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.

No comments: