Sometimes, when I’m reflecting on how far we’ve come since the 1990s, I think about the phrase “too posh to push”. How disgustingly, physiologically misogynistic that phrase is, and how cavalierly people just … said it, as though how a woman decides to give birth – through her vagina or from an incision in her abdomen – was a matter of public debate. Back then, it really was. The tabloids were full of speculation about whether female celebrities gave birth vaginally or not, and the general public adopted the catchphrase, feeding the (false) impression that many women were choosing to have caesarean sections simply for the sake of convenience.
I’d be shocked, these days, to hear someone roll that out. Yet myths about caesareans are still peddled. Take a policy from the Green party’s website, now hastily deleted after a deserved backlash: “We will work to reduce the number of interventions in childbirth, and change the culture of the NHS so that birth is treated as a normal and non-medical event.” C-sections were described as “expensive and, when not medically required, risky”.
Considering the fact this part of their website was updated in April 2024 after several maternity scandals, including at Shrewsbury and Telford NHS trust, where mothers and babies died or were left severely disabled in part because of the pursuit of “normal birth at any cost”, this policy was completely tone deaf. The Royal College of Midwives dropped its initiative to promote “normal birth” in 2017. British women have had the right to a caesarean birth on request since 2011, though some are still having to fight to have that request granted.
So why is the Green party weighing in on a conversation that should be between a woman and her medical team? Let’s be honest, it is likely to be because of the presence of some natural birthing cranks in their ranks who try to dominate this debate. Certain pockets of the left – the more woo-inclined, alternative, hippy-aligned – do seem to be partial to this kind of thinking (I should know, I spent my childhood in the vicinity of one.) I saw the extent of this when I wrote about the rise of freebirthing. The attacks from more militant proponents of “natural birth”, many of them speculating nastily about how I delivered my son – it was complicated, and we both could have died – were unhinged.
Before those women who did have natural, unmedicated, problem-free, normal – whatever you want to call it – births feel attacked, I want to make it clear that defending women who have caesarean sections, for whatever reason, doesn’t mean that I have an anti-natural birth agenda. Some of my friends and relatives have, happily, had problem-free vaginal deliveries. Many others have been pressured into interventions they didn’t want or did not consent to. Supporting a woman’s choice of how she gives birth means having a system that empowers her to make the best choice for her and her baby. Our maternity system is broken, and funding and fixing it so that women feel listened to, cared for and supported should be the priority.
At the same time, the spread of extreme and anti-scientific information about childbirth and modern medicine on social media, as well as offline in certain pre-natal groups, is a threat to this goal. Talking to women who have had natural births, most of them find the fringe rhetoric just as offputting as the women who have had epidurals or forceps or C-sections (or all of those things). Women who might want to try for a “natural” delivery don’t need some of the scaremongering that comes with it, such as being told that asking for pain relief will lead to a “cascade of interventions” or that their own fear will clam them up, resulting in an assisted birth. Nor should they be receiving the message that needing medical interventions during childbirth, such as an epidural or an episiotomy or forceps, is a failure on their part.
I truly believe that on this issue, most of us are united. That we support the women in our families, friendship groups and communities in however they decide to have their babies. Most of us recognise that birth is a lottery, an unpredictable coalescence of factors, from a baby’s size and position in the womb to the shape of a woman’s pelvis and her stature, to underlying health conditions – and which staff happen to be on duty that night. The very existence of obstetric science is to prevent the number of maternal and neonatal deaths and injuries that would occur “naturally” without it. Most of us know that how we gave birth will influence how we feel about it, but we can still find the space in ourselves, even if we are in pain or traumatised, to not make other women feel bad about how it turned out for them.
I don’t need to tell you that most planned caesareans take place after a woman and her doctors and midwives have weighed up her unique medical history and mental health with the risks of delivering that way. Or that emergency caesareans save lives. Or that, while the rising number of caesarean sections should be studied (we currently know very little about the reasons behind the increase), the phenomenon should not be conflated with the offensive assumption that women who do choose C-sections, where their doctor may not think there is a medical need for one, do so for “frivolous” reasons, when this is a vital and hard-won right. Or that the extra cost of a caesarean (which should be contextualised against costs for complications in vaginal delivery, such as prolapses or incontinence, not to mention birth injury settlements in the multimillions), or its carbon footprint, should not be weaponised to roll back a woman’s right to choose her own medical care. You know this; I know this. Does the Green party know this? It’s certainly back-pedalling furiously, and says the policy won’t be in its manifesto.
The party’s health spokesperson, who is also a GP, Dr Pallavi Devulapalli, told me that pregnancy and birth are indisputably natural processes, and that advances in healthcare have made childbirth safer for both women and children. She added: “It is vital that all women are given all the support they need to have a good outcome. And this can, of course, include medical intervention where appropriate and necessary.”
There will always be those who will tell you when you announce your pregnancy that it is not a “medical condition”. It was said to me. I wish I had known then to respond with: “It isn’t, until it is.” This isn’t about pitting unmedicated vaginal births against births that have involved medical intervention. That is a culture war that we do not want. This is about reproductive freedom, and politics muscling in on the issue of female bodily autonomy yet again, something that all women should abhor, no matter how – or if – a woman chooses to have a baby. It detracts from the more important question of how we fix maternity services.
The days of “too posh to push” may be over – even the Mail, one of its main proponents, has condemned the Greens on this – but there are still those who secretly, dismissively, think it. Let’s not let them take over the conversation, when so many woman are hurting, and need to be heard.
Rhiannon Lucy Cosslett is a Guardian columnist and author
