Saturday, September 18, 2010

Taking a knife to caesars

About to have a caesar? You’re not alone, as a health report shows more women are choosing to go under the knife to have a baby
Two of my friends this week have welcomed to the world newborn baby boys.
Coincidentally, both women went past their due dates and while one chose to be induced, the other chose to have a caesarean.
The mum having the caesarean lives in South Africa, so I have no idea what the antenatal care is like in her country, but it did make me question some of the reasons why women choose to have a caesarean birth.
A health report shows that Queensland has the highest rate of caesarean births in Australia, with one in three mums now giving birth in this way.
The Australian Institute of Health and Welfare released a landmark 580-page report on the nation’s health trends, entitled Australia’s Health 2010.
The report shows a dramatic rise in the proportion of women having caesarean sections, from a national average of 2.1 per cent in 1998 to 30.9 per cent in 2007.
Queensland had the highest rate of caesareans, with 33.1 per cent of births occurring in this fashion in 2007, while Tasmania had the lowest rate of 28 per cent.
The report also states that 18.1 per cent of caesarean births happened without labour.
Australian Medical Association Queensland president Gino Pecoraro said there was no single reason behind the high figure, but different rules applied in public hospitals from state to state.
Unlike their New South Wales counterparts, women in Queensland public hospitals could “demand” a caesarean without a medical reason, he said.

Dr Pecoraro, himself an obstetrician and gynaecologist, said he believed it would be patronising to refuse that request if the woman had done her research and made an educated decision.
Dr Pecoraro said one in seven women had genital herpes, which babies could contract during a vaginal birth, while a large number identified as survivors of sexual abuse, and therefore preferred to have a caesarean birth.
He said women who relied on assisted reproduction such as IVF often decide to have a caesarean because they had invested more “emotional capital” in the birth.
“Some of them want a bit more control and some of them see having their own c-section gives them a bit more control rather than putting it out to the cosmos,” Dr Pecoraro said.
Then there are women who are worried no, terrified – about vaginal birth.
Despite reassuring midwives who tell you women have been giving birth naturally since time began, many women are still very afraid of what may happen to them during labour and birth.
Dr Pecoraro said if doctors could help decrease the fear by educating women about the birth process, it may help to reduce the c-section rate.
But isn’t that what antenatal classes are for?
I’m quite sure that doctors are educating women about birth, however, who’s educating the well-meaning but opinionated third parties?
When you’re pregnant, all you hear is the horror stories, and then you get thrown advice from every relative and friend who’s “been there, done that” and got the scars, stitches and stretch marks to prove it.
These stories, whether good or bad, can increase a woman’s anxiety, and potentially push them towards choosing to have a caesaren.
There is also speculation that busy doctors are scheduling caesareans out of convenience, and that obstetricians are doing them for fear of litigation.
Certainly, the report showed that the proportion of women have caesareans was much higher in private hospitals (41.5 per cent) than in public hospitals (27.8 per cent).
Now I’m probably going to receive some hate mail for this, but if there is no medical reason to have a caesarean, what woman in their right mind would choose to have major surgery?
I find it hard to understand how this could be a rational and well-researched birth choice, except for perhaps an instance where a previous birth experience has been traumatic.
But if this is the case, there should be support services in place to help the mother after her trauma.
She should not be left to feel that should she have any more children, that having a caesarean is her best choice.
I also feel that this sort of support should be offered to women who have been victims of sexual abuse. Their choice to have a caesarean seems far more reasonable than a woman who is just too posh to push (such as the gynaecologist who insisted his wife have a caesarean in order to keep her female “bits” in tact... ironically, their daughter decided to come early and was delivered in an uncomplicated natural way).
Dr Pecoraro said a third of all caesareans were driven by medical reasons including higher obesity rates and older mothers.
But what about the other two-thirds?
Choosing a caesarean out of fear is not a good enough reason in my opinion because you’re not thinking about the best option for your unborn child, you’re simply running away from your own emotions.
What we do know is that a caesarean birth costs the public health system about twice as much as a vaginal delivery.
And there’s the catch. If more women were not afraid, attended antenatal classes to educate themselves, ignored negative comments or advice from others, and listened to their doctors and midwives, the caesarean rate might actually drop, and our health system might get a little financial relief.
While childbirth is a natural act, it is a fact that the medicalisation of it has made it much safer.
However, the risks of major surgery are far greater than the risks of vaginal birth if there are no foreseeable problems.
Not one birth experience is like another, so I do believe women should be entitled to make the choice between vaginal birth or caesarean birth.
But I wonder whether the choices being made in Australia today are really putting our children’s needs first.


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