11/23/2011 12:29 pm ET | Updated Jan 23, 2012

Caesarean Vs Natural - An Agonising Choice?

Nice: Will new guidelines, giving women the choice to have a C-section over natural should they want one, present expectant mothers (particularly of first children) with an agonising dilemma?

I have given birth to two children and never experienced so much as a contraction, neither for that matter have they. It's true, I'll feel forever intrigued and somewhat lacking for not having been through that most natural and supposedly life-affirming achievements, vaginal childbirth.

Plus there's the worry that depriving my babies of natural entry into the world has deprived them too of key long-term developmental processes, citing the recent research linking Caesarean birth with obesity in later life.

I was carrying twins. A C-section was always going to be the safer option. That did not stop me agonising throughout most my pregnancy over which way to go, compounded by a barrage of conflicting messages.

"Oh, you realise they will try to persuade you to have a c-section," warned my neighbour. A year previously she'd had a textbook natural birth of a 6lb baby girl, following a careful diet, yoga and visualisation throughout her pregnancy. "It makes life much easier for them", she explained, 'they' being all obstetric personnel, "They can book you into the diary and not worry about holidays, cancelling engagements etc. Don't fall for it."

The NCT group I attended barely mentioned the C-word. The only information they provided was that natural childbirth is better for the baby, both babies in my case, because the trauma involved primes their bodily functions, in particular the lungs, for the outside world. There was plenty of information about the various stages of labour and associative pain, but none about when and why an emergency C-section might be necessary. The impression I was given instead was that they often weren't.

So, when the consultant at my 24 week scan first broached the question of delivery, I was adamant, I wanted to have my babies naturally.

"Ok, I should make you aware of the statistics", he responded, as he daubed my abdomen with ultrasound gel, 'In natural twin births, there is always a risk to the second twin, and for every 270 natural births of twins, there will be one where the second twin dies.'

I gulped. One in 270 struck me as worryingly narrow odds. I veered back towards C-section, as did my husband. 'That's it,' he stated, 'A Caesarean's the obvious option, we don't want to put either child at risk, do we?'

Back home however, somewhat affronted by my consultant opening the debate with such a jaw-dropping statistic, I started to climb back on the fence. I decided my neighbour was spot on. As a medical professional, and therefore a member of the 'convenience conspiracy', he was obviously intent on my taking the easy option. I began to question his statistic. Of those 270 twin births, were they identical or non-identical twins? Identical twins sharing one placenta of course presented a much great risk. Mine were non-identical. Of the 270, were they home or hospital births?

But given that he'd told me of the risk, would it be irresponsible of me to stick with natural? It threw me, at 32 weeks gestation, into a terrible quandary and I began to debate the issue with pretty much every poor soul I happened to encounter.

We had recently moved to the west country, where many mums near me were very much at one with nature, indeed suspicious of any form of medical intervention. All of them therefore were adamant that I have them naturally.

London friends were less earthy. Natural childbirth was frankly awful, pain like you've never experienced, but it was for me to decide. Which of course didn't help. My sister made no bones about it. 'What are you thinking?! You'd be mad to even consider natural child birth where you've got the option.' All very well, but she'd had three kids, all of them naturally. If it had been that bad, she'd never have gone back, right?'

At 34 weeks I was still leaning towards natural. The midwives seemed to think it would be a straightforward twin birth, although were non-committal not wishing to contradict the consultant's advice. The consultant still advised C-section. He drew multiple-forked diagrams to illustrate the unknown quantity (numerous forks) that is natural childbirth. The long and short of which was, that even were I to opt to have the twins naturally, there was a good chance that the second twin would become distressed, transverse and I'd need an emergency Caesarean to extract her. Were I to choose the elective Caesarean route there were no forks, it was a simple straight line. Date set, delivery.

As D-Day approached, I began to panic. I'd thought about the whole thing way too much, heard stories of blood loss, placental abruptions during labour, emergency C-sections after 24 hours of contractions, babies needing resuscitating, high dependency units etc. The whole idea of birth now became a terrifying inevitability. Yet still I felt I would regret not doing it 'properly'.

The turning point came soon after 35 weeks. My husband sat me down and said, 'Look, if you decide on a natural birth that's fine, but who are you doing it for? You or the babies?'

That nailed it for me. Going natural was of course to satisfy own sense of curiosity and achievement, and could have unbearable consequences. There was no conspiracy. A Caesarean, where I was concerned, was pretty much a no-brainer.

I went back to my consultant. I would, as he had advised, go for the elective Caesarean.

In the 24 hours prior to meeting their babies most women go though heinous pain. My husband and I had a hearty lunch, a nap in front of the telly, then went to the cinema before an early night. I had the best night's sleep I'd had for weeks and waddled calmly into hospital the next morning. Some 45 minutes later I was presented with two healthy little girls, 5lb 12oz and 5lb 13oz.

Did I make the right choice? I will never experience giving birth naturally, and I feel a certain amount of guilt rooted in the knowledge that I deprived my children of what is the most natural (and presumably best) way to come into the world. But I look at my girls, now two, and don't have to live with knowledge that my birth choice resulted in the harm, or worse, loss of either of them. A C-section was simply the safest option.

The issue is, with all the potential complications associated with natural childbirth won't it always be. It is after all much more of a known quantity? In which case, Nice, with its new guidelines promoting choice of C-section over natural, may be giving expectant, nervous first time mothers an agonising dilemma they'd rather not face. With the result that many opt for c-sections they don't always need, and may later regret. Too much choice isn't always a good thing.