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Vaginal birth - vogue, default option, fetish and full of risk?

by lizzi (follow)
Helping plant the seeds of positive birth. www.sproutbirthing.com.au
Birth (105)     
A friend of mine shared a scientific article with me today about how the risks of natural birth are being glossed over. While this certainly doesn’t fit with my experience or that of a huge portion of women that I know I had high hopes for this article. Maybe some new research had come out to show that vaginal births are more risky than first thought?

Nope. The article was a total let down. And a huge discredit to New Scientist.

A fetish? Or just a birth? Image courtesy of Wikimedia Commons.

The author mentions that vaginal deliveries do have risks. Yep…totally on board here. Then goes on to say: “there are the rare instances when things go badly wrong and the baby dies or suffers brain damage.” Uh huh. Yes there are rare instances where the baby dies or suffers brain damage. But, given that this was published in scientific journal I kind of feel like I want something to back up that assertion. Like what cases are you actually talking about? Iatrogenic complications? Rates of shoulder dystocia, placental abruption and cord prolapse? Homebirth or hospital birth? Ways to reduce these risks? I'm left wondering if the author actually knows what these risks are that she is trying to convince us of.

She then moves on to the risk of urinary incontinence for the mother. I've heard varying studies on this. Some say that the risk is in just being pregnant and mode of birth has nothing to do with it. Some say that getting older is the risk - regardless of whether you've had any babies at all. According to the study the author quotes the risk of urinary incontinence is doubled if you have a vaginal birth compared to an elective, pre-labour caesarean. And apparently women aren't being told this risk. Given the fact that all the research says something different, my advice: read widely and decide whether a possible increase in the risk of incontinence is worth the risks of a caesarean. In other words: make an informed decision.

Then she talks about tears. Apparently 9 in 10 women will suffer a tear or episiotomy. A huge number of tears can be avoided by seeking a care provider who supports a physiological birth rather than medical. Things like valsalva pushing (also known as purple pushing or coached pushing) and pushing on your back are shown to increase the risk of tears as are inductions and epidurals. There are far less drastic ways to reduce your risk of tearing and episiotomy than going and having a, much larger, incision cut in your uterus – like waterbirth, choosing a care provider who doesn’t do routine episiotomies, following your body’s urge to push and birthing instinctively. I find it highly ironic that this woman is suggesting that in order to avoid a small tear or cut women should have major abdominal surgery. It leaves me wondering just what this woman has been told about tearing! (Which, don’t get me wrong, can be very very detrimental to the health and wellbeing of the woman – in a very small number of cases of tearing.)

Major surgery is a way to guarantee tearing and being cut, not a way to avoid it! Image courtesy of Wikimedia Commons.

The author makes note that informed consent rarely happens as vaginal birth is seen as the default. I know, right? A physiological process that has been happening to women for millennia seen as the default over major surgery – how the heck did that happen? The other thing is: informed consent is a requirement of medical procedures. Generally speaking, birthing a baby vaginally is not actually a medical procedure. The woman is the one who does it.

And those are the risks of vaginal birth - urinary incontinence, tearing and some vague rare occasions where the baby dies or is brain damaged.

Want to reduce the risks associated with vaginal birth? Choose a care provider who specialises in that field! Image courtesy of Wikimedia Commons.

The author wishes that women were able to look at the risks of both sides and make an informed decision. So let's give it a go. This list is by no means exhaustive, If you would like to know more about the risks of caesareans (or vaginal births for that matter) I recommend that you do heaps of research - sorry, there's no easy way to acquire this knowledge!

RANZCOG advise us that yes a caesarean before the onset of labour reduces the chance of urinary incontinence. However, ”the protective benefit is reduced with age and subsequent pregnancies regardless of mode of delivery.” So I guess that if you are a young mum who only wants one baby then this could be a very valid risk assessment. Want to keep having babies until you have your 10th at age 40? Maybe not so valid now.

It is very widely accepted that a woman is significantly more likely to die during a caesarean than a vaginal birth. I have seen statistics quoting anywhere from 3 times as likely to 5 – 7 times as likely. I’m going to leave that one right there while I move on.

The incidence of placenta accreta becomes “increasingly common” with the rising caesarean section rates. Going from 0.24% in the first pregnancy to 6.7% after 6 or more caesareans. The varying forms of placenta accreta all carry significant maternal mortality rates. Between 7 -10% depending on the severity. In terms of maternal mortality overall – that’s pretty hardcore.

Then there are the risks of: pulmonary embolism, infection, anesthetic problems, uterine rupture in subsequent pregnancy and just the plain old risk of having to have ALL your future babies by caesarean because VBAC is not adequately supported (In Australia we have about an 18% VBAC rate) thereby exposing a woman to these risks over and over and over again.

Then there are the risks to the baby of breathing difficulties requiring NICU admission, iatrogenic prematurity (because we are talking elective, pre-labour caesarean) and being cut by the scalpel. As well as all the issues around messing with the hormonal physiology and the microbiome which are leaping into researchers sights at the moment.

New research is emerging regularly into the impact of hormones at birth on the ongoing health of women and babies. Image courtesy of Wikimedia Commons.

Now most women I know were NOT informed of these risks before being bullied or coerced into non-medically necessary caesareans. They were told all the risks of birthing their babies vaginally though. Far more thoroughly and creatively than this author has tried to do!

All in all this blog really brings down the tone of new scientist. I mean, shouldn’t a scientific journal include a little more…you know…science? It really reads more like a woman who, since choosing caesareans for her own births, has heard about all the risks associated with them and is now feeling defensive.

And I’m once again left wondering: Why do we all need to get offended by facts? Caesareans have risks, vaginal births have risks – women are not idiots and are perfectly capable of having the risks shared with them in a neutral manner (without discussion of the fetishisation of natural birth). They can then make the decision that works best for them. But is this author more interested in informed decision making or getting more women and care providers to sing the praises of caesareans.

As a friend of mine said after reading the article: “Placenta accreta vs damp laughter? Hmmmm.”


Want to read more about caesareans, hormones and all things birth fetish-y? Here's some of my other articles:

5 reasons why I didn't love my caesareans

How to have a natural birth...or not

Why we see caesareans as the easy way out

How the hospital environment hinders physiological birth

Maternal assisted caesareans - another exercise in critical analysis

Power, control, ethics and the MAC

Too posh to push or too scared?

Women's bodies aren't designed for birth...or are they?
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Women who have a CS are in more pain that a normal birth. You think a torn perineum has a lot of stitches, you should see the amout they put in your uterus. You are imobile and unable to leave the hospital for a few days where the normals are off a few hours after giving birth if they are not at home in the first place. A mothers milk is often late after a CS and mothers often give up on breast feeding as their baby keeps crying and mum is too distressed to carry on making their baby less clever and less healthy. Why would anyone want major surgery as a choice. Mother of four. www.painfreelabour.blogspot.co.uk
Thanks for this lizzi. I think people need to be made more of these issues. I was so saddened to hear my midwife say to me, just as I was getting into the bath to give birth, "Do you mind if a doctor in training sits in on this? It would be great to show them that women can give birth vaginally with no intervention." What? Our bodies are designed to push out babies. I know that these things are not always so black and white, and that sometimes women require intervention and extra care. I know that vaginal birth does pose some risks to mother and baby, but I can't hep but feel that some perceive vaginal birthing as completely fraught with risk and c-sections as some sort of 'saving grace'. Unfortunately, this view is very much bias. Mothers need all the information they need to make informed decisions for themselves and their babies.
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