Wednesday 23 November 2011

Why I wanted a Caesarian

In September last year, I was seven months pregnant. I had given birth to my first baby two years previously at 33 weeks by fast, frightening emergency section. Second time round I knew I wanted a calm, planned elective Caesarian. According to NICE guidelines, this was my right, as there are small but significant extra risks associated with vaginal birth after caesarian. But I had to argue hard and consistently over a number of weeks to make my case, and was reduced to tears by a consultant obstetrician who was clearly opposed to me having any choice at all in the matter.

The business of how you give birth seems to be all very ideological for those who aren't in the position of having to go through it. What makes me angry still is that the guidance cited by NICE - if you read the long version on the website, rather than the short leaflet you're given by the midwife - states in the very first sentence of its recommendations that "the risks and benefits of vaginal birth after c-section compared with repeat c-sections are uncertain." This statement comes after pages of detailed evaluation of the evidence from many studies.

So why did I have to find myself sitting in front of the consultant feeling furious and increasingly upset at her patronising refusal to allow me to make a choice over the kind of birth I wanted? It didn't matter how much detailed explanation I gave of my reasons for not wanting to risk another emergency section. She and the midwife seemed determined that I would give birth naturally.

My fears were not irrational: around a quarter of women who attempt a vaginal birth after a c-section end up with an emergency Caesarian, which inevitably holds greater risks than a planned one. Having experienced the emergency variety I wasn't keen on a one in four risk of another. But my midwife and obstetrician weren't going to bother giving me the full picture of risks associated with each method of giving birth;  they simply trotted out the mantra that a natural delivery is better for mum and baby.

It feels to me that, whereas in years not so long gone, women who'd had sections were bossily told they couldn't attempt a natural birth, now, through cost pressures and natural birth targets, someone with good reasons for preferring a planned section over a very reasonable chance of ending up with an emergency one may well have their wishes pooh poohed. Worse, I was at no stage informed of any of the risks of a vaginal birth after a section, only told about the possible benefits of a faster recovery time. Nobody ever mentioned, for instance, that the death rate for babies delivered by vaginal birth after caesarian, while still very small, is ten times that of babies delivered by repeat c-section. Given my previous experience of giving birth to a very poorly premmie, that was a particularly salient factor in my decision-making.

It feels like when you're pregnant, nobody listens to you - presumably they think you're too emotional, too confused or not well enough informed to make a sensible choice. I'm appalled that my consultant and midwife didn't give me full information - instead they pushed their preference at me despite that preference holding undisclosed risks of its own.

Obstetricians and midwives simply cannot rely on all women having the support, resilience and wherewithal to research and argue their case; the vulnerability I felt trying to express myself in the face of an obdurate consultant badly upset and stressed me until I got myself referred to another who understood my concerns. That's why I'm glad that women in future won't have to battle to give birth in the way that's right for them. Whatever my consultant would prefer, it wasn't ever going to be her giving birth to my baby and having to choose from a variety of risks - it was me.