How to Decline a C-Section and Have a VBAC
“My doctor said I have to have a c-section. The hospital says their policy forbids me from having a vaginal birth. Do I have to have surgery?”
It’s the question birth advocates hear more often than any other. The short answer is that no, in almost all cases, a doctor cannot force you to have a c-section. Hospital policy does not trump the law, and the law protects your right to decline medical care. The only exception to this rule is if the hospital can show the baby’s life is in immediate danger. Even then, they have to seek a court order; they can’t force you into surgery without one.
The longer answer is that your ability to have a vaginal birth when your doctor recommends a c-section depends on numerous factors—chief among them your ability to fight on your own behalf. If you plan to decline a c-section your doctor recommends, here’s how to do it.
ask about the scientific data
Most hospitals and doctors perform c-sections at at least double the recommended rate. This means that many of the “medically necessary” c-sections doctors recommend aren’t necessary at all. And unnecessary c-sections are significantly more dangerous than vaginal births. So ask your doctor for scientific data supporting their recommendation for a c-section. Scientific data should come either from a peer-reviewed journal or from a medical body such as the American College of Obstetricians and Gynecologists (ACOG). Hospital policies and provider preferences are not scientific data.
Many of the reasons doctors commonly recommend a c-section are not supported by evidence. For example, ACOG recommends considering a c-section for a large baby only if the baby’s weight is estimated to be more than 11 pounds. Baby weight estimates are notoriously misleading, and become less accurate as the pregnancy progresses, so it’s important to also take this into account.
Once you have information from your provider, do your own research. Evidence-based birth is a great source of information for when c-sections are and are not recommended.
begin documenting everything
If your doctor recommends a c-section you don’t want and tells you that you “have to” have the surgery, it’s time to begin documenting everything. Take someone with you to each appointment if you can. And record each appointment, as well as any interactions with hospital administrators. You’ll also need to record your birth. This creates a record that may help you if you have to file a complaint down the road.
determine whether the problem is the doctor or the hospital
Providers generally recommend c-sections for two reasons: because the hospital requires them to do so in specific circumstances, such as if a person has had three prior c-sections; or because they think a c-section is best.
If the doctor recommends a c-section because of hospital policy, they may still be willing to support you in your decision to have a vaginal birth. Consider asking the doctor if they will support you if you show up in labor and decline a c-section.
consider switching providers
Not all providers are c-section happy. And many are willing to follow their ethical duty to obey patient wishes even if they think a c-section is best. So if your provider recommends a c-section you don’t want and gets adversarial, consider switching providers. Finding a more supportive provider is the very best thing you can do to ensure you have a good birth.
prepare to decline a c-section
Under the Emergency Medical Treatment and Labor Act, hospitals are legally required to provide treatment to people who show up in labor. This means they cannot refuse to admit or treat you when you are in labor just because you decline a c-section. So if you are determined to have a vaginal birth, the best strategy is to show up in labor and to clearly and plainly tell the hospital that you do not consent to a c-section.
Declining a c-section can be difficult. You will get pressure from hospital administrators. Your birth may be stressful. The hospital may threaten you. But as long as the baby’s life is not in imminent danger, you have an absolute right to say no. The hospital cannot force you to have a c-section without a court order. If they attempt to use physical force, document the force and continue to assert that you do not consent.
keep seeking medical care
Some pregnant people become so frustrated by the treatment they get from their provider that they stop going to medical appointments. This greatly increases the risk of birth complications. Continue seeking medical care, even if you don’t intend to follow your doctor’s recommendation for a c-section. If you don’t, the hospital could use your refusal of prenatal treatment as evidence that you are endangering the life of your baby.
show up in labor
Don’t schedule a c-section. Show up to the hospital in labor. Ensure you have a recording device audio-recording everything, and continually state that you intend to decline a c-section. In most cases, the hospital will make you sign a waiver and then mostly leave you alone. But in some cases, the hospital might refuse to admit you. If this happens, ask to speak to an administrator and remind them that you have a legal right to treatment.
have an advocate
Labor is hard enough in the best circumstances. When you’re fighting with a hospital, it can feel nearly impossible. You need someone who is willing to advocate for you. So if you and your partner are not on the same page, you need to get there before the birth. A doula can be extremely helpful, especially if your partner is not very assertive. Make sure you talk to the doula about your plans, to ensure they feel comfortable helping you assert your rights.
know when to seek legal advice
In almost all cases, you’ll be able to decline a c-section without major consequences. Your birth might be more stressful and you may feel frustrated and demoralized, but you are unlikely to find yourself in a serious dispute with the hospital. In rare cases, however, a hospital may either attempt to involved CPS/DFCS or say they intend to seek a court order. If either of these things happen, you must contact a lawyer right away. Attempting to navigate the legal system alone will almost certainly mean giving up your rights.
Disclaimer: The Georgia Birth Advocacy Coalition is not a lawyer, and not your lawyer. The only person who can competently advise you about your legal rights in Georgia is a Georgia-licensed lawyer who knows the facts of your case and who has reviewed Georgia law.