This week, childbirth charity Birthrights reported that only 26% of NHS trusts are abiding by guidelines to offer a Caesarean birth to those who have asked for one. Yesterday’s headlines about the report and some of the responses to them seemed to suggest that there are women turning up at hospitals up and down the nation, wondering if they could have a C-section to somehow speed things up, to avoid the faff and mess of birth, to keep things nice and tight down there. Why wouldn’t you neck some lovely drugs, lie back and let someone deal with the nitty gritty, and why would someone deny you that?
For starters, it is all but impossible to get through a pregnancy without every midwife, every doctor and every antenatal class reminding you of how very much you do not want to have a C-section. You hear the words “major abdominal surgery” so many times, accompanied by such a solemn face, that they cease to have any meaning by around week 30. A hypnobirthing course will barely mention that a non-vaginal birth might be an outcome at all, let alone a preference, and almost all books and apps on childbirth focus on vaginal birth to a marked degree. The C-section birth is the wimps route, we learn. It is better to find our animal selves and to do things properly.
And, in part, this is true. Recovery time is usually quicker for both you and the baby, the risks of surgery are avoided and the costs are of course lower for our beleaguered NHS.
However. (And what a however it is.)
“Usually” does not mean “everyone”. Putting aside medical emergencies that lead to emergency C-sections or complications such as (in my case) high blood pressure and a bicornuate uterus, there are still those for whom a vaginal birth might not be a realistic or manageable prospect. These could include those who have been through sexual assault, are vulnerable on account of language barriers or mental-health barriers, or those who have had a traumatic birth in the past. Yes, a C-section is major abdominal surgery and, yes, it does take longer to recover and cost more. But the clue is in the title – it’s abdominal surgery. It’s a part of you significantly less intimate, less painful, less shrouded in half-whispered truths over the coffee and biscuits at mother-and-baby groups. If you return to work eight months later and wince because of your C-section scar when you pick up a bunch of paperwork, it’s just… a lot less traumatic than the alternatives.
I don’t believe there are doctors, midwives or obstetric specialists who want a woman to be in distress when they are giving birth. But I can’t be sure that decisions are being made under pressure because of NHS budgets
The idea that women in these positions – whether as a result of abuse, mental health or past experience – might meet what Rebecca Schiller, chief executive of Birthrights, has described as “judgemental attitudes, barriers and disrespect more often than they find compassion and support” is beyond grim. It shouldn’t need saying that the situation isn’t good enough. But just in case you are one of those women, let me add to the chorus: it absolutely should not happen.
At present, guidelines from the National Institute for Health and Care Excellence (Nice) state that women who ask for a caesarean should be offered one if, after support and discussion with a doctor, they feel it is best for them. The juncture where medical expertise, a woman’s understanding of her own body and what it is has been through and is capable of, and the budgetary restraints of a system under pressure is a particularly gnarly one. Added to this is the fact that stress can have such a negative impact on both pregnancy and birth, only exacerbating the problem.
I don’t believe there are doctors, midwives or obstetric specialists who want a woman to be in pain or distress when they are giving birth. But I can’t be sure that decisions aren’t being made under pressure because of NHS budgets, or that hurried appointments resulting from an over-stressed system result in women feeling unable to best express themselves and their very real anxieties about the trauma of birth.
But, as Rebecca Schiller says, "We are concerned that this lack of respect for patient dignity could have profound negative consequences for the emotional and physical safety for women.” And while I received impeccable care, I also believe others who say they didn’t. Women’s trauma, as ever, needs to taken seriously. And taking things seriously means listening more and responding better, regardless of what the final decision might end up being.