Mummy stuff, Pregnancy

The Beauty of Choice – NHS NICE guidelines for elective Caesareans


About four years ago, when I was pregnant with my first child, I was appalled to find out that in the UK, women did not get to choose the way they wanted to give birth. Sure, you had the (potential) choice of a birthing centre versus a maternity ward and sometimes even a homebirth, but to me, real choice about giving birth would have included the choice of a planned Caesarean section.

I am not contra natural birth. I am sure it can be a wonderful thing, if it works. I just think that it’s not for everyone – and after the experience I had with little L, it most certainly isn’t for me. Back then, after 12 hours of ‘unsuccessful’ labour and a midwife that was the gynaecological equivalent to the dentist in The Marathon Man, little L’s heart rate dropped dramatically and she was born via emergency Caesarean. I found out later that due to her head circumference and thanks to continuously banging her head against an almost closed cervix (remember the TV series Coneheads?), the ugly alternative would have been a forceps delivery – which is my personal nightmare idea of giving birth. In that sense: Hurrah for the C-section!

Had I been in a different country, a country that offers women more choice, I had chosen a C-section right away. I never viewed natural childbirth as particularly empowering; neither did I ever develop the desire to connect to my most primal self by pushing a baby through my vagina. It’s nothing I ever wanted to experience.

It (almost) amuses me when people try to hold the porn industry responsible for a woman’s refusal to stretch her most private bits to the max. I can assure you, I haven’t watched too much porn, nor am I being put under pressure by anyone to ‘stay in shape’. It’s what I want – and I am more than happy that the new NHS NICE guidelines state that this is reason enough to offer me a planned C-section.

We are quick to dismiss anti-abortion remarks as anti-feminist. How come that I can – theoretically – get stupefyingly drunk, have a one-night stand, get pregnant as a result and am then entitled to an abortion? Why should choice over my own body end once I have decided to keep the baby?

There is no research that suggests that a baby, born at full term via Caesarean, has any disadvantages compared to a baby born via natural birth. It is estimated that the major chunk of additional cost (about £500,000) will stem from mental health treatment that will be offered to women in an attempt to overcome their anxieties of childbirth. Just to give you a number to compare this with, the cost of obesity for the NHS has been £15.8 billion in 2007 and is estimated to reach £27 billion by 2015. Additional Caesareans don’t come cheap, but they are by no means the biggest position on the NHS bill.

Maternal request for CS (excerpt from the NHS NICE Guidelines cg132)

  • When a woman requests a CS because she has anxiety about childbirth, offer referral to a healthcare professional with expertise in providing perinatal mental health support to help her address her anxiety in a supportive manner
  • For women requesting a CS, if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned CS
  • An obstetrician unwilling to perform a CS should refer the woman to an obstetrician who will carry out the CS

So. What’s your thought on planned Caesareans?


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