Antenatal advice 'perpetuates C-section myths'

Image caption Caesareans can occur 'even after straightforward pregnancies'

One in four births are by Caesarean section.

But in this week's Scrubbing Up, campaigner Leigh East - who has written a book about Caesarean births - warns pregnant women are not given a positive enough picture of C-sections - meaning many end up with "unnecessary" feelings of regret and failure if they need one.

Sit any group of women down to talk about Caesareans and you will hear all sorts of alarming 'facts'.

Common ones are: that you will have to have a Caesarean if your baby is breech; you cannot pick up your baby or drive for six weeks; bonding will be damaged and once you have had a Caesarean your next birth will have to be a Caesarean too.

What is really alarming about these "facts" is that not one of them need be true.

Hard as it may be to hear, antenatal education does little to disabuse women of these misconceptions.

Rather, it frequently perpetuates the idea that this important procedure is merely a last resort best avoided.

In reality, in addition to being lifesaving in emergency situations, Caesareans have significant benefits in certain pre-labour situations where attempting a vaginal delivery carries greater risks to mother or baby.

Add to these those women who view a Caesarean as preferable to the perceived fear and uncertainty of vaginal birth and there are a lot of women affected by Caesarean birth.

Preparation 'benefits'

Unfortunately the majority of women still understand so little about C-sections that it should come as no surprise to find that many find their experience, if they have one, extremely traumatic, so severe in fact that some go on to develop post-traumatic stress disorder, while those who want or need to plan a Caesarean are left totally unaware of the opportunities for making their birth feel special and personal.

One in four women in the UK will have a Caesarean, with unplanned sections accounting for two thirds of these.

It is a possible outcome of even the most straightforward pregnancy, yet is barely touched on in many antenatal classes.

This reluctance to talk positively about Caesareans has forced them to the periphery of antenatal education.

Books and classes are often biased, making it impossible for women to have open, rational discussions with those responsible for their care.

Most remain unaware of the huge benefits of preparing for the possibility of Caesarean birth, either planned or emergency.

It is well known that a woman's preconceptions can affect her labour and realistic expectations are significant in determining both how she ultimately perceives her birth and how she approaches her recovery.

But all too often the risks of vaginal birth are significantly downplayed while Caesareans are portrayed as an intervention to avoid wherever possible, with those planning a Caesarean labelled selfish or "too posh to push".

This leaves women in the dark about what they face - and unable to develop a flexible approach to birth.

'Toxic combination'

With over half of UK births involving intervention, women need to know more about their options so they can assess the risks for themselves.

Feelings of distress and loss of control become associated with their birth and can have a significant impact both physically and emotionally on mother and baby.

While some would prefer to leave things in the hands of their carers, many more would prefer to play an active role in making decisions about the birth.

To achieve this they need realistic information about the experience they face.

In the case of Caesareans, knowing how to prepare for the procedure, being aware of the opportunities open to them during surgery, learning alternative positions for breastfeeding and ways to improve recovery can all radically improve the experience for many women, even if a Caesarean was not their original preference.

Fortunately the National Institute of Clinical Excellence (NICE) is starting to address the issue, saying women should be presented with "evidence based information" so they can make an "informed decision".

This is a huge step forward, but it is still entirely reliant on those individuals providing the care also providing balanced information.

Unfortunately the toxic combination of out of date or inadequate information and biased advice means that women will continue to face their birth with huge gaps in their knowledge leading to unnecessary trauma.

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