Not too posh to push

In the end, there's no easy way to give birth

Are you too posh to push? If caesareans are good enough for celebrity mums such as Angelina and Gwyneth, then why not you too? After all, a caesarean is safer, easier and more convenient – isn’t it?

Read on for everything you need to know about caesarean birth –before you get to the delivery suite.

Caesareans are one of hottest topics in childbirth right now. More Australian women are likely to give birth via caesarean this year than at any other time in history.

Australia’s caesarean rate has been rising steadily since the 1970s when it hovered at around five per cent of all births.

As surgical and anaesthetic techniques improved, the rate quickly doubled, then doubled again to reach 19 per cent in 1994, 27 per cent in 2002 and then 30 per cent in 2006.

One-in-three Australian women now give birth via caesarean, and the rate is increasing at about one per cent annually.

Professor David Ellwood, a professor of obstetrics and gynaecology at the Australian National University has predicted that at this rate, vaginal delivery could become obsolete within a decade.

“The caesarean rate is rising so rapidly that vaginal birth may well become a thing of the past,” he said

It’s that same story across the globe, in the US the caesarean rate is 31 per cent and in the UK 24 per cent of pregnant women deliver surgically.

In Brazil 90 per cent of private hospital births are caesareans, and 40 per cent in public hospitals; giving the country one of the highest caesarean rates in the world at 44 per cent in 2006.

Yet the World Health Organization (WHO) has advised that individual countries maintain a caesarean rate of between 10-to-15 per cent.

WHO has also stated that “unnecessary caesarean sections should be avoided, because elective caesarean delivery may increase the risk of occurrence of a severe complication in the mother,” yet the rates continue to climb.

Medical experts continue to debate reasons for the surge in caesareans and have come up with a range of reasons including women having their first babies later in life – which new research has shown has ramifications for how well their uterine muscles can contract.

Caesareans have also become largely routine for breech presentation, large babies, after a previous caesarean (you have a 50 per cent chance of having a subsequent caesarean if you had one for your previous delivery) and for older first-time mothers – yet the research supporting surgical birth in all these cases is hotly debated and widely considered inconclusive.

What we do know is that most women are not too posh to push. The percentage of women who choose a caesarean without any medical requirement is somewhere between three-to-ten-percent of all caesareans.

However, the executive director of the Australian College of Midwives Dr Barbara Vernon believes that caesarean birth has been ‘normalised’.

“We have a driving increase of caesarean section of about one per cent each year, which means thousands more women are having caesarean surgery every year, despite substantial research which shows increased risks to mothers and babies.

“Women get the idea that it’s an easy option, but it does involve pain and a much longer recovery than vaginal birth,” Dr Vernon said.

Although most women don’t demand caesareans, they can be easily led in a surgical direction by their obstetrician, who may present a caesarean as an option early in the pregnancy, or during a labour that is slow to progress. It can be a relief to be ‘saved’ from vaginal birth by an expert; other women feel they are scared into having a caesarean.

Victorian mum, Kelly Middleton felt she had no choice.

“I wasn’t dilating as fast as the hospital thought I should. My doctor came in and said the baby was showing signs of distress so we should do a caesarean. Before I knew it I was in theatre and the baby was being pulled from my stomach. He was perfect. I’d question whether he was really in distress, and whether I could have just let nature take its course.”
In a time when we obstetricians are being increasingly sued, caesareans can offer the medical profession a more-controlled, managed birth scenario.

Caesareans can be life-saving operations for mothers and babies, but as with any other major surgery, there are risks associated with the procedure, as well as significant recovery times and ramifications for future pregnancies.

There is risk associated with any form of birth. As parents it is important to assess the risks and benefits that apply in your individual situation.

Although there are inherent risks involved in a surgical birth, these may be overshadowed by the need for the surgery.

“My baby was stuck, she was in severe distress. I have no doubt that the emergency caesarean saved both our lives. Even 50 years ago I think we may both have died,” says Queensland mum Katie Cooper who sees her caesarean as a life-saving intervention.

However it’s important to be aware of the risks associated with caesareans; they are not the ‘easy’ birth option.

Some of the risks include a greater likelihood of infection, bleeding problems, additional surgery (for example hysterectomy or bladder repair), reactions to anaesthesia, and respiratory difficulties for women following a caesarean than a vaginal birth.

Babies born by caesarean can be at greater risk of developing asthma, having breathing problems or being born prematurely if dates were miscalculated.

Subsequent pregnancies may also be impacted by the presence of scar tissue, which can increase the chance of placenta issues, and the rare possibility of the uterus rupturing.

Some women who have caesareans will go on to have a subsequent vaginal birth.

Melbourne mum, Tracey Caulfied gave birth to her son Joe vaginally, after having a caesarean for twins, Jaime and Jasper five years earlier.

“My doctor monitored me carefully during the pregnancy, but he said there was no reason I couldn’t have a vaginal birth this time. I didn’t like having a caesarean for the twins, but my doctor recommended it. I had no problems at all with Joe’s birth. A vaginal birth is much more painful while you’re going through it, but it’s wonderful to be able to get up and around afterwards. With the caesarean I was in pain for days and moving around was difficult.”

Michelle Hamer is the author of Delivery by Appointment, Caesarean Birth Today (New Holland $24.95) and the mother of four children born by caesarean.

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