Empowering Mothers to Make Informed Choices: Considering a Caesarean for a Healthy, Older Mum
For many women, becoming a mother is one of life’s most precious journeys—especially when it’s a long-awaited pregnancy. Older mums, in particular, often face added layers of advice and medical recommendations, frequently framed around reducing perceived risks. If you’ve been advised to have a planned caesarean section, it’s completely natural to want to take the safest route for your baby. However, stepping into motherhood also means stepping into your power. You are the one growing this baby inside your body, and no one else shares that unique bond.
The person who knows what’s best for you and your baby is you. While medical advice can be invaluable, it’s essential to approach recommendations with informed confidence, balancing the evidence, your instincts, and what feels right for your family. Let’s explore some considerations when deciding whether a planned caesarean is truly necessary.
Caesarean Sections and Their Impact
A caesarean is major abdominal surgery, which can come with risks, side effects, and a potentially longer recovery time than a vaginal birth. For older mums, these factors may play a significant role in your decision. While some planned caesareans are unavoidable, it’s worth noting that such procedures are often scheduled well before your due date—sometimes weeks ahead. This timing is frequently determined more by the consultant’s diary than by clinical necessity, ensuring the surgeon is not on call for labour emergencies.
Yet, there is strong evidence that babies born during labour—even via caesarean—often need less help with breathing. This is because they, not the calendar, signal to your body that they’re ready to be born. Labour releases hormones that help mature a baby’s lungs and prepare them for life outside the womb. By scheduling a caesarean too early, you may inadvertently bypass this natural process, potentially increasing the risk of complications.
The Global Concern: Overuse of Caesareans
The World Health Organisation (WHO) has warned that caesarean section rates exceeding 15% in any country tend to do more harm than good. In their guidelines, WHO states:
"Caesarean sections are effective in saving maternal and infant lives, but only when they are required for medically indicated reasons. When caesarean section rates rise above 10-15%, there is no evidence of improved outcomes for mothers or babies and, in fact, harm may occur."
Despite this, many high-income countries have far higher caesarean rates. For example:
United Kingdom: Over 30% of all births (2021-22 data).
Elective caesareans (planned): ~17%.
Emergency caesareans: ~13%.
United States: Approximately 32%.
Brazil: Over 55% (and as high as 80% in private hospitals).
(Source: NHS Maternity Statistics 2021-22, World Health Organisation)
This sharp rise in caesareans in the UK and other high-income countries has not correlated with improved outcomes. Instead, higher intervention rates have been linked to unintended consequences, including persistently high stillbirth rates. For instance:
UK: 4.2 stillbirths per 1,000 births in 2021.
Sweden: 2.7 stillbirths per 1,000 births (lower caesarean rates).
United States: 5.5 stillbirths per 1,000 births. CDC Still-Birth Data
The Lancet series on caesarean sections and stillbirths explores these trends in greater depth: The Lancet - Caesarean Section Series.
Caesareans, the Microbiome, and Long-Term Health Risks
One area of concern linked to caesarean birth is the potential impact on the baby’s microbiome. Babies born via caesarean miss out on exposure to their mother’s vaginal and gut bacteria, which play a vital role in seeding their microbiome and supporting their immune system. Studies have shown a link between caesarean birth and an increased risk of non-communicable diseases, including:
Eczema and other allergic conditions.
Asthma.
Type 1 diabetes.
Obesity.
For mums planning a caesarean, microbiome seeding is an option to consider. This involves swabbing the baby with vaginal bacteria immediately after birth to help restore exposure to the beneficial microbes they would have encountered in a vaginal birth. Research from the Nature Medicine journal supports this practice: Nature Medicine - Vaginal Seeding Study.
For an accessible overview of this topic, consider the documentary Microbirth, which explores the link between the microbiome and lifelong health: Microbirth Documentary.
Long-Term Impact on Postpartum Sexual Health
Studies suggest that women who give birth via caesarean report a higher likelihood of experiencing painful sex (dyspareunia) in the long term compared to those who have vaginal births. This may be due to scar tissue, adhesions from surgery, or a delayed recovery process affecting overall pelvic health. Addressing these issues often requires time, patience, and sometimes professional support from pelvic health physiotherapists.
A systematic review published in BJOG: An International Journal of Obstetrics & Gynaecology highlights the relationship between caesarean births and postpartum sexual dysfunction: BJOG Study on Caesareans and Sexual Health.
The Importance of Delayed Cord Clamping
Another critical consideration during a caesarean birth is ensuring your baby receives all of their blood. Historically, early cord clamping—cutting the umbilical cord immediately after birth—was standard practice. This deprives babies of up to one-third of their total blood volume, which can lead to iron deficiency anaemia and poorer neurodevelopmental outcomes.
Thanks to campaigning by professionals like midwife Amanda Burleigh, delayed cord clamping is now recognised as beneficial and is becoming standard practice, even during caesareans. Ensure your care team plans to allow the cord to pulsate naturally before clamping, unless an emergency arises.
Click on the picture below for a wealth of further information on this important subject.
Using BRAIN to Assess Medical Interventions
When considering any medical intervention, including a caesarean, the BRAIN tool can help you assess your options calmly and objectively:
Benefits: What are the benefits of this procedure for me and my baby?
Risks: What are the potential risks or downsides, both short-term and long-term?
Alternatives: Are there alternative options available, and what do they involve?
Instinct: What is my gut feeling about this decision?
Nothing: What happens if we wait and do nothing for now?
Click below to join my facebook community where I have shared a FREE downloadable BRAIN sheet
to help you make decisions that are right for you and your baby.
Why Planned Caesareans for Older Mums?
It’s puzzling why planned caesareans are sometimes suggested to older mums even before pregnancy has begun. There is no universal guidance from respected bodies like NICE (National Institute for Health and Care Excellence) or RCOG (Royal College of Obstetricians and Gynaecologists) recommending planned caesareans solely based on maternal age.
The RCOG’s Green-top Guidelines emphasise that decisions should be based on individual circumstances rather than blanket recommendations. If this recommendation is made to you, ask for the evidence and discuss your alternatives.
Explore the RCOG guidelines here: RCOG Green-top Guidelines.
Considering a Gentle Caesarean
If a caesarean is part of your birth plan, it doesn’t mean you have to give up on having a meaningful and connected experience. The concept of a gentle caesarean focuses on bringing elements of a natural birth into the operating room, allowing for a calmer and more personalised approach to surgical birth.
Key features of a gentle caesarean might include:
Delayed cord clamping, ensuring your baby receives their full blood volume.
Skin-to-skin contact immediately after birth, even while still in theatre.
Lowering the screen during delivery so you can watch your baby being born if you wish.
Encouraging the baby’s first crawl up to the breast for an early latch.
Creating a calm environment, with soft lighting and minimal chatter among staff.
This approach supports bonding, breastfeeding initiation, and a gentler transition for the baby into the world. If this sounds like something you’d like to explore, talk to your care team early and discuss whether these elements can be incorporated into your caesarean plan.
For a deeper dive into this empowering option, explore our blog on gentle caesareans here.
Final Thoughts
As you prepare to meet your baby, know that you are not only growing a new life but also growing into a new version of yourself. Becoming a mother is about finding your voice, trusting your intuition, and making the decisions that feel right for you and your family. Whether you choose a caesarean, a vaginal birth, or another path, remember: you are already the expert on what your baby needs most—you.
For further resources, consider:
AIMS UK for evidence-based information and advocacy.
Microbirth Documentary for insights into the microbiome and birth.
RCOG Green-top Guidelines for clinical recommendations.
Sixteen years ago, Emma's own transformative birth, supported by an Independent Midwife, inspired her to dedicate her life to empowering women on their journeys to parenthood.
With a degree in Antenatal Education and expertise as a Doula, Pregnancy Yoga Teacher, and Breastfeeding Peer Supporter, Emma combines evidence-based research with compassion and intuition to offer truly personalised care.
Emma shares, 'My mission is to help women trust their instincts, embrace their power, and confidently step into their roles as mothers, while ensuring their partners feel included and supported every step of the way.
✨ Ready to feel empowered and supported in your own birth journey? Book a Power Hour or explore my Virtual Doula Support for guidance tailored to you.