AIBU to think we shouldn’t worry about an increase in c-sections?

[PancakeCloud]

I came across an instagram post earlier where someone had shared data indicating the UK’s c-section rates have increased significantly in the last five or so years. The commenters almost universally consider this to be ‘tragic’ and think it is ‘so so sad’ that some women are electing to deliver via section. There are also a whole bunch of commenters who think if only women were properly informed they would push for a natural birth even if drs are recommending inductions etc.

I accept the UK’s maternity system is under strain and needs improvement, but really isn’t the point that we have healthy mothers and babies not that women give birth via one method or another.

There are downsides of attempted vaginal births, because of course not all of them go to plan! There is an increased risk of severe birth trauma or hypoxic brain injury to baby vs choosing a c section. For women, tears and pelvic floor injury are very common. While C-sections come with their own risks, these are well known and often presented without acknowledgement that vaginal births have downsides too.

For the NHS I understand planned c sections are cheaper than other births, given so many of them end in emergency sections anyway and because of payouts when things go horribly wrong.

Are we not looking at this all wrong? The goal should be healthy mothers and babies irrespective of how those babies get out. Why are people so fixated on reducing the c section rate?

The risk rate of C-section is very distorted versus attempted VBs (including EMCS), because the risks of a VB drop significantly after a first birth whilst the risks of an CS increase with every CS.

In an era where women are having children older and are having far fewer children this is relevant.

If you are not likely to have more than one child then again a CS compares much more favourably because the pattern of risk build up versus method is vastly different to previous eras when women were having 5 or 6 or more children.

I think hospital culture plays a huge part.

When I had my third child I lived in a new, smaller place, and the practice I was at, which included the head ob obstetrics at the hospital, had very few vaginal births. And my sense from talking to the other mothers was that they were being told it was an emergency, or in a few cases had been told the baby was too large even before they went into labour - their babies were in fact normal sized. The doctor there was extremely rude and dismissive to me in hospital when I (very politely) asked if they could give me a differernt painkiller next time as what they had given me gave me bed spins.

The other hospital I gave birth at was much differernt, even though at the time their c-section rate was considered to be higher than was ideal.

The number of inventions are significantly different. By place of birth.

Yes I know lots. Giving birth is hard, but I don’t think it should just be something the first world stops doing, that doesn’t feel like healthcare.

They are often not well managed either. Too little encouragement in many places to do things like walk around.

Farmers would never manage dogs or horses or cows, or even rabbits, the way women are managed.

I chose my two c sections - though I do have a phobia of childbirth so it was either that or not have children for me.

Like many people, I know very few who had an 'easy' vaginal birth. My friends births range from the deeply unpleasant to the life threatening. All coming with a heavy dose of trauma. Very few of them can talk in a positive way about the births because of how traumatic they were. My births, by contrast, were absolutely amazing and pain free.

To me it was easy. No agonising pain for hours or days. No tearing or cutting open my most sensitive parts - potentially without pain relief. Just controlled, pain free surgery. But so what if it is easier, no one gets an award for being brave!

Oh, and the claim often made that you don't notice the tearing isn't reassuring at all - you mean your in so much agony that your labia splitting doesn't register. Great...

Recovery was quick and largely pain free, and back to normal within days. Frankly, my average period is worse than my c section recovery. I was the last to give birth in my NCT, but the most physically recovered when we met a week or so later. Also the only one to have an elective section.

They aren't for everyone, but for me, they were amazing. To meet my children when not exhausted, and I'm no pain, in a calm and happy environment was breathtaking.

I had an excruciatingly painful back to back 'natural' birth, a failed induction - baby was breech and nobody believed me until just before they broke my waters - my trust does not recommend induction for breech babies so I ended up with a semi-emergency section, and an elective section so I have tried all the options. The elective C-section involved the least pain, shortest recovery and most relaxing experience of birth.

With my last baby I requested an elective C-section partly because I wanted to be sure there would be staff there for the process! So many stories of overstretched midwives trying to care for several labouring women at once and I didn't want to be left to monitor myself - I wanted expertise!

I was so glad I did and I definitely made the right choice for me - I was home the next day, driving within 2 weeks and hosted a friend and her family for lunch 10 days post partum where all we could talk about was how easy I had found it and how little pain I was in! And I was 10.years older than when I had my first, so I was expecting to feel a lot worse, but I would recommend a C-section to anyone who asked based on my experience.

I was in labour for a little under 40 hours and they had to perform a csection. My scar is so far down as I had gone through full on labour but the baby could not basically get out of my vagina having come a natural way through the birth canal. The option was fairly simple at this point, have a section or allow my baby to die inside me. My worries about a live child far surpass other peoples worries about how other people give birth to healthy children.

Why do you think this is anti-scientific?

It's obviously not a sure thing, but that is basically how natural selection works. If mothers with poor anatomy, or babies with giant heads, tend to survive now where before they would not have, those traits could be passed on or even increase.

The timeline would likely be significant but it's not a weird concept.

Why do you think it isn't? It would be in any other area of medicine if the reasons weren't clear reflections of a change in practice. Such as a new study for example.

Is it because of some change in health? Is it because of creeping changes in perception of risk? Because doctors are less experienced? Driven by insurance? Because women feel they need to plan leave from work? Because they are emotionally struggling with the nature of a natural process where they don't have the perception of total control? Is it because birth management is poor, or interventions like induction are being used inappropriately?

Many of those aren't neutral things.

That’s amazing you stuck to your guns.
Why did they want to do a CS?
Were you not concerned about oxygen deprivation?
I ask this as for my first we were to have an emergency CS but no one turned up (9 months after a snow day..) and the midwife realised luckily and the only way was to push from 9cm dilation.
Thankfully he’s fine- but he was 3/10 on the Apgar and was blue when he was born.

This. A neighboring hospital has recently become a centre for placenta accreta spectrum and the rate has risen due to a number of factors including c section rate increasing. Many if the women who we refer there didn't know that this was a risk with a section.

I know what you mean OP, most people would agree that all women should have the option/choice to have a cs, but if everyone makes that choice then it's wrong somehow. That doesn't make sense, if it's a good option then why shouldn't lots of people choose it.

is this a genuine question? Surgery is not for funsies, surgery should only ever be if theres a valid medical reason for better health outcomes than not having surgery, and yes of course I bloody well think mental health is relevant here. Higher rates of surgery have a societal cost as well as the individuals recovery time, do you like your nhs wait times for surgery? We also need to keep researching on this, it is not understood the significance of the birthing process on the babies development but it does seem like the squeezing process and exposure to mums bacteria are not irrelevant to the baby. No I am not for a minute saying that c section babies are less healthy, but it is clearly a very complex process and more understanding would be better.

My circumstances are very similar to you! They really pushed for induction, really stressing the risk of baby being stillborn.

At 40 weeks pregnant, with a years awaited pregnancy, I didn't feel I could say no. The induction was a disaster, resulting in emergency c section.

You have to recover from major surgery almost instantly. Straight into child care and lifting after a few hours (husband not allowed to stay overnight). I was home the next day after being in hospital the previous 6 days.

I'm just glad my baby is here and healthy.

Haven’t read the full thread as there was a similar one VERY recently.

I’m not yet pregnant and I already know I will be having an elective c-section. Why on earth wouldn’t I? I have no interest in tearing my vagina and all the other indignities of labour. That’s my prerogative and I don’t give anyone else’s opinion a moment’s thought.

Of course the increasing rate is not a cause for concern. People’s objections are often just thinly veiled misogyny, frankly. Heaven forbid there are medical options and advances that give women choice over their bodies.

We shouldn’t ‘worry’ but we should note because we know there are risks to c-section, including placenta acreta and placenta praevia in subsequent pregnancies, the potential rise in the development of food allergies.. It is not that vaginal birth or c-section is better, it is that they both carry different risk profiles and this should be discussed on an individual basis with women so they can make choices according to their own needs, plans and wants.

Expecting a first child in your 40’s, planning to be one and done, worried about placental deterioration in older mothers and want the safest mode of birth for your baby in that instance then an elective c section may just be for you
Know you want a large family, strong family history of atopy? Perhaps vaginal birth is your preferred option.

We should be talking about ways to mitigate risks in both cases; out of obstetric unit birth maximises vaginal birth chances without increasing risk to baby or mother, seeding baby with your microbiome mitigates the risk of food allergies with c-section potentially.

Being aware of the rise in c sections enables us to anticipate certain needs eg (we may reduce neonatal hypoxia admissions but need more specialist sonographers for the rise in acreta) and it enables us to consider resources. We also should always ask why when things change. Does the rise in. C section indicate a rise in maternal choice or a rise in large babies or breech or fetal growth restriction or general maternity understaffing?
we should always wonder what is going on? Is this a good thing or a bad thing or a neutral thing.

I've spoken about this a lot on MN over the years and in recent years attitudes to this have been a lot better than they were but this thread is throwing up some of the worst ignorant and sexist tropes.

Women centred care absolutely is about ensuring each individual woman gets the right information for their circumstances.

I've always said an ELCS by maternal choice is not necessarily the right choice for a woman in her 20s who wants a large family but a woman in her late thirties, wanting a single child is a very different prospect.

As a rule middle aged, educated women in their late thirties and counties have significantly better health outcomes across the board in all other areas of medicine because they are well informed and have researched thoroughly and can advocate well for themselves. Yet this knowledge goes out the window when it comes to being pregnant. Suddenly women are infantilised as being somehow unable to get the right information about the subject.

Having a first baby later in life is well known to be a risk factor in birth outcomes. Given that we have clear data that women are giving birth for the first at an older age and with more complex medical histories, we should not be remotely surprised that rates have increased.

What pisses me off is the focus that is given to ELCS over and above concerns over an increase in EMCS rates. This is driven by sexist attitudes. An EMCS carries the highest risk of all and is a lot more expensive and difficult to manage than an ELCS. This means the lives of women and babies are more at risk. If we are serious about improving this we need to have more generalised discussions about women's underlying health and when they decide to have a family rather than wanging on about how money is being 'wasted' by ELCS.

This whole crap about wanting to fit in an ELCS to a schedule is absolutely not reflective of the actual reasons women have for wanting an ELCS. It's frankly insulting to drag that sexist trope back out of the rubbish bin where I thought it has been consigned a decade ago with more education on the subject.

As for birth fear. This is a recognised medical condition. It has been described as distinct and having particular characteristics rather than 'women just being a bit scared' since the mid 1800s. It's not a new phenomenon. Again this pisses me off because these renewed calls for 'a review' never ever acknowledge this. There are NHS specialists for this. There is primary and secondary tokophobia which have different patterns of presentation and concern. The latter is closely linked to a previous birth trauma. And women in this group behave differently to the former. If they are signed off early for an ELCS, thoroughly emotionally supported and are able to build up trust with HCP then if helped to build a robust birth plan they are far more likely to change their minds freely and attempt a VB. Of course enabling this requires sufficient resources that no one wants to talk about and ensure. It's expensive. And yeah we already have dickheads saying we shouldn't spend money on giving birth and we should just do it as cheaply as possible... Which is often a cause of birth trauma in the first fucking place. It's likely a vicious circle in terms of mentality.

As for primary tokophobia. This group are older, having delayed getting pregnant, they are much more likely to want fewer children, they have a massive over representation of having a history of sexual abuse, they are more likely to have histories of mental health issues and clinical anxiety and they are generally well informed. This has shown up in research. Research has also shown that women with high levels of anxiety are far more likely to end up with poorer maternal outcomes - in other words if they are forced to attempt a VB the chances of them ending up with significant intervention and birth injury or an EMCS is almost self fulfilling because of the nature of giving birth being so closely related to women's mental health - this is a psychological link. Yet we are still stuck in this dated mentality that giving birth is purely mechanical and women's health generally is some how disconnected to their mental well-being. It's infuriating.

The concerns here should be about the wider and more general state of maternity care which is fucking shocking. Have we not got enough maternity scandals to illustrate the point yet? Maternity needs funding rather than penny pinching fuckwits bellowing about costs when they haven't the slightest fucking clue and they certainly haven't bothered to look at what NICE say on the matter. That's the same NICE who write guidelines which includes analysis of cost effectiveness; if they say it's cost effective to have ELCS on maternal request (which is often extremely likely to be for mental health related reasons) then it's cost effective.

I struggle with the fact that 15 years after these guidelines were first published we are STILL returning to this ignorance and a lack of recognition of maternal mental health issues and a problem with funding maternity care adequately in the first fucking place.

The costs of childbirth going wrong are the biggest single insurance liability to the NHS both in terms of actual money and the number of cases. You'd think this would make improving maternity the single biggest priority for clinical standards but no. We are still battling dinosaurs who think women should put up, shut up and not advocate for themselves and are too stupid to be informed on the subject despite all evidence to the contrary in just about every area.

When it comes to health every dickhead has to have an opinion on giving birth. No one gives a shit in the same way about any other area of health care. It's politicised and driven by ideology in a way that no other area of health care is. Clinical evidence and research is just chucked in the bin because dickheads seem to think they know better.

I really thought in 2026 we'd moved on since 2009. Clearly we haven't.

Maybe just rebuild trust in maternity services and invest in it rather than spouting off about CS rates. These concerns would largely resolve themselves without having all this judgement placed on women if we just had the political will to enable this.

Instead maternity services just get hot air and no action. Nothing changes despite independent report after independent report.

This isn't as difficult as it's made out. No one wants to take the matter seriously though. There's always something else which is a priority.

I suspect also because there are too few midwives, which mean less homebirths (and less choice).

Hospital births by their very nature lead to more interventions which result in more c-sections.

CS is a major surgery with major risks. Not the easy option.

I would choose a c section any day.
Vaginal births can be excruciatingly painful with dreadful side effects.

It’s six of one, half a dozen of another.

One of my sisters had two c sections - one was “emergency” in that she was being induced, had the epidural and then needed it, but not a general anaesthetic go go go situation. The second was elective. She found recovery from the elective section harder than the emergency.

The other had two vaginal births. The first was fine, the second has left her with huge complications that she needs surgery for.

Ive had both VB and c section. C section was for medical purposes, prem baby not growing properly. Vb involved forceps & episiotomy but it was not really bad and I recovered quickly.

I didn't really like the c section, I felt out of control and I took longer to recover.

Nope. That’s already happening because people aren’t dying in childbirth. That’s how evolution works. Someone has to not make it to pass on their genes. Unless you suggest letting women and their babies die if their childbirth is going wrong. But I think that might be a bit extreme. If child birth isn’t working we move one to emergency sections. Those babies that make it pass on there genes so there is not natural selection regarding childbirth anymore.

My biggest issue with the VB is they wanted to monitor constantly so were making me lie in bed.

Its an awful position to deliver a baby so no wonder I just couldn't get him out which led to interventions! I needed/wanted to squat or be on all fours. There should be more training on birth positions. Being in a bed doesn't work.

If understaffing is a concern then major abdominal surgery is hardly any safer!