Whatever we may think of the UK caesarean rate, the fact is a significant number of us will have a caesarean, planned or otherwise. My work over the last six years with practitioners and women preparing for birth and those who have already started their families has made it abundantly clear that this mode of birth is both feared and stigmatised by many. It is little wonder that thousands of us every year experience it as ‘disappointing’ or worse ‘highly traumatic’. So why prepare? I talk to Netmums…

I recently came across a relatively new antenatal organisation – Lazy Daisy. They offer movement based pregnancy wellbeing and birth preparation classes.  While they do not talk about interventions and more traditional modes of pain relief as I would advocate what is fantastic is that they focus on

“helping mum eliminate worry or fear before the birth…encouraging her to look forward to her birthing day, however the journey pans out”.

Of course a caesarean may be the outcome but in viewing birth as a positive journey and focusing on the end goal Lazy Daisy’s founder Julie Long reports that

“even when birth has taken a different path to what they hoped, [women] continue to feel in control and so feel 100% positive about the journey. Many of our mums forget to even mention how the journey finishes [vaginal or caesarean] because they are so enthusiastic about describing how they were riding their waves.”

These classes do not claim to be a one stop shop for antenatal preparation but they do seem to encourage women to have more realistic expectations of birth. The classes provide a safe, open and honest environment in which to discuss all aspects of birth. No topic is out of bounds. Lazy Daisy recognise that while natural birth and breastfeeding are desirable goals they also acknowledge that for some women bottle feeding and medical forms of pain relief may be preferrable. They point out that there should be no shame attached to this and they encourage discussion on all topics.

Anja a mother who recently attended Lazy Daisy classes before her home based VBAC said

“We practised techniques to help keep us calm and once in labour I went into a kind of automatic, I could hear the teachers voice from the relaxation sessions and it really worked, my homebirth was a wonderful, calm experience.”

The organisation is growing fast and there are now classes all over the country.

What should you consider if you have previously had a c-section and are now expecting another baby?

“Decision-making following a caesarean is naturally coloured by previous experience, but if possible the key thing to focus on when making your decision for your next birth is a balanced assessment of risk in your specific circumstances, this time round. It should not simply be a question of ‘This is nature, I am made to do it this way’ or ‘This is my right’. It is the specific circumstances of your previous births, your current condition and the progress of your pregnancy this time that should carry most weight.” More

The idea of the ‘Good Patient’ phenomenon may ring a few bells when you hear Birthwares’ description of how we sometimes interact with our health-carers:

“It presents with the need for the pregnant mama to please her caregivers. Often she will undertake medical tests and procedures without understanding the need for or the value of the information provided by the tests. She will attend prenatal appointments promptly and regularly, but will leave her list of burning questions, unasked, in her pocket, for fear of taking up the time of her busy caregiver. She will accept any intervention or treatment offered to her, with the implicit understanding that her caregivers know best.”

I know I have certainly done this time and again despite knowing that I have burning questions about things that are concerning me. Even with a list in my hand I have felt compelled to keep quiet because someone is frantically trying to keep on top of their own schedule. 

However it is crucial that we ask questions and do so even when we feel pressured to move on.  Each pregnancy is different and new questions will arise even if you have already had a baby. As Birthwares suggests “bring your list of questions. Lose the niceties about the weather and how hot it is. Rattle off your questions instead.” So whether you are planning a vaginal birth or a caesarean stand your ground and ask those questions. It can help to take someone with you to every antenatal appointment, even if you think you are just there to wee in a bottle, you never know what you are going to be told or what you might want to ask and a second pair of ears can mean less gets missed.

The maternal request debate has been in the headlines once again. This interest comes in the month when the National Institute of Clinical Excellence (NICE) will issue the latest version of their guideline on caesarean birth.

This latest review of caesarean research by NICE reveals that “In general, [caesarean section] is a safe operation, especially when performed as planned procedure.” NICE have extended the rights of women to request a caesarean birth on the grounds of tokophobia (fear of childbirth) to all women recommending “if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned CS.” Clearly stating that “if an obstetrician feels a woman’s request for CS is not appropriate after the woman has received appropriate counselling and support, then s/he should be able to decline to support the women’s request. This does not over rule the woman’s rights to express a preference for a CS however, and in this instance the obstetrician should transfer care of the woman to an NHS obstetrician within the same unit who is happy to support her choice.”

Disappointingly there has once again been a rash of commentaries about the cost implications and selfishness of women making such a choice. Such commentaries continue to ignore the flawed data on which it is based as well as the fact that this tiny, tiny number of women who prefer to request a caesarean rather than attempt vaginal birth tyically have very good reasons for their request. For some the origin may be fear while for others it is an informed assessment of risk comparing vaginal and caesarean birth experiences and outcomes. But for a significant number the request is based upon an informed assessment of risk in relation to their own personal circumstances. An example of this latter group are those women falling into what could be considered the ‘grey’ area of clinical need. These women are often categorised as maternal request because, following discussion with their practitioners, they have been given a choice. Examples of ‘grey’ areas are breech, older mother, previous caesarean etc.

A very interesting article in the F-word (written by doula – Amity Reed) discusses the extent to which our culture both reveres and fears childbirth and questions how this happened. Reed asks “How did we get to this place, where giving birth is something to be survived and suffered instead of something in which many women can find a sense of empowerment, accomplishment and joy?”

She believes “we are on the cusp of reclaiming birth as an awesomely powerful and completely normal event.” But what is really striking for me about this article is that Reed emphasises the importance of informed choice for everyone. “It does not mean only advocating for natural birth either, but informed choices, real choices and the autonomy that birthing women and their partners deserve, regardless of what kind of birth they choose or end up having.” This positive and balanced approach is crucial as we strive for greater levels of fairness and safety in our maternity service. “It means we hold women in such high esteem and reverence that we trust them to make sound decisions for themselves, their babies and their families.”