When push comes to scalpel

For further information, please contact Melissa Maimann at Essential Birth Consulting. Link to article here.

New mothers seeking a drug-free, minimal-intervention childbirth face an increasingly uphill battle, writes Bianca Nogrady | March 07, 2009

Article from: The Australian

WHEN a journalist from The New York Times asked British mountaineer George Mallory why he was planning to scale Mt Everest, the reply was simple: "Because it's there." I feel the same way about a drug-free childbirth.

When confronted with the opinion that because modern medicine has developed the pain-free, push-free labour, all women should fall over themselves in gratitude, I can't help but think of Mallory. Why do I aspire to a drug-free and hopefully intervention-free labour? Because I can.

There's more to it than the notion that simply because my female ancestors did it this way, I should too. My female ancestors were far likelier to die in childbirth because of a lack of basic sanitation or bleed to death because physicians of the day had limited surgical skills or knowledge. Their babies also were on the wrong side of the survival odds thanks to pathogens and complications.

I am eternally grateful to be pregnant and facing labour in this era, when I am confident my doctors will be able to fend off almost all the threats that in the not-so-distant past may have put my life, and that of my baby, at risk.

But I am a healthy, fit 33-year-old woman who has been lucky enough to have a pretty normal pregnancy so far.

I'm not quite in the right shape to scale Mt Everest, but I'm approaching labour with the same sense of expectation, excitement, trepidation and motivation.

This is my first child. As a medical journalist, I'm well placed to look up all the facts and figures about childbirth, judge the strengths and flaws of scientific studies, ask probing questions of my healthcare providers, write a birth plan and reassure myself with the illusion that I have some degree of control over this whole process ...

The subject of birth choices is a highly emotive one. Everyone has an opinion, and the tone of the debate about caesareans v trial of labour, midwives v obstetricians and private v public suggests most people think the best way to defend their opinion is to attack everyone else's. For a first-timer ... this makes an already fraught decision-making process much more difficult.

If a woman aspires joyfully to a drug-free birth, she risks being hit with the hippie tag and inadvertently offending those who choose an epidural or a caesarean. If she says she's open to pain relief, then there's the ... criticism of being weak ... And god forbid that she should express a desire for a caesarean section up-front: then she's likely to be stopped in the street and berated for not being a real woman ...

For me ... the most reassuring thought is that my body is designed for this: all women's bodies are ... Hormones loosen the pelvic ligaments to allow the passage of a baby. There are painkiller hormones so strong ... Energy-giving hormones provide labouring women with a boost like no other and help kick-start newborns into activity. Another hormone may well be the ultimate love drug, binding ... a mother and her newborn baby. Labour is like being let loose in the pharmacy without having to worry about overdosing, side effects or cost.

It's a balancing act of hormonal influence. The notion that we can blithely throw a synthetic version of a recently discovered opiate into the mix and improve things smacks of large angry animals in kitchenware establishments. And the notion that cutting open healthy tissue and manually removing a baby is an improvement on millennia of physical evolution seems naive at best ...

I'm not for a moment suggesting that caesarean sections have no place in childbirth ... Should that situation arise, I'll be gladly handing my obstetrician the scalpel (figuratively speaking). My drug-free, intervention-free preferences are all subject to the iron-clad caveat that if my baby is likely to come to harm, all bets are off.

... it bothers me that so many caesareans are being conducted. Have women's bodies suddenly taken a turn for the worse and rendered a significant proportion of us completely incapable of doing something that women have been doing in mud huts, fields, baths and beds since the dawn of time?

Teasing apart the reasons for, and effects of, interventions during birth, whether drugs, forceps or caesarean sections, is difficult ....

Research suggests that most women who undergo elective caesarean section do so out of concern for their baby's safety, contrary to the popular notion they are "too posh to push". But they make that choice on the advice of medical experts working in a highly litigious, pro-interventionist and, some would say, overly fearful environment ...

As soon as the word breech was mentioned, hot on its heels was the phrase elective caesarean. Just a decade ago, breech vaginal deliveries were considered relatively routine. But a single study ... put an end to that by suggesting that there might be an increased risk to the baby from a vaginal breech delivery.

Now most obstetricians wouldn't touch a vaginal breech delivery with the proverbial barge pole and the skills required to navigate through the unique challenges of a breech delivery steadily are being lost.

I'm probably luckier than most because ... I know where doctors go for their decision-making information. I'm able to ask questions about the evidence and subject it to necessary scrutiny.

Yet even armed with this knowledge and research, I feel utterly powerless when I'm told by a midwife that a caesarean is the only way to go and I should book it in as soon as possible to ensure the medical team is prepped and ready. Oddly enough, the only voice suggesting that I might still be able to deliver a breech baby through trial of labour came from an obstetrician, not a midwife. ....

No one told Mallory his aspiration to scale the tallest mountain on Earth was primitive and he should just fly over it like other civilised people.

The author raises an interesting point about the lack of breech birth skills that have developed over the past decade. With our caesarean rate at well over 30%, it's a wonder if soon, all vaginal birth skills will be lost.

Melissa Maimann, Essential Birth Consulting.