Reducing caesareans is not about saving money

Joanna Moorhead writes that women having an emergency caesarean section are traumatised, and often subsequently demand an elective section for other pregnancies (I felt totally out of control, June 16). She points out that these women are now NHS "frontline targets", with primary care trusts "offering cash incentives to hospitals in a bid to reduce the number of surgical deliveries".

The article raised important issues, such as the dilemma facing obstetricians when dealing with high-risk pregnancies, and expectations for them "to at least question a woman's decision to go for a repeat caesarean if there is no clear medical reason". But when it stated that "for NHS managers, there is clearly a financial incentive to reducing the amount of surgery", I was concerned that it risked propagating a common misconception.

As a midwife with more than 30 years' experience, I disagree strongly that reducing caesarean sections is about quotas and saving money. It is about giving mothers a healthier and more holistic birth experience, and babies a better start in life.

We midwives are not bullies who want women to suffer during birth. We support attempts to reduce medical interventions like caesareans, which are major surgical operations, because there are good clinical reasons - such as the "risk of serious complications including haemorrhage, infection and uterine rupture", which you mention. If there was a significant reduction in sections, savings could be made; however, it must also be remembered that hospitals are compensated for the greater costs associated with caesarean sections.

The World Health Organisation says caesarean sections should not exceed more than one in eight births; however, almost one in four babies in England is born this way. For some women, as the article says, it is appropriate to plan a section, or have an emergency one. Still, the issue is whether women are making informed choices about their options for childbirth. And the article did not address the government's four national choice guarantees - for maternity care, antenatal care, place of birth, and postnatal care.

Moorhead pointed out that "many of these [sections] could be avoided by better support in labour, and the sort of one-to-one care that many maternity units struggle to provide". But the question is, why do units struggle to provide such support? This must be addressed: we need many more midwives, not just doctors, to address women's options for childbirth. The issue for me is less about how we professionals deal with the dilemma of women asking for procedures we do not believe they need - it is more about ensuring that women are helped to understand the full implications of the choices they are making. A study of 454 women in Liverpool, published in May, said very few pregnant women opt for a planned caesarean section when thinking about birth options.

A woman is not an NHS "frontline target". She is an individual; and ultimately the decision for her method of birth should be based on her informed choice, with full explanations of the risks and benefits of her birth options.

• Professor Cathy Warwick is general secretary of the Royal College of Midwives

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