Friday, 25 November 2011

Just a Caesarean?

My first child was born via cesarean section, my second born naturally in hospital and my third born naturally... and unexpectedly at home. So I feel that, anecdotally at least, I may have a little to say about the subject.

On the 23rd November, I was woken by the radio announcement of 'NICE guidelines recommend that all pregnant women be offered caesarean section'. As the day wore on they tracked down a couple of women who said that they would definately have a c-sec if offered, in order to avoid the pain. Needless to say, I was a little bemused.

So I had a look at the new guidelines myself. And to say that the news got it wrong, would be to understate the situation. As usual they latched onto the bit that was most likely to make the news, and ran with it, regardless of the actual facts of the matter.

If someone looked closer, they begin to see that the updated guidelines actually are to do with 2 groups of women who have in the past, been routinely offered c-sec. This includes women with an HIV + status and women who have had a previous status; "Once a caesarean, always a caesarean". They find that after new published research, that in certain circs, a vaginal birth has the same rate of HIV transmission as a caesarean; therefore those women can be offered a vaginal birth and that after up to 4 previous caesareans, there is no difference in risk between the two birth methods.

The change however that was latched onto, was the part that said that where a women requests a caesarean due to anxiety about childbirth, NICE recommends that those women be sent for mental health support. If after this, and after all the information has been supplied to the woman and all support offered, only then would a planned caesarean be offered. A far cry from a free for all.

Dr Gillian Leng, deputy chief executive of NICE, said: “For a very small number of women, their anxiety about childbirth will lead them to ask for a caesarean section. The new recommendations in this guideline mean that these fears will be taken seriously and women will be offered mental health support if they need it. If the woman's anxiety is not allayed by this support, then she should be offered a planned caesarean section. Offering these women a planned caesarean in these circumstances is a very long way from saying that caesarean section should automatically be offered to every woman.”

As someone who has given birth 'both ways', I will say every time that I would take a natural birth every time. When I was told that I would need a c-sec to deliver my breech baby, I had no concept of how big a deal the surgery was. It is, after all major abdominal surgery. After which you then need to care round the clock for a newborn. Add to that not being able to drive for 6 weeks, add to that feelings of isolation... Add to that again, in my case, the feeling that my body had somehow let me down by not birthing 'properly' and all the associated feelings of inadequacy, helplessness and fear that brings. Picking up and breastfeeding my baby was a challenge while my wound was healing, I was knocked out by the necessary pain relief in those first 24 hours. I literally remember snippits of my eldests first day and that saddens me.

Caesarean has a valuable place. Babies are born healthily now where, before c-sec, they would not have been born live at all, but it is not ideal and should certainly not be idealised by the popular media.

Informed choice shold be paramount in all situations and that includes childbirth. Being informed is empowering, confidence building and essential to maintaining a sense of control over the situation. In antenatal education, the emphasis is rightly on normal birth but I wonder, can a balance be found between giving the information about the facts of a caesarean and causing unnecessary anxiety about it? Afterall we don't want to frighten women either.

What doesnt help though is stories like this where the media is implanting into peoples brains that to give birth by caesarean is 'just' a choice. Theres nothing 'just' about it.