Who decides whether you have a caesarean section?

Whether you're totally set against a caesarean or keen to avoid a vaginal birth, who makes the decision on whether you give birth by this operation?

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Around one in four babies in the UK are delivery by caesarean – some planned for medical purposes, some in an emergency situation where a vaginal delivery is a risk and a small amount because of a strong preference by the mum to give birth this way.

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My doctors have recommended I have a c-section – who decides?

When your obstetrician recommends that you should have your baby by c-section, you aren’t under any obligation to follow their advice, however forcefully she presents her case. Like any surgery, you need to consent to the procedure before doctors can proceed. So in that sense, the person who ultimately decides is you.

However, the decision-making process is usually a little muddier than this. Unless you are an obstetrician or midwife yourself – or unless you object to caesareans on religious grounds – you’ll probably be basing your decision on the advice of your doctor and midwife and trusting their reading of the situation.

Why might they advise a caesarean delivery?

There are certain situations when it will be the only safe way to deliver your baby and will therefore be presented to you as the only option. For example, if you have a low-lying placenta and it is blocking your baby’s exit route.

In many other cases, a c-section may be the best option for your health and that of your child, such as if he is lying in a breech (feet down) position. In these circumstances, your doctor will probably advise you very strongly to have the operation.

These days caesarean section is seen as a quite low-risk operation by doctors (although it certainly isn’t risk-free). In many cases they may err on the side of caution in recommending one out of their desire to deliver healthy babies to healthy mums. You may even have the feeling that a caesarean is being suggested because it’s more convenient for the medical team.

What if I’m not convinced by their view?

If you’re not sure that a caesarean is really necessary, ask plenty of questions about why the section is being recommended, and what would happen if labour were allowed to continue. If you’re not happy with the responses, you can ask for a second opinion.

One of the roles of your birth partner is to help you assess these recommendations, ask the right questions and support you, so get them involved too.

If you’re lucky enough to have a midwife present who has looked after you through pregnancy and with whom you’ve developed a good rapport, you might feel happier discussing the situation with her and assessing the pros and cons of having a section, or not. She will be honest with you.

Can I be forced to have a caesarean?

Your right to refuse a c-section is protected by law. This means that even if your decision will probably result in the death of you or your baby, you are legally entitled to refuse the advised treatment, as long as you are deemed ‘competent’ or fit to make that choice.

There have been instances of women being declared mentally unfit to make this decision for themselves – not a difficult argument to present for a woman in the throes of labour – and being forced to have a caesarean. However, this isn’t common.

Be aware that in refusing a c-section, you may be putting the life of you and your baby at high risk, or exposing one or the other of you to long-term health risks. If this is the case, your obstetrician will present the case for surgical delivery in no uncertain terms. Make sure you stay open-minded.

What if I want a caesarean delivery rather than vaginal?

Since 2011, official guidelines give mums-to-be the right to elect for a caesarean section on the NHS rather than a vaginal birth, even when there’s not clear medical reasons for one. 

However, before this is agreed, your midwife and doctor need to talk you through all the dangers, to ensure you are not making the decision lightly.

A caesarean isn’t a risk-free operation – it is major abdominal surgery from which you will usually need six weeks to completely recover. There is some evidence that babies born by this method are more likely to suffer breathing difficulties and need specialist neonatal care.

Mums can experience problems such as scarring, haemorrhaging, deep vein thrombosis and damage to the bowel, bladder, uterus, ovaries or fallopian tubes. NHS figures rate c-section as three times more likely to result in death of the mum than a vaginal birth, although the numbers are very low.

What if I am still convinced that a c-section is right for me?

You’ll be asked to talk with members of the obstetrics team – such as the surgeon and anaesthetist – to explore your reasons for preferring an operation to a vaginal birth.

Woman who have a strong fear or phobia of childbirth – known as primary tokophobia in first-time mums and secondary tokophobia in those who’ve had a traumatic previous birth – will be given counselling to see if their anxieties could be overcome first. They will also be given access to the place they intend to give birth.

If, after all these steps, you still want to opt for a caesarean, an elective operation will be offered on the NHS. If your obstetrician is unwilling to perform it, they must refer you to another one who will.

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