It’s Time to Address the Absence of Choice in Childbirth

April 13, 2020

Written by guest blogger Elizabeth Chloe Romanis.

In 2018 the mainstream media was yet again reporting that there had been an increase in caesarean sections and was labelling this a “public health disaster.” Yet again, this was branded a result of pregnant women increasingly opting for caesarean section ‘when it isn’t medically necessary.’ The next thing I knew I was deep diving into literature about maternal request caesarean sections.

There were a few things I found curious: firstly, it didn’t seem immediately obvious to me in the reporting that the increasing number of caesarean sections performed were because women were choosing them. Secondly, it didn’t seem right to me that if women were choosing their childbirth that it should be reported as a public health problem. Thirdly, how comfortable other people felt commenting on women’s choices regarding their body, their welfare and their pregnancy (again: with limited evidence) seemed to signal that we were not yet past treating all pregnant women’s experiences as homogenous, neglecting to consider pregnant women’s welfare holistically and failing to value women’s experiences.

In a paper published in 2019 I addressed some of these concerns arguing that much of the argumentation around maternal request caesarean section is based on myth: there is limited evidence to suggest that planned caesarean is significantly riskier than vaginal delivery, the assumption often made that medical intervention should be reserved for situations of clinical need is flawed, and it is often not the case that there is an absence of clinical need or health/welfare reasoning behind a pregnant woman’s decision to opt for caesarean. It struck me as obvious, therefore, that denying women a choice about childbirth (including maternal request caesarean section) was unjustifiable.

In my recent article published in the International Journal of Feminist Approaches to Bioethics, Addressing Rising Caesarean Rates: Maternal Request Caesareans, Defensive Practice, and the Power of Choice in Childbirth, I argue that if rising rates were the result of more women choosing to have a caesarean delivery it should not be considered a public health problem. However, there are substantial reasons to believe that rising rates are actually the result of defensive practice, rather than increasing choice, not least because MRCS is only just beginning to gain widespread credence in medical communities in high-income economies. Women are systematically being denied maternal request caesareans in countries like the UK and simultaneously women are being expected to defer to professional opinion to have caesareans when they would prefer not to as a result of defensive practices. Thus, ‘the absence of choice in childbirth has become an issue of epidemic proportions.’ What’s worse is that the mainstream reporting is laying ‘blame’ at women’s feet. Routinely offering MRCS is a way to ensure that women are counselled about childbirth and that any decision (vaginal delivery, assisted delivery, caesarean or emergency caesarean) made is a genuine choice.

This is a persistent problem and it is not confined to choices about delivery – there is emerging evidence that women are also being routinely denied pain relief and privacy during childbirth in the UK. It is imperative that we afford women the respect they deserve and pay attention to choices in childbirth.

Elizabeth Chloe Romanis is a PhD Candidate in Bioethics and Medical Jurisprudence, supported by a Wellcome Trust Studentship in Society and Ethics, at the University of Manchester in the UK. Chloe has published extensively on the ethico-legal issues in gestation surrounding the development of artificial womb technologies as an alternative to neonatal intensive care. Her broader research interests include pregnancy and the law and decision-making in obstetrics. Chloe currently teaches Criminal Law, Medical Law and Ethics and Medical Technology and Morals at the University of Manchester Law School. 

Her latest article in IJFAB: International Journal of Feminist Approaches to Bioethics entitled “Addressing Rising Cesarean Rates: Maternal Request Cesareans, Defensive Practice, and the Power of Choice in Childbirth” is free to read for a limited time here.

The UTP Journals blog features guest posts from our authors. The opinions expressed in these posts may not necessarily represent those of UTP Journals and their clients.

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