Caesarean Birth in Britain - A book for health professionals and parents

Helen Churchill, Wendy Savage and Colin Francome

Middlesex University Press 2006 ISBN: 1-904750-17-6

This is the second edition of this book, the first having been published in 1993, in association with NCT. The format of the new edition mirrors that of the first, with the same chapter titles, subheadings and illustrations in many places; although this second edition is longer at about 270, in comparison to the 200, pages.

As before it starts with the history of caesareans, then covers caesarean birth in the 21st as opposed to 20th century, the international viewpoint, whether a caesarean is necessary, and a chapter on coping with a caesarean that is specifically stated to be for parents, midwives and teachers.

New survey results are then presented of the views of women and obstetricians that were carried out in 2004. These are compared with the results from the earlier surveys of the early 1990's that were reported in the first edition of the book.

There are then updated chapters on VBAC (vaginal birth after caesarean) and avoiding a caesarean, with an additional chapter titled - What choices do women have about maternity care?

The book retains the clear referencing format of the first edition, with references listed at the end of a page, so that those familiar with any of the references can see at a glance which reference is used in the text.

The way the book is organised allows the reader to select one aspect of interest and to read that section of the book. However, in most cases more than one chapter will be required to appreciate what the book has to offer on an issue, for example the chapter titled 'Is a caesarean really necessary?' may be better understood in conjunction with the chapter detailing the views of consultants.

I felt that the book could have benefited from an increased midwifery perspective, especially on issues such as the promotion and preservation of normal birth as a means to reduce the caesarean section rate. There were some references to what could be achieved by fully supporting normal birth, such as the 98% VBAC rates achieved at the Farm in Tennessee1.

I found the views of consultants particularly interesting. Responses from 100 questionnaires are reported, but it was not clear whether this was the total of the responses to the 231 questionnaires that were sent out, or not. There seem to be significant changes in the replies that consultants gave from the last time this survey was carried out; forr example in the previous survey only 19% had thought the optimal caesarean rate should be above 14%, but in the current survey 90% though it should be above this level. The results also highlight a lack of agreement between consultants on many obstetric issues concerning caesarean birth, making it clear that many were not well informed about the research or issues of consent. For example when asked about their advice to a woman wanting a vaginal birth after 2 caesareans (VBA2C) less than half said they would support the woman's decision and many of these would expect to impose conditions and limits on the labour and birth.

This would not be my first choice of book to recommend to women, either those planning a caesarean birth, coming to terms with one or exploring their options for a birth after caesarean, although for some who are finding themselves up against medical opinion it may be helpful in providing a fuller picture of the issue around caesarean birth. However, midwives, antenatal teachers, those providing caesarean and VBAC support and others who want an overview of caesarean birth issues are likely to find it a useful read.


  1. Gaskin IM. Ina May's guide to childbirth. New York, NY: Bantam Books; 2003.

Debbie Chippington Derrick

A shortened version of this review appeared in NCT New Digest, Edition 36, October 2006

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