If you had the option of having surgery or not having surgery, something tells me—call it intuition—most would choose the latter. Elective surgery doesn’t exactly sound fun, but throughout my pregnancy in 2017, that’s exactly what I wanted, an elective C-section.
Elective C-sections account for only 2.5% of all births in the United States, according to the American College of Obstetricians and Gynecologists (ACOG). The medical community refers to this desire as cesarean delivery on maternal request, and I knew before I even got pregnant that I wanted one. I have panic disorder, and pregnancy has always been something I feared. The idea of a growing fetus felt claustrophobic. The larger the baby would ostensibly get, expanding from pea- to pumpkin-size, the harder it might be to breathe. From there I might have a panic attack, and because pregnancy lasts nine months, the panic might feel unending. The logic wasn’t there, but the neural pathways that wired my brain to fear the what-ifs definitely were.
Then there was the delivery itself. Vaginal delivery wasn’t what freaked me out; rather, I was fearful of getting to the 39-week mark and feeling so claustrophobic that I’d need an immediate fix. I’m someone who’s had a panic attack on an airplane during the boarding process and run off in order to calm down, but since you can’t exactly run out of your pregnancy, planning for a C-section felt like a safe emergency exit.
Typically, doctors recommend elective C-sections only in cases when there’s a “maternal or fetal indication,” like if the mom has placenta previa or health conditions such as high blood pressure, or if the baby is in an abnormal position. I’d argue my crippling fear of delivery qualified, so before my husband and I began trying to get pregnant, I completed cognitive behavioral therapy (CBT) and met with two psychiatrists who specialized in women’s reproduction. I was grateful to have found experts to help me work through my fear, and chose to try pregnancy without antianxiety medication because I wasn’t on anything to begin with (though that’s great if medication is what works for you).
But my plan was not an easy sell to my ob-gyn. She emphasized the risks of a C-section repeatedly to me—like bleeding and infection—and I also knew that delivering vaginally is known to expose baby to healthy gut bacteria. “Although cesarean section is a common procedure, it is still a surgical procedure that can be associated with risks and complications,” explains Stephanie McClellan, M.D., CMO of Tia, a women’s health care program in New York City. “What is very interesting is that the reasons women request [elective C-sections] are quite consistent: fear of the pain of labor, belief that it is a safer method of delivery for both mother and child, previous history of traumatic vaginal delivery, cultural beliefs about improved sexual function, and specific influences by the opinions of family and friends.”
The panoply of risks associated with a C-section admittedly felt abstract. I was more frightened I might arrive at a place where my panic disorder felt inescapable—the maternal and fetal risks associated with having anxiety and panic during pregnancy felt much more immediate. Shouldn’t choosing to have a C-section be my prerogative?
I’m not alone in thinking that way. “Risks of surgery were not even a concern for me,” says Clare Frances, a mom in Palo Alto, California, who also asked her ob-gyn for an elective C-section when she was pregnant with her first baby. “Easing the anxiety and exercising control vastly outweighed any slight thought of possible medical risks—it was 100% based on what was the best emotional choice for me.”
The Hard Sell
Like my ob-gyn, most are “reluctant to grant requests for an elective cesarean section (ECS) due to childbirth fear,” according to a paper published in the journal BMC Pregnancy and Childbirth.
That may be changing, though. “In 20 years I have seen a trend in this direction with more emphasis on patient autonomy, awareness around consent, and discussion of process and choice,” says Suzanne Gilberg-Lenz, M.D. a board-certified ob-gyn and an adviser for Bodily. “Perhaps as women feel more partnership with their doctors and more empowered and less body shamed, they are asking more questions about the mode of delivery and feeling more able to voice their own expectations.” In her experience, women who request elective C-sections often have a history of trauma, a mood disorder, or anxiety—all things that can add potentially harmful stress to a pregnancy.
We’re told that wanting an elective C-section is potentially dangerous, but what about the risks of going through a pregnancy that seems at odds with your mental health? “A planned cesarean in a controlled environment, while still being an abdominal surgery and carrying risks, is actually quite safe in the hands of an experienced and skilled obstetrical surgeon,” says Dr. Gilberg-Lenz. “Surgeries should never be undertaken lightly, but this is what informed consent is all about.” She finds that when she as a doctor is open to elective C-sections, it helps her patients feel heard. “It's about creating safety and trust by listening to the patient, educating and supporting her through the process,” she says. “Most frequently, when I get requests for elective C-sections, they are abandoned later on because of the relationship that we have developed.”
Even with the support of a doctor, the stigma persists, whirring around in every phase of the pregnancy journey. “I felt very alone,” says Rachel Heston-Davis, a 36-year-old in Illinois. “My husband and I only told our parents and four very close friends about my choice. We told other people we’d had to schedule a C-section for medical reasons. I didn’t feel ashamed of my choice, but I knew I would get angry if people argued or made me defend this mental health decision, so it seemed easier not to poke the hornet’s nest.”
The Right to Choose
An obstetrician who’s willing to consider an ECS can change the experience for women with a fear of delivering vaginally. “As an anxiety sufferer, anything that overwhelms me physically and mentally can send me into a very dark place that is hard to recover from,” says Heston-Davis. “I was afraid to get pregnant until my ob-gyn reassured me that she would okay a C-section for me. The choice to elect for a C-section made a difference to literally every facet of my conception, pregnancy, and actual childbirth experience. If I’d spent my pregnancy anticipating vaginal delivery, I would have had frequent anxiety draining me on a daily basis. After that dark cloud of worry lifted, I became joyful about the thought of starting our family.”
If the power to choose an elective C-section would make a significant impact to your mental health, talk to your doctor. “If anxiety and fear of vaginal birth and labor cannot be assuaged, I believe that a scheduled elective cesarean delivery at 39 weeks' gestation is appropriate,” says Dr. McClellan. You’ll also want to consider the cost. “Not all insurers will cover the delivery if there is no ‘medical indication’ for the cesarean,” explains Giovannina Anthony, M.D., a practicing ob-gyn in Jackson, Wyoming. “My office checks with each patient’s insurer to verify coverage, and you can imagine if the patient is going to be out of pocket; this also can affect their decision.”
Ultimately, it’s about having the power to make that decision.
“Having the choice [for a C-section] gave me the freedom to accurately evaluate what I could handle when the moment arrived,” shares Rachel, who ended up delivering vaginally by choice. “My labor happened to move fast, my epidural happened to be extremely effective, and these two things made labor much less frightening than I anticipated. But if I’d felt like I was fighting the doctors and nurses to have my wishes respected, I couldn’t have taken that step back to realize that I was actually prepared for vaginal birth.”
Finding the courage to go against the grain, putting in the time to research the pros and cons, and finding a physician who supports you are all important pieces for women. They certainly were for me. By the 39-week check-up my husband and I sat in the exam room with my ob-gyn and we picked a date for the elective C-section. We would meet again to discuss and plan for the surgery, my doctor said. I cleared my throat and felt the crisp air of the room pierce my nostrils. Emboldened, I said, “Okay, I like that. And if I go into labor this week, I feel good about trying to deliver vaginally.”
Which is exactly what I did. All I really needed, it seemed, was the option. To feel that in the midst of a long and mentally challenging pregnancy, I had some power in the matter. That and an epidural.
Rebecca Brown is a writer and editor in San Francisco covering fashion and wellness. Follow her on Instagram@rebecca_n_sf or find her memoir, Stop, Drop, and Panic…and Other Things Mom Taught Me on Amazon.
Originally Appeared on Glamour