How attitudes towards C-sections have changed since Victoria Beckham was told she was ‘too posh to push’

David and Victoria Beckham are shedding light on parts of their lives that have previously remained private in the former football star’s new Netflix docuseries, BECKHAM.

The power couple, who have been together since 1997, have navigated numerous storms consisting of rumours and claims about themselves, both as individuals and as a pair. Now, Victoria has hit back at a claim that surfaced when she gave birth to her and David’s first child together in 1999.

Victoria and David welcomed their son Brooklyn on 4 March 1999 in Portland Hospital, London. But the joyous occasion was somewhat spoiled by criticism over the former Spice Girl’s decision to give birth by Caesarean section (also known as C-section).

Victoria, who was famously nicknamed Posh Spice, faced derision from mum-shamers who branded her as "too posh to push" because she did not opt for a vaginal delivery.

In BECKHAM, the four-part Netflix series that delves into the life of David Beckham, the fashion designer recalled that period of her life and clarified: "I wasn’t too posh to push, I was told it would not be safe to give birth vaginally."

What is a C-section?

A C-section is a surgery to deliver a baby through a cut made in the lower part of the stomach and womb. It is considered major surgery that comes with a number of risks, and is usually only carried out if it is the safest option for both mother and baby.

During the 40-50 minute procedure, a 10cm-20cm cut is made in a horizontal line just below the bikini line. Sometimes, it may be a vertical cut below the belly button instead, and the baby is delivered through this opening.

Mothers will be able to see their babies and have them brought over while doctors deliver an injection of the hormone oxytocin to encourage the womb to contract and reduce blood loss.

The womb is then closed with dissolvable stitches, and the cut in the stomach is closed with either dissolvable stitches or stitches and staples that need to be removed after a few days.

Read more: When Posh met Becks — and all that came after. David and Victoria Beckham's love story told in new Netflix doc (Yahoo Entertainment, 8-min read)

Why are C-sections controversial?

C-sections have always been fraught with controversy, despite their popularity soaring since Victoria’s decision caused a flurry of judgement.

In 2021, the global use of C-sections accounted for more than one in five (21%) of all childbirths, according to research from the World Health Organisation (WHO). The organisation expects this figure to continue growing and expects nearly a third (29%) of all childbirths to take place by C-section by 2030.

In the UK, the rising rate of C-sections is even more pronounced. While most births are still done vaginally, NHS data shows that use of the surgery, both emergency and elective, has been rising steadily since 2011, from 23% to around 30%-35%.

Until recently, midwives and hospitals have encouraged mothers to opt for natural childbirth and forgo medical interventions.

The WHO expressed concerns over high rates of C-sections across the globe and said that, while the procedures can be "essential and life-saving surgery, it can put women and babies at unnecessary risk of short- and long-term health problems if performed when there is no medical need".

Read more: Sports Illustrated model proudly shows off C-section scar in 2022 Swimsuit Issue (Yahoo Life UK, 3-min read)

In 2005, the Royal College of Midwives (RCM) launched a campaign to promote vaginal births without the use of epidurals, inductions and C-sections. At the same time, hospitals were given targets to reduce the number of C-sections performed in order to focus on "normal births", with the Royal College of Obstetricians and Gynaecologists advising an average rate of 20%.

However, the RCM’s campaign faced criticism for potentially putting the lives of mothers and babies in danger. An inquiry into the deaths of 16 babies and three mothers at Furness General Hospital in Cumbria found that midwives contributed to dangerous deliveries because they wanted women to give birth without medical interventions "at any cost".

Professor Cathy Warwick, chief executive of the RCM, denied that the campaign put new mothers at risk and said she did not believe midwives thought it meant pushing natural birth "beyond the point of safety".

In 2017, the RCM ended the initiative and no longer uses the term “normal birth” to avoid making new mothers feel bad for opting for medical intervention.

Then in 2022, the NHS abandoned its targets for C-sections after a number of scandals in maternity units found that hospitals were pushing women to have natural births even if it compromised their safety.

A letter from Jacqueline Dunkley-Bent, NHS England’s chief midwife, and Dr Matthew Jolly, the national clinical director for maternity, instructed "all maternity services to stop using total caesarean section rates as a means of performance management".

"We are concerned by the potential for services to pursue targets that may be clinically inappropriate and unsafe in individual cases," it continued.

What is the current guidance on C-sections?

According to the latest guidance by the National Institute for Health and Care Excellence (NICE), pregnant women’s "preferences and concerns" must be "central to the decision-making process" about whether she gives birth via C-section or otherwise.

If a mum-to-be requests a C-section, medical professionals must:

• Offer to discuss and explore reasons for the request

• Ensure they have balanced and accurate information

• Offer to discuss alternative birth options

• Offer discussions with consultant midwife or senior midwife

• Offer discussions with consultant or senior obstetrician if necessary or requested

• Discuss overall benefits and risks of C-section compared to vaginal birth

• Offer referral to perinatal mental health support if the reason for C-section involves tokophobia or other severe anxiety about childbirth

NICE adds: "If, after an informed discussion about the options for birth, the woman or pregnant person requests a caesarean birth, support their choice."