Article: Risks Fail to Deter Caesarean Births

[BellyBelly]

Mark Metherell
December 19, 2006

NEARLY one in three babies in Australia are born by caesarean section, according to new figures that are creating concern among doctors and patient groups.

The rate of caesareans has grown steadily from fewer than one in five births in 1995 as women, particularly older first-time mothers, and their doctors choose the surgical option as "safer" and less painful.

But an obstetrics leader, Christine Tippett, said although caesareans were legitimate in some cases, the high rate of the operations was hard to justify in medical terms given the small but increased risks with the major abdominal surgery involved.

The risk to babies is also greater, according to a large US study published recently that shows the death rate of caesarean-delivered babies to be about one per 1000 births higher than that for babies delivered normally.

"I am concerned because I don't think we can be certain that in fact we are not doing some harm," said Dr Tippett, the president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

"There is an expectation that if you have a caesarean section nothing will go wrong, both on the part of the medical fraternity and patients. But clearly things can go wrong."

Maternity patients in private hospitals, particularly older women, were also significantly more likely to have caesareans than those in public hospitals - 38 per cent compared to 26 per cent, according to latest available figures, published by the Australian Institute of Health Welfare today.

The institute figures show that 74,300 caesareans were performed in 2004, representing just over 30 per cent of all births.

Dr Tippett said there were many factors at play, including a fear of labour pains and the increased risk of birth complications facing the growing number of older first-time mothers.

But the increase in caesareans had not produced an overall reduction in conditions such as cerebral palsy, normally associated with problems with vaginal delivery, she said.

Patients' groups, including the Maternity Coalition, have attacked the growing "medicalisation" of childbirth. In NSW in 2004 only a quarter of women aged 20 to 34 having a "normal" delivery got through labour without some form of intervention such as pain relief, an epidural or an episiotomy - minor surgery to the vagina.

The spokeswoman of the patient group Caesarean Awareness Network Australia, Cas McCullough, described the trend towards surgical interventions "quite alarming" . She said her group believed much of the rise was doctor-driven. "I don't believe more women are asking for caesareans," she said.

Andrew Pesce, obstetrics spokesman for the Australian Medical Association, said his approach was to advise patients of the increased risk of complications from a caesarean, including infection, hemorrhage and scarring that could complicate subsequent pregnancies.

[BellyBelly]

From what I have seen Brooke I dont so much see the c/s being pushed on them, but like I spoke to a client a couple of days ago, as soon as they decide you need a c/s in labour, its madness, all systems go and you are left out of any decision making process. Be that because the couple feels they don't know better or the decision has been made for them.

Some women are trusting when their Obs tell them they need a c/s, for example, some Obs will try and book women in for caesars for low lying placenta in their second trimester and will explain risks. What mother will argue with that? All about education... some women and men just have no idea and completely rely on medical people for their care. I would still like to see the day that midwives are the first point in care for women, then they are referred to Obs if need be. Of course, Obs would be available at hospital, but I really think women spend more time with midwives than Obs while giving birth, so they should get to know the midwives more and of course their Ob if that's what they need to do.

[Tobily]

From what I have seen Brooke I dont so much see the c/s being pushed on them, but like I spoke to a client a couple of days ago, as soon as they decide you need a c/s in labour, its madness, all systems go and you are left out of any decision making process.

This is soooo true.
When I was in labour with my son, one minute the midwife was telling me I was dilating so well that I would be pushing him out within an hour, and literally 5 minutes later I was being told I would need a c section because he was in severe distress.

When it's thrust on you that quick, out of nowhere - and the monitor next to you is beeping like crazy because your baby's heart rate has fallen through the floor - it is extremely difficult to keep your wits about you and ask the right questions, make sure all other options have been considered etc etc. One minute your having a normal labour and the next BANG. It can all go pear shaped THAT quickly

[~Jo~]

Mmm..ive definately felt like caesareans have been pushed on me. I had an emergency one with Emily after too much intervention and then was really made to feel that i couldnt have anything less than a caesarean with Sammy because I had had two already. I can completely believe it.

Jo

[BellyBelly]

I must say I am pleased that Christine Tippett is new to the job, great to see a woman and one that is making some good statements, I am hoping for bigger things Her hubby is a GP here in Melbourne, I used to see him before we moved.

ps. Keep your eyes on the news one of those people was interviewed by Today Tonight, national news programs etc...

[visitor2]

I think a lot of it is the OB giving women the choice in what to do.
When i was pg with Alex and went for my booking appt the m/w said i would have a choice between VBAC and c-section not once until then did i even think i wouldn't have a VBAC. But once that idea was put into my head i choose a c-section.

This time i was told they wouldn't let me try VBAC not sure what would have happend if i changed hospital but i wanted to stay closer to home.

[Kirsty77]

I don't think c/s's are being pushed onto women, well not at public hospitals anyway. And anyone who thinks a c/s is the least painful option has obviously never had one! The recovery is a b$tch!

[BellyBelly]

You'd be surprised... then again, inductions are pushed heaps too, hear it all the time. Interesting the ploys they use. The consequences? Around 50-75% of first time mums having caesars, according to a midwife at the RWH.

[BellyBelly]

Here's the transcript from Today Tonight:

Caesareans and circumcisions
REPORTER: Jackie Quist
BROADCAST DATE: December 19, 2006
Caesareans and circumcisions

Researchers are looking again at whether circumcision can reduce the spread of AIDS, and whether caesarean section births create extra risks.

Two of the most emotive and contentious medical issues affecting most Australian families are caesarean births and whether to circumcise boys.

Now experts say new research may change the way we think about both.

National spokesperson for the Caesarean Awareness Network, Cas McCulloch, says up to 29 per cent of Australia's childbirths are now caesarean sections.

It is an increasing rate that suggests Australia is on the way to having one-in-three babies entering the world in an operating theatre.

Of course, some caesareans are a medical necessity. Some are the mother's choice and others are recommended by the treating doctor.

"Anecdotally, we hear stories that actually confirm that that is the case," Ms McCulloch said.

"We know that litigation plays a really important role in doctors' decisions to prefer caesareans. We also know that a lot of doctors think caesareans are safer."

After two natural births, Karen Hindle was told she had placenta previa. There was no option but to have baby Sarah by caesarean.

"It worked out really well as far as the child was concerned, but for me, I was very sick for about two/two and a half months", Karen said.

Karen can't understand why anyone would elect to have a caesarean.

"I could barely stand for the first six weeks," she said.

"I could only stand at five minute intervals and then I was on the couch, or on the bed, for the rest of the time. It would take me a bit to psych myself up for the shower, so it was a bit horrific."

Ms McCulloch claimed there were other possible downsides to caesareans.

"There’s a longer stay in hospital, there’s a risk of respiratory distress for the baby, there’s a higher risk of breastfeeding complications," she said.

"There’s a risk that the baby might be cut during the surgery, there’s a risk that your other organs might be cut during the surgery, there’s a number of risks."

Severe bleeding was another risk. Studies now show that one-in-155 women needed a hysterectomy after their first caesarean birth, with the risk rising to one-in-40 after the fourth.

If you have a baby boy, there’s the issue of circumcision. The trend these days is not to circumcise, but Melbourne University's Dr. Roger Short said the debate needed to be re-examined.

"The new evidence that has come through should make everyone turn around and do a complete rethink," he said.

This month, the results of a large, two year study conducted in Africa showed circumcised men almost halved their risk of contracting the HIV virus.

The suggestion was this age old practice may be the most effective weapon against a scourge that now plagues some Third World countries.

Karen and Keith McFarlane were among the 10 per cent of Australian parents who circumcise their sons.

The procedure takes only one minute, but does carry a risk of bleeding and infection. In Australia, a child dies every five years from a botched procedure.

According to Dr. George Williams from Circumcision Information Australia, it is a practice the country simply cannot justify.

"The ethics is, do doctors have the right to alter a penis that is normal, and by surgical means?" Dr Williams said.

"I don't think that can be ethically justified."

[Inanna]

I watched this with interest last night Kelly so I was so happy to see it in here.

I think the issue with c/section is varied.

Firstly I believe the medicalisation of childbirth in our country has meant women are giving over their power and their bodies. Women often choose not to educate themselves - they defer this to their *specialist*. When they do educate themselves they will still often defer this again - it's difficult sometimes to argue with someone with a degree that you don't posess! We are taught from a young age that "the doctor is always right!"

Women very often today are like cattle in the waiting rooms. Pee in a jar, weigh in here and check the b/p. I always look on maternity outpatient waiting rooms depressingly. There is no JOY!

Women are often not taught to embrace their bodies, love their bodies and trust their bodies to do just what they know what to do - birth babies!
We are fed hideous stories from our mothers and grandmothers. We are fed even more hideous visual images of *the beautiful* people of hollywood etc - stick thin women who look as maternal as the brick on the side of a house.

Birth and pregnancy is seen as a medical condition that requires treatment and intervention to ensure it goes *right*. Time restraints are put on almost all milestones of pregnancy and certainly of labour. The climate is often all WRONG for positive birth outcomes.

I believe also that birthing and pregnancy care has been snatched from the hands of women and given to the minds of men...
I believe very strongly (so shoot me down!) that birthing is womens business. I don't believe there is a place for a doctor (male or female) at a routine normal delivery. I believe this so strongly and I have been at many births. The climate often changes when an obstetrician (and sadly they are usually men) walk in the door. A woman sees him at times as a saviour - he will get her through when really it is her the woman her does this. The woman births the woman delivers. He is seen as the man with the answers. The scene changes from one of a Goddess birthing to - a patient requiring treatment. I know that that is quite emotive but again I believe it passionately.

Having said the above I have had the blessing to be involved with some pretty amazing obs that quitely enter a room and sit patiently and unobtrusively and wait... This is a quality that is THE most important for a birthing attendant weather it be an assistant, midwife, doula or obs. Birth is about waiting...

Today our health system is short staffed, underfunded and highly stressed. We need to get 'em in and get 'em out. Waiting around for 24 hours for a woman to push out a baby when a quick trip to OT would sort it out is often not the preferred option. Likewise waiting and feeding a baby while birthing a placenta... Why do that when you can have an injection and it's all over red rover?

Women are often not educated about what the birth process is about.
Birthing a child is one of the steps to parenting. A positive birthing experience sets the scene for positive early parenting. It is so closely emeshed so that it can't be isolated.

Women are led to believe that they don't have options. It appalls me that in SEQ there is only 1 public hospital that would support a VBAC of a woman 2 years ago. What is the go there? This woman did birth vaginally in that hospital but was seen as too risky for anywhere else. But was it that?
I wonder if it was that it takes time. It takes time to sit with a woman. It takes time to learn what is in her head it takes time to build trust and for her to build trust. It takes patience and time. Neither of these things are congruent with the health system.

It confounds me that the most educated (and the oldest) among us opt for caesarian at a higher rate. The risks of major surgery for the mothers body the risks to the baby are far greater but women are asking for caesarian. Only today I was talking to a woman... She has a 15 month old toddler and is due in January. I asked her where she is birthing and she told me and then went on to say she is having an elective caesarian. Why? Because her last baby was 8lb 5ozs and she got a second degree tear.

Now... Haven't the obstetricians and the system got a duty of care here? Haven't they got a duty of care to say... this isn't a good reason. WE can do some things to help you. We can let you use the birthing tub so your peri is nice and supple. WE can provide continuity of midwifery care so you feel safe and nurtured. WE can educate you on positions and guide you gently to use them in labour...

Caesarian is wonderful when it's needed. It's wonderful for saving lives. It is not and should not be an option unless there is a firm medical indication.

I am a firm advocate of womens choice. If a woman knows the risks attatched and is fully educated then she has made an informed choice.

However, we don't decide that our tonsils need to come out - we get a consult and then there are criteria that need to be met. Why is it different with major surgery to remove a baby? Why is it bandied about like it's not a biggy. Caesarian is a biggy. It's not a minor op. It has risks and side affects to both people.

As I said when it is indicated it is an absolute blessing. I firmly believe though that the balance is way out of whack...

I was so happy to see this on Today Tonight.

[Janie]

Wow Deb , what a read! It is so fantastic to see that there are people out there who are so passionate on this subject! Another thing to thank BB for........I plan on being as well educated and informed as I can be when it comes time to give birth. I am very respectful of my Ob and do trust him (otherwise what would be the point?!). He is an older-style OB, who is quite into minimal intervention, however - I am aware that as a first-time mum giving birth in a hospital I may have to be strong to get the sort of birth experience I want. I will do almost anything to avoid a caesarian (and induction), unless of course there is a definite medical need. I have seen a number of family and friends recover from caesars and it doesn't look like fun to me! I am also quite adamant that I want to BF, and I want to give me and my baby the best possible chance to do that.

Of course, it may all go pear-shaped, but I want to know that I did everything that I could to try and have my preferred birth experience.

[BellyBelly]

And a huge round of applause here!!! Great post Deb, I'm with you 110%. Birth education needs massive improvements.

[Inanna]

Now I will climb down a little coyly from my soap box...

[Aranah]

I know of two women that have chosen C/S as they need the baby born by a definate date and also they are afraid of a natural birth (think they don't have the pain tolerance).

I have never had a C/S, I had two natural births, the first induced. But I had open stomach surgery around 3 years ago for severe endometriosis and ruptured endometriomas where for some reasont they reckoned they couldn't do keyhole.

I remember the exact moment I woke up from that surgery. While I was still out, I had reacted to the morphine they were pumping into me (I'm allergic to it), so when I awoke, I was without drugs and literally felt like I had been gutted. I knew then what it was like to be stabbed repeatedly in the stomach. The next two days were like this while the awful people tried to find something for the pain, the only thing I could take was pethidine that I wasn't allergic too, but the hospital had a no peth policy. I vomitted from the new drugs they tried as I'm allergic to most all painkillers and I ripped a bit of my wound open.

I truly have never gone through a worse, more painful experience and 2 weeks later, that and some major life issues I had at the time made me have a total mental breakdown...still a few months there I don't remember at all. The mental breakdown actually ended up being a good thing as it got my out of an awful situation, but I know for sure I wouldn't have had it if it wasn't for that surgery.

That changed me, waking up in that much pain, it changed something inside that has never gone back the same again. I went through two long posterior natural births with no drugs, and that was a walk in the park compared to recovering from open surgery.

I'm actually terrified of needing a caeser this time around and I have vocalized already unless someone is going to DIE, I am not considering one for a second. I probably have an abnormal fear of C/s because of my experience...but I remember that and I think of going through all that with a baby to look after...how do women do it?

[Trish]

Deb, fantastic post. I need say no more. I agree completely with what you are saying.

I find it so sad that today people (women) can still be so ignorant to the dangers that they can bring onto their babies. And all of this elective surgery.

As you said, we can't choose to get our tonsils out yet we chose to get our babies taken out of our bodies.

Shannon, I too was refused to be aloud to birth Noah who was breech in my hospital. I wish that I was more informed and really stood up for myself more than I did. I did have a positive c section experience but I think that had a lot to do wiht what I had put in my birth plan. When the surgeon opened me up he said to me, "Oh Trish, you could have delivered this baby". Yeah, thanks, too late now.

I must say though he was a fantastic Dr. I was a mere public patient too

[Tobily]

When the surgeon opened me up he said to me, "Oh Trish, you could have delivered this baby". Yeah, thanks, too late now.

I got that comment too!! 10 weeks later I'm STILL stewing about it and I expect I will be for a long time to come.
When my son was in distress I was examined and it was determined that he had his deflexed his head (it was tilted back instead of forwards) while he was lying posterior. So basically his forehead was banging on my pubic bone with every contraction.
20 minutes later when they opened me up he had already moved. I'm really mad about it. I asked my OB for a copy of the report of my op and Toby's position was OP by the time he was taken out so I could have done it myself after all most likely. Talk about jumping the gun..... I'm absolutely spewing about it :mad:

[Debbie Lee]

However, we don't decide that our tonsils need to come out - we get a consult and then there are criteria that need to be met. Why is it different with major surgery to remove a baby?

Grrreat point there, Deb! My sister suffers from horrid tonsilitis that takes off the top lining of her tongue yet they won't take her tonsils out.

Yet... when I briefly questioned my GP about the chances of me having a VBAC, he was very quick to jump on the risks of vaginal birth... as if the risks of a caesar were lower? I haven't gone in-depth about it with him yet but what if I wasn't prepared to question it and just go blindly along?? Like I did last time.
My emergency caesar with Gab was necessary because she was being strangled by the cord (I know some babies are born with the cord around their neck but she was literally being strangled it was wrapped so tight)... but all the intervention leading up to it probably contributed to that happening. It makes me feel so ill knowing that I just nodded and agreed to what the doctors said because they know best. All because I had high BP that could have been helped with a few meds. Grrr, grr, grr!

It doesn't surprise me that women think that caesars are perfectly ok. After all, there's plenty of women out there (like myself) that have healthy babies and are perfectly fine after having the surgery. Well..... physically fine. I wouldn't say the experience left me emotionally fine at all.
It's medical dominance. Doctors have always been the head of the food chain. It'll take a lot to change that!

[BellyBelly]

Flea, its very, very common your story. Often women will be raced into surgery because 'the baby is too big for the pelvis' when the baby is simply posterior or malpresented, which will likely not happen again - but they left in the mindframe that their body cannot birth vaginally, ever.

Deb - exactly my point!!! Yes it will take alot to change it, but do you know what will make it happen? Women, jumping up and down and yelling and screaming that we are not going to take this $hit anymore! Women saying NO!, changing carers to get the birth they want etc. But the problem is getting people to do it - we are all very busy mothers, but to make change, we have to do something. Hence why I have been so vocal on BB. I have seen members slowly see whats REALLY going on. If I can help just one person, then they help one, and they help one... it's great. We'll get there, change is just slow.

Know that you deserve better women and demand it!!! Fight for it - birth can be the amazing and beautiful experience you want it to be, no matter if it's vaginal or c/s - it doesn't have to be traumatic, disempowering and depressing. Sure things don't always go to plan, but heck, if you feel supported and have a carer who gives you balanced info, and YOU INFORM YOURSELVES it it a much, much better experience - don't just take what you are given. I have been having huge chats to the woman who does the Pink Kit - thats why she is doing it! Couples NEED to educate themselves, properly, or they are at the mercy of the system.