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Last Updated: Tuesday, 4 May, 2004, 10:57 GMT 11:57 UK
Should Caesarean deliveries be restricted?

The National Institute for Clinical Excellence (NICE) has issued guidelines saying that pregnant women should be discouraged from having a Caesarean delivery if they do not need one.

Around 1.5% of all births in England and Wales are currently Caesareans carried out for non-medical reasons.

The government body says that women must be told about the risks and benefits of different ways of having a baby.

However, doctors would ultimately have to allow a woman to choose how she gives birth.

Should access to Caesarean operations be restricted? What can be done to give more support to women giving birth? Tell us what you think.


This debate is now closed. Read your comments below.

The following comments reflect the balance of the opinion we have received:

SUGGEST A DEBATE
This topic was suggested by Donna Chisholm, Staffs, UK
Should Caesarean operations be available on demand?

I'd like to see 'CJ' endure a 30 hour labour and then come back and tell me women have a lower pain threshold.
CJ, Lancashire, England

Like many great men I was born by caesarean section. This was because of medical need and not because my mother was trying to escape pain without understanding the implications for her later life.
Huw Evans, Ipswich, UK

Come on ladies don't be so selfish
James, Dorset, UK
Take, take, take. Mothers get maternity pay, child benefits, flexible working hours and now they want to waste hospital money and resources, so they can skip the żgrotty' part of becoming a parent. Come on ladies don't be so selfish.
James, Dorset, UK

I had a "natural" birth which took over 24 hours. In the end my daughter became distressed and had to be delivered quickly with assistance - with the result that I have suffered with a variety of embarrassing problems ever since and the first month after my daughter's birth was a nightmare as I lost a lot of blood. I also feel that I lost the opportunity to make the maternal bond with my daughter because the birth was so traumatic and I was so exhausted. I had been told I would be unlikely to be able to have a natural delivery due to my height (just under 5 feet), yet I wasn't given the chance of a caesarean - if I had been offered one, I would've taken it - the whole experience would've been much better for both myself and my daughter.
Jane Smith, Insch, Aberdeenshire

I had a caesarean birth and now I needed another one for my second child. I believe it is safer for my baby.
Susan, London

There are too many midwives who believe pain is a good thing
Howard Mckee, Buxton, Derbyshire, UK
The medical profession must share a large portion of the blame, due to their reluctance to offer adequate pain relief for vaginal births. My wife asked for pethidine, it was late coming, and she was told it was too late for an effective dose. There are too many midwives who believe pain is a good thing.
Howard Mckee, Buxton, Derbyshire, UK

I think that if the Caesarean was good enough for Caesar, it is good enough for everyone else. Let's not be elitist.
GeTonya Niez, London, UK

Can we get this into perspective here? 1.5% is a tiny proportion! 98.5% of pregnant women either have 'natural' deliveries or caesareans for medical reasons. I think that further investigation of the 1.5% would show that the vast majority of those women are just plain terrified of natural childbirth for some reason. Isn't this a good reason for allowing someone to choose an option which won't add more stress to an already stressful time?
Maria, UK

A woman here in America was charged with murder after she refused to have a Caesarean and gave birth to twins; one dead one alive. She is poor, drug addicted, mentally ill, alone and afraid. She was charged with a crime for her choice. Our choices are part of our humanity and sometimes we make good choices and sometimes we don't. But it still should remain a choice because it is the individual that will remember their choice forever.
Kevin, CA., USA

The decision ultimately belongs to the woman
Daryl McCormick, Redondo Beach, California, USA
The decision ultimately belongs to the woman. The health ramifications are obviously known to the good physician who communicates them well (it can be argued that the good doctor can convince her out of that choice). Forcing this decision on the woman tells more about the MD's lack of faith in his patient, than her ability to make the right decision for her and her baby -- again, presupposing both sides of the equation are communicated.
Daryl McCormick, Redondo Beach, California, USA

The sad, inescapable truth is that c-sections have to be paid for, and the pot that pays for them is not bottomless. Hospitals now have to make hard, emotional decisions. If we have c-sections, we have less of something else. Elective C-sections are not a right, but should be used when there is the slightest doubt about safety. Emergency C-sections saved the lives of both of my children, long may they be used judiciously.
,

I had a caesarean birth with my daughter. This was not elective - her position in the womb was such that I could not have delivered her naturally, and attempts to turn her failed. So in my case the surgery was a necessity. However, I've since been subject to comments from so-called friends that I took the "easy" way out (nope, I have a 10-inch, raised scar on my stomach and have only just, 2 1/2 years later, regained full sensation) and should have been made to have a natural birth. In this day and age, it is all about choice. Expectant parents should be given full information on both options to enable them to make a decision. Given the chance, I would have preferred a natural birth but hey, the best outcome of all is a happy mother and live child - and if this means a caesarean, so be it.
Sian Evans, Wales

Easy does not mean the same as sensible
Sam Fish, Blackpool
When I was pregnant with twins, I was encouraged to agree to a Caesarean to make it simpler. I was adamant that I wanted to avoid a C-section as the idea of coping with surgery and the subsequent discomfort and lack of mobility AND twins seemed ridiculous. During my labour I was asked twice to consent to a C-section, and although I had an epidural, (just in case it was necessary) I was insistent that I would only have one if either baby or I were in serious difficulty. Due to the excellent care of the midwives, I was able to deliver both normally and also able to take care of them afterward with only the usual discomfort that follows childbirth. Mothers expecting multiple babies are all too frequently told that a C-section is easier. Easy does not mean the same as sensible, and while this may be less traumatic in the moment, it isn't the easy option, not when faced with the recovery period and the baby as well.
Sam Fish, Blackpool

CK (below) is wrong in fact women's brains release hormones to keep them awake during labour, men would pass out. I am appalled by some of the misogynistic attitudes women are still subjected to in the UK. Most of this debate centres around women bashing whereas in reality the main problem is doctors' attitudes and a chronic lack of midwives. For some time I have been watching the birth debate in the UK and it has seriously put me off having a child there.
Maureen, Paris

I believe expectant mothers think a caesarean is the easy opinion. It is not. The after caesarean pain is unbearable and you are unable to move at all. You need constant help with feeding and you will not be able to hold your baby due to the pain - this was my experience and would not suggest it - note I am also aware of the pain of natural child birth.
Laura Goggin-Watson, Liverpool

Women should not suffer from the spurious drive towards demedicalisation
Anon, UK
Our daughter died in our arms two months ago because the midwifes failed to realise that she was a footling breech - she suffocated during final delivery, causing massive brain damage. She died two days later after we asked for her to be taken off the ventilator. The Hospital has confirmed that a caesarean would have saved her. Those who preach against caesareans need to be very careful that women who need them always get them and that women should not suffer from the spurious drive towards demedicalisation. My wife and I wanted to look after our child - We now have nothing but some photos and a grave.
Anon, UK

There should be far fewer "unnatural births" and these should only be for cases where mother or child are at risk. Why not provide more facilities for water births which seem to assist far more than a drugs cocktail or surgery.
Tony, UK

This just proves that women's threshold of pain is a lot less than men's.
CJ, UK

I can't abide the scaremongering, mud slinging and endless debate
Lisa, Neuchatel, Switzerland
As my gynaecologist reminded me, giving birth is one small moment in a lifetime of hopefully healthy children. I had 3 c-sections, the first due to complications and the others by choice. I can't abide the scaremongering, mud slinging and endless debate about what's right and what's wrong. We seem to forget that a healthy child and a healthy mother are the only outcomes which matter. Enforcing statistics is ridiculous. It's not a competition between women being in some way 'better' for having a natural birth than those who have medical intervention, for whatever reason!
Lisa, Neuchatel, Switzerland

I was born by c-section, as were both my brothers, I don't feel that I have been denied a birth right, I'm just grateful that My mum and I both pulled through it without the procedure neither of us would. They are necessary and no woman should be made to feel bad because they have chosen to go this route.
Alison, Nottingham

The fear of litigation unfortunately plays a large part in this
Rebecca Cochrane, Towcester, UK
The fear of litigation unfortunately plays a large part in this. A friend of mine who had an emergency C-section for her first child was told that her consultant would not support a decision by her to opt for a natural birth for the second child. She then employed an independent midwife who helped her deliver her baby naturally; a shame the NHS were too scared of being sued to allow this to happen. They need to change their approach if they want to meet these targets, not change the women coming to them!
Rebecca Cochrane, Towcester, UK

Since when has the patient decided their treatment? Even doctors don't do that to themselves. The whole thing is ridiculous, if you are not ill, you do not undergo operations. I am not even sure that it's right for people to be given the choice to opt for a caesarean privately.
Martin C, London UK

My faith in humanity is restored through reading all the replies here. It is a woman's right to decide what is best for her and her baby, ultimately, and not the government telling doctors what to enforce.
Anon, UK

I wonder if they factor in the additional costs for some of those who give birth naturally, including surgery for incontinence etc??
Emma, UK

Childbirth can be an incredibly painful, terrifying and humiliating time for women. Anything that can be done to help this has to be a good thing, and this includes the right to an elective caesarean. Women are meant to have choices remember.
Emily, Halifax

I suspect this debate might be a little different if men has to give birth. I think choice is the name of the game, women should be allowed the right without the pressure.
Jonathan, London UK

We need full funding for midwife-led fully supportive care
Leanne, Newcastle, UK
There are too many caesarean births in this country, but the tone of today's coverage has focused responsibility for that onto women giving birth. In fact, women opting to have a caesarean without medical cause make up a tiny percentage of c-section deliveries. Far more c-sections happen because over-medicalised labour is encouraged by the UK medical system. It is too easy for doctors to encourage women to have emergency caesareans rather than the alternative. We need full funding for midwife-led fully supportive care. Women who feel in control of the delivery process are far less likely to need an emergency caesarean. Far from being a sign of women making the "wrong" choices, increasing c-section rates reflect women's inability to make their own choices, in a supportive environment.
Leanne, Newcastle, UK

Absolutely not and anyone who thinks that choosing a caesarean is because of current fashion should go and give birth naturally in a third world country and see how long they last!
Paul Hart, Droitiwch, UK

I think the focus on the 1.5% of women who have caesareans for non-medical reasons is misplaced. More time should be spent investigating and dealing with the cases where women were unnecessarily given caesareans by over zealous and overly litigation-neurotic doctors.
Sarah Arnell, Aberdeen, Scotland

For the sake of the baby I believe sections should be done for valid medical reasons only
Amanda , Luton
Please could we remember that birth is a natural process and the method by which it occurs has a certain biological function. I work in a special care unit and see many babies who are admitted with breathing difficulties post c-section as a result of "wet" lungs. The birthing process would naturally squeeze the fluid from the lungs, this does not happen with a section. For the sake of the baby I believe sections should be done for valid medical reasons only.
Amanda , Luton

I think all this information abut why Caesarean's should be discouraged does not help people who are about to give birth. I am due to give birth in a couple of months and due to a previous operations I have to have a Caesarean, and I am being made to feel that it is a terrible thing and that everyone will suffer because of this.
Elly, Reading

This is women's business and perhaps the best reason why Midwives should take a primary role and why Doctors should take a back seat until called in to assist.
Tim Rollinson, Tonbridge, UK

it is a drain on the NHS, one which this country cannot afford
Tracy, Hudds, UK
Having had an emergency Caesarean myself I cannot imagine why any right minded woman would choose to go through the pain and lengthy recovery period required after what is a serious operation. Having been told I cannot give birth naturally I opted not to have any more children for this reason alone. Not only is it more dangerous to both mother and baby to have a section, it is a drain on the NHS, one which this country cannot afford.
Tracy, Hudds, UK

My first child was eventually delivered by forceps and the after care was awful. My second was an elective Caesarean due to the lasting trauma and damage of the first experience. I should have had a Caesarean each time. They are a joy compared with a bad birth. My life since would have been so different. (12 years now)
Jen, Lothian

This is nothing more than a government attempt to reduce health-service costs by reducing patient-choice. NICE is supposedly 'independent' but their recommendations will always be bent to support the will of their government paymasters.
David Moran, Nr. Aberdeen, Scotland

As a granny, can I say that in the 1970's Caesareans were certainly not elective, I for one wish they had been. Perhaps we older ladies wouldn't have to suffer now with incontinence, prolapsed etc from those botched natural births dished out at factory style maternity wards. Give mothers all the facts and all the choices. It's 2004 for goodness sake.
Cath, Sussex

My partner delivered our first child on Sunday, and although she was induced, she gave birth to him naturally, despite being very worried about it. She was adamant that she wanted to avoid a C-section at all costs due to the long recovery time etc. She is home now and recovering well, and does not regret in the slightest going for the natural birth.
Robert Harding, Hockley, UK

I think the main reason for women electing for a caesarean is fear. We are always being told that first labours are longer. This is rubbish as my first was 3 and a half hours. We hear little about good experiences of childbirth and I actually joked that I would rather go through childbirth any day than have a tooth pulled out at the dentist (I was high as kite on gas and air at the time though!).
Wendy, UK

I had to have my son by emergency Caesarean. Luckily, we both survived the experience. I would have much preferred to have him 'naturally'. I didn't get a chance to hold or even see my son straight after birth. I feel that I have missed one of life's best things, and it does hurt listening to other women sharing birth experiences.
Christine, Wark

The thought of having a Caesarean terrifies me even more than the trauma of the first birth
Kirsty, Bucks
I am a mother of one who had a dreadful natural birth but I am now expecting a second child and the thought of having a Caesarean terrifies me even more than the trauma of the first birth. The last thing I want is major abdominal surgery for no good reason. I am all in favour of it if it is for medical reasons and the doctors recommend, after all they are the experts but I don't agree with being able to pay for it like so many other commodities.
Kirsty, Bucks

One day Caesarean delivery will be the norm. Why should childbirth be painful? Nobody would expect anyone to have a surgical operation, routine, emergency or cosmetic, without an anaesthetic. Why should childbirth be any different?
John M, Lyne Meads, UK

I am deeply sceptical about this recent report, what qualifies as 'non-medical' anyway? As an expectant mother I can honestly say that the thought of extremely invasive surgery, which can take a huge amount of time to recover from is the last thing on my mind, and probably the majority of people's. It is also patronising to think that today's woman is not intelligent enough to have looked in to and understand the risks and benefits of ALL methods of child-birth and pain relief. The benefits of living in a modern and enlightened society is the right to choose.
Heather, Colchester, UK

It seems that in some busy hospitals, doctors feel the need to push labours along artificially - thus increasing the likelihood of a woman then needing a Caesarean. I suspect that this factor contributes more greatly to the statistics than the 1.5% non-medical rate. We need more good midwives.
Monica, London

External manipulation to attempt to position the baby correctly for a natural birth also comes with its own serious risks and the decision to undergo this procedure should not be taken lightly either. Believe me, after a failed attempt on my last child, this is not a pleasant procedure and not an easy option. Having had one baby naturally and one by elective-C section, I would opt for a natural birth without hesitation.
Kathryn, Pontypridd, Wales

It's the fear of being left alone and the liability of the hospital to correct any problems during labour
Magdalene Heppel, London
I had my first child naturally, but he died shortly after birth due to complications. There were very few staff available on that night and as a consequence there wasn't an option of an emergency caesarean section. I have had two more children, both by Caesarean because of what happened with my son. I would never say the C-section births are unnecessary, but that many women are concerned, as I was, that having someone there with you throughout labour is only available privately or at an exceptionally well-equipped hospital. It's the fear of being left alone and the liability of the hospital to correct any problems during labour that will have many women reaching to sign the consent form.
Magdalene Heppel, London

The reason I requested a Caesarean for my second child was that the care for the first natural birth was so appalling (due to staff shortages, shift changes) that I was traumatised, had repeated nightmares about childbirth and would have sold my house to fund a C-section to make sure I never went through that again.
Susan S, Horsham, UK

I think many obstetricians would agree that too many Caesarean sections are performed. However, another news story today, about NHS trusts' financial problems, lists negligence claims as a major financial drain. It is much easier to be accused of negligence for what is not done rather than what is done, so any attempts to impose restrictions on Caesareans will squeeze the obstetrician even tighter between the rock and the hard place. Will courts hearing negligence claims pay any attention to such restrictions?
Jon G, Huddersfield

C-sections should be for emergencies only except in cases of potential psychological trauma. Sadly not only the too-posh-to-push trend but also the me-me focus which seems firmly established today is represented by demands for Caesareans, indicating all too clearly that we have become an unhealthily self-possessed society. The understandable desire of a mother to avoid pain and to keep her vagina tight should not cheat the unborn child from its right of passage - natural birth.
Andrea Hargreaves, Seaford

I was born by emergency Caesarean and my wife also had to have a Caesarean because our baby was sitting upright in her womb and refused to move down even up to his due date. We are very grateful for a successful operation and a healthy child. It was the only option and my wife suffered a long and slow recovery process afterwards. She is determined to go for natural labour if possible next time. I totally agree that Caesareans should only be done for medical reasons. But I also feel it is extremely unfair for people to pass judgement on those who have had a Caesarean and immediately assume that they are lazy, snobbish or lack motherly love.
S. Yang, London, England

The operation is intended as a last resort
Adrian, Cardiff, UK
I think there should be restrictions on Caesareans, the same as any other surgical procedure. Unnecessary surgery is a drain on resources and a needless risk to the patient(s). The operation is intended as a last resort, and with good reason. It should not be used as a short term convenience.
Adrian, Cardiff, UK

As a mother of one who gave birth in Bangkok, I was extremely impressed with my hospital's approach - basically that I was the customer and it was my right to decide. Having a Caesarean has in no way detracted from the bonding I have with my child, or caused him any undue distress (if anything, I would say the reverse was true, when he arrived he was a very relaxed little boy, and has been ever since). Therefore I am unclear what the real motivation is behind trying to restrict Caesareans - financial perhaps???
Debbie Watkins, Phnom Penh, Cambodia

I think a Caesarean should only be given for medical reasons. Women are designed to give birth naturally, and there are enough pain killers for a woman to give birth the way they were meant to. However I am totally in favour of a C-section for medical reasons.
Michelle, Colchester, Essex

My first child was an emergency Caesarean - but due to a small pelvis, I had to have Caesareans for my other 2 children. I think they should only do a Caesarean in such cases and not because it's fashionable.
Toni Bradshaw, Storrington, West Sussex

Having experienced four children born at home here in Holland and with the deepest respect to my wife for all the pain she went through to give me these wonderful gifts in life, the wonder of a natural birth to those who can have one is a blessing. As a woman my wife admits that she would rather have a natural birth rather than a Caesarean delivery.
Lyndon Patrick Berchy, Edam, The Netherlands

Ultimately it should be her decision on how she gives birth to her child
Andy Roberts, Southend-on-Sea, Essex
I think as long as a woman has all the options available to her, ultimately it should be her decision on how she gives birth to her child. There should be no medical intervention on this whatsoever, unless there is evidence that a certain method of childbirth could harm the mother or the unborn child.
Andy Roberts, Southend-on-Sea, Essex

Woman should be allowed to give birth how they choose. This is something that only a woman does and only a woman knows. It is scary, painful and beautiful all at the same time. More support is required if fewer women are to have the C-section but as they have said that is unlikely to happen because of shortages. Maybe it is about time pregnancy and delivery and the well being of the mother and child were given a higher priority within the NHS. I, for one, had two natural deliveries. One with support and one without. Without the support I was nearly made to have all sorts of interventions but my determination won out. With the support my delivery and recovery was cut to a fifth!
Deb, UK

Giving birth is a natural process. Given that some medical assistance is advisable (anaesthesia, monitoring etc) there is no reason why a Caesarean section should be performed unless there are good medical reasons.
Carole, Bristol, UK

What is needed is for professionals to listen more to women
Julie, Stockton
During my last pregnancy I had problems with my hips so severe I could barely manage to walk 100m with crutches. I asked for a Caesarean and had to battle to get one. Due to previous guidelines similar to this I was refused. Eventually it was so bad there was no choice and my baby was delivered by Caesarean. What is needed is for professionals to listen more to women, to let them have more control over their labour and pregnancy. The natural, drug free labour is not ideal for every woman. They should be given information and advice but at the end of the day it should be realised it's their choice and their body and baby.
Julie, Stockton

My wife had a scheduled Caesarean because our daughter was breech posterior (upside down AND back to front). She would like to have tried for a normal delivery, but was advised against it. There seems to be a perception in society (encouraged by the media) that ALL sections are unnecessary, this is not the case.
John, Borehamwood, UK

I have had two Caesareans, the first being an emergency after 22 hours of labour. My second birth was an elective Caesarean and was a walk in the park. It is definitely the easier option. I think that there is a lot of scaremongering in the press about the after effects of the Caesarean, particularly the pain and discomfort you experience. They give you very effective pain killers for a couple of weeks afterwards and I had no problem with this. However, while I am very glad I had my C-sections, I don't think that women should be allowed to have one unless there are medical reasons to do so. It is purely a selfish decision on the part of the mother.
Felicity, Northampton, UK

Caesareans are still major operations and should not be considered lightly. I am all for allowing women to choose how they give birth but surely these operations are more expensive, for the already overstretched health system, than natural child birth. Women have been having children for years and with all the new medical equipment now available - it is now the safest time for child-bearing. These operations should be on a need basis and not simply for women who are "too posh to push".
Anon, Kent




SEE ALSO:
Caesareans 'must be discouraged'
28 Apr 04  |  Health


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