That may be changing, though. “In 20 years, I have seen a trend in this direction with more emphasis on patient autonomy, awareness around consent and discussion of process and choice,” says Suzanne Gilberg-Lenz, M.D. a board-certified ob-gyn and an advisor for Bodily. “Perhaps as women feel more partnership with their doctors and more empowered and less body shamed, they are asking more questions about the mode of delivery and feeling more able to voice their own expectations.” In her experience, women who request elective c-sections often have a history of trauma, a mood disorder or anxiety—all things that can add potentially harmful stress to a pregnancy.
We’re told that wanting an elective C-section is potentially dangerous—but what about the risks of going through a pregnancy that seems at odds with your mental health? “A planned cesarean in a controlled environment, while still being an abdominal surgery and carrying risks, is actually quite safe in the hands of an experienced and skilled obstetrical surgeon,” says Dr. Gilberg-Lenz. “Surgeries should never be undertaken lightly, but this is what informed consent is all about.” She finds that when she as a doctor is open to elective c-sections, it helps her patients feel heard. “It’s about creating safety and trust by listening to the patient, educating and supporting her through the process,” she says. “Most frequently, when I get requests for elective C-sections, they are abandoned later on because of the relationship that we have developed.”
Even with the support of a doctor, the stigma persists, whirring around in every phase of the pregnancy journey. “I felt very alone. My husband and I only told our parents and four very close friends about my choice. We told other people we’d had to schedule a C-section for medical reasons,” says Rachel Heston-Davis, a 36-year-old in Illinois. “I didn’t feel ashamed of my choice, but I knew I would get angry if people argued or made me defend this mental health decision, so it seemed easier not to poke the hornet’s nest.”
The Right to Choose
An obstetrician who’s willing to consider an ECS can change the experience for women with a fear of delivering vaginally. “As an anxiety sufferer, anything that overwhelms me physically and mentally can send me into a very dark place that is hard to recover from. I was afraid to get pregnant until my OB reassured me that she would okay a C-section for me,” says Heston-Davis. “The choice to elect for a C-section made a difference to literally every facet of my conception, pregnancy, and actual childbirth experience. If I’d spent my pregnancy anticipating vaginal delivery, I would have had frequent anxiety draining me on a daily basis. After that dark cloud of worry lifted, I became joyful about the thought of starting our family.”
If the power to choose an elective c-section would make a significant impact to your mental health, talk to your doctor. “If anxiety and fear of vaginal birth and labor cannot be assuaged, I believe that a scheduled elective Cesarean delivery at 39 weeks gestation is appropriate,” says Dr. McClellan. You’ll also want to consider the cost. “Not all insurers will cover the delivery if there is no ‘medical indication’ for the cesarean,” explains Giovannina Anthony, M.D., a practicing ob-gyn in Jackson, Wyoming. “My office checks with each patient’s insurer to verify coverage; and you can imagine if the patient is going to be out of pocket, this also can affect their decision.”
Ultimately, it’s about having the power to make that decision.
“Having the choice [for a C-section] gave me the freedom to accurately evaluate what I could handle when the moment arrived,” shares Rachel, who ended up delivering vaginally by choice. “My labor happened to move fast, my epidural happened to be extremely effective, and these two things made labor much less frightening than I anticipated. But if I’d felt like I was fighting the doctors and nurses to have my wishes respected, I couldn’t have taken that step back to realize that I was actually prepared for vaginal birth.”
Finding the courage to go against the grain, putting in the time to research the pros and cons, and finding a physician who supports you are all important pieces for women. They certainly were for me. By the 39-week check-up my husband and I sat in the exam room with my ob-gyn and we picked a date for the elective C-section. We would meet again to discuss and plan for the surgery, my doctor said. I cleared my throat and felt the crisp air of the room pierce my nostrils. Emboldened, I said, “okay, I like that. And if I go into labor this week I feel good about trying to deliver vaginally.”
Which is exactly what I did. All I really needed it seemed, was the option. To feel that in the midst of a long and mentally challenging pregnancy I had some power in the matter. That and an epidural.
Rebecca Brown is a writer and editor in San Francisco covering fashion and wellness. Follow her on Instagram @rebecca_n_sf or find her memoir, Stop, Drop, and Panic … and Other Things Mom Taught Me on Amazon.