I've been AWOL from here for a while, small kids, very busy blah blah blah, but if one thing was going to get me back to the blog it would be shoddy journalism about C-sections. So, thank you The Telegraph, you've got me back in the saddle:
Here's the story: "Caesarian rates support 'too posh to push' theory". To summarise: Chelsea and Westminster hospital has a C-section rate of 33%, at King George hospital in East London it's 8%. Lots of posh people live in Chelsea, lots of poor people live in the east end, therefore the 33% are too posh to push. Also, C-sections cost the NHS "several times more than a natural birth" and mean the mother is "three times more likely to need a hysterectomy after their next pregnancy" while the baby is at increased risk of "death, blood clots and breathing problems".
On the face of it it's pretty damning. Posh women in Chelsea are risking the lives of their infants and draining NHS resources because they just can't be bothered to pop their babies out properly.
Except that's utter rubbish, and here's why:
Firstly it assumes that everyone in Chelsea is "posh". Certainly there are a lot of wealthy people there, the cheapest house currently for sale in the area is a 2 bedroom cottage going for £1,150,000. But there are plenty of "poor" people too, in council flats etc, London is just like that- who do you think is more likely to use an NHS hospital for the birth of their child?*
Secondly, 33% is the overall C-section rate, i.e. it includes emergency C-sections. I had an emergency C-section, after 34 hours of unremitting contractions - was I too posh to push then? Even after an hour and a half of, well, pushing? Ok, the writer also points out the the hospital has the highest rate of elective caesareans, with "16 percent of births performed by choice rather than as an emergency". But this is also misleading. There are only two types of c-section, emergency and elective. So those that take place because of e.g. a transverse baby that could not be delivered vaginally, or a severe heart condition in the mother that means she could well die in labour, are still "elective" although there is very little choice in the matter. The Chelsea and Westminster hospital has a high risk maternity unit, women with exactly these kinds of issues are referred there so it's hardly surprising that they have a higher than average C-section rate.
But what of the cost to the poor old NHS of all these C-sections? Well the Daily Mail re-hashed the Telegraph piece and tells us: "caesarean section costs the NHS about £2,600, more than double the £1,200 cost of a natural birth" Not exactly "several times more" and we're not told where those figures come from either. The only ones I've seen in the past put the cost of a C-section higher, but importantly don't include the costs of treatment and surgery for women who suffered damage during a vaginal birth, or the astronomical costs of a lifetime of care for those (thankfully rare) cases where a child suffers permanent brain damage after eg. shoulder dystocia leads to them being deprived of oxygen during a "normal" birth.
Ah - but C-sections are more dangerous for everyone we're told. I have no idea where the three times more likely to need a hysterectomy figure comes from, guess what - no reference! But even assuming it's true, it's still meaningless. Does it mean 60% of C-section mums need their womb whipped out compared to 20% of those who did it properly? It could equally be 0.0000003% v 0.0000001%. Show me the stats!
|What's more important? A Natural birth or a healthy baby?|
Where the baby is concerned, my consultant agreed that there is indeed an increased risk of breathing problems. But if the baby is delivered after 39 weeks (as is standard if there is no good reason to do it earlier), then that risk becomes negligible. And yes, more do die after a c-section, but not because of the c-section. The vast majority of those poor babies had developed serious problems before or during birth, they were delivered surgically as it was the best hope of saving them. They would not have survived a vaginal birth either but their mothers were brave enough to endure major surgery in the hope of saving them.
How dare anyone label those women too posh to push?
But finally, what about those brave, poverty stricken women in East London, delivering their babies by the Telegraph approved method? Well after five minutes on Google I discovered that the King George hospital maternity services are about to be shut down. The unit currently only accepts low risk women with everyone else going to the Queen's hospital, ten minutes away in Romford. No one choosing, or even needing a c-section would be sent to King George's, even women in labour there who need one unexpectedly are likely to be ambulanced to Queen's instead. To use their 8% C-section rate as a yet another slap in the face to C-section mothers is either lazy, callous or both.
This matters because the vast majority of women who have had C-sections didn't want them. They, we, endured major surgery because we genuinely believed it was the safest thing for our babies and for ourselves as the mothers who would care for them. Comparing the stats from different hospitals is meaningless to the unique situation of any individual mother and if those numbers are deliberately (or just lazily) fiddled, to produce clichéd headlines then they are not only meaningless, they are also deeply offensive.
PS. C-section mum Kirstie Allsopp responded to this piece too, you can read her letter to the Telegraph here
PPS. Neither the Telegraph or the Mail state where the figures come from, my best guess is here
*The hospital does have a private maternity service, but the article doesn't state if this was included in the figures, or if so, what proportion of the c-sections it accounted for.