On facebook in the Cesarean by Choice Awareness Network group there's been a lot of discussion about the American College of Obstetrics and Gynaecologists committee opinion on cesarean delivery on maternal request. I am fairly disappointed at the new committee opinion, one that seems to take a step closer to the stance taken by the Canadian Society of Obstetricians and Gynaecologists - it does not condemn or disallow maternal request cesarean, but makes it quite clear that its members should recommend vaginal delivery in circumstances where there are no medical indications for a cesarean delivery. Which is fairly different from the stance that a physician is ethically justified in performing a maternal request cesarean if he or she believes it is in the interest of his or her patient. In many ways it is no different than the kind of approach taken to mothers who for whatever reason determine that their needs are better met by formula feeding - they are repeatedly told that "Breast is Best" and made to feel no end of guilt for needing or wanting to use formula to feed their children. ACOG has decided to tell women that Vaginas are meant for birthing children, and if you want a cesarean we might do it, but only after you are reminded that a "vaginal birth is best". Many women who are requesting a cesarean already face barriers in finding a physician who will accommodate their needs, to add the feeling that what they are asking for is something "against medical advice" - seems above and beyond what women who are requesting cesarean need.
What women who are asking for cesarean need are physicians who listen to their request, provide them with the risks and benefits of planned cesarean delivery and the risks and benefits of planned vaginal delivery, answer whatever questions they have about their treatment options AND ultimately respect, and facilitate the decision they make regarding the planned delivery of their child. They do not need to have someone else's ideology about childbirth imposed on them. What women who are choosing cesarean need is better information on their choice (much of the information that is currently available is not about "maternal choice" cesarean, but rather about cesareans that are performed as a result of medical indications for cesarean). What women who are choosing cesarean need is the confidence that their choice will be respected, even if their OB doesn't happen to be on-call when they go into labour.
Nothing is more empowering than having the confidence that you have the right to decide what to do with your own body - and nothing is more disempowering than feeling as though you do not have the right to decide what to do with your own body. Perhaps it is time that the ACOG, the SOGC, the mayor of New York and anybody else who feels that women should not have a choice about how their child is born or fed is reminded that - it is the woman's body, let her be free to decide what to do (or not do) with it.