Not too posh, but still pushed

A recent study published in the British Medical Journal has been making headlines in TIME and Salon, among other outlets. Headlines herald the findings as proof that women are “not too posh to push” and can’t be blamed for the rising cesarean rate. Instead, women are having cesareans for “medical reasons.”

From the BBC:

It is “unlikely” that women undergo caesarean sections to avoid the pain of childbirth, research suggests.

Most caesareans were carried out for medical reasons, the review of 620,000 births in England in 2008 found.

However, the study does not appear to question the “medical reasons” given for cesareans. According to TIME:

Further analysis of the reasons for c-section found they were mostly medical: about 90% of women with a breech baby opted for c-section, as did 71% of women who had had a previous c-section. Mothers who experienced serious medical problems during labor also chose surgical delivery following recommendations from their doctors.

Key among the “medical reasons” given are breech birth and previous cesarean, neither of which are inherent reasons for cesarean based on scientific evidence. Current obstetric practice, however, often forces women to “choose”  cesareans in both cases by limiting availability of vaginal breech birth and vaginal birth after cesarean (VBAC).

Media reports about the study hint at the non-medical reasons that other studies have found to influence cesarean rates. Again from TIME:

Overall, however, the study did find a wide range in c-section rates between hospital trusts — from 15% to 32% — and suggested that the differences were to due to doctors’ individual decisions in emergency situations. It’s possible, then, that some doctors, faced with problems during labor, may choose c-section sooner than is necessary.

It bears noting that c-sections make more money for private hospitals than vaginal deliveries. And they’re cheaper than vaginal birth after cesarean section, or VBAC, which, thanks to liability issues, requires additional medical staff at most hospitals; doing the c-section also avoids potential lawsuits by patients.

While it is well worth acknowledging that women are not, in fact, driving the cesarean rate by requesting cesareans, clearly more needs to be done to remove barriers to true choice for birthing women.


  1. Amy October 16, 2010 7:38 am  Reply

    As a doula, I’ve seen this lack of bona-fide choice in childbirth options over and over again. The illusion of choice is often presented to the mother in the manner of, “Well you can be safe and go for Option A, OR you could potentially endanger your life and the life of your baby and go for Option B.”

    OK, perhaps they’ll use different words but basically the mother is told that she is being irresponsible if she chooses to do anything other than what the medical profession WANTS her to do. Thanks for this post! There’s no doubt that we have a long way to go in offering real choice to expecting moms.

  2. Selling December 11, 2015 10:10 pm  Reply

    I had a c-section due to medical need. I knew I would have one, but never made it to the scuhedled date, my son decided to come early.I had my son with me shortly after getting to the recovery room and instantly put him on my chest. He was exhausted and after attempting to nurse, fell asleep. I had a heck of a time getting him to latch. His mouth was just too small to properly latch without two people and 4 hands. The lactation nurses were great, even helping me eat my lunch after we sucessfully got him latched. Unfortunately, after two days, he was getting dehydrated and I had a nasty rash from the formula we were putting on my nipple to cause him to want to open his mouth wider. I made the decision to ask for a hospital grade pump and feed him a few ounces of formula.Luckily, my milk came in that night and I could pump to supliment. His urine went from orange back to a normal color and we got a nipple shield to help me out. I spent the better part of my 4 days in the hospital with him laying on my chest, skin to skin. I wonder if that had anything to do with my milk coming in so quickly. At about 5 days old, my milk came in full force. I pumped 7 oz after he ate one day. I continued pumping and freezing milk just in case something was to happen.At 2 weeks PP, I developed a nasty case of mastitis. I took my medications, pumped, nursed with the shield, and massaged my breast to push the infection out. I started calling lactation nurses to come to my house and help me out. I didn’t want to be tied to the shield, it was frustrating to both of us. At 3 weeks old I had a fantastic nurse come and help me out. She adjusted my hold and presentation to my son, and he latched on with no problem! We weighed him before and after the nursing session, and he had eaten over 2.5 oz! I continued lots of skin to skin time and had another engorgement that night. I felt like I was starting out all over again. I was determined to succeed breastfeeding and ignored all the naysayers that wanted me to just give him formula. They couldn’t believe that I was going through all this when there was an easy solution in formula.He is closing in on 5 months old now. We are still going strong with nursing. When I have another child, I know that I’ll need to have another c-section because of my medical problems, but I’ll gladly do it again. I’ll make sure to have a pump on hand to help stimulate my milk coming in and I won’t give up.

Leave a Reply