When to discuss birth plan/requesting c-section

[Superunknown1]

Hi, I’ve found this forum so helpful throughout my pregnancy and am back with a couple of questions about requesting a cesarean as a first time mother.

When do you generally start discussing a birth plan? I am 25 weeks tomorrow and have a midwife appointment and currently fretting writing down things to mention in case this will be my chance to express the fact that I would like to opt for a c-section.

If you opted for a c-section, did you have issues getting consultant to agree to it? When do you have to raise this as an issue, am I overthinking it? I have a list of pros and cons of section vs. vaginal birth to show I’ve researched both extensively and in a non-biased way.

Finally, my partner is coming to my midwife appointment tomorrow and we are worried that his presence if birthing plan comes up may affect things negatively, as in we are concerned it’ll look like he is influencing me in some way. I am mouthy and it is entirely my choice, but I’m aware for some women they may not have partners as understanding and lovely as mine and I’m sure midwives come across women whose husbands have wanted their partners to have a c-section for vanity reasons (to put it politely). Is this something anyone has experience with, am I overthinking it or am I better off discussing this alone just so midwife doesn’t make any assumptions? OH has already said he will keep quiet through any discussions of birth plan but I just want to give myself the best chance of not having to battle to be heard.

Any general experiences massively appreciated. I am West Midlands if that helps! Thanks in advance ☺️☺️

They do tend to push you towards vaginal birth even though you're perfectly within your rights to ask for a c section.

My sister-in-law used her anxiety as a reason to opt for a c section a few years ago and really had to push to get what she wanted. I imagine it will depend on the hospital/ midwife/ consultant. Worth bringing up now to see what the process it. Pretty sure my sister-in-law was told they wouldn't discuss it until closer to the date and then they didn't want to book her in so was a bit of a faf

Your husband being there shouldn't make any difference as long as he doesn't have to speak for you. I don't bother to have mine at any appointments but the scans but everyone is different

Hello!

I didn’t discuss a birth plan until 37ish weeks which i felt had left it very late! I too was considering a c-section due to gestational diabetes and growth scans showing a large baby!
It was my first pregnancy too.

My community midwife wasn’t as accepting i wanted a c-section and pushed vaginal birth on me at every appointment. The hospital on the other hand were fantastic and gave me the risks of both, yet were happy to discuss my c-section after 37 weeks.

I went for an appointment with a consultant due to surgery i had in pregnancy and was examined, i was dilated already and waters were bulging so when baby had reduced movements the following day i opted to have my waters broken.
I changed my mind at the last minute and had a positive vaginal birth with a fast labour which i didn’t plan for a i was certain id have a c-section.

I didn’t take my partner to any midwife appointments because i thought they weren’t that great, he came to all scans and consultant lead appointments but i felt it looked bad he didn’t come haha! I wouldn’t worry that your partner is there🙂

Raise it asap. Do not wait until your birth choices appointment late in pregnancy, that's not what it's for.

I mentioned it at my first midwife appt, she was generally supportive. i raised it again at 20 weeks and she said sorry that she hadn't booked the ob appointment and booked it then to discuss. This happened at week 27 and my c section was booked during that appointment.

I had my c section last week at a large London hospital and they told me that they are currently doing 46% c sections. They were nothing but supportive and encouraging of my choice while being clear that I knew the risks.

Wow 46% is high. I wonder why ? I am concerned that c- section by request is getting normalised and a negative cycle being established where women and HCPs have no confidence in natural childbirth. Which has huge societal implications.

Why do you want a C-section?

@erikbloodaxe does it matter why op wants one? She shouldn’t have to justify her choice, the nhs supports that it is a choice

Agree with PP - you need to raise it ASAP.

I had vaginal for DC1 and then requested a section for DC2 and actually raised it at my booking appointment. I then raised it in every appointment thereafter. I had to have several appointments with consultants and it took until around 32wk to get it finally agreed to. I had to really push for it.

Hello! Thank you so much for the helpful fantastic replies, makes me feel a lot less alone and better knowing I have a battle plan and people’s experiences have really helped. I’ve raised it at each appointment and been brushed off, mostly in subtle ways ‘you’re SO calm! Why would you want a c-section, I can see you in the birthing pool!’ as well as my midwife just putting off any discussions as much as possible. I’ve weighted up risks and benefits and am armed to go to my midwife today and ensure this is dealt with as until now I’ve just assumed that it’ll be sorted at the next appointment. Now I know it really needs to be dealt with now!

As for why I would like an elective c-section, that’s my own reasoning and my mind won’t be changed on it 😊 Curious about the PP who mentioned societal implications of no faith in vaginal births? I think enough of my friends have had scary births with emergency c-sections and lifelong ailments (as well as their children) as a result of prolonged labour, birth injuries etc. that it does absolutely put me off. I have no fear of birth or pain, but just want my baby to be delivered having the safest situation possible.

You need to bring it up now as there may be a few different spots you need to be referred for when having a maternal request elective CS. The midwife won’t think you husband is influencing you, in my 15yrs as a midwife I can’t remember ever thinking a husband wanted their wife to have a CS for vanity purposes

I had an elective section with my second due to a traumatic vaginal birth with my first. I literally asked for it for my first appointment. I was absolutely adamant that’s what I wanted. I think I saw the consultant around 30ish weeks and they booked it in then but I pushed for it at every appointment really. It’s really important to make your wishes known. They tried to change my mind but I just completely ignored them.

*from my first …

@Mummyme87 thank you, that’s reassuring! I think having him with me will really help and ease my anxiety but didn't want to look like I’d brought him to fight my battles for me or anything like that.

I’ll update my thread once I’ve been this morning! Determined to not have it shrugged off today and it hoped that I’ve forgotten 😅

@Goldencup I know very high right. I thought it was super interesting. Apparently the national average is 27-28% so significantly higher. No real insight into why but I know at this hospital they book 4 electives per day. On my day there were at least another 6 emergency c sections that happened during the day, between the first two electives at 9ish and 10ish. I then had to wait because of the emergencies and it was 4pm before my turn. I was the 3rd elective.

Good luck for your appointment op!

It's good you have a clear idea of what you would like, and your own personal reasons for this are exactly that - personal! You do not owe every nosy person an explanation, although good to have a frank chat with the obs team when you finally meet them. Important to let them know any particular worries you may have, so they can address these.

Ignore the pp 'concerned' for societal implications of women requesting c sections. While there is a time and place to discuss the complex reasons behind c section rates at a trust or national level, it is not relevant to your decisions right now.

Your concern is rightly for you and your baby, not the opinions of others. There are some highly judgemental people who will comment in a derogatory way about women having csections. It can be very upsetting to have this directed at you, especially when you are pregnant (although it still annoys me now, and I am a couple of years down the track from my first baby) These comments often come from a place of ignorance, or their own personal moral crusade. The main thing is you are fully informed what the process is, the complications (which will be discussed at length in appointments pre op); and you have a realistic expectation regarding recovery as well.

I have had 2 elective c sections, at different trusts. I do not have any regrets about choosing this pathway. Like you I had very clear reasons for this (I am a hospital consultant, and knew full well what I was signing up for, and the pros and cons)

My first was in London at a big teaching hospital. Midwife appointments were hit and miss, sadly there were some incredibly judgemental midwives who made it very clear they did not support elective c section, and I had to push for this. The change in demeanour in one midwife during an appointment when I told her what I wanted was startling. From friendly to openly hostile! I was treated in an incredibly patronising way by some midwives, which made for a really negative experience during what should be a lovely and exciting time. As per their protocol I had to meet with a senior midwife to discuss what was involved, and that I understood what I was consenting to, before they would agree to then refer me
to meet the obs consultant, who was happy to book me in. However this process didn't happen until very late in pregnancy, and the midwives made me feel unsure for much of the pregnancy whether they were going to allow it. I found this created a sense of uncertainty throughout the pregnancy, which in itself then causes anxiety. The surgery itself was fine (although aftercare appalling on the wards - a separate issue!)

My second was at our local district general hospital in the country (as we had moved). Absolutely fantastic experience, lovely midwives and staff, absolutely no problems at any stage, surgery went well. As it was a second c section, it seemed a complete non-issue when I requested one again, and the attitude of the midwives was positive and supportive rather than judgemental and dismissive as I found them to be in London.

So much of the experience seems dependent on the attitude of the team you happen to meet in clinics. All I can say is good luck op, be clear what you want, and and I wish you all the best!

@JustbemoreMargo Thank you for the long in depth message, it reassured me a lot as I read it straight after I came out of my appointment and what you said especially about not feeling ashamed for my choices meant a lot. I’m so sorry your first experience was so bad, it’s disgusting how you were treated by people who were meant to be in charge of your care! I’m so glad your second experience was better x

An update, thanks again for the messages all- I went in expecting a face-off but it turns out my midwife is utterly ace and I said ‘I have a question, I know it’s a big one to ask…’ and asked she just shrugged and said ‘it doesn’t bother me what you do, it’s your baby and your body’. I could have cried honestly. I had all notes and info I’d memorised but she just pretty much went ‘sure you can do what you like and I’ll support you’ and wrote the consultant referral. She asked why and didn’t question it at all, let me see what she had put on the notes to check it was how I wanted my request to come across (if that makes sense)- just overall perfect. And a little anticlimactic as I was so anxious beforehand expecting to have to fight to be heard and she was just absolutely cool with it!

So if you’re in the same situation as me, knowledge is power (I took notes and had facts I could reel off regarding risk etc.) and obviously I’m anticipating having to advocate for myself with a consultant at next appointment, but don’t assume the worst. My midwife is quite abrupt, very friendly but no-nonsense and it could have gone either way I thought, but turns out she is an absolute angel. 😭

Huge societal implications re. women wanting c-sections?! Give me a f**king break. So glad you had a positive appointment op.

A c- section rate of 50%, yes that is a societal problem. A majority of women not prepared to labour and give birth naturally? Yes I think we really need to ask how we got to this place ?

https://www.who.int/news/item/16-06-2021-caesarean-section-rates-continue-to-rise-amid-growing-inequalities-in-access#:~:text=According%20to%20new%20research%20from,21%25)%20of%20all%20childbirths.

@Goldencup I’m curious what you think would be a ‘justified’ cesarean, if you don’t mind me asking? And also why you see it as an issue? To me, women being allowed a choice in how they give birth when the options are there can only be a good thing.

So happy you got what you want OP
Best of luck with the impending arrival

I think what the societal implications are that caesarean birth does have risks and the more that are done the less our HCP can learn of vaginal birth.
I know that vb can unfold into difficulties mentioned but it is often also almost entirely uncomplicated non traumatic (not without pain however) and safe for mum and baby.

Also recovery from
The surgery into a world that expects us to "bounce back" during what should be a bedding in 4th trimester is also a lot to ask of anyone imho

So pleased it all went well!
Best wishes for the rest of your pregnancy.

What problem does this cause at a societal level?

Why does it bother you? Natural labour fucking hurts and comes with its own risks. What are these societal implications?

OP - I am relieved things went went for you. The midwife's reaction was exactly as it should have been, but sadly from other posters' experiences, it isn't always like this.

Fwiw, I requested a section this time (third baby) due to complications with my second. Due in August.

I fully support a woman's right to make a choice over how she gives birth. I hope all goes well for you. And yes, there are risks, but there are risks to vaginal births too. From all I hear on here, the overwhelming majority of elective c-sections are a positive experience.

Well to try and answer a few questions:
All surgery carries risk, infection, bleeding and post operative complications like blood clots. These are all relatively rare and can happen with vaginally birth but are less likely. So an elective c- section is medically riskier than an uncomplicated vaginal birth, but both are pretty safe in the 21st century.
Then there are the risks to the baby, most commonly breathing problems (TTN) this affects as many as 10% of babies born this way, also baby misses out on being exposed to the vaginal flora which helps colonise it's gut and is immuno- protective. Finally breastfeeding is harder to establish after a c- section for many reasons including babies tend to be sleepier, mothers in more pain so positioning more difficult and there isn't the enormous hormonal kick up the backside that the labouring process provides.
For society if 50% of all women have a cesarean section there is no folklore established around labour and child birth, as the majority of a pregnant women's circle haven't experienced it, so can't reassure her.
Finally it is totally unnecessary surgey requiring obstetricians, anaesthetists, nurses and usually a 2 day hospital stay, so maternity units need increased capacity and midwifery led units which offer the best outcomes in terms of satisfaction become defunct. The women on the postnatal ward are also less mobile and require more care than those who have given birth vaginally (on average) so staffing ratios need to be higher.

C- sections can be life saving for both babies and mothers. It is vital that all women have acsess to them. There are numerous medical conditions which would make it unsafe for women to labour, of course those women should be delivered safely. A significant birth trauma (either physical or psychological) is also a good reason to avoid labour and/ or vaginal birth, although a " good" birth can also be therapeutic. But for an uncomplicated first pregnancy ? I think the answer is education not elective surgery.