It is difficult to be a cesarean by choice mom - most people do not understand your choice and may even think that you are nuts for wanting to choose a surgical process over a natural process. It is a choice that is stigmatized and even denigrated. It is a choice where it is still debated openly whether or not women should "have the right to choose" and the term "too posh to push" is still thrown around. Many moms have an uphill battle in Canada when they choose cesarean that extends far beyond what their friends and family may think of their choice though - there are prevalent systemic barriers that prevent many women from being able to exercise their legitimate right to choose cesarean.
Many primary care givers - family doctors and OBGyn's do not support maternal request cesarean. When women ask their doctors about it, few are receptive to the request. It is not uncommon to hear of women not being referred to an OBGyn (family physicians and midwives do not and can not perform cesareans) until their pregnancies are very advanced. When I was pregnant with my daughter, I did not get to even meet with an OBGyn until I was practically at term (referred at 32 weeks and saw the OBGyn at 36 weeks) - despite having made my desire for a cesarean known at my appointment to refer to a maternity doctor and at my first and subsequent prenatal appointments with my maternity doctor. Many women who request cesarean have anxiety about the delivery and that anxiety often is not resolved until they have confirmation from an OBGyn about the delivery plan. I found it very difficult to enjoy either of my pregnancies until I knew what the plan was regarding the delivery. Further, there tends to be significant waits to access OBGyn's and as a result it is not uncommon for a woman to wait 4 or more weeks after referral to be seen by an OBGyn.
Unfortunately, many OBGyns in Canada are also not supportive of maternal request cesarean and I do not know of many who openly offer this choice. Quite simply a woman cannot go to a phone book or even online and see that CDMR is one of the services offered by a particular OBGyn. Perhaps this is because the Society of Obstetricians and Gynaecologists of Canada does not currently support CDMR and has stated that “Caesarean section should be reserved for pregnancies in which there is a threat to the health of the mother and/or baby." As such, if a woman is referred late in her pregnancy to an OBGyn for the purposes of getting a cesarean, and the OBGyn she is referred to is not supportive of the request, by virtue of the time sensitive nature of pregnancy she may be unable to get a CDMR.
Then add hospital policies that might present additional challenges to women wanting maternal request cesareans. For example, at BC Children and Women's hospital - the home of the "Power to Push Campaign", women desiring maternal request cesarean are encouraged to undergo counselling at the "Best Birth Clinic" and the power to push website repeatedly reminds women that vaginal delivery is the "normal" method of childbirth. This makes women who wish to choose cesarean feel abnormal or wonder if they are in need of psychological services because they prefer surgical delivery for their children. At the time of my daughter's birth I was told by my OBGyn that an elective cesarean needed to be an "add to slate" procedure, that he could not give me a specific time and date for the surgery. What he failed to inform me, is that by not having a fixed time and day for the surgery meant that there was a very real risk the surgery quite simply would not happen at all, as it would have to compete with all the other "add to slate" surgeries and that unless he advocated and made the case that my cesarean should be a priority that it would get bumped until it was ultimately denied.
So what is the impact of these systemic barriers to maternal request cesareans? Many women who would prefer to deliver by way of cesarean cannot access timely medical care and ultimately are forced to deliver vaginally. The current system unjustifiably imposes risks on mothers who would choose cesarean - it imposes anxiety as a result of the delay in having an OBGyn "approve" the planned delivery, and it imposes increased risk that a planned elective pre-labour cesarean will need to be an urgent cesarean or emergent cesarean or may even be an unwanted vaginal delivery. At the most basic level, every pregnant woman is currently told by this system that she cannot submit to a generally safe medical procedure unless she meets criteria entirely unrelated to her own priorities and aspirations - this removal of decision making power threatens women in a physical sense and the indecision of knowing whether a maternal request cesarean will be granted inflicts emotional stress. Depriving women of their right to make medical decisions for themselves is a travesty and a grave injustice - one that I am battling to change.