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Elective by force

MagazineFebruary 1993 (Vol. 3 Issue 11)Elective by force

Caesarean rates in this country have multiplied five times in the last 20 years, yet foetal survival rates have not seen a corresponding increase

Caesarean rates in this country have multiplied five times in the last 20 years, yet foetal survival rates have not seen a corresponding increase.

Cases where a caesarean is essential are much rarer than our doctors would have us believe.

When a doctor advises an elective (predetermined) caesarean, most understand the sense of panic and failure that a woman feels. But few can empathize with her sense of outrage and betrayal.

Obstetricians know that it is perfectly possible to deliver a breech baby vaginally in up to 80 per cent of cases. This is particularly true if the woman is helped into a squatting or semi squatting position for delivery, (thus increasing her pelvic outlet by some 28 per cent).

But many obstetricians have reduced birth to a means justifies the ends formula, where whatever is expedient in getting the baby out be it drugs or surgery is employed.

The trend toward elective caesareans is only set to increase with the publication of a study by the Department of Obstetrics at St Mary's Hospital in London, supposedly showing that vaginal delivery of breech babies is associated with a 20 fold increase in the rate of perinatal death. The study was met with an outcry in the medical press because it was not a randomized controlled trial and no causes of death were given. Researchers from the Charing Cross and Westminster Medical School said that if the studies for all women starting with a trial of labour (including the emergency caesareans) were lumped together, there was no significant difference in the death rate between babies whose mothers began with a trial of labour and those who opted for caesarean.

Indeed, in a much larger study of 17,000 babies, serious problems occurred less commonly in babies delivered vaginally than in those delivered by caesarean .

Flawed as it obviously is, the study is being touted as conclusive proof that elective caesearean is far safer than vaginal delivery. For the mother, birth is not simply about getting the baby out. It is a total experience physiological, psychological and emotional. Most women feel that they would benefit from the experience of labour, especially with a first delivery, as would their baby.

In labour, chemicals are released which help to dry out the baby's lungs and ensure other major organs, such as the liver and kidneys, are working properly. Babies born by caesarean without a period of labour are more prone to breathing difficulties. "Stress hormones", which help to mobilize a baby's food stores and so improve chances of survival during the first few days, are also released in labour.

You are five times more likely to die after a caesarean than after a vaginal birth (50 women in every 100,000, as opposed to 10 in every 100,000). Women who've had caesareans are more prone to depression, chronic pain and may suffer post operative infection, not to mention hysterectomy, complications from anaesthetics, infection or postpartum haemorrhage.

Caesarean birth requires drugs to block the pain during and after surgery, a prolonged stay in hospital and up to six months to fully recover. With subsequent pregnancies, many women will have to battle against a "once a caesarean always a caesarean" policy, based on ancient statistics for the old "classic" or vertical incision. The scar from a vertical incision is more prone to rupture in labour than the modern lower segment or "bikini line" scar, which has a rupture rate of less than 1 per cent.

My own son, Alexander, was born by a caesarean after a period of spontaneous labour. I treasure my experience of labour and feel happy in the knowledge that he was born in the way he needed to be born. He was a 9 1/2 pound frank breech and it became clear he wasn't coming out any other way.

The particular axe I have to grind is with those doctors in the NHS who fought me every inch of the way to the point of withdrawing their care in the 37th week of my pregnancy thus forcing me into the private sector in my desire to go into spontaneous labour for a trial vaginal delivery. In expressing this strongly felt desire I was told I was "foolish", "dangerous" and "difficult", when in reality I was simply following my own instincts about what was best for myself and my baby.

Pat Thomas is a psychotherapist, journalist, mother and member of AIMS (the Association for Improvements in the Maternity Services).

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