By: Nicki Reid, Bilingual BA
What is a C-section?
A C-section which is also known as a Caesarean section is: a medical procedure in which your baby is delivered via a slight incision in your lower belly (as opposed to vaginally).
Why a C-section May Be Suggested to You
There are a few reasons why a C-section may be suggested, whether it's related to the baby or the mother. Concerning the baby, if there’s an abnormal heart rate or there are abnormalities in the fetus that make it unsafe for labour. In regards to the mother, if the delivery is slow or difficult, the cervix isn’t dilating, or placenta previais present (where the placenta is positioned so that it blocks the cervix). Furthermore, according to a recent Canadian study, the group making the largest relative contribution to increasing the caesarean birth rate is women…who have had at least 1 previous caesarean birth. However, if you’ve previously had a caesarean and would like to have a vaginal delivery this time around or if you don't want to have a C-section (for other reasons), it’s within your right to decline as it’s a basic accepted legal principle that "every human being of adult years and of sound mind has the right to determine what shall be done with his or her own body”. With that being said, you must provide consent as it’s an essential requirement for the initiation, continuation, and termination of medical treatment. While this varies by province, in Ontario the Health Care Consent Act (HCCA) requires physicians to obtain valid, informed consent before providing treatment. So what exactly is informed consent?
Informed Consent, Minors, and Capacity
Informed consent is defined as: the express or implied consent that is provided by a patient after understanding the information provided and having the opportunity to ask questions about the nature of the treatment, its expected benefits, its material risks relevant to their specific circumstances that a reasonable person would want to know, alternative courses of action, and the likely consequences of not having the treatment. Without your informed consent, your physician cannot legally proceed. Something else of importance to note is that under no circumstances can the medical professional pressure or force you to consent, you must arrive at your decision on your own. Furthermore, it's within your right to ask for (more) information and they must provide it to you. In addition to discussing the aforementioned and addressing whatever questions you may have as honestly and completely as they can, they also have the responsibility to give you print material or electronic resources to support the consent discussion. If at this point you’ve decided that you don't want a C-section, you’re within your right to decline as the courts have reaffirmed repeatedly a patient's right to refuse treatment. Please be aware that in the event of an emergency, when the patient…is unable to consent and there is demonstrable severe suffering or an imminent threat to the life or health of the patient, a doctor has the duty to do what is immediately necessary without consent. Another thing to know is that minors can refuse a C-section.
When it comes to being a minor, the criterion for capacity to consent is maturity, not chronological age. This is referred to as a mature minor. Where the physical, mental, and emotional development of the person permits them to fully understand the essence and outcome of their choice. If a minor isn’t able to consent, a parent or guardian provides consent and is required to act in the best interests of the child.
Concerning (mental) capacity, individuals with mental illnesses are able to determine their medical decisions if they comprehend the following: what is proposed and why, the options and risks, as well as the consequences of their choice. In certain circumstances, a substitute decision-maker (SDM) may provide consent when a patient lacks capacity.
Given everything that has been shared, here’s how to move forward with refusing a C-section.
Steps to Take to Refuse a C-section
1) Have a discussion with your physician and share your concerns and reasoning for refusing a C-section.
2) Remember, your physician has the obligation to provide alternative courses of action,
3) Make sure that you’re documenting the process and include relevant details such as days, times, discussion points, the outcomes, etc.
4) Get a second opinion from another health care provider about your situation.
5) Finally, seek a doula or midwife as soon as possible.
In closing, reflecting on my pregnancies, one of the most empowering actions I took was seeking education and support to learn about what my options and rights were so that I could make the best choices for my baby and I. If you’re unsure of where to start, visit Mino Care here. They offer a variety of services from doulas, to midwives, and beyond to support you along your journey.
As always, take deep care, stay informed, live empowered, and be well mama.
Nicki Reid, Bilingual BA
Certified Transformational Health and Life Coach | Certified Yoga and Meditation Teacher | Certified Emotional Emancipation Facilitator | Certified Reiki Practitioner | Founder, Wholesome Mind Health Coaching
