Health: Caesarean births: let women choose

Health Check

WE ARE the product of our experience. That is, presumably, what explains the remarkable finding that one-third of female obstetricians in London would opt for a Caesarean in a normal pregnancy if given the choice.

The figure was cited in a controversial article in the British Medical Journal which argued that pregnant women should be allowed to choose to have their babies by Caesarean section if they wished to avoid the problems associated with a normal labour. But should the experience of London obstetricians dealing with the most difficult labours be taken as representative of women's experience as a whole?

The subject of childbirth arouses strong passions and the article provoked a vehement response.The original argument, put by Sara Paterson-Brown, consultant obstetrician at Queen Charlotte's and Chelsea hospital, London, bears repeating. Although doctors have frowned on the idea of allowing women Caesareans on demand to fit in with busy lives and avoid the pain and unpredictability of labour without sound clinical reasons, attitudes are changing, she wrote.

A clearer assessment of the risks associated with normal labour and delivery has persuaded many women specialists in obstetrics to choose a Caesarean. The risks of vaginal birth include damage to the pelvic floor and to the urethral and anal sphincters which can result in incontinence and an increased long-term risk of prolapse of the genitals. There is also a risk to the unborn baby, with one in 1,500 non-premature babies weighing more than 1.5kg (3lb 5oz) dying during labour. Ms Paterson-Brown wrote: "Elective Caesarean section cannot guarantee normality but it avoids the above problems by virtue of avoiding labour and prolonged pregnancy."

Childbirth, as I have said, arouses strong passions and it is an area where demands for a woman's right to choose have been loudest. Over the last two decades considerable advances have been made in wresting from the doctors control of what is, after all, a natural process, and giving it back to women. This philosophy has entered the mainstream with the publication of the government report, Changing Childbirth, in the early Nineties, which stressed the importance of allowing women to have control of the process.

In the light of this and other government reports urging doctors to respect women's choices in maternity care, Ms Paterson Brown argued that it was unfair for their choices to be discredited because they are not the ones expected. "We are at a turning-point in obstetric thinking brought about not only by advances that have made Caesarean section safe... but also by the attitudes of society which reflect intolerance to risk. We encourage family planning, pre-pregnancy counselling and antenatal screening... can we do all this and then refuse a woman a safe mode of delivery?"

Her critics deny that Caesareans are safer than vaginal delivery, arguing that there is a higher risk of hysterectomy because of haemorrhage, and a greater risk of death. They also argue that doctors are not legally obliged to do everything that patients request, even if they are mentally competent to do so. One pointed out that a survey in Holland found only 1.4 per cent of Dutch obstetricians said they'd opt for a Caesarean in an uncomplicated pregnancy.

My own view is that a woman who feels strongly that she would prefer a Caesarean after hearing all the medical advice should have her wishes respected. In holding this opinion I have no doubt been influenced by the traumatic vaginal birth of my own first son - which ended with forceps under general anaesthetic, with mother's screams finally dulled and father weeping at what he was convinced was the imminent loss of both wife and baby son.

Colleagues who have had happier experiences think differently - that a woman with an uncomplicated pregnancy who refuses the opportunity of giving birth vaginally may be denying herself a rite of passage and a life-enhancing experience - as well as imposing heavy extra costs on the NHS.

Like much else in childbirth, this is an issue that will not yield to simple argument.

Suggested Topics
Arts and Entertainment
Victoria Wood, Kayvan Novak, Alexa Chung, Chris Moyles
tvReview: No soggy bottoms, but plenty of other baking disasters on The Great Comic Relief Bake Off
Arts and Entertainment
80s trailblazer: comedian Tracey Ullman
tv
Arts and Entertainment
Stephen Tompkinson is back as DCI Banks
tvReview: Episode one of the new series played it safe, but at least this drama has a winning formula
Arts and Entertainment
TV
News
Graham Norton said Irish broadcaster RTE’s decision to settle was ‘moronic’
TV
Arts and Entertainment
Attenborough with the primates
tv
Arts and Entertainment
Former Communards frontman Jimmy Somerville
music
Have you tried new the Independent Digital Edition apps?
Arts and Entertainment

ebooksNow available in paperback
Arts and Entertainment

ebooks
Arts and Entertainment
Secrets of JK Rowling's Harry Potter workings have been revealed in a new bibliography
arts + ents
Arts and Entertainment
Fearne Cotton is leaving Radio 1 after a decade
radio The popular DJ is leaving for 'family and new adventures'
Arts and Entertainment
arts + ents
Arts and Entertainment
Public Service Broadcasting are going it alone
music
Arts and Entertainment
Eddie Redmayne as transgender artist Lili Elbe in The Danish Girl
filmFirst look at Oscar winner as transgender artist
Arts and Entertainment
Season three of 'House of Cards' will be returning later this month
TV reviewHouse of Cards returns to Netflix
Arts and Entertainment
Harrison Ford will play Rick Deckard once again for the Blade Runner sequel
film review
Arts and Entertainment
The modern Thunderbirds: L-R, Scott, Virgil, Alan, Gordon and John in front of their home, the exotic Tracy Island
TV
Arts and Entertainment
Natural beauty: Aidan Turner stars in the new series of Poldark
TV
Arts and Entertainment
Taylor Swift won Best International Solo Female (Getty)

Brits 2015
Arts and Entertainment
Shining star: Maika Monroe, with Jake Weary, in ‘It Follows’
film review
Arts and Entertainment

Brits 2015
Arts and Entertainment
Paloma Faith arrives at the Brit Awards (Getty)

Brits 2015
Arts and Entertainment
Anne Boleyn's beheading in BBC Two's Wolf Hall

TV review
Arts and Entertainment
Follow every rainbow: Julie Andrews in 'The Sound of Music'
film Elizabeth Von Trapp reveals why the musical is so timeless
Arts and Entertainment
Bytes, camera, action: Leehom Wang in ‘Blackhat’
film
Arts and Entertainment
The Libertines will headline this year's festival
music
Arts and Entertainment
Richard Dean Anderson in the original TV series, which ran for seven seasons from 1985-1992
tv
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    War with Isis: Iraq's government fights to win back Tikrit from militants - but then what?

    Baghdad fights to win back Tikrit from Isis – but then what?

    Patrick Cockburn reports from Kirkuk on a conflict which sectarianism has made intractable
    Living with Alzheimer's: What is it really like to be diagnosed with early-onset dementia?

    What is it like to live with Alzheimer's?

    Depicting early-onset Alzheimer's, the film 'Still Alice' had a profound effect on Joy Watson, who lives with the illness. She tells Kate Hilpern how she's coped with the diagnosis
    The Internet of Things: Meet the British salesman who gave real-world items a virtual life

    Setting in motion the Internet of Things

    British salesman Kevin Ashton gave real-world items a virtual life
    Election 2015: Latest polling reveals Tories and Labour on course to win the same number of seats - with the SNP holding the balance of power

    Election 2015: A dead heat between Mr Bean and Dick Dastardly!

    Lord Ashcroft reveals latest polling – and which character voters associate with each leader
    Audiences queue up for 'true stories told live' as cult competition The Moth goes global

    Cult competition The Moth goes global

    The non-profit 'slam storytelling' competition was founded in 1997 by the novelist George Dawes Green and has seen Malcolm Gladwell, Salman Rushdie and Molly Ringwald all take their turn at the mic
    Pakistani women come out fighting: A hard-hitting play focuses on female Muslim boxers

    Pakistani women come out fighting

    Hard-hitting new play 'No Guts, No Heart, No Glory' focuses on female Muslim boxers
    Leonora Carrington transcended her stolid background to become an avant garde star

    Surreal deal: Leonora Carrington

    The artist transcended her stolid background to become an avant garde star
    LGBT History Month: Pupils discuss topics from Sappho to same-sex marriage

    Education: LGBT History Month

    Pupils have been discussing topics from Sappho to same-sex marriage
    11 best gel eyeliners

    Go bold this season: 11 best gel eyeliners

    Use an ink pot eyeliner to go bold on the eyes with this season's feline flicked winged liner
    Cricket World Cup 2015: Tournament runs riot to make the event more hit than miss...

    Cricket World Cup runs riot to make the event more hit than miss...

    The tournament has reached its halfway mark and scores of 300 and amazing catches abound. One thing never changes, though – everyone loves beating England
    Katarina Johnson-Thompson: Heptathlete ready to jump at first major title

    Katarina Johnson-Thompson: Ready to jump at first major title

    After her 2014 was ruined by injury, 21-year-old Briton is leading pentathlete going into this week’s European Indoors. Now she intends to turn form into gold
    Syrian conflict is the world's first 'climate change war', say scientists, but it won't be the last one

    Climate change key in Syrian conflict

    And it will trigger more war in future
    How I outwitted the Gestapo

    How I outwitted the Gestapo

    My life as a Jew in wartime Berlin
    The nation's favourite animal revealed

    The nation's favourite animal revealed

    Women like cuddly creatures whilst men like creepy-crawlies
    Is this the way to get young people to vote?

    Getting young people to vote

    From #VOTESELFISH to Bite the Ballot