Can I INSIST on having a caesarian?? also how are caesarian op dates decided?!

[MissDelighted]

I am 5 weeks pg with DC1 and am due to see the doctor next week. I wondered if it is possible to insist on a caesarian (in a normal NHS hospital) or if it is down to the doctors/midwives/hospital/postcode. I am certain I do not want a natural birth and want to make this clear as early as possible to the medics.

I am so set on a caesarian birth I am prepared to use savings to go private as a last resort, although I don't wish to have to do this.

Also, for anyone who has had a Caesarian - do they perform them bang on your due date or is it down to the baby's development nearer the time, or even beds available on particular days? How is it decided?

I would really appreciate any info/advice prior to seeing the doctor as I want to make sure I am armed with enough information not to be swept away with what she thinks should happen. Thanks in advance

Well Turnip of course I read your two posts otherwise I would not have replied! Does nature work well in the majority of cases?

Well the number of women who have intervention of some kind for their 1st vb is considerable (epidural, stitching ,catheterisation, forceps to name but a few!)

Why cant we chose to have cs's if we want them?! I really cant think of a good reason why not! The vast majority of women will face childbirth at some point in their lives and I am sure the option of having a cs would be a great comfort to some, others would reject it immediately (infact I am sure the vast majority would do so).

Why do you you feel the need to subject other women to the unnecessary stress of feeling they have limited choices? As long as women have access to all the information in order to make a reasoned choice this is the way it should be!

Stomach stapling is not a consideration that most women would feel the need to have to think about unless they are morbidly obese.

As for the cost issue well I think I made it clear that it is not as straightforward as just calculating the initial expenditure. Look beyond the stats thats what I say.

Hey if you want a cs for Christmas go for it! I for one would support your right to request an elective any day.

Do people always have the ability to make this decision though? If I needed chemotherapy would I be the best placed person to decide my treatment schedule, or would I let my oncologist advise me?
No-one knows in advance what type of delivery they would have and I believe it is fairly typical for a first labour to be much harder then a second, so to decide to have a CS based on how painful a first labour was is probably not the best way of making that choice.
The way that the NHS works in all other respects is that you can exercise choice by refusing investigations and/or treatment offered to you, but you cannot insist on being offered things.

becaroo, of course it is clear that I am saying if intervention is needed in chilbirth.

Also you need to look beyond the statistics - the majority of css are performed because there are medical problems in the 1st place.

Even in cases of maternal request it is likely that there would be 'complications' necessitating the request in the vast majority of cases.

We are taught to be afraid of birth, that is is bad, messy, dangerous and an out of control experience that will end in intervention anyway. Those perceptions can be totally wrong. My birth was calm, pain free and relaxed,and despite being induced I had no drugs, no intervention and it only tooks a few hours. Try hypnobirthing, try birthlight yoga, read and empower yourself, these practices will change your fears about yourself and your ability to cope.

After doing that, if you still want a ceasarian please, please go private. Ceasarians cost the NHS more, not just the cost of the operation but the bedspace and hotel costs aswell and having worked in the NHS and not having enough resources to treat genuinely ill people I do think it is extremely selfish to demand an unecessary operation. Yes, I'm sure you pay your taxes but don't we all and if we all decided tomorrow that we wanted a ceasarian how long do you think the NHS maternity services would cope????

....I am not sure thats true izyboy.....perhaps I have been influenced by the "too posh to push" stories in the press and other media?

In my opninion, there should always be a medical reason/need for a cs (or any other intervention during birth for that matter!)

Starlight....there are lots of options for pain relief in labour.....a cs should not be one of them!

Also, if someone is that scared of the pain/process of childbirth, then I really feel they should be offered some sort of counselling - unlikely on the NHS I grant you.......

littlepinkie I take your point, but surely it is humane to allow people to have the option of being listened to and the risks explained diligently and carefully for both vb and cs. Certainly I would not feel comfortable deciding who does and does not have the ability to make decisions about what happens to their own bodies.

It is likely that pregnancy and childbirth are probably the riskiest things most women will ever do with their bodies (unless you enjoy extreme sports.)However the risks are still small for both cs and vb so I think it is important to keep this in perspective.

Crikey I cant keep up with all these points ladies please bear with me and I hope some of my previous posts will bear witness to my opinions.

Regarding the medicalisation of birth well, hmm, yes, midwifery services do need extra funds and I would be the 1st to support this being diverted into birthing centres etc. I am all for pro choice ladies! I also wanted a home birth after all. However lets not forget this may not be the choice for all and yes our bodies sometimes cannot cope with natural labour-so people do need to be aware of the medical outcomes if they fail to progress etc. Knowledge is power and medical help is not something to be frightened of.

I think though that for the small minority who want to opt for an elective cs this should be seriously considered as an option.

Is it fair to say... if you know that elective CS are hard to come by for non medical reasons, and you think that's barbaric and absolutely can't give birth without a CS, then you shouldn't be planning a pregnancy? An aquaintance of mine was in this situation. Said she'd never have a natural birth, due to pain mainly and also worries about what damage it would leave her with down below, and that it was unfair that the NHS don't do elective CS. Then chose to get pg, then complained bitterly about it again. She's due in a couple of months and still hasn't got her CS as far as I know.

In Scotland the normal birth rate was about 40% in 2005. In England it was 46% in 2006. Normal birth does not include those that had a CS (elective or emergency), foreceps or ventouse, episiotomy, spinal, epidural or general anaesthetic or induction. To me, that's a pretty high rate. 46% of women in England gave birth without much else except G&A, opiates, natural pain relievers and perhaps some stitches.

Counselling is available on NHS, because I was referred for it.

Spoke to fantastic helpful midwife, but made not one jot of difference.

After what I wentt through with ds's natural birth, I was never going to put myself through that again. The fear was too great

Hospital, midwife, consultant, all very helpful, kind and supportive of my choice.

Well Suzi I think you know I will disagree with you. CS should be available to women with pathological fear of childbirth. Pure and simple. I really would not want to stop someone from enjoying parenthood (which is afterall many years of caring for and loving a human being) because they just couldn't face vb. My consultant was of the same opinion-lucky me!

Crikey Izyboy, things have moved on while I've been bathing the troops!
I don't mind at all sharing my experiences with anyone
My eldest son was breech all the way through,however that is pretty much par for the course on my maternal line and they've all been straightforward VB's , mostly at home (i was born in hospital because my elder brother had birth defects which caused his death at 3 weeks old) so I wasn't too fazed by the prospect of birthing normally, and got hold of the breech guidelines to bolster my case .I had no problem convincing the HOM and she was fully supportive, but when the time came, i attended the labour ward right away as i had been told and things immediately got scary -My first ever VE was more like an indecent assault and all my confidence evaporated, things never really got going (if I'd have stayed at home , who knows what would have been different?) my birthing partners (DH and mum) were out of their depth and I was climbing the walls with nobody to just look me in the eyes and calm me down. that continued until 11am the following morning when after much pressure, i caved in and had an epidural,followed by ARM, followed by synto, then basically a long and lonely wait until a random Reg put his head round the door and decided to review my CTG , even with the synto up to maximum, i wasn't contracting, next thing was a hurried discussion and off to theatre i went on the grounds of failure to progress (Ds was stuck in the transverse, If they'd have palpated and VE'd before ARM it probably would have been noticed and I would have refused it to give him time to complete the rotation)
all my other 3 births have been different, but the middle two might have gone to C/S in hospital, DS2 was brow presentation until transition (lovely bruises all over his forehead in an oval)and the labour was scary at the beginning, but i soon got into the flow and coped fine, even though it was the most painful thing I'd ever done. DD1 did a long rotation from ROA to LOA, taking a good 12 hours over it, no ARM, no pain (seriously! I felt such a fraud, sitting scoffing jaffa cakes lol!DD2 was the awkward one- very slow and niggly, nearly 2 days from start to finish, complicated by 2 APH's , ARM after the second one- 6 cm to fully and pushing in 10 minutes - no reason for the bleeds , but she had the longest cord I've ever seen, with 2 true knots, one on top of the other, so in the scheme of things, it was the right place to be,the pains were annoying, but manageable.
I had a good gap between no's 1+2, but it was a good thing, I'd put the C/S to bed by the time I got pregnant again and treated the whole thing like I was planning care for a client, did my research, weighed it up and made a decision, aided by the fact that I can't stand hospitals(not that unusual for a nurse lol!)
thanks for bearing with the very long post Izy, it's been a pleasure debating with you too!

But how is pathological fear decided? I mean, almost every pregnant woman I have ever known has a certain fear of childbirth. At what point is one womans fear a valid reason and another woman's not? I have to say that if it was me that was terrified at the thought of childbirth, I wouldn't be getting pregnant until I knew that I could have a CS. Part of me thinks that if a woman can contemplate getting pregnant etc without knowing whether she will have to give birth naturally or not, she can't be that phobic can she?

I'm just thinking out loud. I have a lot of fear of a lot of things, but I wouldn't consider myself to have phobia as I don't go too far out of my way and it doesn't impact my life greatly to avoid those fears.

Yep, I disagree as well. Tokophobia can overwhelm people. As we live in the 21st century, people can make a choice if the fear is too bad. We don't live in 19th century where people had no choice, and probabaly endured periods of great anxiety and fear throughout pregnancy.

Why should those people not have children? Does this affect their parenting skills or have I missed something? I know which type of birth I would choose asgain having been through both.

But some women won't get pregnant, although they desperately want a child because of the fr of childbirth. I have read lots and lots about this. I also read somewhere, that some won't get pregnant, until they have it confirmed that they can have a c-section.

But some women won't get pregnant, although they desperately want a child because of the fr of childbirth. I have read lots and lots about this. I also read somewhere, that some won't get pregnant, until they have it confirmed that they can have a c-section.

If your friend doesn't have a pathological fear OF VB it is likely that when she is asked to sign the pre op contract for the elective cs that clearly states all the risks involved she will find this hard to do.

It is very daunting, as is the meeting with the anaesthatist - they really tell it as it is and that is absolutely correct.

might I just say at this point, that the US has the highest C/s for maternal request rate in the developed world- and also the highest maternal and neonatal death rates.

I didn't find any of it daunting at all.....

Thanks for your post Jamila we've just crossed posts and I have to go for my tea now so wanted to acknowledge you beforehand. Will give it my full attention when I get back.

I think that's what I'm trying to say. Some women don't get pregnant due to this fear. And that's wrong as CS should be available to them. Fear shouldn't stop someone from having the chance of being a parent. But what I'm wondering is that if someone can take the first step, ie getting pregnant, knowing there is a strong possibility they won't get a CS, then perhaps that fear isn't as strong as they are saying? I just know that if elective CS was available, several people I know would have taken it straight off without too much thought. I would have been one of them. I actually asked my MW for one at 12 wks. She just laughed.

the reasons for that fear really have to be explored though, I for one think that the main problem is that women rarely see the mechanics of birth unless it's on TV, and they don't have the experiences of a large extended family to fall back on - by the time I had my kids,as the third oldest of 21 offspring of a total of 10 members of my parent's generation,all living in a 15 mile radius I'd listened to plenty of women talk about their births, in fact i was in a position to be the tale teller to my youngest aunt, whose daughter is 4 months younger than my eldest son. It's so unusual to get that now,and birth becomes this thing 'other' and unknown, rather than the natural,talked about event it used to be

Hey Jamila cant argue with you - think that in your case the home births were obviously a far superior experience. Also I agree it would be lovely to have generations sharing birthing experience. However I have vague recollections of my Nan saying she only had one child because of 'problems' and my mum who is a midwife is totally accepting of all intervention (1950s/60's trained) infact probably the more the better in her opinion! (lol.)

Anyway, I also wanted a homebirth for my first DC but didn't get one because of high blood pressure. Transferred to hospital whereby the intervention started (with the heart monitor belt) but I am a stubborn git and would not accept pain relief or further intervention without full ivolvement of DH and myself. Cut to 2nd child chose elective cs because ... wait for it.... I really wanted to plan childcare for my son..

Well my mum is unable to look after DS and any other trusted relatives live hours away - I knew that for my peace of mind I needed to plan well in advance for his sake so asked for a cs and yes I was granted one. I am so very grateful to my consultant for being open minded enough to see that this meant a great deal to me. I did not take the deciosn lightly and knew exactly what it entailed.

Fizzbuzz perhaps you were not daunted because this was what you wanted and had no doubts.