Even when there's no medical reason for it, some women prefer to give birth via C-section. But the procedure is riskier than vaginal birth. Should doctors comply with women's wishes, or make them do what's safer?
The BBC reports on new proposed guidelines for Britain's National Institute for Clinical Excellence that state "For all women requesting a Caesarean section, if after discussion and offer of support, a vaginal birth is still not an acceptable option, offer a planned Caesarean section." That's a change from current guidelines, which state that "maternal request is not on its own an indication for Caesarean section" and "an individual clinician has the right to decline a request for Caesarean section in the absence of an identifiable reason." Final guidelines won't come out until November, and the C-section recommendations could change by then, but one doctor says the new rule just formalizes what's already happening in hospitals, where obstetricians will often perform a C-section if a patient requests it. And Pauline McDonagh Hull of electivecesarean.com says, "I am very pleased that NICE is recognising and supporting informed women who choose a Caesarean birth plan. This is important and most welcome progress."
All things being equal, women deserve to make their own decisions about the birthing process. And despite the "too posh to push" stereotype, there are lots of reasons women might choose C-sections that are a lot more valid than needing to fit in childbirth on the way to the pedicurist — the BBC lists "fear of pelvic floor damage" and "concern about the impact of vaginal delivery on sex life" among them. A 2004 study by University of Toronto ob-byn Mary Hannah notes that planned C-sections do significantly reduce the risk of incontinence — they may also lessen the risk of stillbirth. It's true that C-sections themselves have risks — Hannah also notes the possibility of lacerations and bleeding, as well as complications to future pregnancy. And while patient choice is important, doctors shouldn't perform procedures that are obviously medically counterindicated. Hannah offers a smart summation:
If taken in a vacuum, the principle of patient autonomy would lend support to the permissibility of elective cesarean delivery in a normal pregnancy, after adequate informed consent. To ensure that the patient's consent is, in fact, informed, the physician should explore the patient's concerns. ... If the physician believes that cesarean delivery promotes the overall health and welfare of the woman and her fetus more than vaginal birth, he or she is ethically justified in performing a cesarean delivery. Similarly, if the physician believes that performing a cesarean delivery would be detrimental to the overall health and welfare of the woman and her fetus, he or she is ethically obliged to refrain from performing the surgery.
So basically, women and their doctors should discuss birth options and come up with a plan that takes into account both a patient's wishes and her medical needs. Sounds so crazy it just might work.
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