Mode of birth
While most pregnant women and people prefer to give birth vaginally, for some a caesarean is the right decision for them. Having a safe and supportive space to discuss these options is one of the aspects of The Real Birth Company’s antenatal teaching that many people really appreciate. Birth planning is an essential part of our course (its almost all of it!)
Included in our Programme is a session on planning a caesarean or assisted birth. This is important as the World Health Organisation suggest that in 10% of births, a caesarean birth is effective in reducing mortality and morbidity, yet above that rate, caesarean birth is not associated with a reduction, in either case. 1, 6
It’s important to have the opportunity to discuss what might happen if a caesarean birth is offered during labour. These births are usually referred to as an ‘emergency caesarean’, although this can often make them sound more dramatic than they are in many cases.
While some caesareans really are emergencies (3.8%) 2, many are not of the type where the baby needs to be born within a very short time. We therefore tend to refer to caesareans which happen after labour has started as ‘unplanned caesareans’.
A planned caesarean is one which happens before labour, and is more commonly known as an ‘elective caesarean’. Some women and people don’t feel that there was anything elective about their caesarean, but that they were given no option, for instance if their baby was breach. For others, this is a positive choice and the right decision for them.
Any conversation about reducing the caesarean rate must happen with the women and people who want to have a caesarean birth at the centre of the discussion, ensuring that this option is fully supported for them. It is also essential to balance the risks of waiting too long in a labour before offering a caesarean or instrumental birth (known as “too little, too late”) with the risks of iatrogenic, or medically caused harm, by intervening too soon (“too much, too soon”). This balance is always a challenge, but it is reasonable to assume that it is not the case that over 30% of women and people could not give birth vaginally.