Birth options - choosing a caesarian.

In good, modern, medical practice patients are routinely advised of their options for treatment, and the pros and cons of each. This allows patients to opt for the level of intervention that is right for them. In theory this should extend to maternity and obstetric care and yet, too often, we hear stories of women being denied their right to request, and receive, a caesarean section.

When a woman falls pregnant, it can often be the first time she has ever needed to attend hospital for care of any kind. This introduction to complex medical issues can be a daunting experience, especially when the implications for the health of  mum and baby are so significant. 

When considering options for childbirth, there are many factors to consider. Some  women may wish to have a home birth, some a hospital birth. Some women aim for a ‘drug free’ birth, others ask for epidurals or other anaethesia as soon as possible. Expectant mums may also have a strong preference for either a vaginal birth or Caesarean Section.

Many women would rather give birth vaginally, if possible. However, there may be reasons for a woman wishing to have a caesarean section. There may have been difficulties during a previous birth, or perhaps a pre-existing medical condition, or even anxiety at the thought of a potential lack of control during a vaginal birth. The reasons can be many, and varied.

Whatever the reason, and even where there is no specific reason as such, the NICE guidelines state that a woman is entitled to request a caesarean section, that this request should be considered by the treating medics, and the woman advised as to the potential risks of a caesarean section compared with a vaginal delivery. If the woman, upon considering all the medical advice given, decides she would still like to go ahead with a caesarean section, then this must be arranged.

To not allow such a request is to deny a patient their right to choose their medical care, and contradicts the guidelines that those providing care should follow. At a time when everything can be very overwhelming, this failure to listen to a woman’s wishes can be deeply upsetting and leave the woman feeling helpless and traumatised.

Although medical care continues to improve, we still regularly receive enquiries from women who have suffered physical or psychological injury whilst giving birth in a way that they would not have chosen.  In one case a mum and baby suffered serious injury because clinicians persevered with an instrumental vaginal delivery rather than agreeing to the mother's request for a caesarian.

In many cases, even where mum's wishes are ignored, baby is delivered safely. However the implications for the mum of being ignored are significant. Traumatic deliveries can impact upon family life and women's health. In some circumstances they can lead women to decide to restrict the size of their families rather than face further pregnancies.

Pregnant women should feel empowered to discuss their options and clinicians should, of course, inform and advise.  This approach to obstetric and maternity care should ensure that expectant mums make informed decisions about treatment and this, in turn, should result in better birth experiences, and happier families.