Doctors driving the increase in caesareans


THE popular belief that caesareans are on the rise because women are too posh to push is incorrect, a new study shows.

University of Queensland researchers surveyed 22,000 Queensland mums ...

... 48 per cent of women in private hospitals who had a caesarean did so on the recommendation of their [obstetrician].

Just under 40 per cent of women in public hospitals said the same.

... only 10 per cent said they had wanted to have their baby born that way.

"... the majority of women would prefer to have a vaginal birth," ...

"The increase in caesareans seems to be largely driven by the recommendations of doctors."

... some women are going into the procedure underprepared.

Only 52 per cent of women ... reported making an informed decision to have a planned caesarean ...

Interesting research that backs up what midwives have known for a long time: the main driver for increased caesarean rates is not the mother's choice to deliver by caesarean, but rather the recommendation of her obstetrician, who in most cases will be recommending a caesarean for non-essential reasons. I say this with confidence because upwards of 45% women do not "need" to deliver by caesarean for the sake of their babies or themselves. No-one could be justified in believing that caesarean rates this high are necessary in the majority of women who experience a healthy pregnancy. Private midwifery caesarean rates are well under 10%, with many private midwives having caesarean rates of around 5%.

The lesson is that a woman's choice of care provider has the greatest impact on her mode of birth.

It is more important that her health issues, her choices and preferences for care, her previous birth experiences and her geographical location.

A woman's choice of care provider will literally determine whether she undergoes a (possible unnecessary) caesarean or a natural birth. Late pregnancy and labour are not the times to be asking your care provider if their recommendations (for induction or caesarean) are truly necessary: women are simply too vulnerable in that state to make informed decision, and besides, informed decisions take take to research to come to an "informed" decision. When time is of the essence - in late pregnancy and labour - informed decision making almost goes out the window. Ultimately, the best strategy is to interview your potential care providers and peruse their statistics on birth. They say they support natural birth ... but what are their stats on natural birth? What % of their patients have a caesarean, induction, epidural? If your care provider is vague and non-committal, that should speak volumes. If their rates are high and you are aiming for a low-intervention birth, it is not too late to identify this and seek a care provider whose philosophy - and outcomes - are more aligned to what you are hoping to achieve.

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