By Beverley Turner
Contrary to popular belief, a Caesarean section does not get its name from Julius Caesar. That’s just one of the many elements of b******t that surrounds the issue of extracting a baby through a ‘cut’ (caesa in Latin) in the abdomen. Others include the belief that it’s the ‘easy option’, that it’s risk-free and that it hurts less. It’s also not the preserve of the ‘too posh to push’ crowd, although social class does complicate the issue.
There are many instances in which a planned Caesarean is preferable to a vaginal birth and although the ‘emergency’ version is often ‘life-saving’ for mum and/or baby, it’s important to examine the prior care that led to that outcome. So, just sweep aside all you think you know about this medical act, pour yourself a cuppa and open your mind.
Firstly, as is so often the case in birth, the language is all wrong. Women who have ‘sections’ sometimes report feeling that they ‘failed to give birth’ – which is nuts. Meeting your baby is birth, whether you do so in a pool of dolphins, on an operating table in Birmingham or at the top of the Eiffel Tower. Birth is the emergence of a living being, breathing unaided by a placenta. So, let’s drop the ‘section’ bit and replace it with birth.
The word Caesarean is stupidly archaic, thought up by public school-educated surgeons who learnt Latin and felt all manly with a knife in their hand, but at the moment it’s all we have. I’m currently writing a book that hopes to right that wrong (you’ll read about it here first). The term ‘C-section’ sounds simply clinical, as though it has nothing to do with the miracle of growing a baby and all the sacrifice that takes.
According to the World Health Organization (WHO), no community should have a Caesarean birth rate of more than 10–15%. According to NHS statistics, the UK has a rate of 26%; 11% planned and 15% emergency (though some midwifery-led units have rates of less than 2%). In the US – one of the most medicalised societies in the world, where gas and air is not available (it stops women having epidurals, which is a pain for the drug companies) – it is 32.2%.
In 2010, the WHO examined data from 137 countries, accounting for approximately 95% of global births. Countries with C-section rates below 10% were considered to show underuse, while countries with rates above 15% were considered to show overuse. They found that an additional 3.18 million C-births were needed, but that a whopping 6.20 million had been unnecessary. The cost of the global “excess” operations was estimated at approximately $2.32 billion (which must have made those same drug companies deliriously happy).
The reasons for these figures being so high are manifold and complex. Given that a woman’s mammalian instinct is to seek a private, safe environment to give birth, it’s a miracle that any women labour naturally.
Modern hospitals (not the Birth Centre’s therein) are unfamiliar, clinical environments in which women are expected to give birth with a practitioner they don’t know, rendering the whole process infinitely more difficult for female physiology. Stalled labours are thus ‘chivvied along’ with augmenting drugs; ‘overdue’ pregnancies are rushed with inductions; epidurals slow down labours that are then artificially hurried up and – surprise, surprise – an emergency C-birth is the result. Of course, there are exceptions, but interventions without due consideration are all too common.
A lack of continuity of care means that women are passed from pillar to post without one individual taking responsibility. This absence of a joined up approach also makes the operation more likely.
Private hospitals (from whom it’s impossible to gain accurate C-birth rates) charge huge amounts for the surgery plus the extra nights’ stay (this can easily top £20,000), so we should be sceptical as to whether those establishments are acting in the best interests of the mother or their own profits.
“A vaginal birth is empirically the best outcome for mother and baby. I’m yet to meet a woman who had both and preferred the Caesarean.”
If you sense my frustration, you’re right – but it is in no way directed at the birthing mums-to-be. They want their baby born safely and are at the mercy of a hospital culture that fails to prioritise their inherent needs.
The pervasive, powerful mantra ‘all that matters is a healthy baby’ has skewed too many protocols and led to a one-size-fits-all system. Plus, hospitals are – quite rightly – scared of being sued, so a culture of ‘defensive practice’ has emerged. Often, maternity teams feel ‘safer’ performing surgery than giving a woman the time and support that she might need to birth without it. This is hardly surprising when wards are rushed, under-staffed and under-funded. Doctors aren’t gleefully wielding knives over bumps, but they are on the front line of a failing system. Poor obstetric training also means that too many doctors don’t view a vaginal birth as terribly important or – in some instances – even possible.
As a global community, we have to accept that a drug-free, vaginal birth is empirically the best outcome for mum and baby. I’m yet to meet a woman who had both and preferred the Caesarean.
C-births carry an increased risk of short and long-term problems: infections to the scar, bladder or uterus and a higher than average blood loss, as well as an increased chance of future fertility problems and placenta complications in subsequent pregnancies due to the scar tissue. C-birth babies are five times more likely to suffer from allergies and asthma, most likely due to the absence of a child’s microbiome being seeded with healthy bacteria as it passes through the birth canal. Women are more likely to struggle with breastfeeding as sitting up can be painful in the first few days, and being disallowed from driving for six weeks is simply an inconvenience that some new mums could do without.
Nevertheless, certain celebrities have done a good job of making a Caesarean look like a doddle. Victoria Beckham demonstrating unfathomable slenderness following each of her four births helped cement the idea that it’s aspirational to be ‘too posh to push’. We don’t know whether her births were medically necessary, but she must have a very understanding obstetrician, as risks of complications rise with each C-birth. Having four is highly unusual.
Across the world, birth has become a class issue. In Brazil, the national health service has more than 50% C-births, whilst private hospitals have a rate of over 82%. Doctors schedule and bill as many as eight procedures a day rather than wait around for one or two natural births to wrap up. The culture is immensely macho and chauvinistic: abortion is illegal except in very few circumstances and women are expected to surrender to the hands of a doctor at birth rather than believe in their own physical strength. Stories of denigration, humiliation, bullying and violation are shockingly common. Episiotomies, fundal pressure and the overuse of syntocinon to speed up contractions are routine. It’s no wonder women opt for a Caesarean.
In the Western world, some modern women simply aren’t prepared to accept the uncertainty of labour and don’t like feeling out of control in a time when we can summon anything on an iPhone. I do believe that women should be able to ask for the procedure of their own accord and discuss all the pros and cons. But should we really view the convenience and sterility of it all as a marker of liberation or oppression? We aren’t there yet, but Rio and Sao Paulo are dotted with upscale C-birth resort clinics where women get post-op manicures and room service.
In the UK, there are a small number of women with genuine tokophobia, who should be listened to by staff when they request the surgery for no other reason than that they are scared witless. And in The Blooming Bunch classes, I always ask the couples to consider whether a planned C-birth may well be preferable to a protracted induction of labour for which the cervix is simply not ready. I’d recommend a Caesarean over a debilitating and distressing week-long induction any day.
There are ways in which women can now make choices and feel empowered by their planned C-birth to avoid the common refrain that it was ‘done to them’ rather than ‘by them’ and give the child’s birth the reverence it deserves.
In a ‘gentle Caesarean’, the room is quiet (no chatting amongst the staff about the football results); music can be played; the baby is born slowly, mimicking the way fluid is squeezed from the lungs in the birth canal; the screen can be lowered so that the mum can witness her baby’s emergence; cord clamping is delayed; skin to skin contact occurs immediately rather than after the baby is whisked away to be weighed; and the IV line is placed in the mum’s non-dominant hand so she can easily caress her baby. They may sound irrelevant, but for some couples, these small acts change everything: from a mechanical, medical procedure carried out many times a day, to a reverential and significant moment, which is what every woman deserves.