Wealthier women more likely to be 'too posh to push'

Published on Tuesday 17 May 2011 19:02

WOMEN from affluent backgrounds are more likely to opt to have a Caesarean birth - supporting the "too posh to push" label, Scottish research shows.

A study by a Medical Research Council (MRC) team in Glasgow found significant changes in the rate of surgical births in Scotland since 1980.

These included a move towards increased rates of elective Caesareans - those planned in advance rather than carried out as emergencies - among more well-off mothers, compared with those from more deprived backgrounds.

But the study, published in the journal BMC Public Health, found no difference in rates of emergency Caesareans between social groups.

The researchers said the reasons why better-off women were more likely to have a planned Caesarean were unclear, with further research needed.

The rate of Caesarean births has increased around the world in recent decades.

In Scotland, the overall rate has increased from 11.6 per cent in 1980 to 25.9 per cent in 2008 - outside the rate recommended by the World Health Organisation of 5-15 per cent.

Rising rates of Caesareans are a concern because the surgery can cause complications, including bleeding and damage to the bladder. There are also risks to babies, including increased difficulties in breathing after a surgical birth.

For several years some have dubbed those opting for an elective Caesarean as "too posh to push", with a trend among celebrity parents, such as pop star Christina Aguilera, opting for surgical births.

But doctors say there are many medical reasons, such as women having other health issues or having had a previous Caesarean, which mean a planned surgical delivery is necessary.

The latest study, led by Ruth Dundas at the Medical Research Council Social and Public Health Sciences Unit, looked at Caesarean rates in Scotland in the years 1980/81, 1990/91 and 1999/2000.

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In the past, women from less well-off backgrounds were more likely to have surgical births. But researchers found that in recent years the trend had changed, with those from more affluent backgrounds much more likely to have a planned Caesarean.

Ms Dundas said in the most recent period they studied, just one in 24 women from less well-off backgrounds had a planned Caesarean. But among more affluent women the figure stood at one in 14.

The rate of emergency Caesareans remained the same in all women, accounting for one in eight births.

Ms Dundas said: "Thirty years ago mothers having Caesarean sections were more likely to come from deprived areas and/or from a lower social background.

"This was true for both elective and emergency sections. Ten years later the rates had changed, so that although women from a lower social background were more likely to have emergency sections, there was no difference between them and women from a higher social background in elective surgery rates.

"By 1999-2000 the rates had equalised for emergency section, but babies born by elective surgery were more likely to belong to mothers from the higher of the social classes measured."

Ms Dundas said more work was needed to discover why some women were more likely to have a planned Caesarean than others.

One possible explanation for higher rates of Caesareans in more well-off women could be that they are better educated in pregnancy matters and more articulate, making them more able to express their opinions when asking for a planned surgical birth.Emma Currer, the Royal College of Midwives' (RCM) national officer for Scotland, said: "There is some anecdotal evidence that it is around their ability to act as better advocates for themselves in relation to their needs.

"They may have more insight in regards to their own health issues, and their communication skills are better and more direct."

Patrick O'Brien, spokesman for the Royal College of Obstetricians and Gynaecologists, said that the differences between social groups could be due to different risk factors making some women more likely to need a Caesarean planned in advance.

For example, better educated women are more likely to delay childbirth and older mothers face a greater risk of complications so may prefer a surgical delivery.

"This is very interesting data and it shows us the trends in Caesareans in the last 30 years, but it does not really explain why these trends are taking place," Dr O'Brien said.

"However, it is a very useful trigger for further research," .

"Some people have suggested this is most likely due to the 'too posh to push' thing, which is one possible explanation, but it probably only plays a small part in it."