elective cesarean section advice

Choosing an elective c-section for tokophobia: my thoughts and advice

Since having Max by elective c-section, I’ve had quite a few requests for advice from people who, like me, suffer from tokophobia, and who – also like me – think they want an elective c-section as a result of that, but then find themselves scared to death by all of the information they’re given about the process. You know, that bit where the doctor’s all, “Well, sure, I mean a c-section could be a good way to deal with your fear of childbirth, but it could also be a good way to die in a pool of blood: still want to go ahead with it?” Yeah, THAT.

Now, obviously I’m not here to tell anyone what to do (So, spoiler alert: this post will probably be a bit of a ramble…), but as I’ve had a few messages recently from women who are really struggling to decide whether or not to go ahead with their c-section request, today I thought I’d just jot down a few quick thoughts on the subject: and, as is generally the case with me, anytime I say I’m going to write a “quick” post on something, it ends up being twice as long as War & Peace, so, you know, apologies in advance…

[Trigger warning: this is presumably clear from the context, but there wasn’t a way to write this post without talking about some of the risks of childbirth, so, if you’re dealing with tokophobia, proceed with caution…]

choosing an elective c-section: my thoughts and advice

I always knew I wanted to give birth by c-section: in fact, if NHS guidelines hadn’t been updated in 2011, giving all women the right to choose how they give birth, I don’t think I’d have even considered getting pregnant – THAT’S how scared I was. I wrote about the reasons for my tokophobia in this post, so I won’t bore you with them again, but suffice it to say that I. Was. Terrified. What’s more, I felt very, very alone in that terror: I knew, of course, that tokophobia existed, and that there must surely be other people out there who felt exactly the same dread of birth I did, but, well, it’s not exactly what you’d call dinner-party conversation, is it? Fear of childbirth is, I think, something most women experience, to some extent or another: for me, though, it was a full-blown phobia, which is something very, very different.

Unlike most of the Instagram mummies I followed, I had absolutely no desire whatsoever to experience childbirth: I didn’t consider it some kind of rite of passage, and I knew I wouldn’t be any less of a mother if I didn’t push the baby out myself. I know a lot of women feel like they’ve “failed” somehow, if they don’t have a natural birth, but while I’m not knocking that point of view – we’re all entitled to feel however we feel, after all – I also can’t pretend to understand or relate to it, either, which meant my decision wasn’t clouded by any feelings about the “right” or “wrong” way to give birth. As I kept on saying, I wanted a baby, not a “birth experience”, and all I really cared about was that we both got through it alive – and, ideally, in the least traumatic way possible.

So, I was absolutely sure I wanted a c-section … right up to the moment I met with my consultant to request one, and left the appointment telling Terry that, actually, the baby would just have to stay where he was forever, because I could see absolutely no possible way of getting him out without one or both of us dying. So THAT was a fun car ride home, for sure.

Now, I should probably add here that my reaction to that appointment had absolutely nothing to do with my doctor. She was lovely. She was supportive. She made it clear, right from that very first meeting, that if I really wanted an elective c-section, I would get one. She also, however, said she wouldn’t be happy to give the procedure the go-ahead until she was sure I was aware of the risks – so I left hospital that day with a thick booklet called, ‘Here Are All the Ways You Might Die During Your C-Section!’ – or, you know, words to that effect – and the absolute conviction that I would enter the Guinness Book of Records as the first woman to remain pregnant for the rest of her life.

Like, I could just cross my legs or something, right? Or keep him in there by sheer willpower? I would have to figure something out, anyway, because one thing I was sure of was that, following my chat with the consultant, and a quick flick through the information she’d given me, there was absolutely NO CHANCE I’d be willing to risk having a c-section.

Which brings me to my first – and possibly ONLY – piece of advice to anyone considering having an elective c-section for tokophobia:

Do your own research

Now, I’m not saying the information the NHS give you o c-sections is incorrect here: not at all. It’s just not particularly balanced: and, for someone trying to decide between two, equally terrifying, options, that’s just not very helpful.

When I requested my c-section I was told about all of the risks associated with the procedure – including some that are very unlikely to actually happen – but absolutely NONE of the risks associated with a vaginal birth. And this is incredibly problematic, because, by only providing one side of the story, and comparing the risks of one option with the benefits of another, the information you’re given provides a very skewed perspective.

In fact, when I started to research it myself, I quickly came to understand that the NHS were essentially comparing emergency c-sections (Which are generally riskier than planned ones, for obvious reasons, and which I was very keen to avoid…) with perfect vaginal births. Which I guess would be fine if all vaginal births were perfect … but they’re not, are they?

Actually, statistics show that 90% of women will tear to some extent during a vaginal delivery. That’s not a small percentage, and yet it’s not something you’ll be told upfront when you’re considering your birth options – or, at least I wasn’t, anyway. I know there are currently discussions underway which could require doctors to explain the risks of both types of delivery to expectant mothers, but, when I was pregnant with Max, that definitely wasn’t the case.

Had I said I wanted a vaginal birth, no one would have tried to talk me out of it on the grounds that there was a 90% chance of injury during delivery: they DID, however, list every single possible complication of my planned c-section, no matter how remote a possibility it was, and, whether intentionally or not, that had the effect of seriously making me doubt my decision. In fact, I left the doctor’s office that day essentially believing that there was a safe, easy way to give birth, and a difficult, dangerous one – and that I was choosing the latter.

Which just isn’t true.

And, I mean, YES, there are obviously risks to having a c-section, just as there are risks attached to any kind of surgery. There are also, however, risks associated with vaginal birth: and those are the risks the NHS won’t tell you, even although many of them are the SAME risks you’ll find with c-sections.

I was told, for instance, that, if I had a c-section, there was a possibility that un-named complications could lead to me having to have a hysterectomy. Now, to be fair, my doctor DID tell me that this was unlikely: what she DIDN’T tell me, however, was that the same is true of vaginal birth – i.e., if something goes catastrophically wrong, you could end up having to have a hysterectomy REGARDLESS of the method of delivery. At the time of writing, a woman telling her doctor she wants a natural birth will NOT be told, “Oh, but have you considered the fact that you might end up having to have a hysterectomy if something goes wrong?” A woman requesting a c-section, on the other hand, WILL. At least twice, if memory serves.

I was also told about the risk of me haemorrhaging during the operation: and, again, yes, sure, that COULD happen (Spoiler: it didn’t.) during a c-section… but it could ALSO happen during a vaginal delivery. This is anecdotal evidence, of course, but I can think of at least two women who had dangerous levels of blood loss during vaginal deliveries: neither of them were warned about it beforehand. It just isn’t done.

And so it went on. The surgeon could accidentally damage one of my internal organs while getting the baby out. The baby could be cut by the scalpel. The zombie apocalypse could come to pass while I was lying on the operating table, and, if it did, guess who would be the first one to “turn”? (Er, OK, maybe not that last one. IT COULD HAPPEN, though.) And let me be clear: there are obviously some c-section risks that DON’T apply to vaginal birth (DVT, infection of the scar, etc)… but there are also some risks associated with vaginal births that don’t apply to c-sections: tearing and future incontinence being the main ones that spring to mind. These, however, were risks I had to find out about myself, because they weren’t brought up during the referral process, or at any point in my antenatal care. And sure, that could be unusual, I guess. If the emails and another messages I’ve been getting are anything to go by, though, I somehow don’t think it is: because, what I keep hearing, is that women who request a c-section for tokohobia are being led to believe that they’re making a very dangerous choice, when there’s a totally safe choice they could be making instead. And, I’ll say it again: that just isn’t true.

blogger in a field

In the end, of course, I did decide to go ahead with an elective c-section. Why? Well, I gave some of my reasons in this post, but there were a couple of factors that helped make up my mind. The first was simply that, once I’d calmed down a little after my initial meeting with my consultant, I put the information she’d given me to one side, and did my own research. What I came to realise is that, while there are obviously risks associated with any type of surgery, planned c-sections are, for the most part, very safe. The NHS’s own website actually states this, although it’s not something they seem keen to tell you in face-to-face meetings. I also came to realise that there would ALWAYS be risks, regardless of how I chose to give birth, and that, ultimately, it’s just a question of deciding which risks you’re willing to live with, and which are going to be deal-breakers.

In my case, my deal-breakers were the possibility of me having to be induced (Which wouldn’t have played out well for me, as it could’ve involved me being in hospital, on my own, for a long time while I waited for things to get started…), or requiring a general anaesthetic, which is sometimes necessary during an emergency c-section, and which I have a full-blown phobia of.

So, in a way, I chose an elective c-section in order to avoid having to have an emergency one… which, OK, sounds pretty crazy when you put it like that, but it made sense at the time. (And yes, I was warned that there was no way to guarantee that I wouldn’t need a general anaesthetic: having a planned c-section gave me the lowest possible risk of needing one, though, and that had to be enough for me.) It still makes sense now, though, to be honest, because I must have read hundreds of birth stories during (and before) my pregnancy, and one thing I learned from them was that, while all vaginal births are totally different, most planned c-sections seemed to be pretty similar, really. There are no guarantees, obviously, and there will always be someone who ends up having a totally different experience (Hey, are you guys as sick of all of these caveats as I am by now? Thought so…), but, my personal opinion is that a planned c-section is the closest you’ll get to knowing more-or-less how your baby will enter the world: and, as I got closer to my due date, that was a huge comfort to me.

My best advice to anyone considering an elective c-section for tokophobia, then?


Do your own research – don’t just rely on the one-sided information you’ll get from the NHS.


Work out what your deal breakers are, and which risks you’re willing to live with.


Meet with the staff who’ll be carrying out the c-section, if you can. One of the most helpful things for me was being given a tour of the labour and delivery ward, in which I was walked through exactly what would happen on the day, right up to the moment I entered the operating theatre. Seeing everyone go about their business, completely unfazed, helped me realise that while, for me, having a c-section was the scariest thing I’d ever done, for the hospital staff, it was totally routine, and something they do all day, every day. (We also got to see a new baby just seconds after birth, and that was pretty damn amazing too, it has to be said…)


Understand that there is no “easy” option when you have tokophobia. Honestly, I wish I could say there was a moment when I thought, “Yes, that’s it: I’m totally sure I’m making the right decision here!” but there really wasn’t. I had doubts right up until the moment I heard that first cry in the operating theatre: and, if I were to do it all again, I’m pretty sure I’d have exactly the same doubts and fears. The fact is, if you have tokophobia, there isn’t really an EASY way to give birth: however you do it, it’s going to scare you – so the only thing you can really do is to work out which method will scare you the least, and make your peace with that.

Above all, though, I think my main piece of advice would be to remember that this too will pass. I know that’s one of those things people say, and that you’ll probably just roll your eyes and think, “Yeah, yeah: easy for you to say!” but it’s true. I spent literally YEARS worrying about childbirth: it was the hardest, scariest thing I’ve ever done in my life. And yet, here I am, nine months later: and while I won’t claim that it’s just a distant memory, because I can remember it in vivid detail, it DOES feel like something that happened a long time ago. It passed, is what I’m saying: and it passed safely, and without drama, just as I’d hoped it would. And, of course, if I’d opted for a vaginal birth, I could be saying exactly the same thing: we will never know. As I said at the start of this post, I’m not here to convince you one way or another: I’m just here to tell you why I decided an elective c-section was the right choice for me, and why I’d – most likely – chose one again, if I were to have another baby. (Which, HAHA, NOPE.)

As for you, well, ultimately, you have to make your own decision, of course: but, whatever it is, if posts like this one help you feel even a little bit less alone in your fears, then that’s good enough for me.

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  • Myra


    Great post with sound advice. Interesting that you didn’t get a balanced view of both deliveries, but I guess they didn’t think that was necessary, which is interesting in itself. It begs the question: are medical practitioners the best people to give this kind of advice? I think you should publish a book on your experiences and donate it to maternity units (because I know you have so much time on your hands now lol).
    I wonder though if after having Max you have overcome any of your fears, or if they have disipated at all as a result of your experiences. (This is not a question about whether you will have another child).

    September 24, 2018
    • Robyn


      You are helping me through the exact same experience! Reading your blogs makes me feel like you are writing directly from my brain. It has made me feel like I’m not alone in the feelings that I am having. Thank you so much ????????????????
      I’m not pregnant yet but by reading your experiences its put me in a much better place. So Thank you x

      August 7, 2020
  • Kylie


    Amber, I need to thank you for your original blog post about you c-section. I ended up with an emergency section after two horrible days of unpredictable and painful labour, and as soon as they wheeled me into the operating theatre I thought ‘thank goodness, I know what’s happening to me now because I read Amber’s post!’ It was pretty much as you described, tippy bed and all, and I was so relieved to feel that there was some control at last. I think it’s the uncertainty of natural birth that is so scary, I felt going in that it was like being on a plane, could just be some mild turbulence, or the plane could crash and you could literally die! Or end up with some horrible injury anyway.

    My new mum’s group have been talking about birth recently, and the conclusion we came to is that it’s no good that the health professionals beforehand ONLY talk about the perfect ideal water birth (a birth centre I looked at tried to convince me to go there because of their fairy lights and the nice bread they used to make toast) and ignore all the possible problems, which can be so scary when you’re suddenly facing them. Overall I was so happy that I finally had a section, it was so quick, calm and predictable! I even told my husband to Google your post so he’d know what it would be like. Research is so important!

    September 24, 2018
      • Maria


        Did your doctor argue with you when u asked for a c section and at how many weeks did u ask?

        January 25, 2020
  • Lucie


    Hi Amber nad everyone,
    I don’t suffer from tokophobia (what a great way to start my comment… I will try to write this in a way that doesn’t have too many triggers.) and had two vaginal births. That said, I would like to thank you for your post and your honesty because I definitely agree with you that people (women and men, too), don’t have enough information about childbirth (and pregnancy and also making kids grow up without screwing them up completely).
    I, for instance, was very interested in childbirth quite a long time before getting pregnant (and miscarried once before my two boys came), but I still struggled to find the info I wanted.
    For instance, how comes that nobody tells you hormones play a huge role during childbirth and that you need to feel as secure, trusting and calm as possible and that adrenaline can stop the birthing process altogether? Nobody tells you that! This is exactly the reason I think you chose right because nothing is more important during childbirth than feeling safe (I mean, in good hands).
    Good luck everyone with choosing your own way.
    PS.: about the 90% tearing: I tore twice but once i needed one stitch and once no stitches at all. In those 90 percent, they must include all cases, including those that might also happen to during sex…
    Because what they also don’t tell you is that the worst scenarios happen when a vaginal birth is disrupted and not left to follow its natural course.

    September 24, 2018
  • Kelly Glen


    Even though I never want to have children this was a very interesting post to read. It seems like there is so much conflicting information out there which will obviously make it hard for anybody to make a decision, but at the end of the day it’s a decision that you need to make and that you feel is the best way for you and your baby. I’m sure this post will help many other people who are going through this at the moment.

    September 24, 2018
  • Sophie


    Thank you SO much for this! What an honest and refreshing read. I also suffer from tokophobia and I can’t even explain how much this has helped me. I agree; you get so much one-sided advice and there isn’t as much information out there on both options as there should be. I’m sure this post will help many other people trying to make the decision at the moment. Thank you.

    September 24, 2018
  • I love how honest you are about your experience and your feeling on the subject. There is so much pressure in women to have a “natural” birth regardless of what is the best for them and the baby. I was induced due to being way I wrote my due date. It didn’t go well but they were determined I was going to have a vaginal delivery even though it was pretty obvious that it wasn’t going to happen easily or safely. My baby ended up in distress and I was rushed to theatre in the middle of the night for an emergency c section. I don’t feel guilty for it although the whole experience but the way I was treated left me emotionally scarred and ended up having to deal with post natal depression. I just wanted my baby delivered safely, and if that meant via the “sunroof” then so be it. I work for the NHS and I know it’s all to do with statistics. They want to keep their section numbers down. I just can’t understand why hey out mum and baby at risk for a few numbers. They wouldn’t question having tonsils out or a joint replacement. The risks are still high regardless. Also the recovery from a section isn’t easy. It is major surgery. So people who think it is an easy way out are hugely mistaken. X

    September 25, 2018
  • diana


    in Monterrey, Nuevo Leon, México, c sections are the rule, and natural birth ARE EXCEPTIONS #lol, 90% of women have c-sections, i had two, best birth experiences ever !!!!

    October 3, 2018
  • Thanks for the article Amber 🙂 I also have severe tokophobia and waited till I was 40 to have my first child as I was just too terrified to get pregnant.

    I went straight to my doctor (I was living in the UK then) as soon as I was pregnant and was referred immediately to a hospital close by. I was incredibly lucky that the hospital had a very progressive maternity department and they gave me a Counsellor (who was also a trained midwife) who I saw every month to keep me calm. At my 20 week scan I was also approved for an elective caesarean and given the operation date. I was very, very well looked after throughout my pregnancy, no one tried to talk me out of my decision or belittled my fears. I was even given the option (which I gladly took) of a general an aesthetic so I wasn’t awake for any of the process.

    Yes, the recovery was difficult and painful but for me that didn’t matter as there was absolutely no way whatsoever I could ever have given birth naturally. No way.

    I got pregnant again at 44 and this time I was living in Dubai so healthcare was private therefore it was my decision totally to have another caesarean. No Counsellor this time which was fine as I knew what was going to happen and again an extremely supportive surgeon who didn’t question my decision or try ever and talk me out of it (including the general anasthetic)

    Same tough painful recovery but I’d do it again in a heartbeat.

    March 31, 2020
  • Chantelle


    Hi Amber

    Thanks for this post, it’s helped me so much in my third trimester trying to get a c- section after a previous traumatic vaginal birth. I was told by a birth choices midwife how I was more likely to die with a c section and some extra terrifying statistics which sent my anxiety through the roof. Because of this I was then told I would clearly be anxious giving birth either way so I may as well have a vaginal birth with induction so that pain was controlled. I made it clear I didn’t want to give birth vaginally to then be told they had no slots for a c- section before my due date now! Given that I was 35 weeks I was thrown into a state of severe anxiety and panic.
    I have just transferred to another hospital and I am 36 weeks pregnant, this has caused me so much stress and I know of other people that have experienced similar. Thanks for your reassuring and honest post.

    August 27, 2020
  • Poppy Pine


    Thank you so much for this post – reading it was like a breath of fresh air! I’m pregnant and intend to ask for an elective section for exactly the same reasons as you, and it’s so good to hear it being spoken about objectively and without stigma. You’ve made me feel so much better about my decision x

    October 23, 2020
  • Morganne


    Amber, I found your blog at about 3am this morning, after a 5th sleepless night in a row of trying to decide on an Elective C section or not. I’ve always had a fear of giving birth, there are lots of big babies in my family and have been brought up in horror stories of forceps and stitches. For this reason I never thought I’d have a baby, but here i’am 39wks pregnant, measuring ‘big’ and crapping myself. Your posts have encouraged me to not feel guilty about taking the C Section option, and I have an appointment with my Obstetrician today to hopefully book one. Thank you so much for your openness and honesty x

    March 3, 2021
  • ms g


    i wish i had known about this phobia…i was born with a duplex kidney and was told in the early 80’s at ripe age of 8 that getting pregnant would likely kill me….that was it for me – fear mode installed – and in the decades that followed i even had an abortion as was terrified i would die…that lead to drinking issues in my depression. it was only a few years after that i was told a duplex kidney occurs to some extent in 1 in 100 women and not an issue in pregnancy but by then my marriage had broken down and then i was getting too old and last year had stage 1a cervical cancer and full hysterectomy. Not once did a doctor ask why i didnt want children in the 90’s , 2000’s or even 2010’s as they would no doubt have told me that death due to my childhood kidney issues was ridiculous and wrong and an elective c section would bethe safest route for me. ..i feel somewhat cheated out of motherhood and passed over by the nhs. still, i have my two god children and a wonderful niece so thats something and i love them to bits ….

    i wish doctors would be more considerate of what they tell children/women….the wrong words spoken and overlooked correction of them in later years lead to me believing motherhood was not possible for me

    Always get a second opinion.

    May 14, 2021
  • Gem


    Hi Amber,

    I know it’s a while since you wrote this but just wanted to thank you for what you’ve shared. I have two children – one born via an emergency C-section (through which I lost a lot of blood*) and the second via a sort of elective emergency C-section under general anaesthetic.
    *The 2nd was a planned C-section as after the first I discovered I had a rare bleeding disorder. However baby #2 had different ideas and messed up my v complex birth plan by arriving 6 weeks early. So I was planning to have another C-section, just not then!)
    Anyway, I think you raise some really valid points and yours is a very relatable phobia. Hoping you and your family are happy, healthy and well.

    January 2, 2022