By Picard, Anna
New Statesman (1996) , Vol. 130, No. 4542
Too posh to push? No: growing numbers of women think caesarean births are better.
The Guardian's women's page recently ran the following extract from an interview in Hello! magazine, in which Mandy Smith (the ex-child bride of the Rolling Stone Bill Wyman) described her experience of giving birth by caesarean section: "Ian took pictures of me giving birth and I've got my hair done, my lipstick on. Of course, everyone tells me it would have been quite different if I'd had a 40-hour labour. But that's just the way I've been ever since I was a little girl, always wanting to look my best."
What was the purpose of this? To give us a laugh at Smith's expense. To mock her for getting above herself instead of squatting and grunting through the pain like the rest of us, all messy and sweaty and ugly. For being idle and vain. For being yet another of those bloody selfish women who just can't be bothered to go through labour as nature intended. But, as Hello! magazine informed its readers -- and the Guardian significantly didn't -- Smith's caesarean was a matter not of maternal laziness, but of medical necessity: her baby was in the breech position. So much for sisterhood.
This year, at a cost of [pound]26.6m to the NHS, more than one in five babies will be delivered surgically. In the face of a powerful professional and amateur natural birth lobby, caesareans have risen 17 per cent over the past 30 years. No one knows why. The National Childbirth Trust has blamed the scant availability of one-on-one midwifery. The Royal College of Midwives has blamed litigation-wary obstetricians. Then, at last month's Royal College of Nursing conference, the finger was pointed at celebrity mothers -- specifically, Victoria Beckham, Melanie Blatt and Zoe Ball. In the bitter words of the delegate Rebecca Gray, modern women are "too posh to push", too busy with their "careers and social lives" to make time for an unscheduled labour.
Elective caesareans -- those without medical reason -- have become "trendy", thereby presenting a serious financial challenge to the NHS, and an ideological challenge to the advocates of natural childbirth.
Are women really choosing surgical deliveries as a fashion statement? Or are they just sick of being told by the natural-birth brigade to grin and bear a painful and unpredictable process? In the absence of any hard epidemiological evidence, the entire responsibility for the rise in caesareans has been laid at the pedicured feet of Nurse Gray's richly imagined Nemeses: impressionable and career-conscious girls who want to have their babies just like Posh Spice had hers. It's quite an image -- all fake tan and Filofax -- but why the condemnation? The successful delivery of a healthy baby is the optimum result of every pregnancy, so, provided the mother's wishes are respected, does it really matter how this is achieved? I don't think so. But then, I chose to have my baby by elective caesarean.
As Sara Paterson-Brown, a consultant gynaecologist and obstetrician at Queen Charlotte's and Chelsea Hospital, says: "The old idea of vaginal delivery at all costs no longer holds true." Traditionally, the more prosaic risks of prolapse, incontinence and sexual injury from a difficult vaginal labour have paled against a caesarean's potentially fatal complications. But the oft-quoted 90 per cent risk of post-operative infection is drawn from all caesareans, including emergency, scheduled (due to gestational problems) and elective. Recent anecdotal evidence suggests that the risks are dramatically reduced in scheduled sections, and reduced still further in electives. Some radical surgeons have even suggested that, for healthy women, caesareans may now be the safest method of delivery. Add to this the low incidence of cerebral palsy, and it's not surprising that some women are calmly exchanging one set of risks for another, and turning their backs on natural birth.
Ball, Beckham and Blatt have little to do with this. …