Caesarean rates rise as mothers get older

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

MORE than one in five babies in NSW are born to mothers aged over 35, and almost one in three are delivered by caesarean section, latest figures reveal. NSW Health authorities say women are ignoring warnings about the increased risk of pregnancy complications and birth defects as women age.

This may be for good reason. Risk does not equate with eventuality. If it did, we'd all live in hospitals just in case. Another approach is to argue that since some complications are more likely in women over 35 or 40 or whatever age, let's take the path of prevention, and put our energies into preventing what may go wrong and enjoying the healthful state of pregnancy. Doctors are always available if needed; let's call on them when we need them, not because we might need them.

For the first time, fewer than half of all babies born in private hospitals had been delivered by normal vaginal birth.

This is a disgrace! In some private hospitals, around 1 in 3 first-time women will birth their baby without forceps, vacuum or caesarean. The article goes on to say:

Women with private health insurance had higher elective caesarean rates (25.4 per cent) than the overall rate of 17 per cent. The Mater at North Sydney and Kareena Private Hospital in Sutherland Shire had rates of 32 per cent.

The data will fuel the debate between maternity experts who say childbirth has become overly "medicalised" and those who advocate the right of the mother to choose how, when and where to have a baby.

Is it any wonder women are turning to midwives for their care in an attempt to avoid becoming yet another caesarean statistic?

... Over 10 years, surgical births had risen by more than 60 per cent, from 17.6 per cent to 28.8 per cent of all births. Normal vaginal births had fallen from more than 70 per cent to 60.4 per cent in the same period.

And what is the Govt doing about this? Homebirth midwives have caesarean rates of well under 10% - many around 5%. It's amazing how well nature works, when you let it.

Dr Nicholl said the increased level of medical intervention could not be explained by older mothers alone. He said many first-time mothers who have their labour induced do not progress well and go on to need forceps or vacuum delivery, or caesarean section.

At least there's some acknowledgement of the way the medical model has messed up natural birth and its outcomes. The vast majority of first time mothers do not require induction. Women who start labour spontaneously usually labour very well, and if pain relief consists of use of water in labour and positioning, you'll find epidurals and forceps / vacuum are not needed so often.

"There is a level of fear attached to childbirth, and women who have had a caesarean section are fearful of trying to have a vaginal birth the next time."

I'd be fearful too if I knew that my VBAC was going to be managed with admission as soon as labour started, continuous monitoring, labouring in bed, an IV "just in case", a recommendation of an epidural, vaginal examinations every 2-3 hours, and a caesarean if I didn't dilate at the required rate. Not to mention the fear of friends and family and the scare-mongering of some of the medical profession. Again, private midwives achieve a VBAC success rate of 80%+. Why is that you need to have a private midwife in order to have a VBAC? NSW's rate of VBAC was 12.7%, down from 17% in 2002. Some NSW hospitals have rates as low as 2 or 3%. This is in our private hospital system, where we are supposedly supported in our birthing choices. So long as we are choosing caesarean, induction, epidural. It seems natural birth doesn't exist in the private health system.

To turn now to this article, we can see how it happens that women end up with "necessary" caesareans in the private health system:

FOR Anita Catilano, 43, the choice of a caesarean ... was driven by health concerns and age ... She said she did not feel that she had missed out by having assisted deliveries for Alexandra, 9, and Nicholas, 11 weeks. "I have a history of high blood pressure and the doctor said to me that I had more risk giving birth naturally. When the doctor explained some of the risks it outweighed the complications associated with a caesarean." She said her second pregnancy was a surprise at her age and she did not think twice about another caesarean. "It was a clear-cut decision and I felt very confident ... It was based purely on a medical decision. It was safer for me and my baby."

What a shame this woman, along with so many others, was mis-informed about her options. How can major surgery ever be seen to be a positive thing, in the absense of any obvious complications? Maybe I ought to get an electric wheelchair and start using it now, just in case I need one when I'm 80. Oh, and while I'm at it, a heart bypass would be a good thing too. You just never know when you're going to have a heart attack, after all.

Melissa Maimann, Essential Birth Consulting.