80% caesarian rate?

At my conference this weekend, a midwife, doula and doctor (the same person!) said that in QLD, there is an average 80% caesar rate at the moment. I didn't hear if she said at some hospitals or statewide, but what the heck is going on?! This is crazy... and apparently Thailand has the same rate. It's really scary as to what this is coming to, and we all know that a majority of women having a caesar will opt or be recommended to have a repeat caesar... sometimes I just feel like we're never going to win the race. But I will keep working at it, none the less...

WOW Kelly, that's amazing.

I'm planning for an epidural assisted vaginal birth but woke up last night after a nightmare where I had to have a C/S now because I was sick with something or another.

Wow Kelly....you've got to wonder how much insurance and public liability has to do with these figures. More and more it sounds like hospitals will do a C/S the moment there is any risk at all. I mean, nobody wants to lose a mother or the child in birth; but you have to wonder how much of it is motivated by the hospital not wanting to be sued for allowing a birth to continue naturally if there is any hint of distress in the baby or mother?

Thats an amazing statistic, I know that there is one hospital in the city that has a really high c/s rate, I think its the highest in Australia, something like 70%, but I didn't know it would be that high!! Of my 10 friends who have given birth in the last 5 years, there are 2 c/s, me and one with a breech baby. So I didn't imagine it was that high.

Gosh that is a HUGE figure... and really quite worrying...
It makes me quite afrustrated as well... why do all these OB's need to go out of their way to recommend c/s, or intervene too soon with c/s... its becoming such a trend these days, and turns me off the idea of ever having a private OB with my pregnancy. Some women would be in the position of only knowing what they are told, and if all their info is coming from their OB, then I wonder how many of them are receiving information and advice that discusses ALL options regarding their birth choices.......? :-k
Surely it can't just be a liablilty issue... can it???

Jeez - thats terrible.
Ambah - I dont think a private OB would make much difference unfortunately. People through the public system still have plenty of c/s happening too. I thought the average rate at our hospital (public) was 25%.
Out of our ANC I think there were 3 c/s and 6 vaginal, and in my MG there were 3 c/s and 4 vaginal.

Fi

You're probably right there Fi... I was just basing my opinion on general observations of people that I know... However I would be curious to know if there is actually any difference in c/s rate between private and public patients?
I'm also curious to know what the c/s rate in other hospital or even states of Australia are... surely not nearly as high as this Qld figure? Hopefully?

Some hospitals here in VIC have 60% rates... it's getting higher but generally public is lower.

Ambah, there are many reasons this is happening. More and more, it's not just becoming a social thing for Obs, but for women too. This thing is, women know they have ready access to this stuff and think it wont make a difference if they have a caeser for social reasons - but I wish they would look into it more. It's their choice ultimately, but there's lots more to it.

Also, the birthing world is not only full of fear from women, but Obs fear litigation and of course there is misdiagnosis too. I think if women educate themselves as best possible, with the right information, this is the only way they can really stand a chance at reducing these rates. For example the small pelvis thing (CPD) - yes it does happen, but it is very rare. Women need to know what positions they can try should their Ob mention this in labour and if they have no prior issues with their pelvis. Or alternately hire someone like an Ob / midwife / birth attendant who does know what can be done before going to a caesar as first option.

Caesars are great when used appropriately - for example you wont birth a transverse baby - but the World Health Organisation says that with all factors considered, caesar rates should be a generous 10-15%. I doubt that at 80%, it's being used appropriately.

I'm not saying anyone should or shouldn't birth a certain way, but the figures and statistics I heard at this conference was very disturbing, and some even came from an Ob too... I think it's so important to give a baby the best start as possible, if a caeser is required then use it. But if not...

In my mother's group - out of 5 of us to have our bubs at the same hospital within 1 month of each other, 4 of us had c-sections. Spot on 80% - Crazy huh? One was for breech, and the other 3 of us were good ol' "failure to progress" or cephalo-pelvic disproportion (like me).

Even with my CPD though (my pelvis is actually an odd shape - not so much that it is too small) my doc said he'd support me to try for a VBAC. It's unlikely I can do it naturally (the odds are against me) but he said if all the conditions happen to be right (i.e. smaller baby in just the right position) I might have a chance.

I am still deciding what to do there. It'd be much easier to go for an elective, but I'd really like to try. Only thing is, I think I'd be just as depressed if I tried and failed again, as if I just went elective - only I'd be that much more exhausted and recovery would be harder. Tough choice.

Juliette, have you seen The Pink Kit? It's fantastic for really getting to know your pelvis (and everything else reproductive) for birthing - it helps you map out your pelvis and you can see for yourself how big your pelvic outlets are etc. They had a demonstration at the conference I went to, I think it's brilliant and I will recommend it to everyone now! It helps you get to know everything, even your coccyx, which comes in different shapes and how to manage these different shapes / sizes of pelvis. This might help perhaps?

I believe every woman has the right to the birthing experience they want, of course not all women get that due to complications etc. But, if a woman wants a caesar as a birth experience, be it for whatever reason, then I fully support it. It's her choice (if it's elective) to deal with the pain, and I don't think it harms the baby at all, so I choose not to sweat on what other ppl choose to do

And this is why I am so passionate about birth froofy because there is more to it than that, which women do not know about otherwise. My training over the last nine months and all that I have read prior to this shows me that there is more to consider than that. So many chains of events occur as a result of a baby's birth experience, so many longer term effects for which there is actual study that has been funded and published but ignored - and these people won't get funding a second time around to get it out there. I'm planning on publishing some of it if I can.

I have no problem with women making an informed decision about their birth. But I doubt that 80% of women are choosing an elective caesar. And I doubt women are empowered with the right information before making a decision about the birth that they want. I know I wasn't - I didnt know where to go, what to read and my confidence was very low. I didn't want to question anything the 'expert' would tell me and thought they would do what was in my best interest. But the best thing that I have now, is the power of all this information, as my confidence to birth is very high and I would be very comfortable having a homebirth with my next bub - because I believe my body can do it and with the right support, I can deal with the pain no worries.

Fear of labour and low confidence in birthing women is a terrible epidemic, if I can help women access empowering, factual information that will increase their confidence and reduce their fear, then I would have achieved one of my goals. I don't intend on forcing women to birth a certain way, but offering the right information to those who want / need it.

Wow 80% seems so high....What I don't understand is why anyone would choose c/s as a way to avoid labour pain - I mean there are plenty of pain relief options for a vaginal birth, and a caesarian is major surgery, they cut through your abdomen for pete's sake. How is that any better than giving birth vaginally? It doesn't sound easy or pain free to me. Not to mention a longer recovery and higher complication rate.

Sorry I don't mean to offend anyone by saying this and I am not saying that everyone who has a c/s has done so lightly, but it seems to me that women in general are losing confidence in their ability to birth, it is like there is a culture of fear surrounding labour which is only being encouraged by certain OBs. It is normal to be afraid of labour pain and giving birth but when we voice these concerns to our doctor we should be given support, reassurance and information so we can make informed decisions and not just be encouraged to have a c/s.

Bon

Just to clarify something here, we aren't specifically talking mostly about elective c/s here. But moreso c/s that are performed by an ob who has assured his patient its the "safest" thing to do when really its not necessary. For example I had an emergency c/s with Paris, since finding a great ob, and some great support with my 2nd pregnancy it has come to my attention that my c/s wasn't as "necessary" as the hospital staff had made out to me during my labour. There are many reasons women are told they may need a c/s, for instance the "big baby" syndrome is the most common, and I was also told this by another gyno before finding my current ob that I would "NEED" another c/s, which is also untrue. It doesn't matter what type of birth you have, providing its informed and empowered.

Froofy, whilst I agree that a c/s doesn't always harm the baby it can definitely have emotional repercussions for the mother. Which isn't nice let me assure you. So IMPO I would rather help other women make an informed decision so that she feels more "empowered" after birth than she does traumatised. And no, not all c/s patients feel this way but it is very very common.

Just my thoughts.

*hugs*
Cailin

Exactly Cailin... and that's not even mentioning the effects on the baby, from early bonding through normal hormonal processes and recovery. There is the shock of a sudden birth, usually no skin to skin contact, baby is taken away while mother recovers and the crying as a result in the newborn brain produces corsitol which is a stress hormone. Sometimes it appears that this crying ends up with the baby falling to sleep and all is okay, but it's often the baby shutting down, due to the flood of corsitol in the brain. I have seen many waterbirths for example where baby doesn't cry, is relaxed, palms are not clenched - it's a complete different entry to the world. Of course, this is worth the trade off if it means saving the mother's or baby's life...

But at the end of the day, if no-one stands up and questions or says that these figures are outrageous, then who will? And what will happen to birthing?

Thanks for the pink kit tip Kelly - I'll look into it - it sounds really interesting. I have been trying to find out exactly what went wrong with Hannah's birth, but I keep getting very vague answers.

How does the kit work? How is it possible to map your pelvis etc.??? I am intrigued...

I would never ever choose c/s mainly because I think recovery is much quicker from vaginal, but many other reasons too. However, my midwife thinks baby is breech, so if she is Ihave absolutely no choice but to have a c/s. That is prob why the rate is so high. No one wants to be sued, so the Dr's are not doing anything slightly risky. The whole thing is a joke.

With regard to the difference in cesarian rates b/w public and private hospitals, the PUBLIC hospital I went to told us they have a 30% c-section rate... much better than 80%!!!

I'm reading a great book at the moment, Henci Goer's 'The Thinking Woman's Guide to A Better Birth' - great book recommended for all who are thinking of becoming pregnant or who are, very empowering and based on FACTS ... she said that in some models of midwifery care, the caeser rate was 4% - how's that for some stats?! There is plenty of evidence which indicates that at least half the caesar rates were not necessary in the Obstetric Model of Care. But see, if we don't have complications, then Obs don't have jobs... as Henci Goer says, childbirth is a natural process just like digestion! But it's just not looked at it that way in the usual Obstetric Model.

Her book also deals with breech bubs Meg, might be worth a read for you.

Re: the Pink Kit, it's a video / DVD and shows you how you can see for yourself where your pelvic bones / outlet is. It tells you where to feel for the bones so you can see/feel for yourself how wide your pelvic outlet is :) It also covers everything else about a woman's body, I think it's brilliant and more women would benefit greatly getting to know their bodies this well. Hopefully one day we can all overcome the embarassment - it's easy for guys - they can stand naked in front of a mirror and there is all their reproductive kit in front of them! But most of ours is internal so it takes more effort to get to know all about it ;)

Hi - not just in this topic, but all, you can make stats say almost whatever you want. 4% of what and over what time and where ?

Also wondering about the 'emotional repercussions' for the mother of a CS baby mentioned back there ?

The emergency CS I had last time was hideous, the whole gel, induction not working business only tobe told afterward that Cait was not engaged, and I should not have been induced - and this time I'm not prepared to even think about the possibility of going through it again. I'm also not interested in the possibiluty of labouring for days only to end up in the same place. I'm informed and empowered and am booked in for an elective CS.

Barb.

Barb.

Good on you Barb, all the best for your caesar - that's what you want so that's all that matters.

May I ask why were you induced in the first place? This is one of the many disadvantages of induction, failed induction, which then leads to even more intervention. That's not to say it will happen a second time, but hey we all do what we need to do. If you weren't induced and Cait was left in her own time, you probably wouldn't have had the caesar do you think?

Midwives have very good stats and that is well documented around the world - they are in the business of leaving things be and birthing is a normal event. Homebirth is still very common in parts around the world (e.g. New Zealand) and they wouldn't be doing it if it weren't safe in this modern day. Obs are trained to find problems and 'fix' things and 'save' the baby from our bodies, because apparently our unreliable bodies aren't capable of doing things as they should.

As I mentioned before, the World Health Organisation has stated in it's reports, that with all things considered, a caesar rate of 10-15% is generous. So I don't see it that difficult for midwives to reach 4%. I also hear about many midwives who have worked for many, many years and not even had to perform a single episiotomy, or some perhaps only one - and of the 26 odd years my teacher has been doing birth support, she has only ever known of two infant deaths - and in those cases, both were known to have health problems that would take their lives shortly after birth. The outcomes for birth can be wonderful when left be.

But also back to the original topic - 80% of births as caesers - that's outrageous. At the end of the day, everyone does have the right to choose their birth and they will read and take in what they want to, I'm not here to tell anyone they are wrong or making a bad decision. I am only offering that everyone consider all options. I thought I was informed prior to my two births but now having this training and being pointed in the direction of more informative and useful books, I see that so much else out there in the way of information and books on the topic leaves alot to be desired.

Good on ya barb! And thats great that you've made a decision! Just want to clarify something too, there's nothing "superior" about one woman having a natural birth over a c/s. I think the fact that we each get to hold our babies in our arms is the most important thing. But I do agree with Kelly that its good to keep ourselves informed. Sadly I do think often the c/s can be overdone but I'm not saying yours or anyone else's c/s was unnecessary. And when it comes to the mothers trauma too, I think thats all relative. I had a pretty interesting labour LOL! 27 hrs, no progression sintocin etc but I didn't find any of that traumatic. It was the post birth that I found traumatic, the seperation, the labelling "Failure to progress" and being told I never gave birth, that sort of thing that did my head in. At the end of the day EVERYONE is different, and no two women are going to share the exact same feelings when they give birth, no matter how their labour & birth goes.

Just my thoughts :)

*hugs*
Cailin