Page last updated at 10:26 GMT, Wednesday, 20 May 2009 11:26 UK

Scrubbing up: Your comments

In this week's Scrubbing Up, the editor-in-chief of the British Journal of Obstetrics and Gynaecology, Professor Philip Steer, says women are often urged to opt for a "natural" birth - such as having a baby at home - wherever possible.

But he thinks that rejecting Caesareans is like rejecting technological advances in transport or energy generation.

What do you think? Here are some of the comments you have been sending in to this week's Scrubbing up.

YOUR COMMENTS

Men have it easy, it was only when my wife had our first child that I realised that parenthood is all about guilt for the women. Guilt if you don't have a natural birth guilt if you have one glass of wine when you're pregnant. Guilt if you want to go back to work. Guilt if you stay at home and rely on your partner as the sole income. Given the pressure on costs and resources on the NHS you can see why they're reluctant to let everyone choose a caesarean, when a non-surgical birth costs a lot less and the recovery time is generally vastly quicker for the mother.
Kaz, Hong Kong

This article is somewhat lacking in epidemiological evidence. The epidemiological studies I read (Tew, Campbell & Macfarlane) found that home birth/midwifery care is as safe or safer than hospital/consultant care, and requires fewer interventions. Historically, many maternal deaths have been caused by carelessness and arrogance on the part of doctors. Even now, the need for C-section is increased by interventions such as epidurals and women being encouraged to adopt unhelpful horizontal positions for delivery. Certainly, recovery time is much less for a vaginal birth, and there are fewer implications for future pregnancies. I have had seven natural births (five at home) and am shortly anticipating my eighth. I'm not sure that this would have been possible if I had had C-sections.
Dr Alison Steward PhD, Montreal, Canada

How irresponsible of the BBC to publish this article when it is widely acknowledged that too many caesareans are carried out in this country. Caesarean birth should be reserved for cases where delivery through the birth channel is impossible or hindered. Unless it is necessary for the safety of mother and/or baby, it should be avoided. Unless some plastic surgeons want to profit from all that extra work afterwards?
Helen C, Essex, UK

When I was giving birth to twins a few years ago, the midwife tried to persuade me against taking any pain-relief, because apparently many women feel that drugs spoil the experience of childbirth. What was astonishing about this was that was that everyone, including the midwife, was aware that the twins had already both died in the womb. But such is the hysteria surrounding any intervention, that people just trot out the same old mantra without thinking. Parenthood does not begin and end with childbirth. And the most important thing is a healthy baby. Get some perspective!
Gill, Edinburgh, UK

The birth of my daughter started as a planned home birth and ended as an emergency C-section. I have nothing but gratitude for the medical technology available and nothing but irritation with the anti-technology stance.
Juliet Krouwel, Birmingham, UK

The simple fact is that whilst caesarean section is a wonderful life saving intervention, having a vaginal birth is by far the safest mode of delivery for the majority of woman and, it is far safer for their babies who are designed to be born that way. Statistics show that home birth is not only associated with increased satisfaction for women and their families, but that their outcomes are at least as good as when in hospital. Having a baby at home increases a woman's chance of having a normal birth with less intervention, less pharmacological pain relief by choice, less risk of sustaining perineal injury that requires suturing. Moreover for a service that is stretched to crisis in this country providing home birth is a far cheaper way of delivering first class care than processing through women through a surgical system.
Maria Mills Shaw, Home Birth Lead Epsom & St Heleir University Hospitals NHS Trust, London, UK

I had to have an emergency C-section, and my ante-natal classes had been so negative about it that I was absolutely terrified and depressed about the whole experience. In the end it was fine, and the surgeons were so good that my healing time was very, very quick. I still don't understand why anyone would choose to have a C-section over natural birth. But then I haven't experienced all of natural childbirth so who am I to talk? The attitude towards C-sections in our society, however, has made me feel like I 'cheated' somehow.
Claire, London, UK

Both of my children were born by C-section due to their size and I can agree that yes it is very safe, but the recovery time afterwards leaves a lot to be desired. We need to remember this is major surgery and does put extra limitations on the mother. I am three weeks post birth and I cannot go food shopping on my own, or drive the car, etc. These restrictions really do hinder the early weeks of life with your newborn. If there is no medical reason for having a c-section, I really can't see why someone should opt for it. As your article points out, we have many advances in medicine, so women should take advantage of the pain relief options if they desire them.
Sharon, Nailsea, UK

I am a woman who had a medically necessary c/s last year after several normal, natural births. Physically, recovery was far, far more difficult after the c/s. Emotionally and psychologically, I am a wreck. The experience and its consequences made bonding with my child enormously difficult and has almost destroyed my family. I don't know if I will ever recover emotionally - just writing this, almost a year after my c/s, has me sobbing and shaking. Professor Steer may be correct when he describes c/s as "safe" - as long as we define "safe" as "in adequate physical shape" - but this definition fails to take into account the repercussions which affect many women and their families. The lack of comprehension of these other issues does not surprise me - I have spent much of my adult life supporting other women through pregnancy, birth and the early days of parenthood, but I had, and could never have had, no real understanding until I experienced it myself.
Deborah, UK

Isn't there some middle ground between home-birth and C-sections? What about "natural" birth in an hospital - without an invasive anaesthesia (or just an epidural one), but with a medical staff ready to intervene in case something goes wrong?
Marta Maria Casetti, London, UK

I agree with the professor's arguments, but he fails to mention the flip side, the disadvantages of C- section. Also, from a pragmatic point of view, my UK friends found that if in the UK they give birth at home, they are guaranteed the presence of a midwife throughout labour, and two during the actual birth. At the hospital they might well be alone for long periods of time, and only have attendance at the last minute due to staff shortages. So pragmatically it's easier to get a good service from the NHS at home than at the Hospital.
Nadine, Luxembourg/Germany

Having had both a home and hospital birth I would recommend a home birth every time, that is if all is well with the pregnancy. However some people have a very difficult labour and they should not have to go through this if at all possible. I was one of the lucky ones, no intervention at all, not even gas and air. Epidurals had not even been invented then (I am talking early 1970s). Whatever the mother feels is right for her should be adhered to wherever possible.
Jacqueline Elizabeth Murray, Hampshire, UK

I had two sections. My first was an emergency section and went smoothly. My second was a planned section which was advised from the hospital following my first section because my pelvis was too small for natural child birth. I tried for natural with my first so had the experience of labour so don't feel as though I was cheated. Both sections went ok without any problems.
Paula Mchugh, Sheffield, UK

I might be inclined to consider this article had Professor Steer thought to include details on some of the risk factors he claims half of all pregnancies will develop. It's very hard to take him seriously when he puts out a claim like that and does not back it up with evidence. A desire for home or natural birth does not mean turning one's back on technology. Indeed, for the majority of women, that homebirth would be made possible by that technology. During my own pregnancy, I had three ultrasound scans. My baby's heart-rate, position and growth were monitored. My own health was monitored. This was made possible by technology and meant that when I went into labour, I was sure that my baby and I were healthy. Had I not been assured of that by modern technology, I would not have risked a homebirth.
Lara, Cardiff, UK

Thirty years ago I was living in Botswana and due to have my child. The doctor was not happy about the way the child was positioned such that it would probably be an awkward breech birth unless that infant changed his mind and faced in the proper direction. The doctor said that the final decision was up to me but that he recommended Caesarean. He said the child was well developed and recommended extracting him before the anticipated birth date to remove potential complications. So we looked at dates on the calendar. I had a busy schedule including driving round the Kalahari to see my students on their teaching practice. The doctor wanted to do the Caesarean on the Friday the week before the anticipated birth and I said no, I still had a final student to see and it would have to wait until the Saturday. It as useful being able to choose the date and time of birth to fit in with my work. Then about four days later I was out as I wanted to get the newsletter that I published typed up and off to the printer.
Jane, Essex, UK

Whilst I respect Mr Steer's work in the field, I think he has failed to mention the risks with c-section which, when compared to the risks of a normal birth, are much greater. Bleeding, infection, nicking of internal organs, increased secondary infertility, increased risk of retained placenta next birth, increased risk of stillbirth next birth, decrease immune response in neonates... so, really, why are routine sections good???
Mora Toranelli, UK

I have had four babies. Three were natural deliveries with just gas and air and one was a caesarean. None of the births was as bad as I expected, but recovery was quicker after the natural births and the delivery itself felt more dignified. There are so many people involved once a caesarean is required. I don't think any woman should have a caesarean for non medical reasons, but if one is required they should not hesitate. The most important thing is the health of the mother and baby in that pregnancy. Unnecessary surgery is however to be avoided, it is expensive, not as good for the baby's health, affects bonding and can have an impact on future fertility and deliveries.
Mrs M J Wood, Farnborough, UK

Finally someone who isn't going to make me feel like a failure for having a C-section. My section was not planned it was an emergency. I needed it for the safety of my baby and myself and I will always do whatever I can to protect my little girl even if that means moving away from the "natural".
Suzy, Chesterfield, UK

I am thankful for the advances that have been made. Had my son not been delivered via C-section, it is most likely we both would have died. No one would look down on another who had a heart bypass, or even their appendix removed- why should life saving birth intervention be any different? People assume I've missed out on a wonderful experience, I prefer not to miss out on life!
Mrs. Read, Wisbech, UK

When I was pregnant with my first child, I was recommended a C-section as she was breech. I had absolutely no problem with that decision as it was recommended to me by the Midwife and Consultant. However, when I took a tour of my local hospital, it was all about the natural birth, highlighting the birthing pool etc. When I asked about C-Sections, the nurse showing us round, turned around and said "Oh, you are one of those!!" Therefore in my opinion, the midwives, doctors and so on, need to be as informed, as us, the patients, and provide us with a honest and realistic approach to childbirth, as I know many people who have wanted the natural method but then gone in for a emergency C-Section for one reason and another. Also the media should stop promoting the "Too proud to push" brigade as there are many medical reasons why women have to have C-section. Let the choice be informed!!
Clare, UK

If I had not had an emergency C-section, my child and I would certainly have died. I believe if the skill and the knowledge is there, it should be embraced and not frowned upon. My son is no less of a person for the way he was delivered and I am certainly no less of a mother.
Sue, Stockport, UK

I am a midwife working in West Sussex and I fully support women's choice in mode of delivery, regardless of whether I agree with that choice. I feel it is vital that women are making informed decisions, however fear of labour and vaginal birth often fuels the caesarean option, which saddens me. Yes surgical delivery is relatively safe but it is also statistically much more dangerous for mother and baby than a vaginal birth. I think it's important for us in midwifery and obstetrics to focus on what circumstances lead to increased risk of caesarean and try to reduce them. This is not just for the mother and child's welfare for the current pregnancy but also for subsequent pregnancies as a previous caesarean makes it much more risky.
Sally Harborow, Brighton, UK

My wife had a c-section even though she was cajoled towards trying for a "natural" birth while being advised that she should prepare herself for an 'emergency' c-section as the baby had not descended. We both pushed for an elective c-section which duly happened. It was the most natural and peaceful birth imaginable. Safe, and our baby daughter opened her eyes, no cries, just an easy way to enter the world. Other babies born "naturally" on the ward had bruises round their heads from forceps and cried all night because they were obviously in pain. Let's not romanticise the cards dealt out by evolution to women that resulted in so many mothers and babies dying in the past. Instead we should applaud the advances in health care that have produced lower and lower mortality rates throughout the 20th century.
Liam Parker, Edinburgh, UK

My husband and I wanted a home birth with our first child. The hospital said no, not with a first delivery. Complications during labour meant an emergency C-section. Both myself and our beautiful daughter could have died had we been at home. I myself was born by C-section, and my mother considered herself a failure, and on the day my child was born made it clear she thought I was one too. But we had a beautiful healthy little girl. I knew I was no failure. I gave birth to two beautiful daughters by C-section. Now the mother of two young women, who have yet to have babies themselves, I tell pregnant women just how silly it is to think they are a failure because they have a c-section, that the miracle of their little baby proves they are not a failure.
Liz, UK



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