Writer and broadcaster

Yes, we do need to know. Published in The Guardian.

When I was pregnant, caesareans didn’t figure in my thinking. I neither considered nor planned for one: they were for celebrities or women on the verge of death. So, ending up with an emergency C-section after three days in labour was, to say the least, a shock. Suddenly all the studies about caesareans were relevant to me: I was one of the statistics.

The simple fact is that, although caesareans can be lifesaving, it’s just not how a baby is meant to be born. The latest research, published this month in the journal Birth: Issues in Perinatal Care, says that babies born to mothers who elected for a C-section were nearly three times more likely to die in the first few weeks of life than those born vaginally. The emphasis of the reporting (not the study) was that women who have C-sections are selfish, when most are simply grossly ill-informed. The findings had a darker side that was not explored, which is that once you’ve had one C-section you often have to fight for a vaginal birth or VBAC (vaginal birth after caesarean). In many cases, women find themselves browbeaten into having a “voluntary” C-section, despite research that suggests vaginal birth is better for mother and baby, and costs the NHS less than a caesarean.

Even in theory it’s hard. After talking to a group of midwives and paediatricians I mentioned, informally, my own experiences to a paediatrician (who had herself had two caesareans) and said, half-jokingly, that next time I’d like to try for a home birth. “That would be really irresponsible of you,” she said. “There’s a high likelihood of your scar rupturing.”

Ah, scar rupture. The threat that keeps C-section women in line: If you’re “selfish” enough to try for a vaginal birth next time, your womb will burst open. The chances of a scar rupture are real, but they stand at only 0.5%. The chances of suffering unstoppable bleeding during a caesarean, which results in an emergency hysterectomy, are 0.7%. Doctors and midwives rarely tell you that bit. Neither do many go into other caesarean risks: potential damage to the mother’s bladder and bowel, less chance of succeeding at breastfeeding, compromising of the baby’s immune system (because it doesn’t get vital bacteria from the mother’s vagina as it’s delivered), that the baby may be twice as likely to develop food allergies and more likely to develop asthma. They don’t tell you this because you might start making a fuss and say that, actually, you want to try for a vaginal birth. And that wouldn’t do because caesareans are easier to manage: you’re booked in, you’re cut open, your baby is born. The risks are mainly yours. However, if you opt for a VBAC you have to be closely monitored, which takes time and effort and emotional support. All the way through your pregnancy you will be hectored because you’re being “irresponsible”.

On the website I co-founded two years ago, we’ve seen C-section women spend most of their pregnancies fighting not to have repeats. One woman, not a member of ours, is heralded a hero for having had three caesareans followed by a home birth – you see, it really can be done. Considering that one of the prime factors for a successful VBAC (current success rates stand at 60-80%) is confidence, this is pretty alarming. Women who have not given birth “naturally” often lack the belief that they can “do it” and need support and help. The last thing they need is a legion of health professionals making them doubt themselves. If we are to reduce the number of caesareans, doctors should read and act on the research.

My most chilling encounter was with a surgeon who, when I discussed the risks of repeated caesareans, replied: “Yes, but do women really need to know?” I happen to think they do.

First published in The Guardian.