Article: Risks Fail to Deter Caesarean Births

Mark Metherell
December 19, 2006

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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.

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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.

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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.

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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 :(

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

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...

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.

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!

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.

Here's the transcript from Today Tonight:

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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."

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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. :hug:

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.

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

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

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?

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 :)

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

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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:

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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?

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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!

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.

You would have to have 10 babies to have an 'ideal' birth, so please don't get hung up on that hon. An ideal birth is where you feel supported, your birth preferences are taken seriously and your feelings are considered at all times.

Flea,
As Kelly says your story is so very common. I am always saddened and angered to hear stories like yours. I am sorry that your birth didn't turn out how you planned. However, these stories are what provide the motivation to make things better.

You followed the guidance of your doctor. However, again with position changes, loving support and time your baby likely would have (and did it would seem) change position.
This is the difference between obstetric care and midwifery/woman centred care. The most essential organ for giving birth is your head it has been said. This is true but it could also be said that it is TIME and SUPPORT. Obs (love em) are action men. They are doers, fixers. Most often birth doesn't need to be fixed. Midwives and women operate on an intrinsincly different level. We use intuition and feeling and touch along with our knowledge.
Your baby and his birth have taught you some things that will change your next experience. That is so wonderful Flea - look to the positives that have come from that and the knowledge that you have gained... :hug:

DISCLAIMER: Please know that I am not saying that there are no doctors that have the above qualities. As I have said I have seen quite a few display these very same attributes.

Women are also responsible for the high rate of caesarian as I mentioned in my last post. Women have given over their birthing power. In our Grandmothers time or Greatgrandmothers time birth was a community event. Women supported one another. Neighbour women helped with the woman down the road. Someone boiled the pot, kept a meal warm, watched the younger children and supported and nurtured the mama to birth. Herbs were given, time was given and much love and support.

Yes, women died in birth and how fortunate we are to have the medical services available to us now. Howver we have taken a complete about face. Birthing Mamas are now patients in a system. WE are told what we need and why and that if we dont' do it that our babies will die. We need to be responsible for our own care. We need to inform ourselves. It's not difficult to access information in this age and we owe it to ourselves, our children and our future children. One of the most proactive ways of doing this is to insist on midwifery care. Midwives will give you time, support and an every increasing bank of education from which to draw on. They will refer you on when you have a medical condition but until you do you are not a patient but a birthing Mama.

I laboured with my first child for a very long 33 hours. I was planning a homebirth and I had the tub set up and home. My labour started with a bang and contractions remained at 2-3 intervals for the first 24 hours. I transferred to hospital. I just KNEW something wasn't right. I felt that the position was wrong. The midwives at the hospy were wonderful and confirmed that she was posterior and she was in a similar position to your baby Flea. The doctor (quite a prominent fellow now and I tell you he was an &^*(*&^*&) came to tell me I required a c/s. I asked why and he told me it was rediculous to labour for this long. I was "stupid little girl" for attempting a homebirth and this baby needed to come out. My CTG was fine, there were no indicators of fetal distress. I felt that my baby was doing just fine and that her and I together would birth. I said I was fine but I needed some pain relief just so I could deliver vaginally. He left on his heel. Now, Ruby was a brow presentation and I pushed for a long time. But, I chose to birth her the way I did. I chose to birth vaginally - I knew I could. I have never known such elation as I did when she came out.
Had I been a different woman without the knowledge I had and the trust I had in my body and my instincts I would have had a c/s and faced the very difficult road of VBAC for my next birth. I had a 2nd degree tear that I chose not to suture. My perineum healed within 10 days with absolutely no problem (I used a nice litle recipe I have of herbs I would be happy to pass on! :wink:) It took incredible strength to do what I did and I feel very proud of that. The midwives (there were 4 in the room at the end - teaching hospital brow presentation - big news) were as triumphant as myself. However, they really went into bat for me. They stood by me and guided me. The doctor (oh how I would LOVE to say his name) poked his head in the room and told me he was washing my hands of the situation.

The system is not geared that way - though it is slowly changing. It is hard for some midwives to be strong woman advocates. It is hard to challenge and to rock the boat. This is why having a Doula, a Midwife or a woman that is an advocate of woman's choice and experienced with the birth process at your birth. She can be your voice if you can't find it. For me if my child was at risk I would have made different decisions but she wasn't and so I sat with what I knew.

I think that having your partner at the birth is wonderful and I believe it's important. However he loves yhou and is not detatched. My husband trusted my instincts with Ruby's birth but I could see his fear as well. Having another woman there that is your support and his too is INVALUABLE.

This is how we have to see the system change. WE need to change it. We need to empower ourselves with knowledge and seek out a carer that will be comfortable with that. I birthed my last baby in a private hopsital. It was such a weird thing for me to have an obs. I had my own midwife but my choice of obs was settled only when he would agree to not enter the birthing room unless there was a medical indication. He agreed to this and sat outside the room eating donuts, reading the paper and chatting to our kids as they came and went. My midwife left briefly now and then to let him know how I was doing - but of course he could *hear* how I was doing. It's amazing how much you can know about labour just by using your ears... He honoured my choice. Partly because he knew of me and he also knew that I was educated. He had faith in the midwife and in me and he was at hand if needed.
After Eva was born and I was dressed and in bed he knocked on the door to give me a hug and to congratulate me. Now we need more of this. Obs that don't need to "deliver" babies. We need obs that will honour choice and listen to what women want.
Women don't know that they *can* ask for this.

Why is it that women think they can ask for a c/section but they can't ask for a natural birth in a tub with their midwife?

Anyway you'll all be a bit weary with me. You can probably tell that it might be just one of my little passions!!!

We can all ask for this. We can seek out a doctor who will listen. They ARE out there. Slowly the doctors that don't want to play the womans game will either wake up, have a tanty or leave (my bet is on tanty first!)

I am NOT a doctor basher - some of my best friends are doctors. I just don't believe that birth is doctors business.

Due to my history I do require an obstetrician and close monitoring for future pregnancy's. One of the reasons I decided upon the obs I now have is that she is a woman and I know my history is gonna make any obs unlikely not to want to be in the room. But also she is the kind of doctor who is happy to sit on a stool in the corner and take notes. She is not the PUSH PANT THATTA GIRL! type...

We can all ask for this. It is our right! :hug:

woops I noticed that some of my post is missing - I must have talked too much!!!! I can't remember what else I said...

Shannon,
I missed your post. Mylast one took a while inbetween chopping apples and wiping a bottom! (I washed my hands in between!)

I can't say it any better than Kelly. An ideal birth is where you are supported, honoured and nurtured in a safe environment.

If you need some help to facilitate that than you can contact me my love...

Deb - I'm gonna print out your posts and use them as motivation. I wasn't sure how hard I wanted to push for a VBAC (or if it's what I wanted... just didn't feel all that passionate about it) but now I wanna go in there guns-a-blazin' and get the damn birth I bloody well want!! LOL
Thankyou.

Then choose your carers wisely. Make sure your Ob will be respectful and you feel happy with him, then there are Private Midwives, Doulas or Birth Attendants who help with all of this. Meet a few and ask what they can do for you. Grab a copy of the Pink Kit. Preparing yourself so you can be informed, nurtured and in power is something you can do for yourself, you just have to actively seek it.

I dunno about you, Shan, but I find a lot of male doctors are over-confident and ****y (and I'm sure some female doctors are like that too... I've certainly met some doozies - the reason why I choose to have a male doctor because the female ones I have dealt with have been aweful). They're really good at appearing "superior" and they kind of get off on making the "patient" feel like their word is gospel. They're the guys with all the initials after their names. They are the ones that constantly have the red carpet rolled out for them. It's hard to argue with someone that believes they are right no matter what.

The main complaints I hear about female Obs is that they are 'cold' and some women have even reported them as being firm or rough with them. Yep the guys the ****y thing :) Not labeling though, this is just what I hear :)

Shannon,
Something that may help aside from the other great advice from the others in here.
Make a wish list of what you want your birth experience to be. I don't know anything of your previous births. Have you had a previous c/section?

I *think* you said you were going public at Cabooluture Hosp is that right?
Caboolture have a midwifery led programme that I have heard some good things about. I know we have *talked* about this at some stage so sorry if I am repeating myself. This will help you on your way to getting what you want. :hug:

I was very lucky to have my midwife mainly dealing with the resident and other dr's for me. She helped to push what we wanted, but she also told me to ask all the q's i needed to.
I guess cause I'm an engineer and pretty used to having to force my way with older men in the workplace for project work, I dont have an issue with drs. Lucky I spose.
But if you have a kickass midwife that knows how to play the system it helps :D.
I would have to say I actually got the ideal birth this time, I'm very lucky, I guess it made up for the horror of Jenna.

Theresa - I hear you sister!
I know how very difficult it is to get a vbac in SEQ - so in the far more conservative (I am assuming Rocky area - I lived in the Rocky area and worked there abaout 15 years ago now!) it would be even more difficult.

Your experience with your first birth sounds scary. You are so right what mother would argue? However, as you have found we need to seek out more answers by asking more questions. We then need to get second opinions etc All really difficult stuff when we are in the awkward physical postiion of late pregnancy AND the vulnerable emotional position of pregnancy. This is again why we need to find a care provider who has ideals and values congruent with our own - preferrably a midwife/doula who can help you when things don't go quite according to plan...

Education is empowering!!!!

I think it's important to mention too that we shouldn't get into a state of not being able to trust Obs, while many of them make me feel cross too (I have been accused by a BB member of Ob bashing even, when it wasn't my intent at all!), we also need to be able to rely on them in time of real need.

I am not saying you were saying this Theresa, I agree with all you've said - it's just something I wanted to point out. We need to be wary of what is going on, know we can get a second opinion or say no, and realise that we are the magic answer in all of this.

We can become more educated, informed etc which no-one else can do for us - the Obs wont change in a hurry - but with our own education, we can make the choices and decisions which are going to be better for US :) Ideally women will get their faith and confidence back into their own bodies that they feel comfortable enough to see a midwife during pregnancy for their care, given its a healthy, normal pregnancy, because they completely kick butt. They spend lots of time with you, they come to your home, do all the checks the Obs do at visits, let the siblings help and have that awesome womanly touch. Brings back what we used to have, trusted 'wise women' who you share a life journey with - you get attached to your midwives and fall in love with them!

Long way to go yet - midwifery led care in NZ has had it's problems and caesars are back to 30% - further proof that we can't rely on any person but ourselves to make birth better - we can have great carers, but it takes more... us learning! And how do we find out that we need more education than what we have? We just don't until we've been through birth, but it's through word of mouth, forums like this we can make the biggest difference.

Oh yeah I know him. He has an *interesting* bedside manner. He is actually a very good high risk obs. I have admired him for some things. I am not surprised he is wanting to retire - he has held down the fort for a long time.

As Kelly says obs most certainly have their place. There are many babies and Mamas that wouldn't be here without them. We just need to keep 'em for when we need 'em!

He did my first pap smear!!!

quote: episiotomy - minor surgery to the vagina. unquote

humm i hardly call it minor surgery it the womens most sensitive part and having it sliced open is not minor in my eyes.

That is one of the reasons i would choose a c-section over a viginal delivery any day, and the fact that there are to many traniees who dont know what they are doing!! I would rather be in the care of a doctor doing abdominal surgery an an elected time than a women midwife who just wants to go back to bed and couldnt care less. There are few good midwifes and i dont want to take my chances

Why people are so worried about the increase i dont know? I think its a great thing for those who want it

Women can choose to say no to an episiotomy - so there's an answer to your quote. Not many woman will really require an episiotomy and most midwives in private practice have done none or even only one episiotomy. Obs do the episiotomies a majority of the time - so don't choose one as your lead carer! Easy fixed. And just to clarify, in an episiotomy, did you know that its not the actual vaginal canal that gets cut, It's actually the perineum, the skin between the vagina and anus. Yes a delicate area but I wouldnt say the woman's MOST sensitive area. Not that I am advocating episiotomies I think they are very much over performed and thats all to do with finding out about your carer and his/her beliefs.

We are all entitled to our own opinions, but you still get surgeons new to the job as you do midwives. Its pot luck in hospitals, you can't choose your midwife but you can choose your Ob. In a caesar, your organs can be accidentally cut (hmmm major organs vs episiotomy cut?), as can your baby's (hmmm #2 baby being cut vs episiotomy), you can still have major complications. To think that a caesar will prevent any complications in not a very informed comment, and to compare it to an episiotomy?!

It's all about choosing a carer who you supports you and your choices, does not have high intervention levels and believes in the woman's ability to give birth. Given that so many women are fearful of birth and thinking a caesar will fix that, just goes to reflect the kind of care we are getting. One day of labour or six week recovery period... let alone everything else... hmmmm not a tough choice for me. Choosing a private, personally hired midwife is even better.

I've had a c-section and an epi and trust me when I say that in comparison to the c-section the epi was minor surgery.

Yes, healing from an episiotomy I have heard is tortuous. The perineum (the space between your vagina and your anus) is opened with "sissors" usually to have the baby born more quickly and most often to facilitate a forceps delivery or a manipulation of the babies position.

Episiotomy is most often done to facilitate an instrumental birth (one where forceps are used primarily). In the bad old days all women were given an episiotomy.

It has been shown that women that tear in childbirth have a quicker and more successful rate of recovery than women who have an episiotomy. For this reason many of the front runners in obstetrics avoid episiotomy now days - except in an instrument birth.

Midwives don't generally speaking facilitate forcep births so the man or woman on the end of the episiotomy sissors is most certainly a doctor!

Midwives getting back to bed. I can ASSURE you if you need support and someone to sit by you as you labour through the night it won't be the $2000 + obstetrician. It will be a midwife! Generally speaking (and of course it's not always true) but generally so. Midwives are very dedicated supporters of the natural birthing process who will work a double shift just to see that little head poke out and a slimy baby held in her Mamas arms...

You are right. If you want a c/s and you are fully informed of the risks and consequences involved and you have a doctor who is happy with the decision than it is your decision.

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humm i hardly call it minor surgery it the womens most sensitive part and having it sliced open is not minor in my eyes.

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Hmm... I'd prefer an episiotomy (or tearing better still) to major abdominal surgery that cuts through layers of muscle. Comparatively is IS minor compared to a caesar which deals with your internal organs. There's also risk of the baby being cut during a caesar. Doubt that risk exists with an episiotomy???
Of course having the area around your hoo-haa cut or torn is scary (and I imagine quite painful) but I'd say having your guts ripped open is just as scary! LOL

I actually haven't met anyone who wants a natural birth to sit under a tree, with no intervention and pixies singing Koombayah but I wish I had pixies with me LOL probably would have made it fun!!! I've had both though, a horrible first birth with intervention and a drug-free second one. The difference in recovery is massive.

Natural birth is soooo not hippy these days - I had an *accidental* awesome birth because I happened to stay at home and rock up into hospital at 9cm. I had no choice but to have no drugs, and I am bloody glad I did, because I got the biggest high I could have ever imagined. Hence the passion for what I do. Women just need a bit more support, and when they realise what they are capable of (if they have made the decision to want a vaginal birth and without drugs, as the majority do prior to labour) then more women will be able to experience this. It's a great feeling, and it's not what EVERYONE wants, but everyone who comes to me for birth support, wants no drugs and as natural as possible - and they are far from alternative people. Some with lots of money, expensive houses and cars, right down to those who live a humble existence. None wanted homebirths, but quite a few now want one after having an awesome experience and have the confidence to do that. Hard to imagine for many of you, but this is what comes with good support and a great experience - confidence. I think these days women have more access to information, specifically through the internet. They want to know more, they want to be informed and learn of the risks. More women are not wanting to take those risks.

As for this new Rainbows_ member, I think she is a bit of a $hitstirrer going by past posts only in the labour/birth forum.

I used to think that the concept of natural birth was airy-fairy. I was more than happy to take the drugs (I asked for an epidural and was given an early one because of my high BP).
Now that I've experienced all the intervention and suffered the consequences of that intervention, I've done an about-face. I'm not unrealistic and not ruling anything out but I'd really love to give natural birth a go. Having another caesar just seems too risky on so many levels for me (and I've barely scratched the surface with information).

Brooke - everyone respects your choice (I know I certainly do! - after all, my main reason for possibly wanting another caesar is not based on a medical problem but a fear of history repeating itself) but this thread is more about how some women still believe that caesars are the safer option iykwim? It's not an attack on those that do choose to have a caesar in spite of the risks (you said yourself that you do it knowing the risks... and it's great that you don't have blinders on so that you can have an empowered birth experience).

Brooke, darling! You chose your c/s and thats great! There is nothing against that. And I can tell you right now if I had to choose between having a c/s and not having a baby I would definitely choose a c/s. I have a gf who I know if she ever got pg would no way have a vag birth, and thats her choice and I will support her 100%, so when the time comes I will help her to have the most beautiful C/S she can have totally empowered! BUT I am still up there with the tree hugging pixie singing pro vag birthers :)

Its very different to CHOOSE a c/s and have one thrusted upon you especially when you later find out it was unnecessary. You wouldn't be happy if you went in for a boob job and came out with a penis unless you REALLY needed a penis, or REALLY wanted a penis. But if you came out with a penis because the Dr thought it would suit you or because he had more penis' than boobs thats not ok. BUT there are also very necessary emergency c/s' too. I can't stand bullying, and some Dr's do it for their benefit, I was bullied by an ob to have a c/s I said no way and changed obs. And the amount of women I know who have suffered trauma associated with the c/s (but not really the c/s but the power struggle itself that stems from the c/s) is sooo sad. The reason these risks are good to know is not so it makes people who choose a c/s feel bad its so that women question their medical carers so that they know they are getting the care that suits them.

I hope I'm making sense... You have your C/S its an empowered choice and you are going to make it the best damn C/S there is I bet and damnit woman sing to the pixies... they love it LOL! But please don't think anyone on here especially Kelly (who would have gladly held my hand in theatre had I chose a C/S) is attacking you for your choices coz thats not so... and if anyone does I'll be the first to tell em off LOL!

well after reading all the great stuff on natural births it still does not convince me to go through hours of labour and push out a baby through my tight canal (vigina). natural births are only great for those who want them, my c-section was painless, effortless and qucik, i was walking around the next day and the scar is barely visable.

i will choose a c-section next time if i have more kids as i still cant imagine pushing a baby out in all that pain its to scary!!!! I dont think thats vanity i think it just being able to enjoy your baby as soon as its born rather than waiting to push out a placenta and then getting stiched up being tired etc etc.

Once my baby was born by a c-section i was so happy it was over in seconds. I have read about so many still births, and viginal births going wrong and lots of complications, even though im not againt these viginal births i would never choose one everyone i know who has had one has complained about a baggy vigina, depression and the remeberance of the trauma they went through.

My friend just had her fourth baby and she beged the doctors for a c-section but was not allowed. This is not true for everyone and im sure some people want to do it.

What i dont understand is why some women are sooooo anti c-section if i did not have one my baby could of been a viginal stillbirth!! Im thankful for c-sections.