An Open Letter to Kirstie Allsopp

Kirstie, I cannot quietly sit and continue to read the completely unbalanced view which has been put forward via Twitter last week, and the Telegraph article today.

Kirstie, I understand your experience of birth has been of C Section birth. I understand that you did not feel prepared or supported before or after this. I think this is appalling, and that you were terribly and unforgivably let down. You are correct, NO woman should suffer a stigma for having had a C-Section. C Section is definitely NOT an easy way out. Women who are facing having a C Section should have access to appropriate support, both to prepare and recover, both physically and emotionally.

HOWEVER, Kirstie just because this was YOUR experience, does not mean that the answer to women having better birth experiences, is implementing across the board, surgical birth education. I guarantee, if antenatal education took that direction, that our C Section rate would climb even higher.

Your standpoint is that because approximately 25% of births are now C -Sections, we should accept this statistic and start preparing and teaching parents antenatally about surgical birth, as there is a 1 in 4 chance they will have one.

Sorry Kirstie, on this you are just wrong, and doing expectant parents a huge disservice.

WHY do you not want to challenge this 1 in 4 C-Section rate? WHY are we not looking for a way to lower this, rather than accepting it & educating our expectant parents to just accept it too?! This isn’t about stigma Kirstie, this is where your arguments have gotten confused, its about safety, its about education and its about informed choice.

C-Sections SHOULD absolutely 100% be used when needed – they are an amazing medical advance which undoubtedly saves lives. That is what they are there for, and there should be absolutely no guilt, stigma or failure ever attached to this.

A C-Section should be (which even you, yourself referred to it as on Twitter) – a “life saving operation”. So, if we agree that this is the role of a C-Section, do we therefore really think that 1 in 4 of all births are so dangerous that they require a life-saving procedure?

Your comment that “Not talking C-sections during a childbirth course is like not talking Shakespeare during an English literature course” is so unbelievably misinformed. Unlike you, I believe in the ability of most women to safely birth their own baby. I believe that the majority of traditional NHS and some other antenatal classes do not teach women how to do this, therefore leading to this high rate in interventions and C-Sections. That’s right, I don’t simply blame the NHS for poor care, but I blame the quality of our antenatal education, which has a crucial role to play in the UK’s high ratio of C-Sections.

I was reading with interest some of the tweets which you received during your debate. Proud parents tweeting to say that they agreed with you that it was important they had done the full C-Section role play in class, because in their class “5 out of 9 couples ended up with C-Sections”.

So, this class which had educated and prepared its parents for C-Section, had a C Section rate of around 65%! More than twice the national average… alarm bells ringing for anyone else here??

Compare this to the classes I teach, where my average C-Section rate is around 12% – HALF the national average, and four times lower than this class. Why is this?? Maybe because I am empowering women, educating them to understand their body, understand how it works, and preparing that body to get ready for birth. These are things which are not currently adequately covered in all NHS classes or traditional classes. Perhaps Kirstie, you should attend a private natural birth class, see some of the really great practice out there and the difference it makes, and promote the good… Rather than putting us all in the same boat, and slagging us off across the board with little understanding of what we do.

I am PRO women having the most positive, easy and enjoyable birth experience they can. I am anti unnecessary medical procedures which are risky and can be highly traumatic to the whole family unit. Yes, I support woman to have natural births. By your definition Kirstie, this makes me anti C-Sections. Not the case. I teach all my ladies, that in an emergency, you trust your care provider and their medical expertise, as that is what it is there for, to back you up.

However, I work with women to make INFORMED choices. Kirstie, if I had worked with you for the birth of your second baby; I would have supported you to consider all your options, and then 100% supported whichever decision you felt was RIGHT for you. Considering all the options is not about stigma attached to any particular choice – but about the fact that decisions should be about INFORMED choice. This approach is relevant whether we are talking about C Sections, or which house we decide to buy.

I am working with two perfectly healthy pregnant women at the moment, with perfectly healthy babies, who in the last week who have been told by their medical provider, that no-one should have a water birth because “it will kill their baby”. Not all advice, just because it is offered by someone in a medical role, is unbiased, accurate or informed.

There is a reason some of us are trying to support more women to have natural births, and bring down that overall C-Section percentage, and it is nothing to do with thinking women who have C-Sections are ‘lesser than’. For a start, a vaginal birth is much safer. C Sections carry much higher risk than natural birth, to both the mum and baby. The risk of a woman dying following a C-Section is 4 times higher than following a natural birth. We are talking about major abdominal surgery here. Other reasons include the impact on the mother following the birth, which is also something clearly close to your heart too. The increase in rates of postnatal depression in C-Section mothers is not just about stigma, but also is rooted in physiological factors that are absent when baby is not born vaginally.

The women I work with who have been faced with an emergency C Section during their labour, have been able to utilise the coping and breathing techniques I teach to stay calm and involved in the decision making process. I don’t ostracise, make an example of or highlight as ‘different’ any woman who while attending my classes decides to opt for an elective section. All women learn the same coping techniques which are applicable in a variety of situations.

For those women I have worked with who have had been faced with emergency sections, do I honestly think that having ‘role played’ a C Section in advance with some playmobile will make that moment when their baby’s heart stopped beating, and they got whipped into theatre, with dad chewing his nails in the corridor, any less frightening ? No, this is probably one of the most traumatic, terrifying moments of your life. It is scary, and sometimes there are things in life which we can never be truly prepared for.

Kirstie, you absolutely deserved more support, both antenatally and postnatally, than you received.
C-Section birth should not have any stigma attached to it.
But that’s as far as I can agree with you.

The answer to addressing stigma and support is NOT adding specific surgical birth education to childbirth courses. Women do deserve better education, support and birthing experiences. I already have too many women who come to my classes who have been terrified by descriptions of epidurals or demonstrations of forceps, but no real idea of how to empower themselves to have a better birth. Let’s start to support this generation of ladies who are not “too posh to push” but rather ‘too scared to push’.

Birth & Postnatal Doula & Antenatal Educator
Bump, Birth and Beyond

13 thoughts on “An Open Letter to Kirstie Allsopp

  1. Here, here. Whilst I have no doubt that informing women about csection, when this might happen etc is vital, I do not think that role play for every woman is the right way to help women prepare for birth…rather than alleviating fear and anxiety, I am sure that this would only increase womens concerns as they look ahead to the birth. Antenatal education is vital in helping women fully understand ALL their options and make informed choices…this will sometimes include csection, and that is not to say it is wrong or right…it is a choice based on individual circumstances, but should be made with full awareness of the coping strategies and techniques available to women, . Csection is not something to be undertaken lightly, but also should not be frowned upon as a “failure”… It is there to save lives when needed.

  2. Great article. I had a planned c-section (breech twin) which was fantastic and I qas well supported. However I did feel that from the momen I wax ‘in for a c-section’ I had zero say on what was to happen. The hospital would not allow my Doula in the operating theatre. They did not place the babies on my chest immediately as requested. All other aspects of the care (and brilliant assistance with breastfeeding), were exemplary, but I really feel that women who have c-section for whatever reason should still be listened to, on the ‘non-medical’ aspects of the birth.

    I did also think it a bit odd, when i first found out i was having twins, midewives were already saying ‘oh hav a cesarean’. I know from my twin-specialist Doula friends, that’s definitely not the onle option.

    cheers and love the blog, Pascale

  3. I’d be really interested to know if there was any documented evidence that telling pregnant women in ante natal classes about caesarian sections, what they are and what will happen etc, causes more caesarian sections to take place.
    Unfortunately you haven’t provided any evidence to support this view, and as far as I am aware there isn’t any. I am aware of the continuing medicalisation of labour and I’m against it wholeheartedly.
    I think you’ve made a mistake picking a fight with Kirstie about this article
    Seems to me she has a point about how women who might face caesarians need more support.
    If we are talking personal experiences then mine is this – I had a great NCT group and we still keep in touch 7 years on. I had a shock a few days before 40 weeks and when I saw the consultant my son was breech. Only minor attemps were made to turn him (though my husband, who is an acupuncturist, attempted a number of proven techniques which weren’t, of course, offered by the consultant!) Unfortunately my son became stuck whilst turning after toe acupuncture and the consultant told me I would have an ‘elective’ caesarian.
    I was distraught and angry. When I asked why I wasn’t being offered a VD by breech the consultant gave me all sort of scare stories about killing my baby. Afterwards I found out that very few midwives have experience delivering breech babies any more. So as you can see, in many ways I’m on your wavelength.
    The only thing that really helped me cope with the caesarian was the memory of my brilliant NCT teacher who explained the process with us at class, yes, using playmobil but loads of facts and advice. I remain hugely grateful to her and hope that the NCT investigate the case Kirstie has flagged up to ensure that all the pregnant women who go to NCT classes get at least as much information as I had.

    • Su My concern is that she is confusing two totally different issue. The stigma is one that I abhor and have written about and will write about again. I abhor the term normal birth because by association anything else is abnormal. But what she is doing is in claiming that everybody should be given detailed information regarding C sections is wrong. There are two sides to this issue and my concern is only one was being given air time. People should be free to choose and I have even stated why not look at specific classes for just Interventions so then attendance is a choice. By forcing everyone to know about it will do as much harm as good. Equally frustrating is I agree with her sentiment just not the way she is going about it.

  4. I think women need advice about caesarean section delivery. I had an emergency section after 12 hours of contractions at 1 minute and being on a syntocinon drip and had only dilated two centimeters. I wanted a vaginal delivery but I wanted my baby born alive more. She was in a great deal of distress and I was exhausted. The session my NCT class teacher on c-sections was invaluable. I knew who would be there. I was prepared. I knew not to look at the lights in the ceiling because they are mirrored and I didn’t want to be able to see what was happening.  Five out of the six women in our group had a caesarean section delivery. One who was carrying twins, one of which had died at 28 weeks gestation, two home births where the babies got stuck and two hospital births one midwife led with a baby who was stuck and me with a distressed baby. No one got what they planned but we have six thriving two year olds now. I didn’t dwell on the fact that I didn’t have vaginal birth I just enjoyed having my beautiful baby daughter. Too much pressure is put on women. That having a natural birth is best, that exclusive breastfeeding is best. In a perfect world yes! But that doesn’t exist. Having information about a subject is useful. And men telling women what they need to know about an experience they will never have is very patronizing. 

    • Catherin thank you for your comments. Thank you for supplying further information,that supports the piece written by Steph. A mum, doula and antenatal teacher.

      Your comment “Five out of the six women in our group had a caesarean section delivery.” is exactly the point Steph was making.

      I am concerned by your blatant sexism though. Why you feel a man cannot be a birth professional is of some concern. You are doing a huge disservice to a large number of male birth professionals that work to ensure expectant parents have as positive a birth experience as possible. Including myself, male midwives, anaesthetists, surgeons and obstetricians.

    • Do you complain about having male obstetricians? In my experience most obstetricians are male and definitely telling me about an experience they will never have.

      I agree it’s just sexist to say men can’t train in birth. Do you feel the same about Dr Jack?

      • I didn’t say men can’t be birth professionals. What I meant by my final comment is that I don’t think I should have information withheld from me.
        By the way Claire who is Dr Jack?

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  6. I think this is a great article, and I agree with a lot of what you say, with one exception. Normal birth IS normal birth. Anything else IS abnormal, life saving, essential, critical, valuable and needed, perhaps, but still abnormal. C-sections are to birth what asthma pumps are to breathing. Something to help when you CAN’T do it on your own. As to the stigma, it’s sad that it’s there, but is evidence to the fact that they are abused. If only people who really needed them had them, we’d all be grateful for them, but because they’ve been abused, especially in countries like the US, there is a stigma attached. Which isn’t fair on the mothers who truly needed it, but makes the presence of a stigma more understandable.

  7. Excellent blog. I live in America where our C-section rate is nearly 33%. 🙁 There is a small but growing number of women and men that are seeking to turn that around. It’s slow going though. So many people have been indoctrinated into thinking that a 1 in3 c-section rate is normal. Thank you for your perspective on this!

  8. My second delivery was a planned C section and it was a perferct experience. I had more trauma and health problems following my first delivery ( 18 hours of labour all drugs free). Second time around I wanted a different and more manageable experience. Every woman should chose the best option for her!

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