90% Caesarean Rate in 2 Decades?
Push or pull
============
By Jane Martin
Sunday Telegraph
March 11, 2007 12:00
AUSTRALIA has one of the highest caesarean rates in the western world.
Are vaginal births truly risky or have we actually become too posh to push?
About 40 per cent of all births in Australia are caesareans and some medical experts believe they will soon become the norm.
David Ellwood, a professor of obstetrics and gynaecology at the Australian National University suggests 90 per cent of births in Australia will be via caesarean within the next two decades.
The World Health Organisation says a caesarean rate higher than 15 per cent is an indicator of "inappropriate usage". So why is Australia's caesarean rate rising?
"Caesareans are seen as the new improved childbirth; the nice, clean, managed way to have a baby," says Michelle Hamer, author of Delivery by Appointment, Caesarean Birth Today (New Holland).
Hamer says the popularity of caesareans is partly due to predictability.
Vaginal births are increasingly seen as risky rather than natural by expectant mums and their doctors.
"Our society doesn't tolerate risks or uncertainty any more," says Hamer.
"Women don't want to be in a situation where nobody can definitely say what will happen next.
"At a time when more obstetricians are being sued when labour goes wrong, I don't think any obstetrician has been sued for performing a caesarean.
It's seen as a 'safer' choice."
The caesarean candidates
Women in Australia most likely to have a caesarean are first-time mothers in their mid-30s with private health insurance.
Figures from an Australian Institute of Health and Welfare report say while caesarean rates are 15.9 per cent for mothers under 20, rates rise to 43.2 per cent for women over 40.
Increasing obesity rates may also be impacting on the caesarean rate as obese women are six times more likely to have a caesarean, according to US statistics.
In 90 to 95 per cent of cases, caesareans occur on the recommendation of a doctor or obstetrician says Hamer in her book. But some women choose a caesarean.
"Informed women are increasingly choosing pain relief and surgical delivery, which fits the pattern of their otherwise busy, productive and technology-based lives," says obstetrician and gynaecologist Dr David Molloy.
The too-posh-to-push phenomenon may be overplayed, but Hamer says some women she spoke to while researching her book didn't want to go through childbirth because they were concerned about the impact on their bodies.
"Some women are choosing caesareans because they don't want to have their vagina damaged and they don't want pelvic floor problems and incontinence," says Hamer.
"Some women don't want to grunt and sweat and think labour is too revolting."
The pros and cons
In some cases, a caesarean birth is a necessity. Caesareans save the lives of mothers or their unborn children every day.
However, some people can see it as an easier option. But is a caesarean as convenient as it is portrayed?
A caesarean birth involves major abdominal surgery and while the delivery of the baby may be quicker and less painful, caesarean mums can suffer longer after their baby is born.
"You are recovering from surgery at a time when you want to be at your very best tolook after your baby," says Hamer, who's had four caesareans.
"You have a child and you want to hold him, feed him and give him attention but your body is in shock and you have to care for yourself after surgery.
"You do recover but you also carry a scar in your uterus that can have implications for further pregnancies."
After a caesarean, women are at greater risk of bleeding, bladder injury, ongoing pelvic pain, wound infection and deep vein thrombosis.
Women who have a vaginal birth are at greater risk of incontinence, vaginal pain, prolapse and stretching of the vagina.
A 2003 study in the British medical journal, The Lancet, found caesareans increase the risk of unexplained stillbirth in a following pregnancy, and, says Hamer, only 20 per cent of women in Australia who have a caesarean go on to have a vaginal birth later.
There is also evidence that a caesarean affects the placenta's ability to provide optimum levels of oxygen and nutrients to a future baby.
The badge of honour
Some caesarean mums later regret they didn't experience childbirth. They wonder how it feels to have labour pains and to push their baby in to the world.
An article in the Australia & New Zealand Journal of Psychiatry, says the self-esteem of first-time mothers is highest for women who have vaginal births.
"Women who had caesarean deliveries were significantly more likely to experience a deterioration in mood and in self-esteem," says the report.
A fact sheet published by The International Caesarean Awareness Network states that a caesarean can lead to "psychological outcomes such as negative feelings, fear, guilt, anger, and post-partum depression".
"There is a badge of honour that if women put themselves through as much pain as possible during childbirth, they've done better than the girl in the next bed," says Hamer.
"If you do it without drugs or only use gas you're at the top of the scale. If you have a forceps-assisted epidural, well, never mind.
"After each caesarean I felt I had 20 demerit points. What kind of mother could I be? I had to get someone else to remove my baby for me.
"I think women who've had a caesarean are often treated as second best because they did it the 'easy way'."
McMothering
Hamer wonders if we are at risk of creating a childbirth culture where women no longer try and give birth naturally but who automatically join a conveyor-belt system that ends with the surgical delivery of their baby.
While caesareans have their place in childbirth, Hamer believes women should become more educated so they can make informed choices if they are faced with a decision on how to deliver their unborn baby.
Then they can have no regrets or questions later about how their baby was delivered and their childbirth experience.
"Drive in to any takeaway hamburger chain worldwide and you know what you'll get; it's predictable. Go to an independent burger store down the street and you don't know what the burgers are like," says Hamer.
"McMothering offers a streamlined, fast, efficient birth system. You have a drive-through birth and you won't end up with beetroot when you hate beetroot. But sometimes, I think something meaningful gets lost along the way.
"I think it needs to be recognised that you don't have it easy whichever way you choose to have your baby. Both types of birth - vaginal or caesarean - take a toll on a woman's body.
"At the end of the day we have to look at the beautiful baby we got and remember that's what matters - no matter how that baby gets here."
