I’ve been hearing a bit lately about the caesarean epidemic. It’s great to see this being brought into the media – it’s an issue that needs attention. So, has the discourse on this topic involved lots of looking at how current obstetric practice has caused the increased caesarean rate? The number of women being given no option other than a surgical birth? The link to the increased use of elective inductions and epidurals? Not so much (that I’ve seen anyway). The conclusion everyone seems to have come to is this: Women are to blame for the caesarean epidemic.
Just recently I heard the question asked: Just what is driving the increase in the caesarean rate? And was incredibly shocked to hear someone respond with: Women are asking for them. It wasn't the sort of forum where I would have expected that response. I almost choked on my coffee in my rush to exclaim WTF?!?! You see, I run a VBAC (vaginal birth after caesarean) support group of over two and a half thousand women. And it’s really rare to hear of women who are just rocking up asking for a caesarean for no reason.
Women aren't the one's using the tools. Image courtesy of Wikimedia Commons.
I’m going to look at two different aspects of this including: Are women really asking for caesareans? And secondly – for those that are asking for a caesarean are they really asking for a caesarean or are they asking for something else?
Oops – I was wrong…I have another point that I think needs to be looked at in this conversation and it’s this: What role are care providers playing in this epidemic of women asking for caesareans? Because let's face it - we're not cutting the babies out of ourselves!
So I think that it is pretty easy to establish that, yes, some women (although certainly not 33%) are asking for caesareans. But we really need to look at other things. Like why are women asking for caesareans? Do they actually prefer the idea of major abdominal surgery over a normal physiological process? Sure some do. Even with ALL the info for both options they still prefer the option of surgery. And that’s cool. It's called informed decision making. But it’s important to recognise that these are a VERY small portion of women who end up with a caesarean.
We don’t make decisions in a vacuum. When it comes to pregnancy and birth most of us enter the journey with some pretty well ingrained cultural conditioning. And then we meet our care provider.
A very large number of women, whether they be first, second, third or ten time mummas, are scared of birth. We’re scared of the pain, of tearing, of something “going wrong”, of not making it to the hospital in time, of getting to the hospital too early, of having something done to us without full consent, of the indignity, of not being in control. The fears are endless – and that’s before we even get to the fear of whether we’ll be a good mother.
What if women were told they could have this birth? Image courtesy of Wikimedia Commons.
And seriously why shouldn’t women be scared of birth? Our care providers, the “experts” in birth, seem to be rather a bit terrified of it too! All those policies and procedures designed for the “just in case” moment, all the monitoring and scans and VEs and cannulae all send a very clear message to mums. Birth is dangerous. Birth is scary. Something could go catastrophically wrong at any moment. Next time you tell a woman planning a birth after caesarean that she “needs” continuous monitoring and regular VEs “to keep her and baby safe” ask yourself what message you are sending. Birth is safe? Or birth is risky and needs LOTS of intervention. Next time you advise a first time mum that she “needs” a 30 minute CTG trace on arrival to “ensure that baby is fine” think about whether that tells mum that labour and birth are safe and normal or whether it tells her that she should freak out as soon as labour starts because "the baby might not tolerate labour".
Then let’s give consideration to the women who haven’t just heard that birth is: messy, awful, undignified, dangerous etc but have lived it. When a woman tells me that she has absolutely no interest in a vaginal birth after a previous birth I often ask: what happened during that birth? How was the mother treated, that she now believes that a caesarean is a physically and emotionally safer option for her? Was she violated in such a way that a caesarean seems more humane for her? Was she told that she simply isn’t designed to give birth? Was she left feeling that “choosing” a caesarean is the only way for her to receive respectful care next time? Women who are "choosing" a caesarean for seemingly no reason are often not really after surgery - they are after respect, dignity, care and compassion. Sadly they feel that they are more likely to receive that in an operating theatre than a birthing suite.
Some women feel that they are more likely to receive respect if they "choose" a caesarean. Image courtesy of Wikimedia Commons.
I think that this is a topic that bears much consideration and conversation - more than I can include in one blog. The messages that we send women about birth are disturbing to say the least. And the cultural conditioning women come in with can’t be unpacked and put aside over the course of a 9 month pregnancy even if they do have a truly supportive, unafraid and evidence based model of care. We need to start telling women that birth is a normal, physiological event. Let’s see more care providers reassuring women that birth is safe and that they will help protect the hormonal physiology that makes birth safe for the majority of women. And care providers need to stop bringing their own fears into a woman’s birth space. Women have enough fears to deal with, without having yours added to the pile!
Most women just want a beautiful, safe and respectful pregnancy and birth. Image courtesy of Wikimedia Commons.
I’d like to leave you with two quotes from Hannah Dahlen. I recently saw her speak at the Passage to Motherhood conference in Brisbane on a range of topics – one of them being fear and birth. And she noted that (in the context of care providers):
“We need to see women as full of capacity NOT full of catastrophe”.
“We need to stop blaming women for the system that we created for them”.
So let’s stop blaming the women and start looking a bit deeper for the causes and solutions of this very large, systemic problem.
In my experience more women are asking for a CS for their first birth and what is worse, they are getting them. Talking to these women they are all terrified of birth. They have watched OBEM and do not want to be that woman crying in agony lay down on the bed. Saying that they prefer major surgery over a normal physiological process is not really fair as they do not see labour as normal, they see it as a process managed by hospitals, there is nothing normal about hospital care. For normality they need a home birth or to birth at a midwife let center. They need to learn how to respond physically (stay upright on a comfy chair or birth ball) and psychologically (use a relaxation technique). This support is just not openly given by hospitals. In my experience, hospital parentcraft sessions just teach women to be more afraid. If by luck you meet a normal midwife in labour you are more likely to have a natural birth. If you meet an obstetric nurse, not so lucky. Change has to come from women themselves. Arm yourself with the knowledge needed to understand your birth. Stay at home (or birth at home) for as long as you want to in labour, listen to your inner voice and you will instinctively know how to behave and what position to labour in. We need to take back labour before we all appear on a theatre list for a CS. www.painfreelabour.blogspot.co.uk
'they are after respect, dignity, care and compassion. Sadly they feel that they are more likely to receive that in an operating theatre than a birthing suite.'
I could not agree more with your post. So oftern the blame is put on the birthing mother when the system can be setting them up for failure. I myself had a caesarean as my baby was breech - even though I later find I could of birthed my baby if they'd had a specialist midwife. When going for my vbac i was told continual monitoring - which I refused and had a great birth. Your post puts nicely how they want you to do something on one hand but don't provide the support needed. I explored how dismissing women's reasonings behind a caesarean will stop these women getting help.http://mostlymarvellousmother.blogspot.co.uk/2015/04/whos-superficial-when-it-comes-to.html?m=1 this was after I heard comments dismissing women who had chosen section from well educated people who should have known better.