Nearly everything you’ve been told about the “risks” of C-sections is wrong

A reader sent me the link to a comprehensive, deeply nuance article in The Guardian, Caesareans or vaginal births: should mothers or medics have the final say?. In the course of advancing the argument that medical autonomy REQUIRES that mothers have the choice of C-section on request it makes the point I’ve been making literally for decades: nearly everything you’ve been told about the “risks” of C-sections and the “dangers” of high C-section rates is completely untrue.

1. Contrary to what you’ve been told, C-sections are SAFER for both babies and mothers.

The paper Birth outcomes following cesarean delivery on maternal request: a population-based cohort study published last year demonstrated this clearly. The women who chose cesarean on maternal request had a dramatically lower incidence of both neonatal AND maternal complications.

The Guardian article makes it clear that it was not what the authors of the study were hoping to find:

The data shocked the study’s head author, Darine El-Chaâr, a perinatal researcher at the Ottawa hospital. In the planned vaginal birth group, there was a higher percentage of negative outcomes compared with the MRC group, driven by serious vaginal tears and babies admitted to intensive care. “I myself am challenged by the data,” she says, underlining that she believes vaginal birth is natural. “I wanted it to be the other way around.”

Her reaction is revealing; the spurious claim that vaginal births are safer than C-sections was always about wishful thinking and not about data.

2. Contrary to what you’ve been told, C-section are NOT significantly more expensive than vaginal birth.

According to a 2011 Nice analysis, the expense of MRCs is only marginally higher than that of planned vaginal births, if treatment for related issues such as incontinence is taken into account. El-Chaâr thinks this might be especially true for parents over 40, who are often induced early but then sit around for a long time, waiting for active labour to start. “I would not be surprised if it’s cheaper to have a planned elective in that group,” she says.

And that doesn’t even take into account the massive liability payments awarded for failure to perform a C-section.

3. Contrary to what you’ve been told, there is NO optimal C-section rate.

The World Health Organization says that C-sections are associated with risks for both mother and baby, which is why it campaigns to reduce unnecessary C-sections and considers them a last resort, only to be done when medically necessary,

But as far back as 2009 the WHO acknowledged that there has NEVER been any data to support their preferred C-section rate. Indeed countries with massive C-section rates, like Italy, have remarkably low neonatal and maternal mortality.

The best available data, reported by Neel Shah and Atul Gawande, indicates that a minimal C-section rate of 19% is necessary for low neonatal and maternal mortality. The WHO’s preferred rate of 10-15% therefore, is literally UNSAFE.

So what accounts for the hysteria around C-section rates when C-sections are actually safer and the costs are comparable to vaginal birth?

Professional and personal prejudice.

Professional: Midwives and their supporters, deeply influential in many countries and in the halls of the World Health Organization, prefer vaginal birth because they can’t provide C-sections.

Personal: Many midwives and natural childbirth advocates believe that women are improved by the agonizing pain and disabling complications of vaginal birth and should not be allowed to avoid it.

As feminist philosopher C. K. Egbert has written:

When people tout “natural birth” as an “empowering choice” (sound familiar?), they conveniently ignore all the women who have been harmed by these practices and for whom giving birth was (completely understandably and legitimately) one of the worst experiences of their lives. Natural birth advocates, just like many in the pro-sex movement, don’t seem to be concerned about the harm that women suffer through this practice or finding ways of preventing this harm from occurring. Women can choose, as long as they choose to suffer and see themselves as liberated through suffering.

Look who has finally been forced to acknowledge the fact that C-sections are just as safe and cost effective as vaginal birth: none other than radical midwifery professor Soo Downe.

The goal should be to improve outcomes for everyone, says Downe. “How can we build maternity services where this isn’t a debate any more?” she asks. “Where women have caesareans when they want them, where women have necessary caesareans when they need them and are properly consenting to them, but where women who don’t want any of that stuff have great births as well?”

Let’s start by admitting the truth about C-sections and rejecting the fiction that there is or even could be an optimal C-section rate.