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

As stated above, you need to discuss your concerns with your obstetricion, because he has really seen it all before whereas your concerns are only based on what you think you know, and as you've never had a baby before you really don't know whether it will present problems.

But I would advise you to think very hard before just opting for a section.

It is major surgery.
You will not be able to drive for six weeks. caring for your newborn baby will be harder after having a section than after giving birth naturally.
You will be in hospital for at least 5 days
There is greater risk of hemmerage
greater risk of baby having breathing difficulties
greater risk of post-natal depression
greater risk of infection.

It really isn't the easy solution to childbirth. For people who need an emergency delivery or who have had a section in the past or whose babies are breach it is the only way, but the recovery is far longer than a natural birth.

finallypregnant/MissDelighted... they 'bump' elective sections out of the way if emergencies come in, so the scenario is unlikely. (I was given a time for mine, but told that it was subject to change, depending on whether there were any emergencies that came in that morning.)

ellbell - if an elec c sec was already underway though then somebody who then urgently needed attention may have to wait until you were finised iyswim

also, iirc a section costs the nhs far more than a natural birth (thousands more if i remember correctly) so they have good reason for not handing them out on a wim.

£760 more

There is research suggesting that for mothers at low risk c-sections actually carry a higher risk of infant mortality than vaginal births.

Have only got time for a quick search, but have found this for example.

It's a fallacy that a c-section is the 'safe alternative'. Sometimes it is. It was for me in my first pregnancy, when dd1 and I could both have died if I'd gone into labour. But mostly it isn't (as it wasn't when I had dd2). Try not to listen to horror stories (it sounds as if you've heard a few that have really scared you) and talk to people who've had positive experiences. Try to trust your doctors and midwives to give you good, reliable advice.

Having a smear done is in no way a reflection of whether you can give birth or not.

A non-pregnant, non-labouring, non-dilating cervix behaves very differently to a pregnant, labouring, dilating one.

In labour the vagina and cervix totally alter shape and position so having slightly awkward genitalia will not necessarily prevent you from giving birth safely.

You can certainly discuss your fears and concerns with a midwife and obstetrician but it's unlikely they would automatically agree to a C-section.

True, 2.4... but most hospitals have more than one operating theatre. And sections don't take long to do.

Thanks for your advice Ellbell. When I say insisting I do not mean "I am grandly insisting you medics do as I say".

I have dived straight into the topic without much messing or apologising here due to time (also not much point in dressing up what I want to know) but I would have the sense to be much less confrontational when discussing with the medics in RL.

What I am trying to establish, in advance, if I can be forced to do something that, after considering all the facts, I am still not happy to do. To find out if a caesarian is actually a choice or not, or if it depends on the personal viewpoint of the obstetrician who has been assigned your case.

Out of genuine curiosity - why is there a feeling that caesarians are so bad? Leaving aside for the moment 1) cost of operation 2) taking someone else's emergency spot etc etc - what is the problem? If it is the risk to the woman (complications etc)- then what if that woman is happy to take the risk for herself? Is it because it's worse for the baby than a vaginal birth in some way? Or is it just that it's "not natural"?

"If the technology is available for a caesarians then I can't see why that technology shouldn't be used."

In a nutshell, because the chance of maternal death during a section are several times higher than during a vaginal delivery. I had a (planned)section at 37 weeks due to placenta previa (placenta was covering my cervix), it saved my - and my baby's - bacon but is not without it's difficulties, namely it IS major surgery and you will need anything up to 6 weeks to recover. My consultant cheerfully said that they would always prefer to avoid emergency sections, but sometimes a serious unforseen problem arises and a section is the safest option in those circumstances.

On a practical note, if you are scheduled for a planned section and an emergency section is needed for another woman, the planned sections are pushed back until the hteatre is available. So a planned section is no more 'selfish' than say, a homebirth which requires the attendance of two midwives. (Not being provocative here, just reassuring the OP!)

You really need to discuss all your concerns with your midwife and take it from there.

it can be worse for the baby, particularly if there has been no labour, because labour and the baby's head impacting against the cervix produces hormones that put the baby at an advantage to breathe once it's out of the womb.

also, for the woman, as the uterus doesn't contract down as well as when it had been in labour, so there's a greater risk of hemorrage.

there can also be some scarring that could cause problems later on and in subsequent pregnancies.

to add my twopennyworth MD , I'm pretty much how you describe in thr fanjo deptartment and I can assure you, non of my 3 7.5 -8 pound babies who were born vaginally got in any way stuck - not even the one with the head on the 97th centile. As for taking up the same amount of dr's time whatever - wrong! you're unlikely to see a doctor in labour if all is going well. You can ask, and give your reasons, but no doctor is obliged to perform major surgery on you just because you ask - whether you are paying or not

A quick PS - according to my Dr, the NICE guidelines state that, after taking everything into account, the wishes of the woman should take precedence. So - in theory! - you shouldn't be pushed into the kind of delivery you really do not want.

For most people the risks to mother and baby are higher with a C Section than with a vaginal birth.
Discuss your concerns with your midwife and consultant when you see them, they will be able to advise you if they think a C Section is the best way forward, but it is major surgery, and not to be undertaken lightly.

Don't get me wrong, MissD. I love c-sections (for the reasons stated above - me and dd would probably be dead without them!). So why did I want a vaginal birth the second time around? (I can only answer what I thought/felt... I cannot say that sections are objectively 'worse', only that they felt like the wrong choice for me.) I guess I could draw up a list, roughly in order of importance:

1. Greater risk of infant mortality (all other things being equal)

1. Greater risk of maternal mortality

1. Greater risk of complications (haemmorhage, infection, MRSA, etc.)

1. Longer recovery time

1. Longer hospital stay

1. Possible problems breastfeeding (which may or may not be a concern, but was one for me, for reasons irrelevant to this thread)

1. Probably other stuff that I've forgotten as it was all a while ago now.

The key thing, in your case, is to find out whether the doctors think that your 'interestingly shaped interior' means that all other things are not equal and that, for you, in your circumstances, a c-section would be preferable. It's all to do with getting a sense of perspective about the risks. I hope that was helpful. It was meant to be helpful, not arsey, honest.

Hi Miss Delighted

I too thought I wanted a C section as 18 months prior to getting pregnant with my first (and only) DS - I had broken my pelvis in a riding accident in 2 places.

I was very nervous about a vaginal birth (and posted on here about it loads at the time too).

However, the medics urged me to attempt a vaginal delivery due to the risks involved with a C section for both myself and my lo (yes there are risks for the baby - which many posters have mentioned here but for some reason you don't seem to be picking up on?!)

I had my baby with the help of an episiotomy and all went well.

I am very very glad I didn't opt for the C section as the thought of managing a new born with a rudy great gash in my stomach fills me with fear - but is probably a breeze if you have a fleet of nannies (aka Victoria Beckham etc)

Having had both a CS and a natural, I would say the C section is worse. It takes weeks to get over, risks are higher for both mum and baby and the bonding part kinda get shoved aside. I didnt hold my DD for over an hour, spent a week in hospital when all i wanted was to be in my bed with my husband. I was terrified of natural birth after having csection, but OMG I am so glad I did. HTH

PS (and then I really have to go and do some work!) If you have a look at some of the VBAC threads on here, you'll see that on the whole consultants are not reluctant to perform c-sections and, in fact, there are lots of women out there who are being pushed (or, at best, nudged) towards c-sections when they'd much prefer the chance to give birth naturally. So I suspect that you'll manage to persuade a consultant to give you section if you really want one. But I still say keep an open mind for a bit longer anyway.

Wannabe, I take your point. However my overwhelming feeling is that natural childbirth is completely unpredictable for mother and baby, whereas caesarians appear less so (notwithstanding any secondary complications ie infections which may/may not happen, just as you may/may not develop bowel/urinary/pelvic problems after a vaginal birth).

Miss Delighted - are you a control freak by any chance

just out of interest - what would you do if the NHS drs advised not a section but a safe vaginal delivery? would you really not believe them and pay to tell a private dr to do a section?
if so then i think you would re-examine your reasons for wanting a section.
and rather than deciding on a dodgy excuse for one 'a narrow pelvis' or skewed fanjo you may get more support and understanding by announcing that either you would like a section because you are scared of labour or you don't want your bits streatched t the size of a bucket.

Thanks Pollybell. Just hearing that my wishes should take precedence in guidelines is reassurance in itself and helps a person feel less trapped. I think you are blessed with a little more perception than some.

Sometimes all someone wants to hear is that yes, you will be properly consulted and your preferences will be carefully and properly considered.

All the stories of natural births that went fine are very reassuring too.

I just can't bear the thought that just because a caesarian costs approx £760 more (wannabe) or medics don't take kindly to being told what to do (someone else) or just that the obstetrician in charge of the case personally does not agree with caesarians, then I would have to have a natural delivery.

Its not just the costs or that they dont like being told what to do, its whats best for you and baby. Its a higher risk for both of you, you said you would do whats best for your baby and C section might not be.