Elective C-section on request? Law and health insurance

Can you request a C-section without a medical reason?

Yes, it is possible…

But only under strict conditions:

You must have a detailed discussion with your gynaecologist (Frauenärztin) or with the obstetrician at the hospital.
The mother is expected to explain her motives, for example:
- severe fear of vaginal birth (tokophobia),
- a previous difficult or traumatic birth experience,
- a strong psychological wish for a C-section, sometimes supported by psychological counselling.
In the end, it is the doctor who decides whether an “on-request C-section” is acceptable in this particular case.

You cannot legally force a hospital to perform a C-section without medical indication; some hospitals categorically refuse to perform elective C-sections without clear medical reasons.

Does health insurance (Krankenkasse) cover the costs of an on-request C-section?

If the C-section is performed for documented medical reasons:

Yes, the costs are usually covered in full by statutory health insurance (GKV) or private health insurance (PKV).

If the C-section is requested for purely personal reasons without medical justification:

In many cases, the costs are not fully covered.
The mother may be asked to pay an additional amount, typically between €1,000 and €3,000, depending on the hospital.
Some hospitals agree to perform the procedure on request, but only if the extra costs are paid privately by the patient.

Important points to know before deciding

Possible advantages:

the birth date can be scheduled in advance,
reduced anxiety for women with strong fear of vaginal birth,
avoidance of labour pains in the traditional sense.

Disadvantages and risks:

a C-section is a major surgical procedure with risks such as bleeding, infection, thrombosis and anaesthesia-related complications,
longer recovery period compared with a spontaneous vaginal birth,
increased risks in future pregnancies and births (e.g. placenta problems, adhesions, uterine scar issues),
possible impact on breastfeeding and early bonding between mother and baby.

How is an on-request C-section planned?

Discuss the topic with your doctor early in pregnancy, ideally before the 30th week of gestation.
If the team agrees, a surgery date is scheduled for a few days before the expected due date, usually between 38 and 39 weeks of pregnancy.
You will be asked to sign a written consent form, and the risks will be explained to you in detail.
You should expect a hospital stay of about 3–5 days after the operation.

Are there intermediate options or alternatives?

Yes. Some women choose a vaginal birth with more control, such as:

giving birth in a hospital with a very clear, written birth plan,
requesting an epidural (PDA) for pain relief,
requesting induction of labour before the spontaneous due date, under close medical supervision.

The editorial team of this website aims to provide accurate information based on thorough research and consultation of several sources. Nevertheless, errors may occur or information may be incomplete or not fully up to date. Please therefore treat the information in this article as a first point of orientation only, and always consult doctors and competent authorities for definitive, medically and legally binding advice.