpes, Group B Strep and other risks (I've done my research) and I am making an informed choice - I have made my mind up - want an elective c section.

Earlier in my pregnancy, my midwife referred me to a perinatal psychiatrist because of my anxiety around a vaginal birth. The psychiatrist is of the opinion that I should be supported in my request for a elective c section and that a vaginal birth would be detrimental to my mental health.

This morning I saw a doctor from the consultant obstetrician's team. She went over c section risks with me. I pointed out that I had already gone over the risks a month earlier with one of her colleagues and I still hadn't changed my mind.
She contined talking about the risks of a c section and it was clear she was trying to talk me out of my decision. I felt like my anxiety was not taken into consideration at all, and the whole focus of the conversation was her trying to convince me why a vaginal birth would be best. She then went on to say that I would need to see the consultant obstetrician who would make the decision on whether or not to grant me a c section.... this left me in tears, terrified that I may be told "No!". I asked her what would happen if the consultant obstetrician says "no". She said I could see another consultant obstetrician.

But what if that consultant obstetrician also says "no"? Where does that leave me? Do I then have no choice but to give birth vaginally? I thought it was "my body, my choice" ? I wasn't aware an elective c section could actually be refused?

I am now back home in tears at the prospect of being denied an elective c section and forced to give birth vaginally. My anxiety is soaring at the thought of this.

I know NICE guidelines say I should be offered a c section if I want one.. but they are guidelines, not law. Where do I stand?

Does anyone have advice on what I can do?

Also.. polite request.. I have made my mind up regarding my birthing options, please no comments from anyone trying to persuade me otherwise. Thank you

No experience but i am just really sorry you have to go through this.
I also believe it is your choice and you shouldn't have to beg for it.
I really hope you get your c section approved one way or another.
Best of luck x

I’m so sorry you have to go through this OP.

Make it clear to the next consultant you see that you are absolutely insistent on having a c-section - make it clear that this is simply not something you are willing to be persuaded out of, and that it is essential health care for you. I don’t think they will refuse but if they do ask who you can escalate the decision to. It’s awful that you have to, but keep insisting until they take you seriously

I had an elective c section for mental health reasons. I was firm and unwavering in my choice all the way through. They tried to talk me out of it twice but I stuck to my guns and eventually my section was booked when I was about 36 weeks (I can’t remember exactly). I think you’ll have to be a broken record but you should be able to get your wish. Good luck x

@RollneckJumper

First things first; stay calm! Your situation sounds really hard and I'm sorry for
What you've been through.

I am having an elective C section for tokophobia (my friend recently died giving birth and so did the baby) I have absolutely no inclination to ever try a vaginal birth. EVER.

The death and trauma really affected my decision to have children and I have had to go through a similar process to you in order to have my ECS request heard.

If you are denied, consistently refer them back to the nice guidelines and request to see another obstetrician who will consider your request.

They cannot refuse you. It's really important that you know the risks and you can discuss and relay all the risks back to them and that the risks outweigh the anxiety it's causing you.

A C section is a really serious operation and I am not undertaking it with any kind of lightness. I know the recovery will be rough but I think the risk of death and associated anxiety it has caused me is personally lower in my situation. I had to demonstrate my case and explain my reasoning to 2 doctors. In the end they were incredibly compassionate and understanding.

I was very honest with my doctor and explained that I would love to have a peaceful and calm water birth spontaneously; but that was also what my friend wanted. i'm in therapy and I'm working on it; but for this baby: it's not conducive to deliberate a V birth. The anxiety along with Covid worries was debilitating my mental health. Your situation sounds very similar.

I'm so sorry you're feeling so scared, promise promise you're not alone in feeling this way.

It’s appalling the way patients are treated sometimes. I myself had to really push hard for a second elective c section (after a planned one with my first due to breech) with five medical professionals in the room, all doing their best to highlight the risks and make me change my mind. I am strong and confident and even I was sweating and anxious by the time I left the room. They consented to my request but they weren’t happy. I just really did not appreciate the pressure they applied. Ultimately it’s my decision, I was informed and really felt like telling them all to jog on and leave me alone! Both operations went better than expected.

Under NICE guidelines they CANNOT refuse. Here are the guidelines.

The National Institute for Health and Care Excellence (NICE) sets out national, evidence-based guidelines for NHS and other healthcare providers to improve standards in many areas of health and social care. NICE guidance on maternal requests for caesarean section says that:

a woman’s request for a caesarean section should be explored and discussed and the specific reasons for her request should be recorded;
if a woman requests a caesarean section when there is no medical indication for it, the risks and benefits of caesarean compared to vaginal birth must be discussed with her to explore her reasons and ensure that she has accurate information. If necessary, the discussion can involve other members of the obstetric team. The discussion should be recorded in her medical records.
if anxiety about childbirth is the reason for the request, she should be offered a referral to a professional with expertise in perinatal mental health support to help her deal with her anxiety;
if after discussion and the offer of support a vaginal birth is still not an acceptable option, she should be offered a planned caesarean section;
if her own obstetrician is unwilling to perform her caesarean section, she should be referred to another obstetrician who will carry out the caesarean.

I presume you saw a specialty trainee. It’s their job to try and make you have a vaginal birth for all the reasons they explained to you. They probably manage to change the minds of a percentage of woman in which case these woman don’t need to go on to see the consultant. You still want a section - you will see the consultant and they will agree to it. As you said it’s in the NICE guidelines. The reg doesn’t have the authority to say yes or no. I think you need to calm down and stop catastrophising.

Don't panic! Even if the person you speak to says no that is not the end of it. You can ask to be referred to someone else who will approve it. I had an ELCS at maternal request with my first baby last year. Please stay calm. You don't get your date until near the time anyway so there's time for this all to be sorted for you.

I’m really sorry you’re feeling this way OP anxiety is hideous

In the nicest way possible I think the NHS is just overwhelmed with women who chose to get pregnant, knowing the natural end to this is usually vaginal birth, but then are desperate for C-sections. Obviously under usual circumstances I would argue every woman should have the choice but given where the nhs is with covid and how many needed operations have been cancelled/postponed leaving people in awful pain/suffering I’m not sure it is unreasonable for them to be cutting right back on ‘optional’ procedures.

When I got pregnant I had a severe long standing, crippling fear of vomiting. I’d had therapy, CBT, you name it! I got HG. I took every medicine they gave me and nothing worked, some made it worse. For months I was depressed, miserable (also had perinatal team/psychologist help) but it kept happening. I had breakdowns, didn’t change anything.

I’m afraid to an extent if you enter pregnancy knowing you’re triggered by a common pregnancy issue (vaginal birth, vomiting...etc) you’re pretty much taking on the chance you’ll have to go through that fear.

I was also terrified to give birth because of a sexual trauma in my teens. So I do empathise deeply. I ended up giving birth with an epidural but I found the whole experience of pregnancy/birth deeply traumatic.

I’d remain hopeful that they will agree your c-section but I’d brace myself for the possibility it may be denied. Try and work with the perinatal team on coping strategies, breathing exercises, medication that might help relax you...etc

I really don’t mean to sound harsh in my comment I just honestly don’t know what impact covid will be having on things like ELCS’s. I can only imagine nit great. It’s much harder to give advice in such unusual circumstances.

Have a look on here
www.birthrights.org.uk/campaigns-research/maternal-request-caesarean/

You may have to press for a referral to a different hospital or self refer (but hurry up if the latter). Some hospitals just won't do it.

Pumpterturmper, your comment is not 'nice' at all. You are suggesting that people should just put up with whatever happens when pregnant, even if there is a viable medical solution, because 'they chose it' and 'others had it worse'. This attitude is precisely why so many women are failed and made to feel helpless in maternity care.

You sound like from your history it would be totally reasonable for you to have a CS. But the registrar may not have the authority to agree, it’s likely to be a consultant decision. If this hasn’t been sorted out ASAP then write to PALS. Honestly is often the quickest way to get listened to when you feel that nobody is listening to you. That or the clinical director of obstetrics (whoever is the lead obstetrician).

You deserve to be listened to OP.

I’m so sorry for what you are going through.

I would speak to the PALS at your hospital and also research other local hospitals to see how they view the guidance from NICE. Good luck.

Tbh I gbs comes and goes. I carried it with 1st child and u get anti biotics when Waters have gone. Or u and baby get anti biotics after. U be fine honestly xx

I had to fight for my elective c section, I wanted it due to previous crash section. Even to the point that when we discovered the baby was breach they wanted to turn him and try vbac. When I did I was worried due to my scar they said they could turn him under spinal, so I said if I'm getting a spinal to turn wouldn't it be easier to just do a section instead of putting me through a procedure that at worst could rupture my scar and cause another crash section. He didn't have an answer to it and booked my section date there and then.
Not much there that related to you but all I can say is, like me, stand your ground with consultant, tell him exactly why you need a section, tell him how the mess affect you and how your mental health is affected. FWIW I found the actual consultants to be more reasonable than their registrars. Good luck xx

I'm sorry to hear you sounding so distressed OP

I am in a similar boat, but finally had my section approved this morning.

You need to keep pushing, I know it is so hard.

Does your midwife know how you feel? My midwife and therapist both sent emails to the consultant telling them I needed a c section. I think that helped.

Hey I have a diagnosis of herpes also. I know it's easier said than done but please try not to feel embarrassed. It's funny how there's no stigma with facial coldsores but genital herpes is seen as something to be ashamed of even though it's the exact same virus. At least you are aware that you have hsv and can take steps to reduce the risk to your baby. As previousl posters have said you are absolutely entitled to a c section particularly given your anxiety around transmitting it to your baby. When I was giving birth to DD I had a suspected outbreak during labour (despite not having one for yonks-sods law). I was given the option of a c section but it was more for my own peace of mind as the risk to transmittion to the baby is tiny when the mum has a recurrent outbreak. Incidentally DD was incredibly impatient and was born naturally before I had time to make up my mind(!). But she was absolutely fine and the doctors weren't at all concerned, they just checked her over before leaving hospital but they reassured me that they had never encountered any neonatal transmission with recurrent outbreaks.
I understand you don't want to take the risk though however small. IF the consultant doesn't agree (although it's very unlikely), she will refer to a different one who will likely approve it but I honestly can't see it being an issue.

Just as an add on OP, I also had severe anxiety (and OCD) in pregnancy and was referred to a perinatal psychiatrist too. I had a few sessions of CBT although didn't find it very helpful to be honest. Much of my anxieties were to do with keeping the baby safe so it was a huge shock to find out about the outbreak during labour. I do understand your concerns OP and I really do think that the consultant will too.

Hi OP, have you had any opportunity to discuss your thoughts with the perinatal mental health team? I had an elective CS with my second following a very traumatic birth with my first and subsequent PND.

My consultant (I was high risk due to previous birth) was keen to dissuade me from a CS as physically the chance of the same thing happening again was small. But the perinatal mental health team were very helpful and completely supported my CS on the grounds of mental health. I could not even for one second consider the thought of giving birth naturally and my anxiety around it was very high.

Keep pushing for it OP. If they say no, ask who you need to speak to get them to say yes.

I had an emergency c section with my first baby. I still had consultants trying to tell me a VBAC was best and try to talk me out of an elective second time around.

I'm cynical, but I think it's all down to money. Its more expensive to have a csection and stay in hospital. Isn't it funny that the push for home births came at a time that the NHS was being cut to the bone.

Some obstetricians are more in favour of CS than others, my last one was nicknamed MacTheKnife by the midwives, I had the opposite to you as I'd had an EMCS and wanted a vaginal delivery (I'd already had two so could compare them) and I had to be firm that it was what I wanted. I did agree that if things started to go wrong then I would obviously agree but I wanted to try for a vaginal delivery. He was a lovely guy but he just had a different view but when he was sure he agreed. We also negotiated on a date for induction, he wanted to do it a week earlier and I wanted to wait for my due date, we met in the middle and as it happened when I went in for my induction I was already in labour.

I'm sure they are likely to refer you to someone more in line with your wishes if you can't agree with the Obstetrician. I found the Obstetrician was more open to listening than his more junior staff so you might be pleasantly surprised when you see him.

Good luck.

Sending virtual hugs Op
My understanding is that even if the first consultant you see refuses for whatever reason, they are to refer you to one who is willing to do an elective c section.

You sound as though your mind is already made up so continue to fight for what is right for YOU!