A while ago, a mom-to-be contacted me asking if I knew an OBGYN in her area (Hamilton, Ontario) who would agree to a maternal request cesarean. I asked the grapevine, and managed to wrangle a name - and with high hopes I hoped that this mother would be able to get what she needed when she needed it. I recently got an update from that mother - and my heart sank. She went into labour the day before she was to meet with the OBGYN (she was 36 weeks pregnant) the doctor on call did not support her request and she ultimately delivered her son vaginally. His respiration was depressed, he needed to spend some time in the NICU, he had some broken blood vessels and blood pooled between his skull and his scalp, he needed a blood transfusion and has been on morphine and the mother had some tearing that required stitches.
Her story - is illustrative of the many problems that persist with respect to maternal requests cesareans in Canada. Finding an OB supportive of the request, and hoping that if you do go into labour the OB on-call will be supportive of your request is a risky proposition. You may go from OB to OB (or have you primary maternity care physician neglect to refer you until late in your pregnancy) with each having a wait of several weeks for an appointment (how is that quality care???), or you may go into labour and have someone who disagrees with your choice and withhold the care that is needed, when it is needed. Or you may find a supportive OB but run head-long into a hospital policy that makes acquiring your delivery all but impossible.
It's a situation that must be addressed - all these mothers want is to be counseled on the risks and benefits of their treatment options (planned cesarean delivery and planned vaginal delivery) - and to be free to choose the treatment that best meets their needs and to expect that whatever choice they make will be respected and facilitated to the degree possible. They are asking not to be unfairly deprived of their personal autonomy without good cause - seems perfectly reasonable to me.
There are doctors and hospitals in Canada that do accomodate the needs of these mothers - but the difficulty is that it is difficult to know which doctors and hospitals they are when the time comes.
As I do get requests from time to time from mothers looking to have their needs met (I currently know of a woman who isn't even pregnant yet who wants to find a supportive doctor in Ottawa) - if you are an OBGYN who provides maternal request cesarean or your hospital has an accomodative policy (fixed OR date and time for MRCS and assurance that CS will be accessible if it is wanted should the woman go into labour before her scheduled date/time) - email me at firstname.lastname@example.org - as I'd like nothing more than to be able to help moms find the care they need when they need it.
Thank-you in advance.