My first introduction to the world of C-sections (if you don’t count my own birth) was a horizontal, lined scar which ran up my mother’s stomach, like a huge zip, from her pelvis to her belly button. It’s one of my outstanding memories of childhood holidays on the beach. “Did it hurt?” I asked once with ill-disguised horror as she described how the doctors had lifted me from her stomach through this sizeable slit, following a complicated labour. “Not at all, I didn’t feel a thing,” she replied, adding diplomatically: “Besides, at the end of it you arrived and so it was the best day of my life”.

That, ultimately, was the crux of it: I was in distress, choking on my poo – for want of a more technical term; that is ‘meconium’ – and our lives were in danger. Thanks to medical advances and well-trained staff, we were both able to be saved. It was a sobering thought then, more so now as I prepare to have my third C-section later this year – and more so still as I read this weekend the World Health Organisation (WHO)’s latest guidance in regards to caesareans, which suggests women should only give birth by C-section if “medically necessary”. 

According to the report, the “ideal rate” of caesarean births is – as has been the recommendation for the past 20 years – between 10 and 15 per cent. That is compared to 26 per cent such births last year in the UK; a rise from just 12 per cent since 1990. While new evidence shows that unnecessary operations could be “putting women and their babies at risk of short and long-term health problems”.

I’ve can’t say I’ve met anyone who wants a caesarean because she doesn’t fancy doing it “the hard way”. Those who ‘elect’ for surgery generally do so for a range of compelling reasons

The crux of the argument lies in two new studies by the HRP (a program of research within the WHO), which found that when caesarean section rates rise towards 10 per cent across a population, the number of maternal and newborn deaths decreases. Yet, when the rate goes above 10 per cent, there is no evidence that mortality rates improve. Furthermore, as with any surgical procedure, there are risks. Specifically, caesareans increases the risk of a baby ending up in intensive care, and hold serious possible side-effects for mothers, who will stay longer in hospital, and are more likely to have a hysterectomy or a cardiac arrest. Yet, confusingly perhaps, in its 2011 guidelines, the National Institute for Health and Care Excellence (NICE) states that women who want a caesarean should get one, even if it is not for medical reasons.

The fact that the number of C-sections has grown so quickly in Britain supports the argument that as a nation, we are going the way of America, with over-medicalised births and unnecessary interventions; I have interviewed a number of midwives and healthcare professionals in the past who would attest to that. After all, it is claimed, due to soaring birth rates and deep financial cuts, many hospitals are keen to try to control when and how babies are born. There is certainly anecdotal evidence of an increase in C-sections and other forms of medical interventions including forceps, as a result of a growing number of inductions to encourage labour in women deemed ‘overdue’. Meanwhile, more caesareans – which cost the NHS around £2,500 per procedure, compared to roughly £1000 for a vaginal delivery – are pulling resources away from the wards, where they are desperately with serious lack of funding fuelling what the General Secretary of the Royal College of Midwives, Cathy Warwick, has called a “crisis in midwifery”. Yet, in cases where having a section saves lives, as they frequently do, the final bill is clearly justified.

In my own experience, doctors and midwives have taken great care to ensure I have had as much information and positive choice as possible, within a given set of circumstances. Not once have I encountered a health professional who seemed gung-ho about offering a serious surgical procedure. Having had two sections, and awaiting my third with a slight sense of dread, I would discourage any woman from having one as an “easy” alternative to natural birth. While having a vaginal delivery comes with its own challenges and risks, the alternative  – having layers of abdominal tissues severed, and the subsequent recovery process – is no small trade off. While you hear stories of celebrities paying to have a private section rather than birthing “naturally”, I can’t say I’ve ever met anyone who wants a caesarean because she doesn’t fancy doing it “the hard way”. Those who ‘elect’ for surgery generally do so for a range of compelling reasons. If we consider that while in the past 20 years, the birth rate in Britain has risen by 22 per cent there has been been a simultaneous surge in the number of older women giving birth for the first time, and of women getting pregnant who are obese or have pre-existing medical conditions, this would surely impact in part on the rise in the number of women legitimately opting for sections.

Though I don’t fit into any of the above categories, my own story is far from uncommon in its overall pattern. Four years ago I found myself in the same London hospital where I’d been born, birth bag in tow and ready to have my first baby. I was 27 years old, 42 weeks pregnant and had accepted the offer to be induced – a deviation from our original plan, which had been simple: birth centre, some nice music and a water-birth. After four days in non-progressive labour, during which I was seen by nine different midwives, it was agreed that I was to have a C-section. My waters had long-since burst, my partner and I had been awake for 96 hours – and for reasons still unknown, I’d not even dilated to one centimetre. So that was that.

Second time around I’d accepted that whatever happened, I was about to have a baby, and the hows and when would never be entirely within my control – but that didn’t mean I couldn’t be present and fully engaged in the process

I held my mother’s description of my arrival on earth in my head (“it was a bit like having my tummy tickled!“) as I was wheeled into theatre, shaking with the sudden drop in temperature, exhaustion, and a degree of terror. Within minutes of surgery, a natural surge of emotions took over; and as I saw my daughter lifted above me, all thoughts of the hows, wheres and whys of her arrival disappeared. She was perfect, and nothing else mattered. Not least as if I hadn’t had the option of a caesarean, chances are neither she nor I would be here now. Except not only did I not feel as though my tummy had been tickled, but after a few hours I felt decidedly like it had been repeatedly stabbed. As the weeks progressed and my gratitude wore off, along with the morphine, I struggled to recover from what is ultimately serious abdominal surgery.

So my first words to my midwife when I became pregnant again were: “ I want a VBAC”. As if by verbalising my preferred method in certain enough terms, I was predetermining my birth experience. But again, after months of hypnobirthing CDs (“Baby will come when baby is ready” like hell), yoga and visualisations, I found myself once more, nearly 43 weeks pregnant and no closer to vaginal delivery than I would have been had I never had been impregnated in the first place. Only this time around, I was prepared for it. Somewhere along the line I’d come to accept that whatever happened, I was about to have a baby, and how and when that happened would never be entirely within my control – but that didn’t mean I couldn’t be present and engaged in the process. Regardless of what my unruly body decided to do, or not to do, I had options. In that moment I felt like I had taken ownership of my birth experience, however it progressed. The fact was: I was in a brilliant hospital in a country with access to world-class healthcare free at the point of delivery, and I was about to meet my child for the first time. That was something to celebrate.

Thankfully – and I don’t think it’s coincidence – in the second instance my recovery was infinitely better, mentally and physically, which just goes to show how different each birth can be – and how much difference the right support and information can make. Surely, then, the crucial point of the WHO’s latest report is this: the decision of whether or not to operate should be made on a case by case basis, never according to “target figures” which fail to take into consideration the individual circumstances surrounding every woman and every birth. A healthy, positive birth, after all, is about empowering women to have the safest experience available to her and her child. However the universe decides that will happen on the day.

@philbycharlotte

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