While I appreciate your concern for women who would prefer a vaginal delivery ("Big city mommies *too posh to push'", The Jakarta Post, Nov. 14) being persuaded instead to have a caesarean, I am disappointed that you appear to agree with the refusal by many hospitals in England to support women whose preference is a planned caesarean.
I believe that childbirth autonomy is vital across the whole spectrum of birth choices.
Also, you need to appreciate that when bias against surgical birth is removed, and studies containing mixed caesarean data (emergency and planned) are excluded, there is evidence that caesareans on maternal request can result in better outcomes than planned vaginal deliveries.
Read the stories posted on any birth trauma website (physical and psychological trauma) and you will struggle to find a single complaint from a woman who has had a maternal requested caesarean, yet there are thousands from women who planned vaginal deliveries.
This is backed up by research, such as the 2007 Swedish study involving 357 women; those with maternal requested caesareans "reported a better birth experience compared to those with planned vaginal deliveries."
This is because planned vaginal deliveries may result in instrumental or emergency caesarean delivery, and the baby may be injured during the birth process or the mother may suffer perineal or pelvic floor damage.
Yet in terms of birth risks, women in England are not always informed about the whole truth.
Just two examples: the latest CEMACH report in the UK showed that women were less likely to die following a planned caesarean than any other birth type.
A 2009 Canadian study of 40,000 deliveries concluded that "elective pre-labor caesarean section . at full term decreased the risk of life-threatening neonatal morbidity compared with spontaneous labor with anticipated vaginal delivery".
The bottom line is this: there are risks and benefits with both birth plans - vaginal and caesarean - and women should be allowed to make their own informed decision.
Pauline McDonagh
Hull, England
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