Patient Choice Cesarean, Urgent/Emergent Cesarean or Forced Vaginal Delivery - Is it Really That Hard to Choose?

There's a phrase I hear from healthcare providers and others who oppose patient choice cesarean, "No physician is obligated to perform a procedure that he or she thinks is not medically indicated."

They see the denial of choice as being justified. Perhaps they think that they are saving the healthcare system resources by denying the choice. Perhaps they worry that women are unable to make an informed decision in this regard. Perhaps they see performing a cesarean without medical indication as causing harm, to either the woman or the child.

For whatever reason, there are those, who when faced with performing a patient choice cesarean, will outrightly refuse to undertake the procedure.

This would not be problematic if timely access to an alternate provider who is willing and able to undertake the cesarean can be realized. Unfortunately, under the current system - this is often not possible.

So if a woman cannot access patient choice cesarean when it is needed (either planned at 39 weeks or done urgently after the commencement of labour) - what will happen to the patient?

Perhaps care providers simply haven't thought about this in full - what happens to the woman, pregnant and desiring of a cesarean who is not provided timely access to one? What really happens?

Nature is a cruel wench - she isn't particularly patient, and the woman cannot just delay delivery until she finds a provider and a facility who can accommodate. The woman will eventually go into labour - this is nearly guaranteed. Either a medical need will then arise for a cesarean - in which case an urgent/emergent one will hopefully be provided - or medical need won't arise and at some point the woman will be fully dilated, and given no choice as to what she will have to do whether she wants to or not. She will deliver vaginally. The experience of which is foreseeably traumatic - or at least should be - as the patient will have been subjected to what can only be considered a Forced Vaginal Delivery or an urgent/emergent cesarean where either her life or her baby's is put at risk.

And the thing with traumatic experiences is that they don't just go away - and sometimes they don't ever go away. The physician will have avoided doing what he/she saw as a medically unneccessary procedure - but in so doing will have likely inflicted a rather large emotional toll on a woman as she is entering a very significant life transition.

I can speak to the experience of forced vaginal delivery as it is my own lived experience. I can speak to the toll it has taken on me, and how it has changed me and how having had that lived experience - I would not wish it on any other woman because it is it's own kind of hell.

That is the real choice facing health care providers when women come to them asking for a patient choice cesarean: Do you facilitate the request after having provided informed consent, or do you subject your patient to a Forced Vaginal Delivery or an urgent/emergent cesarean after medical need arises?