Why all the opinions on c-sections?

[Julie Doula]

Most people would agree that a c/section for a genuine emergency or complication is a positive. For some women, even though they know the c/s was necessary, they may still have a sense of grief or disappointment, especially if they were really hoping for a vaginal birth. Even when a c/s is genuinely life-saving, along with the sense of relief that you and the baby are safe, may well be other feelings if the way events unfolded were scary or traumatic.

The conflict comes when there is a growing number of women who look back and feel that the c/s was not necessary, or that they were pressured or even tricked into, or that they missed out on information and support or simply *time* that could have helped them avoid major surgery.

In Brazil, the c/s rate is 80%. That is a cultural issue - not a medical or scientific issue. When a c/s is based on evidence-based care, it is possible to find resolution, to feel it was a "no regrets" c/s - that you did all you could, but in the end it was needful. But to feel that you had an unnecessary c/s because your maternity care was NOT based on scientific best practice, is why many women regard c/s in a negative light.

I would not mind a life-saving c/s, yes I'd be disapppointed but I'd also be relieved and grateful. I would mind it if I knew i had been bullied or coerced into it by a system that holds my instrinsic ability to give birth in doubt or contempt.

There is a schism in Australian birth services. The philosophies and techniques of two models of care - the obstetric model, and the midwifery model - are quite different. When women have naively assumed they are the same or similar, and go into an obstetric system expecting that they will be supported to give birth, many end up feeling either that the system failed them, or that they failed (even sadder). Many then come out of thinking 'well I'm sure going to choose a different model of care NEXT time' and go onto to have a better birth experience that suits their unique needs better.

The difficulty arises when women do not realise the huge difference in the two models, and go into birth either not realising the difference, or not aware that midwifery model options are available to them, or that they are both safe and effective. It is a set-up for birth trauma - when women expect midwifery model care from an obstetric system. It is only well into the cascade of interventions that they start to realise that they'd basically been 'had'. This is where much distress and disatisfaction with high rates of intervention (including c/s) and birth trauma comes from.

I agree totally with informed choice, and would only say, it is fine to choose elective c/s for various personal reasons, and it is fine to choose the obstetric model of birth for various reasons, or to desire a setting that has access to specific interventions such as induction, epidural, etc. These is a place for the appropriate use of these interventions and for this model of care. However, on the basis of the saying, "if I don't know what my choices are, I don't have any", if alternative approaches to birth such as the midwifery model are not equally supported, and made equally available to women, and equally encouraged, then the 'menu' for birth choices is narrowed, and that is not 'free choice'.

I would encourage any first time mother to know that the modern medical model for birth is not the only way or the even best way, and to pursue knowledge of both approaches, and most of all, to be pro-active in choosing the kind of care you think would best suit you. This will not prevent a low percentage of life-saving interventions & c/s, but you may well be able to avoid being carried along by a domino effect of one intervention leading to another that results in an unwanted or avoidable instrumental or surgical birth.

Maternity services in our country ideally should be presenting a truthful picture to our birthing populations, that includes a realistic picture on pros, cons and alternatives, but given that this is rarely the case, it is we women who have to be a bit skeptical, questioning, assertive, and pro-active in getting the birth care we each want.

The article 'Fish Can't See Water' by Marsden Wagner of the WHO is a good place to start researching this.

My heart goes out to every woman who has ever been let down by the limitations of our current system and suffered as a result. By telling your stories, you are being so very brave and also contributing to our collective wisdom, that will help other young women know their rights and choices - I applaud you.