The best day of my life, so far, was 4 August 2009. After two and a half years of fertility and IVF treatment, plus a nine month pregnancy, the day had finally come – I was about to meet my one-and-only. My daughter, Holly.
My husband and I jumped out of bed at 6am and set off for the hospital early – we were first on The List. After friendly formalities, I headed to the anaesthetist’s pre-op room sporting my hospital gown, fetching hat and wristbands. With a comfy vibe and calming chill-out music playing, I like to say the only thing that was missing was a glass of champagne – which (you won’t be surprised to learn) isn’t allowed when you’re having a spinal block in preparation for delivering a baby by Caesarean section.
August 4th had been locked-in weeks in advance because I’m part of the one-third of women in Australia whose special delivery arrives in an operating theatre, whose special delivery was planned and scheduled in advance – and came with a whole heap of negative judgement from others, too.
Illustration: Ben Jennings, The Guardian
CAESAREAN RATES IN AUSTRALIA
About one third of all Australian babies are currently delivered by Caesarean section – the procedure is at an all-time high here, and in most other parts of the developed world. Some call it “an epidemic”. Not a month goes by lately without a new report into “alarming C-section rate increases” and accompanying opinion.
Graph of Caesarean rates in Australia
There has been plenty of research into why our Caesarean rate is so high: more older mums requiring more intervention, speculation that fear of litigation leads clinicians to opt for the control of a surgical procedure, and the personal preference of women who may not medically require the procedure (which despite the popularity of the “too posh to push” caricature, research published in 2015 by the Cochrane Collaboration has shown to only account for about 18 per cent of planned Caesareans).
Fact is, it’s now one of the most commonly performed operations in the world and, in first world countries, while not risk-free, it’s a very safe and successful procedure.
Here’s how it’s done:
Source: ‘The Doctors’ CBS Television
So does having one third of Australia’s babies arrive by C-section really matter? If you want to have a Caesarean, why shouldn’t you have one.
It seems that modern maternity care gives women the option of a surgical delivery by C-section, but only women who don’t really want it – but who must have it for medical reasons – will escape negative judgement.
ADVOCATES OF CAESAREAN RATE LIMITS
Dr Jenny Fenwick, associate professor of midwifery at the University of Technology Sydney, has been involved in a study of women’s perceptions around natural childbirth. She says fear of natural birth is key to the rising C-section rate – and therefore increased education and support for women is what’s needed now.
“When we talked to those women they were absolutely terrified of birth. There was no confidence in their body’s ability to do this most amazing thing which is to have a baby. And so they talked about being really scared and frightened and so they came to it thinking that a caesarean section was safer. When they talked to their obstetricians what happened was that they got positive reinforcement for the caesarean section. None of the women actually said they had been questioned or talked to about their fear,” Associate Professor Fenwick says.
“It’s a good option for those women who need it – but not at the rates that we’re seeing now and I think it’s got some real long term ramifications for women.”
GOVERNMENT POLICY STEPS IN
The increase in Caesarean section rates has prompted action from governments keen to promote birth with less medical intervention – or cost – such as the NSW Government’s 2010 policy Towards Normal Birth.
But as obstetrician Dr Vijay Roach put it, on Radio National’s 2009 Health Report special into Caesareans, policy is inappropriate on this issue:
“I don’t think that it’s up to an obstetrician to tell the woman what to do. I don’t think it’s up to a midwife or a policy maker to tell a woman what to do. I think that it’s important that we respect that woman’s wishes. Our responsibility is to educate her and to make sure that she is fully informed… And if we do that and her fully informed decision is to have a caesarean section then she should be supported in that.”
Hear from Alexi, a young mum who is angered by involvement in her birthing decisions
A leading Australian academic in obstetrics and gynaecology, Professor Hans Peter Dietz from Sydney University’s Nepean Medical School, says the push to reduce C-section rates is misguided – even dangerous. He argues that given factors like increasing maternal age and more pregnancy complications, we’re actually “containing” the levels quite well in Australia.
Professor Dietz and two co-researchers argue that because around one third of women experience long-lasting damage during their first vaginal birth, auditing the rate of pelvic floor or anal sphincter damage to mothers at a particular maternity service is a more meaningful measure of sound practice than whether or not that facility is reducing its C-section rate.
“There are a lot of women out there who are seriously pissed off by this debate,” says Professor Dietz, whose wife is a practicing midwife. “This irrational obsession with cutting C-section rates is hurting mothers and babies.”
Professor Dietz rejects the often-espoused need to reduce women’s fear of natural birth, instead asserting that “an abnormal lack of fear of vaginal birth” is creating foolhardy policy.
“We are increasingly subjected to bullying by the World Health Organisation (WHO) and other organisations. For the last 10 years in the UK, the increasing drive to lower C-section rates has caused the rate of forceps deliveries to double in the public hospitals. Using forceps is the main risk factor for prolapse later in life. Over 100,000 women have been directly damaged.”
WHO ASKED YOU?
Arguably the official artiber of all things appropriate in global health care, WHO advocates for C-section rates of between 10 and 15 per cent. It argues that countries with rates below 10 per cent show unacceptable mortality rates for mums and newborns. But at the same time, it says, countries with C-section rates above 10 per cent don’t show reduced rates in maternal or infant mortality – thereby supporting its view that Caesarean rates should be contained.
This raises the question: Is it just about mortality? Is the fact that a woman and her newborn could survive without a C-section delivery, sufficient to argue that she shouldn’t have one?
A 2014 study by the Norwegian Institute of Public Health, and reported in BMC Pregnancy & Childbirth online, found that women who requested a C-section but ultimately delivered vaginally, were almost three times more likely to develop symptoms of post-traumatic stress.
It’s probably fair to say that when you’ve spent a few years trying to conceive a baby then made it to the Big Day, ‘birth plans’, notions of natural birth empowerment and government policies are, to put it kindly, meaningless.
I’m eternally grateful that, despite the statistical odds, I have a daughter. I’m grateful that she arrived safe and well. And I’m grateful that I ‘experienced’ and enjoyed every moment of 4 August 2009, starting with the procedures that led me into an operating theatre, right through to the moment my obstetrician held up a baby girl from behind a sterile screen.
Welcome Holly! 4 August 2009.
‘The obsession with ‘natural’ birth is just another way to judge a woman’, The Guardian, 30 May 2015.
‘It’s not enough to survive: now we have to give birth ‘properly’, Huffington Post. 28 May 2015
‘Six myths about C-sections busted’, Huffington Post, 23 April 2015
Tags #Caesarean #Cesarean #C-section #judgement #childbirth choice