An elective C/S in Public system?

Hi ~ question for you all. My DH met a lady through his work who has just moved to QLD from regional NSW. She's 36 wks pregnant with twins.

She has a 2 year old, and had serious complications with his birth. The midwives and Doc from the NSW hospital advised her to have a C/S if she ever fell pregnant again.

She has only just moved to QLD two weeks ago, and went to the local Public Hospital, explained the situation and the staff there told her under no circumstances would she be able to have an elective C/S. She would just have to try to deliver vaginally and then they'd give her an emergency C/S if necessary.

She is very distressed about this (I'm not sure of the nature of her previous birth problems) and asked DH if all Public Hospitals followed that policy.

It probably has something to do with the fact that I saw that hospital on the news last week saying they were so short staffed during Jan/Feb they were diverting all police and ambulance to other hospitals... so it may be more a staffing issue than a policy issue.

Has anyone ever heard of this happening? And what should this lady do? She can't afford to go private. Should she try one of the big Brisbane Hospitals?

The cynical side of me says she should probably try the news media, then the Premier ;)

I think it is bit strong to say "under no circumstances" would they give a c/s, but it is true that public hospitals are generally reluctant to give an elective c/s unless there is a serious reason. My SIL last year was in NSW when early pg and was told she had placenta previa and would need a c/s, then she moved back to QLD and was told that she didn't have that condition (after another scan) and they would not give her a c/s unless it was an emergency. Another person I know was having twins and was told she would have to have trial of labour and they do not give elective c/s just because of twins. She ended up having an emergency one though, after she gave birth to the first twin.
If your friend is really concerned she could try another hospital, eg the Royal Brisbane Hospital, but there is no guarantee that they will agree with her to have an elective c/s.
I doubt whether it's a staffing issue, because the hospital you mention is only having staffing issues in the emergency dept, which wouldn't effect maternity. I think it is more a policy issue, because the hospitals have to be really careful that they are giving c/s for the right reasons, after all it is major surgery and has it's own set of possible complications, which is higher than the complication rate for vaginal birth.

Bon

I can't speak for all public hospitals, but the one at which i work does offer 'elective' c/s but only when there is an indication such as previous, breech, placenta praevia etc. Multiple births isn't always an indication for c/s, but this can depend on the position of the twins in utero. Sometimes obs will offer women a c/s when their vaginal birth has been particularly traumatic and this could be the case with this woman. I would advise her to get in contact with the hospital where she birthed previously and try to organise some sort of communication between the obs there and at this hospital in QLD.

Thanks ladies. I will definately tell DH to advise her to get her previous hospital to contact the new potential hospital.

Appreciate the input.

Hi

I am due to have twins at the Logan Hospital (public) within the next 10 weeks and I have been told that it is up to me if I want to elect for a C/S or have them naturally so I don't think it is all hospitals.

I would probably go to another hospital in her case as if she does have to try and have them naturally and ends up having to have an emergency C/S, I would be a bit worried that they wouldn't have the doctors to perform the emergency C/S.

I am still undecided as to how I want to deliver the twins. I had my DD naturally and it wasn't much fun... 30 hours in labour, second degree tear.

At my last appointment they discussed with me whether I would be interested in an international twin birth study. If twin A is head down at 32 weeks and there is no reason that you would need a C/S they randomly choose how you will give birth (ie. elective C/S or natural birth). This is so they can study for future reference if it is safer to deliver naturally or by C/S. Not sure if most people would like their birth decision chosen for them but because I'm having trouble deciding it might be an option for me.

Anyway, I hope all goes well for your friend whether she delivers naturally or by C/S.

Regards
Jane