Caesareans on demand



Originally uploaded by Ola Czechowska

“I decided to have my first caesarean to avoid the pain of childbirth, the possible episiotomy, the future effects of having problems with incontinence and the effects on my sex life. You hear a lot from doctors about caesareans having less risk,” says Tiffany Duarte, pregnant and ready for another caesarean.

After two previous caesareans, her doctor advised her that it would not be possible to have a vaginal birth even if she wanted one — not that she does. “I don’t see any negatives. I quite like them,” she says.

The rate of caesarean sections in Australia has risen from 20 per cent to 29.4 per cent in the last 10 years. Some obstetricians and natal support groups believe this may be due to misinformation and confusion concerning caesareans. Other reasons are that research has found caesareans to be safer for women in certain conditions, whereas others believe the increase is due to women, like Tiffany, requesting caesareans for non-medical reasons. Some have even accused obstetricians of having ulterior personal motives for performing them.

In response to this rate increase, the New South Wales government last year issued a policy directive stating doctors must provide women with all the necessary information regarding caesarean sections.

The lack of accurate information about the risks and benefits of caesarean sections is something the Caesarean Awareness Network Australia (CANA) has been trying to combat for years.

“Women who choose it are not always fully informed about it. We have lots of people contact CANA to say that before they chose their caesarean, they didn’t know the implications of it,” says Philippa Scott, media spokesperson for CANA.

However, Dr Andrew Child, Head of Obstetrics at the Royal Prince Alfred Hospital, Sydney, sees the risks as black and white.

“There are short-term and long-term risks,” says Dr Child. “In the short term, it’s significantly more common to need a blood transfusion with a caesarean than with a vaginal birth. The big danger is a pulmonary embolism, which is when clots go to the lungs, usually within the first two weeks of the caesar; that can be fatal. Post-operative infection in the wound is a risk.

“Then there are the long-term risks and these are becoming more and more of a worry for someone having a subsequent caesarean. The placenta could implant in the wrong place and the uterus could burst. There are quite serious complications. They’re only rare but they do happen.”

Despite the many risks of caesarean sections, Dr Child insists that they are getting safer and are, for some women, a good option.

“A hundred years ago anyone who had a caesar died; it was that sort of level. We’ve certainly decreased the risks. We give everyone antibiotics because that was proven to be beneficial and prevent wound infection. We put special compression stockings on everyone to try and prevent clots forming. So there’s a lot you can do to decrease those complications. It’s getting safer and safer.”

Although many women suffer for long recovery periods after a caesarean, many other women don’t.

“I’ve always found the recovery for caesareans easy. I was in bed for a day and up the next day. I was back to doing full exercise within six weeks. I was lucky both times to have no side effects,” Tiffany says.

Only 1 percent of births in Australia are carried out through “on demand” caesareans. Considering this is only a small amount, it leaves us to question why the overall rate has risen so sharply.

Dr Child believes that there are valid, medical reasons for this rise in caesarean rates. “Studies have shown it’s more dangerous to be born vaginally as a breech baby that it is by caesarean. There’s even a study going on now about twins being delivered by caesarean section. That’s the reason for the increase.”

CANA agrees that this is the reason for the rise in caesarean rates, but believes such medical situations don’t always warrant a caesarean section.

Obstetricians have been accused of coercing women into having caesareans to allow them to work more regular, nine-to-five type hours.

Dr Chid says “Just because you’ve done a caesar doesn’t mean you can go home and get drunk. The patient may have complications that night or have some bleeding; you’re still on call, so it doesn’t make an enormous difference to your work hours to do caesarean sections.”

Included in the policy directive is a controversial short clause stating that women can not have caesareans at public hospitals without a medical reason.

“If I were told I couldn’t have a caesarean without a medical reason, I’d feel very angry. It’s supposed to be a free country and choice is a part of the way we live in Australia. Taking that away from a woman is very depriving of her rights,” says Tiffany.

Dr Kerreen Reiger, Associate Professor of Social Sciences at La Trobe University, disagrees. “The policy seems perfectly sensible. I think choice is a really problematic concept. If people live together in society, there are always constraints on so-called choices. “

The increase in caesarean rates is something that is occurring around the world. Brazil has the highest rate at 56.65 percent and an “on demand” rate of 32 per cent.

“Some women have a caesarean to preserve the condition of the vagina,” Dr Child says. “That’s terribly common in Brazil and Chile. They’ve got extremely high figures in Brazil and some other South American countries. The term they use is that some mothers want to keep the vagina ‘honeymoon fresh’. It’s got some validity in it. There’s not doubt that a vaginal birth stretches a lot of the vaginal tissues and sometimes leaves some quite tender scar tissues where there’s had to be some stitches.”

Dr Kerreen Reiger thinks this belief is misguided. “I think what they’re missing out on is the actual physiological knowledge about what happens to your body in the birth process. A lot of women have a much better sexual capacity after they’ve given birth than they did before. That was true for me and it doesn’t get talked about. It’s a very taboo subject. It needs to be talked about a lot more thoroughly.”


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12 Responses to “Caesareans on demand”

  1. anandaayu Says:

    Interesting post bilangela. Where did you get the idea to write about childbirth? That’s always an issue that kinda freaks me out.

  2. bilangela Says:

    Yeah me too. I wrote it back home when the government decided it was going to make it difficult for women to have caesarean without a medical reason. There was, and still is, huge debate over whether women should have access to caesareans.

    Women were labeled “too posh to push”. But I’m sure that if men’s genitals and sex lives were at risk, there’d be no debate. What do you think?

  3. Cameron Says:

    The thought of having a baby, even a proportionately sized one, through my penis isn’t exciting, that’s true. Being sliced open to have a baby isn’t an exciting prospect either. Maybe more men wouldn’t have a baby at all, considering the options.

    What’s “a much better sexual capacity”? Is it more desire for sex? That goes against what you commonly hear. Is it more enjoyable sex? Let’s talk about it thoroughly.

  4. bilangela Says:

    I think she means the potential to reach a greater…place

  5. jemise Says:

    Indonesian President Susilo Bambang Yudhoyono welcomed the latest member of his family — his first grandchild — on Independence Day (Aug. 17) of all days. And, yes, the birth was by C-section, prompting speculation that the birth was manipulated so the girl could be born on that day. According to officials at the hospital is was carried out for medical reasons. Read more here.

    On Aug. 8, 2008, more caesareans were scheduled than any regular day. Read here.

    What do people think about this?

    For some reason the idea of electing to have a C-section when it is not medically necessary makes me feel a little icky. Like when Britney Spears elected a caesarian, I instantly thought she was lazy. I know this is not necessarily the case and there are lot more factors at hand. I can’t, however, really justify why I feel the way I do — like most cases where people consider whether the action is right or wrong, and work backwards to justify their moral. It, perhaps, is a socially constructed notion that I have, created by a number of taboos. I don’t believe the choice to have a C-section should be regulated though — it is not up to the state to decide.

    I do know that I believe that sex after child birth and the effects that child birth has on a mother’s sex life is important to talk about.

    I am not sure if men would be any different. Any difference between genders, if there is any, is probably created by the mere fact that women give birth and men don’t. If men gave birth, they would be women. But I am just being a smart-arse.

    A really interesting post.

  6. bilangela Says:

    Maybe Britney Spears was lazy to have a caesarean, but maybe there’s nothing wrong with that. I think if having a caesarean becomes as safe as having a vaginal birth, why not allow women to be “lazy”?

    This pattern is true for so many medical procedures which were once incredibly painful and laborious and are now quite simple. But when it comes to childbirth, for some reason, people feel like it should be some kind of communal ethical issue, rather than the individual’s.

    In terms of men, I meant that the people behind the policy directive were pretty much all men. So this caesarean law was being debated among a group of men basically, and a bunch of female politicians did show their outrage about it.

    So, I wonder if c-sections would be an issue at all if it were men giving birth. Another example of this is that Viagra passed through the government quicker than almost all drugs in the history of Australia. Why do you think that is?

    Imagine if we had a whole group of women deciding whether Viagra should be on the market. You’d have a lot of outraged impotent men.

  7. Cameron Says:

    Why would Women not want Viagra on the market?

  8. nyscha Says:

    I would not want to get a C-section, even if it was dubbed ‘as safe as vaginal birth’. It’s a personal opinion, of course. For me, I think the experience of popping a little crying baby out of my vagina is too extraordinary to miss out on. It might not be buckets o’ jolly good fun, but giving birth naturally MUST have some positive effects on a woman, if not anatomically then emotionally.

    I’m currently trying to be more appreciative of the process rather than the outcome (to me, pizza from the microwave is hands down not as good as oven baked pizza made from scratch even if it’s more practical to make), so I guess this subject fits roughly with that new principle of mine.

    As for the choice of getting a C-section, I think it’s the woman’s personal choice, not her husband’s, or her doctor’s or her president’s. It shouldn’t be regulated by anyone else except the woman giving birth. Some people like microwave-able pizza, some people like oven-baked, as long as the pizza itself comes out steaming hot and delicious, it really shouldn’t be a problem.

    Interesting post.

  9. bilangela Says:

    I agree Annisa. Hope my first baby doesn’t look like pizza though.

    And Cameron…sure women would have wanted it on the market…but I have a funny feeling men wanted it more, and that’s why it was passed so quickly. Just speculation though.

  10. Laurene Says:

    It was very interesting to read all this, and it’s funny because I had this conversation with my mum a few days ago. She is an anaestesiologist in a public hospital, at the maternity section so she knows quite a bit about the subject. I said, half kidding, that I wouldn’t mind avoiding the experience of pain (she practises a lot of peridurals, the injection against pain during child birth) and even the experience of having a baby going through my vagina. I think I was mostly concerned about the effects on it and the consequences on my sex life. But my mum told me that having a c-section is way more dangerous, for reasons that have been detailed in this post (quite accurately). In her point of view, it’s really better to do caesareans only when needed to avoid complications, more risks and loss of time (the surgeons’ for example) and even money (I’m sorry if I’m taking the debate to a down to earth level). And you know what? It’s not up to the state to decide, nor to the husband, but maybe it’s not up to the mother either. It’s up to the doctor.
    Now, if Dr Reiger is right, I think I’ll go for the natural childbirth.

  11. Om’bak « Angela Dewan's Portfolio Says:

    […] Click here or on the image to view the full piece on the Om’bak website. […]

  12. alliah khalili Says:

    Ah young unwed and talking about choice ,funny

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