Shea Caplice Caesarean Birth Facts Shea Caplice

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1 Caesarean Birth Facts Shea Caplice In the current climate of more women choosing to give birth via elective caesarean (a planned pre labour caesarean) and new regulations from NSW Health stating women must be told of the possible risks of a caesarean operation it is time to look at the facts. Are women informed when choosing a caesarean over vaginal birth? Or are they just part of the so-called too posh to push phenomenon where the fear of birth problems is steering them into the operating theatre? In times of Ancient Rome with the population low Julius Caesar ordered that if a woman was dying in childbirth her baby should be delivered by cutting open her abdomen. A caesarean performed before labour begins is called an elective caesarean and a caesarean performed during labour is an emergency caesarean even though the situation is often not a true medical emergency. In the days of Julius Caesar and right up to the beginning of the twentieth century caesareans were only performed as a last resort but improvements in operative and anaesthetic techniques has contributed to making caesareans far more acceptable. According to the 2004 National Mother and Baby s Report caesareans account for 1 in 3 births. The rates for elective or planned caesarean in Australia have increased four fold since Many of these are organised in advance for problems in the pregnancy such as a baby that is presenting in the breech position however, more and more caesareans are seen as an alternative to giving birth vaginally and as a another mode of birth rather than abdominal surgery. The recent policy from NSW Health requires that research based information on caesareans be provided to all women during their pregnancy. The information must include the reasons for a caesarean, what the operation actually involves, the problems or benefits for mother or baby, the concerns for future pregnancies and information on vaginal birth after caesarean. In addition the policy states that unless there is a clear

2 medical reason planned caesareans should not be performed before 39 weeks. Most importantly the policy highlights that a mother s request on its own is not a reason to have a caesarean and the issue must be discussed with the woman and recorded in writing. So let s look at the facts according to the available scientific evidence: Prevention of urinary incontinence (when you are unable to control the flow of urine due to weakened or stretched pelvic floor muscles) is one of the common reasons given by women requesting elective caesareans. However, if you have a caesarean you are NOT less likely to experience problems with your pelvic floor than women who have vaginal births. A large study published in the British Journal of Obstetrics in the year 2000 showed women's risk of urinary incontinence is not reduced by elective caesareans. The hormones of pregnancy, which relax muscles, such as relaxin, are thought to be the cause. In the study occurrence of problems, such as stress incontinence (escape of urine when laughing or coughing) or prolapse (where the pelvic organs are unsupported and drop into the vagina) was NOT greater in women who had one or more vaginal births compared to women who'd had a caesarean delivery. Women who have caesareans are 2-4 times as likely to die compared with those who have a vaginal birth! If this fact is too scary leave it out but it is true! Women who have caesareans are more likely to experience postnatal depression and psychological problems than women having vaginal births Women who have caesareans have more problems with breastfeeding than those who have vaginal births Women who have caesareans DO NOT avoid the pain of childbirth they often experience weeks of inactivity and pain after the operation Women are 18 times more likely to need a hysterectomy ( removal of the uterus/womb) with a caesarean than they are with a vaginal birth and suffer more major blood loss Babies born by caesarean section are around seven times more likely to experience breathing difficulties at birth compared to those born vaginally and the earlier

3 they are delivered by caesarean the worse the breathing difficulties can be. Subsequently, the new Health Department Policy includes the directive that planned caesareans should not be done before 39 weeks gestation of the pregnancy. Babies born by caesarean are NOT less likely to experience cerebral palsy than those born vaginally. Babies born by caesarean are NOT less likely to die or be born unwell than babies born vaginally. A study published in the year 2000 looked at over 170,000 normal healthy women giving birth in NSW and found that compared to public patients, private patients have double the chance of having a caesarean. Women who have a caesarean birth are often surprised when their Dr advises them not to drive for 6 weeks after the operation The cost of unnecessary caesarean operations on the health system is huge (three times the cost of vaginal birth) With evidence pointing to increased risks for mothers and babies associated with caesarean Obstetricians now have the responsibility of completely informing each woman of the problems that could be encountered particularly if it is her first baby. Whilst first caesareans are generally safe the dangers multiply with subsequent births. Women who have a caesarean for their first birth are at much greater risk of having a ruptured uterus, hysterectomy or infection, while their babies were more likely to be born prematurely, have serious breathing problems or need intensive care. In the absence of medical problems during the pregnancy the evidence for having a vaginal birth strongly outweighs the evidence to support a planned caesarean yet women continue to request caesarean as an alternative way of giving birth. Researchers from NSW University put together information from interviews with women, obstetricians and midwives in order to explore the beliefs on which decisions about caesarean births are based. The study revealed that the risks associated with

4 caesareans are viewed by both obstetricians and women as minimal. Most women know other women who have survived a caesarean operation and therefore consider a caesarean the safer option. Women consider vaginal birth as more risky and a caesarean the safe, easy and more orderly option. Both women and obstetricians shared the view that caesareans are orderly and controlled with the benefit of timing the birth so that the Dr is available. In a recent Australian study women attempting a vaginal birth after a caesarean for a previous birth were asked what they liked most about having a caesarean or a vaginal birth. The caesarean group responded that they liked being able to schedule the time of birth and they were glad they did not experience the pain of labour. The vaginal birth group liked that they actively involved in the birth, that they were in control during the process and they liked that the birth was natural. Women from both groups described their recovery after the birth as the same. Some women freely choose to give birth via caesarean and find it an empowering and positive experience however it is difficult to know whether the choice is based on real information or unfounded beliefs. Caesareans definitely have their place but only when the benefits outweigh the risks, that is, when the concerns for the health of the mother and baby indicate that giving birth vaginally is riskier than the known possible risks of having a caesarean. In other words caesarean should only be performed for medical reasons. Furthermore it is important to consider that a women who has a caesarean operation for life saving reasons.is more likely to accept unexpected and negative side effects from the procedure than a woman who has a caesarean for non medical reasons. Wendy Twibel s first pregnancy ended with an emergency caesarean due to high blood pressure and Wendy says: I felt very disappointed that I did not experience labour and a vaginal birth, I felt cheated. So when it came to being pregnant a second time Wendy decided to try for a vaginal birth and after quite a long labour she proudly gave birth naturally to her second daughter, baby Astrid.

5 After Astrid s birth I felt so proud of myself being able to give birth vaginally and naturally. I instantly connected with her as she was in my arms straight after the birth. Although it was hard the experience was wonderful and I was on cloud nine for weeks. It is hard to explain but I just felt like I could do anything after that and straight away I was up and about, I felt fantastic!. For more information: NSW Health Website for policy on caesarean: Vaginal Birth After Caesarean:

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