"sabire who decides (after the fact) that the surgery was 'avoidable'? For which women? As you say, the doctor/midwife will weigh up individual risk/benefit.. they make the decisions they do based on their interpretation of that."
Umm, and who here is saying that individual women will know or can be told that their c-section was unnecessary? I made the point that overall there is agreement from all the major health organisation that there are many avoidable c-sections happening. What's the difference between avoidable and unnecessary? An example: when a hospital has very low staffing levels so that large numbers of women are sharing midwives, the c-section rate goes up. This is because women's labours are mismanaged, and they end up needing a c-section. Had the hospital been properly staffed fewer of those women would have ended up in a position where a c-section becomes necessary.
"But some antenatal childbirth classes give women the idea that this is their choice and their choice alone to make: ssomething they can control with their actions and words."
I have never seen a class where a woman is encouraged to think this! But I have seen classes where women are encouraged to think about things they might be able to do, which are proved to reduce the likelyhood of needing a c-section, such as opting out of having continuous monitoring, (unless health care staff can ensure that it is medically justified), hiring a doula, or opting for a homebirth.
"nor do I want to plague myself with considering all the 'additional risks' an unforeseen section might bring to a next pregnancy (which, in reality, many many women don't experience) based on snippets of research."
Tho said that many women do experience serious problems associated with c-section? Nobody. We all know that most women come through a c-section in good health. But it's still the case that all women who have a c-section have an increased risk of these things, and that's worth knowing about I think. At least, I wouldn't want to be facing any other sort of major surgery without knowing what the risks or the benefits were - what adult does?
"I find that it's really hard to read and interpret well if you're not a researcher in that particular area (or have PhD or research training)"
NCT teachers do have training in interpreting research and are required to keep abreast of important medical research in obstetrics and midwifery. But really, it is up to the individual to read the research themselves and decide how significant it is to them and their situation. These things are subjective. Even a small increase in the stillbirth rate might be of real concern to some people.
Have to say, in my personal situation the reduced risk of c-section was a huge factor in me choosing a homebirth. I didn't opt to give birth outside hospital because I thought it would be 'nice', but because I was aware of the increased risk of c-section that comes with birthing in a CLU. I was also aware of the possible complications and furture implications of c-section in later pregnancies. In my case awareness of the research into influence of place of birth was instrumental in my birth choices.