cesareans and "choice"

I read this letter of the day in the StarTribune out of Minneapolis-St. Paul Minnesota and it really got me to thinking. In the letter a mom who had a cesarean birth defends her "choice." She says "I "chose" a Caesarean because medical complications made it necessary, but the OB made it clear that this was still my choice."

Now if a cesarean is medically necessary, is it really a choice?

And then I got to thinking more and I remembered something I read in The Birth Book by William and Martha Sears. In the book they talked about hard and soft indicators for cesarean. Hard indicators include complete placenta previa , a breech in a transverse position,
prolapsed cord , and a very few others.

Soft indicators would be "failure to progress" or "prolonged labour", changes in fetal heart tones, and suspected big baby. These and other soft indicators are covered here at childbirth connection and here at unnecesarean

In the case of a hard indicator, cesarean isn't a choice. It's a medically indicated major abdominal surgery. Like all surgery cesarean carries risks but in these few cases the benefits (i.e. baby born quickly before s/he loses too much oxygen from a compressed cord) outweigh the risks (delayed breastfeeding initiation, wound infection, iatrogenic prematurity, etc) to such an extent that the "choice" doesn't exist.

But I'm going to assume the best. I'm going to assume the woman who wrote the letter had a soft indicator for cesarean, was presented with evidence that examined the risks, benefits and alternatives of both vaginal and cesarean birth for her specific situation and then made the decision that she knew was best for her and her baby.

fyi because this blog is focused on natural birth options I conciously chose to use a link that shows some of the risks of cesarean, I don't intend to imply that there are no risks in a vaginal delivery, but the risks of cesarean are often downplayed at the time a decision is to be made. As to the link for alternatives i chose to link to a site describing an alternative to cesarean that is specific to cesarean for cephalopelvic disproportion, It is not the only alternative and is not a useful alternative to cesarean for other reasons, just one example.

This is why I blog about birth and breastfeeding. This is why I'm taking doula training in the fall. Because I want women to know their options. If there is a choice to be made, if a midwife or ob suggests a cesarean for a non-emergent reason, I hope that women will have the knowledge (and hopefully a doula by her side) to make a choice she is confident in.

edited to add this link to a post from Anne @ Doula-la-la. After I wrote my post I read hers and I think we are talking on very similar points. Then I read Michelle's comment and totally second guessed myself.

Am I assuming other moms would choose as I do if they just knew what I know?