Interesting Article about C-Section and a Woman's Choice

[Cricket]

Here's something I came across in the paper this morning. Thought it might interest some of my fellow BB members.

42% of obstetricians say C-section a woman?s call

Sharon Kirkey, Canwest News Service Published: Monday, September 21, 2009

A record number of women across the country are seeking to have their babies via C-section, a trend that has doctors worried. Getty Images A record number of women across the country are seeking to have their babies via C-section, a trend that has doctors worried.

Nearly half of obstetricians in Canada say a woman should have the right to choose a Caesarean section when there is no medical reason to warrant one.

The finding comes from a nationwide survey of maternity-care providers that found many obstetricians appear to support the wide use of technology, despite a push by their own professional body to "normalize" childbirth and reduce Canada's rising C-section rate.

Forty years ago in Canada, 5% of babies were delivered by Caesarean. Today the rate is 28% nationally, and more than 30% in B.C. and P.E.I. More than 78,000 C-sections were performed in Canada last year.

The Society of Obstetricians and Gynaecologists of Canada says a C-section should not be offered to a pregnant woman unless there is a valid medical reason to perform one.

But the University of B.C.-led study found that 42% of obstetricians were in favour of a woman's right to choose a C-section for herself, even in the absence of a medical indication.

Overall, 549 obstetricians, 897 family physicians, 545 nurses, 400 midwives and 192 doulas from across Canada were surveyed in 2008-2009 on their attitudes toward labour and birth. The study was done against a background of a "technological transformation of birth," the researchers say -- rising C-section rates, more induced labours and routine use of epidural analgesia, or local anesthetic.

Among the key findings

? Most obstetricians agreed that epidural analgesia interferes with the normal progress of labour. Epidurals can slow labour, sometimes so much that labour stops. But 60% of obstetricians agreed that epidurals ought to be routinely offered to women. Midwives and doulas disagreed mostly strongly with the routine use of epidurals.

? The majority of obstetricians are against routine fetal monitoring. "And that's a good thing," says Dr. Michael Klein, emeritus professor of family practice and pediatrics at UBC and the lead author of the study. "But that is not what's happening on the ground."

A recently released Canadian survey of more than 6,000 women who gave birth in the last few years found 91% experienced electronic fetal monitoring during labour; 63% said they had continuous electronic monitoring.

Routine electronic fetal monitoring increases the risk of a C-section, because it can lead to so-called false positives, "meaning it tells you there's a problem, but it turns out there isn't," Dr. Klein says.

"People have been hearing that message for 20 years or more, and so they know what the answer to the question is. But, in reality, imagine that you're a physician in your office and you have a woman who is in labour. Where should you be? You should be with her in labour. Where are you? You're in your office."

? 42% of obstetricians were in favour of a woman's right to choose a C-section without medical indication, but only 21% of obstetricians agreed with the statement that a C-section is as safe as a vaginal birth for women, and only eight per cent would choose C-section over vaginal delivery for themselves or their partners.

Dr. Klein said the findings reflect a dissonance between "what they feel about this [C-sections] and how they would respond to a request." Only 18% of obstetricians said a C-section is safer than a vaginal birth for babies; 58% disagreed with the statement.

"Women's autonomy is a value that we all share," Dr. Klein said. "But we believe that it has to be informed autonomy. And the obstetricians are kind of caught in the middle of this one. 42% of them would support a woman's choice, but the problem is they're also the ones doing the Caesarean section, and they're also the ones who have to have very long discussions with people about the benefits and risks of Caesarean section. It takes a couple of hours by the time you're through, and nobody has that kind of time."

"It's in many respects easier to go along with the woman's choice - especially if you actually believe Caesarean section is not a problem."

Studies show risks to babies from C-sections range from accidental lacerations when the surgeon cuts into the uterus, to neonatal respiratory distress. Risks to women include the higher chance of hemorrhage requiring a hysterectomy, blood infections, wound infections and blood clots in the lungs. As well, every C-section increases the risk for another.

The study is published in the Journal of Obstetrics and Gynaecology Canada.

Canwest News Service

[Cricket]

And here's a thought to go with it - since we have publically funded health care in Canada, should a woman who is choosing an unnecessary c-section have to pay for it, like cosmetic surgery? Why should my tax money have to pay for that, when it could be spent on education and disease prevention, etc?

[bon]

There was a similar article in Australia a while back, basically saying the same thing - that over half of the Obs they surveyed said a woman should have the right to choose a c-section without any medical reason. Interesting that they won't also agree with a woman's right to choose a home birth. Major surgery with no medical indication? That's fine. But a relatively inexpensive (to the govt), low risk, unmedicalised, vaginal birth at home? Oh no that just won't do.

[Cricket]

Funny, eh? Here at least, homebirth is allowed. Not necessarily approved by everyone - I got some flak when I had mine. But allowed and funded, which is wonderful.
I thought the disparity they pointed out between what every doctor *knows* they should be doing, and what is ACTUALLY done was interesting. We need to have our careproviders answer to someone who has the ability to enforce the guidelines, or something.