When Jessica McKey’s first child was born seven months ago, it was in a ‘completely quiet, very calm, restful environment’.
There was no panic, no pushing, and no last-minute dash into surgery, because in fact, surgery is exactly what Jessica had on her agenda all along. At 39 weeks pregnant, she welcomed her daughter into the world through a planned, elective C-section, conducted by the anaesthetists, midwives and consultants of her local NHS service.
Jessica, 30, doesn’t have any existing medical conditions or other qualities that mean that she would be a likely candidate for a scheduled C-section. Instead, she simply chose to experience a Caesarean rather than a vaginal birth, and she’s adamant that her birth story was absolutely the right choice for her.
‘I had a very straightforward pregnancy, and I really enjoyed it, but I didn’t properly engage with how I was going to give birth until I started to get quite big,’ she says.
‘Most women want to give birth naturally – they want to give birth out of their vaginas, because that’s what society tells us that we’re supposed to do. But I became interested in the numbers around birth injury.
‘I wanted to know what percentage of women need stitches or an episiotomy, what percentage of women suffer bladder incontinence, how long does it last for, what percentage of women suffer fecal incontinence?
‘My midwife couldn’t give me an exact figure; she seemed quite surprised that I wanted to know these things, and I found that in turn surprising. If you were going through any other point in your life where you know your body is going to have to go through so much, you would absolutely be expecting to delve into all of the associated risks.’
Jessica was also surprised about the minimal level of planning she was encouraged to do: ‘My midwife kept saying that to me, “don’t worry about making really definite plans because it’ll all go out of the window anyway!” I just thought, why does it have to be like that? I felt I wanted to take back some control over the whole situation.’
She adds that many of her concerns about a vaginal delivery stemmed not only from worry about birth injury, but also from the fear of lack of postnatal care if it does occur. Although women are priorities to the health service when they’re pregnant, she feels that the provision for women after labour is lacking, not only with issues like incontinence, but also pain and discomfort during sex.
‘It’s not seen as a concern for a woman not to enjoy sex, or for a woman to find sex painful,’ Jessica says. ‘Some women even report doctors saying: “Well, it’s probably better that you have all your children and then we’ll sort your vagina out, because there’s no point sorting it out now, when you might have more children.”‘
‘Women’s assessment of pain is really questioned. There’s an element of women being ‘hysterical’; don’t give them too much information, don’t give them too much choice, because they won’t be able to cope.’
After conducting her own research, the mum-to-be quickly became disillusioned by the ‘obsession with the pain of childbirth as a rite of passage’.
‘You’re seen as a vain or selfish person if you’re not prepared to go through that pain. But in what other scenario are humans encouraged not to take pain relief when something is painful?’ she questions. ‘If you go to the dentist and someone says they’re gong to give you a root canal, under no circumstances would anybody advise you not to have pain relief.
‘People sometimes say you opted for the easy option because you had a C-section. Planned C-sections, of course, are very different to emergency C-sections, but nobody gets points for difficulty level – you just want your baby and yourself to be as healthy as possible.
‘And even if it was easy, why does that matter? Why do women have to do the hard thing? Why can’t we say, actually I want the easy option and I’m really glad I chose that option, because it was easiest for me?’
The route to Jessica’s elective C-section actually ended up proving anything but easy, as, like the majority of pregnant women who are young, fit and healthy, she was strongly encouraged to try for a vaginal birth.
Although her midwife was ultimately supportive, one consultant, whom she was required to meet with to get sign-off on the procedure, suggested that her child would be at higher risk of obesity and diabetes should she elect for a surgical delivery (figures she believes he’d miscommunicated, and that actually refer to women who are already overweight and subsequently end up needing an emergency Caesarean).
Her partner, however, was completely in favour of ‘the least traumatic option’.
‘We as a couple engaged with this together. He would have absolutely respected my decision whatever I wanted to do, but we both looked at the statistics, and that’s really what I was focused on. We made the decision together, he was very supportive.
‘I had zero worries about bonding. I had my baby on my chest, so did my partner, I was able to hold her. I haven’t had the experience of a vaginal birth, so I can’t compare the two, but there were certainly no worries about not bonding with her and it was just the most magical experience. They will hand you the baby like they do if you gave birth to them out of your vagina, you still get them placed on your chest. I can’t see how it would have been made any better.’
Jessica’s recovery from her C-section took around five days, after which point she was ‘fine’. Her only difficulties were ‘shuffling instead of walking properly’, and picking up her baby girl, which she could still do, but with extra care and caution. She has a scar, which she says doesn’t bother her at all. ‘I don’t even focus on it when I look at myself. It’s just part of my body,’ she shrugs.
‘I know that every woman is different and there’s no right or wrong, and ultimately what I want for every woman is choice. I’m not suggesting that everyone should have a planned C-section, because that wouldn’t be necessary, and lots of women wouldn’t want that. C-sections are major abdominal surgery, so it’s not like it’s without any risks itself, but there’s a lot of narrative around pain relief and natural birth that I really didn’t identify with at all.
‘You definitely get a response when you tell people that you’ve had a Caesarean and it was a planned one with no medical need,’ she admits. ‘But the main thing I get is “oh, I didn’t know you could get that on the NHS”‘ – and her main aim in sharing her story is spreading awareness of the fact that every woman is entitled to the birth she wants, on the National Health Service.
‘If you want it, it’s your choice,’ she stresses. ‘Lots of people are very supportive of female choice, and they recognise that birth is so personal and so individual that is almost doesn’t make any sense to judge somebody else’s birth.’
Jessica does acknowledge that there is a debate about NHS resources when it comes to planned C-sections: ‘If every woman did decide to have an elective Caesarean, the current NHS set-up wouldn’t able to cope with that. I understand resources are important, and there’s a practical point around this – how are we going to make this possible if we start making Caesareans more available to people or we start promoting the fact that Caesareans can be an option for you?
‘But if that is what you want the NHS is going to have to respond to that, but the NHS should be responding to what women want. It’s very responsive to a lot of other patient groups, and it should absolutely be responding to what women need from a birth service. I can absolutely see that if everyone turns round tomorrow and says “we all want Caesareans”, that’s impossible, but over time, it could certainly be something that the NHS could respond to.
‘This has to be about treating women fairly, and that means respecting their choices and wherever possible providing them with the birth that they want.’