Rights to an elective C section - help winning the argument

[Rachae]

Hi Everyone,

I'd be so grateful of anyone's advice who is FOR elective C sections and understands the value of these and the feeling that they are safer.

I know that I have a right to ask and that under guidelines, the consultant has to refer me to another if they refuse ... It would just be easier if I can win the argument first time round.

Any stats/ facts/ pointers would be very much appreciated!

I'm going to put together a slide deck on this to present my view at my meeting... And I want to be data driven where possible.

My personal thoughts and stance is:

1. Vaginal birth is ideologically pushed on women. A lot of facts about risks of vaginal birth are skirted over or not discussed at all, i.e. tearing, forceps implications, baby going into distress, cord wrapped around neck etc etc

1. There is a national target in the NHS to keep C sections below 25% - this is backed by campaigns for vaginal births and bias language features in every pamphlet

1. The obvious one, C-Sections cost the NHS more money

1. Because I've had many losses and PTSD across the first trimester, I lean towards a c section because I'd like more certainty around due date. I also believe this is the safest option for my baby - rather than necessarily me. (I may end up with a blood transfusion or an infection, yes). Rather than a baby being forced down a birth canal and knowing im in agony and possibly hear me crying out ... The baby is lifted out of my tummy calmly. This to me is safest, most calm way of delivery

Xxx

I think the way you are going about this may cause you problems.
You don't have to convince your obstetrician that c sections are safer than vaginal delivery and it is probably counter to your cause to attempt to.
They have studied for many years and are well aware of the risks and benefits of each and on balance it is in fact safer for both mother and child to have a vaginal birth. Being forced through the birth canal clears the babies longs so they don't inhale liquid with there first breath and stimulates them which means on average c sections babies have lower APGAR score.
Having said that both are very safe and the difference is minimal.

I think you should aim to educate yourself in a well balanced way so that when you ask for a c section it is a well informed decision. For example I know that c sections carry these different/increased risks.... But given my personal history of.... I feel it will be better for my mental/physical health and therefore better for my baby as well.
Ultimately they want to know you understand the risk and are making an informed decision.
If you try to convince them it's actually safer to have a c section it sounds like you are not fully informed and you may be refused on those grounds.

Absolutely agree with Bumble.
I had n elective c-section due to PTSD from a traumatic birth. No questions asked.
Just be clear that it will be better for your mental health and therefore for the baby.

You're going to give your obstetrician a PowerPoint presentation? Just tell them you're looked into it, are aware of the pros and cons and are requesting a c section as is your right. Don't over complicate things

I had two C-sections. Kind of elective but with a valid medical reason. My health insurance paid for me to have them privately from delivery onwards (so all antenatal appointments on the NHS).

I'd agree with the previous poster, you should focus on why you want one, not statistical comparisons.

Even though I knew it was extremely unlikely I'd be able to deliver "naturally" and I had the private route, they wouldn't really commit to it until a couple of months before my due date. You can state your preference but I think you will possibly have to wait for a definitive agreement.

I had a wide choice of hospitals, living near to London, so I also picked one with a higher rate of c sections as I felt they'd be more likely to agree.

And definitely no slides! I think that might rub the medical staff up the wrong way...

If a dr refuses your request you just ask to see a dr who will say yes- they have to refer you

You're going to make them a PowerPoint .

I wouldn't do that.

Just explain why you want one and see what they say. I had a second elective on MH grounds rather than an induction. It wasn't a big argument or disagreement.

If you’ve had a normal birth before they will try and make you have another I feel. However, my advice after having an elective c section for for first child and due a second in may is to focus on your situation not national stats and figures. It’s about what you need. If you have a significant reason for needing one and can back up with drs letters etc. I have a strong feeling that going in with general facts won’t do you any good.

You don’t have to convince the dr that current best medical practice is wrong. You just have to show you understand the risks of both options (vaginal birth vs planned C-Section) and that you personally want to go for the c-Section because you feel it’s the best option for you in your circumstances (physical and/or mental).

Also vaginal births that go well (the majority of them) are the safest for mother and baby. Your argument about birth canals and baby hearing you screaming isn't valid. The majority of the births worldwide are vaginal and babies are fine with the screaming! It's literally the way the body is designed for them to come out. I say this having had two sections.

I've had three c-sections. The last was awful as my little boy didn't clear his lungs of mucous and was seriously ill.

Medical professionals are professionals for a reason!

Do not go in with this attitude. Simply say you've read the pros and cons and would like an elective C Section. They're gonna think you're batshit if you make a presentation!

I agree to avoid the slides. Take notes for your own use and be polite but firm.

Major on the risks that are unacceptable to you:

The prospect of significant tearing/perineal damage is not acceptable to you. 6% risk of a third or fourth degree tear with a first vaginal birth: www.rcog.org.uk/en/patients/tears/third-fourth/
This risk is avoided with a section.

The increased risks of prolapse and pelvic floor damage is not acceptable to you. They will try to bullshit you with “oh but the pregnancy can cause this” - which is true, but risks increased with a vaginal birth.

news.yale.edu/2013/07/01/vaginal-delivery-ups-risk-pelvic-organ-prolapse

But there are loads of studies on this.

The risk of your baby suffering a hypoxic brain injury during birth is unacceptable to you. Yes this is very unlikely but the consequences if it does happen are catastrophic.

In return make clear you are quite comfortable with the increased risks of caesareans in other areas. Also ask about the personal risk to you of a caesarean, because the stats they give you as to increased risks of x, y, and z often lump in emergency sections, third sections, sections for people with risk factors for surgery (which you may or may not have)

It is also not the case that a recovery is necessarily harder after a section because it depends on what kind of vaginal birth you had. I found it a breeze, whereas I was in agony for months after my vaginal.

They have studied for many years and are well aware of the risks and benefits of each and on balance it is in fact safer for both mother and child to have a vaginal birth

Not the case - plenty of obstetricians choose elective caesareans for their own births. The risk profile is different. Which is “better” is a value judgment not an objective truth.

ask and if they say no ask to be referred to another consultant say you have anxiety and cry. Someone will eventually agree. I had my sections due to ivf baby no medical need I didn't want to risk birth injury and I'd had a long fertility journey and really was anxious. No need for those slides and arguments just remain firm and don't be bullied. When the midwife puts you under a consultant ask for a sympathetic consultant.

This has to be a windup?!

I would drop point 1. It’s not ideological. It’s the way the body is supposed to give birth naturally. If you didn’t have access to good healthcare then that’s the way baby would come out. It’s tried and tested over thousands of years. Unless there are good reasons (including mental health) then of course they will encourage ladies to give birth naturally.

All you need to say is that given your previous losses and PTSD, this is what you need for your mental health.

To also add that you may want to consider a private c section if you feel like you are coming up against barriers. The NHS is on its knees, particularly in maternity. They are struggling for every penny and staffing levels are extremely low. If you have to balance the books, several women could have natural deliveries for the same cost as your c section. It’s not taking away from you what you want or need, but there are stark decisions being made every day in the NHS and you shouldn’t take resistance personally.

Check out today’s article on the Guardian website, on exactly this point

I believe that it's safer to have babies clear their lungs of mucus / liquid (by being forced through the birth canal. This not happening is a risk factor of c-sections.

You're entitled to one so just remember that and request one and ask your midwife to put it in your notes

A presentation is going to make them fight back because you will come across as rude

To also add that you may want to consider a private c section if you feel like you are coming up against barriers. The NHS is on its knees, particularly in maternity. They are struggling for every penny and staffing levels are extremely low. If you have to balance the books, several women could have natural deliveries for the same cost as your c section.

The NICE guidelines state that every woman is allowed to have a c-section if she wishes. It’s really not on to guilt trip women into “saving the NHS” by going private (where she won’t have access to emergency care) when the problem is successive governments gutting the system.

Not one scared lady trying to do the best thing for her baby and her mental health.

Where did you get the idea that the baby will by harmed by “hearing you cry out” during childbirth, OP? You are entitled to ask for a c-section but you are armed with a lot of misinformation and you are going about this the wrong way. Do you have trusted friend or relative you could speak to for RL advice?

'Next slide please' I think youve watched too many presentations by Chris Whitty.

Thank you everyone - I really appreciate (almost) all of your comments. You're right... The slides are too much! I guess the first time I spoke with the consultant, I realised she was incredibly data driven and came across as aggressive to me. She came across as someone who was very much against c sections and said something like 'we'll see about that'. So I was trying to think about how I could appeal to her logical nature and somehow find some common ground in the discussion.

On reflection of what everyone's said, I'm going to go way more human-centred now. She actually jeered at me when I first mentioned c section and said ' oh is it for the mental health?' in a very eye roll way. So I'd ruled this out as a plausible point that she would accept.

To the comments like 'is this a wind up' - you know it isn't. I've mentioned pregnancy losses and PTSD, so what kind of pleasure do you get by putting a judgemental remark like that? Nice empathy for other women.

Thanks everyone, I'm really grateful xx

@20viona

Do not go in with this attitude. Simply say you've read the pros and cons and would like an elective C Section. They're gonna think you're batshit if you make a presentation!

This.

Go in, be clear and firm. This is what I am opting for. Feel free to refer me into whoever you need to have it arranged. I am aware of the risks but understand if you need to go through them with me. Thank you.

Done.

You don't need a presentation! Honestly don't do this they'll think you're mad

www.theguardian.com/lifeandstyle/2022/feb/13/caesareans-or-vaginal-births-should-mothers-or-medics-have-the-final-say