The short answer to this question is yes, since C-sections can be a life-saving operation both for the baby and on occasion for the mother. However if we ask “are all C-sections necessary?”, or “is your C-section really necessary?”, then the answer is not always a definite yes.

Up until about 10 years ago the C-section rate in Europe accounted for approximately 15% of all births (slightly higher in the United States) which means 85% of women were delivering their babies by the vaginal way. More recently the rate has been rapidly increasing to 30-35% in some units in Europe, higher in the United States and last year some units in Shanghai had rates of 60%. The perinatal mortality and morbidity, which is a measure of the condition of babies at birth has not changed significantly during this period, suggesting that the reason for the C-section cannot be primarily to benefit the baby. However the increase in C-sections is still rising, even despite the massive costs to the hospitals. Why?

It seems it has become fashionable for women to request a C-section in recent years. This has partly come about because female celebrities interviewed in the popular women’s magazines have reported that they preferred to avoid normal labour and delivery. In the UK this was dubbed the “too posh to push” syndrome but in a recent survey, women said it was not that they were too posh to push, but “too frightened to push” being afraid of the pain of labour and possible pelvic floor damage from having the baby naturally. This is a sad reflection of current obstetric practice.

Women have evolved to give birth by delivering the baby through their pelvis and out through the vagina. In 85% of cases this happens safely and without damage to the mother or baby provided there have been no complications during the pregnancy or labour and labour is managed efficiently by experienced obstetricians and midwives. There is an old saying: “If it ain’t broke, don’t fix it” This applies just as much to human physiological processes as it does to the engineering industry.

The whole aim of obstetricians and midwives should be to give confidence to women that management of their labour and delivery will be as safe and comfortable as possible. With the use of modern pain relief techniques, including epidural analgesia, but especially the presence of an experienced obstetrician and midwife, with careful assessment of progress in labour, most women can develop trust in their attendants to manage them safely and so be able to enjoy the experience of normal birth. Every pregnant woman has this right.

Recent evidence has shown that babies born vaginally have fewer problems than those born by C-section unless there were complications in labour. Indeed one recent survey has shown that babies followed up at 2 years after unnecessary C-section showed an increased risk of neuro-developmental delay. It has been calculated that 175 unnecessary caesarean sections would have to be carried out to avoid 1 foetal death. Other reasons why C-section may be contra-indicated are that it predisposes the mother to the risk of placenta praevia in future pregnancy and therefore another C-section with the attendant risk of severe haemorrhage. The relative risk of placenta praevia following 1 previous caesarean section is 4.5, for 2 it is 6.5 and for 4 or more it is 44.9

There is also the risk of rupture of the previous scar in a subsequent pregnancy. Again, it has been calculated that for every infant saved by C-section, one woman would experience uterine rupture and possible hysterectomy during a subsequent pregnancy. A large epidemiological study showed an absolute risk of unexplained stillbirth at or after 39 weeks of 1.1 per 1000 women who had a previous C-section compared with 0.5 per 1000 for those who had not.

It is essential practice for the obstetricians and midwives to inform women of the possible disadvantages and complications of unnecessary caesarean section. I can say I have personally been responsible for over 60,000 deliveries during my career, and am concerned about the rising rate of C-sections. So next time you ask for, or are advised to undergo C-section, which is not an emergency, just ask yourself or your obstetrician. “Is my caesarean section really necessary?”.