And no, I don’t mean drug-free. I just mean this:
Leaders of Canada’s pregnancy specialists are urging doctors not to induce labour unless there are compelling medical reasons.
The call is part of a campaign to “normalize” childbirth and efforts to reduce Canada’s soaring cesarean section rate. Some studies suggest inducing labour in a first-time mother significantly increases her risk of a C-section.
It’s great to have modern drugs and medicine at one’s disposal. But it can be taken too far. I’m not much of an expert, but I always thought babies came when they were ready and that nothing could really get them going before their time (as any 40-week-pregnant woman can tell you). Forcing Mother Nature’s hand may sometimes be the best, or least worst, option available. But doing it routinely just for convenience’s sake can’t be a good thing.
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Rebecca adds: In normal cases, though, a C-section is riskier for mother and baby than a vaginal birth, with or without medication. I really see this as an issue of how we frame childbirth, what we believe about women’s bodies, and once again, the illusion that we can control everything.
When something goes wrong after an intervention, the assumption seems to be that the intervention was necessary and carried some risk, whereas when something goes wrong with no intervention, the assumption is that an intervention would have fixed it. In urban Brazilian hospitals C-section rates are around 80%. There is no question that the great majority of these are not medically indicated, and that a large number of these women and children suffer avoidable problems.
The fact that so many women and doctors opt for C-sections when, by any rational medical standard, the risks outweigh the benefits, is a serious problem.
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Véronique adds: I love those professional associations’ statements. They have such an ability to state the obvious. The problem with the medicalization of childbirth is not that interventions are performed for no good reason but that women and their caregivers really think they have a good reason even when they do not. And who will challenge them? My last labour – baby is 3 ½ months – was induced because labour didn’t start spontaneously after the membranes ruptured. What I found difficult to accept was that labour had to be induced right away. Surely, they could give me a couple of hours? It’s not like my body had never done this before, right? Not only that but 9 years ago, when I had another pre-labour rupture, they – the medical practice guidelines – gave me 18 hours to deliver safely after the rupture. But there’s nothing like a couple of aptly quoted statistics on transmission levels of nasty group B strep to get an expecting mother – and fathers are probably worst – going medical.
The same goes for levels of c-sections. Yes, there is increasing momentum for c-sections on maternal request — a topic I have published on in 2007 – but those c-sections are still marginal compared to the “medically needed” ones. When you start scratching a little however, you see that while most c-sections are medically needed, the need is often created by other medical interventions such as inductions, epidurals, continuous fetal monitoring or non-physiological position (i.e. lying on your back as opposed to letting gravity be your friend). That’s one side of the c-section epidemic. The other side is increasing maternal age causing complications (things the women’s liberators didn’t tell you), increasing rates of medically assisted reproduction (or what I call “Your body didn’t really think it could handle it…”) causing complications such as multiple gestations and premature childbirth and increasing maternal girth causing blood-pressure and diabetes-related complications.
I had five natural drug-free deliveries – including one breech birth and 3 homebirths – and one induced but otherwise drug-free delivery. I should have had drugs the last time. But despite the complications, the pain, and the fact that I always promise myself never to do this again, childbirth remains the most empowering of experiences.
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I have wondered at the increasing number of C-sections being done. For those who truly need them, thank goodness for modern medicine, that mother and baby come through the birth process and everyone is alive and well.
But, as Brigitte says, birth is a pretty normal occurrence for most women. So why so many C-sections? I can’t help but wonder if doctors push this route in order to avoid any possible lawsuits after births that go awry.
I know that many GPs no longer will deliver babies and their main reason is the very high cost of insurance coverage, and the reason for that is law suits.
With a C-section, mom and baby are both okay and no one sues the doctor after because the baby suffered damage during delivery, died with the cord around its neck, etc etc.
Like so many things, could money be at the root of this?
When my youngest child was born five years ago, I was on a ward with three other women, all first time mothers and all of whom had c-sections. I was astounded that I was the only woman on that ward who had given birth vaginally. At the time, I remember commenting to my husband that it seemed rather strange, statistically speaking, that three out of four of us would have been sectioned. I guess I was on to something.
This is not a topic that has any easy answers. During my pregnancy with my first son a few years ago, I was very, very, very anti-C-section (as I think many of us are when we have not had one). I ended up giving birth surgically (in my more jaded moments I don’t say “gave birth” but rather “had the baby cut out of me”), as a result of a labour that probably was induced too early. (I was induced at exactly 40 weeks due to concern about his size. Too small, not too big — they worried the placenta was no longer functioning correctly.) When I got pregnant with #2 eight months later (!!) I really strongly considered VBAC and ultimately decided against it. I had no idea up till that point what a HUGE deal this is for some people, to the point where having a C-section for any reason other than to save a life is looked on almost as a moral failing. On the one hand, I am quite certain that many surgical births are unnecessary, and I will never know if mine was one (or two); on the other hand, I personally know of several people who have waited until the baby was ready and then had homebirths that went terribly wrong. I know of two women whose babies died in that situation, and it used to be the case that so many women died in childbirth. Now, I am aware that there is a HUGE continuum between all-natural homebirth and a C-section in a hospital, and that yes, probably births should not be induced for more or less trivial reasons. I also know that most people can give birth without a whole lot of intervention, and that there is a whole lot of room for middle ground. But. I am also aware that I would MUCH MUCH MUCH prefer having an unnecessary C-section than to be that (albeit rare) mother whose baby actually died because she didn’t have one.
(Please understand that I am NOT disgreeing with anyone here. I am just trying to explain why I think it may be better to err on the side of caution in this situation.)
I had my son by c- section because of “failure to progress” which was declared after 2 hours of pushing without being able to get his big head through my pelvis. With my daughter (I got pregnant 8 months later as well) my obgyn wanted me to get a scheduled c- section (after a long discussion about how I shouldn’t have another baby so soon that almost resulted in having to get another doctor). I wanted to have vbac after a lot of research that showed that c- sections without medical need can cause problems for both mother and baby. I successfully had my vaginal delivery with my daughter (and was much happier with the much shorter healing time). Things that seem to be coming up lately that I’ve seen is people who want to “pick” the day their baby is born and doctors that are pleased with scheduled c- sections for time management reasons. My sister had both her kids by c- section. For the second birth she scheduled it on a weekend that my mom and I could take her older son and dropped him off the night before. It was more like a weekend away then a birth but it worked for them. When I went into labor with my daughter my husband and I were lucky enough that my mother in law was staying with us and she kept my son. My daughters birth was more chaotic but really I was much happier with it. It turned out that I didn’t need a c- section so a scheduled c- section would not have been medically warranted. I couldn’t tell you about whether home births are better because you can’t have one with vbac. I think there are medical reasons for a c- section. I also think we jump to c- section all too quickly these days. It’s kind of become the “fast food” method of giving birth. Having had both experiences I would say that it’s in everyones best interest health wise to at least try for a “natural” delivery but don’t be too hung up on it if your child’s life is at stake.
My first two children were (and still are!) twins. I was induced at 38 weeks as there is concern about how well the placenta can support two babes beyond that point. I was in labour from a Tuesday night til a Thursday morning and delivered them vaginally. Many people are amazed that the twins were not delivered by c-section. In fact, I do recall both my husband and I begging for a section at one point in my labour. The doctors never pushed the surgical route. However, I was forced to lie down the entire time so that the babies’ heart rates could be monitored. Perhaps things would have moved a little faster… My next two babies were born naturally and very quickly (3 hours and 1.5 hours). When I compare these labours to that of the twins (30+ hours), I can’t help but wonder if i was induced too soon. Nevertheless, at the time, I was an inexperienced 25 year old who didn’t dare question the wisdom of my doctors. But, 6 years later, I have two happy and healthy six year olds to show for it all. If twins come again, I might do things differently.
Hi
very interesting to read all the comments.
Sometimes, yes C-sections are warranted but one does wonder about the number. Especially since women should be generally healthier and stronger today than 100 years ago. Perhaps the large number of c-sections is the result of various factors:
1. we as women are losing the art of giving birth
2. women don’t want to invest physically in the birth process because they know they don’t have to suffer it out
3. lack of understanding of how some of the interventions are not good for either mom nor baby
4. lack of really good birthing support during labour. (this was a major factor for me!)
5. some really bad hospital practices. Elena, for my first birth I was lying down. didn’t do that for the next ones – I got on all fours and it was great – for me.
This is not to demean in any way, those women who’ve had sections. There is certainly a time and place for them. They can save mom and baby!
My first baby’s birth was terrible. I had every intervention known to womankind except a c-section. I also suffered from post-partum depression.
Second time around I had a new doctor – prolife, pro-breastfeeding, pro-homebirth!
I got myself a doula and she was wonderful.
4th baby I had a home birth. It was wonderful. The labour was terrible with a half hour transition that I thought would be the death of me. But I got through it. And I was a lucky home birther – because I had a doctor who did home births!
Rebecca and Michelle: I agree with your points too.