Maternal Request Caesarean

[Candlesoftime]

Hello 🙂 This is my first ever post... I'm 13 weeks pregnant and I've always planned to have a maternal request caesarean if I ever got pregnant. (In fact, I'd always thought I would adopt but when I met my husband 8 years ago, he said he didn't think he would ever choose adoption and I changed my mind). I spent the following eight years considering if I could give birth vaginally (we also spent a lot of time discussing whether we were sure we were sure we wanted children). I spent a lot of time reading up on maternal request caesareans, NICE guidelines, etc. When we decided to try to get pregnant I assumed that if I really wanted one, and could show that I understood the risks, this would be possible.

At my first appointment with the midwives (7 weeks I think), I was feeling anxious. Pretty much all things gynae and maternity make me feel uncomfortable. I nearly fainted twice in the appointment, which was embarrassing. My BP dropped to 80 over something.

Anyway, I was so feeling faint and sitting with my head between my knees when the topic of birth place came up. I started to explain the above but I didn't do so very clearly- I wasn't feeling great and I was looking forward to the appointment being over. I garbled about how I thought a home birth would be better for me then a midwife unit but that as a first time 34 yo mother I understood that my chances of staying at home without intervention weren't great, and that I had been considering maternal request caesarean. The midwife looked uncomfortable, didn't give me any eye contact, and mumbled something about that being an extreme option, and said that she'd tick home birth as my preferred option.

I should have been clearer and pushed the point, but I thought perhaps I could fight that battle another day.

Anyway! My question is this! I have an appointment with a mental health consultant for other mental health issues when I'm 16 weeks - would this be a good time to mention caesareans again and would this consultant be the relevant doctor? I've considered calling the midwives to mention that home birth is in my notes but that I really don't want this, but I think I might get fobbed off.

I've been obsessing about this ever since - and I mean googling things until 3am, not getting dressed all day, not cleaning my teeth or showering, hardly achieving a single thing. Sometimes it feels like hardly anything else matters, and I just need to think myself up a solution to this situation
Xxx

Of course you can request a c section. There's a page in your green notes where you can write about your birth choices. Write in there now that you want a c section and write "as discussed at booking in appt". Also write a note under the midwifes writing saying she misunderstood and you want a c section, not a home birth.

It's not up to the midwife to decide. It's not their decision at all. It's your body, you choice. You need to be referred to discuss with a consultant.

Just in case this is relevant, I often faint or throw up in gynaecological situations... I was nearly sick when I first saw childbirth in a film when I was about ten, flat out fainted in sex education at school... Once when I was working, I had to leave the student I was working with because they were taking about childbirth and I ready nearly threw up/ started to black out. Same with smear tests. First time I tried to use a tampon I hated it and felt sick - never managed to use one and I'm 34 now. I don't know if this would qualify as tokophobia, though, as I have desensitised myself over time. I can watch you tube videos of live births now, no matter how graphic, without fainting. I'm not scared of contractions. I just want to avoid any examinations or interventions and I don't feel I have a great chance of successfully avoiding these

@ChikiTIKI Thank you. I will do that

Hi fellow anxious-mum-to-be 👋

I’ve been having lots of similar thoughts.

Be comforted by the NHS’s own guidelines (attached) your consultant and/ or midwife has to account for your requests. I get the impression they may give you the hard sell first if there is no medical need but ultimately it’s written in black and white that you should be offered a planned c section if that’s what you want.

Good luck!

With DS2 i had a csection due to medical recommendation from DS1 birth. I still had to fight and argue my case every single time birth got brought up. The consultant agreed with me 100% but unfortunately you don't get to see them to discuss a csection until 34 - 36 weeks so it was a rather tense discussion everytime I saw midwives even though some absolutely agreed, others seemed to just like an argument. Csections aren't for the faint hearted but if you have the knowledge and understand how hard recovery is, its your choice. Try having a calm conversation with the midwives so its in your notes.

Just so you are aware you do have to have a catheter for a csection. I unfortunately cannot let them put one in, my body just fights and I can't control kicking legs etc but they eventually agreed to put one in once I had had the spinal in theatre. Because I was then numb I had no problem. They said it was for patient dignity and privacy as there's lots of people in theatre as opposed to my room

You have a right to request a c section but your hospital may make it difficult for you - some places are supportive and others will refuse to do it regardless of nice guidelines which are non binding.

Check out birthrights website for advice and some info on what your hospitals position is. Hopefully it will be the kind of place where you discuss the risks and benefits with a dr and they sign you off for the section if that is your informed choIce

My local hospital is strongly against maternal request sections (one of the most extreme) and I ended up having to travel about 50 miles to have my baby in another area. But, I did get the c section.

It's absolutely your body your choice. Would you be comfortable using the stuck record technique with midwives etc and say "vaginal birth is not an acceptable option for me" repeatedly in any consultations until it is agreed. If you feel that would be difficult in an appointment would you be able to write a list of your reasons out and take it with you for the midwife to read? You shouldn't have to do that but it might give you confidence before the appointment if you have it ready to deploy. Or would you feel happier if your DP or a friend went along to an appointment with you to advocate for you? I went along with a friend to an appointment because she didn't feel heard - hadn't grown up here and didn't know about our maternity care system and was very anxious- and she said that it made a huge difference having a second person there (literally) making notes.

Of course you can go for a c-section as previous posters have pointed out - it is your right. The midwife definitely shouldn't have treated you the way she did and put down your preference as home birth.

However please know what you're getting yourself into. With a c-section you could still have to have your genitals exposed e.g for inserting a catheter. I'm not trying to put you off a c-section but just to give you a realistic picture of things. Realistically there is no 100% guaranteed way of having a baby without some kind of intimate exposure, I'm sorry. Good luck whatever you decide.

I always had the catheter done after the anaesthetic. Privacy seems a bizarre reason not to - you don't have much privacy while they are extracting the baby anyway! But you won't mind because you are numb and high on diamorphine, and it all happens behind a screen.

Hi OP. Sorry you are feeling so worried. I had a maternal request c section. I mentioned at booking appointment and they booked me in to see a special midwife who talked about pros and cons of each birth. At the end of the appointment I still wanted the c section and it was written in my notes that I was getting one. It was actually booked in later when I was around 35 weeks. You have to be quite sure of what you want as they are more keen for you to have a vaginal birth. I would see if you can find details of the pathway to getting the maternal request section for your specific hospital trust online. In your case I would contact your midwife again and not wait until your mental health appointment. You can ask them more about the hoops you have to jump through etc. Good luck. Being worried about this is not fun. X

You have every right to a C-section if that’s what you want. I’m 24 weeks pregnant and that’s what I’ve requested as I don’t think my anxiety could take a vaginal birth. I laid this all out at the booking appointment and told them I need to see a consultant about it sooner rather than later as I wouldn’t be able to sit fretting about it until 33 weeks! I saw a consultant at about 18 weeks and she went through everything with me - all the pros and cons of both a vaginal birth and a C-section. After going through it all with her and going home to think about it, I’ve settled on the C-section as that’s what I feel is right for me and my baby.

Luckily, my midwives have all been of the opinion “Your body, your baby, your choice”. Keep repeating that to yourself. Best of luck with the rest of your pregnancy xx

Oh bless you! Be very clear, this is what you want and under NICE guidelines they either do it or refer you to a consultant who will.
I requested mine at the 20 week scan and had it documented. I know some hospitals really make you feel bad but if they force you into a birth you don’t want you’ll feel worse. My elective section was so calm and I knew baby was safe all the way through. Maybe print out the guidelines and take them in? Xx

I'm very similar to you, thought I'd prefer to adopt and never be pregnant until I met my husband who always wanted his own kids so I decided long before we even started trying that if we ever do have kids I'm going to ask for an elective caesarean. I told my midwife this at my first appointment and she put in the referral for a consultant meeting. I have that coming up end of January (moved from the 6th originally) when I'll be 23 weeks.

I've heard experiences that sometimes you may have to go through a few people first before even getting to see the consultant, all of who will try to talk you out of it, but at the end of the day, it is your right to choose and if after all of it you still want it they are supposed to approve it, and if the first consultant doesn't they're required to refer you to someone who does. The advice I've had from people I know who've had ELCS is to just stay firm and keep repeating you still want it, don't let them bully you out of it as it is your right to choose.

I've started collecting stats and articles about vaginal births vs. ELCS as supporting information when I have my meeting as I want to be prepared and be sure that I do know my own mind, I wouldn't trust my own decision if I didn't look into both options, and so far everything I've found supports going for the ELCS. I also don't want to go into it from a position where they can argue I don't know what I'm asking.

In my experience, if you can get the mental health consultant on board with your request, there's very little opposition. Most of my 'birth plan' was decided by the psychiatrist rather than a midwife or gynae consultant and I never had to fight for anything that I wanted as she agreed it was in the best interests of my mental health.

Beware though, that planned C-section slots are hard to find at the moment. Even if you are approved, it can be tricky to get a slot in the weeks you need it, and if emergencies come in, they take priority. Staff shortages are making things really tricky in many areas at the moment.

Op do not be fobbed off. I was exactly in your position but much later down the line. Unfortunately I went completely nuts after attending a hypno birthing session and my mum rang the midwife and gave it to them both barrels (god help me I was 34!) my family helped and supported me a lot. I not too scared it was going to send me over the edge for my own personal mental health reasons. They agreed to c section and it was amazing and I have the most wonderful relationship with my 3 yr old son now. No stress ptsd or pn depression. You know yourself and you know what you can and can’t handle. Stick to your guns. But don’t worry you have a long, long time to sort this out.

Wow I can't believe so many of you have replied and so quickly! I really appreciate it and I feel a lot less alone! Thanks everyone.

@ChuckMater Good to know, thanks. I'll expect some tough chats with midwives and prepare myself. Yes I was aware of the catheter, that may be tricky but I was hoping I could handle that if that's the most invasive thing... And I had heard that some people had catheters inserted after the spinal, like some have said here. That would be great and I'll see definitely request it

@MotherOfCrocodiles I'm so glad you got the c section you wanted I looked on the map and my hospital didn't have a colour at all... I have read on mumsnet that someone else had one there, and I found a newspaper article claiming that they allow them... so I'm hoping I would eventually find a consultant who would agree

Agree with @SerendipitySunshine

In my area they are down to 1 hospital only that will do maternal request c sections/planned c sections. (Major city so not a rural town etc) It's not necessarily a hospital that would be first choice for many women either so something to consider. That you may have to travel and may have to have the baby at a lower choice unit

I would do lots of research into the hospitals in your area first so you know what the options are

With my first child I had a planned c section. I had to see 2 psychologists first and get it approved and it wasn't until around 34 weeks. Baby ended up breech anyway so would have had one in any event

As your fear of Labour is so pronounced I won't go into detail as to why I wish I'd never had that first c section but please be aware it is still major surgery with associated risks

@Philandbill Thank you so much, great idea. I can definitely do the broken record technique, I think! (I'm quite stubborn when I'm not feeling faint). I'll also take in some notes, and maybe my husband too so they can see he's supporting my choice

@SerendipitySunshine I hadn't thought about that. Thanks for the heads up. I'm due in July, which I saw somewhere is a pretty popular month for giving birth...

@bonetiredwithtwins Thank you for your honesty. I hope that you got good treatment and any support after the section. It is a big deal, isn't it, there's no easy option with childbirth it seems.

Just come back to add... You don't always have to wait til 36 weeks to see the consultant. My c section which I am having in January got booked in back when I was 13 weeks pregnant. Last time I had a c section it got agreed at 12 weeks but booked in at 20 weeks. This is at St Mary's Manchester. I'm sure if you were anxious you could request to see the consultant earlier. Also at my hospital they do 6 elective c sections a day and there's never been a problem booking my ones in.

I've never heard of people having the catheter put in before the spinal. Why would they do that? Seems like unnecessary discomfort to me. My sister is an anaesthetist and always has the midwife put the catheter in after the spinal.

They do usually put the catheter in after the spinal. Neither time was I aware of them even doing it.

Absolutely no regrets here!