Maternal Rights to Request an Elective Caesarean

Photo Credit Cesar Abner Martinez Aguilar

Photo Credit Cesar Abner Martinez Aguilar

New research by Elizabeth Chloe Romanis explores a woman’s rights to an elective caesarean in the absence of clinical/ medical indications. This is known as a MRCS or maternal request to a caesarean section.

The main issues are the physical and emotional impact of birth on a woman, and the ‘lottery’ of access to MRCS depending on where you are giving birth.

According to Birthrights, the issue of access to an elective caesarean section is one of the most common issues they deal with. From the research, many NHS trusts lack adequate guidelines to support women with MRCS which means that many women are denied requests and often treated insensitively.

Who decides how a woman births her baby?

According the NICE guidelines in 2011, women should always be the primary decision makers in childbirth. At the same time, the guidelines protect the right of individual doctors to decline to support a woman with MRCS. It’s too simplistic to categorise women into Earth Mothers or ‘Too Posh to Push’. And by these broad brushstrokes, we lose the ability to really listen to the questions and choices that are being considered. 

In my doula training, there was a sense that the optimal birth experience is that of a quick, drug-free birth, preferably in water, perhaps at home. Over the years of attending births and supporting women osteopathically, I’ve opened my eyes to the idea of personalising the experience to the individual. While I do agree with reclaiming birth from an overly medicalised system, I also support a woman’s right to decide what happens to her own body, especially at such a precious and impactful time. 

For example, a client who was raised in a country where there is a high rate of elective c-section may feel safer with a more medical birth. Body autonomy is an ethical issue, as well as one of power and control in a hierarchical system that often leaves the patient out of key decision-making.

Why would someone request an elective caesarean section?

There are complexities related to birth choices. It may be simply, personal preference or convenience. There may be a history of mental health issues or sexual abuse. Tocophobia or fear of birth is a complex one as it doesn’t technically fit under the umbrella of clinical reasons. There may be a request in order to prevent pelvic floor damage. There’s also the conversation about a smooth, elective caesarean over an arduous birth that may involve attempted instrumental delivery (forceps and venture) and end up in an emergency caesarean. Symptoms such as pelvic girdle pain or pain from fibroids may not be deemed medical issues that would require a caesarean, but they could cause enough discomfort to the individual. There may have been a traumatic history of fertility treatment such as IVF and procedures, and/ or miscarriage.

Why would MRCS be denied?

It will vary from case to case, but birth is considered a physiological process and recommended . It could be due to a lack of clear guidelines in the NHS trust so that a woman is not offered counselling to weigh up all her options, and is instead steered towards vaginal birth. Risk and cost are also factors that may restrict MRCS access.

It’s a complex conversation but one that I’m glad to see is being researched.

Further reading:
Research by Elizabeth Chloe Romanis