Since the time Robyn found out that she was pregnant with her first baby, she was determined to have a natural birth. She had spent countless hours reading books and researching on the Internet.
But things didn’t go according to plan when Robyn was 8 days overdue. She knew that if she went too far over her due date, she would need to get induced.
Robyn, a vegan and a firm advocate in ‘natural is best’ felt that she was not given adequate support during labour. “It is difficult being out of control of the whole process,” says Robyn.
When Robyn finally went into the early stages of labour, she was laid down on her back, strapped to a heart-rate monitor, given oxytocin (a hormone to induce labour) and advised to have an epidural for pain relief.
She believes that lying down on her back during labour made her contractions more painful and the birthing experience much more stressful. Robyn says she wanted to try other birthing positions but at the time was “too frightened and unsure to stand my ground.”
Nathalie Horn, an experienced midwife within the private and public hospital sectors says that physiologically lying down on the back is the worst position to give birth in. “If a woman understands the shape of her pelvis, and how the bones in it move, she would know that in that position she is trying to push up hill and around a curve which is obstructed by her tailbone because she’s lying on it!”
To the surprise of her midwife, Robyn was fully dilated within a just a few hours. However, when the baby’s heart rate fell to dangerous levels, the obstetrician recommended an emergency caesarean.
“Nobody mentioned anything about breathing techniques, moving around or anything to help relieve the pain naturally,” says Robyn. “Perhaps if I had the reassuring and experienced presence of a doula during my labour, things might have been different.”
Doulas are skilled birthing companions who provide non-medical support to parents prior to, during and after labour. They assist with breathing techniques, birth positions, massage and emotional support. They also assist mothers in the transition period from hospital to home by helping with feeding, light housework and looking after siblings.[i]
Robyn gave birth to a beautiful, healthy girl with no complications to either herself or her baby. She says she has no regrets, “I have no idea what the outcome would have been if I hadn’t had a c-section so perhaps this is the way it was meant to be.”
Robyn’s physical recovery took approximately 3 weeks. She says that she is happy and grateful that her baby girl was delivered to her healthy but says, “Next time I will gladly pay for a doula.”
There is no denying the fact that over the last two decades
caesarean births have increased. Queensland Health statistics show that they have risen from 22.5% in 1997 to 33.8% in 2007. That’s more than a 67% increase in 10 years.[ii]
The same study found that births in the private sector were 70% more likely to be delivered via caesarean section than births in the public sector.
Nathalie Horn says that this is because “obstetricians don’t work to the same guidelines as the teams in the public system. Unfortunately, private obstetricians get paid more to do c-sections than to attend vaginal births, and when they are on call 24/7, often c-sections get done out of convenience for the doctor. Likewise, due to the monetary incentive and the convenience, more private obstetricians are likely to let their women choose a c-section for less than solid medical reasons.”
The World Health Organization recommends that rates for caesarean sections should range between 5 and 10% and should not exceed 15%. Rates above this are in fact deemed to increase the risk of “poor maternal and newborn health outcomes.”[iii]
The most common reasons for caesarean births in Australia within both the private and public sectors are uterine scar caused by previous caesarean procedures, failure to progress, breech presentation and foetal distress. However, in the private sector, caesarean sections that are performed without any medical reason make up almost 17% of all caesarean section births compared to the public sector where only 4.36% are performed with no medical reason.ii
And so, arises the question, are the associated risks of c-sections being communicated to mothers to be?
A comprehensive 2005 World Health Organization study reveals that the rising rates or caesarean sections in many countries has led to an increase in infant and maternal mortality and illness. In births that have been deemed low-risk, mothers are 3 times more likely to die as a consequence of caesarean birth, and infants 2.4 times more likely.[iv]
Horn says, the only advantage of having a c-section
“Is the ability to quickly deliver a baby when either the mother’s or the baby’s life is in danger. In situations where birth itself is going to be complicated or high risk, the c-section can provide another option for birth where the benefits may outweigh the risks of attempting a vaginal birth.”
Horn says that the medical disadvantages of having a caesarean section are extensive, “A c-section is an invasive, major operation, which has all the risks related to major surgery.”
Some of the risks include:
· Death
· Sepsis
· Adhesions
· Uterine scar rupture (in the future)
· Wound infection (as in Kylie’s case below)
· Haemorrhage
· Deep vein thrombosis (DVT)
· Paralytic illeus (when the bowel stops working and becomes obstructed)
· Perforated bowel
· Perforated bladder
· Wound dehiscence (where the entry wound opens up and the contents of the abdominal cavity come out) and hysterectomy.
Apart from the many physical risks associated with Caesarean births, there are also psychological risks for the mother.
Australian research suggests that 46% of women who have had emergency caesarean sections were six times more likely to develop symptoms of depression. Some of the reasons for this include the expectations of the mother; the physical pain experienced after the operation and for some mothers, the inability to bond with their new babies.[v]
Katrina, a mother of two boys had her first baby via vaginal delivery and her second via emergency caesarean section says, “I was really disappointed after having a caesarean section, it took me a few years to get over it, I felt like a failure.” Katrina has suffered from depression for years and believes that the emergency c-section may have contributed to it.
Kylie however, was one of those who didn’t suffer from depression post caesarean. She was advised to have the operation after it was discovered that her baby was in a breech position. “When I was first told I would need a c-section, I was upset and disappointed that I was not going to get to give birth naturally, but that feeling didn’t last long and I didn’t mind that I had to have a c-section.”
However, Kylie did suffer some physical complications with her first caesarean, “I was quite sick straight after the c-section with vomiting and itching. The doctors gave me medication to help me sleep and I didn’t see Emma until 14 hours after she was born.”
Kylie said that she was quite sore for the first week, but was able to do some minor housework after the second week. “The recovery was not as bad as I expected it to be,” says Kylie.
Kylie decided that an elective caesarean section for her second baby was a far more desirable option than having to go through an extensive and stressful labour only to end up with having an emergency c-section at the end of it. She found that her recovery was much quicker the second time around.
With her third caesarean section, Kylie required staples instead of stitches to close the wound. She found the staples “quite painful and extremely painful to have removed. I got a small infection in the wound, but anti-biotic fixed that up quickly.”
Along with risks for the mother, Horn says that there are also some risks for the baby, “During a vaginal birth, the fluid in the baby’s lungs is squeezed out during the journey through the birth canal, this is a normal physiological experience, designed with a purpose, so the baby is able to breathe clearly upon birth.”
She says that during a c-section this does not occur and therefore the baby often suffers breathing difficulties as a result. Horn says she has also “seen babies damaged by the scalpel upon entry to the uterus.”
Kylie’s first baby, Emma, suffered from some breathing complications and required oxygen after she was delivered via caesarean section.
So why is it that with all the apparent risks involved to both mother and baby, that 1 in 3 Australian babies are born via caesarean section?
Nathalie believes that the, “Too Posh to Push” theory or women choosing to have a caesarean section for convenience is a myth. “In the public system, elective c-sections are booked only for medical reasons. A woman cannot request to have a c-section without medical grounds. It is not a choice.”
Nathalie says that there are two reasons for increasing numbers of caesarean sections within Australia, and they are: 1) Women don’t know how to birth their babies, 2) Cascade of intervention.
Cascade of intervention is the theory that one medical intervention such as the use of drugs for pain relief, hormones for induction and lying down on the back can lead to other medical interventions such as caesarean section, forceps or vacuum delivery.[vi]
Sharon is one mum who chose to have a caesarean section after having experienced significant tearing and some complications from her first natural birth. She says, “ I had not long given birth to my son 16 months prior and had 3rd degree tears. I felt I needed more recovery time before having another child naturally.” Sharon had chosen to have a caesarean section without any advice either way from doctors.
She describes having a caesarean section as feeling like “a gutted fish. Not a nice experience at all.” And that, after experiencing a caesarean, “natural is definitely the way to go.”
Kate, the mother of a 2½-year-old boy and a 9-month-old girl had both of her babies via caesarean section. She has worked as a medical receptionist within an obstetrician’s surgery and knew her doctor well when she chose to have her babies privately.
Her first baby was born via emergency caesarean because of the baby’s positioning.
“My obstetrician was concerned that the umbilical cord could come down first and cut off my babies oxygen supply,” says Kate. “I was told not to move and wheeled into theatre straight away.”
Kate followed the advice of her obstetrician to have an elective surgery for the birth of her second baby due to the risks associated with uterine rupture and complications with her first born.
“I have had quite a lot of people ask me if I felt robbed of the opportunity of labour. I don’t like to think of it like that but rather that this is just how it was for me,” says Kate.
Kate says that she had a lot of faith in her obstetrician and that she would definitely follow his advice if he were to recommend another caesarean section. “I was very happy with all facets of my care,” she says.
With greater awareness and education for mothers perhaps caesarean section births will start decreasing back to the 5-10% as recommended by the World Health Organization.
The fact that medical interventions including caesarean sections have lowered the mortality rates for both mothers and their babies in the developed world is not debatable. In fact the Australian Bureau of Statistics reveals that in the year 1894, 104 out of 1000 babies died before their first birthday. In 1994, that rate was just 6 per 1000.[vii]
So it goes to show that medical intervention has come a long way in helping prevent both maternal and infant deaths. Australia also has one of the lowest infant mortality rates in the world. In emergency situations, caesarean sections definitely have their place.
However, the question still remains, why are more and more mothers electing to have caesarean sections when their pregnancies have been deemed low-risk? Is it out of convenience for the doctor, better financial incentives or because women perceive the operation to be safer, less painful and/or much more convenient. Perhaps it is a combination of all these factors.
What can be said is that all mothers should feel well informed and prepared when entering the birthing suite and should never feel guilty when things don’t go according to plan. Women should feel that their obstetrician or health care professional is providing them with the best medical advice and not making decisions based on financial incentives, the fear of lawsuits or convenience.
“I think we focus so much on the actual birth and it is a huge thing to go through whichever way it happens and it will be something I will never forget, but the birth is only the beginning and there are so many more experiences ahead in our children’s lives and I just look forward to those,” says Kate.
All mothers interviewed for this article had healthy medical outcomes for both baby and themselves.
For more information on caesarean sections and natural births please visit the following websites or visit your local doula, midwife or health care professional:
http://www.health.qld.gov.au
http://www.childbirthconnection.org
http://www.bellybelly.com.au
http://www.australiandoulas.com.au/wsdindex.html
www.who.int
[i] Australian Doulas
[ii] Queensland Health
[iii] World Health Organisation: Maternal and Perinatal Health, Epidemiology of major maternal and perinatal conditions
[iv] Lancet 2006: Caesarean delivery rates and pregnancy outcomes: the 2005WHO global survey on maternal and perinatal health inLatin America 2006
[iv] Obgyn.net: The Emotional Scars of Cesarean Birth
[v] Obgyn.net: The Emotional Scars of Cesarean Birth
[vi] Childbirth Connection: Vision, Mission & Beliefs, Cascade of Intervention in Childbirth
[vii] Australian Bureau of Statistics
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