An excellent article published in South Africa’s City News today, titled, Let’s Scrap ‘too posh to push‘, and written by researcher Berenice Paulse, deserves mention here.

Paulse rightly makes reference to a “shortcoming” in the UK’s NICE (CG132) caesarean guidance, but I really want to highlight some of the other the points she makes, as they are so articulately put, and resonate with everything I’ve written about and felt for so many years.

Is it not time that policymakers concede that this trend is unlikely to see a reversal in the near future? Instead of trying to arrest the trend, should it not be embraced as the product of scientific progress and changing attitudes towards reproduction? Should resources not be used to empower women to make informed choices about the method of birthing best suited to their (and their babies’) clinical, emotional and social wellbeing? A woman better informed about her birthing options is also less likely to be coerced into any decision.

Concerns that nonmedically motivated C-sections may divert skilled health workers away from where they are most needed are not justified as there is no evidence that such professionals would be drawn towards resource-constrained settings in the public health sector, for example, in the event of fewer ­C-sections.

We have witnessed this in the persistent human resource disparities between the public and private health sectors in South Africa, as well as the brain drain from developing to developed countries. Policies aimed at achieving a more equitable distribution of resources should target health workers instead of straitjacketing women.

A global paradigm shift is needed from prescriptive attitudes about what are acceptable or appropriate choices for women, to those that embrace a woman’s right to choose, and that prioritise resources that will support that choice.

Update NHS maternity care pathways

This is precisely why the organisation of maternity services in the UK needs a fresh look.

We cannot continue to shape, map and resource a maternity pathway that assumes (or forces) all ‘low risk’ women will want a ‘normal’ (MCWP definition including adverse outcomes) birth.

We don’t.

More women are choosing a caesarean birth than a home birth, and have been for some time.

Our maternity services structure and policy needs to reflect this, and act sooner rather than later to accommodate this reality.

If not because it’s the right thing to do, then at least because it’s the most cost effective (particularly in terms of litigation claims).

  • Author and journalist Pauline Hull