Maternal request cesarean is a women's rights issue - every bit as much as abortion or participation in the paid labour force, or the right to vote or own property. At its very core, it about a woman's right to self determination - her right to choose what to do with her own body, her right to decide which risks she is willing to accept and which risks she refuses. It is about a woman's right to be treated the same as any other patient - and not differently because she is a maternity patient. Both access to choice and recourse for unreasonable denial of choice is needed. I look forward to the day when I will know that a similar experience is extremely unlikely to happen to another woman - and while that day is closer now than it was three years ago, there is still a ways to go.
It is frustrating knowing that planning a homebirth in British Columbia, even a home birth after a previous cesarean is far easier than planning an elective cesarean. Finding a care provider who is willing to facilitate a maternal request cesarean is difficult as they do not generally advertise that they are willing to facilitate a woman's desire for one - and many family physicians, midwives and OBGYN's do not support maternal choice cesarean. This is despite rather clear evidence that a planned cesarean at 39 or greater weeks poses some health and safety advantages for the child and may be comparably safe for the mother as a planned vaginal delivery. Personally, I believe that planned maternal request cesarean at 39 weeks' is a far less risky proposition than planned home birth and a far, far less risky proposition than planned home birth after a previous cesarean.
If it is a matter of cost - I would think that there are some very strange economics at work. A single preventable brain injury or death would make the cost difference between planned home birth and planned cesarean disappear many times over. Even a preventable pelvic floor injury that results in some incontinence nearly obliterates the cost difference. Further - home birth does not eliminate the need for hospital resources to be available as many home births (upwards of 40 percent in first time mothers) result in a transfer to hospital. In deed, planned cesareans could be cost competitive with planned vaginal deliveries as the ability to plan resource availability is improved.
At the end of the day - I cannot see how one choice (planned home birth, and planned home birth after cesarean) is widely supported in British Columbia, and another choice - maternal request cesarean - generates a kind of loathing usually reserved for pregnant women who choose to light up publicly while swilling Manhattens and Martinis.