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

www.rcog.org.uk/globalassets/documents/guidelines/management-genital-herpes.pdf

obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.14821

I suspect you have read this but may help look at preventative treatment etc that the hospital will be looking at and give some background x it also covers active lesions at time of delivery, swabs to check GBS etc.

However if you do want a lscs , I would have it all written down and a copy of Nice so you can refer them it to time each Time you see them to discuss .

The consultant will more than likely say yes considering you have seen the perinatal MH team who have recommended you have a C section as well as the fact that you want one. They usually do have someone going over the risks, it is major surgery and for some it will make them reconsider; if you are sure though which you are, then I'm sure it'll be fine. If not then you have the right to have see a different consultant, but I'm sure you won't need to.

Dont panic! I had an elective c section for my 2nd birth and am having one for my third. Just stay firm in your choice and make it clear that you are aware of the risks and you still want to go ahead

First of all, so sorry you’re going through this, and keep going. Even though you shouldn’t have to. I so understand where you’re coming from.

I found myself in a similar situation nearly 2 years ago now (DD is 16m). The Birthrights resources and NICE guidelines really helped, as did the support of MN.

When I first asked for an ELCS at around 20 weeks (they refused to discuss before that, and I quote, “because your baby is not even viable” 🙄), I was referred to a consultant MW. She tried to tell me it’s perfectly natural to have “fears” as a FTM. It’s not “fears” that I had, as such, it was a medical condition that everyone agreed could adversely impact a vaginal birth/be likely to lead to EMCS. I was also well versed in the CS risks and had all the print outs with me. That MW agreed with me and didn’t press further after about 5 minutes. The hospital’s attitude further down the line was still “if it gets stuck, we’ll operate!”. My position was simply that, being older and knowing this was a fairly substantial risk in my circumstances, I just didn’t want that sort of drama. Plus this was pregnancy no4 in 3 years and the others had all sadly been lost, so the anxiety was already through the roof. It happened to my own mother durning my birth, the whole “baby got stuck”, and I wasn’t a well baby as a result. Why tempt fate? Two consultant appointments later, they grudgingly agreed that I could have an ELCS but each time they bureaucratically insisted it was “maternal preference”, even though they “informally” agreed I had higher risks than many others giving birth vaginally of baby becoming distressed/things leading to EMCS.

In the end, persistence, putting things in writing and emailing/calling various heads of midwifery at the hospital as the weeks ticked on paid off for us. The turning point was when they saw me and DH and 36w, said I could certainly have the ELCS and that they were sorry about the “handling”. ELCS went fine and we had a lovely smooth start - as much as you can do with a newborn! So I’d say keep going. And don’t for one moment feel bad about asking for the best outcomes for you and the LO.

I also recently read something about how the ELCS/VBAC debates in hospitals are often unduly influenced by the doctors’ or their hospitals’ risk appetites, versus those of the individual women. It hadn’t occurred to me to say this at the time, but I think this would have been a perfectly legitimate thing to say in my case, that basically my own risk appetite, given all that’s happened specifically to me, was low and probably lower than the hospital’s. That’s perfectly valid.

Finally, I don’t know how it all works w Covid, but if you’re seen alone for some of the more stressful discussions you can have someone else on speakerphone listening in/taking a note. Even knowing they’re there can be a comfort.

Hope it goes well for you. In the end, I the squishy newborn is worth it all, I promise.xx

@Floopyandtired what was it like having a c section

I’m so sorry you’re having all this trauma on top of your anxiety around birth too (and for all the suffering your diagnosis has caused you). Birthrights are a brilliant organisation that I’d definitely recommend ringing as they cannot deny you a C section and it’s awful they’re making you push so hard. If the outcome is always endless referral onto other obstetricians to find one who’ll eventually agree it seems very cruel to force women through it; I don’t think they should have any right to deny with the NICE guidelines as they are. Explain risks even multiple times I get, but outright denying people healthcare just out of their own opinion/ego seems callous. You are entitled to a C section and it is clearly justified on mental health grounds as supported by your perinatal mental health team. I complained to PALS about terrible communication at the start of my pregnancy that caused a huge escalation in my anxiety and was contacted by the lead midwife who was brilliant, apologised and told me how they would make changes. Your local maternity voices partnership might also be worth contacting and I’d second the suggestion to have someone on the phone for support or ask for a chaperone - the way they’re treating you is understandably really harming your mental health and that’s unacceptable from healthcare providers, of all people! Well done for staying so strong in your decision so far - it will be worth it, though you shouldn’t have to do it.

Stay strong OP. My DSis had a c section based on anxiety alone, she had to keep pushing at every appointment all the way until 38 weeks. Baby was delivered via c section exactly on her due date. For her second baby she was aiming for the same but placenta issues from previous c section scar forced the hospitals hand. Luckily it didn't turn out as bad as they had anticipated. But please know that you cannot be forced to give birth vaginally. You may have to keep pressing them, but it is your choice.

I’m a consultant (albeit not an obstetrician) - based on your comment it sounds like you saw a junior doctor - they definitely wouldn’t be the one to make that decision and probably worded it that way (ie you have to talk to the consultant) because they worry about getting in trouble themselves if they told you one thing and their superior was like what the hell absolutely not... I don’t think any consultant would ever say no to your valid reasoning to requesting a c section - don’t take the junior doctors hesitation in agreeing as anything definitive, they just can’t say one way or another and probably don’t have experience with patients in your situation so they were extra cautious to not give a definitive answer in case they were wrong! I’m sure when you see the consultant they will understand and agree.

You need to speak to birthrights .

Make sure you are calm and composed for your consultant meeting .

Make a list of your core points and that you've reviewed the risk data and you have decided X is your choice .

I'm with you and won't be having a VB either, and I am aware it can be a tooth and nail fight

@Moo678

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.

Also they DOWNPLAY VB risks which really irks me ( new scientist - www.newscientist.com/article/mg23130812-000-a-womans-right-to-choose/ )

I chose an ELCS earlier this year. Mine was granted with no problems but it did have to be a consultant who agreed to it. AFAIK that is standard practice, so try not to worry too much that you have been asked to see one.

Unfortunately a hospital can refuse you an elective c-section, however unfair this seems. It is up to individual hospitals to decide their policies on elective c-sections regardless of NICE guidelines, unlike what some PP have said. Hopefully these consultants will have compassion and take into consideration your medical history and the professional opinion of your psychiatrist. If they don’t then please please do not panic, go to another hospital, where they will respect your wishes. A lot of hospitals do follow the NICE guidelines. I’ve known people who have changed hospital for this reason. Hoping your appointment with the consultant goes well, and they listen to you and your concerns!

What the PP says. Do you know for definite that your chosen hospital does elective caesareans? A hospital near me doesn't, only emergency ones. They get round this as there is another hospital under the same trust that does, so if you choose or have to have a ELCS you have to go to the other hospital.

If the consultant refuses ask to see another more sympathetic one it is your right. They will try everything to get out of giving you a CS because it costs more just stand firm and keep insisting some tears will help as well.

I'm sorry about this. I only know what I read online but from the sounds of it they can't deny you an elective CS. They have to inform you of the risks but the decision according to my understanding is up to you. I'd talk to your mental health counsellor asking them for a letter to support the choice. You have a valid reason for wanting it.

I've had 2 elective sections due to fear of birth, I got them fine even though it was first pregnancy. It is a womans right to choose how she gives birth. Stay strong, keep pushing and stay confident in your decision.. someone will approve it.

im so sorry about this OP, they really do like to stress mothers out, i hope you get heard and sorted soon, maybe ring up the unit manager?

Sorry haven’t RtFT but did the person you saw then refer you to another dr for a second opinion? If not that’s what they should do (NiCE guidance) and you could also write to the head of department/PALs asking why they feel the need to not follow nice guidance.

I am sorry for your anxiety but please stay calm - they haven’t refused you, you aren’t being forced to have a vaginal birth. You are being forced to jump through some hoops but you WILL get a C-section, so try not to worry. Just keep insisting and it will be OK.

Very best of luck and I hope your birthday experience is smooth and your baby adorable xxx

Sorry you’re going through this, really makes me angry when hospitals won’t listen to women and I’ve heard too many stressful stories about women trying to get an ELCS. All the advice on here is really good, you may have to jump through hoops but it is absolutely your right to request a section, is there another hospital you could transfer your care to that may be more understanding and make things a bit easier?

I really hope you can find peace with your herpes diagnosis. It’s so extremely common- statistically more than one poster replying to this thread will also be carrying virus- but most people just don’t know and never get diagnosed, especially since it isn’t even included in std screenings. You will certainly know people in your family and friendship circles who also have it. Would you feel the same for having an abnormal smear caused by HPV? HPV is also a sexually transmitted virus caused by skin-to-skin contact like herpes yet we normalise it a lot more. When it’s not causing you any physical discomfort it really should be a non-issue.

I don't have personal experience with this but it might be a good idea to write down all the issues you have and points for why you want one. So when you speak to the doctor you don't forget any. It's rubbish that it's caused you so much anxiety.

I can see your reasons and understand why you want one. (And for your reasons do think you should) But you also need to see it from their side of things. Someone has listed already the NICE guidelines that has to be gone through. And unfortunately it sounds like you will just have to keep on persisting. From their side there does need to be these guidelines as I am sure they have plenty of people who request for one for silly reasons and/or will lie to try to get one. They have to take into account that this is major surgery, yes it is done everyday but still. Also there is a higher cost for one. Staff, equipment, theatre. Can you imagine the costs if everyone requested one and also what if the theatres were then too busy and someone who needed one didn't get one, coz Jane Bloggs didn't want her vagina stretched. Write your reasons down and stick to them

@PurpleMustang what nonsense. I don't see why anyone would go through major surgery so their "vagina didn't get stretched". Also ELCS are pushed or rescheduled if an emergency comes through.

Just on the cost, there was some analysis done in 2019 and ELCSs came out slightly cheaper to the NHS overall than vaginal births...

www.thetimes.co.uk/article/caesarean-section-delivers-a-400-saving-on-natural-birth-vr6j9wzr0

Regardless of costs, women should have the right to choose. Especially in a clear case such as the OP’s.