Who’s Too Posh to Push? High Cesarean Section Rates Aren’t Moms’ Fault

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The number of women opting to deliver by caesarean section in the U.K. has doubled since 1980, a phenomenon that has been popularly attributed to women being “too posh to push.” But a recent study published by the British Medical Journal says that’s hooey, and finds that most c-sections were in fact performed for medical reasons.

The review of more than 620,000 births at 146 hospital trusts in the U.K. in 2008, found that 147,726 single births were delivered by cesarean section.

Further analysis of the reasons for c-section found they were mostly medical: about 90% of women with a breech baby opted for c-section, as did 71% of women who had had a previous c-section. Mothers who experienced serious medical problems during labor also chose surgical delivery following recommendations from their doctors. (More on Time.com: 5 Pregnancy Taboos Explained (or Debunked))

The authors of the study contend that there was no evidence that women with low-risk pregnancies were asking for caesarean sections inappropriately. Regarding c-section rates, the authors write:

The results also suggest that another explanation — that high numbers of low risk women are requesting elective cesarean — is unlikely to be a major contributor because most women undergoing a cesarean section in 2008 had at least one clinical risk factor, and there is little variation in adjusted rates of elective cesarean section.

Overall, however, the study did find a wide range in c-section rates between hospital trusts — from 15% to 32% — and suggested that the differences were to due to doctors’ individual decisions in emergency situations. It’s possible, then, that some doctors, faced with problems during labor, may choose c-section sooner than is necessary.

It bears noting that c-sections make more money for private hospitals than vaginal deliveries. And they’re cheaper than vaginal birth after cesarean section, or VBAC, which, thanks to liability issues, requires additional medical staff at most hospitals; doing the c-section also avoids potential lawsuits by patients. (More on Time.com: 5 Little-Known Truths About American Sex Lives)

Mervi Jokinen of the Royal College of Midwives told the BBC that women should no longer be blamed for increasing caesarean rates. “The massive driving force in the rise of caesarean sections is the threat of litigation faced by hospitals and clinical teams,” she said.

Indeed there are many contributors to the soaring rates of c-section — multiple births, older mothers, overweight mothers, avoidance of VBAC — and the question of how to reduce unnecessary surgeries is a matter of ongoing debate. But the new study suggests we can at least lay to rest the “too posh to push” myth.

—By Claire Mc Cormack

More on Time.com:

Do We Need Vitamin-Supplemented Birth Control Pills?

Diagnosing Postpartum Depression with a Brain Scan

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