What You Need To Know About Requesting A C-Section, According To An OB-GYN

by Cat Bowen

Childbirth options can feel less like options and more like mandates from interested parties. Sometimes, you have concerns, and you just need a measure of control over what happens. It's not always medicated or unmedicated, but you may just want more intervention. But with so many people veering away from inductions and elective surgeries, can you request a C-section? You need to know your rights as a patient.

There are many potential reasons for wanting to request a cesarean. Perhaps you're concerned about being in labor or the delivery. You may be worried about post-labor urinary incontinence, or perhaps it's just general nerves — you're better when it's not in your hands.

Cesareans are almost de rigueur in the media. They're an expected, common way of delivering a child, and are available to everyone who wants one. But is that the truth? Can you request a C-section like you would a mammogram or epidural?

It turns out to be a lot more complicated than what it seems. A full 32 percent of women in the U.S. delivered their children via cesarean section in 2016, according to the Centers for Disease Control and Prevention (CDC). That's a pretty high percentage, and the American College of Obstetricians and Gynecologists (ACOG) wants to change that. A study published by the group in 2011 looked at the spike in C-sections in the last 30 years and determined that convenience and an overabundance of caution tended to dominate over the typical physical processes of the body, perhaps to the detriment of women.

The ACOG's official stance on whether or not to grant a maternal request for a C-section is that all factors need to be considered when making the decision. It should be avoided — if possible — if the woman plans on having a large family, as it can make subsequent pregnancies more difficult and increase the risk of hysterectomy. It also shouldn't be performed before 39 weeks gestation, and basically, the OB-GYN should do what they can to convince their patients not to get an elective cesarean.

I spoke with OB-GYN, Dr. Wayne Furr of Lone Tree Obstetrics and Gynecology, in Lone Tree, Colorado, and he tells Romper, "A patient has every right to request a cesarean section from her obstetrician. On the other hand, though, her obstetrician has a right to refuse this if he or she believes the cesarean would not be in the mother's or baby's best interest."

According to Furr, most obstetricians will honor a mother's request for an elective C-section if he/she believes that you are well informed regarding your desire. But while most C-sections are known to be uncomplicated and uneventful, he notes that the procedure is not without risk. "Your obstetrician will be able to discuss these risks with you, and indeed, should, prior to performing any elective surgery, including an elective Cesarean section. Some points to be considered in discussing and deciding whether or not to electively do a C-section can be listed."

Furr recommends asking yourself, "Why do I want a C-section?" Pregnancy can be a happy, fulfilling time, he says, but there is anxiety involved with it, too. "Fear of the pain of labor, fear of whether or not baby will be OK during the labor and birthing process, fear of the pelvis being traumatized by a vaginal birth — these fears, anxieties, and concerns should be thoroughly discussed with your obstetrician," Furr notes.

But he says you should also ask yourself how many children you eventually want to have. If you plan on a small family, risks of something called 'abnormal placental implantation' tend to be minimal, he says. "A C-section will not only leave a scar on your tummy, but a scar on the uterus also. With any scar on the uterus comes the possibility of the placenta 'growing' abnormally into that scar on subsequent pregnancies. This phenomenon is called 'placenta accreta.' Most advanced abnormalities of this condition are called 'placenta increta' and 'placenta percreta.'" Rather than the placenta simply attaching to the uterine surface, Furr explains, it actually grows into the uterine wall, resulting in difficulty in removing the placenta on subsequent deliveries and with increased risk of hemorrhage, transfusion, prolonged hospital stay, and possibly hysterectomy. "If your plans are to have one or two children, this risk is low," he says. "But if you plan on a number of children, the risk of the placental problem increases significantly."

And finally, Furr suggests asking yourself, "Do I know all there is to know about a C-section?" He notes that C-sections carry a risk of increased blood loss during delivery, and therefore a slightly higher risk of needing a transfusion. "C-sections are considered, and are, major surgeries, involving entering the abdominal cavity. This carries a slightly higher risk of infections that can occur post operatively. There is usually a prolonged recovery time with a C-section, and hospital time will most of the time be longer than that with a vaginal delivery." These are all important things to keep in mind when requesting a C-section.

Furr stresses that open communication and knowledge are essential factors when considering how you want your childbirth to play out, and that is something I think everyone can get behind, no matter what their ideal birth looks like. Just be open and honest with your OB-GYN and trust their input; they want the same outcome you do — a healthy baby and a healthy mom.