Docs: Elective Caesarean - advice pls!

Can a doctor refuse a c-section?

16 messages
04/09/2007 at 16:54
Any docs out there, please can you help on this question?
A very good friend of mine is 34 weeks pregnant with her second baby and wants to have an elective c-section.
Her first baby was born at 39 weeks by a planned c-section as he was breech and weighed a hefty 9lbs 10oz (she, on the other hand, is a petite 7st).
She is absolutely terrified at the prospect of a natural delivery given the size of her first (and you should see her now, she's HUGE!) in spite of being told the usual stuff about everyone's pelvis being roughly the same size. She is totally stressed, not sleeping, not eating properly etc because the Obstetrician has told her that he will decide what's best for her and at the moment he considers that to be an attempt at a vaginal delivery.
In this day and age is this really the case? That we are given no choice or contribution to the decision making process? I find it quite hard to believe, so advice gratefully received. I am quite aware that there is a National drive to reduce the number of caesarean deliveries, but in this case I can't believe that they won't even discuss it with her.
I am also interested from a personal perspective as I had an emergency caesarean with my son and should I ever pluck up the courage to have another one would love to know where I stand.
thanks in advance
Hegs x
kittenkat    pirate
04/09/2007 at 17:02

Hegs, I've had 2 c-sections, the first was emergency and the second elective. I was lucky, the doctors were supportive of my decision to have an elective and in the end it was a good thing as the baby was an unstable lye.

I can see that the doc doesn't want her to have a c-section as he/she feels that there is no medical reason to do so and c-sections carry risks.

This won't help but I know very petite friends who push out whoppas with no trouble at all!

Doesn't it help her to know that they will c-section if they need to on the day?

I do think at least the doc should discuss it with her, it's awful that someone should be left feeling so frightened!

kittenkat    pirate
04/09/2007 at 17:04

I also know people who've delivered very normally with subsequent babies after emergency sections with former babies.

04/09/2007 at 17:04

I would advise her to speak with her midwife and doctor and explain her worries to them.  I had 3 difficult and lenghty labours with my kids. My first got stuck and i ended up totally out of it on drugs with a ventouse/episiotomy/forceps etc just to get him out.   It was hell.

With my second i assumed it would be easier and opted for the drug free ward.......again the baby got stuck and i ended up in theatre with the ventouse/forceps etc.

Third baby  - i went in and told them the baby WILL get stuck and that i wanted an elective forcep delivery.....i got my elective forcep delivery and it was a weight off my mind not worrying about going into another difficult birth.  It was the best labour ever as i was prepared and ready for it.

I think you have to tell them what you want. It sounds like she has reasonable cause for requesting this especially as it is making her stressed so close to the birth - that's not good for the baby!

KKD
04/09/2007 at 17:24

My Mum's a sister in the labour ward and says loads of people request sections as an "easy option".  Most don't realise that it is MAJOR SURGERY and to avoided if at all possible.

However, the doctor should be taking your friend's history into account, taking her weight into account and also requesting a scan to give an indication of the length and weight of baby.  A big tummy doesn't always mean a big baby; there can be alot of amniotic fluid. A scan would also reveal how the baby is lying as at 34 weeks theres still time for the baby to change position if its head's not yet engaged.

I would suggest she talks to her obs consultant again and if she's not satisfied that s/he's suggesting SVD in her, and her baby's, best interest, then request to speak to someone else.

Best of luck to her.

KKD
04/09/2007 at 17:30

I think that there is a lot of inconsistency about this - I had the opposite scenario (twice) where I hoped to avoid subsequent c/sections despite having had one with my 1st child - I ended up having trials of labour with my 2nd and 3rd babies but not without going against the wishes of my consultant who advised elective c/sections for both.  Has your friend looked at the Nice guidelines  ? They seem to be aimed at trying to reduce c/S rates, however they do say:

An individual clinician has the right to decline a request for

CS in the absence of an identifiable reason. However the

woman’s decision should be respected and she should be

offered referral for a second opinion.

so I should think that your friend has a) an identifiable reason and b) the right to be referred to another consultant.  Hope that's of some help.

04/09/2007 at 17:34
PS Also if she does go into labour and it's not progressing due to the size of the baby it is highly likely she will be advised to have a c/s - this is what happened to me (3 times!) so I did end up having 3 c/sections.
04/09/2007 at 17:48
Thanks kittenkat - I've had that conversation with her myself, but she can't help the way she feels. She was terrified the first time round and so relieved that he was breech.
I just think that if someone is so clearly traumatised at the prospect, and having had a c-section once already, that they would let her go for it.
I would like to know how they can prove that the risks of a second caesarean are any greater than the risks associated with a vaginal delivery after a caesarean......
It seems to me that her Obs is a control freak. Apparently he did the same to a friend of hers who ended up having another caesarean which was an emergency as the scar on her uterus from the first delivery became stressed and herniated. Which has not helped!
04/09/2007 at 17:53
Oops, my reply got posted after a few of you replied!
thanks for the replies. As I say, I just think it's wrong that he seems to be playing "the hand of God" with her when she's getting so distressed about it.

I must admit that I was vehemently against a c-section when i was pregnant but in the end it was taken out of my hands. And if I am honest I would probably want another caesarean in the future even though the recovery was tough and not what I wanted at the time. I at least would like to think that I will have some sort of informed choice to make!

Given that she's already had one c-section and knows the score I don't think she's over reacting. She's also a very mature and educated lady and is not the sort who thinks its "easier" she's just genuinely panicked at the prospect of a delivery that she doesn't want.

For info, she's been told at 34 weeks that they estimate the baby to be close to 7lbs already! (thank God for tiddlers I say - mine was only 5lbs 5oz!)

thanks for all your advice
Hegs x
04/09/2007 at 18:03

I think Dr's should discuss with women and try and reassure. Too many women assume that natural childbirth is awful and a section is the answer. tbh they can both be crap and both be great in differing circumstances

Her personal risk from a section is the usual....it is major surgery however an elective is very controledd compared to an emergency. Her personal risk from delivering a baby disproportionate to her size is her pelvic floor.

 Govt targets and NCT pressure to reduce section rate may sway the surgeon 

I'd ask for a second opinion even if she only gets same answer but to reassure her more. She needs that. 

Farnie    pirate
04/09/2007 at 20:48

I had my little boy by emergency section even though I knew he would be born that way.  It was all very nice and relaxed and I would do it again that way without question. 

If she goes in and mentions NICE guidelines and starts quoting they will start to listen to her more.  Midwives are great but consultants re not so interested in the birth you want, only what will be better for them.  Some are more pro section, some are more natural delivery.

 If she arms herself with information, she will go some way to getting the birth she wants.  She should also point out how stressed it is making her.  This is really important, and if she feels she isn't being listened to she need to complain loudly.

Sadly with the NHS it does seem to have a 'he who shouts loudest' philosophy.

07/09/2007 at 13:23
Thanks everyone for your thoughts on this - thought I'd just drop a quick line to say that she went for her Obs appointment and due to a scheduling error ended up seeing someone different who went through all of the available options with her and listened to her concerns.

As a result she is scheduled for an elective caesarean on October 9th )

She is also being retested for gestational diabetes since the baby seems to be growing at an alarming rate and her first was pretty big too.

My faith in the NHS has been restored!

hegs x
07/09/2007 at 14:15
Good.
07/09/2007 at 14:38

"Midwives are great but consultants re not so interested in the birth you want, only what will be better for them. "

 Completely unsubstantiated, prejudiced nonsense. As the next post proved.

07/09/2007 at 20:16

I may be in a minority of one, but people who come in quoting NICE guidelines make me want to listen to them less, not more!

07/09/2007 at 20:17

hegs that is good news

its a tricky issue this one


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