A couple of days ago, the charity Birthrights published a report into maternal request cesareans. It found that 75% of UK maternity units were going against NICE guidelines and refusing women this option for giving birth to their babies. The story was covered by TV and online news, including this piece by Rebecca Schiller from Birthrights, it’s excellent by the way, go read it (then come back here).
What is less worthy of reading, this being 2018 and all, is the comments on Rebecca’s article and on tweets about the report.
Yes I know – NEVER CLICK ON THE COMMENTS! But I did a bit of innocent, idle scrolling, waiting for a pan to boil and now I have to somehow find time to write a blog post about it to release the fury.
The comments fall broadly into the following 8 categories:
1 – Doctor Knows Best:
I am all for taking medical advice from actual medical doctors. There is a reason that the training is so long and so grueling and so very not interchangeable with a few minutes on Google. But Doctors are humans. Humans sometimes make mistakes and sometimes their personal experiences and beliefs can creep into their professional opinions. My family GP once offered to say a prayer for my Mum’s dodgy knee. I’m happy to side with her, non medically trained, opinion that a physio referral would have been preferable.
Doctors are also (mostly), employees. They have to follow hospital policy and as the Birth Rights report shows, most hospitals have a policy of refusing maternal request C sections even though that goes directly against NICE guidance.
Most significantly though, doctors are not in possession of infinite knowledge or the ability to foretell the future. Despite women giving birth for a fair while now there are huge gaps in our understanding of what is normal, nevermind the myriad variety of ways it can go a bit wrong. Doctors can make a good, educated, experienced, guess about how an individual birth will go, but until it’s actually happened no one can know for sure.
2: Only If Necessary:
Which brings us on to the “They should only be done if necessary” brigade.
Ok – define necessary?
A baby lying transverse with absolutely no chance of exiting by itself is a clear example of necessary. But what about a mother who has had an emergency Cesarean because her baby was huge and got stuck and this one looks like being a whopper too? It might come out ok so is a CS unnecessary?
Or a Mum who nearly died along with her last baby because of a massive bleed during labour. Is her request for a CS so she can be certain the same won’t happen again actually necessary?.
What about a low risk Mum who has carefully weighed up all the pro’s and cons, talked with her doctor and midwife and decided that, on the factors she is most concerned about, a planned CS is probably the best thing for her and her baby?
None of us, not even the doctors, can really say what is and isn’t necessary for someone else. We all have different tolerances for each of the many potential risks in childbirth and it’s often impossible to quantify those risks in order to weigh them up methodically.
How can we reserve cesareans for when they are necessary if we don’t know what necessary is?
Before my third CS, the Doctor explained that there was an issue with stitching me up last time. The scar was unusually thin giving me a higher than normal risk of it rupturing. If that happened then me and the baby could die. But it probably wouldn’t rupture and if it did the hospital would almost certainly be able to save us both. I decided not to chance it and took the CS. Was my surgery necessary?* It was to me.
3- Nature Knows Best:
Nature is fascinating and glorious and complex and fabulous. But it doesn’t give an organic shit if any individual mother or baby survive. It wants a species of big-brained bipeds and if a few of those massive heads don’t fit very well through those oddly shaped pelvises and some of us end up damaged or dead then nature is just fine with the collateral damage. I love nature, but I’m prepared to mess with her if it means me and my babies don’t end up dead.
4- It’s too expensive:
This is a very popular one. People are very very worried about the cost of all these C sections. They cost £7000 more! Or they Cost Double! Or “Insert Figure Here!”. There are a lot of different numbers floating about because it’s actually really hard to accurately work out how much more a c section costs than a vaginal birth. NICE put it at a rather less panic inducing £84 once you factor in the costs associated with pelvic floor issues from vaginal births.
But there are a huge range of things that could be into these calculations. A straightforward vaginal birth with a couple of midwives and home a few hours later is, of course, a lot cheaper than a fully loaded operating theatre and days on a ward. But you can’t actually choose the former. You can hope for it, but the average cost of both kinds of birth needs to factor all the things that could happen unplanned. For a vaginal birth, this could include epidurals, postnatal stays and of course emergency cesareans. Then there is the enormous cost of litigation and even the lifelong costs of caring for a child disabled at birth.
4b. She Can Have One But She Has To Pay:
How much (see above)?
Also, you can get treatment for a lot of things that aren’t actually life-saving on the NHS should we stop them all? Some of them aren’t even just for us girls! Erectile dysfunction treatment for example. Why should my taxes pay for that treatment just because a man wants to have sex when nature is telling him to pack it in? I have nothing against men wanting hard-ons but they can damn well go private for them etc. etc.
5 – It Will Harm The Baby:
See also- MICROBIOME!! EPIGENETICS!!
Yes there are studies that link cesarean birth with health issues in the baby. But rarely in the science of squishy beings in a complex world, do we get simple cause and effect relationships.
A major flaw in most research into C sections is the lumping together of elective, and emergency surgery. A calm, planned operation is likely to be far safer than a middle of the night rushed emergency when something else has gone wrong. What’s more, that something else could be influencing the health of the baby too. If a study says babies are more likely to go to the NICU if they were born surgically is that because the surgery sent them there? Or because of the problem that put then in the operating theatre in the first place? Babies born by CS are more likely to be unwell, at least in part, because unwell babies are more likely to be born by CS.
I’ve written more specifically about the microbiome issue here. But to summarise, it’s a big buzzword at the moment. It may well turn out to be very important but it’s influenced by many many things throughout life. Last time I checked there were some very small studies showing short-term differences in the microbiome between babies born vaginally and by C section and at least one the showed these didn’t last long. We can speculate that microbiome differences cause issues with the immune system etc. but at the moment it’s no more than speculation. Stand down the micro panic.
6 – All Is Vanity:
Damn, these commenters found us out. If only we weren’t so busy filling our airy little lady heads with Hello! Magazine or fretting about being ripped from fanny to farter and living the rest of our lives incontinent! Then perhaps there would be space for us to understand that a C section isn’t just for shits and giggles, that we shouldn’t just pick one up on a whim like a knock-off handbag and that it might actually be pretty bloody painful and incapacitating to be cut open and have another entire human pulled out of you. But no – look! A Kardashian!
7- None Of This Is Even Real:
Then there are the commenters who think it is utterly ridiculous that having a say over something momentous happening to your own body is considered a human rights issue. I mean, for it to be a human rights issue women would have to be human – PMSL! ROFLMAO!
Or the gang who don’t believe there is any kind of dogma around childbirth or that anyone would ever criticise or judge a woman for her choices about her own body. I can only assume these people haven’t read the thread they are commenting on, or that they have ever been on the internet before the precise moment they made their comment.
8- This Happened To Me Too:
But there are other comments too. Plenty of them. From other women who were denied cesareans despite careful consideration or horrendous past experience. Women who felt railroaded into horrible inductions or who were denied pain relief.
A lot of those criticising the work of Birth Rights are men. I’m not going to say that men don’t get to have an opinion on this issue, anyone can have an opinion on whatever the hell they like. But if you are going to voice that publically, then also be prepared to listen. Especially to those who have more knowledge and more first-hand experience than you. Don’t double down as some of the guys did, flinging justifications and lightweight evidence to try and prove that what they read online trumps anything the woman replying has actually lived.
Comment if you really must, but maybe, shut the fuck up sometimes too?
*Turns out that scar was even worse than they thought and labour would very likely have resulted in an emergency C section so yes the planned one was necessary, or at least a heck of a lot safer.