Working-class women 'too proletarian for a Caesarean'

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It used to be that pregnant women from the upper classes were "too posh to push". Now it appears that working-class women may be "too proletarian for a Caesarean".

It used to be that pregnant women from the upper classes were "too posh to push". Now it appears that working-class women may be "too proletarian for a Caesarean".

A study of hospital births for 2001-2 showsno statistically significant difference in the Caesarean rate for the top four social classes. Only in class five, the lowest, are women less likely to have a Caesarean.

Specialists said the explanation could be age. Women in social class five tended to have their babies younger, and Caesareans are more frequent in older age groups.

The Caesarean rate, which has almost tripled in 20 years and accounts for one in five births, has been blamed on affluent women demanding a trouble-free delivery to fit a tight home and work schedule. Pregnant career women with busy lives who booked their Caesareans in advance to avoid the uncertainty of child birth were dubbed "too posh to push".

But the label turns out to be a myth. There is no evidence that affluent women are more likely to opt for a surgical delivery than those lower down the social scale, researchers say, except for those at the very bottom. These women, dubbed "too proletarian for a Caesarean," may be missing out on the best care, they say.

The study, conducted by researchers from Dr Foster Ltd, the health information and research company, is published in the British Medical Journal. It shows that just under half of the Caesareans performed during the year were "elective" - planned in advance - with the remainder carried out as emergencies when normal delivery went wrong.

"Maternal request" is the fifth most common reason for an elective Caesarean, accounting for 9,000 of the 130,000 carried out each year, and is a growing category, according to obstetricians.

Roger Taylor, head of research at Dr Foster, said: "Theories about the rising caesarean rate have put it down to the increasing threat of litigation and an increase in maternal request. But the only significant difference we found was in social class five. It may be that these women are less articulate, less assertive and less well informed and it raises a question whether we are failing to hear these patients."

Peter Bowen-Simpkins, the spokesman for the Royal College of Obstetricians, said the increase in requests for Caesareans had affected all social classes. "We have always said it was across the board and did not just affect the affluent. "People who have had a bad experience in their first delivery are more likely to request a Caesarean next time. We do get a lot of pressure in that way, much more than from the busy professional who wants to fit the birth in with her schedule."

Official guidelines published in April by the National Institute for Clinical Excellence (Nice) said women who requested a Caesarean should "not automatically" be granted their wish. A Caesarean costs around £1,000 more than a vaginal birth and the rate varies from 18 per cent of all births in the North-east to 25 per cent in London and the South-east.

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