The C-Section Debate: Should We Choose?

November 24, 2011

Before I got pregnant I had thought a lot about giving birth. It’s difficult not to; if you want kids like I always knew I did they have to make their way from your belly and into the outside world somehow. And as scared as I am of pain (I weep at threading appointments, actually weep) a Caesarian section never entered my thoughts. It’s major abdominal surgery and involves slicing through skin, muscle, and uterus, and I have never understood how women would voluntarily select to go for this option over a more natural vaginal birth.

I had a long time to consider my birthing choices. All my pre-natal care was carried out at UCLH at Euston and after plenty of thought and discussion I opted to go for a hypno waterbirth in their midwife-led centre. I read books, researched natural pain management techniques and learnt exercises to help birth my baby in the most natural way possible. I felt prepared and secure enough in my research and choices I had made that I was confident to follow the path of a natural, non-medicalised birth. For god’s sake, I even read Ina May.

Of course life has other ideas and I was gutted to be booked in for a non-emergency C section when it was discovered at 37 weeks that Elfie was a footling breech, apparently the most difficult sort of breech baby there is. Her foot was hanging down somewhere near my cervix and the doctors refused to attempt to turn her as the cord was in the way. Acupuncture didn’t have any effect, neither did hours bouncing up and down on a yoga ball. I was very sad to not be getting the sort of birth I’d spent months researching and planning for but I focussed on the most important thing: getting her delivered safely.

Elfie was born at City Hospital Nottingham via planned C section at 39 weeks and the experience was pleasant. I recovered well and had no nasty side effects apart from an abdomen that is still fairly numb from where it was cut into though I’m sure bonding didn’t happen as quickly as it could have.

A bit of a history lesson: for a long time birth was long a process dealt with by a woman and an attending midwife until people started to revere science above physical processes. In the 1940s it became the norm to give birth in a hospital, with the addition of forceps, arm and leg restraints and enemas. Often women were tied-up and then knocked out with chlorofom while they gave birth, only woken up once the process was over. Between 1970 and 1990, surgical birth soared from 5% of all births to 25-30% of all births and it’s only recently that women have reclaimed power over their choice to birth naturally.

Women have literally been giving birth for as long as there’s been life; our bodies are built to carry and birth babies and it upsets me that mothers are so terrified of this process that they opt to choose major surgery over their chance to experience their bodies at their most primitive and natural. It was for this reason I was shocked and saddened to read in the news yesterday that NICE guidelines are to be changed, offering women the opportunity to choose a Caesarian section even if there is no health reason for it.

In my opinion a lot of fear behind childbirth stems from a lack of education and knowledge. In the course of my pregnancy I was offered the choice of an NCT pregnancy and birth course (for around £300) or a couple of hours at my local hospital, neither which focussed on natural pain management techniques. As far as I am aware these courses are more matter-of-fact, teaching women about hospital processes and what pain medication would be offered.  I opted out of these courses as I was confident in my own research and choices, but I do wonder how further education on the history of birth and the possibility and processes behind non-medicalised births would effect Caesarian section figures. Knowledge is power and I feel that so many women enter into the pregnancy and birth process without being fully appraised of their choices or with a lack of understanding of what their bodies are capable of.

I would love for all women to be aware, for example, of the increased chance of an intervention with the introduction of pitocin, or the effect that water can have on relaxation and pain. I truly believe that the effect stress and fear has on the body impedes its natural course in childbirth and current maternity and hospital procedures do nothing to alleviate this. Conversely, I believe that women should be aware that sometimes the body doesn’t do what it is supposed to and in these times it is acceptable and completely unshameful to opt for pain relief. In these times of emergency a Caesarian should not be considered a failure, but it shouldn’t be an option before natural avenues have been considered.

But the option for this sort of open education just isn’t there right now. If I was ruling the NHS I’d take the extra budget that will be spent on Caesarians (which apparently come in at around £1,000 more expensive than your regular vaginal delivery) and concentate on educating Britain’s women on the process and history of birth. This knowledge just isn’t there right now and this breeds a culture of fear.

I’m not saying all this to be provocative or start fights but it is something I feel very passionate about. I am of course not a medical professional nor have I even been through a vaginal birth, but I do believe that my Caesarian section was a disappointing second choice of birth and that bonding did not go as smoothly had I achieved the birth experience I’d so wanted.  I will do everything in my power to achieve a VBAC for baby number two and will again educate myself on the birthing process and make efforts to understand exactly what my body is capable of.

Over to you: what were your birthing experiences like? Did you feel well-informed and comfortable with your choices? Would you ever choose a Caesarian?

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  • Reply fritha November 24, 2011 at 9:49 pm

    totally agree and very well written piece, I am 37 weeks pregnant at the moment and like you have researched a lot into my birth plan. I am hoping to have a drug free home water birth and feel at ease with the thought of giving birth. I would say that a lot of what has helped me feel this way are the NCT classes which (well mine) focussed on relaxation and natural methods of birth. They also really helped my partner to feel included and at ease but are very pricey and not available to all. I’m sorry your planned birth didnt work out but as you said the reason you were given a C section was for medical reasons, I think its awfully sad to think of women that are so scared of giving birth naturally they would opt for major surgery like this with all its risks and implications both physically and mentally!

  • Reply Bryony November 24, 2011 at 9:57 pm

    This sums everything up that’s been going through my head the past 24 hours perfectly. I was so incredibly upset to read about this all and I just don’t get it!

    Right up until 30 weeks there was a 80% chance I was going to have to have a c/s and I was devastated. I understood it was for medical reasons but I wanted my little girl to come into the world as nature intended and I didn’t want to spend the next 6 weeks out of action!

    I ended up having a very hurried, complicated natural birth without any pain relief (not through choice, I was desperate for something to take the pain away!) but I wouldn’t change that for the world. And more importantly a couple of hours later the pain was mostly gone and I didn’t have to recover from major surgery!

    I completely agree that the money should be spent on educating people on options, a more comprehensive antenatal service included on the NHS would be amazing and extremely beneficial to so many women!

    Brilliant post!

  • Reply Janet November 24, 2011 at 10:18 pm

    A brilliant post, really sums up my feelings on the subject. I was completely terrified of having a C-section. Other than anything happening to Becca, it was my worst fear about childbirth. I wanted things to be as natural and unmedicated as possible. Unfortunately she was back to back, and the pain was unelievable, but as no one realised she was back to back I thought this was normal pain and I needed to man up. I used gas an air until after 2.5 hours of pushing she just wasn’t moving. When they took me into theatre to have an assisted delivery and got me to sign the consent form for them to do a c-section if it was needed I felt so sick. I cried, and I shook, and I was absolutely terrified at the prospect of it happening. Thankfully a ventouse was all that was needed (when the doctor put the suction cup on her head was when they realised she was back to back, and they all seemed to suddenly understand why I was in so much pain) but I was so scared until she was out that I would end up needing this major surgery. Major surgery. That’s what it is, and that’s why I cant understand people taking it as an option unless its required. But then, I can’t understand people having cosmetic surgery for the same reasons. If we think of all the surgeries people would like to have on the NHS for cosmetic reasons and are refused, I really don’t see why an unnecessary c-section is any different.

  • Reply ruth baldock November 25, 2011 at 9:24 am

    I really think that people need to think through the psychological rammifications of having a c/s. My first was a crash section, second sort-of-elective (You know the back story). With both I have felt a bit gutted that I didn’t do it au naturale; even with Lex, whose birth and my recovery couldn’t have gone smoother, all things considered.
    I’d worry about people really regretting their decision after it’s all done, so to speak.
    The NICE decision on changing the guidlines has really, really upset me, yet I can’t actually articulate why; I think this post sums it up all pretty well.

  • Reply Katie @mummydaddyme November 25, 2011 at 4:38 pm

    I have also written a post on this recently as I find the new guidelines from NICE to be a little shocking to say the least. My daughter was born by elective section due to being a footling breech (snap!) and although my experiences were positive, the recovery was hard work. The thought that some women would go through that without any medical necessity makes me feel concerned. It was hard work and I felt it difficult to bond with her while I was in the hospital having to rely on midwives to even pass her to me.

    This is a great post and very well written. I also think that we seem to be quite similar from what you write on twitter and on here! Spooky!

  • Reply Richmond Mummy November 26, 2011 at 7:23 am

    Really interesting post. I too tried to approach childbirth like you Alice and read hypnobirthing books and had acupuncture and was convinced I could birth my baby naturally, in the midwife led unit at our local hospital, with positive thinking and deep breathing (and maybe a bit of gas and air!). When I was told I would have to be induced, because I was 2 weeks overdue, I was devastated and cried for a day! The thought of such a medicalised birth really terrified me and it wasn’t what I had wanted at all. The induction didn’t work for me, after 34 hours of pain and lots of drugs, I was only at 3cms! It was then the decision was made to do a c/s and by this point I was just massively relieved. It went smoothly, I was up and walking about the very next morning and had no problems lifting baby by myself etc so for me I don’t think it affected the early bonding process. It’s not the birth I had wanted but I’m just grateful my little one arrived safe in the world and that’s all that matters really. Xx

  • Reply sara November 26, 2011 at 9:11 am

    I know my response may be seen as controversial but I actually welcome these guideline changes. I’ve had two births – the first an emergency C section following a failed induced labour (similar to the post above – 28 hours of pain followed by the announcement that I’d only just got to 3 cm after all that time). The second was an elective at 38 weeks. My 2nd pregnancy was controlled by lots of drugs that kept me (& they hoped, the baby) safe as I have a weird blood disorder that only kicks in during pregnancy. As a result of these drugs I was not allowed to go into labour naturally, the risk of me haemorrhaging was way too high, no pain relief was allowed (other than gas & air) because an epidural could cause a haemorrhage and the other drug options would interact with my blood controlling drug. And no surgical intervention would be allowed within 24 hours of my last injection which meant no emergency C section or other type of intervention. This was discussed in depth at a meeting between the head of fetal medicine & my haematologist and written up in my notes as a care plan.

    So you’d think a C section would be obvious? Well, no…. At least 3 consultants pushed me to try for a VBAC, one woman asked me if I’d considered the fact that I might feel like a failure and wouldn’t I want the experience that other women have had to bond me to the sisterhood or some such crap, another told me I should at least give it a go before I give up and asked me what I was so scared of, and the 3rd told me how much money I would be costing the NHS by insisting on a C section. READ THE NOTES PEOPLE!

    I really felt that I was being bullied and pushed into something that just wasn’t the right course of action for me or my baby. Yet the guidelines insisted that everybody try to get me to go down the VBAC route.

    After the last appt I marched off to find my FM consultant, cried buckets and from that point onwards I only ever saw him.He arranged my C Section and actually did the operation for me. I honestly had a lovely birth, I recovered easily, was home within 24 hours and had no issues bonding with my son. And hand on heart I don’t feel like I’ve missed out on anything.

    I’m all about choice. If these new guidelines give people like me more choice, allow us to make an informed decision and not have to justify and explain that decision at every step then surely its a good thing?

    • Reply alice November 29, 2011 at 1:05 pm

      I completely agree with everything you’ve said Sara and I think the key phrase here is ‘informed decision’. I think too many women don’t know enough about birth to do this, I think they make decisions based on births they see on TV and horror stories they read, enough to scare anyone into a CS! Ideally there would be way more education given to women on births before they made their birthing decisions.

      Your experience sounds horrendous, how can so many medical professionals be so misinformed??!

  • Reply Han November 26, 2011 at 12:09 pm

    This is something that I have been thinking alot about recently, after a perfect natural birth with my little one I would definately do it all over again and felt that I bonded well with my baby because of the birth. I did however have 4th degree tears and had to have major surgery and an epidural after my perfect natural birth. My rercovery is still ongoing and even after 4 months I am still attending physio to ensure my insides don’t fall out!

    This has made me think about my next birth experience, I would love to be able to do it naturally again but have been told that if I did the likeyhood that I will tear again is high – this has lead to me making the decision already that I will be having a c section for baby number two (as and when this happens) I do believe that our society has made women scared of a natural birth, programs like one born every minute really do not help as only women in pain screaming and swearing make good tv. The programme makers are hardly going to show a lovely, calm and happy birth experience as it’s just not good tv! Women need to be made aware that it really is not as bad as they think and if all goes well the recovery time is excellent after a natural birth.

    If I were to advise anyone through a natural birth there are a couple of very simple things to keep in mind… Breathe, Laugh and remember that women have done this since the beginning of time!

    • Reply alice November 29, 2011 at 1:16 pm

      oof… ouch! I met a lady with similar birthing injuries and it did not sound easy. I was advised to wait a year to heal before I thought about more children – she had to wait for two!

      I think whichever way you give birth your body is going to go through the mill a little bit. Maybe women forget this before they get pregnant and then freak out a little when they realise the baby has to get outside somehow!

  • Reply Kitty November 27, 2011 at 1:51 am

    Very thought provoking piece, Alice. My daughter was born 6 weeks ago and I certainly didn’t have the birth I wanted or anticipated. Throughout my (obstetrician managed) pregnancy I did yoga, took Calm Birth classes (kind of like Hypnobirthing: had acupuncture, took chinese herbs, read all the natural birthing books, etc. I was adamant I would do the whole thing just on gas and air, nothing else.

    My labour was very different to what I anticipated. I had 34 hours of sporadic non progressive labour. Halfway through they tried to induce me and after the 34 hours I had only progressed to 4cm. She wasn’t engaged. My cervix was thickening. My OB gave me the choice of an emergency C-Section then or waiting but he said that he couldn’t see an option that didn’t end in a Cesarian. I took the offer and my little girl was born less than an hour later.

    Do I regret it? No. I tried natural labour. It hurt. I guess I ended up with the worst of both worlds – a long drawn out, exhausting labour followed by the recovery of a Cesar (which actually was okay for me but still, in relative terms is quite hard).

    I don’t feel any less bonded to my little girl because of the experience and would likely opt for an elective C-Section if we decide to go around again. I do agree with you – people should know the risks and rewards of both types of deliveries. In Autralia, Cesarians are at an all time high – the hospital I delivered in has a 46% C-Section rate.

    However – I wish I would have done research beforehand into the implications of a C-Section. I might have been more prepared but everyone (including my OB) was so keen on a natural delivery no-one considered the option. For me, the real issue was breastfeeding. The emergency c-section delayed my milk for almost three weeks. I felt like such a failure as a mother because I couldn’t feed my baby and it took a very expensive lactation consultant to tell me that. No-one in the hospital even mentioned the possibility that c-sections can delay milk coming in.

    • Reply alice November 29, 2011 at 1:18 pm

      I didn’t know this about the milk, either. It sounds like I was lucky, I recall my milk taking 4 days to come in. I’ll add it to my list of ‘things women don’t get told during pregnancy’!

  • Reply Tori November 27, 2011 at 10:02 pm

    Interesting one – as you know, was induced after waters broke and nothing happened for 24 hours, then Joseph became distressed each time they upped the syntocin drip. So after a day of induction using hypnobirthing pain relief techniques and a complete stop at 5cm I had a section.

    For number two I’m just not sure – I don’t know if I can cope with a failed VBAC attempt which will be completely medicalised anyway. Going through a day of no sleep and painful contractions only to be told that I had to have a section was pretty horrible as you are not only exhausted, but have a newborn whilst trying to recover from major abdominal surgery. All in all, my recovery was OK from the section with no complications and breastfed just fine… however one of my greatest concerns with an elective section with number two (apart from uterine rupture and risk to mother and child) is not being able to breastfeed because my milk is delayed coming in, because I never actually go into labour (thus have the hormone ‘rush’).

    • Reply alice November 29, 2011 at 1:21 pm

      I am also pretty scared about a uterine rupture and will definitely be researching this more before baby no 2 comes. I can only imagine how hard it must be to labour for 24 hours before having the section; at least I knew it was coming and could sleep in preparation!

  • Reply Jordan Marie Schilleci November 29, 2011 at 4:57 am

    Thanks for sharing your experience. I wanted a vaginal birth so bad.. I went into labor in the morning around 7 or 8 (it is all written down in my phone somewhere) and got the go to push around 2 in the afternoon. After 30 minutes of pushing with a nurse in front of me, the doctor finally walked in and peeked down there, and told me there is no way you are going to have this baby.. I cried and cried and fought them for as long as I could, but there was so way around it.. I had a tilted pelvis and this supposed 7 lb baby had a huge head and was 8 and a half pounds.. So c-section it was. I got really lucky.. Was up walking in less than 24 hours and nursing right away and milk came in before I even left the hospital. I had to walk three flights of stairs and did the mommy thing single for a while. The beginning was the hardest, but almost 9 months later, life is pretty great. Perfect actually. :)

    You’re right though.. Get yourself educated.. I think this is the best piece of advice and it applies to all facets of life and choices.

    I just found your blog through tbb. I really really like it!


  • Reply Kara December 2, 2011 at 4:02 pm

    I’ve never been pregnant or delivered a baby, so do not have any wisdom for you. As always, my encouragement is to do what YOU and your hubs think is best for your baby. I totally agree with making a well-informed decision.

    If I ever have the priledge of getting pregnant, I am going to research the heck out of my options. In the U.S. we have way too many interventions and too many unnecessary C-sections – I don’t want to be one of those women who allows a hurried doctor and staff call the shots for me and my baby.

    Best of luck! Hugs!

  • Reply Metropolitan Mum December 3, 2011 at 10:07 pm

    Well, I am not sure that more choice is necessarily a bad thing. In Germany, where there is a choice and has been for a long time, 30% of all births are c-sections. That’s the same as here, where women cannot choose. I am not sure that rates will jump up only because women have a choice. But maybe there would be less emergency c-sections? And maybe the stigma of c-sections as a failure would lift a little.
    The reason why there are more and more c-sections is – against the polemic used by the media – not because women are ‘too posh to push’ but because women are giving birth at an older age. Pregnancies are on average much riskier than they have been a decade or more ago. Also, babies become bigger and bigger whilst our pelvises don’t. It just doesn’t add up.
    Without the emergency c-section both L and I would be dead today. As would be many many other women and their babies. Globally, the number of maternal deaths dropped from more than 500,000 a year in 1980 to 343,000 a year in 2008. You have missed that bit in your history lesson.
    Even though I didn’t plan for a c-section during my pregnancy, I was shocked to find out that in Britain women do not have the choice of a c-section. I don’t associate failure with a c-section, it’s just a way of giving birth.
    PS: Needless to say that I still love you :) xx

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  • Reply hannah March 18, 2012 at 7:30 pm

    Wow, Alice, I found this post really moving (hormones are raging but I’m sure it was what you wrote!) – as a first time mum-to-be, I have to say, so far I’ve been avoiding looking into birthing too much as I’m worried I’m going to terrify myself. So, no One Born Every Minute or anything like that as of yet.

    However, at 19 weeks preggo and after a very long (and a little bit boring) conversation with friends about their experiences, I think it’s finally time so I’m glad I came across your post…
    The experiences mentioned above certainly fill me with the fear but on the other hand, I’ve been leant a hypnobirthing book and CD by my brand new nephew’s mum who had a natural birth at home with no drugs – so I feel that with the right preparation and all things being right with baby, I can handle giving birth naturally.

    Anyway, I think my point is that despite there being a choice, I would never elect for a C/S unless I had to. As you say, this is being a woman at its most primitive and I WANT to experience this (incidentally this is why you apparently shouldn’t have your mum around during birth as you naturally revert to being a child and for birth you need to be ALL woman!) . Having said that I also don’t want to put myself under pressure, or feel like a failure (p.s. I can’t believe a midwife actually said that above) if I have to have a C/S.

    In the meantime, from the comments above it looks like I’d better research it all – from hypnobirthing techniques to home birth vrs hospital to recovering from a C/S! What will be will be and thanks for a great post. Hxx

    • Reply alice March 19, 2012 at 9:26 pm

      That’s interesting about not having your mum with you when you give birth – mine is DYING to be there! I think I just want to stick with having my husband there though.

      Is it the Mongan Method book you have? I’m just re-reading it, it’s very very good.

      Great to get your thoughts, I love discussing this topic with women. It can be pretty emotive! x

  • Reply Suzanne April 17, 2012 at 9:32 pm

    Really enjoyed reading this post and the subsequent comments. Even learnt something new! Like you and some of the other mom’s my daughter was born via section. She too was breech, positioned herself in my right hip and didn’t budge for the entire time! As she is my first I had no idea that she was barely kicking and didn’t think anything of it when the midwife failed to find a heartbeat (listening in the wrong place, assuming baba was head down…), my daughter did do this weird back arch thing though and you could see her little scalp under my right boob! After a consultation and a late scan we made the decision to go with the section and I had an amazing birth experience. Although I did my homework and attended classes etc, I actually had no birth plan and was really just planning to “wing it” whatever came my way… don’t get me wrong am not a chilled, laid-back type person but probably just very naive and tend to face each challenge with this “wing it” concept (drives the other half nuts!). This probably saved the birthing experience for me though as I did’t feel disappointment or anger or deprived in anyway. In fact, I still get that lovely “birth” warmth inside when I remember that day. I don’t even remember the recovery being an issue (M is now almost 3 years old) and my scar faded unbelievably quickly. However, feeding was my big problem! The section recovery probably seemed simple because I was sat down so many hours of the day trying to (breast)feed this apparently forever hungry baby! No one has ever suggested that my lack of milk could have been down to the section? But this is a very interesting thought, I always thought that my body kind of betrayed me in that department as I had a massive influx the first week and then my breasts just seemed to stop producing (hence hungry-cry baby). After 2 weeks of literally solid feeding, a mammoth 4 hour breast session and a crying mom, baby and probably daddy too, I dispatch HimIndoors to a 24-hour shop and gave her a formula bottle. Oh, the silence of a sleeping baby was bliss. I continued to combination feed until M was 3 months old, gradually dropping a great for a bottle. By the time I stopped, she would go on the boob first thing in the morning only and have a bottle immediately afterwards, as really the boob thing was becoming more about me letting go than her and the poor Toot did need some food! Long winded response, but in summary an educated choice is always the preferred option. Also an open mind and maybe some naivety will go a long way too;) ! Thanks again for sharing. x

    • Reply alice April 23, 2012 at 10:04 pm

      I could always see Elfie’s head on my right hand side too!!

      Combo feeding for us was the right choice for a while as well due to how poorly she was, whatever works for you is the right choice in my decision. You sound a lot like me – I feel quite comfortable that I know all my options for the next birth but am also going into it with a slight ‘wing it’ attitude! x

  • Reply Jess May 17, 2012 at 4:54 pm

    Hi Everyone,

    I am a student currently studying a range of a levels hoping to get to university, to train as a midwife, reading this this blog and all of your comments has really started to educate me, and I would be really interested if any of you could contact me and tell me a little bit more about your experiences and the choices you made for your birthing plan. I would also be interested in how you felt about your body image as your body began to change, and whether the media put far to much pressure on new mums to get back into shape and to be back at work.

    Thank you

    Jess x

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