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

I had an elective section nearly two years ago and am due to have another one in just a few weeks.

I had a cold recepttion at first from my midwife and the first onsultant I saw, both of whom dismissed my reasons as being more to do with my head and my problem, not theirs.

I have a rare connective tissue disorder and the consultant who treats me for it, told me to make sure that my obstetrician knew I had it as it has implications for pregnancy and birth. The first consultant I saw said - and I quote - "I've never heard of that, so it can't have any implications for childbirth!".

I was very lucky to move towards the end of my pregnancy and I saw the most wonderful consultant who - miracle of miracles - had seen my condition once before when she was training. I went in armed with information and fully prepared to argue my case. Instead, I had no problems and I had an elective section at just under 37 weeks.

I have no medical knowledge, so I can't say anything about whether your pelvis/vagina is not suitable to giving birth naturally - that for a midwife/gynae to say, they'll know how pregnancy and labout will change your body and whether or not a natural birth is an option for for you.

I will say one thing - I posted on here when I was pregnant the first time and I did get one poster who was a little hostile but people - for some reason - get all het up about sections. There are a lot of people on this thread who have given sensible advice and the only things I have to add are:

1 - Talk to your midwife about your pelvis/vagina. She might reassure you somewhat about a natural birth and there may be some investigation that can be done that would help you decide how you want to give birth.

2 - Be prepared to argue your case, just in case you get a midwife/consultant who is not sympathetic and dismisses you - not a helpful thing and more likely to make you want a section.

3 - I know pregnancy is a fraught time for any woman. So many changes and adjustments to make. Remember that you have nine months before this little one arrives and, therefore, plenty of time to decide what's right for you.

A section is not always the horrid thing that people make out it is - my recovery time was only really two weeks - but it is major surgery and shouldn't be undertaken as a knee-jerk reaction to the intial discovery of your pregnancy. Saying that, it may well turn out to be the best thing for you and your wee one.

Good luck!

Everyone's got a right to make their own choice... but we are not always the best judge of our own bodies and their capabilities. You would do well to listen to both sides and take some of the excellent advice on this thread and whatever your choice is, make sure it's fully informed.

jscot is it vascular EDS?

MissD..

You are so wrong in your assumptions.

I can tell you now, that the next time I am pg, the next time I give birth will, god willing, be through an elective section. Because of what happened to me the last time I gave birth. I will not do that again.

However, even though that is my personal stance on the situation, I still think you are being precious, ignorant and unwilling to listen to anyone who is not agreeing with you. And I think that is very sad.

Please heed the advice given here, It is good advice.

jscot is it vascular EDS?
]
No, thankfully! I have Hypermobile EDS (pretty badly, most of my joints are affected) but I have some of the aspects of Vascular EDS in that my veins blow and are fragile and I bleed very easily. I also have POTS (related to the EDS) which makes for very low blood pressure and frequent faints and blackouts.

We didn't know about the excessive bleeding until my first section but this pregnancy has been a drag from day one. I've been on crutches and wearing a scary corset since around 13/14 weeks and on bed rest/feet up since about 12 weeks as my hips are subluxing under the weight of the pregnancy.

sympathy jscot I have eds hypermobility, mostly major joints, -luckily I've a good deal of muscular strength which holds me bits together, but means going to the gym is a necessity, rather than a lifestyle choice, I've blown small blood vessels before, that's getting more common as I get older, but I've not dislocated for a while- the last major one was a subluxed hip thanks to the epidural with DS1 - I never thought about low bp being related- mine can be a bit hairy at times, but I rarely black out,even when I should be unconcious! i decided not to mention EDS in pregnancy, cos OB's only learn about vascular type, which is very scary

Very glad to see you back, Miss D. I'm not going to say TOO much cos I said quite enough yesterday - especially that post that came up about eight times - how does that happen, anyway?? I'm a tough old boot actually but all those posters who just lose their rag and start ranting at the first thing that makes them feel a bit impatient, obscure and mar the good advice and interesting experiences that many have got to share. One of the brilliant things on here is that you get all perspectives, and it CAN change minds as well (I know I have learned a lot from here). But for me, there are ways and means of putting things, and I don't think that makes me an oversensitive pansy. I don't really like the sweeping statements that pour out about caesarians either, such as the greater risk of pnd (when it is actually if you don't get the birth you want you have a greater risk of pnd - and it just so happens that a lot of people who get given emcs are unhappy with them), or not driving for 6 weeks (most people drive earlier). My sister had a breech baby and was pressurised by her midwife and NCT mates to try for a vaginal birth, against her better judgement. She was told that sections were unnatural, she was young etc, all the usual. And she ended up with a nasty forceps delivery, where my beloved nephew nearly died, my sister felt mutilated and traumatised and suffered severe pnd as a result. If there hadn't been the stigma about sections, or this culture of thinking that you've failed if you have one, all this might have been avoided. I realise this is a separate issue to Miss D's point, and believe me I am not anti-vaginal births AT ALL; but let's not stone anyone for wanting a cs. If you've had a bad experience with one, explain why, but calling someone an **hole and shouting at them isn't doing anyone any favours. Sermon over. Amen. And I hope you all get the birth experiences that are best for you.

I have had two electives both for breech.
They are not much fun, recovery is painful and slow and imo affected bonding with both babies, though all is fine now

But your concerns are very valid and you should talk them through carefully with a consultant. It's terrifying to think your body might not be up to a "natural" birth and people on here who don't know you and haven't physically examined you can't possibly make a judgement either way. IME consultants are usually sympathetic to women wanting electives so if you prepare yourself carefully you should be OK.

found this article interesting and it mentioned some website that supports electives, you should maybe look at that?

www.telegraph.co.uk/education/main.jhtml?xml=/education/2008/05/25/st_birthplan25.xml&page=1

Without reading all posts, has anyone actually pointed out to you that it involves major surgery to have a section? I have had two, one emergency, which was a disaster and I couldn't get dressed for a month and one planned in agreement with doctors, which was much more calm, but I still couldn't drive for weeks and the pain for the first week is almost unbearable, you are incapacitated. It is, after all abdominal surgery, much better that you let the doctors assess if they think that your shape will cause a problem - they will give you regular scans and internals (the joys of having children)and after all - they do this every day and would not put you or the baby at risk.

Just to clarify LadyT (and lets draw a close to this tit for tat) I didn't call the op an a*hole because she wanted a c section but because she was being vile and argumentative to anyone who didn't agree with her.
All this is so hypothetical anyhow - as suggested in the early posts she really needs to talk this through with a midwife / consultant to understand what the risks are for her (if any).

DKMA, tbh I didn't really see what you said coming across like that, or what she said either. Some people on here agree with you, and some agree with me. But seriously - no hard feelings, to you or anyone else, (and I really am coming off this thread now, and not in a flounce, but I just think I've said enough and want to read of other people's concrete experiences rather than my own!) and I totally, totally agree with you that the op needs to talk this through with a midwife/consultant, which I am sure she will.

Interesting, Starligh, the grass is always greener
There you go - either way of giving birth is not ideal and we have to accept that whatever decision we make/are pushed into re birth.
I think we live in a world where we try to assume so much control that it's a shock to get pg and realise actually there ain't no perfect way of getting a baby out!
I can't drive either, so was always amused at constant warnings, but I guess if you are someone who drives everywhere it could be a downer though from what I gather there's no actual insurance thing stopping you driving before six weeks it just might not be a good idea - and same if you had a bad vb!

Sorry if I am repeating previous conversations on this thread , not got time to plough through them all! had an emergency c-setion as I was not dilated and dd was too high up and getting distresed . Even after all this the decision to do a section was taken by 3 drs . This is not a casual decison and this operation is very big and risky. Due to the anthestic I could not hold dd as my hands was shaking so much ,following this I had difficulty picking her up to feed her. I think I am still not over what happened and dd is 20 months now and a bouncing toddler . Most c-sections are nessecary but I think if I had better ante-natal care ie more scans more support during labour then maybe they would have still done a section but it would have been planned and I could have been mentally prepared.

Have just whizzed through the whole thread and it confirms - again - that there is a strong element on MN that sees certain aspects of pregnancy, birth and parenthood as the 'correct' way and anything else as wrong. Talk about black and white. And it presents itself in a very high-handed and bullying way. I bet these people think that they are all for women making choices - just as long as they make the 'right' ones.

The OP asked a perfectly reasonable question. It is definitely worth discussing whether women are entitled to request a CS, because practice seems to vary greatly in different parts of the NHS - despite the NICE guidelines.

There is nothing unreasonable about raising the issue of a CS at an early stage with your MW or consultant. And you should definitely take the NICE guidelines along as a basis for discussion. From my own experience, I think it's likely that they will assume that they can persuade you to abandon the idea - and it's definitely worth considering all the points they make. But if they tell you that they can 'guarantee' you a safe and straightforward vaginal delivery, I would be sceptical - because it just isn't possible to guarantee anything. I think that a wish to avoid an emergency CS should be a valid reason for requesting an elective one, especially if you have reason to believe that you may well end up having an emergency CS.

My hospital - a large London teaching one - made no bones about the fact that it has a target to reduce the number of sections it does. And I felt that the target was the main reason for opposing my request. The policy there is that if you want a CS and there is no acceptable medical reason, they refer you for psychological assessment. (Yes really, and you may have to contain your rage.) Then if you can convince the psychologist that you have a well-founded 'fear of childbirth', the obstetrician may agree to it. I was resigned to going through this process for DD2 (having had an emergency CS for DC1, which had been highly traumatic) when other factors, irrelevant to this thread, intervened. In the end the baby was breech and an elective CS was scheduled at 39 weeks with no fuss!

So I think the OP should be prepared to get hold of all the facts (as distinct from opinions and ill-informed diatribes) on both sides of the argument, and then hold her ground if she still believes a CS is the right option for her. But it's an early lesson that 'choice' and 'control' are often idealistic concepts rather than a reality in the world of pregnancy and birth.

And people have different experiences of recovering from CS - as they do from vaginal births - but for what it's worth I recovered very quickly from both of mine - by day 3 the pain was minimal and I went home from hospital, by day 5 I was out and about with the baby, in both cases. So even though it is major surgery, it's wrong to assume that you'll be incapacitated for weeks - some people may be, but certainly not everyone.

MissD,

Can I align myself with the non-scary, non-judgmental camp?

I can only give you my experience. I've had one baby, and had a C-section. Baby was breech and had the cord round his neck so no option. It was FINE. In fact it was quite lovely, very non-panicky and non-urgent and non-emergency. I even had a bad experience afterwards (my wound got infected, which is very unusual). But all in all it was fine, I've got over it and have a very close bond with my DS.

It make me SO ANNOYED that people have trenchant views about the right thing to do. Surely this is like anything - as long as you are making an informed decision, who cares if you having a section, a natural labour or giving birth hanging upside down from a tree. Ultimately, we're all different, and we should all be allowed choice!!!

Treeny , You have made some really good points , I also recovered ( physically ) very quickly from c-section . I was out of bed and showering 24 hrs later . I also threatned to self -discharge after 2 nights so they checked I was medically fit and discharged me .I was back to normal and walking with pram on day 5 . Miss d- good luck with your pregnancy - it still very much early days and I hope you not feeling to anxious about it already . I found I spent a lot of time during my pregnacy worrying about the birth and not a very much about feeding , nappies , no sleep etc etc .

oh I just suddenly remembered this - 5 out of my 8 ante-natal group had c-sections ,emergency and planned. These were all in london hospitals .

the issue here is that the OP has gone into pregnancy with the mindset that she'll have an elective- over the course of the thread, leaving out some of the more colourful posts in both camps, she has decided to have a discussion with the proper person for the job, thats how you go about it -there are no absolutes in birth and you take advice and do your homework before making an irrevocable decision, end of.
treeny -the reason for the targets is that according to all known measures, about 13% is the figure representing C/S for medical need -in some hospitals it's running at 33% plus , this is giving a huge level of what they call 'excess mortality and morbidity' ie deaths,injuries and disability which were caused by C/S. The Northwick park situation has really solidified the debate on that as well.So, the targets aren't arbitrary, they are aimed at saving lives and long term health, not money, or just to be awkward IYKWIM

Only two people in my antenatal group of 10 had a section. One was elective but under medical advice (breech). The other was emergency and she was extremely ill afterward with a massive internal blood clot. This was in London too.
I struggle a bit why people are posting their traumatic experiences which ended in section as perhaps justifying why the OP should hold out for one, when she is 5 weeks pregnant and not a glimmer of any medical reason for a section? Surely the best advice is to raise her fears and preferences throughout the birth planning process and to ensure she is listened to appropriately by those who really know. To my mind a genuine phobia of giving birth is absolutely as valid a reason as anything physical, but to opt for a section over a VB just because you THINK the outcome is more certain (it wasn't for my poor friend) just sounds like someone who is crying out for decent advice to consider the options and ask all the questions, not to be egged on by detailed unhappy birth stories.
There is a big part of me that is extremely glad I didn't know about mumsnet as a first-timer as I think a lot of the stories on here would have put me off a VB too if I'd had no experience - whereas mine was absolutely fine!

I think I was someone who went off on a tangent that would be better placed on another thread.

Personally I think that the best way of keeping down the CS rate is to reduce the number of inductions done for the medical team's convenience (not those done for the safety of the baby, obviously) and by supporting women in labour to cope with active birth, if they can and they want to. There are an awful lot of women who would like a natural birth experience, but who just don't seem to be given the resources. And some of those do end up with emergency CS for "failure to progress".

Blimey what a long thread to trawl through!

I totally understand where MissD is coming from - i was absolutely bricking it when i had my first child and i tried to block out the idea of labour. Also, operations scared the hell out of me. i knew the baby HAD to come out but didn't need to think about HOW!

At 41 weeks they induced me and after a 6hr labour and some complications i was given an emergency C sec. It was a relief! I was so off my head on gas and air and in so much pain i didn't care what happened as long as it was over.

when i had DD 3yrs later, i saw a consultant at 34weeks who booked me in for a C sec at 39weeks. To be honest, it was the worst thing EVER! I had my pre-ops and had to be told EVERYTHING that would happen (the exact order everything would happen in theatre, the times everything would take, the risks etc) i was PETRIFIED! Had my DD and she was fine.

I am due 3rd child in november and was told at booking in appt at 7weeks that i would be having a C sec. I guess i could put up a fight and insist on being allowed a natural birth but due to various complications in last pregnancy it's easier - plus i've done labour pain and that was hard enough and i can't imagine the pain of pushing out a baby (I am a small person who has big babies!).

I am bricking it already! i am trying to avoid reading or seeing anything about C sections (this thread helped loads! LOL!) and i will be asking the person who does my preops not to inform me of anything - just take me in there, numb me and get the baby out!

Everyone is different, every hospital is different, every experience is different.

My local hospital - Dorset county - is very very highly rated but does not like doing sections. fair enough! some hospitals may have different opinions - like people!

One of my best friends has a section a month before me at the same hospital and was admitted to hospital a month after her birth with a womb full of blood - a complication post birth. I was fine.

Yes, recovery from a section is crap - but then so would be a recovery from a traumatic birth i guess. Everyone is different.

My advice to MissD is to chill out for now. Have your booking in, explain your problem and concern to midwife and ask if you can see a consultant for reassurance. You will probably be sent an appointment for just after your 20week scan. when there, explain to him/her your concerns and ask how easy a natural birth would be, do they have any experiences of such conditions/births at that hospital and what would s/he recommend. Express your worries and say that you feel that it would be more beneficial to you - and your baby - to have a section and is there any reason they would disagree/agree.

Most consultants are very understanding and i am sure that they will treat your case on it's own individual merit.

Most of all, good luck and don't be put off by everyone else's opinion - wouldn't the world be a boring place if we all had the same ideas!

x

My MWs were very supportive and actually lied on my notes to give me more time in the MLU and a better chance to deliver naturally. I was still transferred for FTP and I reckon that DD would have been stuck no matter where I was or what I did.

I bet that there are a lot of women for whom that would have made a big difference though.