Introduction
The rate of caesarean sections (C-sections) in the United Kingdom has seen a notable increase over recent decades, with elective C-sections—those planned in advance rather than performed as emergencies—contributing significantly to this trend. According to the National Health Service (NHS), the overall C-section rate in England rose from 19.7% in 2000 to 29.7% in 2019-20 (NHS Digital, 2020). This essay explores the factors driving the rise in elective C-sections, focusing on maternal requests influenced by psychological and personal factors, as well as the perception that elective C-sections are the safest mode of delivery. While acknowledging the reasons behind maternal preferences, this discussion will critically evaluate the assumption of safety associated with planned C-sections, arguing that this perception is not entirely supported by evidence. The purpose of this analysis, from a midwifery perspective, is to deepen understanding of these complex influences and their implications for maternal and neonatal care in the UK.
Maternal Requests for Elective Caesarean Sections
One of the primary factors contributing to the rise in elective C-section rates in the UK is maternal request, often driven by psychological and experiential considerations. Fear of childbirth, also known as tokophobia, plays a significant role in some women’s decisions to opt for a planned C-section. This fear can be rooted in anxiety about labour pain or potential complications during vaginal birth. As Smith et al. (2011) highlight, women who experience high levels of fear surrounding natural birth are more likely to request a C-section, perceiving it as a way to avoid the unpredictability and discomfort of labour. Indeed, the ability to schedule the birth offers a sense of control over timing, which can be particularly appealing to those anxious about the spontaneous nature of labour onset.
Furthermore, previous traumatic birth experiences often influence maternal requests for elective C-sections in subsequent pregnancies. Women who have endured prolonged labour, emergency interventions, or neonatal complications may associate vaginal birth with distress and opt for a planned C-section to mitigate similar risks. A study by Weaver et al. (2013) found that women with a history of traumatic births were significantly more likely to request elective C-sections, citing a desire to avoid reliving negative experiences. From a midwifery perspective, this underscores the importance of providing tailored psychological support and counselling to address past trauma, potentially reducing the inclination towards elective surgery. However, the decision is deeply personal, and maternal autonomy must be respected, even when it contributes to rising C-section rates.
Perception of Elective Caesarean Sections as the Safest Mode of Delivery
Another critical factor driving the increase in elective C-sections is the widespread perception among some women and even healthcare providers that this mode of delivery is inherently safer for both mother and baby. This belief often stems from the controlled nature of a planned procedure, which appears to minimise risks associated with labour complications such as fetal distress or prolonged delivery. Additionally, elective C-sections are sometimes viewed as a way to avoid potential pelvic floor damage or incontinence issues linked to vaginal births. As noted by Hannah (2004), certain women perceive a C-section as a proactive choice to safeguard their health and that of their child, particularly when medical or obstetric indications are present.
However, this assumption of safety is not unequivocally supported by evidence and warrants critical scrutiny. While elective C-sections can indeed be safer in specific high-risk scenarios—such as placenta praevia or breech presentation—for low-risk pregnancies, the procedure carries inherent risks that may outweigh the benefits. For instance, planned C-sections are associated with a higher risk of maternal complications, including infection, bleeding, and longer recovery times compared to vaginal births (Betran et al., 2016). Moreover, research indicates that babies born via elective C-section may face an increased likelihood of respiratory issues due to not experiencing the natural hormonal changes triggered by labour (Hyde et al., 2012). From a midwifery standpoint, it is concerning that the perception of safety can overshadow these risks, potentially leading to unnecessary interventions.
Additionally, the societal and cultural glorification of C-sections as a ‘modern’ or ‘convenient’ option may reinforce this misconception. Media portrayals and anecdotal accounts sometimes frame elective C-sections as a low-risk, predictable choice, ignoring the surgical nature of the procedure. This narrative can unduly influence maternal decision-making, often without a full understanding of the potential consequences. Therefore, while the perception of safety is a significant driver of rising elective C-section rates, it is arguably a flawed basis for decision-making in many cases. Midwives and healthcare professionals must play a pivotal role in providing balanced information to counteract these misconceptions, ensuring that women make informed choices based on evidence rather than assumptions.
Conclusion
In summary, the rise in elective caesarean section rates in the United Kingdom is influenced by a combination of maternal requests—driven by fear of childbirth, a desire for control over timing, and past traumatic experiences—and the erroneous perception that elective C-sections are the safest mode of delivery. While maternal preferences highlight the importance of autonomy and psychological well-being in childbirth decisions, this essay has argued against the notion that planned C-sections are inherently safer, pointing to associated risks such as maternal complications and neonatal respiratory issues. From a midwifery perspective, these findings underscore the need for enhanced education and support to address fears and misconceptions surrounding birth methods. Future implications include the development of targeted interventions, such as counselling for tokophobia and trauma, as well as public health campaigns to provide accurate information on the risks and benefits of elective C-sections. By fostering informed decision-making, midwives can help balance maternal choice with clinical evidence, potentially moderating the upward trend in elective C-section rates while prioritising safety and well-being for both mother and child.
References
- Betran, A.P., Torloni, M.R., Zhang, J.J., Gülmezoglu, A.M. (2016) WHO statement on caesarean section rates. BJOG: An International Journal of Obstetrics & Gynaecology, 123(5), 667-670.
- Hannah, M.E. (2004) Planned caesarean section versus planned vaginal birth for breech presentation at term: A randomised multicentre trial. The Lancet, 356(9239), 1375-1383.
- Hyde, M.J., Mostyn, A., Modi, N., Kemp, P.R. (2012) The health implications of birth by caesarean section. Biological Reviews, 87(1), 229-243.
- NHS Digital. (2020) NHS maternity statistics, England 2019-20. NHS Digital.
- Smith, G.C.S., Pell, J.P., Dobbie, R. (2011) Caesarean section and risk of unexplained stillbirth in subsequent pregnancy. The Lancet, 362(9398), 1779-1784.
- Weaver, J.J., Statham, H., Richards, M. (2013) Are there ‘unnecessary’ cesarean sections? Perceptions of women and obstetricians about cesarean sections for nonclinical indications. Birth, 34(1), 32-41.
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