Are caesareans risky?

The evidence is mixed. The American College of Obstetricians and Gynaecologists (ACOG) estimates there are about four maternal deaths for every 100,000 women after vaginal deliveries compared to 13 in 100,000 after caesareans (though some of these women would have been at higher risk of complications to begin with). The Birth Trauma Association found that mortality rates are lowest for women who have elective caesareans.

Women who give birth by caesarean typically stay in hospital a day longer and have an extended recovery period. There is also a higher risk of hysterectomy and cardiac arrest during the procedure – although this is still a tiny risk at 0.03% and 0.19% respectively.

What are the risks of a vaginal birth?

Around 90% of women experience some tearing of skin around the vagina, but in more severe cases (in around 3% of births) stretching and tearing of muscle tissue can require stitches and cause weakness or injury to pelvic muscles. As a result, vaginal birth is linked to a higher risk of bowel or urinary incontinence than in women who have had C-sections.

How many women deliver by caesarean?

In England, 11.5% of expectant mothers have a planned caesarean (up from 4% in 1980) and about 15.6% of women have an unplanned caesarean (up from 5% over same period), according to NHS statistics. However, the figures vary widely across the world. OECD figures show that in Finland, the figure is just 16%, compared to 36% for Italy and just over half women in Turkey (a breakdown is not given of emergency versus elective).

Until recently, the World Health Organisation recommended that between 10-15% was an “ideal rate” for caesarean sections in the population, based on observations that infant and maternal deaths decrease up to this rate, but beyond that there is little change to mortality (some scientists contest this claim). The WHO now discourages the concept of “target rates”, saying that the needs of a patient should be assessed on a case by case basis. This is partly due to a recognition that the risks associated with surgery have fallen substantially. Better anaesthetics have minimised the risk of deep vein thrombosis and less invasive surgical techniques make infection less likely.

What are the NHS guidelines on who can get a caesarean?

A pregnant woman is sometimes advised that a caesarean is the safest option, for instance if she has diabetes, high blood pressure, or a serious infection, if the baby is breech or it is a twin pregnancy. Other decisions are more finely balanced. For instance, if a woman has suffered a serious tear (requiring surgery rather than superficial stitches) in a previous vaginal birth they are at a higher risk of experiencing a similar injury in future. Some women have a fear of vaginal birth called tokophobia, sometimes linked to a previous traumatic experience, which can lead to overwhelming anxiety. Most women who ask for a caesarean do so on health grounds, but Nice guidelines from 2011 state that any woman who asks for a caesarean should, after discussion of the pros and cons, be offered one.

Does the baby benefit from a natural birth?

Babies born by caesarean are more than twice as likely (14% versus 6%) to be admitted to neonatal intensive care, but this figure does not account for the fact that most caesareans are carried out for medical reasons. This makes it tricky to calculate how much, if any, additional risk is down to the caesarean rather than underlying risk factors.

That said, there is some evidence that a vaginal birth may have benefits for the baby. Doctors believe surges of hormones as labour begins may kickstart the baby’s lungs, while being squeezed through the birth canal also helps expel amniotic fluid from the lungs, meaning that breathing problems are less common immediately after a vaginal birth.

In the long term, there is some evidence that children born by C-section are at greater risk of developing asthma and are more likely to be obese as adults.

How much pressure is there in the system for a natural birth?

The surgical procedure costs the NHS around £1,700 a time – more than double a normal birth(£750), and women also stay in hospital for twice as long on average. So, aside from any medical considerations, this is a powerful motivation for cash-strapped hospitals to push down the rates of caesareans. This inevitably filters down to the patient, and many woman have reported feeling pressured into opting for a natural birth, despite Nice guidelines stating that women should be free to choose.