Sun. Oct 2nd, 2022
Cesarean section on demand: can the mother request to give birth by

Caesarean section is a surgical intervention to extract the baby that is quite common in our environment. 26 percent of births in Spain are by caesarean section, double the recommended by the WHO for whom the “ideal” rate of caesarean sections is between 10 and 15 percent.

Cesarean section may be necessary when vaginal delivery poses a risk to mother or child, as long as there is a medical reason that justifies it , such as in case of prolonged labor, fetal distress or when the baby is poorly positioned. But, what happens when it is the mother herself who expressly requests to give birth by caesarean section because it is her wish ?

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It is what is known as “caesarean section on demand” , “caesarean section a la carte” or “caesarean section at the patient’s choice”, a fairly common phenomenon among some celebrities, women who have had a previous vaginal delivery that has been traumatic, or women afraid of childbirth .

According to a 2017 study , the reasons that lead women to request a C-section is the combination of fear of pain and unpredictability.

Vaginal delivery is always the best option

It is important to know that caesarean section is not a panacea, and that it is not an alternative to vaginal delivery, but rather it is performed when it is not possible and should be limited to those cases in which there really is a need for its performance. Vaginal delivery is the most recommended, safest and always the best option, since the risks of undergoing a cesarean section are greater than those of vaginal delivery .

We must not forget that although it is very frequent, it is still a surgical intervention , with the risks of any operation. Among other risks, cesarean section presents a higher risk of hemorrhage and uterine atony, tears of the uterine wall, pelvic organ injuries (bladder, intestine), as well as possible anesthetic complications. It also has postoperative complications such as an increased risk of abdominal infections and of the surgical wound itself. Not to mention the longer recovery and wound discomfort after C-section .

Assuming that all the conditions for a vaginal delivery are met but the mother rejects this way of giving birth, an ethical debate is opened. Caesarean section at the request of the mother must be assessed by the medical team taking into account each particular case.

It is clear that the woman has the right to choose her way of giving birth, but it is also true that the patient’s decision may entail real risks for her and her child. Therefore, the doctor should try to persuade her of these risks and get her to change her mind.

If the woman persists, the obstetrician must ensure that she is informed and if her reasons are based on this information, “caesarean section would be ethically permissible.”

According to this medical article , cesarean section at the request of the pregnant woman must be considered and respected in accordance with the principle of autonomy of the pregnant woman , but the doctor has the obligation to fully explain the advantages and disadvantages in her specific case.

If an elective cesarean section is performed, it should be scheduled after 39 weeks of gestation to reduce the risk of fetal respiratory morbidity.