This destructive habit can cause significant problems between couples. Both feel that their daily life is the most difficult and that the other just doesn’t understand. It is easy to then let resentment fester under the surface and spend valuable time and energy arguing about who has the worse deal.

This behaviour can occur regardless of the type of birth you have had. Remembering that your birth partner has also gone through huge upheaval and stress is important.

They are sleep deprived, they are anxious, they witnessed their loved one in pain. They may have felt inadequate during the birth blaming themselves for not having prevented unwanted intervention. Then and once back at home they may be taking roles and making decisions on your behalf that they are not used to.

For example, unless discussed in advance your partner will, in the case of a general anaesthetic, be making decisions about feeding and clothing your baby for her first few hours. Unless you have discussed it in advance they are unlikely to know what you are planning to do and may not know the potential impact of giving formula instead of breast milk immediately after birth. Try not to criticise decisions, particularly if you did not discuss such eventualities beforehand – they will have done what they thought was right at the time.

Similarly, while you are recovering, some jobs you have previously done within the home probably now fall to them. Some may relish this, but others may feel the pressure, particularly if you are overly critical. This will all be in addition to their working day so quite quickly they are going to end up as exhausted as you. Appreciate what they are doing and try not to criticise when things are not done your way. Does it matter if the washing is left in the machine for 24 hours before going into the dryer? Probably not. Nor is it the end of the world if they gave the kids the wrong drinks in their lunchbox.

Ask each other for help and support and try to remember that you are both going through a huge learning curve while extremely sleep deprived.

It is only in truly believing the roles are totally different and have extreme and unique pressures of their own that you can hope to remove this barrier to emotional recovery.

A UK hospital has challenged targets handed down by others (in this case their Clinical Commissioning Group – those who set the targets for the hospital). The Royal Berkshire Hospital was told their caesarean rate was too high (27.1%) and they must get it down to 23%. When asked whether it was cost driving this target the interim Medical Director Brian Reid said “That would be the driver.”

Unfortunately this target led approach to hospital care of pregnant women is typcial rather than unusual. Targets are a major factor driving policy and practise in many places. Where targets are based on cost cutting this can only mean that the health and safety of pregnant women and their unborn child cannot take top priority.

The NICE guidelines on Caesarean Section have stated that:

• women wanting to request a caesarean where there is no medical need should engage in a detailed discussion with their practitioners. All the risks and benefits of both vaginal and caesarean birth should be fully discuss but if, after this, the woman still prefers a caesarean this should be granted
• women wanting to request a caesarean on the grounds of fear should be offered perinatal mental health support and if, following this, they continue to want a caesarean, this should be granted

So if more women are making an informed decision in favour of a caesarean birth over an attempted vaginal birth then the targets need to reflect this need.

The World Health Organisation retracted their recommended target 4 years ago when the studies on which they had based their recommendations were found to be flawed. They have now stated:

There is “no empirical evidence for an optimum percentage”, an “optimum rate is unknown,” and world regions may now “set their own standards”. ‘Monitoring Emergency Obstetric Care: a handbook’

Despite this, official bodies continue to use such figures to beat their hospitals into submission with unachievable targets.

And lets be clear many caesarean requests are from women whose circumstances are not clear cut, where a decision in favour of either birth mode is equally justifiable. So simply telling them no when they ask for a caesarean and the press labelling these women as selfish or too posh to push is simplistic and insulting.

Take for example a baby lying in the breech position. A breech birth can be delivered vaginally or by caesarean section. However any woman making an informed decision about her birth will know that a breech position can make for a more protracted birth. Protracted births can increase the need for pain relief and instrumental assistance or ultimately an emergency caesarean. Couple with this, the fact that in the recent past many breech births have been delivered by caesarean, so practitioners are getting less experience with these births and this may justifiably lead some women to choose a planned caesarean over a vaginal attempt. These women are not selfish, they are making informed decisions on behalf of their own bodies and their baby’s.

So if you are planning your birth, read the NICE guideline and arm yourself with the facts prior to requesting a caearean, particularly one where there is no clear medical need. In addition my book “Caesarean Birth: A positive approach to preparation and recovery” provides all sorts of information about both caesarean and vaginal birth so that you can make an informed decision about which way you would prefer to proceed.

At long last there is a trial of the pioneering proceedure commonly referred to as a ‘Natural Caesarean’. Jenny Smith a senior midwife at Queen Charlotte’s and Chelsea Hospital in London developed the idea 10 years ago. There are many annecdotal benefits to the procedure and women report a much better experience of caesarean birth if they have been able to give birth this way. It is hoped that a successful trial will lead to this process being rolled out across the NHS.

We discussed this wonderful technique a while ago and there is an excellent video describing the process.

“It is about the mother. After the incision is made, the curtain is removed and the mother is able to see her little baby wriggle out. It is a special moment that is missed otherwise…The baby remains in the abdomen for up to four minutes and the mother can look at it, see its little face and eyes, and when it wriggles out it is the parents that first determine the sex.” Jenny Smith