Friday, October 9, 2009

Reducing cesarean rates at what cost to women?

Yesterday, I was browsing the website '' to see what they had to say about elective cesareans. On my first search, the video clip that came up was this one: elective caesarean

The woman being interviewed had had two vaginal deliveries and she had torn during both of them (the second birth making the first tear even worse). Fearful that her third pregnancy could result in even further damage, she requests an elective cesarean.

The Royal Sussex County Hospital however, is taking measures to reduce its cesarean section rate, and although in the end, the video shows that this woman does have a cesarean, just listen to what the hospital has to say to her during her maternal request consultation.

Vaginal reconstructive surgery versus planned cesarean surgery
It is suggested that she may want to consider operative perineal repair after the birth in order to avoid a cesarean, and the midwife says, '...if they had a terrible time last time, they haven't thought about the things they could do differently next time and still have a vaginal birth.'

What many obstetricians and midwives don't always appreciate is that the number one goal for every pregnant woman is not necessarily 'natural birth.' On the contrary, a healthy outcome for baby and mother is most likely top of the list. Efforts to reduce cesarean rates for the sake of reducing rates is of great concern to me because I genuinely believe that that in some cases, women and babies are bearing the physical and psychological cost of such arbitrary policies.

I don't believe in underestimating the risks of cesarean surgery - that would be irresponsible. But to underestimate the risks of vaginal delivery is, in my opinion, just as bad.


Anonymous said...

I am so happy to find your blog. This is my fourth pregnancy, but only the first to go nearly to term - I'm now 36 weeks.

My only concern is that my son gets out safe and healthy, and I would love to have a caesarian, and I could have my partner and mother with me, still have skin to skin contact and some predictability and calm for his birth.

I am not tokophobic, not relishing birth but not paralysed by fear either. I would love to make an informed, calm and rational choice to have our baby by elective caesarian but anticipate guilt-trips, dissuasion and obfuscation if I do. Living in Brighton, it's almost a crime to think of it!

Thank you for giving me the courage to at least investigate whether or not I have an option.


cesarean debate said...

I sincerely hope that you are able to find a supportive midwife and/or obstetrician to talk to.

You should not be made to feel guilty for your birth choice if it is an informed one, and you sound like you have been giving this a great deal of serious thought.

Wishing you and your baby the best of health... Pauline M Hull.

Anonymous said...

I'm due to give birth in the same hospital shown in the video and I also want CS for medical reasons. Thank you for postng this as now I know what I'm up against. I'm horrified at how the consultant blatantly lies to this woman ('CS won't stop you tearing' - WHAT??!!?) and how he and the midwife try to bully the woman into having what is obviously going to be a dangerous and traumatic birth. They just totally ignore her. Thank god she got what she needed in the end but I can imagine the fight she had to put up to get what she needed.