Denise and her blog

Caesarean Birth Is Not A Lifestyle Choice!

The alarming rate of Caesareans, not just in the UK but in other countries too, is of grave concern. There is, of course, a multitude of reasons, not least the incidence of greater pathology in many women, lack of midwives to help maintain physiological birth, obstetric and managerial fear of litigation from failure to act when labour deviates from physiological progress and changing social trends in relation to childbirth and parenting. In the UK we are fast approaching a 50% Caesarean rate; in private care in South Africa, it can be as high as 90%. I cannot believe that almost 100% of the birthing population has so many issues that operative delivery is the only answer. However, with induction of labour rates at 60% or more in some UK units, it is hardly surprising that the “cascade of intervention” leads to increasing indications to manage and control birth.

Sadly, as I’ve mentioned before, Caesarean has become so normalised that young couples accept it as something that is, without challenge, part of their childbearing journey. My almost-daughter-in-law said she hadn’t made her mind up yet about the possibility of having a Caesarean, as if it is a lifestyle choice (no criticism intended, Ninka – and having twins in South Africa definitely increases the possibility of needing one). But Caesarean is not something on which you can make a decision until the time comes, usually shortly before or during labour, that indicates its necessity. It’s not like choosing whether to buy a new car or become vegetarian or change jobs.

Many expectant parents seem to take it in their stride that Caesarean may be needed, but I doubt they fully understand its implications. Caesarean is a major operation, the risks of which have been belittled by its frequency. It carries risks for both mother and baby that are rarely discussed at length with parents, just that it is “necessary”, with little opportunity to opt out. It has long-term sequelae that are almost never mentioned, not least a longer postnatal recovery time and the possibility of poor parent-infant bonding. Having a Caesarean is like having your appendix out – and having a baby as well. It is difficult enough recovering from physiological vaginal birth and caring for a newborn baby which, for most, is a completely alien concept until it happens. There is no rule book for caring for newborns – you are just expected to get on with it, deal with the sleepless nights, the difficulties of learning to breastfeed, the change in relationships between partners and sometimes the loss of identity for those who may, even temporarily, be stay-at-home parents rather than the competent professionals they were before pregnancy.

Caesarean birth – and its little sidekick, induction – are at risk of changing the microbiome of the human race. Will women evolve with zips down their abdomens that can conveniently be opened to lift the baby out? Women’s bodies are intended to become pregnant and to give birth – billions of people for thousands of years have been doing just that. Yes, there are some who experience difficulties or even die in childbirth, but that is not usually dependent on operative delivery – of course, in some cases, surgery can be a lifesaver for either or both mother and baby. But whilst we continue to normalise such deplorable and increasing rates of what can only be termed operative assault on women’s bodies, the higher the rates will rise. 

Expectant parents need the facts, applied to their individual situations rather than a blanket policy of reaching for the scalpel as if all other avenues have failed. They need to know the benefits and the risks of both having or not having a Caesarean. As a society we need to stop treating major surgery as a minor inconvenience. And professionally, we need to acknowledge that childbirth is a normal biopsychosocial life event that, in the main, progresses without complications and brings a baby into the world without drama or trauma.  Caesarean is NOT a lifestyle choice!  

Birth Of My Son 

My son, Adam, was born at home in July 1989, after a 24 hour labour with a four hour transition, ending in a forceps birth (yes, at home – it’s not what you know but who you know!) The consultant obstetrician was a friend who agreed to care for me even if it meant coming out to the birth. Adam was 10lb four ounces (4.3 kg). I was looked after by two midwives who were friends; my husband spent the very hot day washing cars and ordering in pizza for the midwives, whilst I huffed and puffed my way through first stage. To think Adam has just celebrated his 37^th birthday is amazing.

See his proud grandfather with a newborn Adam. 

Paternalism in Maternity Care: The “Just In Case Syndrome”

The recent intrusive national ‘phone alert advising us that the weather is hot (really?) and we should avoid bonfires and disposable barbecues (err…?) was a true example of the paternalistic nature of governments. Isn’t it common sense to consider the risks of fire on excessively hot days? It is just another example of the population being told what to do, what not to do, what to eat, how to bring up our children and all manner of things that should be the responsibility of individuals. Personally, I object to this patronising approach which implies that only those in government know what should be done – and I have turned off my ‘phone’s alert system. I work on the theory that if World War III breaks out, someone will tell me (or I’ll be dead so won’t have needed the national alert anyway). 

Examples of paternalism in healthcare include Covid vaccinations, fluoridisation of public water supplies, taxing foods with high sugar content to discourage consumption and restricting the number of aspirins allowed in one purchase. Now don’t get me wrong, there are some examples of positive paternalism which are for the greater good of the population, such as compulsory education for children or imposing speed limits when driving. However, even a well-intentioned paternalistic approach affects people fundamentally without their consent and focuses on populations rather than individuals.

In maternity care, we see this all the time, with increasing frequency and for increasingly spurious reasons. This is what I call the “just in case syndrome” –  the “you’re 42 weeks so we’ll just book you in for induction on Thursday” or “I’m just going to attach a clip to the baby’s head to monitor the heartbeat” or “we’ll just transfer you to labour ward because …” approach. And let’s not even get into the almost unspoken actions of routine synthetic oxytocics to manage third stage labour or vitamin K injections for all babies. 

There is an arrogance about these litigation conscious, risk-averse interactions (or lack of) with expectant and birthing parents that presumes that professional expertise is superior to individual choice. I absolutely endorse the role of midwives and obstetricians in guiding parents towards safe childbirth, but we see many examples of unthinking bias in decision-making. Much of this comes from a professional autonomy that presumes authoritative knowledge and experience, yet increasingly this is not the case. 

University-led education for midwives supposedly encourages critical thinking but does not emphasise skills and the application of detailed theoretical knowledge to demanding clinical scenarios. Midwifery management focuses on institutional numbers – staff, money, risks etc – but seems incapable of applying these statistics to the provision of high-quality care. National directives, especially NICE guidelines, make clinical recommendations based on “evidence” – either in support of an intervention or dissent for humanistic and – dare I say it – physiological non-interventions.

“Informed consent”  is another example of paternalism in maternity care. Parents may be given the reasons why a particular action is “necessary” but rarely are they given comprehensive information about the risks of that action. They are, of course, always given the risks of not “agreeing” to the proposed action. It is conveniently forgotten that “informed consent” also means the “right to decline” – and this should be an unconditional right without censure or coercion to conform.

When I was first a midwife in the 1970s, there was definitely an element of midwives and doctors “knowing best” – and perhaps at that time, this was true. The public respected authority and felt happy with their interactions with the professionals. Certainly, we had more time to care for women. There were far fewer choices to make, and women were guided by the information they were given. However, as more information has become available to the public, expectant parents are generally better informed (despite – or perhaps, because of - “Dr Google” and Co-pilot). People want to remain in control of their experiences of having children, yet the fear factor of professional caution, compounded by the media’s influence on healthcare knowledge, leads to courses of action that leave parents feeling dissatisfied and sometimes traumatised by their experiences.

We have had numerous investigations over the last fifty years, and I have seen them all come and go. Maternity Care in Action, Changing Childbirth, Better Births, Amos and Ockenden – and NOTHING has changed – or at least not for the better. Yet another set of “experts” comes out with yet another solution to the maternity care situation – and nothing works.

The sooner we relinquish our paternalistic approach to pregnancy and birth care, the more parents are treated with respect as individuals rather than a cog in a government-managed wheel, the better we will be able to get back to what maternity care is about – helping women through a normal physiological life-event that does not (usually) need to be medicalised and does not need to be controlled by paternalistic professionals and a paternalistic government.

Transitioning Role From Midwife To Grandmother

My son, Adam and his fiancee, Ninka, are expecting their first baby – or should I say, babies – as they ‘ve found out it is twins! (Ninka is a twin). Until now, I have not been mentally ready to become a grandmother, but it is an exciting time and a new chapter in all our lives. I find myself swaying between the potential joys of grandmothering and the professional concerns as a midwife, although friends tell me it’s the best thing in the world. Their GP warned them that Johannesburg has one of the highest Caesarean rates in the world at 90% in the private sector – with twins, I would think that narrows it down to possibly 99.9%! Thankfully, they have been able to register with a midwife-led birth centre with visiting obstetricians, and currently the fact that it is twins does not seem to be a barrier to continuing their care there. It is a little alarming though to hear Adam and many of his contemporaries say that they don’t mind if they have a Caesarean – almost as if it is a normal expectation of having a baby. More on this later.

Midwifery, Aromatherapy and Natural Birth Under Attack Again

A recent article in The Skeptic (June 2026) has yet again seen fit to lambast midwives, midwifery care, “natural” birth and – of particular interest to me – aromatherapy use by midwives. Granted, this was published online prior to the Ockenden and Amos reports, but is simply more of the same rhetoric against midwives and against women who desire a physiological birth.

I do wish these journalists would get their facts right. Quite frankly, Michael Marshall does not know what he is talking about. He is one of a growing number of journalists and campaigners determined to undermine the maternity services and physiological birth and all that goes with it. He slates water injections for analgesia in labour, incorrectly assuming there is no evidence base, moxibustion for breech presentation (a Chinese technique which he cannot get his head around), homeopathy (there is anecdotal evidence, but I might concede on that one) and – of course – aromatherapy – of which he has absolutely no understanding whatsoever.

Marshall states that “this” (presumably complementary medicine) is an area “in which (he) has a degree of experience” – yes, mainly in demonising centuries-old modalities and being instrumental in the political agenda to have them removed from public accessibility.  He twists facts to suit the political narrative and is ignorant of the evidence that supports these strategies. He states that there is no clear mechanism of action of aromatherapy, despite it having been proven to have a pharmacological mechanism – which is known to have both positive and negative impacts on human physiology. Either it does something or it doesn’t, but if it doesn’t, then how can it have negative effects? Aromatherapy is not simply “nice smells” and a bit of massage: it is a powerful chemical modality, and essential oils continue to be researched by the pharmaceutical companies as potential sources of new drugs.

Apparently, his Freedom of Information request to discover the prevalence of aromatherapy use by NHS midwives uncovered some questionable practices by enthusiastic but ill-informed midwives (about which I have written previously). He quotes NHS expenditure on aromatherapy as anything up to, in one trust, a totally unrealistic £30,000 – even if we account for training, this is at least three times the standard cost (and if the trust has quoted that, there is something inherently wrong). It costs no more than £1,000 a year to provide a midwifery aromatherapy service for women undergoing physiological labour – less than half the cost of a Caesarean section. If we add in around £7,000 to train 24 midwives, and factor that in across three years, plus £3,000 for oils, we are looking at a total of £10,000 or an annual cost of around £3300 – NOT £30,000! So, you only have to save two Caesareans, and the service has paid for itself.

Marshall quotes NICE guidelines as stating that aromatherapy should only be used if women request it, but NICE is part of the same establishment political agenda as Marshall supports. In any case, the NICE publications are guidelines, not directives or legally binding. Heaven forfend that a trust decides to offer an option to women that, allegedly, has no evidence to support it – when there are plenty of obstetric initiatives introduced into maternity services that have little or no evidence to support them. From his FOI request, he has uncovered some practices which, if correct, I would deem inappropriate (such as using midwives using oils for non-pregnancy related conditions such as coughs and colds, which are not part of midwifery aromatherapy) or frankly, unsafe (eg some quoted uses of oils which should be used with care, especially clary sage which should be discontinued once labour is well established and never used with Syntocinon). 

And let’s face it, we are looking at CARE here, in a broken maternity service, where compassion and individualisation has currently left the building. Marshall gives no credence to the use of simple complementary strategies such as massage (part of aromatherapy for which there is considerable evidence) on the physiology of labour and birth. There is plenty of research to show the reduction in cortisol and adrenaline and the corresponding increase in oxytocin and endorphins – and if only he focused on that aspect rather than vilifying something of which he quite obviously has no knowledge, things would be a great deal better.

Marshall is one of those sceptics whose views are based on … absolutely nothing …. except prejudice, misogynistic, anti-physiological opinion. He is, of course, entitled to his opinion but should take care as to how he expresses it. Instead, his frankly dangerous and unfounded lack of factual integrity is counterproductive to the whole intention to improve maternity services. He uses language intended to ridicule claims for the effectiveness and safety of aromatherapy and divert attention away from the things that matter in today’s maternity care. So, he should stop taking on subjects about which he is ignorant and start supporting the changes needed in maternity care to make it a service acceptable to those who use it and those who work in it.  

https://www.skeptic.org.uk/2026/06/aromatherapy-the-nhs-maternity-crisis-and-the-obsession-with-natural-birth/