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Cut it out

Is it worth suffering the agonies of childbirth when the experience = can=20 leave you scarred? No, you should be allowed to opt for a Caesarean = instead

Lois Rogers Published: 26 June = 2011

3D"Surgeon It is = estimated that=20 200,000 women a year suffer 'birth trauma' of some kind (Getty)=20

C ompetition among = women is=20 generally less intense than it is between men, but motherhood involves = measuring=20 up to a set of standards few could imagine in a process that begins the = moment a=20 woman announces herself pregnant. The =E2=80=9Cbest=E2=80=9D mothers in = the eyes of the=20 maternity sisterhood, and of the government, are those who give birth = naturally=20 with minimum demand for pain relief and, most important, minimum cost to = maternity services.

Indeed, many women see delivering a baby as an emotional high point = and could=20 not imagine missing a second of agonising pain, despite the fact that, = according=20 to the Lancet, up to one in three of them will afterwards suffer some = form of=20 incontinence, and up to one in six some form of sexual dysfunction. At = the other=20 end of the spectrum is the growing band of feckless wimps who want = planned=20 caesareans with a virtual guarantee the birth process will be a painless = 20=20 minutes =E2=80=94 and, least maternally of all, on a date of their = choosing because of=20 work commitments.

Victoria Beckham is leading the trend =E2=80=94 the delivery of her = fourth caesarean=20 is booked for next month. Despite admonishments from the sisterhood that = childbirth must naturally involve intense suffering =E2=80=94 and = warnings from the=20 government of the risks of surgery, Beckham is following a = well-established=20 pattern in much of South America, where 9 out of 10 educated women have=20 caesareans.

According to Victoria Harris, a British doctor in Rio de Janeiro who = recently=20 gave birth there naturally, the foreign bourgeoisie who choose not to = have=20 caesareans are viewed as eccentric exponents of an outmoded tradition. = The=20 Brazilian argument is that labour is painful; you do not look smart or = sexy=20 while you=E2=80=99re doing it; you do not know if the baby is suffering = until it arrives=20 looking furious but intact. What=E2=80=99s more, you stretch, and even = permanently=20 wreck, the bits you need for sex and maintaining continence in old age. =

Harris, whose two older children were born in Britain, remains an = exponent of=20 natural delivery, and puts the Brazilian fashion for caesareans down to = poor=20 medicine. =E2=80=9CI just don=E2=80=99t think natural delivery was well = managed in Brazil in the=20 past in terms of pain relief,=E2=80=9D she said. =E2=80=9CPeople saw = what their parents went=20 through and they don=E2=80=99t want it themselves.=E2=80=9D

Many British mothers might point out that =E2=80=9Cnatural=E2=80=9D = delivery is often pretty=20 badly managed here. For every woman who found childbirth a sublime = experience,=20 there are at least four more who admit they were speechless with pain = and terror=20 during labour, but were so grovellingly grateful to end up with a = healthy baby=20 at all, it would have been churlish to complain that the chaotic NHS = system=20 nearly killed them.

Even those who try to reduce the risk of permanent damage by having = at least=20 one baby by caesarean might not be any better off, according to findings = from a=20 recent study part-funded by the charity Wellbeing of Women. The study, = which=20 followed 3,763 women for 12 years, found that a woman who has one baby = naturally=20 and another by caesarean, not necessarily in that order, has = =E2=80=9Cthe same=20 propensity to develop urinary incontinence as a woman who has only ever = had=20 natural births=E2=80=9D.

Few people would go in for unplanned root-canal treatment declaring: = =E2=80=9CNo=20 anaesthetic for me =E2=80=94 I want to experience every excruciating = tug.=E2=80=9D But bringing=20 the same attitude to childbirth is viewed as evidence a woman really = isn=E2=80=99t up=20 for motherhood. In fact, the latest medical guidelines suggest such = individuals=20 should be referred for immediate psychiatric help.

There=E2=80=99s no question=20 that most women are treated as if they are a bit mad if they actually = ask for a=20 caesarean The National = Institute for=20 Clinical Excellence (Nice) is currently consulting on its updated = instructions=20 on when to grant a request for a caesarean. It recommends that pregnant = women=20 who ask for one are referred to =E2=80=9Ca healthcare professional with = expertise in=20 providing perinatal mental health support=E2=80=9D. There is no network = of such people=20 at the moment, and recruiting them would undoubtedly cost a great deal = more than=20 getting on and doing the caesareans, but no matter. The cost would fall = to=20 another bit of the NHS.

=E2=80=9CLike lots of women my age, I never thought I would have a = baby, and didn=E2=80=99t=20 want to take the risk of anything going wrong,=E2=80=9D said Amanda = Street, 41, whose=20 son, Beau, was born last year.

=E2=80=9CThe consultant patronisingly told me I couldn=E2=80=99t have = an NHS caesarean=20 because it would be too expensive, even though she agreed that, in my=20 circumstances, it was likely I would end up having an emergency one. It = was=20 clear it was going to look better on their budget if it was listed as an = emergency.=E2=80=9D Street, from north London, who runs her own = musicians=E2=80=99 agency, was=20 forced to pay privately for a planned caesarean to get the peace of mind = she=20 wanted.

Louise McGuinness, 43, from Durham, also waited years for a = much-wanted baby,=20 conceived naturally after repeated failed IVF and attempted adoption.=20 Conversely, she was readily booked in early in her pregnancy for a = planned=20 =E2=80=9Cpeace of mind=E2=80=9D caesarean. Her daughter, Maisie, was = born two weeks ago. =E2=80=9CI=20 would recommend it to anyone,=E2=80=9D she said. =E2=80=9CIt was, to me, = totally painless.=E2=80=9D

=E2=80=9CThere=E2=80=99s no question that most women are treated as = if they are a bit mad if=20 they actually ask for a caesarean,=E2=80=9D said Lucy Jolin, of the = Birth Trauma=20 Association, which supports women who have suffered permanent nerve = damage from=20 instrumental childbirth =E2=80=94 forceps, ventouse suction or emergency = caesarean.

The association estimates 200,000 women a year suffer =E2=80=9Cbirth = trauma=E2=80=9D of some=20 kind, and they say the risks of natural delivery are understated. = =E2=80=9CThere is=20 clearly a need for more balanced information about the risks and = benefits,=E2=80=9D=20 Jolin said. =E2=80=9CWe are all for choice, but it should be informed = choice.=E2=80=9D

Since 1980, the number of caesareans in Britain has risen from 9% to = almost=20 25% of births. An average natural delivery costs =C2=A31,665 on the NHS, = =C2=A3700 less=20 than an average caesarean. The number of women who suffer incontinence = or sexual=20 problems after natural childbirth depends on which study you look at, = but there=20 is no question that such problems were unmentionable for previous = generations.=20 Buried in the 266-page Nice document are figures of 64% of women = suffering=20 sexual problems six months after childbirth, and a 21% risk of = incontinence. An=20 average figure of almost =C2=A37,000 is given for lifetime treatment of = incontinence,=20 and that is still assuming everyone dies by the age of 80. And fewer = than two in=20 three of the women affected actually see a doctor.

No treatment at all is suggested for sexual problems. =E2=80=9CYou do = see a lot of=20 British women with vaginas you could drive a bus up,=E2=80=9D one woman = obstetrician=20 remarked graphically. =E2=80=9CI think a lot of them just accept that = forgoing sexual=20 pleasure is the price they have to pay for having children.=E2=80=9D =

Women nowadays are also generally much older when they embark on = motherhood.=20 =E2=80=9CHow many 40-year-old Olympic gymnasts do you see?=E2=80=9D = Kevin Harrington, a London=20 obstetrician in private practice, says. =E2=80=9CI don=E2=80=99t think = it=E2=80=99s my place to tell a=20 woman she=E2=80=99s wrong to opt for a caesarean, because scientifically = she=E2=80=99s not. You=20 have the size of the baby=E2=80=99s head and the flexibility of the = woman=E2=80=99s pelvis to=20 factor in. It=E2=80=99s common sense. At 40, the body is much less = likely to adapt to=20 the process.=E2=80=9D

The message, then, is look at the statistics and learn. A government = report=20 revealed that 31% of obstetricians would choose a caesarean for = themselves.

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