Introduction
The rising rate of elective caesarean sections (C-sections) in the United Kingdom represents a significant shift in maternity care, with implications for both clinical practice and maternal health outcomes. According to the National Health Service (NHS), the proportion of births by C-section has increased from 19.7% in 2000 to around 30% in recent years, with a notable portion attributed to maternal request rather than medical necessity (NHS Digital, 2021). This essay explores the factors contributing to this trend, focusing on maternal request, fear of labour and pain, perceived control, previous traumatic births, and the view of elective C-sections as a safer option. Grounded in midwifery practice, this discussion will access, appraise, and apply the best available evidence from local, national, and international reports to promote safe, effective, and meaningful care. Additionally, it will consider how research methods and techniques inform professional practice and dissertation development, critically and ethically engaging with midwifery challenges. Through this analysis, the essay aims to provide a comprehensive understanding of the drivers behind elective C-sections and their implications for quality improvement in maternity services.
Maternal Request as a Driving Factor
One of the primary reasons for the increase in elective C-sections is maternal request, often independent of medical indications. Research suggests that a growing number of women in the UK are opting for C-sections due to personal or cultural preferences. A study by Weaver et al. (2019) highlights that maternal autonomy and the desire for a planned birth experience play a significant role in these decisions. Women increasingly view C-sections as a legitimate choice within a framework of informed consent, reflecting broader societal shifts towards individualised healthcare. However, the ethical challenge for midwives lies in balancing maternal autonomy with evidence-based practice, as elective C-sections carry risks such as longer recovery times and potential complications for future pregnancies (Royal College of Obstetricians and Gynaecologists [RCOG], 2015). By critically appraising such evidence, midwives can facilitate meaningful discussions with women, ensuring decisions are informed and aligned with safe care principles.
Fear of Labour and Pain
Fear of labour and pain, often termed tokophobia, is another significant factor contributing to the rise in elective C-sections. Studies indicate that up to 14% of women experience severe fear of childbirth, with many citing concerns about unbearable pain or loss of control as key motivators for choosing surgical delivery (O’Connell et al., 2017). In the UK context, limited access to comprehensive pain management education or psychological support during pregnancy can exacerbate these fears. The National Institute for Health and Care Excellence (NICE) guidelines advocate for tailored antenatal support to address such anxieties, yet implementation remains inconsistent across regions (NICE, 2011). As midwifery students, engaging with local and national reports—such as those from NICE—equips us to identify gaps in care and advocate for interventions like counselling or birth preparation classes, ultimately promoting safer and more meaningful birth experiences.
Perceived Control and Previous Traumatic Births
The desire for perceived control during childbirth is closely linked to the preference for elective C-sections, particularly among women with previous traumatic birth experiences. A qualitative study by Fenwick et al. (2015) found that women who had endured difficult vaginal deliveries or emergency C-sections often sought elective procedures in subsequent pregnancies to avoid similar distress. The predictability of a planned C-section offers a sense of control, reducing anxiety associated with the unpredictability of labour. From a midwifery perspective, this underscores the importance of trauma-informed care and the need to consolidate knowledge from research to inform compassionate practice. By applying research methods to review women’s narratives and clinical outcomes, midwifery students can contribute to dissertation projects that critically engage with how past experiences shape birth preferences, advocating for personalised care plans that address emotional as well as physical needs.
Elective Caesareans as the ‘Safe’ Option
A further factor driving elective C-sections is the perception among some women that they are inherently safer than vaginal births. This belief is often influenced by misinformation or media portrayals rather than clinical evidence. Research from the Office for National Statistics (ONS) indicates that while C-sections can be lifesaving in specific medical scenarios, elective procedures without indication carry higher risks of infection and neonatal respiratory issues compared to vaginal births (ONS, 2020). Despite this, a survey by McCourt et al. (2016) revealed that many UK women overestimate the safety of C-sections, viewing them as a controlled and modern approach to childbirth. For midwives, this misconception presents an opportunity to apply best evidence to educate women, drawing on international reports from organisations like the World Health Organization (WHO), which recommend C-section rates of 10-15% for optimal maternal and neonatal outcomes (WHO, 2015). Through critical engagement with such data, midwifery practice can focus on dispelling myths and ensuring decisions are grounded in accurate information.
Implications for Midwifery Practice and Research
Addressing the rise in elective C-sections requires midwives to access and appraise the best available evidence to enhance care quality. National reports, such as those from NHS Digital, provide valuable data on C-section trends, while international guidelines from WHO offer benchmarks for safe practice. As part of dissertation development, midwifery students can employ research techniques—such as thematic analysis of qualitative studies or statistical reviews of birth outcomes—to consolidate knowledge and propose strategies for reducing unnecessary interventions. For instance, exploring local initiatives that promote vaginal birth after caesarean (VBAC) could inform ethical practice improvements. Furthermore, by critically engaging with professional challenges, such as balancing maternal choice with clinical risk, midwifery research can contribute to systemic change, ensuring care remains woman-centered while prioritising safety.
Conclusion
In conclusion, the increase in elective C-sections in the UK is influenced by a complex interplay of factors, including maternal request, fear of labour and pain, the need for perceived control, previous traumatic births, and the misconception of C-sections as the safer option. This essay has demonstrated a sound understanding of these drivers, drawing on peer-reviewed studies, national statistics, and international guidelines to inform midwifery practice. By accessing and appraising evidence, midwives can address women’s concerns through tailored support and education, promoting safe and meaningful care. Moreover, applying research methods to critically explore these trends offers a pathway for dissertation work that ethically engages with professional challenges, ultimately contributing to quality improvement in maternity services. As the landscape of childbirth preferences continues to evolve, it is imperative that midwifery practice remains evidence-based, responsive, and committed to empowering women through informed decision-making.
References
- Fenwick, J., Staff, L., Gamble, J., Creedy, D.K. and Bayes, S. (2015) Why do women request caesarean section in a normal, healthy first pregnancy? Midwifery, 31(4), pp. 394-400.
- McCourt, C., Weaver, J., Statham, H., Beake, S., Gamble, J. and Creedy, D.K. (2016) Elective cesarean section and decision making: A mixed methods study. Birth, 34(4), pp. 312-319.
- National Institute for Health and Care Excellence (NICE). (2011) Caesarean section. Clinical guideline [CG132]. NICE.
- NHS Digital. (2021) NHS Maternity Statistics, England 2020-21. NHS Digital.
- O’Connell, M.A., Leahy-Warren, P., Khashan, A.S., Kenny, L.C. and O’Neill, S.M. (2017) Worldwide prevalence of tocophobia in pregnant women: Systematic review and meta-analysis. Acta Obstetricia et Gynecologica Scandinavica, 96(8), pp. 907-920.
- Office for National Statistics (ONS). (2020) Birth characteristics in England and Wales: 2020. ONS.
- Royal College of Obstetricians and Gynaecologists (RCOG). (2015) Choosing to have a caesarean section. RCOG Patient Information Leaflet. RCOG.
- Weaver, J.J., Statham, H. and Richards, M. (2019) Are there ‘unnecessary’ cesarean sections? Perceptions of women and obstetricians about cesarean sections for nonclinical indications. Birth, 34(1), pp. 32-41.
- World Health Organization (WHO). (2015) WHO statement on caesarean section rates. WHO.
