Is csection a choice?

[Blue2020]

This is longer than I thought it would be.

I was under the impression a csection was a choice. I’m 31 weeks and today my midwife asked me if I had made any choices about the birth yet. I said I think I’m going to go for a csection.
To which she said you can only have a csection if you have a medical reason, otherwise they won’t let you. What is your reason?
To be honest I wasn’t prepared to list my reasoning so I felt taken aback a bit.

She did then look on the front and see my first was an emergency csection, said was it due to high bp and I explained while worsening preeclampsia forced me to have my son at 35 weeks, it was technically my sons static ctg that led to the csection being the safest option for him. She did then shrug it off saying they may possibly let me because my first was, and if that’s what I want to choose. I walked out of there and cried afterwards while sat in my car (maybe it’s my hormones). I don’t think the reasons I had my first will happen again this time, I could be wrong though. I just have optimism this time, and a very low bp.

I am consultant led and the midwife won’t schedule the csection because I’m consultant led. However now I’m worried I need to justify a case to choose a csection when I meet the consultant at 33 weeks. In previous sessions I have said ‘no induction under any circumstances, can I request a csection but I’m willing to try if I go into labour naturally before then’. The same midwife just said well if you go for a csection you likely won’t naturally go into labour before it because it would be around 39 weeks. Eg being dismissive of my choice. To the point today I just decided not to mention the final part and just say I would like a csection.

My initial worry was uterine rupture (especially with never reaching full term before so my uterus is going to grow bigger than before with the weakened scar- I had my son 22 months ago for reference). The consultant gave me the statistics at 14 weeks on the phone and from there I have been thinking more against a vaginal birth as the weeks pass. First ruling out induction but now just leaning towards csection to know. I could be wrong but I don’t think they will let me go over anyway due to my last pregnancy. Even my friend who is a student midwife just witnessed a uterine rupture with a person labouring with an epidural. She said it was touch and go for both the mother and baby, and the baby was out of the uterus by the time they opened her up. This will be my second/last baby all being well.

Well shes friendly overall but I have also been having a few issues that I have overlooked:

-at the booking apt she didnt know what the rsv vaccine was (fair enough)
-at the booking apt I mentioned I had low iron and issues with it in my last pregnancy, she said she would add ferritin to check it. She didnt, unless the decision was overridden somewhere else. To be fair I felt ok and my haemoglobin at that point was 130 so it was fine.
-at 16 week apt I told her how tired I was and was really struggling and she said my haemoglobin was ok at 8 weeks so it’s likely just usual pregnancy. I was really struggling at work by 2pm, starting to pass out driving to work. I tried to contact the midwife at 18 weeks because I’m used to pregnancy tiredness and I also knew what more extreme tiredness felt like but I got no answer so I asked my gp for a blood test at 19 weeks and it showed both my ferritin and haemoglobin were low. I have been on iron tablets since then and they have still not reached the minimum values but they are slowly creeping up.

There is a bit more but it’s just minor things that have added up. Today is the first time she has been quite abrupt.

At this point I just don’t want to go to any more appointments. Ironically it’s from this point when I developed preeclampsia last time. I am seeing a different midwife next time due to mine being on holiday. I could ask for my remaining appointments to be at a health centre closer to me if they have space and it might mean someone else then, she prefers to work at a site further away and I initially wanted to have continuity of care.

I have only talked to the consultant on the phone at 14 weeks. I am seeing them next at 33 weeks. Should have been 32 weeks but I went in for reduced movements last week, so they have pushed the growth scan back a week, and the midwife today has asked for the consultant apt to be pushed back too because seeing the consultant ‘would be pointless without the scan’.

Yes it's a choice but it's wether they think it's appropriate or not.

I choose a elective c-section second time
Round as I had a emergency c section the first time after being stuck in active labour for 60 hours and by the time I actually got to pushing my eldest head was to big. 🙄🙈

So yes you can choose, but it doesn't mean they won't say no.

And if they say no, they have to refer you to a consultant who will say yes.

It is a choice OP, it’s your choice.

It is absolutely 10000% a choice. I know a few years ago it was only for ‘medical reasons’ as such. But that is not the case anymore, yes you might need to say why eg ‘last birth was awful / anxiety surrounding birth / want more control as you have a child now - but any reason you give us valid and that’s that.

It is absolutely your choice, I'm sorry you've had to deal with this.

I had an ELCS with my first for medical reasons that no longer exist but have elected to have another section this time round rather than try a VBAC - I have many reasons for my choice and just told them from the beginning this was what I wanted.

I've had a couple of telephone appts with the consultant and midwife etc but nobody has ever questioned it and I've never had to really justify my decision. I'm 34+3 now and have my date already.

Good luck.

You don't have to see a midwife.
Make a gp appointment and explain.
I had to move to a gp when the midwife- 2nd baby- tried to gossip with me about another pregnant woman - I had to say ' please don't tell me, I don't want to hear this'
And ' for a larf' pretended she couldn't hear a heartbeat. Yeah fucking hilarious.

I had no idea I could request a gp instead, did so. He was in total agreement re c section and efficiently sorted it all out with no fucking around.

I had 2 c sections. I had the second because first baby was enormous. And the second one because the womb might split where weakened on first c section.

OP I think it depends on the reasons and possibly by trust

Im a first time mum and asked for an elective c section due to severe anxiety regarding giving birth.

I have been referred for hypnobirthing classes through the NHS and advised it is unusual for first time mums to have an elective unless there is a very strong reason why.

They said they can refer me to the consultant after the classes but it depends on whether the consultant agrees to do it.

@Halo20 it doesn’t depend on reasons, or vary by trust. If you want one, you have the right to have one. They can’t say no.

If after discussing all the risks and hearing about all the support on offer you still feel that a vaginal birth is not an acceptable option, you should be offered a planned caesarean. If your doctor is unwilling to perform the operation, they should refer you to a doctor who will.

@Halo20

I have been referred for hypnobirthing classes through the NHS and advised it is unusual for first time mums to have an elective unless there is a very strong reason why.

They shouldn’t be “advising” this

They said they can refer me to the consultant after the classes but it depends on whether the consultant agrees to do it.

If the consultant says no, then they must refer you to a consultant who will say yes.

You can ask for a different midwife.

Hi OP, just to say what others have said really... you can absolutely make a choice about this. I did when I had my first baby and will be requesting another one with my second.

Wishing you all the best!

I think this is the relevant NICE guidance here

Under 1.2.30 it says:
If, after an informed discussion about the options for birth (including the offer of perinatal mental health support if appropriate; see recommendation 1.2.27), the woman or pregnant person requests a caesarean birth, support their choice. [2011, amended 2023]
and
1.2.31
If a woman or pregnant person requests a caesarean birth this should be offered within their obstetric unit. [2011, amended 2023]

Thank you for this.

I am seeing my midwife again this week and will use these points if needed and the NICE guidance.

Midwife is full of shit. And unkind. Quote NICE to her. It's a choice.

I chose a csection for my first for no medical reason whatsoever - I'm a midwife myself - and have requested another one as I'm pregnant with my second. You may require to attend a workshop about the pros and cons of the different options or a chat with a consultant going through the same but utimately you don't need a medical reason, it is absolutely your choice and she is wrong.

I was the same and demanded a section and got it. They actually cant say no and need to refer you to another consultant who will do it, you have the right to birth hiwever you choose just like with many other medical procedures. They can try and change your mind or talk you out of it but stand firm and you will get what you want. I dont regret my section at all I had an amazing experience compared to my friends who had vaginal births.

It's 100% a choice and you don't need a reason. I had two ELCS and when asked for the reason just said 'because I feel it's the safest option for my baby and me'. First pregnancy they tried to engage in discussion on the pros and cons (I listened but said I'd made my mind up based on my own research and independent advice) and then tried make me do counselling first which I refused, in the end the consultant booked it straight away, it was only the midwife objecting. Second pregnancy no one bothered questioning my choice.

You can definitely choose to have a Csection, there maybe some pushback from some but end of the day NICE guidelines allow for it which they have to follow.
The fact you have had an emergency C section as well the consultant will go through options but will book you in. Just be clear and put in your notes for C Section referral to obstetrics.

Thankyou everyone. I had heard of people choosing to have a csection before, so when she said I needed a medical reason and if I didn’t have one they would say no, then asking what my reason was I just felt under pressure and didn’t expect it. I guess I expected her to say something like ‘have a discussion with the consultant’ or something passive.

The rupture is what scares me due to having a first csection not at full term. I never felt like I got an option with my last pregnancy but it all happened so quick and my priority was whatever was best for me and my baby, I just went along with what the doctors said at each stage. Waiting to be induced, switching to an emergency section.

This time I have been thinking more and more what I want. A small part of me still thinks if I go into labour naturally I’m possibly not opposed to trying, however a bigger part of me now wants a csection. I’m at the stage of actually asking for it as my decision and I just wasn’t expecting the reaction I got.

I see my consultant in two weeks time, so I will attempt this again then and possibly have my reasons ready just to be better prepared.

It is a choice and she should of been more supportive

My sister is due to have her first baby this year, healthy pregnancy no problems at all and she has opted for a c-section and has been given the date it will happen. My sister is very good at advocating for herself though, she said she was worried they would try and argue with her but nobody did.

She's not got a great pain tolerance and likes to be in control of her environment and those are the reasons she gave the consultant

As others have said it is definitely a choice. I had EMCS with DS1 and just had elective section with DD2, my consultant didn't want me to be induced due to higher risk of scar or uterine rupture so was scheduled a section if labour didn't happen naturally by just over 40 weeks- my consultant actually suggested this to me.

Just be prepared for your consultant appointment to state the facts around having one and stick to your guns, you have plenty of reasoning to ask for one.

So I had an EMCS after failed induction last time.

The midwife referred me to a consultant who asked me at 24ish weeks how I wanted to deliver and I said ELCS and she said "very sensible " and I'm doing the paperwork next week.

When do you next see your consultant? I'd get it signed off through them and not worry about what the midwife has said. Remember you can always change consultations or even hospitals. But I can't see it being an issue.