I've had a csection on psychological grounds for extreme fear of birth and HCP because of a lack of trust in them, but they will only term in NHS terminology as 'being on request'. There is no classification for mental grounds.
In my case I had to demonstrate a psychological need which involved several sessions being assessed plus talk of getting social services involved (I was put as high risk and watched accordingly). I had to demonstrate I fully understood the risks and what was involved.
As it stands this is a care pathway that is recommended by NICE DOES have a body of evidence which suggests that in certain circumstances it is beneficial and lower risk than a natural birth and has a cost to the NICE which isn't prohibitive (and may well be less than the alternative).
My case was unusual in that I didn't have too much hoop jumping to do compared with that many others have.
You have women in their late 30s with PTSD from a previous birth unable to get adequate mental health support AND are being refused a CS, not because of health reasons but because Trusts are deeming it too expensive. Yet these women are being completely infantilised or cast as simply demanding or weak.
The double standards are incredible.
As it goes I think it's an area where there needs to be a case by case assessment and much more mental health support across the board, particularly post birth but also in prenatal setting to tackle this. But a lot of the problems stem from shocking unfunding, respect for proper consent and poor care through the NHS which ends up in a building up of anxiety which for a variety of reasons tends to manifest most in maternity. I personally think that C sections like mine are now being pitched as a magic solution to a very deep and complex problem which might not be the best approach for everyone.
The problem I have most is with this idea of one size fits all medicine with no nuance and no exploration of what's causing the mental health issue.
In my case they made the point strenuously that focusing on getting the CS was fundamentally flawed. Focusing on that, neglected whether I would be able to cope after my baby was born. And that I needed to think about this and develop or consider coping strategies and support.
My age and particularly small size and my physical health were certainly taken into consideration. As was only wanting one child. My situation would be very different to that of a 18 year old, wanting 3 or 4 children and being an average size with a more complex medical history.
CS in these circumstances are still controversial and are regularly framed as simply being a 'too posh to push' thing with no discussion to the medical background and evidence for there being a mental health issue that needs to be addressed regardless of whether you think that should be accompanied by a CS or a natural birth.
I get very frustrated by it all. There is absolutely no consistency. It comes back to the same thing about how womens health and medicine is regarded as fair game for ideological encroachment and comes second to men's health. Mental health is one of those things which is badly neglected or deliberately framed as unimportant in some way.
The strands of the same forces are definitely within the way trans medicine is carried out but they act in a fundamentally different way.
But many of the roots of problems are very similar indeed - particularly for women.