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    The rise of the C-section

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    By Bump Club contributor Beverley Turner

    Being somewhat addicted to birth, I felt truly honoured to be invited by Bump Club parents Lorna and Justin Morley Medd to witness the birth of their baby last week.  Like all of our mums to date (nine in total), this child would emerge by caesarean section (C-section). The World Health Organization states that no more than 10-15% of women should be giving birth under the surgeon’s knife. Yet in the UK roughly 25% of babies are born in this way, with the figure at some hospitals touching 35%.

    Some people say that is fine: what matters most is a healthy baby. This attitude saddens those who see the longer term damage done to women whose confidence is shaken by the sense that they had their birth wrestled from them.  Sit in on a VBAC (Vaginal Birth After Caesarean) discussion group and the effects are all too clear. These women will weep that they ‘failed;’ that they weren’t told of their options during birth; that they were ignored, bullied or humiliated. They can feel that their bodies let them down and they were labelled by that truly dreadful phrase, “Failure to progress”. These can be a hugely destructive emotions - a sense of failure plays a key part in almost every case of post-natal depression.

    Perhaps in order to avoid this disappointment we should merely lower women’s expectations: if we expect birth to be hideous, we won’t be surprised when it turns complicated and traumatic. Isn’t it better if women accept that doctors know best and they should shut up and put up with medical direction? But wouldn’t that be extraordinary? It’s hard to imagine that men would accept a similar doctrine if such a personal, exposing, painful, important and life-changing experience applied to them.

    Sadly, low expectations – and abstract terror – are already having a self-fulfilling prophetic affect on birth. Fear increases adrenalin which stops hormone Oxytocin, and therefore labour, in its tracks. Stop-start labours are helped with augmenting interventions of artificial hormones and both mother and baby can become distressed. Every global study into birth outcomes concludes in one way or another that women need to birth with a midwife that they know and trust. For the vast majority of women, unless they subscribe to their hospital’s Homebirth team, this is a remote possibility.  It is no coincidence that many mums report a slow and stalling labour that suddenly kicks in when the shift changes and they meet eyes with the midwife they know and like who has just clocked on.

    Lorna’s obstetrician decided that her patient’s best chance of avoiding a similarly depression-making scenario was to opt for a pre-labour C-section. Lorna talks of the lack of control she had last time and an elective section certainly gave her some of that. She was calm and chatty throughout. A different doctor might have given her a one-to-one midwife specializing in post-traumatic stress derived from birth trauma who would have supported her through a normal birth. The best hope is that every woman is happy with whatever decision is made together. Some couples will be unaware that each doctor brings their own preferences to the table. This is partly why rates vary across different hospitals. This is also why it is often misleading to say that more women are ‘choosing’ C-sections; they may be unaware that they have any choice whatsoever.  

    Action that is – or is not – taken in early labour seems to play a huge part in the likelihood of emergency C-sections. Although completely rigorous statistics are hard to come by due to the many variables, most studies suggest that induction and epidurals are more likely to lead to an emergency section as women cannot ‘feel’ the body’s natural impulses or get into positions that will help a baby descend.  There is also the role of ‘defensive practise’: the fear of being sued that tips the elbow of the deciding surgeon in favour of the unit rather than the individual woman’s experience.

    It has become almost inappropriate to mention the risks of c-section in case women are made to “feel guilty” (although if you say you fancy a homebirth it’s ok to be gasped at for your recklessness). But if we agree that informed choice is the best case scenario, it’s important to say that babies born by C-section are five times more likely to suffer asthma and allergies because they aren’t exposed to healthy bacteria in the birth canal. Women who have c-sections are more likely to have difficulty conceiving again and have a higher incidence of miscarriage. Heads of maternity units have told me they’ve seen a rise in infected scars due to poor post-natal care.

    The fatality rate for all caesarean sections is six times that for vaginal delivery, and even for elective caesarean section the rate is almost three times as great. In the absence of other evidence (eg, from randomised controlled trials of different modes of delivery), it is not appropriate to be dogmatic about best practice, but any decision to undertake major surgery with an associated maternal mortality should be taken very seriously by all concerned.

    Of course there are instances whereby emergency and elective sections are medically or psychologically vital. We are so fortunate to skilled surgeons who can work around tricky Placenta positions or unwell babies that may suffer from the stresses of labour.  And the NICE guidelines now recommend that any woman requesting a section is given proper counselling beforehand. Thanks to misogynistic phrases such as “Too posh to push” C-section has been sold as the “easy option” – as though women were receiving a manicure whilst they baby is pulled out. But ask any woman who has had both and most will tell you that they’d take a normal delivery over a C-section any day.

    What struck me as I watched Lorna’s daughter arrive is that sections take a massive physical toll on the body. The Obstetrician and her assistant yanked and pulled at the uterus – a magnificently strong muscle – to get the baby out and spent nearly 40 minutes sewing Lorna back up again. It wasn’t gory or shocking. It just made a drug-free, normal birth look easy.

    Medicine can be our life-saver but we are oddly conditioned not to question or criticise a doctor’s decision. Next time you hear a woman labelled as “Failing to progress” ask if there’s a chance that she was “failed” by an over-worked and under-funded system that might have prioritised the department’s needs over hers. Over 85% of women can birth normally – as long as they are given the right support.  Bump Club’s current 100% caesarean rate might be shocking now but it could prove to be a portent of the future.

    Bump Club is on BBC Radio 5 live at 11am on Sunday mornings. You can subscribe to the podcast here.

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