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Cesarean Delivery upon Maternal Request

Reviewed by James Brann, M.D.

You Can Choose a Cesarean Birth to Avoid Labor

Learn about Cesarean Delivery upon Maternal Request

For many years, the number of babies born via Cesarean section deliveries has been increasing. Nearly 1 in 3 babies in the U.S. is now born via C-section, and most of these are for medical reasons. In some cases, though, women choose to have a C-section even if they have no medical need. These are called elective C-sections, or Cesarean deliveries on maternal request.

Medically Necessary C-Sections?

There are many reasons women have a C-section instead of a spontaneous vaginal birth. Medical reasons for C-sections include the following:

  • There is an emergency complication during labor

  • The labor is very long or difficult and may become dangerous to the mom or baby

  • The mother or baby has a reason that makes vaginal delivery unsafe such as, your baby is too big, your pelvis is too small or the baby is lying sideways or breech

  • The mother has had a prior C-section and her physician feels it would be more risky to have a vaginal birth than a repeat C-section

Why Do Some Women Request Elective C-Section Deliveries?

In addition to increasing numbers of medically necessary C-sections, women are increasingly requesting C-sections for non-medical reasons. Women may want elective C-sections for a variety of reasons, but the most common concerns are the following:

  • Women fear the pain and risks of a vaginal delivery

  • Women want a sense of control over the due date and the process of childbirth

  • Women wish to avoid the potential complications or side effects of a vaginal delivery (such as urinary incontinence)

  • Women have had a vaginal birth in the past that was very negative or unpleasant

All of these concerns are normal and understandable. It is perfectly natural—especially for first-time moms—to feel anxious about giving birth. Many women find the idea of having a baby less stressful when they can plan the day and time in advance, and even arrange for family to be in town for the big day. Sometimes, women have heard horror stories from friends or relatives who had a terrible childbirth experience. Still other moms know how common C-sections already are and just want to save themselves the trouble of having an emergency (or acute) C-section. Women who have given birth before may want to avoid repeating the pain or risk, especially if they had complications or a long labor.

What You Should Know (or Ask) About Elective C-Sections

If you are thinking about requesting a C-section and you have no medical need for your choice, take time to learn about the pros and cons before you decide. Always talk to a physician or midwife about your questions and concerns before scheduling an elective C-section. This helps make sure that you have all of the facts before you make up your mind.

After doing some research on your own, be sure to think about and discuss the following topics with an obstetrician or midwife:

  • What are your main reasons for wanting a C-section? Are you afraid of delivery, pain, or complications? Are there ways you could prepare for a vaginal birth to make it less intimidating?

  • Does your facility or insurance even provide elective C-sections? If so, what are the restrictions on timing or reimbursement?

  • What are your personal risks for major surgery? What can you expect in anesthesia and recovery time?

  • What are your personal risks for an unplanned C-section if you do not elect one in advance? Will your weight, health, or birth history put you at higher risk of a medically necessary C-section if you try to deliver vaginally?

Make sure your healthcare provider can answer all of these questions and any others you may have before trying to schedule an elective C-section. Many women may find that more information about what to expect from childbirth and the risks involved with major surgery may make an elective C-section less appealing.

In addition, most hospitals do not perform Cesarean deliveries on maternal request until the pregnancy has completed 39 weeks. Other hospitals may try to discourage elective C-sections whenever possible to avoid delivering a baby preterm, as some estimates of gestational age are incorrect (and preterm birth causes many problems for the baby’s health and development).

Elective C-Sections Vs. Vaginal Birth: Pros and Cons

Planned C-sections are usually safe surgeries. Women who undergo a planned Cesarean delivery are less likely to experience certain surgical complications, like infections or excessive blood loss, than women who have an emergency C-section. Despite the safety of this procedure in the U.S., an elective C-section is still major surgery. It carries serious risks, such as blood clots or organ injury, and some women may have a poor reaction to the anesthesia. Women who want to have more children may require a C-section for all future births.

Most women who undergo a C-section delivery also have longer recovery times than women who have a vaginal birth. They may spend more time in the hospital, have higher rates of infections postpartum, and experience more pain when they hold their babies or try to sleep.

On the other hand, women who give birth vaginally may be more likely to have urinary incontinence, which makes it harder to control the bladder. They may also suffer injuries to the pelvic floor or perineal tears (which are tears in the vaginal tissue). Vaginal birth is also typically a more painful process than elective C-sections, even when pain relief medications or injections are given.

Elective C-sections may prevent some pain and risk to the mother, and they may also spare her the pain or inconvenience of a long or complicated labor. When planned in advance, elective C-sections can normally prevent a baby from experiencing a lack of oxygen or an injury from the birth canal that a vaginal delivery can cause. Vaginal birth may offer the baby some benefits that a C-section cannot offer, however, such as exposure to helpful bacteria from the mother’s vaginal fluid. Some women may also find it easier to bond with their baby or successfully breastfeed after a vaginal birth. Long-term outcomes for children born from elective full-term C-sections do not differ from children born vaginally.

Requesting a C-Section: Making Your Decision

Before you decide on an elective C-section, try to get to the root of your concerns about vaginal birth. Taking a Lamaze class or talking with a birth coach may help relieve anxieties about vaginal birth and help you have a smooth vaginal delivery. If you decide to request a Cesarean delivery, be prepared to explain your reasons to a healthcare provider. Finally, remember that your childbirth method has to be a personal decision that you make for you and your baby. Each birth method has risks and rewards, so weigh your options carefully before making your decision.

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