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Can you time a C-section on the NHS, for example, to have one 00.01 on the first day of the month? My question arises after reading about how to get your child a place in the school or nursery of choice. Name and address withheld

Few operations are as politically charged as Caesarean sections (see my article of February 16). The indications for consideration of a Caesarean are laid down. The absolute indications are those that would render birth impossible by the vaginal route. The relative indications for a Caesarean section are a matter of judgment.

The NHS is opposed to any reason for a Caesarean section that smacks of a lifestyle indication; whether it is to preserve someone's figure, their pelvic floor, convenience of the timing so as to fit in with holidays or other plans or simply being too posh to push.

I am afraid that the NHS would not arrange a Caesarean to fit in with finding a place for your child in a nursery school of your choice. However obstetricians are all human and certainly my bosses in the very large maternity unit where I worked many years ago as a junior hospital doctor always discussed with a woman who was having an elective (planned) Caesarean section, for a good medical reason, which of the several possible dates would suit her best. I am not certain that hospitals are quite as understanding and flexible as they were in the past, but if you are having an elective Caesarean for a medical reason, and you particularly want the baby delivered on some particular day around the 37th or 38th week of your pregnancy, and this coincides with one of the operating days of your surgeon, it is worth asking.

Can you get liposuction and or a tummy tuck done at the same time as a Caesarean? If you can, how advisable is it to do so? Name and address withheld

The atmosphere in the theatre when a woman has a Caesarean section reminds me of that on the flight deck of an aircraft as it comes in to land. Although it is a routine procedure carried out hundreds of times every day, and has been done by the surgeon a thousand times before, there is a tension and edginess displayed by everyone present in the theatre until the baby is out and is crying lustily. Similarly once an aircraft is safely on the ground the crew on the flight deck once again exchange banter, laugh and joke, just as doctors do in the theatre after the baby is safely delivered.

I don't suppose the average obstetrician would want a plastic surgeon around the theatre with his liposuction kit, nor would the anaesthetist want to keep the patient under the anaesthetic for longer than would have otherwise been necessary. The mother has more important things to attend to. However the surgeon will often remove obviously redundant skin when closing the wound. The excess skin may perhaps have dated from an earlier Caesarean or repeated pregnancies but a surgeon always does his best to give a patient as neat a scar and abdominal wall as possible.

The modern pfannenstiel incision cuts into the skin underneath the pubic hairline just above the pubic bone and runs across the lower abdomen so that it is later virtually invisible. It doesn't disrupt the abdominal wall musculature any more than any other pregnancy. This incision can sometimes tend to push the underlying fat up into the abdomen, so that it forms more of a pouch than would otherwise have been the case. This might therefore make later liposuction easier if it was needed.

What questions should I ask to be sure that the advice I am given is totally for the benefit of me and my baby and not for the benefit of the hospital and medical staff of what is, admittedly, a very busy area? Name and address withheld

A very difficult question to answer. It is to be hoped that hospitals and doctors are always acting on behalf of their own patient, but recently they have been taught that they also have a moral duty to the community at large and to the NHS. As a result of the regular repeating of this message, there is an increasing acceptance that it is morally justified and can't and shouldn't be questioned.

On the other hand when I started in medicine I was taught that a good doctor was one whose patients swore by him (or her) and that in achieving this goal it might well be that the rest of the world, including colleagues and superiors, might swear at him. I still believe that my own patient must be my first consideration. The argument that the NHS is constrained because of lack of cash is also in my own opinion faulty on two counts. We are the fourth, or possibly the fifth richest country in the world and yet the medical services struggle to come halfway up the European league table, and that league includes all the smaller countries of Europe like Slovenia and Lithuania. The second argument against the cost argument is that there are expensive aspects of the NHS services that are considered beyond criticism for politically correct reasons. These are not even questioned, let alone attacked for fear of offending powerful lobbies whose supporters may well already be working hard in difficult circumstances.