Five myths about childbirth, debunked by science  ...Middle East

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In the past week, new figures have shown the number of childbirths that happen by Caesarean section are continuing to rise, now accounting for about four in 10 births in England in the last year.

Such figures are often greeted with disapproval from bodies that promote so-called “normal” births – vaginal births without medical intervention – who say the number of Caesareans should be reduced.

But this ignores the reasons for the increase – and is founded on several other misconceptions about birth. Some of the popular advice for pregnant women either contradicts findings from medical research or glosses over facts that most women would want to know about.

Here are five common beliefs about childbirth that are not supported by science.

According to NHS England, 42 per cent of births were by Caesarean in the year ending in April 2024. In a little over half of these cases, 25 per cent of the total, the operation was a planned one. The rest were emergencies, carried out after labour had begun.

This is part of a long-term trend of rising numbers of surgical births that is happening in nearly every country. And until very recently, several official health bodies saw it as something that should be reversed.

Caesareans can be life-saving if the baby gets stuck during labour. But they can also take longer to recover from, and raise the risk of complications in later pregnancies, research has shown.

The UK government sent out guidance to hospitals in 2012, asking them to cut their Caesarean rate to 20 per cent, down from about 25 per cent at the time. The World Health Organisation (WHO) said for decades that there was no medical need for more than 15 per cent of births to happen by Caesarean.

But the main cause of the rise in Caesareans are two major demographic changes, the Royal College of Obstetricians and Gynaecologists (RCOG) said this week.

The first is that people are choosing to have children later in life – and women’s bodies are less capable of having their first baby at an older age. The baby is more likely to get stuck during birth or the woman may have some other medical complication.

This is coupled with another health trend – populations are getting heavier, and obesity also makes vaginal childbirth more difficult.

Another caveat is that much of the older research that suggested Caesareans are riskier combined emergency Caesareans with planned ones, but planned Caesareans have better outcomes than emergency ones. A recent large study found that planned Caesareans due to maternal request led to better birth outcomes than planned vaginal births, mainly because the babies had better health – something that is often glossed over in discussions about the rise in planned Caesareans.

Both the UK government and the WHO have since torn up their Caesarean targets. Women are also allowed to choose a caesarean in advance, even if there are no medical reasons, according to NHS guidelines.

“Women should be supported to make an informed decision about how they want to give birth, including a discussion on the risks and benefits of both vaginal and Caesarean births,” said Dr Ranee Thakar, president of the RCOG.

Babies will be born when they’re ready

After 40 weeks – the average length of pregnancy – women may resort to a range of home remedies to try to kickstart labour, such as herbal teas, hot baths or even having sex. NHS guidelines say none of those approaches are supported by evidence.

But if the pregnancy goes overdue, or if the mum or baby has a health issue, then staff may recommend medical induction of birth, for instance, by starting a hormone drip. Assuming a Caesarean is not planned, this can be many women’s first major decision about whether to try for a “normal” birth or to get medical help.

Rates of inductions are also on the rise, now accounting for 33 per cent of all births, in the latest figures. Critics say that staff have become too keen to induce, and that the birth is more likely to go well if the labour begins naturally.

A common claim is that induction leads to a “cascade of interventions”, ultimately leading to emergency Caesareans.

The danger of letting a pregnancy go overdue is that the rate of stillbirth increases the longer a pregnancy progresses, accelerating upwards even more steeply after 40 weeks. This is probably because the placenta deteriorates as pregnancy continues.

And studies show that inductions can be safer than letting pregnancies go on for more than 39 weeks – and actually cause a lower Caesarean rate.

An NCT spokesperson said: “Our NCT antenatal course content is refreshed frequently, most recently in 2023, to ensure all types of birth are explored with a focus on parents making informed decisions about their care.”

This idea is another part of the intervention cascade myth. Epidurals – when drugs are delivered into the back – usually gives complete pain relief, according to NHS guidelines.

They can have side effects like nausea and skin itching and they also have a practical drawback, in that the patient usually then has to stay lying down.

A bigger concern is that they slow down labour because they stop women from pushing at the right time, without the contraction pain to guide them. Some “normal” birth advocates have claimed they make a Caesarean more likely.

But research has shown that with current forms of epidurals, there is only a small effect on duration of labour, prolonging it by about 45 minutes (when labour can typically take most of a day, or even several days). The same studies have shown they also don’t cause Caesareans.

Hypnobirthing can help you avoid an epidural

Hypnobirthing is when women learn deep breathing techniques and may repeat positive “affirmations” to help them feel calmer. Advocates say this makes women feel less pain and so helps avoid epidurals.

The evidence is mixed about how effective hypnobirthing is. Many of the studies have included only small numbers of women or have not been in the form of randomised trials, the best kind of medical evidence.

But there has been one large randomised trial. This found that women who listened to a hypnobirthing CD before birth did report less anxiety and pain. But both the hypnobirthing and comparison group had about the same likelihood of getting an epidural, at 30 per cent.

There are also possible downsides, said Catherine Roy, of the Maternity Safety Alliance, a group that campaigns for childbirth care to be safer.

Hypnobirthing affirmations may include statements like “my baby is safe”, which could be factually incorrect, and lead to delays in women accepting medical assistance, says Roy.

Recent guidelines from the National Institute for Health and Care Excellence say hypnobirthing should not be offered, although women who want to do it should be supported.

This is another common affirmation in hypnobirthing classes. In fact, babies certainly can grow so big they cannot fit through the woman’s pelvis or birth canal. Doctors even have a name for the condition – cephalopelvic disproportion.

The baby being too big is more common in shorter women, who tend to have a narrower pelvis, and in women with obesity, diabetes, or who are older – all of which can make the baby grow larger.

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I’ll be taking a two-week break from Everyday Science over Christmas, but I’ll be back in your inboxes on 2 January.

This is Everyday Science with Clare Wilson, a subscriber-only newsletter from The i Paper. If you’d like to get this direct to your inbox, every single week, you can sign up here.

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