Letter: Caesarian push

The pejorative phrase "too posh to push", is intended to make women feel inadequate or selfish in the choices they make. Published evidence confirms about one third of female obstetricians - presumably the best informed about risks - elect CS for uncomplicated first deliveries.

The reasons provided by them include the baby's safety, convenience, and risks to the mother of incontinence and impaired sexual function.

The study you cite apparently fails to notice the risks associated with elective CS are negligible compared with the overall benefits and risk avoidance. NICE guidelines make clear the issue here is cost.

Responsible health care professionals at the Portland Hospital in London do not stand in the way of women who wish to deliver by elective CS. No doctor acting responsibly could force a woman into an instrumental delivery, as the authors of the report seem to recommend as better practice.

Is vaginal birth really cheaper? Have NHS auditors factored in the many millions of pounds paid to children each year for birth injuries which could all have ben avoided? CS is a safe and effective means of delivering babies while minimising stress to mothers; it avoids risks of catastrophic birth injuries and it is a method of delivery which properly informed patients would freely choose.

There is a powerful argument that Caesareans should be used to "cut" forceps deliveries, and not the other way around.

Andrew Smith QC

Compass Chambers,

Edinburgh