I’ve chosen to have a caesarean – so why am I being made to feel like a cheat?
When I had my daughter seven years ago, I experienced what is termed “birth trauma”. Coupled with postnatal depression, mild PTSD and other physical rehabilitation issues, this meant my first birth took years to recover from – seven, in fact.
Now that I am pregnant with my second, I’m choosing to have an elective caesarean. There are always good reasons, physically and mentally, for having a C-section, elective or not. So why do we still, deep down, believe it to be the cheat's option?
When I found out I was pregnant, I was ecstatic but terrified. My husband was thrilled but worried, with the memories of my last birth colouring the long-awaited joy for both of us.
So I reached out to the same hospital where I’d delivered my daughter. While I was still unsure whether I wanted to give birth there again, luck handed me the chance to speak to the matron of the delivery suite which was the first step in a cascade of helpfulness.
That conversation put me on the path to a birth reframing session (I hadn’t known these existed and so hadn’t had one) and specialist mental health services; at every step I talked through my previous traumatic experience and was assured that a C-section was absolutely an option for me if I wanted it.
It has only been more recently, when I had a follow up appointment with a specialist midwife that there was a change in the party line. “Well, you are being allowed to have a caesarean like you asked,” she snapped when I expressed some worries.
“Allowed?” As if major abdominal surgery, which cuts through seven layers of tissue, is a special treat.
It felt as if the mask had slipped and I wonder whether it’s a generational thing. This midwife is in her late 50s. The Call the Midwife actor Jenny Agutter is 68 and has recently commented that C-sections are “sad”.
“Now, of course, people say that they’ll have their baby taken out on such a date by C-section, which is sad, in a way,” she said, adding that while it depends on the circumstances, “childbirth is something to be experienced fully, if one can”.
Yet I've also overheard commiserations for elective C-sections expressed by my peers at parent and baby classes. A friend of mine mentioned that she'd had a C-section, to which another mother responded: “Oh no, I'm sorry.”
“Don't be, I asked for one!” my friend replied.
A lot of the positive rhetoric around water births, free births and breathing with surges (also known as contractions) can make us feel like we're letting down the motherhood by opting for a caesarean: I had to look really hard for a hypnobirthing teacher who offered a caesarean-specific course.
And while currently around 30 per cent of births in the UK are by C-section (both emergency or elective), it can vary greatly between hospitals as to how easy it is to choose one, despite the most recent March 2021 NICE guidelines reiterating that “the women's preferences and concerns are central to the decision-making process”.
The problem is that, while it's good practice to follow the guidelines, it's not legally required. A 2008 Birth Rights report showed that 15 per cent of NHS Trusts explicitly do not offer maternal request C-sections and 47 per cent effectively don't (by making it very difficult to request one or having inconsistent policies and procedures) – which, of course, ends in a lottery of care. Oxford University Hospitals Trust, for example, has only just changed its policy to offer maternal request caesareans going forwards.
And we all know that, though thankfully it’s changing in some circles, a vaginal birth is usually called a “natural birth”, as if choosing an abdominal birth is not a valid way to come into the world.
My first birth was characterised by a lack of control and inability to influence decisions – as is often the case when you're tired from days of labour and in pain. I didn’t know what I was doing and felt unprepared. I didn’t have the confidence to speak up and advocate for myself and neither did my husband.
This time I'm more prepared and informed; I know what's going to come and how to recover. I’ve had years of therapy, trauma rewind sessions, an incredibly helpful hypnobirthing course and asked for NHS support via perinatal mental health and my midwife. And part of that – of my taking control – has been to choose a C-section.
For me it's not unnatural or something for you to comment on. It's certainly not the cheat's choice – to be clear, I'm nearly as scared of this birth as I was for my first. It's about the right to decide what's right for me and my body, physically and mentally, after properly weighing up all the risks and advantages; I'm the one who knows my body best.
Sometimes we can't help having an unplanned caesarean. Just as we also can't help it if past experience means that we know an elective caesarean is right for us.
So could we, perhaps, stop treating it like the easy way out?
