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Not too posh, but still pushed

A recent study published in the British Medical Journal has been making headlines in TIME and Salon, among other outlets. Headlines herald the findings as proof that women are “not too posh to push” and can’t be blamed for the rising cesarean rate. Instead, women are having cesareans for “medical reasons.”

From the BBC:

It is “unlikely” that women undergo caesarean sections to avoid the pain of childbirth, research suggests.

Most caesareans were carried out for medical reasons, the review of 620,000 births in England in 2008 found.

However, the study does not appear to question the “medical reasons” given for cesareans. According to TIME:

Further analysis of the reasons for c-section found they were mostly medical: about 90% of women with a breech baby opted for c-section, as did 71% of women who had had a previous c-section. Mothers who experienced serious medical problems during labor also chose surgical delivery following recommendations from their doctors.

Key among the “medical reasons” given are breech birth and previous cesarean, neither of which are inherent reasons for cesarean based on scientific evidence. Current obstetric practice, however, often forces women to “choose”  cesareans in both cases by limiting availability of vaginal breech birth and vaginal birth after cesarean (VBAC).

Media reports about the study hint at the non-medical reasons that other studies have found to influence cesarean rates. Again from TIME:

Overall, however, the study did find a wide range in c-section rates between hospital trusts — from 15% to 32% — and suggested that the differences were to due to doctors’ individual decisions in emergency situations. It’s possible, then, that some doctors, faced with problems during labor, may choose c-section sooner than is necessary.

It bears noting that c-sections make more money for private hospitals than vaginal deliveries. And they’re cheaper than vaginal birth after cesarean section, or VBAC, which, thanks to liability issues, requires additional medical staff at most hospitals; doing the c-section also avoids potential lawsuits by patients.

While it is well worth acknowledging that women are not, in fact, driving the cesarean rate by requesting cesareans, clearly more needs to be done to remove barriers to true choice for birthing women.

One Comment

  1. Amy says:

    As a doula, I’ve seen this lack of bona-fide choice in childbirth options over and over again. The illusion of choice is often presented to the mother in the manner of, “Well you can be safe and go for Option A, OR you could potentially endanger your life and the life of your baby and go for Option B.”

    OK, perhaps they’ll use different words but basically the mother is told that she is being irresponsible if she chooses to do anything other than what the medical profession WANTS her to do. Thanks for this post! There’s no doubt that we have a long way to go in offering real choice to expecting moms.