FFS, even if you go private it doesn't mean a doctor suddenly has no ethical duty to tell you risks and that they won't. Given that most private obstretrians in the UK also work in the NHS, I think thats insulting to them on a professional level that they suddenly leave all ethics at the door entering a private establishment. It makes me SO ANGRY when people suggest that women are making the decision based on 'social' reasons. They aren't. Its a hell of a lot more complicated than that. The limited evidence there is suggests entirely the opposite - women will almost always have some sort of health reason motivating them as part of their reasoning - and often they have more than one reason for choosing an ELCS over a VB. The social reason thing - eg to fit in with schedule, or to avoid labour - is being hugely exaggerated if not completely made up by the press to sell newspapers. Below is some of the evidence found on the subject. Not sure how newspapers are coming up with the theory of 'too posh to push' based on this little lot...
The only thing we do know for sure is that reasons for maternal requests have been poorly studied, but the majority are for fear and concerns over physical health of mother/baby and that they are poorly recorded by the NHS.
Also that women want to discuss risks as part of their decision making process.
Wiklund 2007 - Caesarean section on maternal request Personality, fear of childbirth and signs of depression among first-time mothers
Known reasons for requesting CS and factors contributing to the request are; age above 35 years, a history of elective or emergency CS, a previous negative birth experience, a complicated pregnancy and fear of giving birth. A relationship has also been seen between socioeconomic factors such as unemployment, smoking and immigrant status. Low education and low income has also been connected with a high rate of request for CS. This group of women has also been shown to have more antenatal depressive symptoms. Nevertheless there is insufficient understanding as to why women may request a CS in the absence of obstetric indication. If these women have different life styles, expectations of pregnancy and birth and personality need to be explored.
RCOG News from 17th October
TOG release: Reasons why women request caesarean sections need to be explored more by clinicians
Clinicians need to explore the reasons behind why women request a caesarean section rather than counsel women about the risks says a new review published today (17 October) in The Obstetrician & Gynaecologist (TOG).
Caesarean section on maternal request (CSMR) is carried out in the absence of maternal or fetal indications. One of the main psychological causes is tokophobia, an intense fear of childbirth affecting between six to ten percent of women.
In addition, women who have had previous vaginal delivery may request caesarean section because of adverse experiences during labour known as secondary tokophobia.
The authors of the review state that rather than counselling women requesting caesarean section about the risks, a better approach would be to explore the reasons for the request.
For women with tokophobia, frequent, regular psychotherapy by trained personnel to address why they are requesting a caesarean section is recommended by the review.
In 2003 The Select Committee on Health Fourth Report stated:
86. According to the Centre for Family Research at the University of Cambridge, the RCOG and many others who provided written evidence for our inquiry, pregnant women want more information on the risks and benefits of caesarean section and wish to be involved in the decision-making process. A survey carried out between 1999 and 2002 by the Centre for Family Research at the University found that that maternal requests for caesareans were made mainly because of fears about the health of mother or baby. In their most extreme form, these fears constituted a phobia of giving birth (tokophobia), and a small number of seriously traumatised women may need surgery in order to avoid severe psychological problems."
British Journal of Midwifery, Vol. 19, Iss. 11, 02 Nov 2011, pp 708 - 716
Caesarean section at maternal request remains a contentious issue, fuelled by reports of associated morbidity. To explore the motivations behind women's expression of preference for a planned caesarean birth, an internet survey was conducted using semi-structured questionnaires available via a UK-based international website, www.electivecesarean.com, over a 9-month period. A convenience sample of 359 pregnant women who stated that their preferred delivery method was 'elective caesarean section through my own choice' was included. Data were analyzed descriptively and thematically. Women from 16 countries were included. Two main themes were identified: 1) anti-vaginal birth; and 2) physical and psychological validation. Women who were anti-vaginal birth had a fear of morbidity (maternal and neonatal) and of the birth experience. They viewed vaginal birth as unpredictable and saw planned caesarean birth as a safer alternative. Some women justified their decision of birth mode by referring to either a physical or psychological issue that related to a previous birth or an existing medical complication. Respondents had similar views regardless of country of residence. We concluded that women have multiple reasons for wanting a caesarean birth. These reasons are usually considered, and motivated by a genuine desire to avoid the potential problems of vaginal birth. Individualized birth consultations should include discussion of the risks and benefits of vaginal and caesarean birth as they relate to individual women.
Yes, obviously lots of women 'copying' Victoria Beckham (shall we ignore the fact that her first two were apparently breech? Or does that spoilt everyone's fun?).