What does "at risk of needing a caesarean" actually mean?

What does “at risk of needing a caesarean” actually mean?

I often hear and read comments about women being, “…at risk of needing a caesarean.”

But there’s so much to unpack in that statement!

What do we mean by ‘at risk’?

What does ‘need’ actually mean?

And who determines the existence or degree of both of those things?

Risk and need

You may already be aware that the notion of risk is pretty unstable and dependent on who is doing the labelling. I have lots of resources on risk here if you’d like to explore it further.

What about need?

Well, if you ask the dictionary, you will find that ‘need’ means that something is essential to us rather than desirable.

So when I (like so many other people, because we often use this word to express irony or just out of habit) declare that I have a need for chocolate or wine, I’m probably not being as accurate as I could be.

I do need to drink fluid to survive.

I don’t necessarily need that fluid to be chilled prosecco.

Pedantic, but important

How many of the women who have a caesarean really needed that caesarean in order to enable them to survive?

There’s no way of knowing for sure, but probably very few.

How many of them needed the caesarean in order for their baby to survive?

Well, that’s a few more, but still a small number in absolute terms and nowhere near the number of women who actually have a caesarean.

There are complex reasons for that, and one of the key ones is that caesarean section is often done as a preventative measure – or because there is a chance of a problem happening – rather than as a treatment in an actual emergency situation.

I’m not saying that’s always a bad thing. I’m just unpacking the issues so we can take a look at them.

Not a natural consequence

Another important point is that a caesarean section is not a natural outcome, or something that will happen on its own if we leave things alone and don’t intervene. A few years ago, I had a conversation with the brilliant Anne Frye about this very issue.

Why, she said, is it that so many medical researchers write about the outcome of caesarean section as if it were the natural consequence of a proportion of pregnancies?

A caesarean section (or an induction of labour or any other medical intervention) happens because someone makes a decision that it should happen. It’s not a consequence of anything the woman does or doesn’t do.

And being “at risk of needing a caesarean” isn’t an objective state.

It’s subjective…

The outcome of a caesarean section results from a subjective decision, which in turn is dependent on who a woman has around her and on what they believe and think.

There are plenty of women who are told by one person that they need (or don’t need) a caesarean who might have been told something totally different if they were with someone else.

And yes, there are also some who would probably be told the same thing no matter where they were. I’m not saying there are no clear-cut situations here, just that there is a lot of grey…

It’s really easy, in this fast-paced world, to skip over the way we use words like ‘risk’ and ‘need’. But I’m concerned that, when we do that, we aren’t always accurately reflecting what happens in real life.

Perhaps more importantly, we’re not giving women and families an accurate picture of the decisions that are theirs to make.

I have written more about this in a few of my books, including In Your Own Time: how western medicine controls the start of labour and why this needs to stop, and What’s Right For Me: making decisions in pregnancy and childbirth.

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