Leigh East talks to BBC Coventry – Antenatal education may let women down

Following my article for the BBC I was interviewed by BBC Coventry for a debate on whether antenatal education prepares women effectively for caesarean birth.

I was asked why I thought women need to know more about caesareans “Women need to know there are risks with it [caesarean birth], but they also need to know that there are ways to make their birth more managable. They go into birth expecting one experience and some women come out with a completely different experience and they are, naturally, traumatised by this…But if they are told they can breastfeed in theatre, if they are told that they can hold their baby within minutes of her being born, if they are told that they can be the one to work out whether it is a little boy or little girl, (all the sorts of things that women consider important with a vaginal birth) and that they can also do these with a caesarean this can make MASSIVE difference to the way in which women perceive their birth.”

Unfortunately some antenatal classes spend little time discussing caesarean birth. Women may get a bit of information about epidurals and perhaps how many people are in the room but sometimes it is little more than this. While I am aware that not all antenatal classes brush over caesarean birth so lightly I found during my research for Caesarean Birth: A positive approach to preparation and recovery, from the interviews with countless women and indeed in my own experiences of antenatal classes that a significant number do.

So when I was asked why I thought women are told so little my response was “unfortunately it is a scary message, 1 in 4 women will have a caesarean, 50% of women giving birth in this country [UK] will experience some form of intervention, be that epidural, forceps delivery or caesarean etc. These figures are scary and a scary message to give to women when they are pregnant.”

Despite this I believe that women do need to know even very basic facts about caesareans. For example, the majority of the women I have spoken to on this subject over the last 6 years believe that a breech baby automatically requires a caesarean. This is not true and if a woman wishes to plan a vaginal birth she can do so assuming there are no medical complications identified with her birth. However the reality is that women are “up against the personal opinion of the practitioners, which sometimes doesn’t take account of the opinion of the woman. For example, if you have a breech baby there is actually no reason why, if the woman wants to deliver vaginally, she shouldn’t (assuming there are no other complications). However women are not told this because some practitioners think it is safer for mother and baby if the baby is delivered by caesarean. So then it is down to whether the woman understands this…this is where education is important, if women understand this, they know they have options and can make more informed decisions.”

A seemingly simple point can have significant ramifications for both mother and baby as well as her subsequent family planning. But to simply tell women that they can refuse a caesarean if their baby is breech is also insufficient. The number of breech babies delivered by caesarean in recent years has led, some say, to a de-skilling of some midwives in this regard. Before women are encouraged to go against a medical recommendation for a caesarean they should be encouraged to check the experience of their midwives with breech deliveries.

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