Caesarean Birth: A positive approach – goes to 2nd Edition

The 2nd edition of Caesarean Birth: A positive approach to preparation and recovery is now published and available globally via Amazon.

The update came about because conversations with many women in the 7 years since this book was first published reveals little has changed in terms of a woman’s experience of a caesarean or the extent to which it is included in antenatal education and the need for up-to-date information is as vital as ever.

That said, once a caesarean is agreed, ideas about how to improve the experience are being more readily accepted by some practitioners and the ‘natural caesarean’ approach is now more commonly discussed. However, the barriers faced by women wanting to discuss their options in the first instance are still many. Hospitals and individual practitioners, driven by economics and/or professional bias, continue to make things difficult for some women wanting more say their birth options.

Despite the World Health Organisation’s retraction of their recommended target levels (retracted in 2009), which clarified that the “optimum rate is unknown”, hospitals continue to be threatened with unachievable targets and women labelled ‘too posh to push, are blamed for driving the caesarean rate up.

This update:

  • Adds new research
  • Updates facts and figures pertinent to both caesarean and vaginal birth
  • Adds learning from women and birth partners who have shared their experiences with the author
  • Highlights the needs and issues of same sex birth partners – in this last case the needs of this group are frequently over looked and while much of their experience of birth is the same as for male birth partners, research suggests that these co-parents actually have a significant number of additional emotional factors to deal with and the impact of this is only just beginning to be researched and understood


I haven’t checked Amazon for a while to see the latest reviews. It was a lovely surprise to see several new ones, all which had such lovely, positive things to say.

Thank you readers, I am glad it is proving so useful to so many.

Here are some of the comments that have just made my day:

Franca: “I read this book from cover to cover – it is the first unbiased, non judgmental, evidence based book I have ever read on the subject. An absolute must-read for anyone who might end up with a caesarean e.g. basically everyone who is pregnant! Brilliant book.”

Mazi: The book is written in a very non-judgemental way and its only agenda appears to be to inform and support women (and birth partners). I certainly felt much more knowledgeable after reading this book. I would definitely recommend `Caesarean Birth’ for all mums to be, especially as despite being an outcome for many women it is so often given only lip service at ante-natal classes. I particularly liked the chapter on recovery as it gives excellent, practical advice on what to expect afterwards and how to cope, even if your section wasn’t planned.

Anonymous Amazon customer: Fantastically informative guide to c sections, all you need to know to be prepared.

Jennifer: Brilliant prep before I had my planned c section. Felt much calmer as having read this.

Agnieszka: “You only need this one book if you are considering an elective C-section or you need one for medical reasons. Finally facts not old women’s tales about the procedure. Also no breast feeding ‘propaganda’ in this book which is a nice change from other publications.

Helen: This book was really helpful with my decision on whether to have a c-section second time round. Definitely worth reading before giving birth.

Caesareans, breastfeeding and gut bacteria

Once again the media have gone rather mad about a research paper without assessing the details of paper itself in an attempt to deliver sensational headlines about caesarean birth.

This paper actually describes gut bacteria in 24 infants at 4months of age but the media have rehashed old concerns about links with asthma.

It is entirely possible to make statements about the presence of the various bacteria from reliable tests conducted on the infants fecal matter and the paper should really have stopped there. However, it goes on to suggest links between caesarean birth and lower levels of breastfeeding and an increased likelihood of developing health problems in the long term (as a result of a lack of exposure to certain gut bacteria due to not having passed through the birth canal).

Aside from the media’s poor attempts at reporting on a very small, inconclusive study, I  take issue with the research paper itself:

  • No mention, or assessment of any environmental factors which can also easily influence gut bacteria level, other than use of antibiotics, (it looks purely at birthmode and breastfeeding patterns)
  • Only one assessment of gut bacteria levels are taken (at 4 months of age – no follow up to assess changes due to on-going development and exposure to new environmental factors – yet it is widely acknowledged that “gut profiles vary widely in the first year of life.”)
  • Sample size is laughable small (the total number of babies assessed – 24, of these only 6 were actually caesarean births) “A study of this size is too small to reliably detect any differences between natural and caesarean deliveries, and formula and breastfed babies, and even less so to detect any differences according to type of caesarean delivery (emergency vs. elective) or brand of infant formula, for example”

What is particularly disappointing is that the researchers feel comfortable making vague statements along the following lines “It could be that C-section physically prevents newborns from acquiring microbes they would during vaginal births” (which quite clearly shows even they cannot say their study provides conclusive evidence let alone how these bacteria levels relate to later health issues) and yet they are happy to produce a paper suggesting there is a link with caesarean birth specifically. Not only this but they take no account of the impact their statements may have on mothers who ‘need’ a caesarean to avoid serious outcomes. Nor dothey offer any information about how women can redress the bacteria imbalance. In otherwords they scare without offering any hint of a solution.

The NHS have been very quick to denounce the media’s scarmongering and suggest extreme caution when attempting to draw any conclusions from such a small study.

“The study does not provide any evidence that the mode of delivery or feeding pattern was the cause of the bacterial levels measured. Neither does the study provide any evidence that being born by caesarean delivery leads to developing asthma later on in life”

They go on…

“The researchers say that the development of bacteria in the gut in the early part of a person’s life is poorly understood. However, the design of this study means that it arguably adds little to that understanding. It only examined the gut bacteria of an extremely small sample of babies at one point in their life and can tell us little else about the causes of these bacterial levels, or how they related to longer-term health outcomes.”

And there is more…

“Neither does the study provide any evidence that being born by caesarean delivery leads to developing asthma later on in life.”

As for the media’s poor attempts at interpreting the paper, they have chosen to re-hash claims suggesting there are links with childhood asthma. This despite the majority of studies investigating such a link having been repeatedly shown to be inconclusive often omitting significant environmental factors, such as the presence of parental smoking.

Actually don’t get me started on the media…

An increase in the UK rate of forceps deliveries

The forceps rate has doubled in the last few years, according to a recent report picked up by the Mail On-line (over 42,000 last year) but is that really a surprise given:

  • The suggestion in 2010 (from within the medical profession) that there be an increase in forceps use if the aim is to reduce the emergency caesarean rate
  • The increased focus on natural birth, seemingly at all costs
  • The drive to reduce the caesarean rate making it ever more difficult to plan a caesarean for border line cases

It would be useful to know how many of these forceps deliveries were performed on women who might actually have been better advised to plan a caesarean? Indeed some of them could well have been advised of this but were so afraid of this ‘unknown evil -the caesarean’ that they actually preferred to take their chances.

Caesareans are regarded as a “last resort, best avoided” and because women are still not given balanced information many will resist a caesarean when it might actually be the safer option for them and their baby. Some of these women will go on to require highly medicalised instrumental births, many of which are truly traumatic, (damaging them both emotionally and physically, not to mention the risks to baby).

Women’s preparation should not simply be driven by the current bias towards natural birth. They need more information across birth modes and their opinions should be respected. Crucially in order to form these opinions in the first place they need to be supported in the development of realistic birth expectations using balanced information. Sadly neither of these can be guaranteed in many antenatal publications and clinics and many women will continue to have traumatic births, some of which could have been better managed, and experienced far more positively, with a planned caesarean.

NICE Caesarean Section Quality Statement Review

NICE (National Institute for Clinical Excellence) issued new Caesarean Section Guidelines back in 2011 and since then they have been going through the process of defining Quality Standards (QS) for some of the recommendations from that Guideline. are actively participating in this review process. We were disppointed with the  quality of the Draft document and have provided extensive feedback in the form of concrete recommendations for enhancements and qualifications. We hopes to see significant changes to the document when it is issued and will keep you posted.