Elective c-sections still have 'huge stigma' attached, and that really needs to stop. Women feel under pressure to give birth 'naturally,' even when it compromises safety. An obstetrician shares how to ask for a caesarean if that's how you want to give birth.
The recent Traumatic Birth Inquiry findings highlight the shocking state of maternal care in the UK. It's simply not acceptable that substandard care is being tolerated as normal, and women and babies suffering life-altering conditions or even death as a result of inadequate standards of care. In light of the findings, it's unsurprising that more women might prefer to choose an elective caesarean to mitigate some of the risks.
Alternatively, some women might opt for an elective c-section simply because they want to - and that is their right, nobody should be made to feel guilty for the way they choose to give birth. However, a huge stigma surrounding elective C-sections remains, with women reporting being refused the procedure even when they request one. It really should be time that women's rights are respected, and the c-section myths busted.
GoodtoKnow editor in chief, Anna Bailey, had an elective c-section, and doesn't regret her decision for a moment. She says "I asked for an elective c-section, and I have no regrets. I’d had IVF and was told because of this I’d have to be induced at 39 weeks, as they didn’t want me to go overdue. I just really didn’t want to go through that - I envisioned days of labour, and painful interventions. My husband’s parents had both died in the previous 18 months, and he’d spent enough time wandering around hospitals filled with anxiety and feeling hopeless - we just wanted to know when it was happening, so we could mentally prepare for the timing and get on with it.
"I felt really nervous about asking my consultant and planned what I was going to say. I was convinced I'd get some push back. They did ask me if I knew about the potential risks and complications, and asked me to reconsider - but eventually, agreed. I think they could see I was adamant. I was annoyed that I'd have to feel so bad for asking - like I was a bad mum already because I wanted that choice. Funnily enough though, when I told my midwife, she said 'good for you.'"
"I felt really nervous about asking my consultant and planned what I was going to say. They did ask me if I knew about the potential risks and complications, and asked me to reconsider - but eventually, agreed. I think they could see I was adamant."
Anna Bailey
Speaking to the Irish News, Dr Ranee Thakar, president of the Royal College of Obstetricians and Gynaecologists, said "Every pregnant woman is different, and their individual needs and preferences should play the most important role in planning the birth of their baby." She adds "If someone is considering a caesarean birth or has questions or anxieties regarding birth, they should tell their healthcare professional as soon as possible. Personal feelings, concerns and opinions are all important and should be respected by healthcare professionals when discussing birth plans."
However, despite the National Institute for Health and Care Excellence (NICE) guidelines suggesting women are free to choose how they give birth, a stigma remains regarding this method - both from healthcare practitioners and the general public. The NICE guidelines are the gold standard of practice for clinicians, and should therefore be followed - this means putting aside their own opinions regarding such a personal decision.
Outside of the clinical environment, the notion of c-sections being the 'easy' option, pushes some mothers down the path of a vaginal birth even if that's not what they want - fear of being deemed bad at motherhood before they've even started by having a c-section, is a lot of pressure. Among many other factors that should be taken into account when discussing the option of a c-section, previous birth trauma, medical conditions that make vaginal delivery risky, and psychological factors such as anxiety and depression, are especially pertinent for consideration.
Dr Shazia Malik, a consultant obstetrician and gynaecologist at The Portland Hospital, has outlined how to ask for a c-section if you really want one.
How to ask for a c-section
- Openly discuss your wishes. Dr Malik advises pregnant women to be very clear with their healthcare providers, what it is they want. If you have a particular fear that makes you want a c-section - push it on your team until they understand. Malik said "It’s crucial women feel empowered to have these conversations without judgment. As obstetricians, we want to work in partnership with expectant mothers, providing the necessary support so mothers-to-be can make a fully informed choice."
- Don't be pressurised. Don't worry about what your antenatal teacher or the other mums are doing - if you want a c-section, you're entitled to it. Malik acknowledges the pressure that delivering vaginally is 'optimal' even when it compromises the safety of mums and babies. She adds "A safe, healthy mother and baby should be the top priority, and no one should feel shame around how they deliver their baby. We must move past outdated attitudes and ensure all mothers feel empowered and have access to respectful, inclusive antenatal and postnatal care that supports their choices."
- Raise the matter of informed consent. If your care providers fail to discuss the option of a c-section with you, raise it with them instead. Let them know you've done your research, and are practicing informed consent by landing on the conclusion to have the procedure.
- Don't be scared to complain. If you feel you aren't being listened to, or your concerns over a vaginal birth are being dismissed, don't be afraid to speak out. You can formally complain, and ask to see a different team or team member. You have the right to be supported in making the best birth decision for yourself, and not have to appease other people.
- Be prepared. Arrive at your appointment armed with any questions you have. Let the people you speak to know you're aware of the policies that state you have a right to choose. If they try and talk you down, ask as many questions as you need, and let them know if you feel unsafe with the conclusion if it isn't the one you arrive at the consultation wanting.
Many of the reasons women are denied c-sections appear related to healthcare professionals' gate-keeping over what women should be doing with their own bodies. Much of the social stigma arises from this too - there is often a lot of 'competitive mumming' when you're pregnant, with a strong onus put on having 'natural' births with little to no pian relief.
With these notions being outdated and lacking progression, it's about time women's preferences were respected, and women supported women in the choices they make for what feels best, and what is safest when it comes to giving birth.
Have a look at our guide for the best gifts for new mums, and the best swaddles - these are amazing for babies with a strong startle reflex. Thoughtful gifts are one of the best ways to see a new mum through the complex process of matrescence.
