Too Posh To Push

Rewind to March 1999, the month Brooklyn Beckham was born and the month the whole ‘too posh to push’ controversy began.  And I for one was with Victoria on this one.  I remember clearly the conversation I had with my Mum and my stance for an elective C-section at 38 weeks.  Why would anyone possibly choose delivery via the birth canal if there was an alternative ‘sun-roof’ option.  It was certainly a rite of passage I was clear I could do without.

Of course this was before I started doing Paediatrics.  Before I saw the transient tachypnoea of the newborn in all its different guises, a result purely of the lungs not being squeezed dry of fluid from a vaginal delivery.  The baby essentially struggling to breathe due to the fluid on their tiny lungs.  This was when the first niggles of doubt set in.

Now, fast forward 13 years….to now.  This morning in fact.  I have been assisting in theatre for the elective Caesarean sections.

“Is she having a fit?” implored the Dad-to-be grabbing at my arm in a lightening flash manoeuvre as I walk past.  I look over to his wife, fully conscious, talking and very much in a non-seizure state.  But violently shaking in an involuntary manner that only a spinal anaesthetic affords.

“No, she’s absolutely fine, this is normal, common in fact, due to the anaesthetic”, I try my utmost to reassure them both.  The anaesthetist is nodding in agreement.  The couple exchange horrified looks between them.  She really is shaking quite violently.  The risk of infection, bleeding, hysterectomy and even death are discussed during the consent process but not the “shakes”.  They do not get a mention.  They probably should.

I shuffle past.  This lady has a BMI of 50, mine is 20, and if she shakes herself off the trolley which is not beyond the realms of possibility, given the shakes and her now waist-down paralysis, I am unlikely to catch her.  And the stakes would be quite high in attempting to pull that off, there being two people on the table as opposed to my one.

I am simply here to assist the registrar.  Never before have I been quite so thankful of my menial role.  The idiosyncrasies involved in all of this are beyond me.  I simply have to pull, push, and hold on cue.  This I can manage.  Occasionally that 3rd hand of mine is required to help with the stitching.  At one time a 4th hand would’ve been useful to apply fundal pressure to the uterus to help the head be delivered.  Sadly at this point my 2nd hand had to relinquish its hold as my octopus mastery is yet to be perfected.

Don’t get me wrong it is amazing to see a baby lifted out of a lady’s swollen belly.  To hold up the wriggly little one for the new Mum and Dad’s first look; that coveted first look after 9 months of waiting.  The delight and the tears are moving every single time.  It is a miracle and I don’t forget this.

And here it comes, the ‘but‘…..

But, once the baby has been lifted out, followed by the placenta, what is left, in reality, despite the cleanest and neatest of wounds, is a mess.  The uterine muscle is contracted but slit open, the fat and muscles lie apart and there is a hole 12cm long on your abdomen.  This is major surgery.  This is a big deal.

Of course it all comes together nicely.  The skin is finally stitched and looks good.  Cosmetically, in fact, the result is amazing.  What lies beneath however will take a long time to heal.

Au naturale is the way forward in my mind.

‘Too posh to push’ being a total misnomer. The alternative to either of these is to ‘wield the steel’……….this is a discussion for another day.

My final thought, in the words of Laura Stavoe Harm “we have a secret in our culture, it’s not that birth is painful, but that women are strong”; never before have I been quite so glad my child-bearing days are over.

*       *       *      *      *     *     *      *

As an aside, I have just been told I got a mention in Pulse’s best medical blogs:

Medical Marbles charts the days of a GP and mother, although as one reader says ‘the everyday examples are very interesting and make it applicable to everyone’.

Medical Marbles was also described to us as a ‘fresh and current blog that any doctor with children can relate to (not just mothers)’ and readers said it ‘tackles main issues in a very informative, thought-provoking way leaving you wanting more'” – it was published in April apparently, damn the curse of A+E! Thank you to everyone who voted, I am touched.

5 thoughts on “Too Posh To Push

    • Thankyou for taking the time to comment. My sister has also had 3 sections, 2 elective and 1 emergency, and all for medical reasons with the best interests of mum and baby at the heart of the decisions. It is important that these are done. I’m trying to rationalise why women would choose a cold-section from choice having no medical reason, having never experienced labour. It is now part of the NICE guidelines that if this is what women request then that is what they should get…

      • Perhaps people just don’t realise the extent of the surgery when they agree. I had forgotten about the shakes until I read your post – it was a very frightening experience.

  1. Having had 2 emergency sections I would choose a vaginal delivery if I ever got the chance. I recognise the shakes you describe! I for one would not choose to be flat on my back with my blood pressure in my boots, vomiting and watching staff squeeze the bag of fluids hard while my baby is born.
    But, it’s not for everyone and knowing of at least one person who had high forceps I am not sure which is worse.
    2 healthy babies is the best result for me, despite the sections. Not sure why it is part of NICE guidelines though. Is there an evidence base for “too posh to push” elective sections?

  2. Way, way before I thought of having children, I thought like you did – why would you want to go through that when you can just open the sun roof, as you say? But then when the time came, there was no way I was going to have a section unless I had to (I didn’t have to, the little man’s birth was an almost straightforward and amazing event). As Ellen said, best not to think about it!! Polly

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