The 'popular' message on caesareans

The media and antenatal classes are increasingly making us aware of our right to a natural birth. However what our health professionals, antenatal classes and the media sometimes miss is the importance of ensuring women are properly informed about the possibilities of a caesarean and the means for making it a positive birth option rather than a depressing last resort.

The media frequently reports the figure 7.3% as the number of women electing for a caesarean. The information accompanying this is often inadequate as it has created the misconception that this percentage are requesting a caesarean for no good reason i.e. they are simply "too posh to push". This negative message may be teaching women that caesareans are a selfish approach to birth. In actual fact this figure relates to all elective caesareans and includes all of those carried out at the recommendation of the mother's obstetrician, i.e. when medical situations indicate, prior to labour, that a caesarean is preferable to a vaginal birth 57. The number of requests for a caesarean by a mother with no additional medical indications is far lower than the 7% quoted 22.

A survey of obstetricians suggests that only 3% of caesareans are requested by women in the absence of medical indications, and typically only about half of such requests are granted 46. A recent Nuffield study found that the use of the term "maternal choice" was often recorded as the reason for a caesarean "even when the operation was recommended" 56 46 The study concludes that "Despite strong rhetoric around the topic, existing research fails to support the notion that large numbers of women are demanding caesareans in the absence of any clinical indication. This study has also been unable to find evidence for women asking for the operation for social/trivial reasons e.g. because they are 'too posh to push' or solely to time the birth…Most women did not take the decision to ask for a caesarean section lightly…Sometimes although a woman made the final decision about caesarean section the issue had already been raised by a health professional…Thus, although a decision might be described as a 'maternal request' it was not always made in the absence of professional input." 56