The Lady Garden

Tea and Strumpets

Is there a right to choose C-sections?

Cross posted

Women could be given right to choose Caesarean birth

The National Health Service in the UK is considering giving women the right to choose a c-section, even when there is no medical need. That seems appropriate to me.

My reasoning goes like this. Yes, caesarians are risky, as all abdominal surgery is risky. However, mere risk alone is not enough to disallow particular activities. If it was, then none of us would ever be allowed to get into a car. Even high degrees of risk are not enough to rule out activities, such as studying volcanoes (volcanologists, especially those who study erupting volcanoes, have a very high death rate).

You might argue that caesarians can cause harm to a woman, but again, choosing an activity that causes harm to yourself is permissible. As it turns out, delivering babies vaginally can cause harm to women too, as women who have spent years and years doing Kegel exercises will tell you.

Perhaps we might worry about harm to the baby, but that only comes into play if we ascribe moral standing to the baby, and treat women merely as receptacles of precious objects. It does seem to be the case that babies are at higher risk of complications if they are delivered through a c-section, but in order to use that as a reason for refusing c-sections, we would have to say that the woman’s role in pregnancy and childbirth must be to be the best possible bearer of babies. That is, she is not important, and only the baby is important. If a woman says that she wants the best outcome for the baby, then it would be appropriate to take the risks to the baby into account when determining whether or not to have a caesarian, but only in the sense that in order to achieve the outcome she wants, that is, factors militating against that outcome must be considered.

We might be concerned about whether a c-section is medically necessary, with the underlying assumption that no medical procedure should be undertaken unless it is medically necessary. But if that’s the case, then there goes the entire plastic surgery industry, including plastic surgery or reconstructive surgery. Of course, we can defend plastic and reconstructive surgery on the grounds of psychological need, but in that case, the psychological needs of women preparing for childbirth need to be considered too, and those psychological needs may well be met by planned c-sections.

Following on from that, perhaps women choose c-sections because they are concerned about the process of labouring and delivering a baby. If that’s the case, then the answer is to provide more support for women who are preparing for childbirth, perhaps in the form of counselling and education, not just to prohibit one option for giving birth.

On the financial side, if planned c-sections are more expensive than other forms of childbirth, then given that the National Health Service in the UK is funded by taxpayers, then we might have some concerns about cost, both for the caesarian itself, and for the on-going care of mothers babies. However, it seems that allowing women to choose a c-section would just formalise existing practice, whereby women who want a c-section can already arrange to have one. Formalising the practice might well be preferable, because it would at least reduce the capriciousness of the health system, whereby women in one hospital might be able to access c-sections, but women in another might not, just because of differences in attitude.

In general, we tend to think that if someone has considered all the relevant factors, and chosen to engage in a particular activity (such as going bushwalking by themselves in the middle of winter), then that is their business. We might deplore their choice, but we don’t stop them from doing it. And if they get into trouble, we pile in resources to help them. I think that the same approach must be taken with respect to childbirth. Setting aside the matter of cost, if a woman wants to have a c-section, and she has considered all the issues, then that is her business. In fact, even if she hasn’t considered every last detail, we should still not put barriers in the way. To do otherwise is to treat women as though they were children, dismissing their fears and concerns, and telling them that they just don’t understand and that really, they had better just let the grown-up doctors and nurses and midwives make the decisions for them.

9 responses to “Is there a right to choose C-sections?

  1. Trouble September 8, 2011 at 2:33 pm

    My understanding, and sorry I can’t remember where I got the stats from, is that under some circumstances (perhaps repeat c-sections vs VBAC), performing a c-section rather than having a vaginal delivery saves babies at about ten times the rate that it places extra risk on mothers.

    The study you link to talks about elective inductions (not just c-sections) prior to 39 weeks, not c-section vs spontaneous vaginal delivery at full term.

  2. Isabel September 8, 2011 at 4:07 pm

    I struggle with this issue so much – mostly because, with the number of women I’ve seen battling to avoid unwanted and unneeded c-sections I find it really hard to get my head around someone wanting one. I think it’s two sides of the same coin though – the medical professional should provide information and advice but it must be the woman’s choice as to what she does with her body (and also what level of risk she wishes to assume for herself and her unborn baby).

  3. andie September 9, 2011 at 10:21 am

    I’m a little biased after being through two C-sections (one emergency, one elective) and having no issues, but I think it’s one of those situations where we may abhor the practice (for instance, I LOATHE plastic surgery, with exceptions due to disfigurement), but one’s own body is one’s own body and as distasteful a person, or society in general may find it, the decision to weigh the pros and cons of natural birth versus cesarean lies solely with the pregnant woman. We can only hope that her medical practitioners have fully informed her of the risks and benefits of both options.

    • Profligate Promiscous Strumpet September 10, 2011 at 2:06 pm

      “We can only hope that her medical practitioners have fully informed her of the risks and benefits of both options.”

      This is the issue right there.
      The current medical birthing system does not treat woman according to evidence based medicine, nor does it inform women adequately of their choices and the consequences.

      The current cesarean rate in Australia is approx. 30% and the WHO recommends less then 10%.
      There are repeated stories of women being denied access to VBAC due to the risk of uterine rupture, when evidence shows the risk of uterine rupture is 0.7%(and no higher then woman who have not had a cesearan)
      Women are routinely induced because of ‘macrocosmic’ babies, based on decisions regarding pelvic size (which is no indication of birthing ability!) or ultrasounds which have an error rate on baby size of 20% in the last trimester. Inductions lead to a higher risk of cesearean.

      I am absoloutly, no arguments, 100% behind women having birthing choice. But in the current environment, women are not given choice but are bullied, coerced and forced into decisons based on convience and not evidence based medicine.

      It is something that makes me so incredibly angry and the level of arrogance and complacency shown by the medical model of birthing is unforgivable.

      • Trouble September 19, 2011 at 3:39 pm

        “The current cesarean rate in Australia is approx. 30% and the WHO recommends less then 10%.”

        Not anymore it doesn’t. And it was 10-15%, not less than 10%.

        With respect to uterine rupture, the most cited study Google Scholar search concludes “Uterine rupture occurs at a low rate in women with and without prior cesarean delivery. Risk of rupture is increased among women with prior cesarean delivery and among those who attempt VBAC.” VBAC is certainly done in NZ hospitals – I’d want to make a calculated risk decision like that with guidance from the experts. I understand in the US, doctors can be sued for bad outcomes regardless of patients being fully informed, and that drives practice there.

  4. Matthew Proctor September 19, 2011 at 8:22 am

    I have two issues with this.

    One is largely with the terminology used. “Perhaps we might worry about harm to the baby, but that only comes into play if we ascribe moral standing to the baby, and treat women merely as receptacles of precious objects.” With respect, that’s not the case at all. To say that x is greater than y (in this case, the health of a baby versus the discretion of the mother) in no way implies that y is zero.

    The second is that this is a policy change, and there is nothing in this post to suggest that it meets the kind of cost-benefit analysis that is expected of policy. As mentioned, NHS is tax-payer funded, and so we would EXPECT it to be based on medical rather than discretionary decisions. The reference to elective plastic surgery is misleading, because NHS does NOT pay for such procedures. But the comparison is worthwhile: if NHS isn’t going to pay for medical procedures that aren’t medically necessary in one context, they shouldn’t in another.

    I’m not arguing that choice is unimportant, it clearly is! But this is a policy question, and requires that this is public money well spent. If peeps are going to elect to have a c-section as a matter of discretion, that is what private hospitals are for. Just as with elective plastic surgery.

  5. Mrs. W January 26, 2012 at 10:28 am

    Matthew (why am I not suprised you’re a man) – the cost argument on this is rather flawed, and the differences between planned vaginal birth (of which 20% end in emergent c-section) and planned c-section are surprisingly small. Add in the cost of birth injuries (such as cerebral palsy, brachial plexus injuries, etc.), and the cost of fixing problems caused by vaginal birth down the road (urinary and fecal incontinence, pelvic organ prolapse, etc.) and chances are its a wash between the two delivery methods.

    • Matthew January 27, 2012 at 1:00 pm

      I can’t answer the first question.

      I’m happy to defer to you on what follows. I have a zero risk of ever becoming pregnant, so I haven’t looked into the matter at all. So if the costs end up being equivalent, sweet, that’s an argument in favour of making elective c-sections available to all at no charge. But that’s kind of my point; that sort of cost-benefit analysis has to be done before you can go spending public money.

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