Page last updated at 05:00 GMT, Wednesday, 20 May 2009 06:00 UK

C-sections 'a rational choice'

Philip Steer
By Professor Philip Steer
British Journal of Obstetrics and Gynaecology editor-in-chief

Baby born by C-section
Caesareans are a 'remarkably safe' childbirth option

Women are often urged to opt for a "natural" birth - such as having a baby at home - wherever possible.

But in this week's Scrubbing Up health column, Philip Steer, emeritus professor of obstetrics and gynaecology at Imperial College, London, says rejecting Caesareans is like rejecting technological advances in transport or energy generation.

''I'll tell you what I want, what I really really want". So went the opening line of the Spice Girls' 1996 hit song.

Most of us "really, really want" to be healthy and yet many of us eat hamburgers, swig sugary drinks and have assorted take-aways delivered to our door when we know we should be eating a mixed diet and walking at least 10,000 steps a day.

For the several million years that we were hunter-gatherers, a mixed diet and lots of walking was unavoidable and this is what our physiology and metabolism is adjusted to.

However, in times of scarcity, survival was enhanced if we could get a quick fix of calories and get by with less energy expenditure - and so evolution has programmed us to seek out and enjoy sweet foods and energy-saving devices.

This sets up a tension between how we are programmed to behave and the logic of what we know is good for us.

There is a widespread misapprehension that human beings behave logically, but many of society's ills illustrate that most of us are driven instead by our primitive instincts and emotions.

Discussions about choices in childbirth demonstrate a similar dislocation between emotional drivers and logical behaviour.

Universal acclaim?

Until as recently as the 1930s, maternal mortality around the globe was horrendous.

In the early 1930s, one in 250 women in UK who became pregnant would die as a result - the same as in India today.

Without the technology of agriculture, transport, housing and energy generation, how many of the world's population would survive?

In many parts of Africa, the current figure is one in 16, and the global toll is more than half a million deaths per year.

Advances in the technology of surgery, anaesthesia, blood transfusion and antibiotics have so dramatically improved outcomes in developed countries that mortality is now one in 10,000 or fewer.

You would think that these technological advances would be greeted with universal acclaim, but many women see childbirth as an essential "rite of passage" and exhort others of their gender to eschew technological assistance (is this "the female macho"?).

Advocates of home birth have, within the last month, claimed that "the vast majority of women have low-risk pregnancies".

In fact, by all accepted standards, more than half of women have, or will develop, risk factors that make home birth unwise.

'Emotional wish-lists'

In BJOG (an international journal of obstetrics and gynaecology), the majority of valid science we publish goes unnoticed by the mass media.

But publish something about home-birth, and we are guaranteed to get onto the national news.

The discussions that ensue are repetitive, predictable and fail to distinguish emotional wish-lists from practical reality.

Delivery by Caesarean section now accounts for almost a third of all births in many developed countries, and is remarkably safe - certainly as safe as many of the cosmetic operations that do not excite similar criticism.

And yet many still argue against allowing women the autonomy to choose their mode of birth, either on spurious economic grounds or by suggesting that "birth is natural so we mustn't become dependent on technology".

Without the technology of agriculture, transport, housing and energy generation, how many of the world's population would survive?

Probably our survival depends on recognising our primitive instinct-driven behaviour and learning how to substitute rational lifestyles instead.

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