Mothers Not Just 'Too Posh To Push'

Sarah Buckley: Mothers not just too posh to push

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* Cultural factors are behind the rise in caesarean births
* May 22, 2007
* The Australian

ARE Australian women becoming too posh to push? A West Australian study released last week shows an approximate doubling in caesarean rates between 1983 and 2003. Researchers have found higher caesarean rates among privately insured women, who are ironically at lowest risk of complications. Author Fiona Stanley suggests societal factors may be influencing women to ask their obstetricians for a caesarean delivery.

Does this mean women are driving our increasing caesarean rates - now among the highest in the Western world - or are other elements at work here?

Research from Australia and overseas does not support the "too posh to push" argument. Brisbane researchers surveyed 300 pregnant women, in both public and private care, and found that 93.5 per cent of women preferred a vaginal birth. Most of the women who preferred a caesarean had medical complications, or a previous caesarean or traumatic birth. Only one woman preferred a caesarean without a medical reason. Other studies suggest similarly small numbers.

If large numbers of women are not requesting caesareans, why are caesarean rates increasing so dramatically? To be blunt, our cultural over-confidence in medicine is largely to blame. Many in our culture, including many doctors, are convinced that surgical birth is at least as safe as normal, vaginal birth. This gives us a low threshold for caesareans, and few reasons for women and their carers to put in the effort required for normal birth.

Add in the extra convenience for obstetricians, who don't need to wait around for caesarean mothers at difficult times of the day and night and who are much less likely to be sued, and you have a recipe for full operating theatres and empty labour wards.

The problem is, caesarean delivery is not safer, and our high rates (especially among first-time mothers) may be setting a reproductive time bomb. A US study published in September 2006 found that low-risk babies born by caesarean to healthy mothers were almost three times more likely to die in the first year of life, compared to babies born vaginally. A French study, published at the same time, confirmed the risks to healthy caesarean mothers, who were three times more likely to die after a caesarean, compared with women giving birth vaginally.

These risks may be acceptable when mothers' or babies' lives are at stake. But increased risks of life-threatening complications continue for mother and baby in every subsequent pregnancy. These include placenta praevia, where the placenta overlaps the cervix, and placental abruption, where the placenta peels away prematurely. The risk of postpartum hysterectomy for catastrophic bleeding is also increased. Most of these risks accumulate with the number of caesareans. This makes the reported increase in caesarean rates among first-time mothers, most of whom will have at least one more surgical birth, particularly worrying.

It is also notable that caesareans do not offer long-term protection of the mother's pelvic floor. In contrast, vaginal birth gives babies a head start in life. The stress of being born activates the lungs in preparation for breathing, increases blood sugar for energy and stimulates virtually all body systems for the radical change in environment that birth brings.

Elective caesarean babies obviously miss this pre-birth preparation. They are consequently two to three times more likely to have breathing difficulties after birth, five to six times more likely to need artificial ventilation for severe breathing problems, and three to five times more likely to need intensive care after birth for any reason.

Caesarean mothers also miss out on natural hormonal help. In the final stages of labour, the mother experiences an immense release of oxytocin, the hormone of love, which physically helps her to give birth. Oxytocin also activates the mammalian "maternal circuit" in her brain, priming her for motherhood and reducing stress as she meets her baby. High levels of beta-endorphin - the body's natural opiate - activate pleasure and reward circuits in the new mother's brain.

When women miss these rewards and pleasures, it is not hard to guess that birth rates will drop. Research shows that women have fewer subsequent children after a caesarean birth, giving our high caesarean rates an added political dimension.

It is easy to blame women for our high caesarean rates, and the "too posh to push" label is unhelpful. What we need is a cultural respect for the ability of women's bodies in birth, and an understanding of the consequences of surgical birth.

Ninety-three per cent of us would also like some decent choices that will enhance our chances of normal birth, such as care from the normal-birth experts: midwives. And if you didn't know, pushing can be the best part.

Sarah Buckley, a mother of four and a Brisbane-based GP, is author of Gentle Birth, Gentle Mothering: The wisdom and science of gentle choices in pregnancy, birth and parenting (One Moon Press, 2005).

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Yay, I'm glad someone's said it! I've always known it wasn't women's "fault".

that's a really interesting article Kelly - it's amazing how the label seems to be put on the mothers for making the decision to have a c-section, but from what i've been reading in a lot of your articles lately, it really seems to be the medical "experts" pushing for the option that's easier for them! and the worst thing is that first time mothers are more susceptible to believe what they're being told is "best" for them, and it has long term impacts mother, baby and for future births! the articles have definitely been an eye-opener for me!

i'll be honest and say it scares the cr@p out of me to go through labour (SIL had three very traumatic births with 3 ending in emergency c-sections) - but the more i read on here, the more determined i am to make a decent go of a natural birth when the time finally comes - just have to keep convincing myself that fear isn't a reason to give up on nature taking it's course!!

Wow - what a fantastically written article!

mmm not sure how i feel about that article. At the bottom it says about women wanting more choice which everyone agrees with, but the first half of it seems very negative to people who have had c-sections. The bit about c-section women missing out on the rewards and pleasures of the hormones after giving birth vaginally kind of makes it sound like we don't instantly bond with our babies and that we haven't been 'primed for motherhood'.
I'm probably being too sensitive so no offence meant to anyone but i can't help but feel that it does look down on people who have had c/s. Just my thoughts.

Julie x

I don't think it is putting it in a negative light, just simply stating facts based on research.

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Caesarean mothers also miss out on natural hormonal help. In the final stages of labour, the mother experiences an immense release of oxytocin, the hormone of love, which physically helps her to give birth. Oxytocin also activates the mammalian "maternal circuit" in her brain, priming her for motherhood and reducing stress as she meets her baby. High levels of beta-endorphin - the body's natural opiate - activate pleasure and reward circuits in the new mother's brain.

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I think that even someone who has a c/s would still experience that rush of hormones once her baby is born, it is just a different trigger for them, kwim? you still get that overwhelming feeling of joy once you see your baby. Obviously that wont be the case for someone who has a GA though.

I just wanted to add - Sarah's specialty is hormones in labour - she is an expert and really into the hormones side, she has some articles on the main site about it... her pet topic :)

Sherie I didn't get that with the c/s the same as with the vaginal birth. With the c/s I was in shock physically and mentally unable to comprehend what was going on. I mean everyone around me was crying and so happy and I was just staring at everyone and shaking physically. I don't think I ever experienced that feeling I had with the vaginal birth. Of course leading up to the c/s was traumatic for me & my body did not cope with the anaesthetic in the spinal block so that was working against me.

What a brilliant article - but I reckon I'd venerate Sarah Buckley's shopping list, given half the chance ;)
Julie - being familiar with Sarah's work, I would say that she is writing to help alleviate those feelings of guilt that, often, other women put on women who have had C-S's. There are physiological scans and tests that measure hormone activity in the human body, and the parts of the brain that are active in that production, so that would be where she gets that information from. She is saying that the physical act of giving birth is a hardwired trigger for women to produce the hormones that are believed to be nature's way of helping us love our children - in an evolutionary sense, it means we are less likely to abandon our children. Oxytocin is also released during orgasm, so it really is the love drug! I know what you mean, though, and it's easy to see where you're coming from, but please don't feel guilty - the article is more for awareness than it would ever be for generating guilt!
ETA: oxytocin is also found during breastfeeding - another way nature helps keeps us chained...ahem, attached...to our children ;) In research studies, it has been found that mothers report higher levels of bonding whilst bfing than women who do not bf, but these studies also tend to find that the bonding feelings level out at about 12 months, so that whilst bfing HELPS, it is not the be all and end all of bonding mechanisms (I have one such study on my hard drive, if anyone really wants it!). Bfing has more benefits than just bonding, so those study results are not a good reason alone to bypass bfing, but for women who are in that minority who physiologically cannot breastfeed, they need not beat themselves up that they will never properly bond with their children - they'll just take a different journey :) However, I digress...but my point is that these bits of information are not researched in order to generate guilt.

I just think it's fantastic that someone is going out there and removing blame from women. This happens all the time when there is a C/S debate, many interviewed Obs/doctors will say, yes its women's choice, putting the blame on them. But I don't see that they are going to come out and say, 'Well yes I actually choose to do more c/s these days...' of course they have to justify their work (their $$) and also they may genuinely believe that the c/s they call are all required and essential no matter what their c/s rate. Stop blaming women and come clean I say!

Disclaimer: Not all Obs/doctors are like this but it does take more than one Ob to take the c/s rate to over double the WHO recommendations and going by studies, not many women are choosing elective c/s - proof in the pudding.

What about each to thier own and who cares. Each woman has a right to choose what they want done to their body. I personally think if someone wants to have a c/s then that's not my business! Whatever the reason, too posh, medical, etc, it's up to each individual. xo

Webmeg, if you have zero care factor, that's fine. But it's not as easy to just say 'each to their own', because for a lot of women, it's not even 'their own' - it's something that someone else is taking from them, by imposing their own agenda. That is what the article is about. Maybe you need to read it again? :dunno:

All of this hoo haa in the media isn't about forcing women to have vaginal birth that want a c/s. It is about giving more power and choice to the MANY of them who don't. As per that study and many others concur, over 90% wanted a vaginal birth - so thats representing a huge amount of women.

It's just that those who want one can see it as an attack on their choice, but they don't realise that SO many women out there do not set out to have a c/s so it is the choice of the majority which is being hindered. I am sure if it was the other way around there would be lots of jumping up and down for choice too.

I personally think alot of people don't understand until they are in the situation. I had to Fight very very hard for a vaginal birth after caesarean. I had to go against what was recommended to me by OB's at my hospital. That is not easy to do. Its like waging a war and you have to have so much support and people willing to help you when you are crying over the fact that people are telling you that your baby is at risk. My baby wasn't at risk because they could never give me a reason why or what the risk factors were that made it so bad.

It IS a fight for some who desperately want to give birth naturally and fact opposition. This has nothing to do with women having the right to choose a caesarean, but everything to do with women having the right NOT to have a caesarean.