Caesarean Birth: A Positive Approach to Preparation and Recovery – A table of contents

For those interested in seeing more detail about the content and structure of my book – the following is the table of contents from the 2nd Edition – available on Amazon and from various other on-line bookstores.

Foreword……………………………………………………………………………… 5

Introduction………………………………………………………………………….. 7

  • 1 Caesareans explained………………………………………….. 11
  • 2 Why prepare for a caesarean birth?………………………….. 19
  • 3 I would prefer a caesarean…………………………………….. 27
  • 4 I do not want a caesarean……………………………………… 37
  • 5 How can I make the most of my caesarean?……………….. 55
  • 6 How can I improve my recovery?…………………………….. 75
  • 7 I am the birth partner, what can I do?……………………… 113
  • A The caesarean procedure……………………………………. 139
  • B Why do caesareans happen?………………………………… 151
  • C The benefits and risks of caesarean and vaginal birth….. 165
  • D Clinical definitions of difficult reactions………………….. 191
  • E Birth guide template………………………………………….. 195
  • F Questions to ask your practitioners………………………… 199

Glossary…………………………………………………………………………….. 203

Other resources…………………………………………………………………… 209

Acknowledgements………………………………………………………………. 217

References…………………………………………………………………………. 221

Index………………………………………………………………………………… 247

Where can I get advice?

Hospitals remain under pressure to reduce their caesarean rate – despite recommendations to Inspectors to refrain from judging hospitals in this way. And where there are no targets in place, women can still face opposition from individual care givers.

This is why BirthRights – a UK information and advice centre – offer the option for 1:1 advice via their website.

They firmly believe in a woman’s right to an informed choice.

“Women have a right to make choices about the circumstances in which they give birth. This simple but powerful principle was established by the European Court of Human Rights in Ternovszky v Hungary (2010) under the right to private life in Article 8 of the European Convention which encompasses rights to physical autonomy and integrity. Article 8 is a ‘qualified right’ and so limitations on the right are permitted. The Ternovszky case concerned the right to give birth at home, but the principle applies equally to all choices that women make about childbirth. The decision represents a profound challenge to medical authority: if women have a legal right to make a choice, any limitation on that right must be justified. The decision-maker, whether a hospital or a doctor or midwife, must give proportionate reasons for their decision based on the individual circumstances of the woman and their reasons can be tested in court before a judge.”

To ask them a question click here.

Why Do We Fear a Caesarean Birth?

Australian Birth site, Natural Parent Magazine, recently posted one of my articles. It is great to see more and more birth sites willing to talk about the possibility of a caesarean delivery. Knowledge is power!

“In reality a caesarean is an extraordinary addition to the tools available to those who help us with our births and it should be respected for the advantages if can bring to those who need it.”

Caesarean targets for hospitals

For years hospitals have been asked to record data about caesarean births. The results of a Freedom of Information request revealed that the way in which this information was recorded varied significantly from one hospital to another.

For example:

  • Inconsistency in criteria used for recording whether a caesarean delivery was emergency or planned
  • Inconsistency in criteria for recording a delivery as a maternal request or performed as a result of an obstetricians recommendation

It is easy to see that in reality reports about current rates face an impossible task – the truth is hard to discern. Despite this many hospitals faithfully report their figures and face judgement for their caesarean rates – some praised for low rates, some criticised for rates that are considered ‘too high’.

In fact the WHO retracted their recommendation for an ideal caesarean rate back in 2009 because there was insufficient evidence to define one.

Despite this, UK hospitals have continued to be scrutinised and judged according to their rates. Loaded statements by official bodies and the press have pushed many hospitals into defining, formally or otherwise, ideal targets for themselves. Stories of women requesting caesareans and being refused are all too common and maternity litigation claims in the UK are now thought to run to billions every year. The personal cost to families of these arbitrary targets can be shown to result in: “loss of life, life altering injuries as well as obvious psychological distress.”

Now, finally as the Sunday Times reports “Inspectors have been ordered to stop judging maternity units on their caesarean rates after the care watchdog accepted that it had sent the wrong message on normal birth.”

Heidi Smoult, deputy chief inspector of hospitals – commenting on the report by P Hull which led to this directive – stated that “medical intervention, while important “should never be at the expense of a woman’s or baby’s health.””

The Sundays Times speaking to Alison Wright, of the Royal College of Obstetricians and Gynaecologists, recorded the view that: “The need for a medical intervention can vary dramatically across services and regions, depending on the local demographics and the health needs of women. Therefore, we believe the approach should be more nuanced than promoting a particular maternity indicator, such as a caesarean birth rate.”

A step in the right direction. However, if you are trying to investigate your own birthing options, whether that is to have or avoid a caesarean be aware that internal politics within your hospital may be an additional factor to consider. Despite this new recommendation, it is worth finding out whether your hospital still refers to target levels for caesarean births.