Victoria Beckham has had her fourth C-section. Was it one too many?
So how many C-sections is too many? When Victoria Beckham proved that she was
once again too Posh to push with the safe arrival of baby Harper Seven last
week, her fourth child delivered by Caesarean, you could probably hear the
cries of horror from the moon.
Victoria Beckham with newborn daughter Harper
With Caesareans rising to 24 per cent of delivered births in the UK, and more
than 30 per cent in some parts of London, there is no doubt interventional
delivery has become established both as a practice – and as a controversy.
There is nothing surer to raise the hackles of certain commentators than
figures which point to a rise in Caesareans.
Last week, the Royal College of Obstetricians and Gynaecologists (RCOG)
published a report into maternity services which seemed to suggest that
fewer in-patients and more home beanbags was desirable – with the clear
implication that, in their view, the number of C-sections and other forms of
intervention have got out of hand.
David Richmond, vice president of RCOG and author of the report, said that
most women could have their babies in a local birthing centre, “without a
doctor going anywhere near them”.
That is what Lynsey Langdon of Hoddesdon, Herts, wanted for her first birth.
But Lynsey, then aged 26, endured a difficult pregnancy. And when, at 40
weeks, she developed pre-eclampsia (a condition that can affect a mother’s
blood pressure), her consultant told her it was time to act.
“I was given an epidural initially, then a spinal block, but my body wouldn’t go numb,” says Lynsey, a Slimming World consultant, whose husband Greig, 37, is a policeman. “So I was knocked out and woke up to see my son Jack, 5lb 12oz. I felt robbed of the whole experience of childbirth.
It never occurred to me that I would have a C-section. It was all thoroughly traumatic, and I had MRSA in my scar which took four months to heal. I developed post-natal depression and the whole of Jack’s first year is a bit of a blur.”
Lynsey fell pregnant again – a boy, who was named Harry – three years later. Like many women who have a C-section, Lynsey was desperate for what is known as a VBAC (vaginal birth after Caesarean). “Even one contraction would have done, just so I knew how it felt.”
Lynsey went into labour on Harry’s due date, and, at first, everything seemed to be progressing normally. But her consultant grew alarmed. “There was a risk my uterus was going to rupture.”
When she woke after her second C-section, Lynsey was told the umbilical cord had been wrapped around Harry’s neck. A natural labour could have killed him.
Lynsey’s story encapsulates the complexity of the problem. A healthy young mother, she would have expected to handle natural birth easily. Yet health problems for her, and a complication for the baby each time, could have ended in tragedy – had she not been in hospital.
So is it right to be cautious? Should home births be abandoned for more doctors, monitors and drugs? Perhaps Victoria should be rechristened Smart Spice?
“It does seem to be more modern,” says Pauline Barrett, head of Nursing at the London Fertility Centre, “that you plan for your birth with a
C-section. But most mothers want the childbirth experience. And that’s right. The best option should be natural childbirth with pain relief.”
Mary Newburn, head of research at the National Childbirth Trust, agrees: “Most women want as few interventions as possible. They want to see how they cope. Everyone’s pain thresholds differ, but aspirations remain the same: a healthy baby delivered safely.”
In her experience, the debate is polarised between the “Poshs” and the “Pushs”, but the reality is a large, muddled grey area. “The proportion of women who ask for a C-section for non-medical or psychological reasons is small. But, then, so is the number of women who want home births.”
That number has risen from 1 per cent to 3 per cent since 1993. Back in 1959, more than a third of women gave birth at home.
“What women want are competent, alert staff in clean, comfortable surroundings, with intervention provided only if necessary.”
Yet, not enough women are being offered this choice. Instead, they are faced with the stark lack of comfort, but the reassurance of every medical option, in the average big hospital – or a more pleasant, but lower tech, birthing centre. And it seems this lack of practical options is partly to blame for the trend towards medicalised births.
“Some patients who have normal deliveries are doing so in high-tech hospitals when they could easily be in midwife-led birthing units; others need more medical aid, but may not get access to it due to too few resources,” says Dr Anthony Falconer, president of the RCOG.
He explains: 'Thirty per cent of women will need a doctor for a C-section or assisted birth of some kind. Another third will be fine with a midwife and access to some extra assistance (such as painkilling drugs).
And the last 30 per cent will be a low risk group who have probably had one or two babies before and a 99 per cent chance of a good outcome. We have to identify better who is in each group and offer appropriate care.”
To do this will mean changing the use of some maternity hospitals, getting midwife units set up on-site to hospitals – for ease of transfer if things do go wrong – and then getting more consultants qualified, so one is available 24 hours a day in every unit in the country. This would be a gold standard that no UK hospital currently meets.
Dr Falconer would like maternity services to be more like the support network available to cancer sufferers, where patients could access more or fewer services as their cases developed. This is not to suggest that medical intervention isn’t sometimes necessary:
“We are getting more women in need of medical assistance (including C-sections). Older mothers, the impact of obesity, multiple pregnancies – these are all high-risk situations,” he says.
However, he also believes that “the use of some of these midwife-led units is not as great as it should be. These places are safe and appropriate to have babies.”
When Lynsey had her third child, Isla, 15 months ago, she had no choice. Although VBACs are possible after one or two C-sections, they are unsuitable for many women as the uterine muscles are weakened following the operations and formation of subsequent scar tissue.
“It was all organised,” she says. Indeed, the only drawback was the bad scarring she was left with her on skin – and an “apron” of fat on her lower tummy. Lynsey had that removed in an operation called an apronectomy at McIndoe Surgical Centre in East Grinstead, Sussex in February this year.
“I would like to have pushed one baby out naturally. I won’t have any more. But I have no regrets – the C-sections gave me my children.”
“I was given an epidural initially, then a spinal block, but my body wouldn’t go numb,” says Lynsey, a Slimming World consultant, whose husband Greig, 37, is a policeman. “So I was knocked out and woke up to see my son Jack, 5lb 12oz. I felt robbed of the whole experience of childbirth.
It never occurred to me that I would have a C-section. It was all thoroughly traumatic, and I had MRSA in my scar which took four months to heal. I developed post-natal depression and the whole of Jack’s first year is a bit of a blur.”
Lynsey fell pregnant again – a boy, who was named Harry – three years later. Like many women who have a C-section, Lynsey was desperate for what is known as a VBAC (vaginal birth after Caesarean). “Even one contraction would have done, just so I knew how it felt.”
Lynsey went into labour on Harry’s due date, and, at first, everything seemed to be progressing normally. But her consultant grew alarmed. “There was a risk my uterus was going to rupture.”
When she woke after her second C-section, Lynsey was told the umbilical cord had been wrapped around Harry’s neck. A natural labour could have killed him.
Lynsey’s story encapsulates the complexity of the problem. A healthy young mother, she would have expected to handle natural birth easily. Yet health problems for her, and a complication for the baby each time, could have ended in tragedy – had she not been in hospital.
So is it right to be cautious? Should home births be abandoned for more doctors, monitors and drugs? Perhaps Victoria should be rechristened Smart Spice?
“It does seem to be more modern,” says Pauline Barrett, head of Nursing at the London Fertility Centre, “that you plan for your birth with a
C-section. But most mothers want the childbirth experience. And that’s right. The best option should be natural childbirth with pain relief.”
Mary Newburn, head of research at the National Childbirth Trust, agrees: “Most women want as few interventions as possible. They want to see how they cope. Everyone’s pain thresholds differ, but aspirations remain the same: a healthy baby delivered safely.”
In her experience, the debate is polarised between the “Poshs” and the “Pushs”, but the reality is a large, muddled grey area. “The proportion of women who ask for a C-section for non-medical or psychological reasons is small. But, then, so is the number of women who want home births.”
That number has risen from 1 per cent to 3 per cent since 1993. Back in 1959, more than a third of women gave birth at home.
“What women want are competent, alert staff in clean, comfortable surroundings, with intervention provided only if necessary.”
Yet, not enough women are being offered this choice. Instead, they are faced with the stark lack of comfort, but the reassurance of every medical option, in the average big hospital – or a more pleasant, but lower tech, birthing centre. And it seems this lack of practical options is partly to blame for the trend towards medicalised births.
“Some patients who have normal deliveries are doing so in high-tech hospitals when they could easily be in midwife-led birthing units; others need more medical aid, but may not get access to it due to too few resources,” says Dr Anthony Falconer, president of the RCOG.
He explains: 'Thirty per cent of women will need a doctor for a C-section or assisted birth of some kind. Another third will be fine with a midwife and access to some extra assistance (such as painkilling drugs).
And the last 30 per cent will be a low risk group who have probably had one or two babies before and a 99 per cent chance of a good outcome. We have to identify better who is in each group and offer appropriate care.”
To do this will mean changing the use of some maternity hospitals, getting midwife units set up on-site to hospitals – for ease of transfer if things do go wrong – and then getting more consultants qualified, so one is available 24 hours a day in every unit in the country. This would be a gold standard that no UK hospital currently meets.
Dr Falconer would like maternity services to be more like the support network available to cancer sufferers, where patients could access more or fewer services as their cases developed. This is not to suggest that medical intervention isn’t sometimes necessary:
“We are getting more women in need of medical assistance (including C-sections). Older mothers, the impact of obesity, multiple pregnancies – these are all high-risk situations,” he says.
However, he also believes that “the use of some of these midwife-led units is not as great as it should be. These places are safe and appropriate to have babies.”
When Lynsey had her third child, Isla, 15 months ago, she had no choice. Although VBACs are possible after one or two C-sections, they are unsuitable for many women as the uterine muscles are weakened following the operations and formation of subsequent scar tissue.
“It was all organised,” she says. Indeed, the only drawback was the bad scarring she was left with her on skin – and an “apron” of fat on her lower tummy. Lynsey had that removed in an operation called an apronectomy at McIndoe Surgical Centre in East Grinstead, Sussex in February this year.
“I would like to have pushed one baby out naturally. I won’t have any more. But I have no regrets – the C-sections gave me my children.”
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