Hi-tech childbirth? Yes please, doctor!

CHILDBIRTH is surely one of the great unpredictables in life. Like the weather, you can't accurately foretell what's going to happen, or when. You can go to all the classes, write out impeccably PC birth plans, eat all the right foods, drink none of the wrong drinks, even avoid smelly cheeses and raw eggs. But when it comes down to the finishing line and the baby is about to be born, your experience may bear no relation whatever to the blissed-out woman on the video you and your partner watched at the preparation for parenthood classes. Because you can't always "plan" what is going to happen.

In spite of this, most pregnant women do develop a sense of what they think their baby's birth will be like. Spurred on by organisations like the National Childbirth Trust (NCT), they rule out drugs or forceps or cuts. But what happens if, in the delirium that is a long labour, you - and your baby - find you need such tools? Does the anti-intervention lobby mean that women who opt for hi-tech devices - some even choosing them well in advance - are left feeling they've failed the test of womanhood, by not delivering their baby "as nature intended".

Ms S - the health worker who was sectioned under the mental Health Act so that doctors could perform a Caesarean section on her as she was suffering from pre-eclampsia - brought such birth back into the headlines last week. While hers is a murky story (she is alleged to have said she would be glad if her death made her ex-partner feel guilty) her court case - one of seven pending - raises the whole issue of modern technology in birth. Once again, the heavy black line is drawn between advocates of the natural childbirth movement and the kind of woman who is, in the words of one who has had three Caesarean sections, "only happy when I have access to all the drugs and doctors possible".

Louisa was told when she was 33 weeks pregnant that as her baby was "small for dates" they would probably have to deliver it early by Caesarean. "I was very worried until they got to the Caesarean bit; I remember thinking, 'Yes!' I'm not one of those people who thought that childbirth was going to be some great experience. I think you only go through it to get the baby." In comparison to what she calls the "violence of other women's labours", Louisa says hers was "incredibly calm - I just strolled in and it was all over in about half an hour". She believes post-Casearean incapacity is exaggerated by those pushing the dogma of natural childbirth: "Five days after giving birth to my daughter I sprinted across the hospital car park because there was a woman giving birth in a car, and only later did I think that I oughtn't to have done it because I'd had an operation."

In contrast, Madeleine was in labour for 24 hours, with a total of three epidurals "just waiting and waiting. I was exhausted and because of the epidurals I couldn't really push." Her doctor, who she had already primed to avoid technological intervention, said he'd give her only three more pushes before taking her into theatre for an emergency Caesarean. In the event, her daughter was born by forceps delivery - "she still has a scar over her eye" - and the doctor almost dislocated his shoulder in the process. "The next day a woman doctor told me that I should never have never been allowed to take it that far, but I have to say that I was pleased that I did - even if it meant that because of the third-degree tear to my perineum I didn't have sex for about six months afterwards." She has subsequently had another baby, by normal delivery.

Between 15-20 per cent of births in Britain are Caesareans, and the medical profession is fairly consistent in believing that it is a useful method, when needed. NHS policy is to aim for vaginal delivery if at all possible - obstetricians vary greatly in their attitudes to elective Caesars as an option, and there are no separate figures for these at present. Yet a survey of 282 female obstetricians published in the Lancet showed that one third would choose a Caesarean delivery. Eighty-eight per cent cited fear of perineal damage, while 58 per cent were concerned about their long-term sexual function. Professor Nicholas Fisk, at Queen Charlotte's Hospital, who conducted the survey, says, "It is arguable that elective Caesarean is at least as safe as vaginal delivery". He argues the risks are much lower these days since most Caesareans are done under epidural rather than general anaesethetic and women are always given antibiotics to reduce the chance of infection. As he says, "They say labour is natural but you don't find a great demand for dentistry at home without anaesthetic."

By comparison, some individuals within the NCT malign it at every turn. One woman, whose twins were born by Caesarean just over a year ago, was told by her NCT teacher that it would take a year to recover from the operation and that it would have a dire effect on her relationship on her children. "All crap of course. It's just part of their anti-doctor, anti-hospital line. Frankly, the only good thing about the NCT is meeting other women who are pregnant. Otherwise, it's just alarmist and macho."

Helen certainly experienced some extreme reactions when telling people she was having a planned Caesar, even though the reasons were medical. "My yoga teacher was the worst. She treated it like a bereavement: the worst possible thing that could happen to me and my baby. Even though I felt really happy with my choice, I was made to justify it."

Lucy Turner, a London midwife, doesn't see why she should justify such a personal decision. "I think it's good to have the choice. I didn't want to take the chance of having a long, painful delivery. Instead, it was quick and easy. My husband was with me, it was painfree and I cuddled my baby daughter as soon as she was born. I had a fantastic experience and I'd do it again."

Paula Reed, fashion director of Harpers & Queen and mother of two, has seen both sides. Her first child was Caesarean and her second was born naturally. Reed says she suffered far worse, from damage to the perineum, following the natural birth: "I couldn't move properly for about a month after Alfie was born, and they even talked about having to 'refashion' me! Whereas after the Caesarean, I recovered quickly and was swimming lengths when Chloe was only six weeks old."

Caroline Flint, immediate past president of the Royal College of Midwives, will acknowledge that some women, like Paula, prefer Caesareans, but says that others are devastated by the process. "They know that they should be happy that they have a healthy, live baby and so on, but they are completely consumed with loss and grief, feeling that their bodies have failed them." She likens it to a man's experience of impotence: "It niggles at them in the same way."

Research on the subject is scanty and inconclusive. Flint cites some work by psychiatrist Judith Trowell of the Tavistock Clinic in London, showing that women who have had emergency Caesareans are more anxious mothers, and go on to have more difficult relationships with their babies. But she does not know if this would prove true for those whose Caesareans were planned in advance. On the other side, there is evidence that a particularly traumatic natural labour can also cause bonding problems for mother and baby. Dr Lorraine Sherr, senior psychology lecturer at the Royal Free Hospital and author of The Psychology of Pregnancy and Childbirth, says, "For every study that looks at problems with Caesareans, there's been another that fails to find any. It's very mixed but the most crucial issue is whether the Caesarean is planned or not."

The Caesarean rate is rising in Britain. Up until now, this has largely been put down to "interventionist" doctors, working at their own convenience or wanting to whip the baby out at the first sign of trouble, mother's wishes regardless. But, more recently, there does seem to be something of a trend for women to choose the Caesarean "option"; according to a 1994 survey more than half of obstetricians thought such patients' requests were upping the rate. Perhaps there would be more if women felt it really was a free choice. As Professor Fisk says, "The next issue is whether women should be able to request an elective Caesarean. In 10 or 20 years time women may well be offered them as a matter of course. We talk about consumer choice and there's no reason why that shouldn't be part of it."

Louise Chunn is Features Director of Vogue

Additional reporting by Emma Cook.

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