When it comes to affording women their rights, it seems that the vast majority of NHS trusts are falling behind. Through a Freedom of Information request made by the charity Birthrights, it has emerged that only 26% of trusts are fully compliant with NICE guidelines which state that ‘women should be allowed to choose a Caesarean Section without providing a medical reason’. 15% of trusts deny all elective caesareans, and a further 47% are inconsistent in whether they permit or deny them. The government issued a statement appearing to support NICE’s guidelines, but it seems that it is going to take more than a few recommendations to shake-up current practice in many areas of the country.
So what is stopping doctors from allowing women to elect to have a caesarean? Some studies suggest that with a planned caesarean, the risk of a maternal heart attack or of bleeding which would require a hysterectomy is marginally higher than with a vaginal birth. Another, perhaps more significant reason, might be that caesareans typically cost £700 more than vaginal deliveries. But although this may be the case, it appears that regulatory bodies, unlike some hospitals, have understood that you cannot put a price on the mental health needs of women, many of whom suffer throughout difficult pregnancies and are naturally anxious about the impending birth.
A report by the BBC details the case of Lucie Tidman, who suffered a serious haemorrhage and subsequent PTSD after giving birth to her first child. She was denied a caesarean against medical evidence during her second pregnancy, and then went on to suffer another haemorrhage. This is a woman who had already suffered a traumatic first birth; both her physical and mental health had already been severely tested. Who could possibly have had more right to say whether or not she needed a caesarean the second time, than Lucie herself? Instead, Lucie says that when she requested a caesarean, she was told that there was no reason why she would haemorrhage a second time. No consideration was given to her anxiety or mental health.
Similarly, the Telegraph reports that women requesting caesareans are often met with prejudicial attitudes and a blatant disregard for their bodily autonomy. Certainly, caesareans are expensive for the NHS, but so is dealing with complications of vaginal deliveries that go wrong. What we see when women are denied their rights to choose how they give birth are a lot of old-fashioned and outdated attitudes.
Research has shown that sexist stereotypes have led to the creation of something now dubbed ‘the gender pain gap’. Research has found that men presenting with stomach pain in A&E wait approximately 49 minutes before treatment. Women, on average, wait for 65. It seems that when women present with symptoms of pain, they are more likely to be viewed by doctors as exaggerating or being dramatic. Just as when women are not listened to readily enough when they detail their pain, so too are their voices easily dismissed when they express concerns about their births.
It is worrying that, in 2018, how a woman feels about her body and what she thinks is best for her body is disregarded by many medical professionals as a worthwhile resource in her treatment. And while women may be able to choose how they dress and how they accessorise their bodies, when it comes to understanding their own bodies, women are deemed to be lacking the proper knowledge.
Women who have tried to opt for a caesarean in some NHS trusts describe being made to feel as though they are being told-off, or as though they have no choice. Women describe being told to ‘manage their emotions better’, and feeling as though the ‘too posh to push’ stereotype has created a climate where women who elect to have a caesarean aren’t seen as proper mothers.
We must remember is that all this occurs at ground level. Despite what official bodies and the government say, attitudes which are prevalent in the hospitals where women are treated are ultimately letting them down. Proper legislation would of course compel NHS trusts to give women the choice they deserve. What we need to see is a seismic shift in attitudes. For as long as women’s pain is deemed less important, and as long as women are seen as unable to make significant decisions about their bodies, they will not get the treatment they deserve in any medical system.