Published: 13/05/2004, Volume II4, No. 5905 Page 21

Caesarean is the new C-word. Jennie Bristow looks beyond the hysteria and asks why It is so wrong to think that in childbirth, mum knows best

The National Institute for Clinical Excellence has instructed NHS doctors to cut down on the number of Caesarean sections.Apparently, this is both a costly enterprise, and, more to the point, a dangerous activity undertaken by selfish women.Or so the shrill anti-C-section campaign would have us believe.

It is strange that a routine, straightforward operation should have become so controversial.What is it to NICE - or all the other commentators - if increasing proportions of women choose to have their baby under local anaesthetic on the operating table rather than hooked up to drips and monitors in the labour ward?

But in childbirth, like so many other areas of life, the personal has been politicised, and practical questions have been turned into principles. The limited range of choices that a woman does have about the precise method of the birth have become a battleground, on which a range of political and moral disputes are fought.

About one in five UK births involve Caesarean section. This is higher than the maximum limit recommended by the World Health Organisation of 15 per cent, but why is it high? As the NICE guidance illustrates, 93 per cent of Caesarean sections in England and Wales are carried out 'as a result of a preexisting medical condition or concerns about the health of women or babies'. In other words, the vast majority of all Caesareans are performed on the advice of health professionals.

But you wouldn't guess this from the news reports - and you are hard pressed to believe it when reading the NICE guidance itself. It might just be possible to read the NICE recommendations as being grounded in clinical judgement - until you find this recommendation: 'Women should be informed that continuous support from another woman, with or without prior training, during labour reduces the likelihood of Caesarean section.'

As the BBC explains: 'Men can become distressed at seeing their partner in pain, or try to take control of the situation.' The idea that a woman in labour is best helped, not by her partner who loves her and wants to reduce her pain, but by a midwife or relative who will talk her out of the easy option, is highly dubious.

The 'other woman' recommendation flags up two of the most disturbing aspects of this official anti-C-section advice. The first is that women must be dissuaded from a Caesarean, whatever the cost to their pain or peace of mind. The second is that there is a conflict of interest between the wishes of the father and the well-being of the expectant mother and her baby, and that fathers should simply leave it all to professionals.

More disturbing is the implication that there is a conflict of interest between the wishes of the expectant mother and the wellbeing of her child. The focus on reducing the proportion of elective Caesareans emphasises the problem of women making choices for their own apparent benefit, rather than for the obvious benefit of the baby. But it is not possible to separate the interests of a pregnant woman from the child she is carrying, and attempts to do so are very dangerous.

This is an edited version of a column by Jennie Bristow for political website spiked. www. spiked-online. com