Choosing where to give birth

Choosing to have an elective c-section

8 min read

You have the right to request a planned caesarean section on the NHS. We guide you through the pros and cons of having an elective c-section and explain how to arrange the birth you want.

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Can I choose to have a c-section on the NHS?

Yes, you can ask to have a caesarean section on the NHS without having any medical reason. This is known as a ‘maternal request c-section’.

Often, c-sections for non-medical reasons are requested by women who have birth anxiety, perhaps because of a previous traumatic birth, or who have suffered sexual abuse in the past. But there are many reasons for choosing to have a c-section, and your request should be considered in any case.

“I had an elective c-section out of choice without any underlying health reasons. It was an amazing experience – my baby was born healthy and I recovered quickly.” Amanda

Pros and cons of having a c-section

There are a number of things to consider when choosing how to give birth, and some reasons are likely to be very personal to you. One thing which can help you to compare a c-section with vaginal birth, is the statistical risks and benefits of each option.

It’s important to note that these pros and cons are for a planned c-section versus planned vaginal birth for women without any complicating factors.

What are the pros of a planned caesarean birth?

  • You’re at lower risk of injury and pain to the perineum and vagina.
  • You’ll have a lower risk of early postpartum haemorrhage.
  • You may have a reduced risk of urinary incontinence and prolapse after birth, though studies into this have been inconclusive.
  • An emergency c-section often comes with more complications than a planned c-section, and more than one-in-ten women end up having an unplanned c-section.
  • You’ll know the date your baby will be born in advance, which can make it easier if you need to make childcare arrangement for older siblings, or if you want friends or family around to help after the birth.
  • Elective c-sections are more predictable than planned vaginal births, so can be a better option if you’re keen to feel that you are in control of your birth, for example after a previous traumatic birth or sexual abuse.

What are the cons of a planned caesarean birth?

  • The c-section recovery period is generally longer than that after a vaginal birth.
  • You may contract an infection in the scar or the lining of your uterus following the operation.
  • Your chances of developing a blood clot are increased and you may experience anaesthetic complications, as with any operation.
  • Scar tissue called adhesions can form in bands between the organs in your abdomen, which can be painful and result in the need for further operations.
  • Your baby is at higher risk of having breathing problems and needing to spend some time in the neonatal special care unit after the birth. They are statistically more likely to develop asthma, allergy and obesity later in life.
  • In any future pregnancy after a c-section, there is a slightly increased risk of miscarriage, stillbirth, placenta accreta, low-lying placenta and uterine rupture.
    Read more about birth after a previous caesarean section.

It’s important to bear in mind that the overall risk of many of these complications is low, regardless of whether you give birth vaginally or through a c-section.

Questions to ask

You should have an opportunity to discuss all of the pros and cons, and any other thoughts or concerns you have, with your health professional before you decide how to give birth.

It can be easy to get overwhelmed when faced with making a decision about your birth. To help ensure you have all the information you need, you may find it useful to ask the following three questions:

  1. What are my options?
  2. What are the benefits and possible risks of each option for me?
  3. How do I get support to help me make a decision that is right for me?

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How to arrange an elective c-section

You can have an elective c-section either on the NHS or in a private hospital.

Having an elective c-section on the NHS

If you’re considering having a planned caesarean birth, the best thing to do is to bring it up at one of your antenatal appointments.

Your midwife or doctor will be able to refer you to an obstetrician, who’ll go through the risks and benefits of having a planned c-section with you.

If your reason for asking for a c-section is that you’re worried about vaginal birth, you should be offered a referral to a health professional who can help you cope with your anxiety in a supportive way.

If, after talking things through with the necessary professionals, you decide that you would like to have a caesarean, official guidelines state that you should be offered a planned c-section.

If the doctor you see is unwilling to perform the caesarean, they should refer you to another doctor who will do it for you.

NICE guidance states: “For women requesting a c-section, if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned c-section.”

What if my hospital won’t agree to a c-section?

Around a quarter of NHS hospitals go against NICE guidelines and don’t offer maternal request c-sections, as highlighted in this 2018 report by Birth Rights.

If you’re having problems arranging a c-section through your consultant, a good first step is writing to the hospital. Caesarean Birth have useful tips on what to include in the letter.

You can also talk to other health professionals in your NHS Trust to try to get support to arrange the birth you want, for example:

  • Your GP or midwife
  • A Professional Midwifery Advocate (PMA)
  • Consultant/senior midwives at the hospital
  • The head/director of midwifery at your NHS trust
  • Maternity Services Liaison Committee (MSLC)
  • Patient Advice and Liaison Services (PALS).

We have more information on how to find out who to contact at your hospital on our page about negotiating your maternity care.

If you find that you’re still having problems arranging a c-section at your hospital after writing a letter and seeking further support, your best option may be to transfer to a different hospital that is more favourable to maternal request c-sections.

You don’t need to stay within your NHS Trust; you can ask to have your baby at a hospital in a different area if you wish.

Search for a location to find maternity units and their contact details – we also have a list of every NHS maternity unit in the UK.

Can I have a private c-section?

Yes, an alternative to having an elective c-section on the NHS is to have a planned c-section privately. The proportion of women having c-sections in private hospitals is higher than in NHS hospitals.

You’re likely to need to jump through fewer hoops with a private hospital, but it comes at a price: having a c-section privately costs several thousand pounds.

Find out more about private maternity care and where your nearest private maternity hospital is.

Getting ready to have a c-section

If you know that you’re having a c-section, you can often plan for the birth a bit more specifically than if you were planning to give birth vaginally.

Making a birth plan

Having a c-section doesn’t mean that you don’t get to make any choices for the birth. You may still like to write a birth plan and consider if you want:

  • your own music to be played during the birth
  • dimmed lighting
  • the curtain lowered so you can see your baby being born
  • the hospital staff to be quiet when your baby is born, so yours is the first voice they hear
  • photos to be taken during the birth, or someone to film when your baby is born
  • to discover the sex of your baby for yourself
  • immediate skin-to-skin contact and breastfeeding.

You can talk about all of these things at your antenatal appointments with your consultant or midwife, to come up with a plan for the birth which feels right for you.

“My husband and I put together a playlist for the c-section birth and our daughter was born while Stay Close by The Blue Nile was playing. We have a really nice video of when my husband saw her for the first time in the theatre.” Read Amanda’s story

Packing your hospital bag

There are some things you always need to bring when giving birth – for example, nappies and clothes you’ll need for the baby and maternity pads for you.

But there are also specific things that can be good to consider putting in your hospital bag if you know you’re having a c-section. In particular, it’s helpful to have high-waisted knickers and loose clothing that won’t put pressure on your abdomen wound.

Read our tips on packing your hospital bag and download this c-section hospital bag checklist for more ideas on what you may like to bring.

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References

These are the sources of information used in this article:

NICE, Caesarean section, NICE Clinical Guideline 132, London: National Institute for Health and Clinical Excellence (2011)

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