Birth Choices

We believe that women should be given the right to choose the way in which they give birth. Giving birth is possibly the most enriching yet physically and mentally stressful thing a woman will ever do. For many the decision is not taken lightly, regardless of whether they are aiming for a homebirth, a water birth in an independent midwife unit or an elective caesarean in their local hospital.

As it is such an important and life changing experience we believe antenatal classes should provide as much unbiased information about birth choices as possible to allow women to make an informed decision on birth choices. A study in 2000 on Tokophobia shows the importance of being happy with a birth choice... "women with primary tokophobia (a fear of birth before they have had any children) strongly desired a caesarean birth. Four achieved this, bonded well with their baby and enjoyed excellent psychological health. Three women endured vaginal deliveries against their will; all suffered postnatal depression, two suffered symptoms of Post Traumatic Stress Disorder and two had delayed bonding with their infants." 131

Campaign group's agendas can often have a big effect on promoting, or reversing, certain health policies. For example: until recently homebirths have been discouraged. The National Childbirth Trust (NCT) campaign aimed at improving the possibility of achieving a homebirth has resulted in a government target of 10% homebirths being set. It is unfortunately the case that the right to request a planned caesareans does not have the same support. This is despite increasing evidence about the levels of fear of childbirth experienced by some women.

The following NCT policy identifies many admirable goals but in emphasizing the need for more 'normal' births, caesarean delivery is specifically excluded as a valid birth choice. Until a woman's right to make a fully informed choice is recognized a caesarean will not be included as a valid birth choice. Specifically excluding caesarean birth excludes a whole group of women from having a positive birth experience. On top of this, it encourages a general negative perception of caesarean births and reduces the likelihood of unbiased education on the subject.

"Maternity care should be a positive experience for women and make a significant contribution to public health, the well-being of families and the next generation. Experiences of pregnancy, birth and the early weeks with a new baby can have a long-lasting impact on the family, affecting physical and mental health, social relationships and child development. It is important that women begin motherhood feeling good about themselves, and valued and supported by others. It is not sufficient simply to aim to reduce deaths and major illness. Positive experiences act as a buffer against later physical and emotional stress...maternity services should be developed and managed to increase the proportion of straightforward vaginal births. With appropriate support and care, the vast majority of women can have a straightforward vaginal birth. Maternity services should provide one-to-one midwifery care for all women in labor. The NCT uses the term 'straightforward vaginal birth' to mean a birth that starts, progresses and concludes spontaneously, without major interventions, such as a caesarean or an instrumental delivery, or a series of other medical procedures." 122

Perhaps the most damaging impact of failing to recognize a caesarean as a valid choice is that poor education on the subject means that a whole group of women attempting vaginal births are going to be severely disappointed. The 23% of women who experience an emergency caesarean, or one which has been recommended to them for medical reasons, are excluded from achieving a positive birth experience as their birth education has completely omitted the possibility that they might need a caesarean. The result of this is that they have little or no information on how to make a caesarean birth a positive experience and they have little balanced information about what will happen to them during the caesarean procedure and during recovery.