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Old 20.01.2017, 17:44
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I would like to select C-section without exact medical reasons. Will it be covered?

Hello Everyone!

I am due with my baby at the end of February. I have visited the hospital where I would like to give birth.
I have discussed with my gynaecologist that I would like to proceed with C-section and said that I can choose that option if I want.
In the hospital they asked me why I want that and they told me that if I don't have a "good" reason (I guess she meant medical reason), the insurance company may not pay the procedure, which is very expensive.

Any experience with this? Also, if they may not pay, they have to pay above the franchise, right? ( I have allgemeine insurance)

Thanks for your help in advance!
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Old 20.01.2017, 17:51
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Re: I would like to select C-section without exact medical reasons. Will it be covere

I had a C-section 'for no good reason' and it was totally covered by insurance. Why don't you contact your insurance company and find out their stance on elective C-sections?
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Old 20.01.2017, 17:57
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Re: I would like to select C-section without exact medical reasons. Will it be covere

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I had a C-section 'for no good reason' and it was totally covered by insurance. Why don't you contact your insurance company and find out their stance on elective C-sections?
Thanks for your answer, Daff!

They had to write some reason on your paper (at least they have put "afraid of pain" on mine, however I explained them that I have such a low pain tolerance that I feel I would endanger my baby with giving natural birth), do you know maybe what they have written as reason on your one?

I also thought about asking them, but might sound stupid, I was afraid they would think, they could refuse more easily, if I am asking around.
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Old 15.01.2018, 22:42
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Re: I would like to select C-section without exact medical reasons. Will it be covere

Hello. I will have my baby in 2 months and I was curious how this ended. Did you have an elective c section in the end? What reason did you mention?
I kniw that my insurance is not covering this without medical reason but I cannot stand the idea of having a natural birth. I will speak with my doctor as well. And I hope we will find a solution if not I have no idea what I would do...
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Old 15.01.2018, 23:08
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Re: I would like to select C-section without exact medical reasons. Will it be covere

Speak to your doctor. You can easily get approval for a c-section for psychological reasons...

And I suggest you also speak carefully with your doctor about the possible complications and recovery experience from a c-section. My mum had three of them, they were not straightforward and there was plenty of pain and complications to deal with...
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Old 15.01.2018, 23:31
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Re: I would like to select C-section without exact medical reasons. Will it be covere

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Speak to your doctor. You can easily get approval for a c-section for psychological reasons...

And I suggest you also speak carefully with your doctor about the possible complications and recovery experience from a c-section. My mum had three of them, they were not straightforward and there was plenty of pain and complications to deal with...
Abdominal surgery is a serious matter, it may seem like an easy option at the time.......
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Old 15.01.2018, 23:33
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Re: I would like to select C-section without exact medical reasons. Will it be covere

I understand the medical condition is called "too posh to push".

But putting the flippancy aside, please do listen to the warnings above and ask around about the post-surgical consequences of C-sections. Sure, you'll have a spinal block or be under general anaesthetic and won't feel a thing at the time, but this is really major surgery! The surgeon has to cut through some substantial muscle to get to the uterus, then cut into the uterus. Obviously, this surgery leaves a scar (usually about 15–20 cm long).

The recovery time from a caesarian section is longer than from natural childbirth, and can involve quite a bit of post-surgical pain. Granted, the pain is said to be less intense than that experienced in natural childbirth, but it can go on a lot longer (for weeks). Of course, anaesthesia is available for natural childbirth as well.

Some negative consequences for babies delivered by C-section, and their mothers, have been recorded. These are reasonably rare but should still be considered. From Wikipedia:

"C-sections result in a small overall increase in poor outcomes in low-risk pregnancies. They also typically take longer to heal from, about six weeks, than vaginal birth. The increased risks include breathing problems in the baby and amniotic fluid embolism and postpartum bleeding in the mother."

It's your choice, and I hope you get full insurance coverage if you do choose a C-section, but please be fully aware of all the consequences of both methods of childbirth.

Good luck, and congratulations in advance!
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Old 16.01.2018, 01:21
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Re: I would like to select C-section without exact medical reasons. Will it be covere

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I understand the medical condition is called "too posh to push".

But putting the flippancy aside, please do listen to the warnings above and ask around about the post-surgical consequences of C-sections. Sure, you'll have a spinal block or be under general anaesthetic and won't feel a thing at the time, but this is really major surgery! The surgeon has to cut through some substantial muscle to get to the uterus
You don't really know what you are talking about do you? First: modern techniques don't cut through muscle, but stretch them out of the way, google 'Misgav Ladach method'. My personal experience with recovery from this, even though it was an emergency procedure after a labour stretching over 3 days, was that I was on my feet 8 hours after and off painkillers within 24hrs. Of course, it does not have to be that way, but recovery from vaginal birth can be tough and long too.

Second: in fact, a planned c-section at 39 weeks is the safest way for a baby to come into the world: the higher risk of respiratory problems is offset by preventing stillbirth after 39 weeks and intrapartum oxygen deprivation.

Although there clearly is a higher risk for problems in future pregnancies and the risk for complications for the mother is greater, vaginal birth also comes with risks, in particular to the pelvic floor of older mothers. Google 'levator trauma' (which is not about a 'tight vagina', it is about your organs falling out of your pelvis).

Finally, a planned C-section will always be safer for everyone involved than an emergency procedure. With a C-section rate of over 30% in Switzerland it is not unlikely you will end up with one.

Most mothers want an active, 'natural' birth with as few as possible interventions but in the end less than half will 'achieve' this. To suggest that a woman requesting an elective one without 'medical reason' has not thought through her options and considered the best one for her particular situation is patronizing, using the phrase 'too posh to push', even if it is framed as 'flippancy', is disgusting. So what is it? If the recovery really is that much harder it is not 'the easy way out' is it?

To answer the question of the OP, I believe you will be invited to talk through your considerations for choosing a CS without medical reason by the hospital. Alternatives will be discussed, for example, if you are afraid of the pain mostly, you could get an early epidural. If after this consultation you will still be convinced it is the best option for you, insurance will pay. For pregnancy and childbirth related care your franchise is not touched and you don't have to contribute 10%. In the worst case scenario, average cost difference between vaginal vs. CS birth is 3-4KCHF depending on complications (p37 here) so even in the extreme case of refusal by the insurance company the payment out of your own pocket would be overseeable, but also they are aware an emergency CS is the most expensive option.

Last edited by mgosia; 16.01.2018 at 02:29. Reason: Found and added cost difference
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Old 16.01.2018, 08:13
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Re: I would like to select C-section without exact medical reasons. Will it be covere

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...Second: in fact, a planned c-section at 39 weeks is the safest way for a baby to come into the world...
Any science to back that up?

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If there are no complications with your pregnancy or labour, a vaginal birth is safer than a caesarean birth. This is true for your current pregnancy, and for any future pregnancies, because complications are more common with c-sections. A vaginal birth is also better for your future fertility.
https://www.babycentre.co.uk/a102906...#ixzz54KEr7DNV
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Old 16.01.2018, 09:27
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Re: I would like to select C-section without exact medical reasons. Will it be covere

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was that I was on my feet 8 hours after and off painkillers within 24hrs.
I am happy for you that your c-section was not "complicated".

During my mother's first c-section, the surgeon accidentally cut the main artery to her left leg, almost killing her. After her second c-section, she experienced a spinal stroke which has affected her walking for the rest of her life.

I had three natural births. The first two involved epidurals. The third was a planned unmedicated birth. I was out of bed within 30 minutes, took a shower, able to walk and only taking small amounts of ibuprofen for the first day when I felt that I needed it... The first birth recovery was harder, but the third one, born in under 5 hours from start to finish and zero complications...

C-section may avoid some specific complications, and certainly are life-saving for some babies, however, the idea that it is 'safer' for the mother, is definitely not true. The risk of complications from surgery are significant and not to be under-estimated.
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Old 16.01.2018, 10:18
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Re: I would like to select C-section without exact medical reasons. Will it be covere

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Any science to back that up
Oh yes, a lot actually, and from better sources than BabyCentre (the problem in the statement you linked to is ‘if there are no complications in pregnancy or labour’ while complications arise in most, often unpredictable until the last minute, thats why the emergency C-section rate is high).

E.g. Here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2475575/
'.... existing data suggests that elective cesarean delivery is associated with greater risk of neonatal respiratory morbidity and fetal laceration, and potentially decreased risk of brachial plexus injury, neonatal sepsis, intracranial hemorrhage, intrapartum asphyxia, and neonatal encephalopathy. Though neonatal deaths may be increased among infants delivered via elective cesarean, overall perinatal mortality may be reduced due to prevention of antepartum stillbirts...’

The point is explained also in this graph:

from here and you can read it also hidden in the document I linked to in my previous post. 39 weeks is safest whatever the birth method. But few women are naturally ready at 39 and induction has its own set of problems. Some doctors will also tell you this.

Last edited by mgosia; 16.01.2018 at 11:00. Reason: Fixed image
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Old 16.01.2018, 10:25
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Re: I would like to select C-section without exact medical reasons. Will it be covere

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however, the idea that it is 'safer' for the mother, is definitely not true. The risk of complications from surgery are significant and not to be under-estimated.
Have you read through what I said? Safest for baby not mother. My point was that methods have improved since your mothers time. Surgery always has risks, but so does vaginal birth, which is not as clearly communicated as the warnings about dangers of c-sections.
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Old 16.01.2018, 11:39
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Re: I would like to select C-section without exact medical reasons. Will it be covere

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Hello. I will have my baby in 2 months and I was curious how this ended. Did you have an elective c section in the end? What reason did you mention?
I kniw that my insurance is not covering this without medical reason but I cannot stand the idea of having a natural birth. I will speak with my doctor as well. And I hope we will find a solution if not I have no idea what I would do...
You can talk more with your doctor and midwife about the whole process of giving birth naturally, what to expect for each phase, all the aid provided by the hospital (btw, did you know that they offer even acupuncture?) etc. I think I know where this terrible anxiety comes from, but giving birth here can be a positive experience. Please, do consider talking to someone about your fears and how reasonable they are before making any decision.
If need be, there's always the possibility of having a C-section, of course, which, I agree with a previous poster, is a pretty safe procedure these days, although it takes a lot more to recover from it than the natural birth.
Take care and courage, you'll laugh off all these worries one day.
(btw, C-section by request is usually covered by the insurance, talk to you Gyn about it, it's definitely do-able if you really want this)
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Old 16.01.2018, 11:40
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Re: I would like to select C-section without exact medical reasons. Will it be covere

There will be always an argument on this topic as every birth givings are different. Complications come with both natural birth and C-section.

Most of the women want to give birth naturally, but I know very well that some women can be so terrified of the natural birth that it may affect the whole process in a bad way. In the hospital, they also told me that if someone doesn't really want to do it, their body will not cooperate and the final result will be an emergency C-section which is the worst thing for everyone.

Also, don't forget that nobody can assure that there will be time for epidural. Two of my close friends for example did not receive it as doctors said there is no time for that (and they expected their first baby) That would have been my biggest nightmare.

Like I am convinced that I can get the epidural, so my very low pain tolerance is not effecting the birth and finally I cannot get one as there is no time. No, thanks
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Old 16.01.2018, 11:53
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Re: I would like to select C-section without exact medical reasons. Will it be covere

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There will be always an argument on this topic as every birth givings are different. Complications come with both natural birth and C-section.

Most of the women want to give birth naturally, but I know very well that some women can be so terrified of the natural birth that it may affect the whole process in a bad way. In the hospital, they also told me that if someone doesn't really want to do it, their body will not cooperate and the final result will be an emergency C-section which is the worst thing for everyone.

Also, don't forget that nobody can assure that there will be time for epidural. Two of my close friends for example did not receive it as doctors said there is no time for that (and they expected their first baby) That would have been my biggest nightmare.

Like I am convinced that I can get the epidural, so my very low pain tolerance is not effecting the birth and finally I cannot get one as there is no time. No, thanks
You could elect to have an epidural as part of your birth plan?

I had a similar experience where I was utterly cramped up because I was afraid of the pain. They did what they could to relax me and I was determined to try it without intervention but in the end they gave the epidural which then completely solved the pain problem, made me relax and the birth progressed pretty well from then on.

You should know, though, that they reduce the epidural significantly in the final stages because you need to be able to feel the contractions, but by that time, it didn't take long.

If you are young and reasonably fit, you should be fine, even if the baby is on the large-ish side.

Bottom line is that you need to be comfortable with the whole thing, but you should know that a C-section isn't the only way that will limit the pain of labour, the pain management during a natural birth is pretty good, too.


ETA - it's funny how different we all can be - I was terrified I'd have to have a C-section if I couldn't go through with a natural birth. The whole "operation" scenario gave me the willies...

Last edited by Sandgrounder; 16.01.2018 at 11:59. Reason: Additional comment
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Old 16.01.2018, 11:53
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Re: I would like to select C-section without exact medical reasons. Will it be covere

Humans have evolved so that women can give birth naturally.

Be thankful you're not a type of spider where you would have to eat your partner after giving birth.
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Old 16.01.2018, 11:55
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Re: I would like to select C-section without exact medical reasons. Will it be covere

Everyone should have a choice when it comes to birth. Both natural birth and c-section have prons and cons, can end up well for all involved or leave mom and/or baby suffering from serious, long-lasting consequences. I don't see the reason to quarrel over personal choices, especially in the country offering first-class healthcare making both ways relatively safe.
To the topic: I've chosen a c-section with my first one, my doc made a note in my record and I was invited to discuss my case with the docs in the hospital of my choice. They offered full medical information of negative and positive aspects of both choices, asked my reasons (as someone stated above - if it's pain only, they would offer epidural ect.) and offered counselling, 1:1 midwife meetings ect. Eventually, they said it's up to me and that they will always find a valid reason - even if it's purely psychological. My ob/gyn said for most of the doctors here, mom not accepting natural birth means difficult and potentially dangerous birth so they don't refuse. I had a wonderful experience, was walking the same day and recovered quickly. Now expecting nr 2, I didn't even consider natural birth, have a very supportive doctor and wouldn't have to justify a c-section in any hospital as it's obvious after having one previously - it's VBAC that would require discussion and doctor's approval.
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Old 16.01.2018, 12:05
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Re: I would like to select C-section without exact medical reasons. Will it be covere

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Oh yes, a lot actually, and from better sources than BabyCentre
Why better?

https://www.babycentre.co.uk/e100110...advisory-board
All of our medical articles are written by experts and reviewed by a Medical Advisory Board composed of experts in women's and children's health and development. Our evidence-based health content is reviewed every three years to ensure that BabyCentre parents are getting the most up-to-date information and advice.

Our Medical Advisory Board includes doctors, midwives, breastfeeding specialists and dietitians.


Quote:
Though neonatal deaths may be increased among infants delivered via elective cesarean, overall perinatal mortality may be reduced due to prevention of antepartum stillbirts...’
To what significance? Also I note the conclusion is:
There are insufficient data on which to base conclusions regarding rates of neonatal morbidity and mortality between planned elective cesarean and planned vaginal delivery.
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Have you read through what I said? Safest for baby not mother.
Mmm.

I think the OP needs to be aware that the risks either way are low, though probably slightly higher with a cesarean, that anxiety may be a valid medical reason for an elective cesarean, that a cesarean is certainly no guarantee of a painfree child birth and unproblematic recovery, and that any pain or discomfort experienced is entirely overwhelmed by the joy of a new life.
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Old 16.01.2018, 12:09
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Re: I would like to select C-section without exact medical reasons. Will it be covere

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You could elect to have an epidural as part of your birth plan?

I had a similar experience where I was utterly cramped up because I was afraid of the pain. They did what they could to relax me and I was determined to try it without intervention but in the end they gave the epidural which then completely solved the pain problem, made me relax and the birth progressed pretty well from then on.

You should know, though, that they reduce the epidural significantly in the final stages because you need to be able to feel the contractions, but by that time, it didn't take long.

If you are young and reasonably fit, you should be fine, even if the baby is on the large-ish side.

Bottom line is that you need to be comfortable with the whole thing, but you should know that a C-section isn't the only way that will limit the pain of labour, the pain management during a natural birth is pretty good, too.


ETA - it's funny how different we all can be - I was terrified I'd have to have a C-section if I couldn't go through with a natural birth. The whole "operation" scenario gave me the willies...

Well, at least in the hospital, they told that I can get epidural if I want. Finally I had the C-section, so I don't know how it would have ended.
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Old 16.01.2018, 12:47
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Re: I would like to select C-section without exact medical reasons. Will it be covere

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Why better?
BabyCenter is a company owned by Johnson&Johnson, not a peer-reviewed journal and I don’t know how they appoint their medical advisory boards. I have caught them on providing biased information in other places. You are right that available data are not of the best quality (one of the reasons is that it is unethical to randomize) but I believe that overall the evidence that there is does suggest that a C-section at 39 weeks is safest for the baby, in that particular birth, UNLESS you can guarantee a complication-free vaginal birth before 40 weeks. Which nobody can. And I agree we should not forget that thanks to all medical advances and high standards of care serious harm to mother or baby indeed is extremely rare (even less likely by about 100x to mothers).
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