Introduction
The rise in elective caesarean sections (C-sections) has become a significant topic of discussion within midwifery and maternal healthcare globally. An elective C-section, defined as a planned surgical procedure to deliver a baby before the onset of labour, contrasts with emergency procedures prompted by medical necessity. In the UK, data from the NHS indicates that the rate of C-sections has risen from approximately 12% in the 1980s to over 30% in recent years (NHS Digital, 2021). While some of this increase is attributable to medical indications, a notable proportion stems from maternal requests without clinical necessity. This essay explores the factors contributing to the growing preference for elective C-sections, focusing on maternal request as influenced by fear of childbirth, perceived control over timing, previous traumatic birth experiences, and the perception of C-sections as a safer option. Drawing on current evidence and national reports, this analysis aims to inform midwifery practice, aligning with the need to access and apply best available evidence for safe and meaningful care, and to consolidate knowledge for critical engagement with professional practice in preparation for a dissertation.
Maternal Request as a Driving Factor
One of the primary factors behind the increase in elective C-sections is maternal request, often rooted in personal, psychological, and social influences rather than medical need. A systematic review by Long et al. (2021) highlights that maternal request accounts for a growing percentage of elective C-sections, particularly in high-income countries. Women may opt for this method of delivery due to a range of individual concerns, often shaped by their perceptions of childbirth and personal experiences. As midwives, understanding these motivations is essential to provide person-centred care and address underlying fears or misconceptions. This aligns with the professional imperative to appraise and apply evidence to improve care quality, ensuring that women’s choices are informed and supported by accurate information.
Fear of Childbirth and Pain
A significant driver of maternal request for elective C-sections is fear of childbirth, also known as tokophobia, which encompasses anxiety about labour pain and potential complications. Research by O’Connell et al. (2017) suggests that approximately 6-10% of women experience severe fear of childbirth, with many citing pain as a primary concern. This fear is often exacerbated by societal narratives or media portrayals of labour as inherently traumatic or unmanageable. For some women, an elective C-section represents a way to avoid the unpredictability and perceived intensity of vaginal birth. However, it is worth noting that while a C-section may reduce labour pain, it introduces risks such as prolonged recovery and surgical complications. Midwives play a critical role in exploring these fears through antenatal education, offering evidence-based information on pain management options to potentially reduce unnecessary requests for surgical intervention.
Perceived Control Over Timing
Another factor contributing to the preference for elective C-sections is the desire for control over the timing of birth. Unlike spontaneous labour, which can occur unpredictably, an elective C-section allows women to plan the delivery date, aligning it with personal, family, or professional commitments. A qualitative study by Weaver and Statham (2015) found that some women value this predictability, viewing it as a means to reduce stress and organise support systems. Furthermore, control over timing can provide a sense of empowerment, particularly for women who feel anxious about the uncertainty of natural labour. While this preference is understandable, midwives must balance respect for maternal autonomy with discussions about the potential risks of non-medically indicated C-sections, ensuring decisions are informed by best available evidence as part of safe midwifery practice.
Previous Traumatic Birth Experiences
Previous traumatic birth experiences also play a pivotal role in driving requests for elective C-sections. Women who have endured prolonged or complicated labours, emergency interventions, or perinatal mental health challenges may associate vaginal birth with distress and seek to avoid similar experiences. According to a study by Ryding et al. (2015), women with a history of traumatic births are significantly more likely to request a C-section in subsequent pregnancies. This decision often stems from a desire to prevent retraumatisation, reflecting a protective mechanism. From a midwifery perspective, it is crucial to identify such histories during antenatal care and offer tailored support, such as counselling or birth planning, to address underlying trauma. This approach demonstrates the application of research to consolidate knowledge and inform ethical engagement with professional practice, a key component of dissertation preparation.
Perception of Elective C-Sections as the Safe Option
The perception that elective C-sections are inherently safer than vaginal births is another influential factor. Some women view surgical delivery as a controlled, predictable process that minimises risks to both themselves and their babies, particularly in light of horror stories about birth injuries or maternal mortality associated with vaginal delivery. However, this perception is not always supported by evidence. The World Health Organization (WHO, 2015) notes that while C-sections can be life-saving when medically necessary, non-indicated procedures carry risks such as infection, haemorrhage, and longer recovery times. Moreover, studies suggest no significant reduction in neonatal risk for low-risk pregnancies undergoing elective C-section compared to vaginal birth (Hannah et al., 2004). Midwives must therefore critically appraise and communicate such evidence, countering misconceptions with data from local, national, and international reports to promote informed decision-making and quality improvement in care delivery.
Implications for Midwifery Practice
The increasing trend of elective C-sections due to maternal request poses both challenges and opportunities for midwifery practice. On one hand, respecting maternal autonomy is a cornerstone of midwifery ethics; on the other, ensuring decisions are grounded in evidence is equally vital to safeguard maternal and neonatal health. This dual responsibility requires midwives to engage in continuous professional development, accessing and evaluating the latest research to inform care. Additionally, the rise in elective C-sections underscores the need for enhanced antenatal education and psychological support to address fears, trauma, and misconceptions. By applying research methods to review and consolidate knowledge, midwives can contribute to policy and practice improvements, aligning with the academic and professional goals of critical engagement in dissertation work.
Conclusion
In conclusion, the increase in elective C-sections is a multifaceted issue driven by factors such as maternal request, fear of childbirth and pain, perceived control over timing, previous traumatic birth experiences, and the view of C-sections as a safer option. While these influences reflect valid personal concerns, they are often shaped by misconceptions or societal pressures rather than clinical evidence. As midwifery students and future practitioners, it is imperative to access, appraise, and apply the best available evidence from local, national, and international sources to support informed decision-making and promote safe, meaningful care. Furthermore, by engaging critically with these factors through research and professional practice, midwives can address complex maternal needs and contribute to quality improvement. Ultimately, this analysis not only informs immediate practice but also lays the groundwork for ethical and evidence-based engagement in dissertation research, ensuring midwifery continues to evolve in response to contemporary challenges.
References
- Hannah, M. E., Whyte, H., Hannah, W. J., Hewson, S., Amankwah, K., Cheng, M., … & Willan, A. (2004). Maternal outcomes at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: the international randomized Term Breech Trial. American Journal of Obstetrics and Gynecology, 191(3), 917-927.
- Long, Q., Kingdon, C., Yang, F., Renfrew, M. J., Jahanfar, S., Bohren, M. A., & Betran, A. P. (2021). Prevalence of and reasons for women’s, family members’, and health professionals’ preferences for cesarean section in China: A mixed-methods systematic review. PLoS Medicine, 18(10), e1003799.
- NHS Digital. (2021). Hospital Episode Statistics, Maternity Data. NHS England.
- O’Connell, M. A., Leahy-Warren, P., Khashan, A. S., Kenny, L. C., & O’Neill, S. M. (2017). Worldwide prevalence of tocophobia in pregnant women: systematic review and meta-analysis. Acta Obstetricia et Gynecologica Scandinavica, 96(8), 907-920.
- Ryding, E. L., Lukasse, M., Van Parys, A. S., Wangel, A. M., Karro, H., Kristjansdottir, H., … & Schei, B. (2015). Fear of childbirth and risk of cesarean delivery: a cohort study in six European countries. Birth, 42(1), 48-55.
- Weaver, J. J., & Statham, H. (2015). Women’s experiences of planning a vaginal birth after caesarean in different models of maternity care in England. Birth, 42(2), 136-143.
- World Health Organization. (2015). WHO statement on caesarean section rates. Reproductive Health Matters, 23(45), 149-150.
