Sunday, September 28, 2008

Should C-section be a choice?

Should doctors continue to allow women to have a c-section simply through choice and without any pressing medical reason to do one?

Most women would say yes. Most women would talk about how it is her body and she should have the right to control what happens to it - as many brave women have fought for the that right over the years.

However, I feel that sometimes this particular "right" becomes confused when it comes to the issue of childbirth. A woman should surely have the right to control what happens and how things happen to her body during pregnancy and birth. But should a woman really have the right to choose something that has been scientifically shown as more dangerous to both her and her baby?

I often end up thinking that because it is us, as women, who are the carriers of children, and who do the work to bring the child into the world, we assume that anything surrounding childbirth instantly qualifies as a woman's issue. Instead of childbirth being about health and safety, it becomes about oppression of women and the very un-politically correct behaviour of denying her a choice.

But lets take a step back for a moment....

During the first half of the 1900's the biggest leap in the quest for pain free childbirth was made. The Twilight Sleep was heralded as the end of woman's suffering in childbirth. Many of those involved in the Women's Sufferage called for it's widespread use. By the time of the post-war baby boom the horror stories began to surface about what it was really like. Women were strapped down as they continued to thrash about, often inflicting wounds on their wrists and ankles. It is believed that the Twilight Sleep did not really alleviate the pain, but simply erased any memory of what had happened.

As a result of this method of pain relief left women totally disconnected from childbirth and therefore bonding was very difficult. There were also serious effects on the baby that lead to extreme difficulty breathing.

At this point I would like to make it clear that I am not against C-sections. They are without a doubt a life-saving obstetrical technique that has enhanced our ability to bring babies safely into the world - when they are used appropriately.

The problem is that they are not being used appropriately. In recent studies into the rising numbers of women having c-sections, it has been found that very few of them actually choose this option outright and were in fact persuaded by their doctors into "choosing" this method.

You see, doctors have a vested interest in a nice, easy surgical birth where s/he is completely in charge of the situation. In the highly litigious society of the US, doctors are more concerned with the prospect of being sued and at the slight indication of anything untoward they will immediately start pressuring to have a c-section. I guess you could call a c-section damage control. You only need to look at the statistics to see why they would be so quick to suggest a c-section as to date the majority of doctors have been sued as a result of natural birth gone wrong and only one case is currently known of where a doctor was sued for doing a c-section.

In South Africa I'm not sure it's quite the same motivation. My experience of South African's in general is that we're quite a conservative bunch, and we're all still under the impression that the Doctor knows best and are happy to give in to their advice without much of a fight (or even a discussion). This is not to say that all women are like this - I'm basing this solely on a vast amount of conversations with women. And I think that this is slowly changing too.

One particular close friend of mine, T, fought better part of her pregnancy to avoid as much intervention as much as possible, and boy was it a fight. T was threatened into getting an ultra-sound even though it was against her express wishes. One always has "the right" to turn down any medical procedure, but what good is this right if your doctor can turn around and refuse to treat you in the case of you refusing? The most ironic thing is that T had done everything she was supposed to in order to achieve her goals, like seeking the care of a midwife - but sadly this midwife was on the side of the doctor and also hinted at refusing care if T disobeyed.

Being the classy, ballsy chick that she is, she dropped said midwife and found another that seemed way more on-board with what she wanted. Not the easiest decision to make from my experience. In the end she had a beautiful homebirth, due in most part to her serious dedication to achieving that.

My own story seems like a very typical pattern to most women I know in SA who have ended up with c-sections. They get pressured into an induction and get left no choice but to have the c-section when it fails. It was even admitted to me that the problems that motivated the induction were found to be magically non-existent once my son was born. I too went with a midwife - something I thought would be a guarantee of a vaginal birth at the very least.

So back to the issue of c-section as a choice!

I personally feel that Doctors are abusing their position by insisting on c-sections, for whatever (personal)reasons. There really is no defense for an 80% c-section rate in South African private hospitals. The rate in government hospitals is still much higher than the WHO recommended rate of 15%, but it is far, far lower than 80% (maybe around 40-60%, depending on the province).

Women are being strong-armed into unnecessary major surgery, with the threat of denial of care if they exercise their right to informed consent (in the case of a private patient). Government Hospitals are not somewhere anyone wants to give birth - and I can say this from having worked in one while studying nursing.

I honestly feel that the only way to prevent doctors from doing this for their own convenience is to no longer allow it as a choice. It needs to be something that is medically necessary before someone is allowed to consider it to be an option. Having an extreme phobia about pain is quite obviously a good reason to have a c-section, but seeing as a c-section can also involve a fair amount of pain then surely counseling is in order?

Women in South Africa are being denied choice under the current laws. They are told they have the right to informed consent and informed refusal, but information about the risks of c-section is rarely, if ever, given to them. In the case of a private patient refusing a procedure she can be denied care and are left with finding another care provider (and there are only rare gems who favour vaginal birth) or going to a government hospital where the most extravagant pain relief you are given is two paracetamol tablets in the case of a vaginal birth.

Medical Aids also have to be considered in all of this, as they also have a fair amount of persuasion when it comes to doctors. And pretty much all private patients will have medical aid. Medical Aids are currently structured in favour of planned c-section births where they will cover the entire procedure 100% whereas a vaginal birth will end up with the member having to pay in money from their own pocket!!

C-section is the only on-demand major surgery a person can have. It carries the same risks as all other major abdominal surgeries, yet despite the fact that doctors are supposed to seek surgery as a last resort, it has become the first choice for them. It's "no big deal" and women are lead to believe that it's easier and safer.

Currently there is no independent source of information in South Africa about childbirth other than one's own doctor. This needs to change, and so do laws so that women are given back the control over their bodies and their babies. They also need to be able to do with without fear of being refused care.

Saturday, September 27, 2008

The other side of the glass

I found this rather interesting trailer for a movie in the making which comes from the perspective of the father. Not many films seek to address this aspect, despite many fathers being an important part of the whole childbirth process.

It also delves into the idea of the baby as being a conscious part of the process, and how the experiences during the birth process can affect the psyche (and it's ongoing development). This isn't a new idea, as can be seen with the work of Frederick Leboyer and Elena Tonetti. It will also be most interesting to see what literature and studies they base their claims on, as this to me is always a very important aspect to include!

On a more disturbing note, it would appear that good ol' Dr Phil is set to be recording a show about homebirth but will be approaching it from a very negative angle. On his website the questions appear to be aimed at finding people who had a bad homebirth experience and with a little more research it also seems like some people that were approached were turned down because of a lack of conflict surrounding their choice of having a homebirth (ie turned down because husband and family *shock horror* actually supported them in this choice)

As Dr Phil airs regularly in South Africa I feel this is a particularly relevent piece of information. I have a funny feeling that this show may be in response to the documentary by Ricki Lake on her experience of homebirth. Sadly The Business of Being Born has not been widely shown at South African Cinema's and so I can only see a show like the one Dr Phil is showing to provide more "amo" to those who are all to quick to tell the homebirth horror stories they know.

I know in my local area there are quite a few natural birth stories that get fed to pregnant women on an almost religious basis! By this I mean people will go out of their way to approach a women (whom they may not even know) and passionately "show her the light" about how horiffic childbirth is. (this also based on personal experience)

Hopefully I will have the opportunity next year to make something in the medium of film that is pro-homebirth pro-natural pro-midwife and all that! :)

Friday, September 26, 2008


So when I was expecting my son, I was already imagining how I would carry him around. I had seen people with a very "hippie" looking contraption and I really loved the way it looked, and the fact that the babe was carried so close to mum/dad.

I managed to track this down and it was a godsend! When my grandfather passed away, at the glorious age of 92, I had to travel from South Africa to Ireland for the funeral. There was never any question of whether I would go or not, and I had no choice but to take my 4 month old baby with me. Flying to Ireland also involves a change-over at London Heathrow and I was going to be doing this on my own.

I remember sitting on the plane and thinking "What on earth am i doing?!" while I pondered how I would cope with making bottles during a 12 hour flight, with no help from anyone. It turned out my son was a complete angel and I was complimented a number of times on how "well behaved" he was (um... yeah... because a crying baby is misbehaving!).

Anyway, the baby wrap that I used was brilliant because it allowed me to be able to collect luggage, wrestle my passport out of my bag and even fill in a form at one point, while keeping my son perfectly happy.

On the way home I stayed with my sister in London for a week and we did some traveling while my son happily slept in the wrap!

On days when he really struggled to sleep, it was also a great way to settle him. I'd stick him in the wrap and walk into the back garden and before I'd reached the other end of the garden he'd be out cold. Magic!

So now I recommend this handy (oft "life saving") device to anyone I know who is having a baby. I also mention that I have back problems (from being thrown from a horse) and this is one thing that was comfortable to use do to the way the weight is distributed. You can continue to use it until the child is quite old as there are different methods of using it that allow you to use it as extra support for carrying a toddler on your hip.

My one is a Yazo Wrap

but you also get one's from overseas called:

Moby Stretchy Wrap

Alternatively I know of another cool way to snuggle your baby called The African Baby Carrier which I might try next time around (i didn't know about when I was having my son). It also looks like a good one for people who might struggle with back problems (depending on what those problems are obviously).

Thursday, September 25, 2008

Natural Vaginal Birth vs C-section

I came across the SA-based article and found the following quite interesting

"Like Catherine's doctor, Dr Jack Pretorius, an obstetrician and gynaecologist in private practice, believes that a woman should have a caesarean section if she wants one. 'I'm easily persuaded,' he admits. 'If a girl says she's too scared, I'll do a caesar. A birth without pain relief is idiotic, and the idea that you don't bond with your baby without pain is absurd; there's no logic in it.

'Long labours went out with the Boer War. A doctor has to be gentle with his patients; it's a joint decision. I'd put all the options to her, but it's her body. A caesarean section is quick and easy; there's no doubt that it's the ideal way to have a baby.'"

And this about sums up why we have such a horrendously high c-section rate! This man obviously has no clue about research by people like Michel Odent which shows there is clearly a link between the hormones of childbirth and the effect on bonding. And to call it "idiotic".... well that just takes the cake.

I'm glad they had a midwife to give her views on natural childbirth but it's really sad that the focus of her comments came across as rather new-agey:

'Natural birth is better for the mom and the baby,' she asserts. 'There's no satisfaction in having an epidural caesar. Birth is a right of passage, an adventure, a journey that a woman takes to become a mother. It's not just a physical experience; it encompasses the heart, the spirit and the psyche. How you give birth affects your relationship with your baby, your mother, your partner and yourself.

'It's a battle and it's painful but afterwards you can look back and say "Look what I did!" After a water birth at home the woman can get out of the pool, have a pee, eat something and get into bed with her baby. It's a family event; a celebration. An epidural isn't a spiritual experience!'

She could have said *why* natural childbirth is better for the mother, instead of just having an open-ended statement like that. As so many women are scared of pain in childbirth, why not rather talk about the importance of pain and how it can be managed? What women, terrified of pain and that she'll never have sex again, is going to be persuaded by the idea of it being a spiritual experience?

The most ridiculous comment of all?

And, indeed, horror stories abound of women whose babies were born prematurely because the doctor induced labour before leaving for Mauritius on holiday, or performed a caesar because he was due on the golf course at 2.00pm. But the blame for unnecessary inductions can't be laid solely on the doctors who perform them.

'Many girls say they don't want to be induced,' says Dr Jack Pretorius, 'And I have no problem with getting up at night to deliver a baby. But at least 50% of my patients are dying to get it over by 38 weeks.'

Of course the blame is solely the doctors! What the hell?! It is the doctors responsibility to do things that are best for the mother and baby, and inducing at 38 weeks just because of the mothers preference is downright irresponsible! It is his responsibilty as care provider to explain why it is important to wait and to help the woman find ways to cope. If midwives can do this, then why can't he?!