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« The Nurse Curse: Reality Rounds Tells Her Birth Story | New Statistical Brief from Healthcare Cost & Utilization Project (HCUP) »

British Study Says Maternal Request Not Reason for Rising Cesarean Rate

The Telegraph reported the following yesterday:

Women are not too posh to push – new research has found vast majority would choose natural delivery and Caesareans are done for mostly medical reasons.

Only three per cent of women said they would opt for a caesarean delivery without a medical need for one, in the first study of its kind carried out in the UK.

When questioned nearer the birth the proportion had dropped to just two per cent, according to research carried out on 454 women giving birth at the Liverpool Women’s Foundation Trust.

There has been intense debate about women who have caesarean section deliveries as the UK has one of the highest rates in the developed world with one in four babies delivered surgically. However 60 per cent of these are carried out as emergencies and the vast majority of the rest of them are planned for a medical reason.

(Or for a perceived medical reason.)


The Sunday Times reported in February 2009 that the NHS stopped paying for non-medically needed c-sections, but the study indicates otherwise.

None of the women in the study, published in the British Journal of Obstetrics and Gynaecology, thought that women could request a C-section without a medical reason on the NHS but in fact this is possible.

The results of this small study seem similar to the 2006 Listening to Mothers II survey conducted in the United States by Childbirth Connection which found that one woman out of the 1,573 women surveyed said that she had had a planned initial cesarean by her own choice with the understanding that there was no medical reason.

Of the 394 women who remained in the study and gave birth, two had a planned home birth, one was born on the way to hospital and 76 per cent had a vaginal delivery. The other 23.7 per cent had caesarean deliveries, and only two women had the reason given as maternal request recorded on their notes, one mother who had multiple sclerosis and the other who asked for the operation while in labour.

While BJOG editor-in-chief, Philip Steer, complained about how women are not criticized for elective cosmetic surgery as they are for elective c-sections and deserve autonomy and choice in how they deliver, the study’s author points out that women’s choices ARE limited in birth in a different way.

Lead author, Dr Carol Kingdon, from the School of Public Health and Clinical Sciences, University of Central Lancashire, said: “This study has highlighted that few women may have any real choice about how they give birth in NHS maternity hospitals. One in four women in the UK now give birth by caesarean section, with maternal request for caesarean delivery supposedly the leading reason as to why national caesarean section rates continue to rise.

“However, our study found that whilst many women supported the principle of choice, in practice their choices were limited by the circumstances of the pregnancy (e.g. baby in breech position) and available care provision. All women felt that medical concerns should take precedence over personal preferences and recognised how any choice expressed can change as pregnancy progresses.”


Reframing the rise in the c-section rate by painting a picture of droves of women exercising their choice by requesting a c-section could be seen as insulting to all of the women who have simply wanted to let their body do what it needs to do and give birth vaginally but were not permitted to do so in a hospital.

As someone that had to plead my case (with medical journals in tow) to give birth normally to my suspected large first baby to various doctors and CNMs, I am personally more annoyed than offended when I see doctors pat themselves on the back for extending the choice of cesareans to women who don’t need them, yet work to scare healthy women with every evidence-defying reason that their pelvis or scarred uterus will cause grave injury to their baby.


How about you?



Hat tip to Barb of Navelgazing Midwife.


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Reader Comments (4)

Seems like another no-brainer study to me. Well, I guess it seems like a no-brainer to us women, who already know that most, if not all, the women we know who were sectioned did not request it.

April 22, 2009 | Unregistered CommenterEmily Jones

Do you think this will make any difference in the "too posh to push" media discourse? I'm grateful for the studies, but I worry that they won't get enough media attention to stop doctors from saying, "Well, a lot of women are asking for c-sections these days and that's why the rate is going up". And I worry that this just fuels a normalization of maternal request cesareans, and cesareans in general.

April 22, 2009 | Unregistered CommenterPublic Health Doula

Hey, if you get a chance read my post on my hospital tour... you might find it, uh.. interesting.


April 23, 2009 | Unregistered CommenterJanelle

Hi Janelle,

I read it yesterday. Does "holy crap!" sum it all up? I laughed... sort of. You're hilarious, btw.


April 24, 2009 | Registered CommenterJill
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