Too posh to push? I think you’ll find it’s a bit more complicated than that

A story last week claimed that caesarean sections were on the rise because women are demanding them.

The Times story, headed “Hampstead mothers are behind rise in caesareans” began like this:

“Caesarean sections are twice as common in some NHS hospitals than others, according to a report that suggests some doctors are more willing to give in to women’s demands for the procedures.”

Middle-class women – and middle-class mothers in particular – seem to be a particular focus of hate for a lot of the press, which is odd, given that middle-class mothers make up much of their readership. “Hampstead mothers” is a real dog-whistle phrase, conjuring up as it does posh, entitled women who have the nerve to think they should be able to deliver their babies whichever way they want, rather than meekly doing what the doctor tells them. (Let’s assume the Times doesn’t want us to believe that women living in Hampstead are literally behind the rise in caesareans throughout the country.)

There’s even a faintly disapproving quote from Louise Silverton of the Royal College of Midwives: “Some women do opt for a caesarean section because they can’t cope with the uncertainty. They control the rest of their lives, but they can’t control labour.”

What a bunch of feeble losers, eh?

Or could there be another reason why women have caesareans? Both Susanna Rustin and Hadley Freeman in the Guardian do a good job of showing how ridiculous this story is. Freeman points out that the rising age of women giving birth and the growing size of newborns are both factors in the growth in caesarean sections.

But we should also remember that most caesareans aren’t carried out as a result of the woman demanding them. The national c-section rate now stands at 26.2%. Half of those are emergency caesareans, carried out when something has gone wrong and the procedure needs to be performed urgently to save the life of the mother or the baby.

The other half are “elective” or “planned” sections – a misleading name, because they imply that the woman has elected to have them. In practice, “elective” simply means that the caesarean has been scheduled in advance, almost always for medical reasons: placenta praevia, which means the birth canal is blocked, and the baby cannot be born vaginally; a breech presentation, which makes a vaginal delivery more difficult; or the woman has had a previous caesarean, and a vaginal delivery might be dangerous.

Sometimes women do choose a planned caesarean (and sometimes doctors refuse – it’s not a given that obstetricians will agree to perform the procedure). Why? Well, not because they’re entitled or pushy or hate uncertainty. Very often it’s because they’ve had such a traumatic experience the previous time that having a caesarean feels like the safer, less frightening option. Or perhaps they’ve had a caesarean before and don’t want to risk rupturing the scar (a small risk, but nonetheless a real one with potentially fatal consequences). Perhaps they suffer from tokophobia – an extreme fear of childbirth.

For what it’s worth, I’ve never met a woman who has opted for a caesarean because she “can’t cope with the uncertainty” or is “too posh to push”. Giving birth is almost always going to be an intense and painful experience, however the baby comes out. It’s time to stop making women feel worse by berating them for supposedly giving birth the wrong way.


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