I'm increasingly convinced that the whole c-section v natural birth debate is currently being driven by cultural and political reasons rather than necessarily medical reasons.
A lot of NHS Trust are in the process of banning elective c-sections by maternal request on the grounds of costs. Its supported by a lot of people because there is a belief that the number of c-section is on the rise because loads of women are 'too posh to push'. The reality is that the rise is being driven by more overweight women and women over 35 having children rather than a lifestyle choice. I think maternal requests only account for no more than 2% (and many of those are questionable about whether you could truly put them down to lifestyle choice over mental health considerations) And in addition to this political pressure is driving a push towards home births as an option rather than hospital births despite The Netherlands, where it is the norm, having one of the highest perinatal death rates in Europe. It is good that is a move to give women more choice by encouraging home births, but the irony is that one method which is more expensive and more risky is acceptable whereas the other is unacceptable.
And here's the crunch. The cost of c-sections v vaginal births is being used too much by the NHS as its a red herring. It doesn't take into account complications, short term or long term and it doesn't take into account any care that might arise from mental health needs. For example there is evidence to suggest that a woman forced to undergo a vaginal birth against her will, is more likely to suffer PSTD and/or PND. She's also more likely to need intervention in the first place, if her motivation for an elective c-section is fear.
I also find it very interesting that in other parts of the world (China, Iran, Brazil) there is a move towards c-sections in the middle class. If you can afford it, you have a c-section. Its seen not only as acceptable but preferable. It is culturally seen as safer and better (despite even in private clinics, the level of care not being as good as the UK). In Iran, natural child birth is increasing seen as barbaric, uncivilised and questions 'why go through the pain' of labour if a modern alternative is available. Of course, the private clinics also make more money...
And then, when you start looking at the stats for c-section v natural births, a lot of the data is misleading. Common flaws are electives lumped with emergencies which are riskier, reasons for electives not properly recorded (electives are generally done for medical reasons so the women involved are higher risk than women who actively choose a c-section), studies comparing outcomes that are based on studies outside EU medical standards etc etc. Which makes you really question the quality of the information we are all given about vaginal births and the level of risks involved.
The fact that Obs have been shown in several studies in the UK and US to opt for a c-section tells an untold story. Yes, they have been more exposed to bad births, but they are also more aware of the risks all around and are in a position where they are able to make an active and informed choice. Obs are also in a more powerful position to fight their corner and get the birth they wish - either through knowing their rights, being deemed to fully understand the risks that 'normal people' might not or just knowing the right colleague. For the majority of women that kind of choice just isn't an option and is frowned on by midwifes and other women. Especially given the pressure that the NHS is putting on departments to cut the number of c-sections.
Female Obs may well be making a good decision based on their personal circumstances. They may feel that if the chance of them having an emergency c-section after attempting a natural birth is high enough then opting for the lower risk elective as a precaution may be better. Its worth remembering here that as a general rule, female doctors will tend to have children at an older age than the general population, because they study and qualify first - they are therefore more likely to fall into the higher risk over 35 group too.
Personally I favour a much more informed and honest debate on the subject, that isn't dominated by agendas of the tabloid press and natural birth advocates. I'd like to see better research and more emphasis on trying to give women a better idea of the pros and cons on an individual basis based on their circumstances and their needs rather than a generalised opinion that natural birth is simply better. We need to stop the tragedy of women feeling they have some how failed for whatever reason - which culturally seems to be the outcome from all this pressure. Both c-sections and natural births have their place in this day and age.
The truth is, that natural birth will be the best option for the majority of women but not for all. The judgements and in some cases, blind ignorance and bigotry displayed by some don't help anyone. I think we do need to be more aware of who is driving the debate and what their agenda is and to be more aware of what research is really showing and just how reliable it is (and indeed whether more needs to be done).
The ironic reality is that women across the board, will almost universally put the perceived risk to their child before the perceived risk to themselves, rather than make a lifestyle choice. Studies prove this. Which is why empowering women with the best possible information and ability to make a choice is just so important. It shouldn't simply be placed in the hands of budget decision makers or profit makers or those with their own political agenda. Its putting the individual into the equation rather than the mass production line of babies.
/rant