The 'popular' message on caesareans

The media play a significant role in leading popular thought about the issue of childbirth and of controversial subjects such as elective caesareans in particular. 137 All too frequently studies conducted in the medical community are jumped upon by the media and reported irresponsibly.

Too Posh to Push

The figure 7.3% is frequently reported as the number of women electing for a caesarean. The information accompanying this is often inadequate and 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 caesarean births 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

A survey of obstetricians suggests that only 3% of caesarean births 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 "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

Despite the findings of such studies women are labelled, meaning shame and distress is often associated with caesarean births. Caesareans are currently not allowed to be a positive choice and are frequently described as an undesirable last resort.

Elective caesareans cause breathing difficulties

Recent reporting of increased respiratory problems connected to elective caesareans failed to acknowledge that this was actually in premature babies i.e. babies born before 39 weeks and that at 39 weeks the risk of 'respiratory morbidity' [breathing illnesses] "...was not statistically significant". 100

A number of studies have confirmed that babies born after 39 weeks through elective caesarean show no increased risk above those born vaginally. 99 100 103 104 106

Media reports failed to identify the importance of distinguishing "between the direct effects of caesarean section and the effects of the factors which led to performance of an emergency procedure" 104 In other words, the initial reason for conducting an early caesarean may in fact be the reason for the subsequent development of breathing difficulties. Several media articles also failed to point out that in the UK NICE guidelines 27 recommend that caesareans should not be scheduled before 39 weeks in any case.

The scare mongering that such headlines creates only serves to increase the fear for those women who have an early emergency caesarean (pre-39 weeks) and those who have an early caesarean recommended to them for medical reasons.

The media blame the medical 'industry' for the increased caesarean birth rate with reasons of convenience, reduced risk and avoidance of litigation and mothers with being selfish and 'too posh to push'. While there will be elements of truth to this, for some individuals the negative opinion that such reporting generates has pushed caesarean delivery to the periphery of ante-natal education. This reduces the likelihood of balanced education and the possibility of informed choice. Most importantly perhaps it removes choice for those women who feel that a caesarean is actually the right birth choice for them.

Caesarean mothers are twice as likely to be re-hospitalized

Media reporting of medical studies can be easily over/under emphasise study findings. This can lead to misunderstandings and over emphasis of those parts of the study that suit the press report. One such study looking at caesareans carried out in the absence of any medical indications 134 caveated their study saying "there may be medical indications for caesareans not recorded" in other words the re-hospitalisation figures showing as higher for caesarean deliveries may have actually included women with medical indications. Indications which in themselves may be the cause of the re-hospitalisation rather than the caesarean itself.

Media reporting failed to point out an important point raised by the study itself namely "the problems with vaginal birth are manifested over a longer period of time in terms of urinary and fecal incontinence. These problems would seldom manifest themselves so seriously that it would require hospitalization, the outcome measure used here." 134 In other words significant risks associated with vaginal delivery did not show up in their results because of the source of data used to generate the statistics.

In an attempt to generate eye-catching headlines, genuine findings can be sensationalised, exacerbating the bias towards/against a specific mode of birth - in this case caesarean birth.