Coping with disapproval

If you are opting for a caesarean for reasons not currently recognised as medical, you need to get your story straight. It is unlikely that people will come right out and say that you are a bad or irresponsible person but do not expect the reaction to be one of approval. The media hypes up the "too posh to push" argument and allow people that are less well informed to assume that an elective caesarean is a selfish, cosmetic choice.

The following pieces of information may help you construct your responses when faced with a negative reaction.

• Researchers reporting in the Nuffield Study stated that "Despite strong rhetoric around the topic, existing research fails to support the notion that large numbers of women are demanding caesareans in the absence of any clinical indication. [The Nuffield study] has also been unable to find evidence for women asking for the operation for social/trivial reasons e.g. because they are 'too posh to push' or solely to time the birth." 56
• The often quoted figure of 7.3%, as the number of women electing for a caesarean, actually refers to the total number of elective caesareans. This includes all of those caesareans carried out at the recommendation of the mother's obstetrician, i.e. when medical situations indicate that a caesarean is preferable to a vaginal birth. In other words not simply because the mother wants one. 57 Very little is actually recorded about the number of women electing for a caesarean for other reasons. A survey of obstetricians suggested that only three per cent of caesareans were requested by women in the absence of medical indications, and only about half of such requests were granted
• The Nuffield study found that "Most women did not take the decision to ask for a caesarean section lightly. Many described coming to their decisions after much heart-searching and many mind changes and some women feared both the operation and vaginal birth. Sometimes although a woman made the final decision about caesarean section the issue had already been raised by a health professional… Thus, although a decision might be described as a 'maternal request' it was not always made in the absence of professional input." 56 While it may be cosmetic for some there are many other reasons why women elect for caesareans and these reasons should be respected too.

Many people will be unaware of the research that has been conducted and the advances made in this field even over the last 10 years. It is worth thinking seriously about who to tell and how much you will tell them, not everyone will support your choice. If you are making an informed decision it will be very straightforward to defend your corner should you be faced with an adverse reaction. So:

• know your reasons for choosing a caesarean
• ensure that your birth partner supports your decision

As you will know by now, there are risks with both a caesarean and a vaginal birth. At the end of the day only you can weigh up the pros and cons for your situation.

Paterson-Brown reporting in the Obstetrics and Gynacology Journal in 2000 stated that "The risks of CS and labour are real but different, and if fully explained to the woman, she should be allowed to accept one set of risks over the other - after all she is the person who has to live with the consequences. An elective CS in a fit healthy woman is neither unsafe nor bad practice if she truly understands the risks involved and is adamant that she cannot accept the risks of labour or vaginal delivery." 45