Electing for Caesarean

‘Women phone us and say they want a Caesarean because they’ve already had one bad birth experience and don’t want another, or they’re afraid of being left alone and in pain during labour,’ says Beverley Beech of AIMS (The Association for Improvements in Maternity Services). ‘Very few really choose Caesareans for convenience. I think, also, that the media-fuelled image of birth is largely a negative one. The portrayal of birth as full of drama and danger adds to women’s fears.’

In the cash-strapped NHS, the element of ‘choice’ may not come into play, but the consultant’s preference certainly does. Some obstetricians like the convenience of being able to plan the delivery – a survey of female consultants in 1997 found that 31% would choose a Caesarean over any other method. Perhaps not surprisingly, women who are cared for by midwives during labour are far less likely to end up with an unnecessary Caesarean.

The way birth is managed in hospitals also plays a part. Some hospitals place a time limit on the first stage of birth of around 12 hours for first-time mums (less for second-time mums). If women go into ‘overtime’, they may be advised to have a Caesarean. This practice continues in spite of studies, such as the one published in Obstetrics and Gynaecology in 1996, which showed that normal labour is longer than doctors think. According to researchers, the average first (or dilating) stage of labour for a first-time mum lasted nearly 20 hours, not 12. The average second (or pushing) stage of labour was 7.7 hours, not 2.5.