9 hours ago
I won't be shamed for having an elective c-section — trust me, it wasn't easy
Readers, I have a bone to pick. With myself. In my first dispatch here, written when my son was 12 weeks old, I told you that it was 'fine to take shortcuts' and under that umbrella included 'having a c-section'.
Oh dear. Even while still nursing a very sore scar and after months of replying 'because I want one' to NHS midwives and obstetricians who asked 'and why do you want a caesarean?', I had still internalised the message that it's somehow 'cheating'.
So let me set the record straight: I had an elective c-section and, given the experiences of other women I know — some of whom still can't talk about their births years later — I'd do the same thing again in a heartbeat. But it really wasn't a shortcut. I don't want to sugarcoat it: this is major surgery and my recovery was slow, painful and reliant on painkillers (I was taking codeine on and off for three weeks, when I'd expected maybe one). I had to inject my stomach with anti-clotting drugs for ten days afterwards. Still no regrets.
• I'm not breastfeeding. Why are mothers still pressured into it?
That's me. I have no interest in playing different types of birth off against one another. But what I do want to talk about is how we're letting women down by withholding information, conflating facts and scaremongering, where we should be doing everything in our power to inform and reassure.
Take the new Nice guidance, published this week and designed to improve care for women having caesareans. One minor problem: it conflates the data for planned c-sections and emergency ones. And, as any woman who's had the latter (often after many hours of excruciating and exhausting labour in the pursuit of a vaginal birth) will tell you, there's a bloody world of difference.
Lumping the two together is unfair and skews the statistics — for example that one in 25,000 vaginal deliveries ends in maternal death, compared to one in 4,000 for caesareans. Except that includes emergency caesareans, where the mother or baby is in distress and already at risk.
For crying out loud. Nice has explained that it's too difficult to separate the two, but frankly I'd rather it didn't publish any numbers than ones that could confuse women even more. How about properly informing parents-to-be, rather than scaring them?
It plays directly into the stigma that still exists around choosing a caesarean — that you're entitled and happy to put your baby at risk. A pal admitted to me that before having her daughter, by emergency c-section, she might have judged other women for actively choosing that type of birth. 'Of course, I feel ridiculous now,' she said.
I don't blame her. We're rarely told another story, one that says planned caesareans — while not a walk in the park — are at least, all being well, more predictable. I arrived at the hospital feeling calm, my Spotify playlist prepped, happy in the knowledge that my baby would be lying on my chest about 30 minutes after the anaesthetist said: 'Can you feel that?'
After two decades of suffering thanks to undiagnosed endometriosis and adenomyosis, I wanted some control over how I gave birth. Yet even I felt a bit embarrassed and felt I had to explain to anyone who asked. When I was eventually told that, a) it would actually be more sensible to have a caesarean given my health conditions, and b) that the baby was breech, meaning he couldn't come out via the traditional route anyway, I felt a wave of relief. Now I had a proper excuse as to why I needed a caesarean and didn't just want one. Looking back, I find it sad that I felt that way.
• My painful battle to have the 'unnatural' birth I wanted
Out of eight women in my antenatal class, two of us planned caesareans. We spent most of the sessions eye-rolling at each other across the room as our tutor focused on 'normal' birth (the worst term imaginable if you're not having one), and pretty much ignored us, aside from a few minutes spent playing with tiny plastic dolls to demonstrate how many people would be in the room during our surgery. Translation: heavily medicalised and 'unnatural' birth, which also happens to be more expensive for the NHS.
And yet. Out of those eight women, seven ended up having caesareans — five emergencies. No wonder they now feel furious that they weren't better equipped to cope.
It might be anecdotal, but it's also not unusual from where I'm sitting. A friend tells me that out of the eight women in her antenatal group, every single one of them ended up having caesareans. Off the top of my head, I can think of four electives among my wider social circle and upwards of 20 emergencies.
According to NHS Digital, 46 per cent of all the births in England last September were vaginal and 44 per cent were c-section (the other 10 per cent involved instruments). So what exactly is a 'normal' birth now?
Officially, the NHS has moved away from its target-led pushing of vaginal birth over caesarean and most women I know haven't had to fight to get one. But what seems more common is uncertainty around when those c-sections might actually take place — time not really being all that flexible at the end of a pregnancy.
The NHS says you'll get a date two weeks in advance, with the surgery planned from your 39th week onwards. Hmm. One pal was told the hospital could call her the day before — would that be OK? Another currently has hers scheduled for the end of the week and is terrified by the prospect that she'll be pushed down the list and have to wait until the following Monday. Me? I got a call from the birthing unit to book mine when I was already 38 weeks and three days (having not been booked in, I'd moved my care elsewhere at the last minute).
• Natural birth v caesarean — what the latest statistics tell us
I know the NHS is stretched but, as one friend put it, it's like they're delaying in the hopes you go into labour and they don't have to pay. For any woman who's been trying to book in for the best part of nine months, it's a nervy prospect, a bit like relying on the Glastonbury resale to get a ticket.
Look, I don't want to scare anyone. I hope I haven't. The biggest problem we have is how petrified we make mothers-to-be, or those who haven't yet made up their minds about starting a family. But we're letting women down if we don't tell them the truth: that whatever birth you want is the right birth for you — just also make a plan A, B or C. After all, babies tend not to behave as you want them to, even before they've been born.
