There are undoubtedly situations where c-sections are lifesaving for mothers and babies.

However, because of the longer recovery times, risks, and complications for future pregnancies, it’s important to avoid having c-sections when they aren’t medically necessary.

The World Health Organization recommends that countries aim to maintain c-section rates at 10-15% of births, and that surgery be performed only when medically necessary. When c-section rates rise to 10%, the rate of maternal and newborn deaths decreases.

When the rate is above 10%, there is no evidence that mortality rates are reduced.

Despite these recommendations, c-section rates continue to rise, especially in first-time mothers.

Why Are The Rates So High?

It is no secret c-section has risks attached for both mother and baby. So why are the rates of c-section climbing? The reasons vary and are often powerfully emotive.

Some hospitals have policies about how birth should progress, and how fast; there is also constant threat of malpractice in some areas. Many women have lack of birth choices, and sometimes the reasons are connected with cultural norms (in Brazil, for example, c-section rates are as high as 80% in private hospitals).

A c-section performed after labour has begun is referred to as an emergency procedure. This term reinforces the idea that every non-elective c-section is a matter of life or death for either mother or baby. And that is definitely the case for some women.

But for other women, their baby’s birth could have, and should have, been different and at some point during labour, decisions were made which completely changed their birth outcome. The result is a vicious cycle: women who have had a c-section find their options for future births are limited.

Most women will be told they can try for a vaginal birth after c-section (VBAC) but the restrictions placed on them means it is highly unlikely to be successful. Women who want to home birth after c-section find midwives inaccessible, or restricted by guidelines.

Other women opt for elective c-section to avoid the potential stress of another emergency c-section, or perhaps they are told the reasons for their original surgical birth will prevent them from vaginal birth in the future.

What Does This Mean?

C-section is becoming normalised. Dr David Richmond, president of the UK’s Royal College of Obstetricians and Gynaecologists, believes c-sections should not be the norm for low risk women. He has recently been quoted saying: “The benefit of reducing the number of first-time mothers having a caesarean would be to reduce the risk of having a caesarean with any later pregnancies.” Dr Richmond advocates more midwifery-led maternity services across the UK.

Midwifery-led models provide care from the same midwife, or team of midwives, during pregnancy, birth and the early parenting period. Evidence for the positive outcomes of midwifery-led care show there is a reduced risk of c-section.

A Cochrane review of 13 trials involving more than 17,500 women showed midwifery-led care has many benefits with no adverse effects, compared with medical care. This means more spontaneous labours, fewer interventions, fewer preterm births, and less risk of c-section.

The cost of c-section is high. The World Health Organization looked at information on c-sections performed in 137 countries and found in 2008 an estimated 6.2 million unnecessary c-sections were performed at a cost of US$2.3 billion.

The emotional and physical cost to women is also high. Women are left to deal with post surgery recovery, a newborn baby, and often a load of emotional trauma. They might feel they have failed, or their bodies are faulty; they might be traumatised, and suffer in silence, because of the social and cultural expectation that a healthy baby is all that matters.

How Can We Change This?

Women seeking normal birth find themselves facing many obstacles. They might not have many options for birth locally. Services could be unavailable to them due to strict inclusion criteria, and they might struggle to be able to afford the maternity services that offer better outcomes for them. Many women go through pregnancy with very little support for a normal birth, being told instead what is and isn’t allowed at their place of birth.

Fear of labour and what might go wrong is increasing. This is partly due to lack of information about normal birth available to women during pregnancy, and partly due to the lack of support for normal birth in the place women are most likely to give birth – hospital.

About 98% of women give birth in a hospital setting, and most of those women will experience some form of intervention during labour. The vast majority of women are unable to achieve normal birth because of the system they are birthing in. Maternity systems are set up to focus on what can go wrong during labour, and attempt to prevent it.

C-sections performed in genuine emergency situations save lives, but overwhelming evidence points to a large number of unnecessary surgeries being performed on women today. This possibly contributes to a cultural and social acceptance of c-section as a normal part of labour and birth. It’s important women are aware of the benefits of normal birth, choose their care provider and setting to support and achieve this, and avoid unnecessary interventions which can affect their future birth experiences.