It's time doctors told mothers the truth about caesareans

newborn
Scientists have found that surgically delivered infants have a greater susceptibility to antibiotic-resistant superbugs Credit:  Moment RF/Petri Oeschger

Like one in four women in Britain, I have had a caesarean birth. And so, like one in four women in Britain, I read with mounting horror the new evidence of just how harmful a C-section can be to babies. Last month, a Swedish analysis of data from 20 million births in 19 nations showed that C-section babies were 33 per cent more likely to develop autism and 17 per cent more likely to develop ADHD.

Now, scientists from the Wellcome Sanger Institute, University College London and Birmingham have found that surgically delivered infants have a greater susceptibility to antibiotic-resistant superbugs found in hospitals, possibly because the drugs associated with operating on the mother wipe out many of the healthy bacteria or microbiome in the gut of the baby. While infants may not become sick immediately, the long-term effects these hospital bugs have on their immune system can place them at higher risk of allergies, asthma and diabetes in later life. Guilt is, of course, part and parcel of parenthood.

But what I feel right now is something much much deeper than any work-life balance angst. It is a sense of self-reproach that my ten-year old daughter’s birth could be the reason for her allergic reactions, her rashes and hayfever so extreme that, as we recently discovered on holiday, grass pollen can make her throat constrict to the point that she struggles for air.

There is nothing I can do now, of course, but I can’t stop ruminating all the same – and nor can my circle of mothers left aghast that they may have unwittingly compromised their children’s health. I hold my hands up and admit I requested an elective caesarean. I was eventually persuaded, coerced and coaxed into changing my mind, but I ended up with an emergency one instead. It was the middle of the night. Life or death. No time to debate the pros and cons.

See how I’m trying to justify a surgical delivery because I want to avoid the finger of blame? Even though nobody is blaming me. Yet. What about those women who have elective C-sections? Are they to be vilified – will they vilify themselves? – even though they were given a choice based on the fact that doctors told them C-sections were safe?

What a nightmarish prospect. When someone dies of cancer, particularly lung cancer these days, the very first question people inevitably ask relatives is whether the deceased was a smoker? The amount of compassion very much depends on the answer. 

Rightly or wrongly – but invariably – innocent victims garner more sympathy than those deemed complicit in their own misfortune. Will our children be quizzed in future about the circumstances of their birth every time they need medical care? And be met with expressions of disapproval because it was their own selfish, unthinking, too-posh-to-push mothers whose elective surgery millstoned them with poor health? Except not all of us are too posh. I was psychologically damaged by the hospital birth of my first child, which was very fast and very ghastly. I had no midwife.

I suffered from post-traumatic stress as well as having physical complications, so when I became pregnant again, I met with the consultant and asked if she could guarantee that this time I would have midwife taking care of me labour. She could not. So I reluctantly asked for an elective caesarean. Had I known there was any risk at all to my baby’s immediate or future health, I would not have chosen a C-section in a million years. What mother would? As it turned out, I was diagnosed with gestational diabetes and had to have an early emergency caesarean at 36 weeks, which was awful. But now I have healthy, happy daughter.

Judith Woods with her daughter, Lily Credit: Rii Schroer

My heart goes out any woman who has a child with serious health issues now riddled and who is now agonising over whether her elective caesarean was the reason. At this stage, researchers remain slightly circumspect about any direct causal links. But if there is any suspicion then women – all of us – need more information as soon as possible. Not sensationalised, no need for scaremongering or sending pregnant women who have been advised to have a planned caesarian for medical reasons into a meltdown. Is it time to stop all C-sections apart from those absolutely necessary for medical reasons? I have no idea. That’s one for the Chief Medical Officer or the Royal College of Obstetricians and Gynaecologists. The onus is on them.

Risk and benefit must be balanced, sober facts interpreted by medical experts and used to raise awareness and give support, not spread fear. Kneejerk reactions do patients and doctors alike a grave disservice. Sometimes, the truth is unpalatable, but that is no reason to disregard it. Sometimes, the truth is so complex that its nuances need to be explained. Freedom of choice is a great thing, and an empowering thing. But only if we know the facts before we make that choice.

There’s a valid argument that children most likely to need a planned C-section may be those most likely to develop autism or ADHD regardless; further research is desperately needed. Until then, pregnant women and those planning to become pregnant need to be brought into the discussion so they receive guidance to make the right decision for them and for their babies.