That's what recent stories in the news have suggested. After the Research Council/Chief Scientist Office Social and Public Health Services Unit (phew, let's call them the MRC/CSO SPHSU, much better) undertook research looking at mothers' social classes and the levels of deprivation they lived in, along with numbers of emergency and elective caesareans, they concluded, among other things, that babies delivered by elective caesarean these days are more likely to be born to mothers from the middle classes.
The press leapt upon the idea that affluent women are insisting on expensive operations because they just don't want to go through labour and the National Institute for Health and Clinical Excellence (NICE) has issued draft guidance to health professionals saying such women should be offered counselling by a mental health specialist – essentially to talk them out of it.
But it all sounds a bit fishy to me. I've spent a lot of time in the company of pregnant women, and the idea that middle class women are generally afraid of labour (and what it might do to their bodies), or just can't be bothered to try it, does not compute. It simply does not match my experience. Every mother I know wanted to go for a natural birth in the knowledge that, if all was progressing well, it would be the best thing for her baby.
So where has this idea come from? Rumours abounded about celebrities (firstly Victoria Beckham, of course, whose Posh nickname helped coin the phrase) who apparently opted for the scalpel rather than labour. But Mrs Beckham has repeatedly stated those caesareans were a medical necessity – perhaps all those little boys of hers were trying to enter the world goldenballs first.
To put it into perspective, an audit by the Royal College of Obstetricians and Gynaecologists in 2004 showed only 7% of caesareans in the UK are requested by mothers who have no underlying medical reason for having one. And who might those mothers be? I'd be willing to bet an awful lot of them are second-timers, women who had a traumatic and damaging experience the first time round.
Every mum I know, despite her initial intentions and her (gawd, they hardly ever come to fruition) 'birth plan' had a different outcome. Some (not many) 'enjoyed' a straightforward labour; some (me for example) endured labour followed by an emergency c-section; one nearly had her baby in a car park; and some women had labours that would make your eyes water to even hear about them. I have seen women left like rag dolls after childbirth, and those women found themselves feeling terrified when they fell pregnant again. What of those women? Why should they be talked out of a caesarean?
Let's be honest here, there is no way to get a baby out of your body easily and a caesarean is no picnic. It's major abdominal surgery (it hurts, a lot) that carries risks for mother and child, and leaves you with a six-week recovery period and a scar for life. I don't know anyone who thinks a c-section is an easy option. But I do know some women for whom it has seemed the preferable option – preferable, for example, to another experience of third or fourth degree tearing.
Caesareans have gone up across the board – more than twice as many are performed now than in 1980. But there must be many reasons for that, such as different choices being made in challenging situations. And could it not even be possible that the increasing number of emergency caesareans has something to do with the UK's midwife to mother ratio?
Belinda Phipps, chief executive of the National Childbirth Trust (NCT), said earlier this year: "All good practice says: one midwife to one woman in labour. But we too often have one midwife running between three women in labour. If you are sharing one midwife between three women, she may not spot a problem arising as soon as it should be spotted. Many of the women who come to our NCT reunions after giving birth tell frightening stories. Some are very traumatised, others have been badly treated and some end up with postnatal depression."
You can see where there might be a link. Just recently a friend of mine, who had had a perfectly normal and healthy pregnancy but was induced at 41 weeks, ended up having an emergency c-section because after hours of labour, a midwife realised her baby was breech.
It seems to me that there are myriad reasons why the UK's caesarean levels have soared (we're by no means the highest in Europe, by the way) and focusing on the small proportion of women who ask for one electively is not going to go a huge way towards the NHS objective which is, of course, to save money. Every time a woman has a vaginal birth rather than a c-section, it saves the NHS £800. But I wonder what that figure would come down to after paying for all the counsellors.
I do agree that the more information, advice and support (rather than pressure to change their minds) there is available to mothers the better, but I refute the idea that the so called yummy mummies are too posh to push – and any suggestion of that is a cop out in terms of the bigger picture.
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