Caesarean, anyone?

Globally, rates of caesarean births have increased dramatically over the last twenty years, and in most of the “developed” world tower above World Health Organisation estimates of 10-15% required for medical reasons.  In world leaders China, nearly half of women give birth via caesarean now; in the US, it’s one in three.

WHO research suggests that without medical need, vaginal birth is preferable in terms of a range of health outcomes for both mother and baby.  In Latin America, they have even demonstrated that reducing high caesarean rates through seeking a second medical opinion has no negative outcomes. 

The world-wide increase in caesareans –  up to 23.4% in Aotearoa in 2005 from 11.7% in 1988 – is typically laid at the womb of mums “asking for it”.  Being too posh to push, too oldfrightened of labour or damage to vaginas, or if you live in the US, pressuring physicians with the threat of legal action if birth does not go smoothly.   Health researchers in Canada and the US even suggest that despite doctors following guidelines designed to reduce unnecessarily high caesarean rates, they have crept upwards as the relationship between doctor and patient drifts towards supplier and consumer.

But just what does “elective caesarean” really mean?

A survey carried out in the US in 2006 by Childbirth Connection asked 1,573 mothers all about their experiences of pregnancy, childbirth, and coming home with a baby.  One in three had given birth via caesarean, and one quarter said they’d been pressured by a health professional to have a caesarean.  And how many “chose”?

Although the media and some health professionals have given much attention to the phenomenon of “maternal request” cesareans, just one mother among the 252 survey participants with an initial (primary) cesarean reported having had a planned cesarean at her own request with no medical reason.  Similarly, just one mother (in a repeat cesarean) reported having a cesarean in the belief that it would help avoid incontinence later in life, despite extensive media and professional focus on cesarean as a purported preventive measure for long-term pelvic floor problems.

That’s 2 women out of 1,573 choosing caesareans with no medical “need”.  Or a whopping 0.1%.

30% of US hospitals refuse to offer vaginal birth as an option to women who have previously delivered via caesarean, despite there being no medical reason for this.*  In some parts of the US the caesarean rate tops 50%, in others it varies between 6% and 60%

Remember women in the US will be charged for this, and guess what, caesareans cost more.  (In New Zealand in 2000-01, vaginal births cost an average of $1731 compared with $3701 for caesareans.)

In one appalling US case a mother had her child removed on the grounds that she refused to consent to a caesarean section and behaved erratically while in labor. 

Just how you should behave when you’re in agony and having a doctor hovering over you trying to perform unnecessary surgery – her vaginal birth went without a hitch – I’m not sure.  Apparently saying “No, I’ll handle this,” just isn’t good enough. 

If the push for C-sections is not about women’s desires or health, then feminists are right in describing it as an important issue for pro-choice activists:

As someone with a passion for pregnancy and birth issues and someone who has worked in the industry, I have heard countless reasons doctors have told mothers they “need to” have a C-section. I have heard everything from the baby is past due to the baby is big, to the mother has had a previous C-section (a fact that in no way should prevent a mother from delivering vaginally in the future). On one occasion I even heard a new mother say that her (male) doctor had told her she “had” to have a C-section because her baby moved around in the womb so much! It was just not true.

Childbirth Connection argue the real reasons for spiralling caesarean rates in the US at any rate boil down to low priority of enhancing women’s own abilities to give birth, side effects of common labor interventions, refusal to offer the informed choice of vaginal birth, casual attitudes about surgery and cesarean sections in particular, providers’ fears of malpractice claims and lawsuits and incentives to practice in a manner that is efficient for providers.

I’m not interesting in setting up a hierarchy of types of birth – several of my friends have given birth to beautiful babies both naturally and via caesarean – but I am interested in our bodies being under our control, and being empowered to make health decisions in our best interests.

Any comments from New Zealand mums out there?

*This is not New Zealand official policy.

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