Sunday, 30 January 2011

Why are more women "choosing" caesarian sections?

Yet another piece in another national newspaper today about "birth choices" and why women are, or aren't, giving birth in accordance with whatever the latest guru/bit of research/NHS funding report says.

And, actually, this time this one didn't really irritate too much. Mostly because Joanna Kavenna, a mother of two herself, acknowledges that each woman's "choice" is personal to her, and based on her history, both medical and emotional, the circumstances she finds herself in, the size and position of her baby and a million other factors, over most of which she has absolutely no control.

But she did get me swearing at this:
Now it seems we have lost confidence in our ability to give birth naturally: today one in four babies is born by caesarean, up from one in 10 in 1990"
Why, why, why, why, why, can't she and any of the other hundreds of people who opine on this subject not see what seems so perfectly obvious to me: this isn't about our confidence in ourselves; women don't choose to have caesarians.  The medical profession chooses for you. Women simply, in the main, do what they are told is best for them and their baby.

Look around at your friends and relations. I bet lots of them will have had, or their partners will have had, caesarians. How many of them actually, prior to the birth of their first baby, decided, with no medical requirement to do so, to have a caesarian?  One?  None?

How many of them, rather, after a 24, or 36, or 58-hour labour, exhausted and frightened, were medically advised that it was necessary; or were told their baby was breech and the hospital didn't have enough midwives with the necessary expertise to deliver a breech baby; or they were (like me) having identical twins and were informed (although it turns out this isn't the policy at all hospitals) that the risks to mother and babies meant a caesarian was the safest option? Pretty much all of them, I suspect.

So why do we say this is about maternal choice?  Why do we use words like "elective" caesarian, when what we mean is "planned" or "medically advised", or even "had an absolutely horrendous time last time, culminating in an emergency operation, followed by weeks of painful recovery, and is understandably terrified to go through it again"? Why does the media label four in ten British women "too posh to push"?

Now, I accept that there may be women who really do have the mythical tummy tuck at the same time, or want to time their birth so it fits in with the release of their latest fitness DVD or whatever, but I don't know any of them, and I'd be pretty surprised if they make up even a thousandth of a percent of the many, many women who have caesarians, on medical advice, and against what they had originally hoped for in this country every year.

So can we please, please, stop beating women up about this?  Why can't we accept that any delivery that results in a healthy mother and healthy baby (or babies) is a successful delivery, whether it costs the NHS more or less and whether it is the one we planned or not?


  1. I had a caesarian first time round because it was deemed necessary, but being a type 1 diabetic I'd pretty much expected it to be that way anyway, and was perfectly appy with this. Second time round I was offered the choice as I was in labour, and chose a caesarian again because I had a really good experience the first time round and knew my obstetrician really well.

    One thing I was told (by my obstetrician)was that the vast majority of female obstetricians choose to have caesarians because they feel it's safer than a natural birth, while midwives choose natural births. It's a split camp and probably always will be.

    One thing I will say is I know fewer people who have 'chosen' a caesarian than I know women who have had problems during births that have resulted in stillbirths. I'm all for just delivering a healthy baby no matter what the method of birthing is.

  2. Golly - I'm amazed they even considered it with your second - my diabetic friend was categorically told with both hers that a caesarian was the only option. But you're right, and I should have said that of course there are lots of people who have caesarians on medical advice first time and then go on to have a second because it was a good experience (as indeed my c-s was).

    I think what gets my goat is the implication that all women who "choose" caesarians, do so because of fashion, or vanity, or fear, and in my experience it's not that at all.

    I too have heard that doctors tend to opt for caesarians, but when I asked a friend (who is a doctor but not an obstetrician) about it, she said it was to do with the fear of long labours followed by emergency caesarians, not labour and vaginal delivery per se. It's about control - they know exactly what's happening when with a planned caesarian, where as if labour is allowed to run its course there is always the fear that it might not go well (sometimes with utterly tragic consequences as you say).

    I've done both, and both had their advantages and disadvantages. I just wish the media would stop trying to simplify into black and white something that actually has no right and wrong but a million different personal permutations.

  3. I totally agree that to imply all c-sections are simply a choice issue is misleading.

    However, I am the elusive woman that chose to have two c-sections simply because I didn't fancy the pain, the risks to the baby and potential long lasting damage to my lady bits of a natural birth. As it turned out I developed gestational diabetes in both pregnancies so it may have been medically recommended anyway, but by that time I was already booked in. It was very easy to get the obs to agree to however, maybe in part due to my age (39 and 41) and/or the fact that both pregnancies were assisted conceptions and/or the fact that they did the same themselves and/or I was so insistent they realised I wouldn't take no for an answer lol.

    The only things that matter in my opinion are that risks to mother and baby are minimised and the mother is at ease with the choice/decision she has made.

  4. Hello Louise - and incidentally I'm guessing you used to be the "Geriatric Mummy": and if you are, delighted to have found you, as I've been wondering where you were and how the second pregancy was/is going (or is he here yet?) - anyway, that's not the point, really wanted to say thank you for your point of view, and for proving me wrong! Interesting too (although as you say, maybe because of your circs) that they were so happy to go ahead, when we're told that they're trying to get the rates of caesarians down...

  5. Doh! Just re-reading your comment, I realise No 2 must be here. I hope it's going really well...

  6. As a woman who has had both types of deliveries, I say DON'T have a c-section unless you have to. The pain is much worse after. On a side note, I'm sick of being told that I didn't give birth to my twins. Hello, did they come out of me? Yes. Oh then I gave birth.

  7. Me again! On the subject of pain after my second c-section I thought it had gone quite badly as I remember thinking 'God, this hurts a bit' on my little forced walk to the shower on the same day that I'd had the baby. And so it should have hurt as the anaesthetist had forgotten to write up any pain relief for me and all I'd had was a paracetemol (which I had presumed was some kind of morphine tablet).

    Everyone is different and some have painful births and some have painful c-sections and some people are ok after either.

  8. You're absolutely right. I only know one person who wanted a C-section, and that was because she'd been forced to have one with her first and that was all she knew. She did end up having it, but only because the doctor thought it was safest. My doctor wouldn't even agree to my pleas for an induction, so I doubt he would ever agree to a C-section if he didn't think it was necessary.

  9. I had a crash section with Maxi and it was the most scary thing in the whole wild world, but it did mean a healthy baby and a healthish mummy. With Mini I had no choice at all, due to the issues I had with Maxi, the choice was taken out of my hands.

    I would never opt to have surgery if I didn't need it!

  10. Makes me so cross - its not women that have lost confidence in their bodies, its a system that in part has

    C-sections aren't a bad thing, far from it, but the culture of if in doubt have a c-section just in case rather than one on one midwives supporting women gently, or fewer inductions, or lying on beds rather than being active in labour have meant that more are being done than probably should be

    Its rarely that people choose to have a c-section and even rarer because it fits in with hair appointments or whatever

    But what does make me cross is seeing women not being given the right information, being scared into doing things because the doctor says it has to happen this way rather than questionning what is going on and ending up on a rollercoaster ride of interventions ending in a (sadly inevitable) c-section

    Sorry have wibbled on but main message was that its rarely a choice and I've yet to meet anyone too posh to push

  11. All interesting. One point often forgotten in these discussions, the c-section rate is higher, the medical recommendations more common because we women are older. Sure a 24 year old might need a section, and a 36 year old might delivery vaginally, but it isn't the way to bet.

  12. Fiona and Twingle Mummy - as Fiona says, I think it's (again) one of those very personal things. I had a planned c-s second time around, was out of bed six hours later, and home thirty six hours after that on paracetamol and nurofen (having refused the codeine because I'd been told that the pain of the constipation was worse than the pain of labour!). I'm not nails, I'm really not, I just think I was lucky. Still didn't mean they'd let me drive/pick up the toddler/push the double buggy for six weeks though....

    Mwa - I'm in a funny position this time, having had a good experience with both, but I don't think anyone would voluntarily submit to "major abdominal surgery" (the phrase they quote at you endlessly AFTER you've had the operation) if they didn't have to, if only for the hassle factor of six weeks of recovery.

    Mad Mummy - I think that's it. Women aren't choosing, so why is it presented as a choice. That said, Ghostwriter Mummy posted something in response to this:

    and one of the comments (from Him up North) linked to this article from the BBC, which makes precisely my point. Glad to see that actually the tide may be turning (even if I'm not about to hold my breath)

    Mudding Along Mummy - it is about information, though isn't it? A very lovely friend of mine got such different information when she pushed from what they had originally told her. I wish the medical profession would realise that one size doesn't always fit all...

    AH London - very good point. I hadn't thought about all the added complications of maternal age. Still doesn't make the actual delivery a "choice" though, does it. I mean if we actually thought about the fact that we were going to have to give birth to these babies (in whatever way), I'm not sure any of us would ever get pregnant!

  13. Silly reporting, I don't know anyone who has been given a c-section through choice only need. I do think the medical community add to the 'problem' by pushing it as the safest option. I loved both of my c-sections and recovered with no trouble very quickly. In fact, hit publish today on a c-section post which has been sitting in drafts for a few weeks now.

  14. Thse kind of articles make me boil with rage - although having said that the one you link to ( which I had happened to have read) was quite balanced and well articulated.

    I don't know where these terms come from ' too posh to push. I'd like to track back to where it started - probably The Daily Mail or somewhere. Maybe they just think it sounds good with the alliteration. I don't know anyone who falls into this category. I know plenty of people who have had caesarians but because they were advised to for a whole host of different reasons. It's such lazy and divisive journalism.

  15. Great post, glad I clicked onto it!

  16. Hear hear, well said my love. Media madness over c-sections these days. Just another thing to add to the guilt layer for mothers. I totally agree that it is a very very rare woman who wants a c-section.

    MD x

  17. Kat - I agree. My c-section was also a really good experience, but it's still not what I would have chosen had I not had a "complicated" pregnancy.

    Deer Baby - Good point - I'd love to know where it came from and you're probably right: it sounds good and it simplifies what is a personal and complex issue. Of course the media are going to love it. But you're also right about the article, which generally, as I said, I thought was well-written and balanced. In a way that was what irritated me more - she'd clearly thought about all this stuff and then went and repeated the same old orthodoxy...

    Mammy Diaries - why thank you *blush*!

    MD - It is, isn't it? Guilt, guilt, guilt. Actually, I think we need to remind ourselves we're all fab. Well done us for having the babies, in whatever way, and continuing to love them despite the poo, and the whinging, and the constant guilt...

  18. You're right, of course. But I still do seem to have friends who honestly "elect" to have a c-section. One even then couldn't believe how grim the recovery process was afterwards....... That said, I would have done anything to avoid mine, but when the ventouse doesn't work on the third attempt, yes, I do honestly believe they had no choice.

  19. I think that you are "spot on" in your assessment. 99.9% of c-sections will be because the hospital told us we needed one. Both of mine were!

  20. @Planb
    "Still doesn't make the actual delivery a "choice" though, does it." Precisely my point. One of the big drivers of c-sections, and doctor recommendations for c-sections is maternal age. It is typically harder to deliver when you are 35 than 25, forget 40. Outside the rarefied strata of celebrity or high society, c-sections are far from a choice. And it crushes me to see women racked with guilt if they have to have one. I'm with the commenters who said they wouldn't choose major surgery. That said, it shouldn't impact our woman-ness if we have to have one. Same goes for breastfeeding, by the way. I've written a bit on that.
    I don't really understand when women say from the start that nursing grosses them out and don't try it. But for the women who try an fail and then beat themselves up about it, I ache for them. Nursing, and most domestic things, are not rocket science but are practical skills. They require practice; practice that modern women don't get in a JD or MBA program. We are sold this bill of goods about what our lives should be like, and then when children come along, we beat ourselves up because motherhood is nothing like an MBA program, and we have to learn how to do it on the fly.


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