How much resistance did you meet when requestion an ELC? (Scotlan)

[TheBestPlansAlwaysFail]

Hi all,

Not pregnant yet but this seems like the kind of thing best to ask before, you know, I am and the kid has to come out of me somehow

I MUCH prefer the risk profile of an elective c-section vs vaginal delivery, both for me and the hypothetical baby. I'm a statistican, so please spare the "you don't understand the risks" - I very much do and won't be responding to those posts. I also wouldn't willingly consent to induction or an instrumental delivery, so the risk of am EMC would be increased anyway.

If you had a ELC since the NICE guidelines changed, particulary in Scotland, how much did you have to fight for it? I don't want to have to wait until 36 weeks or something like that being left up in the air and being stressed about it.

Any experiences? It would be my first child and I wouls likely be me around 35 years, generally fit but I have hypothryoidism (so likely consultant-led).

Two friends had one (Edinburgh) with relative ease. You don't need a convoluted excuse, you just state thats your preference. You'll have to meet with a consultant who will discuss with you but you don't need to be dissuaded if the ELC is what your preference is based on all the information and your own circumstances.

Oh, that sounds re-assuring, @Bluecheck679, thank you - I have heard so many nightmares, I am half-expecting that you have to threaten to sue and/or curse the the consultant, midwife, and their ancestors.

If you are consultant led from the beginning I think it's easier as it tends to be midwives that are a little more resistant to ELCS. The difficulty is getting past the gatekeepers to speak to a consultant about an ELCS.

My first was 2013 (I think that was before the guidelines changed in Scotland? Correct me if I'm wrong but believe it came about due to a 2015 court ruling after a type 1 diabetic had a disastrous birth after being refused/dissuaded from an ELCS) but even then I didn't have the fight I thought I'd have.

Like you I had made my decision based on an ELCS having the risk factors I was comfortable with. Like you I was consultant led from the start as a type 1 diabetic and would have refused an induction (would have been required at 38 weeks) and any kind of instrumental delivery.

I had a little resistance from the consultant but I think he had a bit of a god complex where he thought he knew me better than I knew myself. As long as you are aware of the risks, are willing to listen to them painstakingly go through every worst case scenario and still sign the consent forms then you shouldn't have any issues.

I'm sure you know your rights and if you come up against any kind of resistance simply state this is your choice and you are entitled to make your own decisions. You are entitled to be referred to a consultant who will perform an ELCS for you if your consultant won't.

This time round has been much easier, no resistance but I have a different consultant and so far she has been wonderful.

Best of luck!

I’ve had two in the last 7 years in scotland. Both elective. At my booking appt each pregnancy I told the midwives I wanted an ELC and each time they tried to pass it off, we can talk later, your just nervous etc but I asked for them to mark it in my notes and to arrange an appt with a consultant so it would be agreed. Met with consultant each time, best advice is to go in prepared, unemotional and armed with facts. It was the midwives who were the most in accepting of my decision honestly. Once it’s in your notes it’s sorted. I actually went into labour before my c section date and i was asked if I wanted to continue with the labour or go for the planned ELC. I said ELC and they did it.

Thank you both, too. Yes, @Gem176 that would have been pre Montgomery v Lanarkshire Health Board (2015). I do hope that this has changed things slightly. The NHS Highland guidance was updated in response to it and basically implies that as regretful as it may be, they cannot withold ELCS from women und should therefore aim to maintain rather that reduce c-section rates. I would likely be at QEUH in Glasgow, the last guidance I could find from them is from 2012, firmly stating maternal request is insufficient reason for a c-section and should not be granted. Might put in a FOI request to see if that was updated - they also have the reputation to screw those up, though.

@Hardchoices The "unemotional" is part of what I am worried about. I have supported campaigns for women's right to make informed birth choices since I was a teenager (long story) and I am also a deeply sarcastic person who lashes out when backed into a corner. Not a good combination. Essentially, I will pretty much have to drag DH along - he might just about be able to remind me that the goal would be for me to get the birth I want and not to question whether the staff ever researched beyond their insufficient lecture notes.

I know that legally, they need to allow me an ELCS after informing me about all the risks, I am just worried that they would drag things out until the last minute and/or until it is too late, which they often seem to try.

What is the risk profile of c section Vs vaginal please?

Not a great deal more info but Birthrights has stuff on their website from a FOI request in 2018:
www.birthrights.org.uk/campaigns-research/maternal-request-caesarean/
www.dropbox.com/sh/jhrgsmn6fe50qs4/AABTZ8t1MC7hcwWa8C0_I32da/54.%20Greater%20Glasgow%20and%20Clyde%20(Scotland)?dl=0&subfolder_nav_tracking=1

Gave you both the dropbox and the original website (click on the GGC pin) in case the dropbox link doesn't work

Depends on your circumstances @Horehound. For example, it is recommended to not have more than 3 c-sections, as the scarring of the uterus can lead to all sorts of complications. That wouldn't affect me, as I would want a max. of two children anyway and the risk of that not being possible after one ELCS is minimal (slightly higher for EMCS, as they need to move quicker = slightly risk of something going wrong). For EMCS, not ELCS, there is a higher risk that something goes wrong and you won't be able to have more children.

For ELCS vs non-instrumental vaginal delivery, studies generally find no relevant differences, see for example: bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-1028-3 Studies that combine EMCS and ELCS into one single intervention often find a slightly higher risk of e.g. adhesions and poorly healing scars. Some also report a slightly higher risk of asthma and allergies, and some argue that the vaginal bacteria benefit the child's health, which obviously they won't get during a section (although vaginal seeding can fix that if people feel strongly). The odds-ratio for these aren't particularly high but if asthma runs in your family it might be something to consider. That being said, there are a number of social and geographic factors that usually aren't considered in this, e.g. maternal age increases the likelihood that a c-section is needed and - statistically speaking - well-educated women are more likely to have babies later and to life in urban areas (i.e. worse air quality). I couldn't find any studies on this, though.

One of my main concerns are pelvic floor disorders, especially as women's physiotherapy in the UK is a bit of a joke and has months-long waiting lists. The type of damage caused by a c-section is alo often "easier to fix", while if your pelvic floor is really poorly after vaginal deivery, there is nothing that can really be done about it - unless you want to give pelvic mesh a try. Many women also don't notice a prolapse caused by giving birth until menopause kicks in, so "I don't know any of my 20/30-something friends who had issues" isn't quite convincing to me. This article gives a good overview: www.ncbi.nlm.nih.gov/pmc/articles/PMC3178744/

For EMCS vs non-instrumental vaginal delivery there is a whole list of things that make the c-section the worse option and hospital guidance helpfully lists all of these when they try to deter you from an ELCS, at least the ones I have read (but then, so does NICE and that is what most of this will be based on).

@swanswallow Oh, that is great, thank you! I haven't been able to find a FOI for them after 2012, so this is perfect and just the kind of information I was looking for!

@TheBestPlansAlwaysFail it's NHS highland I am under. But last time round was before guidance changed so maybe that's why I'm finding things so much easier than last time?

In 2013, despite all evidence supporting delivery at no later than 38 weeks for a type 1 diabetic, my consultant wouldn't book my section until 39 weeks. Thankfully, even though I went into labour before my booked date, I called the hospital early on and they told me to come in. All I had to do was confirm I still wanted to proceed with a section and I was prepped for theatre. So even if they do drag their heels you should still get your section even if you go into spontaneous labour.

Hi I’m in Scotland and have just gone through this. My c-section is next month! From what I’ve seen on posts on here a lot of people who struggle to have one approved are in England! Have you looked on the birth rights website? I was so scared of giving birth I was 100% sure I just wouldn’t have a baby. Then after years of looking into getting a section I found the birth rights website and found my hospital. The only ‘green’ rated hospital in Scotland is Dumfries and Galloway (which I was willing to travel to if need be)! Mine was rated Amber, more due to their paperwork I think rather than their actual process to get one. I found the most stressful part was dealing with the midwives. I don’t think there can have been anyone at my hospital so sure on how I would be giving birth, from the second I found out I was pregnant. I first spoke to my midwife at 7 weeks and told her then. She acted like she was interested but really I think she just fobbed it off and thought I was a typical nervous person who would change my mind. I mentioned it again at 16 weeks because this was the next time I saw my own midwife and my hospital says that’s who you’ve to tell so you can be referred. She listened and reassured me I’d get one again but didn’t actually do anything about it. She told me we’d deal with it at 22 weeks. 22 weeks came and I was ready for her 😂 Really went for it and said it was now affecting my every day life because I was waking up during the night worrying about getting to speak to a consultant and how I felt like it was going to end up being too late, what if something happened early etc. She had originally said I would need to be referred to the birth reflections unit at the hospital, where I imagine they offer you a hypnobirthing course and try to scare you with the risks of a section. For some reason she let me by-pass this though, probably because of how much I was emphasizing the anxiety side of it. She referred me to a consultant and I got to speak to her at 29 weeks. I had five pages of typed notes prepared about my reasons. I said I was convinced I’d die giving birth, have always been sure of it, wasn’t going to have a baby, would end up with PND if I was forced to give birth vaginally, said I’d been asking since 7 weeks etc etc 😂 Also had the birth rights info and nice guidelines to hand but didn’t need them! I found she was actually a lot easier to convince and didn’t really try to sway me. She did really go on about the risks but after my ten years of research I was well aware these risks aren’t actually the risks of a basic planned section on a healthy person. Most of them apply to people who have gone through hell trying to give birth vaginally and are hanging together getting carted into theatre at a million miles an hour. I just kept my mouth shut about that though and agreed to the risks 😂 My friend had a bit of a problem getting a date booked with them so I was quite insistent on really needing to know when it would be, again due to my anxiety about it all. I think she felt sorry for me because she gave me another appointment for 33 weeks. It turned out to be a telephone appointment from a different doctor who told me my consultant had already booked the date in for me (at 39 weeks). So I’ve known my date since 33 weeks. I don’t know how I could continue on with daily life right now if I had to wait til 36 weeks+ 🙈 I would say go for it! You WILL be able to get one and more often than not it seems to be really straightforward for women in Scotland. My consultant even quoted the NICE guidelines to me before I had a chance and said it wasn’t her job to tell me I couldn’t have one. Watch Eilidh Wells c-section YouTube videos! That also helped me decide x