Elective C-section: What You Need To Know For an Informed Choice (in Berlin) "Wunschkaiserschnitt"
- Anne Matei
- 2 hours ago
- 10 min read
I believe that the request for an elective C-section deserves, above all, to be listened to without judgment. It is essential to take the time, supported by a supportive care team to take the time for informed decision making, exploring the ins and out of this intervention and alternatives to see what actually aligns with your true needs.
My role as a birth doula is to support your autonomy; by providing objective information on the risks and benefits, we place informed choice back at the heart of the birthing experience.
If you are interested to find out more about requesting a C-section in Berlin, and wonder about the process, risk/benefits, costs... read on!
Medically Indicated vs. Elective C-Section: What’s the Difference?
It is helpful to distinguish why a Cesarean might happen.
Medically Indicated C-Section: This occurs when there is a clear physical reason why a vaginal birth would be risky. These can be decided before labour starts or during labour.
For Baby: baby is in a transverse position, multiples (like twins or triplets, in an unfavourable position), or placenta previa (placenta is obstructing the cervix)... and so on.
You should know that having had a previous C-section is not necessarily and indication for a subsequent C-section! And that for a breech baby, a vaginal delivery can also be possible and safe.
For Mom: Preeclampsia, certain heart conditions etc.
During labour a C-section may be decided upon, if baby or mum's life is at risk: for example, baby's heart tone weakens and does not recover.
You may also request a caesarean birth during labour. You should then be offered support such as pain relief, if you feel this would help you to be able to have a better conversation about a caesarean birth or other alternative options. On occasion, you may have to wait to have a caesarean if there are other individuals in the unit who need a caesarean more urgently.
Elective C-Section : "Wunschkaiserschnitt"in German: This is a C-section on request, a planned surgery where no immediate physical medical necessity exists for the mother or the child. The mother chooses a C-section as a preference. This may be linked to fear of childbirth, past traumas etc.
Understanding Why You May Prefer a C-section
If you are leaning toward an elective C-section, it may be rooted fear of vaginal birth: often I hear clients talk about their fear of pain, fear of tearing, or fear of birth trauma.
These feelings are valid and deserve to be questioned and explored.
Sometimes, speaking with a psychologist, doctor, midwife, or a doula can help unwrap these fears. Are they based on stories you’ve heard? Or perhaps a previous difficult experience? Sometimes, being able to clearly identify and verbalise your fears can help you see more clearly what the issue is and tackle it, maybe find adjustments. An example.
I had a client who was terrified by birth because of the traumatic story of her sister who had a 3rd degree perineal tear. She was also afraid of having a C-section, but considering it (although there was no medical indication in her case). After doing some research together, looking at the statistics around severe perineal tears, on ways to avoid perineal tears, and risk/benefits of C-section in her case, she opted for a vaginal birth. Her experience was positive and empowering. On the other end, I accompanied women who made informed decisions about elective C-sections and also lived positive experiences!
Are You Afraid of Pain?
If you’re leaning toward a Cesarean because the fear of pain feels overwhelming, please know you have an entire toolkit available to you. From the quiet power of hypnobirthing and acupuncture to the relief of laughing gas and epidurals, there is a path to a comfortable birth that fits your needs. I also encourage you to dive into the physiology of birth, understanding exactly how your body is designed to work can transform fear into a deep sense of trust and peace.
You can contact me if you are interested in some sessions or even in birth companionship. Numerous studies have documented the benefits of having a doula present during labor. They proved how having a doula decreases: the overall cesarean rate by 50%, length of labor by 25%, and requests for an epidural by 60%...
The Official Recommendations & Process in Berlin
In Germany, the DGGG (College of Gynecologists and Obstetricians) provides clear guidelines on how "C-sections on request" should be handled. The process is designed to ensure you are fully informed (Aufklärung). Note that this is a recomendation, but not all clinics follow this process.
Consultation with your Gynecologist: Your first step is your regular doctor. They will assess the situation and discuss your reasons.
Psychological Support: Per the guidelines, if the request is based on fear, you may be referred to a specialist in perinatal mental health. You will have one or more appointments to talk about this topic. This isn't to "talk you out of it," but to ensure you have adequate support for your anxiety.
The Hospital Consultation (Anmeldung): You will have a specific appointment at the clinic (e.g., Charité, Vivantes, St. Joseph etc.). They will perform an exam, explain the risks/benefits, and if the decision is firm put a date on the calendar.
Insurance & Referrals: In many Berlin clinics, you may need an Überweisung (referral) from your gyn before your consultation to ensure costs are covered by health insurance.
From the DGGG Guidelines: "If, after a thorough discussion and support... a woman continues to request a cesarean section, this wish should be granted."
How Much Does it Cost?
Statutory health insurance cover a cesarean section upon request only if there is a medical necessity, often proven by a medical certificate, for example in cases of severe tokophobia (fear of childbirth) or significant psychological distress.
Otherwise, the costs (approximately €2,000–4,000) must be paid out of pocket. In contrast, private health insurance generally covers an elective cesarean section without difficulty and allows free choice of doctor and hospital.
Always make sure that you talk to your health insurance to understand the process and criteria to be eligible!
What a C-section Means For Your Health and Your Baby's
"Caesarean sections should ideally only be undertaken when medically necessary." WHO
The WHO is very clear that a C-section is a life-saving intervention when medically indicated. They emphasize that there is no evidence of health benefits for mothers or babies who undergo a C-section that is not required for a medical reason, and highlight several risks that are higher compared to a vaginal birth:
For the Mother: Increased risk of infection, heavy bleeding (hemorrhage), organ injury during surgery, and blood clots.
For the Baby: A higher chance of temporary respiratory distress, possible injury (about 2% occurence!).
For Future Pregnancies: A significantly higher risk of uterine rupture, placenta previa, or placenta accreta (where the placenta grows too deeply into the uterine wall) in subsequent births. This can be an important criteria to consider, if you are willing to have more children later on.
Short and Longer Term Effects on Children
Impact on Inborn Reflexes & Neurological Development
In his book "The Caesarean (2004) & Long-term Consequences", renowned obstetrician Dr. Michel Odent, highlights that birth is not just a mechanical event but a neurological one. His research suggests that the hormones and physical stimulation of labor serve to 'switch on' a baby’s primitive reflexes. There are important differences that your baby experienced during the birthing process.
For Odent, these reflexes are hindered during a C-section birth (especially when there is no labour, like in most planned C-sections), having short term but also longer term consequences.
As more and more children are born around the world with C-section, research is studying these effects in more depth. Some recent research highlighted how cesarean delivery may influence infant brain development.
A study found that C-section birth was associated with lower motor and language development scores during early childhood. Further prospective and longitudinal studies are needed to confirm these novel findings.
Impact on Gut Health:
There is also a growing body of evidence around the impact of c-sections on baby's microbiome: CS-born infants display distinct gut microbial compositions due to the absence of microorganisms that are present in the mother's birth canal. These alterations potentially link to long-term health implications like immune-related disorders and allergies.
Gentle Transitions For You and Baby
Here are a few recommendations from me as doula, on what you can opt for in order to have a C-section that is as gentle as possible for baby and yourself.
The Misgav-Ladach Method:
With this surgical technique, your doctor makes a continuous horizontal incision of about twelve centimeters through only the top layer of skin. Most of the tissue layers underneath are then carefully separated by the surgeon using their fingers after a small initial cut. This protects the nerve pathways and results in less blood loss. After the birth, the lower layers usually grow back together on their own, so fewer sutures are needed to close the abdomen. Generally, you experience less pain afterward than with conventional procedures.
This is very often offered in Berlin. Ask your providers about what type of C-section they perform and why.
Skin-to-skin:
Skin-to-skin care (also called kangaroo care) is a natural process that involves placing a naked newborn on their parent’s bare chest and covering the infant with blankets to keep them dry and warm.
Research demonstrates that both immediate and very early skin-to-skin care after a Cesarean is safe and beneficial, including skin-to-skin care that is started in the operating room. For parents interested in any form of bodyfeeding, from nursing to pumping, skin-to-skin care after Cesarean can help support that plan.
Although separating parents and babies after a Cesarean may have been perceived as more “convenient” for staff in the past, in the end, keeping birthing parents and babies together after a Cesarean has been shown to safe, evidence-based, and beneficial.
It may be helpful to ask your provider these questions during a prenatal visit:
If I have a Cesarean, is it possible to have skin-to-skin care with my baby in the operating room? What are the conditions?
Do you provide a bonding top? or could I bring mine
Are parents and babies able to do their post-op recovery in the same room?
Delayed Cord Clamping:
I explain about the benefits of delayed cord clamping here.
During C-sections it is not always possible/allowed by protocols to delay the cord clamping, but some places still offer "delayed" cord clamping (over 1 minute wait or more) with C-sections.
This is definitely something to discuss ahead of time with your care team to understand possibilities, risk/benefits. There is a lot of evidence showing how this practice of waiting to cut the cord is especially beneficial to C-section babies.
Stimulating Inborn Reflexes:
If a baby does not have a vaginal birth, it may mean these inborn reflexes aren't stimulated properly. This is why some parents wish to see specialised professionals to stimulate those reflexes such as chiropractors, cranio, or osteopaths after a C-section birth - but this is to date, not evidence-based.
Colostrum Harvesting:
Colostrum is the first milk your body produces during pregnancy. It forms in your breasts already during the pregnancy and plays an important role in building your baby's immune system. It is "liquid gold" for your baby: rich in antibodies, nurtients and many other treasures.
Colostrum harvesting is a process where mothers express colostrum during pregnancy to store it.
Saving your expressed colostrum may also be beneficial if your baby is likely to need special care after birth - or if you may be separated for baby right after birth. This is why is it often indicated for a planned C-section. The idea is to ensure that even if you are separated from baby (because of a complication), baby will be fed your colostrum, as the first thing entering their gut.
Your midwife and other members of your care team may have information to share on breast massage and how to hand express. It is important to ask for their validation before doing it - breast stimulation can lead to "induction" of labour!
They should also be able to give you small sterile syringes in which to save your colostrum. Then you store it and bring it in a freezer bag with ice packs on the day of the planned C-section.
Preparing for Postpartum
You will be recovering from major surgery while caring for a newborn... this is not an easy task and it's worth taking the time to prepare (you and your partner) ahead!
Logistically, this means setting up a support system in advance whether through a meal train, a partner on parental leave, a postpartum doula (or Haushalthilfe if you are eligible)to handle household chores while you heal.
Ask your midwife for advice on how to optimise recovery, take care of your scar, massages you can do to avoid adherences and how to take care of your pelvic floor.
Studies have linked c-sections to a higher risk of postpartum depression (PPD), often due to the intense recovery and the feeling of "missing out" on the immediate physiological shift of labor. Giving yourself permission to move at your own pace and validating your feelings is essential. It is perfectly okay and very common not to feel an instant "spark" of love for your baby while you are in surgical pain.
Your body is focused on survival and healing; your only job is to be gentle with yourself as the bond and your strength grow in their own time.
Finding the Right Decision for Yourself and Feeling Supported
When making this decision, it is essential to weigh the real "ins and outs" based on clinical facts rather than the anecdotal stories we often hear.
You deserve to be surrounded by people and professionals who provide objective information and support you without judgment.
Are you set on your choice? If you are informed, feeling good about your decision (e.g. have weighed the recovery aspects, potential risks on yourself, baby and future pregnancies), then that is wonderful! Follow the process by talking to your doctor and health insurance.
Are you still wondering? You may need some space to express your questions without judgment and gather objective information based on facts rather than opinions.
You could seek professional support from a therapist or psychologist, do more research into the clinical "ins and outs," or reach out to me for a doula’s perspective. Whether you consult with your midwife, your doctor, or speak with your partner or friends/family, the goal is to find someone who makes you feel welcomed and respected in your questioning.
I offer free 1-1 introductory calls to help you find clarity, as well as online consultations and full doula companionship.
Anne Matei is a birth and postpartum doula based in Berlin, supporting French-, English-, and German-speaking families. She accompanies births in hospitals, birth centers, and home births alongside midwives. Read what families say about working with her in client testimonials. Feel free to get in touch to schedule a non-binding introductory call.
Sources
Book: The Cesarean by Michel Odent
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