There is a hidden cost to the NHS’s big push for caesarean births

The NHS has announced that, for the first time ever, more women in the UK are giving birth by C-section than by vaginal delivery.

The increase has been ascribed by NHS England to women having babies later – 23.9 per cent were mums aged over 35, up from 19.9 per cent a decade ago – as well as increases in obesity levels, both of which make natural birth harder. There is also a strong sense among midwives that the increasing medicalisation of birth is happening because of huge staff shortages in the health service, resulting in a culture that makes being able to schedule a birth (“Your caesar will happen at 11am on Friday morning…”) less tricky for an overloaded system to manage than the vagaries of a natural delivery.

Now, I believe totally in a woman’s right to choose what is right for her body and her baby. But there is a lot to be said on the subject.

Birth, like death, has its own rhythm, its own logic which doesn’t take account of midwives changing shifts or labour units being under staffed in the middle of the night. In an increasingly chaotic NHS landscape – recent official reports into maternity services all over the country paint a terrifying picture of women being left alone, not being listened to, understaffing and much unnecessary terror, pain and loss of life. In such a system, and after a CQC review of maternity services found that almost one in two maternity services in England were rated as requiring improvement for safety, can you blame women for opting for what seems to be the less risky option and scheduling a caesar?

Of course, being cut open in a massive operation is not actually “safe”, “pain-free” or particularly “good for the baby”. On the contrary, there is much evidence that travelling down the birth canal triggers a hugely beneficial microbiome hit for the newborn, boosting its immune system and halving the risk of premature death. A natural birth also helps the mother’s body set itself up for bonding and breastfeeding, via the release of oxytocin, and helps the birth of the placenta and the womb to contract post-partum.

After my own second natural delivery, I walked out of the birthing suite to my room on a different floor unaided. Two days later, I was walking my new baby and toddler in the park.

Of course women who know they will have a problematic delivery, or if there is an issue with the baby’s health, should of course be offered an elective caesarean. I am all in favour of the wonders of modern medicine. Historically, women in childbirth died in their droves, and it was a bloody, agonising and scary business.

But it saddens me that so many women who could probably have a safe vaginal delivery with the right support are either being persuaded to have a C-section because it is more convenient for the NHS, or are too scared to attempt giving birth naturally, because they have heard so many terrifying stories of abandonment by midwives.

Twenty years ago, I gave birth naturally twice, with just gas and air – but I was only able to do so because of the constant and loving care of my one-to-one midwife. She came and did my pre-natal checks with me at home, got to know me and my husband – and when it came to both labours, I trusted her totally. I knew that if I did what she said – she had been a midwife in Nigeria for 20 years, and had done another 20 in the NHS – I would be ok.

I am no “free-birther”. The free-birthing movement, which insists that the body knows best and all medicalisation can be avoided, is dangerous for mothers and babies. Indeed, a friend who insisted on having a home-birth lost a child when he got stuck, and they couldn’t get her to hospital in time.

It’s time for a more level playing field in maternity services – an NHS birthing system that allows all women to try and have a vaginal delivery if they can, with the levels of one-to-one midwife support that I enjoyed. But also a system that gives women the choice if they are older, or more obese, or scared of the pain, to deliver in a way that will be safe and work for them.

Pregnant women need real, supported and adequately resourced choices. But we must also try and strike a better balance between nature and medicine.

Eleanor Mills is author of Much More to Come (HQ, £10.99), and founder of noon.org.uk, a network for women in midlife