An Obstetrician’s views of caesarean

For further information, contact Melissa Maimann at Essential Birth Consulting.

Article

I’m not sure where this doctor got his information from. Aaahh well (deep breath ….)

Women are often urged to opt for a “natural” birth – such as having a baby at home – wherever possible.

But in this week’s Scrubbing Up health column, Philip Steer, emeritus professor of obstetrics and gynaecology at Imperial College, London, says rejecting Caesareans is like rejecting technological advances in transport or energy generation.

… Most of us “really, really want” to be healthy and yet many of us eat hamburgers …

For the several million years that we were hunter-gatherers, a mixed diet and lots of walking was unavoidable and this is what our physiology and metabolism is adjusted to.

… This sets up a tension between how we are programmed to behave and the logic of what we know is good for us.

There is a widespread misapprehension that human beings behave logically, but many of society’s ills illustrate that most of us are driven instead by our primitive instincts and emotions.

Discussions about choices in childbirth demonstrate a similar dislocation between emotional drivers and logical behaviour.

Until as recently as the 1930s, maternal mortality around the globe was horrendous.

… In many parts of Africa, the current figure is one in 16, and the global toll is more than half a million deaths per year.

Advances in the technology of surgery, anaesthesia, blood transfusion and antibiotics have so dramatically improved outcomes in developed countries that mortality is now one in 10,000 or fewer.

You would think that these technological advances would be greeted with universal acclaim, but many women see childbirth as an essential “rite of passage” and exhort others of their gender to eschew technological assistance …

Advocates of home birth have, within the last month, claimed that “the vast majority of women have low-risk pregnancies”.

… Delivery by Caesarean section now accounts for almost a third of all births in many developed countries, and is remarkably safe – certainly as safe as many of the cosmetic operations that do not excite similar criticism.

And yet many still argue against allowing women the autonomy to choose their mode of birth, either on spurious economic grounds or by suggesting that “birth is natural so we mustn’t become dependent on technology”.

Without the technology of agriculture, transport, housing and energy generation, how many of the world’s population would survive?

Probably our survival depends on recognising our primitive instinct-driven behaviour and learning how to substitute rational lifestyles instead.

Thank goodness it’s only one person’s opinion. Funny how the doctor polarised his ctance so much – home birth versus caesarean. Most women are somewhere in between those two.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Tags: birth, Birth choices, Caesarean, Home birth, hospital birth, Normal Birth, Obstetrics, VBAC, women's rights

Death twice as likely by caesarean

For further information, contact Melissa Maimann at Essential Birth Consulting.

Article

BABIES born by elective caesarean are almost 2½ times more likely to die within their first month than babies born vaginally, researchers have found, adding weight to the argument that caesareans should only be carried out in emergencies.

The study, which involved more than 8 million births in the US over four years, is the first of its kind to focus on full-term babies born to women with no medical reason for choosing a caesarean over a vaginal delivery, an increasingly common phenomenon in Australia.

One in three babies are born by Caesarean in Australia: most of these caesareans are elective. The most common reason for performing an elective caesarean is for a previous caesarean. This is despite evidence that suggests that a vaginal birth after a caesarean (VBAC) is safer for women and babies.

… babies … born before the onset of labour are often unresponsive and unable to breathe without help.

They are frequently admitted to neonatal intensive care units because their lungs cannot eliminate secretions and they lack catecholamines, a vital chemical secreted during labour that keeps them alert and eager to feed.

“We are designed to give birth vaginally. When will people wake up and realise this?” the secretary of the NSW Midwives Association, Hannah Dahlen, said yesterday. “When a baby is born vaginally, fluid is squeezed out of the lungs as it is pushed through the birth canal. The baby can then inhale with clean lungs … A baby born by caesarean quite often comes out gurgling because its lungs are full of fluid, requires suction and is non-responsive because it lacks the hormonal surge delivered during labour.”

… babies born vaginally with high levels of catecholamines were usually alert and quick to seek out their mother’s breast …

The study … only included women who had not had a previous caesarean; were giving birth to a single baby which was head down in the cervix; were between 37 and 41 weeks gestation and had none of the 16 common risk factors, such as diabetes or hypertension, associated with birth complications, in a bid to ensure that only low-risk births were evaluated.

It found the mortality rate for babies born vaginally was less than one in 1000 births while the rate for elective caesareans was 1.73 per 1000 …

Midwifery care reduces the caesarean rate and increases the VBAC rate.

Melissa Maimann, Essential Birth Consulting 0400 418 448

Tags: birth, Birth choices, Caesarean, intervention, Obstetrics, Public and private hospitals, VBAC, women's rights