Caesarean section rates are always a hot topic in this country.
Figures released by the HSE have shown that the rate of birth via C-Section is growing year-on-year. With a professional interest in birth, and also pre and postnatal care and education, I’m interested in why this rate continues to grow and also, what we can do to reduce it.
Firstly, let’s address the elephant in the room: there seems to be a myth out there that undergoing a C-section is the ‘easy way’ to give birth and that women are choosing to have this surgery to avoid vaginal childbirth. A C-section is definitely not the easy option. It is a full surgery, it has a significant recovery period and if it's not what a woman had planned or wanted, it can have a significant affect on her, both mentally and physically.
I have worked with many women both prenatally and postnatally as a yoga and hypno-birthing teacher and active birth coach and I have yet to meet a woman who wants to give birth via Caesarean section to avoid vaginal birth.
I’ve met plenty however, who have accepted that that’s what needs to happen on the day for the best outcome for their baby; heroic mums, who’ve thrown their own plans, hopes and desires out the window and rolled with an entirely different plan at the drop of a hat. Women who’ve given birth through Caesarean section. And let’s call it that, because they are indeed growing, nurturing their babies and then giving birth.
I was at a recent midwifery conference in Dublin where we discussed empowering women and how flippant words and negative language can disempower within seconds. So let’s not talk of ‘sectioning women’ as we would a grapefruit, let's talk of those heroic women who give birth by Caesarean section.
I know lots of you are saying to yourselves, sure what’s wrong with giving birth by C-section anyway? Surely a healthy baby at birth is all any of us care about?
There is nothing wrong with birth by Caesarean section if it is medically necessary. It is a life-saving procedure, when a life is in danger. And because a life is in danger, the benefits of the procedure outweigh the risks.
But many women are not fully aware of the risks involved. Here are some of them:
- The procedure carries all the risk of surgery for mother and baby - infection, blood loss etc.
- There is a significantly higher level of maternal death with C-sections (2.1 for vaginal birth, 5.9 for elective section and 18.2 for emergency section in a UK study)
- The recovery is significantly tougher and there is a higher risk of post-birth complications (recent figures show double the number of re-admissions after a C-section than non C-section births)
- Studies suggest that babies born via Cesarean section miss out on exposure to many of beneficial microbes, which may have an impact on their long-term health
- Clinical studies have also shown babies born by Caesarean are more likely to develop asthma, type 1 diabetes and to become overweight
- Breastfeeding can be more difficult after a Caesarean section
And the fact is, many Caesarean sections are being carried out when it is not medically necessary.
I am not talking about circumstances where women have pre-existing medical condition or physical or mental health factors that will make birth via C-section the safest and best option for them and their babies.
I am not talking about situations where women have been taken for emergency section during labour as a result of their baby being dangerously distressed or because they themselves are traumatised and exhausted.
But I have seen women encouraged to choose to give birth by C-section by their caregiver because of baby’s position (breech, transverse etc.), because of baby’s perceived size, because they’ve had previous birth by Caesarean section, they’ve had a previous fourth degree tear during birth, because it's Christmas, because they are having twins, because of the mother’s age, because they could have their baby before the weekend.
One couple were encouraged to elect because their personal friend, the consultant, said he wouldn't put his own wife through childbirth if it was up to him.
Bottom line is, 30 percent of all Irish births are now via Caesarean section – a fourfold increase in the last 30 years. If you are over 40 years old, that rate is over 60 percent.
Figures shared by AIMS Ireland show that women in private, consultant-led care are significantly more likely to give birth by C-section than those cared for in the public system.
Elective sections are 6.1 per cent higher in private care but only 50 percent of this can be explained by obstetric risk and age factors. The emergency Caesarean section rate is 6 percent higher in private rather than public care - but 80 percent is explained by age and clinical risk.
In other words, we can stop blaming mums. We can stop saying it's because they’re ‘of an age’ or overweight.
Instead, let's look at how women are treated during birth. Are we encouraging them, believing in them? Or are we expressing doubt as soon as they walk in the door of the delivery room? We know that midwife- led care carries less risk of interventions - we have amazing midwives, let's trust them and let's invest in that.
We know that low-risk mums do better birthing at home - let's make that more accessible for those that want to go that route. We know that induction of labour has a higher risk of intervention - let's stop doing that.
Let's stop blaming women.
Emily is a mum of three, yoga and hypnobirthing teacher at Naturalbirth.ie and founder of The Positve Birth Movement Dublin, positivebirth.org. 
