Case study 3: the UK
The situation is different yet again in the UK. As a high-income country with a world-renowned health system, its maternal mortality rate is very low at 7 deaths per 100,000 live births as of 2017. The UK has a much lower caesarean rate than Brazil – 29% as of May 2020 – but still exceeds the globally accepted optimal rate.
Healthcare professionals are often pressured to make overly cautious treatment decisions to protect their professional registration – a phenomenon called defensive medicine. This has been known to affect birth workers, with high numbers of obstetricians and midwives reported to practise defensively. Practitioners may try to cover all bases and encourage women to give birth in hospitals, where they are theoretically safer because they can access emergency care and interventions if needed. The practitioner is less likely to be sued or have their professional registration revoked if something goes wrong.
For many women, the hospital is not an ideal birthing environment: bright lights, loud noises and shift changes for hospital staff are stressors that counteract the feelings of safety needed for the hormonal changes of birth to take place. In combination with the common use of epidural anaesthesia, which restricts a mother’s movement and her urge to push, the physiology of birth is compromised and a greater number of women will need obstetric interventions such as forceps or a caesarean to deliver.
What would be the ideal future for caesarean birth?
Three case studies cannot provide a comprehensive global picture of caesarean birth, but they do demonstrate the disparities in this area. We must ensure adequate provision of caesareans where needed, while managing them to prevent overuse.
Caesareans are not inherently good or bad for public health, and striking a balance between supporting all women to make informed choices while keeping caesarean rates within the optimal range is not a simple task. These case studies highlight a complex web of factors, including cultural values, health funding and women’s agency, which all feed into the caesarean rates we see.
Whether you are in Chad, Brazil, the UK or anywhere else, giving birth is no easy feat. We must help all women feel safe, supported, and in control of their bodies and choices. This will give all babies the best start to life, no matter how they come into the world.
The opinions expressed in this blog are those of the author and do not necessarily represent the views of The Health Policy Partnership.