Refused C Section- can anyone offer advice/share their experience?

[Quinners]

I am currently 36 weeks pregnant and have always leaned towards an ELCS despite being low risk (the unknown, uncontrolled element and higher risk of incontinence later in life for V birth were the main elements for my preference).
I told my Midwife at my last appointment and she was very patronising. She booked me in to see a consultant and i was hoping we could have an informative discussion about the risks, pros and cons etc. Wow was I wrong!

Firstly, the consultant took me to a room in the hospital and asked me to sit while she stood over me for the entire meeting (weird power dynamic move). When I said I'd like an elective she simply said 'no' and didnt even ask for my reasons. She then asked how tall I was and said 'oh you're tall and nice you'll push a baby out easily'. How is that a professional comment? She also dismissed my concerns around vaginal birth complications and said that she'd had three kids and was fine. I was hoping for data and statistics rather than a personal anecdote. She then became very keen on writing in my notes that l didn't want an induction (I hadn't even mentioned this) and said that if I got to 40 weeks without going into labour they'd book me in for another c sec discussion.
I left the meeting feeling extremely upset and disheartened. I don't mind the refusal so much but the way I was spoken to and the lack of actual facts/clarity is really disappointing. Would love to hear some advice or to see if anyone else has experienced a similar thing? My health board is in Wales so unsure if that makes a difference.
Thanks for listening

If you needed it then it wasn’t okay. Sorry I just can’t agree with I just feel like one.

You have a right to request but the consultant also has a right to say no if they think the risks out way the benefits.
You can go back to your midwife and request a different consultant but considering you are low risk and the worries you have, I'd say they would also say no.
You can go private if you are not happy with the NHS service offered though.

Where I am, in a low risk uncomplicated pregnancy, it would be a no from all consultants. Even for me with my complicated history, fear of giving birth again and a higher risk pregnancy, I was encouraged to have a VB as the benefits out wayed the risks. They helped address the issues I had around another VB though and supported that rather than just a blanket no sorry we cant help you

That's not right. No doctor can be compelled to perform any treatment they don't believe warranted or in the patient's interest. You certainly have the right to ask as many doctors as you want, but they also have the right to refuse.

The point about you being spoken to this way is very valid. Perhaps they were condescending and generally awful. This is not acceptable. From the other side they’re coming from an educated angle where they know the potential problems and dangers with a c section far outnumber those of a natural birth. They thought you were „being silly“.
As someone who has had sections and would definitely try to avoid them if I could do it all over again, I do understand that.
However you have a right to your choice. What is important from a legal and ethical perspective is that it is an informed one, so inform yourself and go in armed with information and good reasoning. Not just something vague about your pelvic floor (which I hate to tell you is already affected by the pregnancy!)

The potential problems with a C section do not ‘far outnumber’ those of a vaginal birth. They’re actually very near to each other these days (but different), with vaginal birth being slightly safer for the mother but slightly riskier for the infant, and elective c section slightly riskier for the mother but slightly safer for the baby.

An unplanned instrumental birth is much higher risk, as is EMCS. Both of these options only arise from a failed attempt at vaginal birth, so overall, being in the category of going for a vaginal delivery presents the highest risk.

OP I would go straight to PALS on this, as the midwife isn’t cooperative. Ans simultaneously inform the consultant that you wish to see somebody else to get your c section agreed.

I had an emergency CS because of pre-eclampsia. It was no walk in the park. The pain was excruciating. I struggled to bond with baby after. But my CS was medically justified. I don't think (in my layman's view) yours is.

There were at least 10 people on the room at one point when I had my vaginal birth, including the on-call consultant anaesthetist. I was in hospital 3 nights including the first night being induced after my waters broke, full of meconium. I was subsequently referred to the birth reflection service during my second pregnancy because of the anxiety caused by my first delivery. DC2 was born by ELCS and I was in hospital less than 36 hours. The recovery was vastly quicker as well. I don't know which birth took up the most nhs resources but I have a hunch it was the first one.

This isn't true anymore, NICE guidance has been updated and you can request an ELCS without a specific medical reason. They are still not compelled to agree but you have the right to request another consultant.

ETA the OP didn't say she thought there was no risk - her comment about "low risk" was about her pregnancy, not CS.

In which case, you just ask for another professional to provide the care.

I wish people would stop getting confused between emergency and planned C-sections - the risks and the recovery times are very different between the two!

Nonsense. If every woman had a c-section it would save the NHS money long term. They’ve done studies on it.

What’s part of pregnancy and part of becoming a mother? Vaginal childbirth? What nonsense. You sound like those male Japanese doctors who don’t allow pain relief in labour as the pain helps the mother to bond… nonsense.

What nonsense. C sections on a population level are much safer than vaginal births - look at the stats!

You're very fortunate then. It took me longer than a year to be pain free, and this includes paying privately for physio and other interventions. And some rather painful NHS treatment.

I will never be the same down there and am fighting hard to avoid long term incontinence, but the truth is this is going to be a life long thing. It's rather depressing at my age to be honest.

I’m sorry you struggled, it sounds like you had a very rough experience. Your experience leading up to needing an emergency c section may well have been the main factor in your struggle to bond, rather than the op in and of itself.

OP is requesting an elective section, which is a lot less risky and traumatic than an emergency one. In the nicest possible way, you are entirely correct when you say you have a layman’s view. Your experience is valid as your experience, but that’s as far as it goes. For every person who has an experience like yours, there’s at least one other who has a really positive experience with an ELCS. That’s why looking at risks and benefits more objectively via stats is so important. As is, of course, OP’s own knowledge of herself, her psychology, medical history, preferences, etc.

Yes! It makes it difficult to interpret the risk factors, but as a rough rule of thumb the order from lowest to highest risk is:

1. Unassisted spontaneous vaginal birth
2. Planned ELCS
3. Unplanned CS (not an emergency as most of us would understand the term, but where the patient may not have had as much time to discuss things with the consultant/anaesthetist beforehand)
4. Instrumental delivery/induction/more complicated vaginal birth
5. EMCS

Obviously there is overlap and this is a huge generalization before anyone comes at me with whatabouts!

So you could hope for option 1 and end up with 3-5 anyway, or go for option 2 from the outset.

It costs a lot of money to have an ELCS when there aren't any mental or physical reasons. More medical professionals, more resources etc. I had tokophobia and considered a c section but decided to have a vaginal birth. I was scared of childbirth, but even more scared to have surgery and the complications that came come with surgery.

I asked whether a C-section for my second one may make sense once they started talking induction. The first consultant I saw was awful, refusing to give statistics on risks of instrumentals during inductions. Just totally against the idea. She also said my injuries from the first time won't become worse, even if I needed an instrumental delivery, as the damage was done.

I emailed PALS and asked for a meeting with proper statistics of outcomes to be able to make an informed choice and give consent. I said without the information I can't give informed consent and agree to anything. That did the trick and I saw a lovely consultant next time. She had print luts of risks. We discussed how often inductions end in sections. The risks specifically related to me and my baby. And in the end we agreed a section. I wasn't even set on a section, but what I really wanted was to be treated with respect and to be able to have a discussion. So that may be the way forward.

I don't have the stats to hand and so happy to be corrected if I'm wrong, but I read somewhere that the budget for clinical negligence associated with maternity care (many cases of which will involve things like 4th degree tears) is higher than the entire maternity care budget! And takes up a massive proportion of the overall cost of defending negligence claims.

I'm sorry to read you had a bad experience, but you don't get to gatekeep who gets what medical treatment.

It's only more expensive if the alternative is an uncomplicated vaginal delivery, which is never certain. If the outcome is a failed instrumental delivery followed by EMCS (say), the cost is much more than an ELCS.

Wtf
of course worrying about birth injuries is a valid reason

I would never choose to have a ELCS. But that's my personal preference.

I had 2 natural births. They were long births - induced the Friday morning had him the Wednesday night. 2nd baby, Sweep on Wednesday, went into labour Wed night had him Friday morning. Both were over 40 weeks. Baby 2 turned breach at week 38 but they managed to turn him.

I was glad to be up and walking around the following day and not have the additional recovery.

It's up to you, I am sure you have done your research, and if you push for it you should find a consultant who will perform the surgery.

There is always the possibility that you go into labour and its really fast. If you are too far along by the time you get to the hospital you might not have a choice.