midwife's muse

The pain of the childbirth issue.

I am reproducing this article here, in full, as well as linking to it. It is wonderful to know that good old blighty is not the only country to be experiencing high caesarian rates but it is also refreshing to have someone consider the whole pregnancy, birth experience in relation to fashion, culture and expectations. I feel that pressure is being exerted on women by the media, whether it be in magazines with articles telling them how to have the best childbirth experience, newspapers scaremongering one day about normal birth and how dangerous it is for Mothers and Babies, and calling for homebirths for all the next or the Government weighing in with its plans to increase the number of homebirths, producing little booklets which advise women that they have a choice, and initiatives which they proclaim to the public but omit to say that they are on a wish list and not really available. Which way should a woman go? Protect her reproductive tract and have a caesarian, saving money then on having her 'designer vagina' constructed by a surgeon. Perhaps she should just seek out a birth unit, all low lights, soft music and large baths, certainly that sounds like a lovely option but unfortunately they don't offer epidurals so if it is a birth centre it should be close to the consultant unit and that way, once the aromatherapy and the massage has failed to smother the outrageous contractions, a wonderful anaesthetist can come and site the ultimate in pain blockers and instantly double their odds of requiring an instrumental delivery, if not a caesarian. 

Caesarean glut not just about too few midwives

Michelle Hamer
April 30, 2007

The introduction of one-on-one midwife care alone will not curb Australia's soaring caesarean rate; it hasn't worked in New Zealand and it won't work here.

Catherine Deveny (Opinion, 26/4) wants the Federal Government to support independent midwives as a means of reducing our caesarean rate, which at 30 per cent is double the maximum number of surgical births considered appropriate by the World Health Organisation. (But the WHO figure was set more than 20 years ago, and many argue that it is outdated.)

To support her argument, Deveny cites the introduction of one-on-one midwife care in New Zealand 13 years ago - and the huge maternal shift towards it. What she doesn't mention is that despite the switch to midwife-led care, New Zealand's caesarean rate has continued to rise steadily.

In 2003, 23.1 per cent of New Zealand women underwent a surgical birth; in the same year Australia's rate was 27 per cent. Australia's rate has continued to rise in the past four years and there is no sign that the New Zealand figures have done otherwise.

In Finland, which, as Deveny correctly states, has one of the world's lowest caesarean rates of 16.1 per cent, pregnant women are largely cared for by midwives during their pregnancy, but this is often under the supervision of a specialist, and does not continue during the birth, which is managed by an obstetrician. So something else must be contributing both to Finland's reduced, and Australia's rising, caesarean rate.

Certainly in Scandinavian countries such as Finland, childbirth is seen more as a natural, physiological process, rather than a condition to be managed and controlled. It's no coincidence that the countries with the lowest caesarean rates are also those that most warmly embrace family-friendly work and government policies.

If having a baby is seen as a natural part of life, rather than a scary endeavour that will damage your career and cut you off from mainstream life, then it's likely you'll approach it in a more relaxed manner.

But in countries such as Australia, the baby stakes are high. We're constantly reminded of the cost of bringing up children, and we tend to slot baby-making into a calculated position somewhere after paying off a cavernous house and getting as much travel and experience as possible under our belts. Strange that starting new life is often seen as the ending of so much more.

In this culture it's no wonder the thought of having a baby "the old-fashioned way" is less appealing. Making the decision to have a child in the first place often requires so much agonised consideration and strategic planning that mucking it up at the end is not an option.

And this is the way vaginal birth is increasingly being seen: as a little wild and out of control, messy and unpredictable.

Caesareans are certainly safer for obstetricians; no Australian doctor has ever been sued for performing a caesarean, though many have faced litigation following vaginal births gone awry.

For a society that has elevated technology to a new form of religion that offers a more sanitised, controlled experience of the world, a caesarean is often seen as the "new, improved childbirth".

This month the NSW Government weighed into the debate, trying to reduce the number of medically unnecessary caesareans by ensuring mothers are clearly informed of the risks of such a choice - but research shows that just 5 per cent of Australian women are storming into their obstetricians' rooms and demanding to have their child cut out.

Most mothers set out with the best of intentions for a natural birth, but are often swayed when the "risk" word creeps into prenatal discussions. Multiple birth - ooh risky. Breech - let's get out the scalpel. Previous caesarean - sorry love, no choice. The baby's heart rate is too fast; too slow; too loud - what the hell, let's cut.

We're all scared by the what-ifs of childbirth and have been seduced into the idea that a caesarean will be safer, more predictable and manageable, but major abdominal surgery is not a walk in the park.

Legislative support for midwife care may help, but there are many more conversations about the importance of family, about our shame and blame culture and our intolerance of (perceived) risk before midwife care alone will reduce the caesarean rate.

Michelle Hamer is the author of Delivery by Appointment - caesarean birth today (New Holland) and the mother of four children born by caesarean.

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30.4.07 18:39