Saturday, January 12, 2013

Under what circumstances should women be able to "Choose Cesarean"?

In the years since I first considered having a child and the relative risks and benefits of different modes of delivery for my particular situation, I have read a lot of material on the subject - both in the mainstream media and in the scientific literature. There continues to be an active debate on the subject. There continues to be a relative paucity of research that is "on all fours". There continues to be judgement and a persistent derogation of women who elect cesarean delivery. There continues to be uncertainty regarding a woman's "right" to choose cesarean. There continues to be a lack of awareness and respect, support and empathy. There continues to be tremendous barriers to exercising the choice of cesarean delivery, including difficulties in finding supportive health care providers and unreasonable and obscure hospital policies and practices.

That being said, tremendous headway has been made in those years. The commentary that news articles and related forums attract is becoming less vitriolic and more respectful of the choice. The National Institute of Clinical Excellence in the UK confirmed in November 2011 a British woman's right to elect cesarean on the NHS. Pauline Hull and Magnus Murphy published their revolutionary book "Choosing Cesarean". There is now a Cesarean by Choice group on Facebook. A lawsuit in Canada has been filed with hopes that it might formally recognize the right of women to make this medical decision and confirm that a failure to provide reasonable access is a reprehensible violation of patient autonomy - and may constitute a form of malpractice for which hospitals and/or doctors can be held liable.

So under what circumstances should women be able to choose cesarean? Under the exact same circumstances that women or men are able to direct any medical care - that is, after they have been provided with enough information on the available treatment options for their particular medical condition and the risks and benefits associated with those options (they have met the requirements of informed consent). Further, they should expect timely access to the care that has been chosen - otherwise the right to direct one's own medical care is rendered void - after all what good is the ability to choose treatment, if time makes that treatment choice meaningless?


  1. Hi,

    I wanted to thank you for going public with your story. It serves as a warning to all of us hoping for an elective c-section to try and take whatever steps necessary beforehand to ensure that we get the c-section we want, even if we end up going into labour early. I will certainly be requesting a letter from my oby-gyn saying that if I do go into labour early, an emergency c-section is to be performed and a letter from my psychologist outlining the potential traumatic consequences of making me go through vaginal birth. I will also try and find out in advance the policies of local hospitals regarding elective c-section (and try and meet with whoever makes the ultimate decision on the day) to try and figure out the place where my c-section is most likely to happen.

    Just a couple of ideas to help other people in a similar situation....

  2. It is a little disheartening - a woman should not need to take extraordinary steps - rather she should be confident that she can communicate her wishes to her care providers and expect her care providers to inform her of the risks/benefits of her plan and to advise her accordingly. I thought I did all that was neccessary the first time around - I communicated my wishes with my care providers, they consented to my plan, but it appears that they did not facilitate the plan when it mattered. They did not access the resources when they were available - and as a result my decisions regarding my medical care were frustrated.

    It should be obvious that trampling on an individual's right to direct their own medical care will have adverse psychological consequences.