"Explained: why women choose cesarean delivery, and why it's a legitimate choice they're making"

This month witnessed three ‘firsts' in cesarean news. On a personal note, electivecesarean.com published its first survey results (see our press release here), together with an accompanying article that provides evidence of CDMR as a legitimate birth choice. Our (1,232) surveys found that 56% of expectant mums (and 40% overall) would choose cesarean delivery, with the most common reasons cited as wanting to avoid physical damage to their body (39.4%) and a planned versus unpredictable birth experience (33.6%).

Meanwhile, earlier in the month, the Karolinska Institute in Stockholm published its findings on why women opt for CDMR, although there, researchers found that 43% of (n.496) women ‘suffered from a clinically significant fear of childbirth', compared with ec's 16.7% rate. And straddling both research findings was the explanation from singer Christina Aguilera on why she chose to have a cesarean delivery for the birth of her baby boy. As the first celebrity mum I can recall talking openly about CDMR, she described how she was too scared to give birth naturally: ‘I'd heard horror stories about tearing. I really wanted a calm and peaceful environment. I didn't want any surprises.' 

The upshot of all this is that it confirms a rather obvious truth. Women are simply not homogenous creatures. We don't all want a homebirth and we don't all want a cesarean, and what influences our birth choices in addition to our basic instinct is our personal level of tolerance for a specific set of risks. At least this is how I see it. Almost every week, we are bombarded with news headlines reporting (for example) "double" or "five times" the risk of mortality and morbidity with cesarean delivery compared with PVD. Now, these risks might be a 0.5% PVD occurrence compared with 1% cesarean or 0.1% PVD and 0.5% cesarean, and yet it is not always put in context with other applicable PVD risks such as needing an emergency cesarean (up to 23% with PVD) or having an episiotomy (up to 73% with PVD).

At the NIH CDMR conference in 2006, I heard a doctor make an important observation on the evaluation of any risk, which is this: ‘Whatever % risk of outcomes are quoted in medical research - whether it's 1% or 90% - if that outcome happens to a woman (or her baby) when she gives birth, that % becomes 100%, and she (and her baby) alone will have to live with the repercussions of that outcome.' In other words, it is reasonable for different women to identify different ‘100%' worse case scenarios that they could bear to live with should they occur.

I've put together a list of some of the hundreds of research reports I looked at when I was pregnant, which compare the outcomes of PVD and (various types of) cesarean delivery. I found that the balance of benefits for my baby (and for me) was in favor of cesarean delivery at 39 weeks EGA, and these pages help to explain why. Access to this information requires registration (completing a short survey and a one-time fee of $5) but if you genuinely cannot afford this amount, please contact us and access will be provided. For the first time since its launch in 2006, ec is asking members to pay for full access so that we can raise funds for additional services on the site (for example, the installation of an online chat room/forum).

One final observation this month: in what could be described as a current climate of ‘natural versus cesarean', ‘midwives and doulas versus obstetricians and physicians', it was refreshing to read the comments of Carol Velas, a veteran labor and delivery nurse, nursing instructor and longtime childbirth educator, who was quoted in a recent Los Angeles news article: 'When I started practicing 18 years ago, to do a primary caesarian section as elective surgery was unheard of. ‘But some women say, `It's my right. I don't want to go through labor.' 'We're saying you have the right and as long as that person gets informed consent and understands the risk, it is her right and I'm going to support her.' This sentiment is exactly what I've been trying to say on this website from day one - that as women, we all have personal goals, personal priorities, personal preferences and personal fears. When it comes to our choices in childbirth, we should be supporting each other's personal choices and not, as some groups seem intent on doing, seeking to prevent those which don't conform to our own.