What Is Caesarean Awareness Month and Why Does It Matter?

April is caesarean awareness month. It was first started by the International Cesarean Awareness Network (ICAN), a non-profit organisation founded in the US in 1982 by a group of mothers who had experienced caesarean births and wanted to provide support and education to other families. They wanted to challenge the status quo at the time where in the US the ‘rule’ was no vaginal birth after caesarean. One of their aims became about prevention as they were witnessing a sharp increase in the rates of caesarean section. Their mission to date is to “improve maternal-child health by reducing preventable caesareans through education, supporting caesarean recovery, and advocating for vaginal birth after caesarean (VBAC)”. Caesarean awareness month was set up by them over 20 years ago to highlight this work. Not much has changed in their ethos, and they firmly believe in the respect of human rights in childbirth regardless of how someone chooses to give birth. 

Do You Have the Right to Request a Caesarean Section?

Human rights mean that you have a right to request or decline a caesarean section. This is no different from any other intervention offered to you along your pregnancy and childbirth journey, but we know this can be much harder to achieve in reality. To help you understand how this relates to you and your choices in birth take a look at Birthrights, a UK registered charity determined to protect your human rights during pregnancy and childbirth. On their website you can find some useful, yet simple, factsheets all about your rights in relation to a number of different issues. For example, Your right to choose your midwife and doctor.

What Is a Maternal Choice Caesarean Section?

This is the term given to women and birthing people in the UK, who make the choice to have an elective caesarean section. At first glance the national guidance around requesting a caesarean all seems a bit convoluted so you’re definitely going to want to read the Your right to a caesarean birth factsheet, courtesy of Birthrights.

How Do You Request an Elective Caesarean on the NHS?

Simply put, if you request a caesarean then you will be advised to have a thorough discussion with your healthcare provider, an obstetrician or a senior midwife, to go through the benefits and risks of both birth by caesarean section and vaginal birth. The depth of this conversation will depend on the individual health care worker and my understanding is that this is widely varied.

This is the slightly convoluted bit…if your healthcare provider feels that you are making an informed decision then they should accept your request to birth via caesarean section. But it is possible they may not support this if they believe you are not making an informed choice, or perhaps the ‘right’ choice. UK national guidelines advise that if the obstetrician declines your request, the hospital must provide access to an obstetrician who is willing to do the caesarean for you.

It may feel like jumping through hoops to prove yourself and there is a lot of paternalistic language being thrown about in the guidelines. But the key here is ‘informed choice’ – hard to fully achieve in the NHS when you only have a rushed 20 minute antenatal appointment in which to discuss this. In our experience it is uncommon that women are declined a maternal request caesarean but this is anecdotal evidence and based on our own experiences as midwives working in a handful of London maternity units. Should you find yourself in a position where your request is being declined, know that there are a lot of resources out there. The first step would be to seek out the Consultant Midwife based at the trust you have booked with. Your community midwife will be best placed to put you in touch with them.

Why Do Women Choose an Elective Caesarean Section?

You do not have to explain your wishes for a caesarean birth to anyone and there are many reasons women have shared as to why they wish to have an elective caesarean section. These include but are not limited to: fear of childbirth and the pain of childbirth, safety concerns they hold around their own pre-existing health conditions, previous traumatic birth, a history of sexual abuse and a fear of having to undergo vaginal examinations during labour and childbirth. In addition some people find an elective caesarean birth offers convenience and a sense of control as they feel they can pick a date and time and feel reassured by this. There is of course always the possibility of going into labour before this date! Another reason, women and birthing people may choose an elective caesarean is that they have a positive attitude towards caesarean, for instance their family members may have had positive experiences giving birth via caesarean section. Whatever your reason, your choice should be respected and supported. You do not need to prove yourself to us, or indeed anyone!

We offer elective caesarean care packages, whereby you receive all the benefits of continuity of care throughout your pregnancy, we can provide non-clinical support and advocacy during your birth and then provide in-depth postnatal care at home when you are discharged from hospital.

Can You Decline a Caesarean Section?

We often hear women talk about requesting a caesarean section as an alternative to an induction of labour (IOL) and this is because they feel they have no other option. For many women and birthing people, knowing you can decline interventions being offered could make a world of difference and open up birth options you never knew were possible.

As I write this I am reflecting on all the conversations I’ve had with women and birthing people and the revelation that they can decline is both a positive one for me and also quite upsetting. The fact that they didn’t know this is deeply concerning and illustrates the challenges people face when accessing mainstream maternity services.

How to Avoid an Unnecessary Caesarean: Understanding the Cascade of Interventions

If you are very much planning to avoid a caesarean section then understanding your options about place of birth and other interventions is key. Choosing to birth in a hospital setting does increase your risk of medical interventions including caesarean section. The Great Birth Rebellion have released an episode on their podcast called the Cascade of Interventions. Understanding this so called ‘cascade of interventions’ is key to Caesarean Awareness Month and the ICAN’s mission to provide education and prevention for unnecessary caesareans. 

If you are planning a hospital birth and wish to avoid a caesarean section then you might want to find out the statistics on the rates of caesarean sections where you have booked for your care.

It is important to note that an elective caesarean section can be an entirely different experience to an emergency caesarean section. In addition, not all emergency caesareans are performed for life threatening situations – much as the term ‘emergency’ might lead you to believe. But if you have never had an operation, or stepped foot into an operating theatre, any kind of caesarean section may feel daunting to you.

Why Your Birth Experience and Choices Matter

How you give birth and the respect for your choices throughout this experience is key in your journey to motherhood and the wellbeing and development of your newborn baby. Preparing for your birth and understanding your choices is the first step on this journey to a birth that leaves you feeling empowered; a birth where you felt listened to and your choices respected. This is why your wish to request a caesarean or to decline one, really matters.

Read: What’s Right For Me? by Sara Wickham

Follow: @birthrightsorg on Instagram